Objective: To discuss the effect of early enteral nutrition support on immunological function in patients with acute stroke. Methods: Forty-nine stroke patients with dysphagia were randomly allocated into study group (n = 24) and control group (n = 25). They were received enteral nutrition via nasogastric tube and ordinary nasal feeding of liguid diet, respectively within 72 hours after admission. The levels of total lymphocyte count (TLC), immune globulin A (IgA), immune globulin G (IgG), immune globulin M (IgM), complement 3 (C3), and complement 4 (C4) in both groups were detected on day 1, 7 and 21 respectively after admission. The changes of nutritional index and the incidence of infective complications were observed. Results: The levels of TLC [(2.1 ± 0.4) × 109/L], IgA [(2.7 ± 0.5) g/L], IgG [(11.1 ± 2.2) g/L], IgM [(1.7 ± 0.7) g/L], and C3 [(1.2 ± 0.2) g/L] in the study group were significantly higher than the levels of TLC (1.7 ± 0.4 × 109/L, P < 0.05), IgA [(2.0 ± 0.4) g/L, P < 0.01], IgG [(8.9 ± 2.5) g/L, P < 0.01], IgM [(1.3 ± 0.6) g/L, P < 0.05], and C3 [(1.0 ± 0.3) g/L, P < 0.01] in the control group after 21 days. The incidence of infective complications in the study group (29.1%) was significantly lower than that in the control group (60.0%; P < 0.05). The nutritive index of the study group was also significantly better than that in the control group. Conclusion: Early enteral nutrition support may improve the immunological function in patients with acute stroke, and decrease the incidence of infective complications.

BACKGROUNDAs a treatment of depression, the efficacy of conventional repetitive transcranial magnetic stimulation (rTMS) is limited, and symptoms recurrence is easy to occur after the treatment. This study aimed to examine the efficacy and safety of sleep electroencephalogram modulated repetitive rTMS (SEM-rTMS) in the treatment of depression.

METHODSAfter 7 days without psychoactive medication, 164 patients with clinically defined depression were randomly divided into 3 groups: SEM-rTMS group (n = 57), conventional rTMS (C-rTMS, n = 55) group and sham-rTMS group (n = 52). Every patient was treated with the corresponding method for 30 minutes everyday for 10 days. Before and after scores on the 24-item Hamilton rating scale for depression (HAMD-24) and the clinical outcome on the 10th day of therapy for all subjects were analyzed.

RESULTSTwenty-two cases in the SEM-rTMS group obtained improved mood as compared to 6 in the C-rTMS group and 2 in the sham-rTMS group (χ(2) = 15.89, P = 0.0004). After completion of the rTMS phase of the protocol, a (51 ± 5)% reduction of HAMD-24 scores from the baseline in the SEM-rTMS group was found compared with a (34 ± 4)% in the C-rTMS group (q = 26.09, P = 0.001) and a (14 ± 3)% in sham-rTMS group (q = 57.53, P = 0.000). The 88% total effective rate in the SEM-rTMS group was significantly higher than 68% in the C-rTMS group and 20% in the sham-rTMS group (χ(2) = 12.01, P = 0.0025). No significant side effects were noted.

CONCLUSIONSEM-rTMS is an effective and safe way for treating depression with repetitive transcranial magnetic stimulation (ChiCTR-TRC-00000438).

Adolescent ; Adult ; Aged ; Child ; Depressive Disorder ; psychology ; therapy ; Electroencephalography ; Emotions ; Female ; Humans ; Male ; Middle Aged ; Sleep ; physiology ; Transcranial Magnetic Stimulation ; adverse effects

OBJECTIVETo investigate the relation between different extents of cleft malformation with the speech characteristics in patients with cleft palate.

METHODSThe formant frequency of vowel [i] of 46 incomplete cleft palate patients (ICCP group) and 56 complete cleft palate patients (CCP group) before and after cleft palate repair, as well as 30 normal people (C group), were measured and analyzed on spectrogram.

RESULTSThe comparison of F1 between C group and CCP, ICCP before surgery showed no difference. So did the comparison of F1 between C group and CCP, ICCP after surgery. The comparison of F2 between C group and CCP, ICCP before surgery showed significant difference. The value of the C group was the highest. The value of the ICCP was higher than that of CCP. So did the comparison of F2 between C group and CCP, ICCP after surgery. The comparison of F3 between C group and CCP, ICCP(including before and after surgery) was similar to the results of F2 between the three groups. The comparison of F1 between before and after surgery in ICCP group showed no difference. However, the same kind of comparison of F2 and F3 showed significant differences: Both the values after surgery were higher than those before surgery. The comparison of Fl, F2 and F3 between before and after surgery in CCP group was similar to that in ICCP group.

CONCLUSIONThe extent of the cleft malformation is closely related to the status of the speech in patients with cleft palate. With the malformation more severe, the tongue will move backward more obviously, the elevation of the soft palate after cleft palate repair will be less active. Two ways are recommended for those patients with CCP: (1) Early interceptive orthodontic treatment to reduce the extent of palate malformation; (2) The hard palate repair can be performed prior to the soft palate repair. Patients with severe cleft lip and palate can have hard palate repaired while accepting the early cleft lip repair.

Cleft Lip ; Cleft Palate ; Female ; Humans ; Male ; Palate, Hard ; Speech

OBJECTIVETo investigate the rational digestive reconstruction after total gastrectomy for gastric malignancy.

METHODSThree types of digestive reconstruction were performed after total gastrectomy in 189 cases with gastric carcinoma. The operating time, morbidity and mortality, food intake, digestive tract symptoms, nutritional status at 1 and 3 years after surgery and 1-, 3-, 5-year cumulative survival were compared.

RESULTSThere were no significant differences among the three procedures in operative morbidity and mortality, postoperative food intake, nutritional status (Hemoglobin, total protein and labium), and incidences of diarrhea and dumping syndrome (P > 0.05). The overall 1-, 3-, 5-year survival rates were 75.3%, 38.2% and 20.5% respectively, and there were no significant differences among the three groups (P > 0.05). Orr-type and P-type esophagojejunostomy had an advantage of anti-esophageal reflux, and were obviously superior to Moynihan-type anastomosis (P< 0.01). Compared with P-type reconstruction, Orr-type reconstruction was simpler with shorter operating time, and less complications.

CONCLUSIONSOrr-type Roux-en-Y esophagojejunostomy can be recommended as an adaptable method of digestive reconstruction after total gastrectomy for gastric cancer because of its avoiding reflux esophagitis, maintaining better nutritional status and quality of life, and simpler procedure.

Adult ; Aged ; Anastomosis, Roux-en-Y ; methods ; Esophagus ; surgery ; Female ; Gastrectomy ; Humans ; Jejunum ; surgery ; Male ; Middle Aged ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Stomach Neoplasms ; surgery

Adult ; Glomerulonephritis, IGA ; etiology ; Hepatitis C ; complications ; Humans ; Male

Lung transplantation is the only effective treatment of end-stage lung diseases. Nevertheless, shortage of donor lungs has become increasingly prominent worldwide. A large quantity of patients died while waiting for lung transplantation. Urgent lung transplantation is a prioritized allocation strategy for donor lung transplantation according to the urgency of diseases, aiming to shorten the waiting time for donor lungs and reduce the fatality of patients on the waiting list for lung transplantation. However, no consensus has been reached worldwide on the definition, criteria and application of the terminology of urgent lung transplantation. In addition, the survival and net benefits of lung transplant recipients based on this allocation system are still controversial. On the basis of previous clinical research on urgent lung transplantation, the definition criteria, risk factors, survival outcomes, limitations and optimization measures were explicitly elucidated in this article, aiming to provide theoretical reference for comprehensive evaluation of the feasibility of urgent lung transplantation and further optimizing the allocation system of donor lungs.

OBJECTIVETo investigate the prevalence rates of snoring disease and obstructive sleep apnea-hypopnea syndrome (OSAHS) and their risk factors among truck drivers in Guangzhou, China.

METHODSA questionnaire survey was conducted in 374 truck drivers who were selected from 5 logistics companies in Guangzhou by cluster sampling. Those who had potential snoring disease or OSAHS underwent polysomnographic monitoring at night. The obtained data were analyzed to calculate the prevalence rates of snoring disease and OSAHS and determine the risk factors for OSAHS.

RESULTSA total of 335 subjects completely questionnaires, with a response rate of 90%. Among the 335 subjects, 125 (37.3%) had habitual snoring, and 42 (12.5%) had OSAHS according to the diagnostic criterion (apnea-hypopnea index ≥ 5 times/h). The multiple stepwise regression analysis showed that the risk factors for OSAHS were age, alcohol use, family history of snoring, body mass index, and upper airway abnormality. Of the subjects with grade ≥ 2 snoring and OSAHS, 65.4% often felt sleepy when driving during daytime, and 42% had suffered or nearly suffered traffic accidents due to sleepiness when driving. Moreover, 95.5% (320) of the 335 truck drivers did not consider snoring a disease, and 98% did not think traffic accident might be related to snoring.

CONCLUSIONThe prevalence rates of snoring disease and OSAHS among truck drivers are 37.3% and 12.5%, respectively. Therefore, prevention measures should be established according to the epidemiological characteristics to help the truck drivers realize the hazards of snoring disease and OSAHS, thus minimizing the prevalence and hazards of the diseases.

Adult ; Automobile Driving ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Sleep Apnea, Obstructive ; epidemiology ; Snoring ; epidemiology ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo investigate the effect of uvulopalatopharyngoplasty (UPPP) to obstructive sleep apnea hypopnea syndrome (OSAHS) in patients with resistant hypertension (RH).

METHODSUPPP and modified UPPP were performed on 36 moderate and severe OSAHS patients, who also suffered from RH [who taking more than three kinds of antihypertensive drugs (including diuretics) and still not able to control blood pressure at 140/90 mm Hg (1 mm Hg = 0.133 kPa)]. Polysomnography monitoring, ambulatory blood pressure monitoring, apnea hypopnea index (AHI), lowest saturation of blood oxygen (SaO2) and the changes of antihypertensive medication dosage were performed to the patients before and 6 months after the surgery.

RESULTSSix months after surgery,the total efficiency was 61.1% (22/36). The AHI median [25 quartile; 75 quartile] from 37.5 [26.0; 48.3]/h to 9.5 [9.0; 21.3]/h, the lowest the SaO2 average (x(-) ± s, the same below) increased from 0.655 ± 0.114 to 0.860 ± 0.037, the differences were statistically significant (P value < 0.05). 24 h systolic blood pressure, daytime systolic blood pressure, night contraction, diastolic and mean arterial pressure decreased from (160.8 ± 6.8), (170.5 ± 2.5), (163.6 ± 10.5), (100.8 ± 5.6) and (96.8 ± 7.5) mm Hg to (142.5 ± 7.3), (150.8 ± 7.6), (140.1 ± 6.4), (81.8 ± 7.4) and (93.7 ± 2.4) mm Hg, the differences were statistically significant (P < 0.05). The degrees of AHI descent and the average SaO2 improvement were concerned with the degree of systolic blood pressure, diastolic blood pressure decent (r > 0.80 and r(2) > 0.50). The average numbers of antihypertensive drugs decreased form (3.6 ± 0.5) to (2.9 ± 0.5) compared preoperatively and postoperatively, the difference was statistically significant (t = 5.537, P < 0.01). The use of antihypertensive medication reduced in 23 cases (23/36, 63.8%) compared preoperatively and postoperatively.

CONCLUSIONSThe blood pressure of the patients with OSAHS and RH dropped significantly after UPPP surgery. Recent follow-up shows that the varieties of antihypertensive drugs taken in these patients are reduced significantly after operation.

Adult ; Blood Pressure Monitoring, Ambulatory ; Female ; Humans ; Hypertension ; complications ; surgery ; Male ; Middle Aged ; Palate ; surgery ; Pharynx ; surgery ; Sleep Apnea, Obstructive ; complications ; surgery ; Uvula ; surgery

OBJECTIVETo investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD.

METHODSIn total 1,397 type 2 diabetic patients aged 50 years and older were enrolled and determined ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in 15 Class III Grade A hospitals in 7 major cities of China.

RESULTSMean patient age was 63.7 +/- 8.2 years and mean duration of diabetes mellitus was 9.39 +/- 7.4 years. Two hundreds and seventy-two (19.47%) patients were diagnosed as PAD by ABI < 0.9, 122 (18.37%) in male and 150 (20.46%) in female. PAD patients had a significantly longer duration of diabetes mellitus, higher hemoglobin A1c, and a significantly lower mean body mass index than non-PAD ones. Aging, smoking, and systolic blood pressure were found to be positively related with the prevalence of PAD. In terms of lipid profiles, no variable was found to relate with PAD. Notably, baPWV showed as the same significant guiding index for PAD, almost matched with ABI.

CONCLUSIONSPAD is a common complication in China type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for diabetic patients with high risk factors.

Aged ; China ; epidemiology ; Diabetic Angiopathies ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Peripheral Vascular Diseases ; epidemiology ; Prevalence ; Risk Factors ; Urban Population ; statistics & numerical data

To understand Helicobacter pylori's drug resistance,genetic diversity,and relationship with clinical diseases in the Guiyang and Qiannan minority areas of Guizhou Province,we collected samples through endoscopy,and isolated and cul-tured H.pylori.The drug resistance and genotype characteristics were determined.The differences in different regions and dis-ease types were compared,and the structural characteristics of H.pylori and mixed infections with different strains of H.py-lori in Qiannan Prefecture were analyzed.A difference in the composition ratio of EPYIA typing in the cagA variable region was observed between the two areas(P=0.012),and the composition ratio of the vacA genotype differed(P=0.000).A total of 94.6％(53/56)new sequences of H.pylori strains from two regions were obtained by MLST.The rate of infection by H.pylori mixed with different strains was 44.4％in Qiannan Pre-fecture,and no significant difference was observed in the com-position of H.pylori mixed infections among patients with dif-ferent clinical diseases(P=0.349).Differences in EPI YA typ-ing and the vacA genotype composition ratio in the cagA varia-ble region of H.pylori were observed between the Qiannan Prefecture and Guiyang City.