Objective The aims of this study were to compare the clinical and laboratory responses to ursodeoxycholic acid (UDCA) monotherapy with the combination therapy of UDCA plus prednisolone/azathioprine in primary biliary cirrhosis(PBC),and to investigate the risk factors affecting the therapeutic responses.Methods Eighty-two patients with untreated PBC were divided randomly into three groups.Group U (28 patients) received UDCA alone,group UP(27 patients) received UDCA and pr ednisolone,while group UA (27 patients ) received UDCA and azathioprine.The clinical and laboratory data were recorded after treated for 3,6 and 12 months.Repeated measures ANOVA and COX regression model were used for statistical analysis.Results Fatigue and pruritus were improved only in group UP(P=0.015 and P=0.037 respectively).Alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma-glutamyl transferase (GGT),total bilirubin (TBIL),direct bilirubin (DBIL) and IgM in the 3 groups were decreased (P＜0.05),while there was no statistical significant difference between the three groups (P＞0.05).The patients with disease progression had higher Mayo risk score (MRS) (P=0.018) and prolonged prothrombin time (PT)(P=0.042).In group UP,side-effect associated with glucocorticosteroids occurred in eight patients while there was no side-effect in group U.High baseline levels of ALP、GGT and CHO were risk factors for biochemical remission(P=0.015).The increase of DBIL,TBIL,total bile acid(TBA) and PT did not contribute to the prediction of biochemical remission ( P=0.075 ).Conclusion There are no differences among the three groups in the improvement of hepatic biochemical data and IgM.The combination therapy of UDCA with prednisolone could relieve fatigue and itching.The disease of patients with higher Mayo risk score and prolonged PT tend to progress.High baseline levels of ALP,GGT and CHO are risk factors for biochemical remission.High baseline levels of TBIL,DBIL,TBA and PT could not predict biochemical remission.The incidence of adverse effect is lowest when treated with UDCA alone.

Objective To evaluate the efficacy and safety of tiotropium bromide in treating stable mild and moderate chronic obstructive pulmonary diseases. Methods A randomized,double-blind,parallel comparison clinical trial was conducted in 40 patients with COPD. Twenty patients in tiotropium bromide group were treated by tiotropium bromide powder,and another twenty patients in controll group were given ipratropium,in contrast. The spirometry of both groups was conducted. 4 weeks after treatment. Results The forced expiratory volume in one second ( FEV1 ) and forced vital capacity(FVC) in two groups were significantly increased after treatment( P<0.01 ). The increase of FEV1 in tiotropium bromide group was higher than that in controll group after 4-week. There was no significant differ-ence in rescue medication consumptions. The incidence of adverse effects has no statistical difference between two groups. Conclusion Tiotropium bromide is an effective and safe bronchodilator in treating patients with COPD.

Antiviral Agents ; therapeutic use ; Hepatitis C ; drug therapy ; Humans ; Liver Cirrhosis ; drug therapy ; virology

OBJECTIVE:To investigate the effects of different doses of sufentanil citrate on hemodynamic indexes and stress response indexes of Crouzon syndrome children with craniofacial reconstruction. METHODS:60 cases of Crouzon syndrome under-going craniofacial reconstruction were selected from our hospital during Jan. 2010-Jan. 2016,and then randomly divided into group A,group B and group C,with 20 cases in each group. 3 groups were given pump injection of Propofol injection 4-8 mg/(kg·h)for anesthesia induction+Sufentanil citrate injection [group A 0.3 μg/(kg·h),pump injection;group B 0.6 μg/(kg·h),pump injection;group C 1.0 μg/kg,iv,0.5 h/time] for anesthesia maintenance, Cisatracurium besilate for injection 0.1 mg/kg,iv,every 40 min, drug withdrawal 5 min before the end of surgery. The hemodynamic indexes(MAP,HR)and stress response indexes(ACTH,cor-tisol)were observed in 3 groups at different time points as well as the occurrence of ADR. RESULTS:MAP levels of group C at 5 min after skin incision,1 h after operation and immediately at the end of surgery were significantly higher than before anesthesia, while those of group B were significantly higher than group C at same time points. HR of group A at 1 h after surgery and that of group B at 5 min after skin incision and 1 h after surgery were significantly higher than before anesthesias;HR of group B at 1 h after surgery was significantly lower than that of group A,and its HR at 5 min after skin incision and 1 h after surgery were signifi-cantly lower than those of group C. ACTH levels of 3 groups at 5 min after skin incision,1 h after surgery and immediately after the end of surgery were significantly higher than before anesthesia. ACTH levels of group B at 5 min after skin incision,1 h after surgery and immediately after the end of surgery were significantly lower than those of group A and C,and the group A was signifi-cantly lower than the group C at same time points. Cortisol levels of group A at 1 h after surgery,and those of group C at 5 min af-ter skin incision,1 h after surgery and immediately after the end of surgery were significantly higher than before anesthesia. Corti-sol levels of group B at 1 h after surgery were significantly lower than those of group A;cortisol levels of group A at 5 min after skin incision and immediately after the end of surgery and those of group B at 5 min after skin incision,1 h after surgery and imme-diately after the end of surgery were all significantly lower than those of group C. There were statistical significance all above(P<0.05). No obvious ADR was found in 3 groups. CONCLU-SIONS:Pump injection of sufentanil citrate 0.6 μg/(kg·h) can maintain analgesic effect of Crouzon syndrome children with craniofacial reconstruction,can keep hemodynamics sta-ble and effectively inhibit stress response during surgery with good safety.

OBJECTIVETo evaluate the efficacy on hemiplegic spasticity after cerebral infarction treated with plum blossom needle tapping therapy at the key points and Bobath therapy.

METHODSEighty patients were collected, in compliance with the inclusive criteria of hemiplegic spasticity after cerebral infarction, and randomized into an observation group and a control group, 40 cases in each one. In the control group, Bobath manipulation therapy was adopted to relieve spasticity and the treatment of 8 weeks was required. In the observation group, on the basis of the treatment as the control group, the tapping therapy with plum blossom needle was applied to the key points, named Jianyu (LI 15), Jianliao (LI 14), Jianzhen (SI 9), Hegu (LI 4), Chengfu (BL 36), Zusanli (ST 36), Xiyangguan (GB 33), etc. The treatment was given for 15 min each time, once a day. Before treatment, after 4 and 8 weeks of treatment, the Fugl-Meyer assessment (FMA) and Barthel index (BI) were adopted to evaluate the motor function of the extremity and the activity of daily life in the patients of the two groups separately. The modified Ashworth scale was used to evaluate the effect of anti-spasticity.

RESULTSIn 4 and 8 weeks of treatment, FMA: scores and BI scores were all significantly increased as compared with those before treatment in the two groups: (both P<0. 05). The results in 8 weeks of treatment in the observation group were significantly better than those in the control group (all P<0. 05). In 4 and 8 weeks of treatment, the scores of spasticity state were improved as compared with those before treatment in the patients of the two groups (all P<0. 05). The result in 8 weeks of treatment in the observation group was significantly better than that in the control group (P<0. 05). In 8 weeks of treatment, the total effective rate of anti-spasticity was 90. 0% (36/40) in the observation group, better than 75. 0% (30/40) in the control group (P<0. 05).

CONCLUSIONThe tapping therapy with plum blossom needle at the key points combined with Bobath therapy effectively relieves hemiplegic spasticity in the patients of cerebral infarction and improves the motor function of extremity and the activity of daily life.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; Aged ; Cerebral Infarction ; complications ; physiopathology ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Muscle Spasticity ; etiology ; physiopathology ; rehabilitation ; therapy ; Treatment Outcome

Objective To estimate reliability of magnetic resonance elastography (MRE) in measuring liver stiffness of volunteers and patients with chronic liver disease and to assess inter-rater consistency.Methods MRE was performed on a 3.0 T scanner in all subjects,including 24 volunteers (control group) and 64 patients with liver disease (chronic liver disease group).Liver stiffness was measured blindly by two raters.The pathological fibrosis score was applied as a standard reference for liver fibrosis in 22 patients.The intraclass correlation coefficient (ICC) was used to evaluate inter-rater reliability.The differences of liver stiffness between two groups were evaluated using non-parametric MannWhitney U test.Spearman analysis was used to analyze the correlation between fibrosis stages and liver stiffness.Results The intraclass correlation coefficient of liver stiffness was perfect (ICC =0.99,P ＜ 0.01)between two raters.There was significant difference of mean stiffness between control group and patient group (U =90.5,P ＜0.01) with(2.35 ±0.34) kPa and(4.17 ± 0.47) kPa,respectively.The correlation between fibrosis stage (3,3,5,5 and 6 patients in fibrosis stage S0,S1,S2,S3 and S4) and stiffness (2.13,3.25,3.82,5.45 and 7.35 kPa) was very strong (r =0.96,P ＜0.01).Conclusion MRE is a reliable and promising tool to measure liver stiffness and to assess liver fibrosis.

Objective To analyze the medium and long-term results of tricuspid valve replacement (TVR)and summarize the operative experience for tricuspid valve disease.Methods Clinical data of 27 patients with severe tricuspid valve disease from September 2005 to May 2010 were retrospectively reviewed.Biological valve prosthesis was replaced in 23 patients,while mechanical valve prosthesis was replaced in 4 patients.Accompanying procedures included mitral valve replacement in 8 cases,mitral valve replacement and aortic valve replacement in 4 cases,and repair of atrial septal defect in 4 cases.Results The operative mortality was 11.1％(3/27),among these patients,2 cases died of serious low cardiac output syndrome,1case died of muhiorgan failure on the 7th day after operation,1 case who underwent reoperation for hemorrhage postoperative was improved after treatment.During follow-up,1 patient died of biological valve prosthesis dysfuncion 3 years after operation,1 patient died of cerebral embolism 19 months after operation.Six cases were in New York Heart Association(NYHA)class Ⅰ,and 14 cases in NYHA class Ⅱ during the period of follow-up.Conclusions Because operative and follow-up mortality is high,TVR is the last selection for the treatment of tricuspid valve disease.Appropriate operative technique and perioperative therapy are the key for clinical success.For those older than 50 years,follow-up inconvenience and reproductive-age female patients,biological valve prosthesis should be recommended as a preferential choice.

Objective To study the clinical and pathologic features,histological criteria and pathologic factors contributing to diagnosis of mixed epithelial and mesenchymal tumors(mixed m?llerian tumors,MMT)of the uterus.Methods A retrospective study of 102 cases of MMT of the uterus (74 adenofibromas including 9 recurrent cases,3 atypical polypoid adenomyomas,2 carcinofibromas,10 adenosareomas and 13 carcinosarcomas)was undertaken.Clinical records,gross features and tissue slices were reviewed.The follow-up data were analysed.Results The most common symptom was vaginal bleeding.Clinical signs included pelvic mass,uterine polyps,and enlarged uterus.Benign MMT usually presented as exophytic polypoid masses extending into the uterine cavity or protruding through the external os,often broad-based,lobulated and papillary.It was hard to distinguish low-grade malignant MMT from the benign ones by gross appearance.High-grade malignant MMT had the common gross features of carcinoma and sarcoma.Histologically,MMT showed a biphasic differentiation of mesenchymal and epithelial components.MMT were classified according to whether these elements were benign or malignant.Nine cases of adenofibroma without unique features for the diagnosis of adenosarcoma recurred at postoperative intervals of 3 to 96 months.Recurrent tumors were almost always confined to the original site.Conclusions Uterine MMT tumors according to WHO diagnostic criteria are not rare.The differential diagnosis depends on a multifactorial analysis.The recurrent adenofibromas may be a kind of borderline tumors with benign appearances and malignant behavior.

Objective Clinicians are very cautious on operationsof laparoscopic cholecystectomy(LC) in patients with cirrhosis because of its high risk.And few researches were carried out on this situation.This article aimed to summarize the LC in cirrhotic patients with cholecystolithiasis and cholecystitis, observe the clinical therapeutic effect and analyze the feasibility of this treatment.Methods The clinical data of 112 operation cases of cholecystolithiasis and cholecystitiswith cirrhosis were retrospectively analyzed from January 2012 to December 2015 in Department of General Surgery, Changzhou Third People's Hospital.According to different surgical methods, all patients were divided into laparoscopic cholecystectomy group (n=56) and open cholecystectomy group (n=56).Peroperative period indicators including operation time, intraoperative blood loss, Postoperative exhaust time, postoperative hospital stay and complications were recorded, data were analyzed to evaluate the clinical effect.Results Compared with open cholecystectomy group, laparoscopic cholecystectomy group had shorter operative time[(54.28±15.34)min vs (91.63±20.09)min,P=0.000];less intraoperative blood loss[(73.42±4.28)mL vs (98.54±7.16)mL,P=0.000], shorter Postoperative exhaust time and postoperative hospital stay(P=0.000).The complication incidence in laparoscopic cholecystectomy group were lower than that in open cholecystectomy group(7.14% vs 21.43%, P<0.05).Conclusion Operation of laparoscopic cholecystectomy on cirrhotic patients has a high clinical efficacy.It is safe and feasible to carry out such an operation on the basis of strict indication and reasonable risk assessment.