Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Integrative Medicine ; Medicine, Chinese Traditional ; Phytotherapy

Objective To assess the safety and feasibility of utility of the third arm in robotic partial nephrectomy(RPN) through retroperitoneal approach for complex renal tumor.Methods 36 roboticassisted partial nepbrectomy were performed by one surgeon between November 2015 and January 2017,including hilar tumors in 12 cases,central tumors in 11 cases,endophytic tumors in 7 cases and multiple tumors in 6 cases.A 12 mm camera port is placed 2 fingerbreadth above iliac crest.The lateral and medial robotic trocars are placed in the posterior axillary line and anterior axillary plane respectively parallel to the cameraport trocar.Under direct visualization,the peritoneum is swept medially towards the paramedianplane.The fourth arm trocar is placed in the most medial and inferior aspect of the field approximately 7 cm to 8 cm across and parallel to the medial robotic trocar.Descriptive statistics on patient characteristics,operative parameters,and oncologic outcomes are analyzed.Result The 4-arms retroperitoneal approach was used in all patients without any conversion.Mean console time was 127 ± 21 (98-357) min.Mean ischemia time was 25.5 ± 8.3 (12-38) min,Mean estimated blood lost was 198 ± 201.5 (50-510) ml.No patients required blood transfusion,except one case underwent selective intra-arterial embolization with DSA (digital subtraction angiography) and blood transfusion post-operatively.Pathology revealed renal cell carcinoma in 12 patients,angiomyolipoma in 16 patients,chromophobe renal cell carcinoma in 6 cases,oncocytoma in 2 cases and all had negative surgical margins.Under 3 months follow-up,Mean decrease in eGFR was 4.3 ml/(min · 1.73m2).No patients found recurrence or metastasis.Conclusions The third robotic arm provides the console surgeon maximal independence from the surgical assistant when performing kidney retraction,ligation or clamping of renal hilar vessels in complex renal morbidities.It would be beneficial for patient with merits of retroperitoneal approach and overcomes limited space during RPN.

Objective The aim of this study is to analyze the relationship between the development of audito‐ry and speech in infants with hearing loss after hearing aid fitting and discuss the development of speech with the a‐bility of auditory in infants with different degree of hearing loss and different stage of evaluation after hearing aid fit‐ting .Methods A total of 32 infants (17 boys and 15 girls) with prelingual hearing loss participated in this study . The age at hearing aid fitting ranged from 3 to 34 months with a mean of 15 .6 months .According to their hearing level ,all infants in this study were divided into three groups :group of profound hearing loss(16) ,group of severe hearing loss(11) ,group of moderate hearing loss(5) .CAP and SIR were used to evaluate their abilities of auditory and speech at pre -fitting ,1 ,3 ,6 ,9 and 12 months after hearing aid fitting respectively .A linear and regression a‐nalysis was done in the statistic procedure .Results There was a significant correlation between the scores of CAP and SIR for the three groups respectively .The correlation from low to high followed by the group of profound hear‐ing loss (R=0 .656 ,P=0 .000<0 .05) ,group of severe hearing loss (R=0 .758 ,P=0 .000<0 .05) ,group of mod‐erate hearing loss (R=0 .849 ,P=0 .000<0 .05) .There was also a significant correlation between the scores of CAP and SIR for the different evaluating stages respectively .The correlation from low to high followed by pre -fitting (R=0 .559 ,P=0 .000<0 .05) ,1 month after hearing aid fitting (R=0 .575 ,P=0 .000<0 .05) ,3 months after hearing aid fitting (R=0 .726 ,P=0 .000<0 .05) ,6 months after hearing aid fitting (R=0 .823 ,P=0 .000<0 .05) , 9 months after hearing aid fitting (R=0 .838 ,P=0 .000<0 .05) ,12 months after hearing aid fitting (R=0 .855 ,P=0 .000<0 .05) .Conclusion The development of auditory ability is closely related to speech ability which increases with the improvement of auditory ability .The less the infants have the hearing loss and the longer the infants use the hearing aids ,the higher the auditory ability is related to speech ability in infants after hearing aid fitting .

Objective To study the relationship between the development of auditory and speech in children with hearing loss after hearing aid fitting and discuss the development of speech with the ability of auditory in children at different stages of evaluation, with different degrees of hearing loss and different ages respectively.Methods A total of 19 children (14 boys and 5 girls) with hearing loss participated in this study.The age at hearing aid fitting ranged from 3 to 8 years old with a mean of 5.42±1.86 years old.According to their hearing levels, the children in this study were divided into two groups: the moderate hearing loss group (n=10) and the severe group (n=9).According to their ages at hearing aid fitting, all children in this study were divided into two groups: the less than or equal to six years old (n=11) and greater than six years old (n=8).MAIS and MUSS were used to evaluate their abilities of auditory and speech at pre-fitting, 1, 3, 6, 9 and 12 months after hearing aids were worn respectively.A linear and regression analysis was done in the statistic procedure.Results There was a significant correlation between the scores of MAIS and MUSS (R=0.774,P<0.05).There was also a significant correlation between the scores of MAIS and MUSS for the different evaluating stages respectively.The correlations were pre-fitting (R=0.710,P<0.05), 1 month after hearing aid fitting (R=0.774,P<0.05), 3 months after hearing aid fitting (R=0.814,P<0.05), 6 months after hearing aid fitting (R=0.819,P<0.05), 9 months after hearing aid fitting (R=0.707,P<0.05), 12 months after hearing aid fitting (R=0.649,P<0.05).There was also a significant correlation between the scores of MAIS and MUSS for MAIS (items 3~6) (Sound awareness) and MAIS (items 7~10) (Sound understanding).The correlations for MAIS (items 3~6) were (R=0.768,P<0.05), and for MAIS (items 7~10) (Sound understanding) (R=0.794,P<0.05).There was also a significant correlation between the scores of MAIS and MUSS for different group of ages.The correlations for the group of <6years old were (R=0.808,P<0.05), and for the group of the ≥6 years old (R=0.775,P<0.05).There was also a significant correlation between the scores of MAIS and MUSS for different groups of hearing loss levels.The correlation for the group of moderate hearing loss was (R=0.771,P<0.05), and the group of severe hearing loss (R=0.787,P<0.05).Conclusion The development of auditory ability is closely related to the speech ability.The speech abilities increase with the improvement of auditory abilities.The less severe the hearing loss is, the longer the use of hearing aids, the younger the children are, the better the speech ability improved with auditory ability development after hearing aid fitting.

Objective To evaluate the effect of dexmedetomidine on hippocampal neuronal apoptosis in endotoxemic rats.Methods Twenty-four pathogen-free male Sprague-Dawley rats,aged 6 weeks,weighing 200-250 g,were randomly divided into 3 groups(n=8 each)using a random number table:control group (group C),endotoxemia group (group E),and dexmedetomidine group (group D).Dexmedetomidine 50 μg/kg was injected intraperitoneally,and lipopolysaccharide 5 mg/kg was injected via the caudal vein 30 min later in group D.Normal saline 2 ml was injected intraperitoneally,and lipopolysaccharide 5 mg/kg was injected via the caudal vein 30 min later in group E.Normal saline 2 ml was injected intraperitoneally,and normal saline 2 ml was injected via the caudal vein 30 min later in group C.At 12 h after the model was successfully established,Morris water maze test was used to assess the cognitive function.The escape latency,swimming distance and frequency of crossing the original platform were recorded,and the swimming speed was calculated.The rats were then sacrificed,and hippocampi were harvest for determination of neuronal apoptosis (by TUNEL) and expression of glucose-regulated protein 78 (GRP78),CAAT/enhancer-binding protein homologous protein (CHOP) and caspase-12 (by immunohistochemistry).The apoptosis index (AI) was calculated.Results There was no significant difference in the swimming speed between the 3 groups (P＞0.05).Compared with group C,the escape latency and swimming distance were significantly prolonged,the frequency of crossing the original platform was significantly decreased,and the AI was significantly increased,and the expression of GRP78,CHOP,and caspase-12 was significantly up-regulated in E and D groups (P＜0.05).Compared with group E,the escape latency and swimming distance were significantly shortened,the frequency of crossing the original platform was significantly increased,and the AI was significantly decreased,and the expression of GRP78,CHOP,and caspase-12 was significantly down-regulated in group D (P ＜ 0.05).Conclusion Dexmedetomidine reduces cognitive dysfunction probably through reducing hippocampal neuronal apoptosis mediated by endoplasmic reticulum stress in endotoxemic rats.

Animals ; Education, Medical ; trends ; Humans ; Medicine, Chinese Traditional ; methods ; trends

Objective To explore the feasibility and safety of the posterior approach of robotassisted laparoscopic radical prostatectomy and to the approach.Methods From November 2001 to April 2017,32 patients underwent posterior approach of robot-assisted laparoscopic radical prostatectomy.Patients aged 53 to 81 years,with mean of 66.9 years old.Their prostate volumes were 12.0-73.7 ml with an average of 32.9 ml.All patients were diagnosed by prostate biopsy before surgery.The operation time,blood loss and length of hospital stay were recorded.Results All the operations were completed by robotic assisted laparoscopy with no transition to open surgery.The surgery time was 129-210 minutes with an average of 163.6 minutes.The estimated blood loss was 20-200 ml with an average of 59.3 ml.The hospital stay was 8-21 days with an average of 12.8 days.The postoperative hospital stay was 3-13 days with an average of 6.9 days.The time of postoperative catheter removal was 4-14 days with an average of 7.5 days.Postoperative follow-up was 1-6 months.Twenty-four (75％) patients had early recovery of continence,and all (100％) patients regained continence 3-month postoperatively.Conclusion The posterior approach of robotic assisted laparoscopic radical prostatectomy was a safe and effective surgical technique,which was beneficial in early continence recovery.

OBJECTIVE To compare the outcome measurement scores for hearing impaired people with hearing aids. Two kind of questionnaires of Chinese version--COSI and IOI-HA were developed in order to find out the more specific outcome measurements for hearing aid users in China. METHODS The COSI and IOI-HA were administered for 30 hearing aid users via telephone or by clinical interview. SPSS software was used to analyze the collecting data. RESULTS Five prevalent problems to which most of the people with hearing aids pay attention were summarized. The mean level of the satisfaction of all the participants was high. CONCLUSION The outcome measurement inventory reflects the major problems which patients concern most and it can be used to evaluate the aural intervention and rehabilitation. After further study, this method is worth extending clinical application.

OBJECTIVETo evaluate the efficacy and safety of etanercept plus Tripterygium wilfordii polyglycoside (TWP) in elderly patients with active rheumatoid arthritis (RA).

METHODSTotally 46 elderly patients with active RA were randomly assigned to the treatment group (22 cases) and the control group (24 cases). All patients received subcutaneous injection of etanercept, 25 mg each time, twice per week. The dosage was reduced to once per week 3 months later. Patients in the treatment group took TWP Tablet (10 mg each time, three times per day), while those in the control group took methotrexate (MTX), 10 mg each time, once per week. The whole course lasted for 24 weeks. Patients' rest pain, tender joint number, swollen joint number, health assessment questionnaire (HAQ), patients' global assessment, physicians' global assessment, erythrocyte sediment rate (ESR), C reactive protein (CRP), rheumatic factor were assessed at week 0, 4, 8, 12, and 24. The curative effect was statistically evaluated by the United States Institute of Rheumatology ACR20, ACR50, and ACR70 improvement criteria. Meanwhile, any adverse event was recorded and evaluated.

RESULTSTotally 41 completed the trial, and 5 dropped off (3 in the treatment group and 2 in the control group). Compared with the control group, there was no statistical difference in ACR20, ACR50, or ACR70 in the treatment group (P > 0.05). Compared with before treatment in the same group, there was some improvement in tender joint number, swollen joint number, visual analogue scale (VAS) for patients' global assessment, VAS for physicians' global assessment, ESR, CRP, and HAQ between the two groups, showing statistical difference (P < 0.05). Compared with the control group in the same phase, there was no statistical difference in the treatment group (P > 0.05). There was no statistical difference in the occurrence of adverse events between the two groups.

CONCLUSIONSEtanercept plus TWP could achieve equivalent therapeutic effect to that of Etanercept plus MTX. The two regimens could improve clinical signs, symptoms, and QOL related to RA. They were well tolerated in the treatment of elderly patients with active RA.

Aged ; Antirheumatic Agents ; therapeutic use ; Arthritis, Rheumatoid ; drug therapy ; Drug Therapy, Combination ; Etanercept ; Female ; Glycosides ; therapeutic use ; Humans ; Immunoglobulin G ; therapeutic use ; Male ; Middle Aged ; Receptors, Tumor Necrosis Factor ; therapeutic use ; Treatment Outcome ; Tripterygium ; chemistry

OBJECTIVE: The aim of this study is to evaluate the development of auditory performance and speech intelligibility within the first year after hearing aid fitting in children with moderate or severe hearing loss, investigate the effects of hearing level on auditory performance and speech intelligibility and provide a clinical database for their hearing and speech habilitation. METHOD: Twenty-nine children participated in this study, ranging in age at hearing aid fitting from 3 to 8 years old with a mean of 5. 6 years old. 19 were boys and 10 were girls. According to their hearing level, they were divided into two groups. 14 children were in group of moderate hearing loss (41-60 dB HL). 15 children were in group of severe hearing loss (61-80 dB HL). The categories of auditory performance (CAP) and speech intelligibility rating (SIR) were used to evaluate their auditory performance and speech intelligibility. The evaluation was performed before hearing aid fitting and 1, 3, 6, 9, 12 months after fitting. RESULT: There was significant difference in mean score of CAP between group of moderate hearing loss and severe hearing loss before hearing aid fitting (P < 0.05). However, no significant differences were observed between these two groups at 1, 3, 6, 9, 12 months after fitting (P > 0.05). There was also significant difference in mean score of SIR between group of moderate hearing loss and severe hearing loss before hearing aid fitting (P < 0.05). How ever, no significant differences were also observed between these two groups at 1, 3, 6, 9, 12 months after fitting (P > 0.05). The mean scores of CAP for group of moderate hearing loss at 6, 9, 12 months after fitting were significantly superior in comparison with the score before hearing aid fitting (P < 0.05). The mean scores of SIR for group of moderate hearing loss at 6, 9, 12 months after fitting were significantly superior in comparison with the score before hearing aid fitting (P < 0.05); the mean score at 12 months after fitting was also significantly superior in comparison with the score at 1 month after fitting (P < 0.05). The mean scores of CAP for group of severe hearing loss at 3, 6, 9, 12 months after fitting were significantly superior in comparison with the score before hearing aid fitting (P < 0.05); the mean scores at 9,12 months after fitting were significantly superior in comparison with the score at 1 month after fitting (P < 0.05). The mean scores of SIR for group of severe hearing loss at 3, 6, 9, 12 months after fitting were significantly superior in comparison with the score before hearing aid fitting (P < 0.05); the mean scores at 6, 9, 12 months after fitting were also significantly superior in comparison with the score at 1 month after fitting (P < 0.05). CONCLUSION Auditory performance and speech intelligibility in children with moderate or severe hearing loss improved significantly within the first year after hearing aid fitting. The development followed different trajectory.
Child ; Child, Preschool ; Deafness ; psychology ; rehabilitation ; Female ; Hearing Aids ; Hearing Tests ; Humans ; Male ; Speech Perception