Objective To summarize clinical experience of reconstructive operation with transpositional colon behind the sternum after corrosive esophageal burns and to explore the treatment for its complications.Methods Clinical data of 65 cases with esophageal scarred stricture after corrosive burns receiving reconstructive operation with transpositional colon behind the sternum were reviewed,56 of them by end-to-end anastomosis between transpositional anterograde peristaltic colon and esophagus,seven by end-to- end anastomosis between transpositional anterograde peristaltic colon and pharyngeal fundus,and two by end- to-end anastomosis between transpositional reversed peristaltic colon and esophagus,to summarize treatment experiences in pre-operation,operation and post-operation.Results Fifty-one of this group of patients recovered and discharged form the hospital smoothly,12 with cervical anastomotic leakage after operation including two cured by re-operation and ten cured by conservative treatment,and two with necrosis of transpositional colon including one died during operation and the other cured.Conclusions Corrosive burns of esophagus can be cured by leaving scarred stricture esophagus open without resection,and the effectiveness of reconstructive operation with transpositional colon behind the sternum is satisfactory with good pre-operative preparation,correct surgical operation,and correct post-operative treatment.

OBJECTIVETo explore the diagnostic values of vestibular autorotation test (VAT) for patients with vertebrobasilar insufficiency (VBI).

METHODSVAT and videonystagmography ( VNG) were performed on 73 patients with VBI and 48 patients with peripheral vestibular lesions (contrast group). Parameters analyzed included Gain, phase and asymmetry of VAT, as well as the canal paresis (CP) of caloric test and results of optokinetic-pursuit tests in VNG. Positive result of the test could be defined if anyone of the parameters was abnormal.

RESULTSFor VAT test, Gain was enhanced in VBI group and was reduced in contrast group. In VBI group and contrast group, Gain enhanced showed in 47 (64.4%) cases and 5 (10.4%) cases, respectively (chi2 = 31.19, P < 0.01). Simultaneity, Gain reduced in 11 cases (15.5%) and 22 cases (45.8%), respectively (chi2 = 13.82, P < 0.01). But there was no statistics significant for results of the parameters of phase, asymmetry and integration between two groups. For VNG test, results with optokinetic-pursuit tests were more abnormal in VBI group than that in contrast group, which showed central lesions characteristics. Forty-four cases (60.3%) in VBI group and 10 cases (20.8%) in control group showed central lesions results with optokinetic-pursuit tests and visual fixation test (chi2 = 15.89, P < 0.01). Unilateral or bilateral CP showed in 33 cases (68.6%) in control group and 51 cases (69.9%) in VBI group with caloric test.

CONCLUSIONSGain of VAT is mostly enhanced in VBI group, and Gain as a main characteristic is reduced in patients with peripheral vestibular lesions. The Gain parameter is availability for assessing characteristics of vestibular lesions. Phase and asymmetry can be used to assess the vestibular function but can not indicate the characteristics of vestibular lesions.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Middle Aged ; Vertebrobasilar Insufficiency ; complications ; physiopathology ; Vertigo ; etiology ; physiopathology ; Vestibular Function Tests ; methods ; Young Adult

Objective To evaluate the clinical effect of ganglioside com-bined with ginkgo dipyridamolum in the treatment of craniocerebral inju-ry.Methods Sixty-four traumatic brain injury patients were randomly divided into treatment group and control group , 32 cases in each group.Control group was intravenously dripped ganglioside 20 mL, two times a day.Treatment group was intravenously given the injection of ginkgo dipyridamolum 10 mL, once a day , on the basis of control group.All pa-tients were treated for 1 month.Clinical effect , activity of daily living ( ADL) score, the degree of neurological deficit and the incidence of ad-verse drug reactions were observed.Results After treatment , the clini-cal efficacy of treatment group was 96.87%, significantly higher than 78.13%in control group ( P<0.05 ).After treatment , the ADL scores of two groups were significantly higher than those before treatment ( P<0.05 ).The neurological deficit score in treatment group was statisti-cally lower than that before treatment and control group ( P <0.05 ).There were no adverse drug reactions in two groups during the treatment.Conclusion The clinical effect of ganglioside combined with ginkgo dipyridamolum in the treatment of craniocerebral injury was better than that of ganglioside , which can improve the ability of daily life and the quality of life of patients.

Objective To analyze the characteristics of subjective visual horizontal ( SVH) and evaluate its clinical value for vestibular function in peripheral unilateral vestibular hypofunction ( UVH). Methods Eighty-five patients with UVH (study group) and 39 normal persons (control group) accepted vestibular function tests, including SVH, subjective visual vertical ( SVV ) and caloric test by video-nystagmography. The parameters of the angle of SVH and SVV, directional preponderance ( DP) and unilateral weakness(UW) of caloric test were observed. The correlation between SVH/SVV, DP, UW and the course of disease were investigated respectively. SPSS 16. 0 software was used to analyze the data. Results Reference range of SVH and SVV was from - 2° to 2° in the control group. Among the 85 patients, 46 cases(54. 1% ) and 43 cases(50. 6% ) had the abnormal values of SVH and SVV respectively, with no statistical significance( χ2 = 12. 5, P = 0. 481 ) by chi square test Fifty-five cases (64. 7% ) withabnormal DP had no statistical significance when compared with SVH and SVV respectively (χ2 values were 0. 19 and 2.86, respectively, P value were 0. 164, 0.067, respectively). In UVH, there were positive correlation between SVH, SVV and DP( r value was 0. 939, 0. 648, 0. 658, all P <0. 05) respectively, but no correlation between UW and SV H or SVV (r value was 0. 048, 0. 085, all P > 0. 05). According to the permutation and combination of the four parameters, positive or negative, three main groups could be defined [SVH(+)DP(+)UW( +), SVH( -)DP( +)UW( +), SVH( -)DP( -)UW( +); SVV( + ) DP ( +)UW( +), SVV( -)DP( +)UW( +), SVV( -)DP( -)UW( +)]. The course of disease in the three main groups was positively skewed distribution,with median of 5. 0, 10. 0, 15. 0 d and 5. 0, 9. 5, 14. 5 d respectively. By Kruskal-Wallis Test, χ2 value were 8. 80 and 6. 26, respectively( P value were 0.012, 0. 040, respectively), with statistical significance between the above three main groups. Conclusions The SVH value can evaluate the function of the otolithic. The angle of SVH and SVV are changing in the course of disease, SVH and SVV can be used as a guidance of the vestibular compensation evaluation.

Objective To assess the characteristics of the dysfunction of semicircular canal in benign paroxysmal positional vertigo and the relationship with the ectopic otoconia.Methods There were 214 patients with benign paroxysmal positional vertigo( BPPV),including 107 cases of posterior semicircular canal canalithasis(PSC-Can) 80 cases of horizontal semicircular canal canalithasis( HSC-Can),27 cases of horizontal semicircular canal cupulolithiasis (HSC-Cup).One hundred and ninety (88.8％)patients were accompany with relevant diseases while 24 ( 11.2％ ) cases were not.They accepted low,middle and high frequency vestibular function tests,including caloric test ( CT),head shaking test (HST) and video head impulse test(vHIT) respectively.The parameters of the unilateral weakness(UW),head shaking nystagmus (HSN) and video head impulse test gain(vHIT-G) were observed.Patients classified into three groups (PSC-Can,HSC-Can,HSC-Cup) according to the involvement semicircular canal.The results of the three tests were analyzed with SPSS16.0 software.Results The positive cases of the three tests were vHIT:15 (7.0％),HST:52(24.3％ ),CT:152(71.0％ ),a statistically significant difference(P ＜ 0.05) was found between the three tests.When compared the Calorie Test,HST and vHIT between the BPPV patients with and without relevant diseases,there were no significant differences ( P ＞ 0.05 ).The variance without statistical significance(P ＞ 0.05) was showed between three tests' results in each groups,it was also showed that the variance between the three groups in each tests reached no statistical significance(P ＞0.05 ).The test of affected side UW between PSC-Can,HSC- Can and HSC-Cup showed the variance without statistical significance( F =0.970,P =0.383 ). Conclusions The lesion of semicircular canals has the same etiological factors with the utricle pathological change in benign paroxysmal positional vertigo,and the dysfunction mostly happens in low frequency range of semicircular canal frequency band. The ectopic otoconia is not the main etiological factors for that.HST and vHIT of middle and high frequency can not be ultimately used for the screening test evaluating due to the semicircular canal function in BPPV.

Objective: To observe the short- and long-term clinical outcomes of fraction flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in coronary artery disease (CAD) patients with SYNTAX score≥33 unsuitable for coronary artery bypass grafting (CABG). Methods: A total of 117 CAD patients admitted in our hospital from 2012-01 to 2015-06 were enrolled. Since SYNTAX score≥33, EuroSCORE>6, the patients were unsuitable for CABG and treated in 2 groups: Medication group, n=20 and PCI group, during FFR-guided PCI procedure, patients received ROTA or IVUS according to physician's experience, n=97. All patients were followed-up for at least 12 months. Meanwhile, taking "coronary stent and bypass", "CABG and PCI" as key words, we searched relevant documents in VIP Chinese science and technology journal full-text database, WanFang medical database, ChinaNet and Chinese biomedical literature database from 2012-01-01 to 2015-12-31, patients' outcomes were compared with the above references to explore the clinical benefit. Results: ① PCI group and Medication group had similar SYNTAX score and EuroSCORE, P>0.05. The common pathogenesis was LAD involvement, chronic occlusion was 31.3% (5/16) in patients with partial revascularization.②PCI group had 18.6% (18/97) incidence of major adverse cardiac and cerebral events (MACCE), 2 patients died during follow-up period and 9 received revascularization; Medication group had 60% (12/20) incidence of MACCE, 3 patients died during follow-up period; the difference between 2 groups showed statistical meaning, P<0.05.③There were 22 relevant documents retrieved as comparison; in our research, PCI group had similar incidence of MACCE to the documents, P>0.05; Medication group had increased incidence of MACCE than the documents, P<0.05. Conclusion: FFR-guided PCI could bring clinical benefit in CAD patients with SYNTAX score≥33 unsuitable for CABG.

ObjectiveTo observe the morphological changes of bone in the progress of chronic fluorosis.MethodsWistar rats were randomly divided into three groups,30 rats in each group:normal control group,experimental group Ⅰ and experimental group Ⅱ according to body weight.Rats in normal control group drank distilled water freely.Experimental group Ⅰ and group Ⅱ drunk distilled water with sodium fluoride preparation of fluorine containing ion 100,150 mg/L solution for six months,respectively.Bone mineral density was detected by X-ray,bone morphological changes were observed under light microscope and bone histomorphometric parameters were calculated using image analysis software.ResultsThe bone mineral density values were different statistically between the three groups after feeding for 2 and 4 months(F =19.79,3.28,all P ＜ 0.05).However no significant difference was found after feeding for 6 months(F =1.80,P ＞ 0.05).The bone mineral density of experimental group Ⅰ (0.20 ± 0.03,0.21 ± 0.03) was significantly higher than that of the normal control group(0.17 ± 0.03,0.20 ± 0.04) after feeding for 2 and 4 months.The bone mineral density of experimental group Ⅱ (0.21 ± 0.02) was lower than that of normal control group(0.22 ± 0.03) after feeding for 6 months.The bone lamella in experimental group Ⅰ was arranged disorderly,the number of osteocytes increased with their nucleus atrophy and the osteoblasts were more than that of control grouo which arranged in layers observed under light microscooy.In exoerimental group Ⅱ,the bone lamella was bent deformation,the number of osteocytes had decreased with their nucleus shrinking or even disappeared and the number of osteoclasts had increased significantly observed under light microscopy.In experimental group Ⅰ,the mean trabecular density [(0.33 ± 0.03)％] increased and the mean trabecular separation,thickness [( 163.57 ± 1.99),(59.26 ± 7.18 ) μm] decreased compared with that of normal control group [(0.31 ± 0.02)％,(186.60 ± 2.90)μm,(86.42 ± 1.48)μm,all P ＜ 0.05].In experimental group Ⅱ,the mean trabecular density[(0.26 ± 0.02)％] decreased,the mean trabecular thickness[(71.42 ± 10.77)μm] reduced compared with that of normal control group[(0.31 ± 0.02)％,(86.42 ± 1.48)μm].ConclusionsExcess fluoride can damage bone tissue.Low doses of fluoride can stimulate osteoblast activity and enhance osteogenesis.The activity of osteoblasts is great than that of osteoclasts.High doses of fluoride can stimulate both osteoblasts and osteoclasts activity,but mainly the activity of osteoclasts,and bone resorption increases.

Objective To discuss the objective characteristics and mechanism of nystagmus direction,intensity and time in horizontal semicircular canal benign paroxysmal positional vertigo (HSCBPPV).Methods A total of 233 patients with HSC-BPPV,whereas 179 horizontal semicircular canalithasis (HSC-Can) and 54 horizontal semicircular cupulolithiasis (HSC-Cup) were involved respectively.The induced nystagmus in roll tests recorded by video-nystagmograph(VNG),whose direction,intensity and time characteristics were compared in various BPPV.Results Horizontal nystagmus was both induced by turning left or right in HSC-BPPV roll tests.The direction of the induced nystagmus was the same with turning in HSC-Can.The latency,duration time and intensity (x ± s) turning to lesion and normal side were (1.922± 1.501)s and (1.447±0.855)s,(25.620 ± 10.409)s,and (22.110± 10.931)s,(56.441 ± 33.168)°/s and (24.239 ± 13.892)°/s in HSC-Can.The latency,duration time and intensity turning to lesion side were larger than normal side(t =3.715,15.219 and 4.070,P ＜ 0.01),the difference was statistically significant,and the intensity rate was about 2∶ 1.The direction of the induced nystagmus was opposite to turning in HSC-Cup.The intensity turning to normal side was larger than lesion side obviously.The intensity rate was about 2∶ 1,the difference was statistically significant(t =-7.634,P ＜ 0.01).While the latency and intensity of turning to lesion side in HSC-Can were larger than turn to normal side in HSCCup,and the difference detected no statistically significant difference (t =1.554 and 0.305,P ＞ 0.05).Conclusions The induced nystagmus intensity of head to two sides in roll tests for HSC-BPPV both follow Ewald's law,and the ratio between stronger and weaker are both 2∶ 1.These nystagmus parameters of VNG in roll tests are an objective guideline for BPPV diagnosis.

OBJECTIVETo evaluate the safety and long-term effect of recombinant human epithelial growth factor (rhEGF) on deep partial-thickness burn wounds.

METHODSThirty-seven burn patients were enrolled in this study and were observed by randomized, double-blinded and placebo-controlled protocol. An area of deep partial-thickness burn wounds from each patient was divided into control (C) and treatment (T) portions. The wound in C was treated with normal saline while that in T with rhEGF. The patients were followed-up for 1 and 4 years after wound healing. The healed wounds were evaluated by modified Vancouver scar scale in terms of scar index (SI).

RESULTS1 year after wound healing, it was found that the SI in T group (7.19 +/- 1.67) was obviously lower than that in C group (8.92 +/- 1.78, P < 0.01). The SI in T group (6.12 +/- 1.54) was still evidently lower than that in C group (8.09 +/- 1.81, P < 0.01) four years after wound healing. There were no signs of development of tumor or cancer in all the tested burn wound areas.

CONCLUSIONExternal application of rhEGF might be beneficial to the healing quality of deep partial-thickness burn wound with less scar formation and better long-term effects, and it is safe.

Adult ; Burns ; drug therapy ; Double-Blind Method ; Epidermal Growth Factor ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Male ; Recombinant Proteins ; therapeutic use ; Treatment Outcome ; Wound Healing ; drug effects ; Young Adult

OBJECTIVETo investigate the role of c-Jun NH (2)-terminal kinase (JNk) in insulin resistance after burn and its mechanism.

METHODSTwenty-four Sprague-Dawley rats were randomized to control, burn and burn + anisomycin groups. The rats in control group received sham burn trauma, and burn and burn + anisomycin groups received 30% total body surface area (TBSA) full thickness burn injury. Anisomycin (5 mg/kg) together with 250 microl dimethyl sulfoxide (DMSO) was injected to the rats in anisomycin group intravenously, and only 250 microl DMSO in the other two groups. Euglycemic-hyperinsulinemic glucose clamps was performed 2 hours after the injection. The changes of phospho-serine 307, phospho-tyrosine of insulin receptor substrate (IRS)-1 and phospho-JNK in muscle tissues were determined and compared using immunoprecipitation and Western blot analysis or immunohistochemistry in the three groups.

RESULTSThe infusing rates of total 10% glucose (mg x kg(-1) x min(-1)) in control, burn and burn + anisomycin group were 12.3 +/- 0.4, 6.6 +/- 0.3, 6.5 +/- 0.4, respectively. The level of IRS-1 Serine 307 phosphorylation and phospho-JNK in muscle increased significantly, while insulin-induced tyrosine phosphorylation of IRS-1 decreased markedly after burn.

CONCLUSIONSThe activation of JNK elevates the level of IRS-1 phospho-serine 307 and might play a role in insulin resistance after burn in rats.

Adaptor Proteins, Signal Transducing ; metabolism ; Animals ; Anisomycin ; administration & dosage ; Anti-Bacterial Agents ; administration & dosage ; Blotting, Western ; Burns ; enzymology ; metabolism ; physiopathology ; Dimethyl Sulfoxide ; administration & dosage ; Disease Models, Animal ; Female ; Glucose Clamp Technique ; Immunohistochemistry ; Injections, Intravenous ; Insulin ; administration & dosage ; Insulin Receptor Substrate Proteins ; Insulin Resistance ; physiology ; JNK Mitogen-Activated Protein Kinases ; metabolism ; Male ; Muscles ; metabolism ; Phosphorylation ; drug effects ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Serine ; metabolism ; Tyrosine ; metabolism