OBJECTIVETo discuss diagnosis and treatment of post traumatic spasmodic flat foot.

METHODSFrom 2002 to 2007, 7 diagnosed patients were recruited and underwent following procedures: under epidural anesthesia or common peroneal nerve block anesthesia, massage was performed on the peroneal muscles for about 5 minutes, then ankle joint was underwent with passive functional exercise. Feeling muscle relaxation, we held the wounded foot in varus and adducted position forcefully, then immobilized it with short leg cast. After 3 weeks of continuous immobilization, the cast was removed and patients were given physical treatment and functional training.

RESULTSSymptoms of these patients such as claudication and pain in foot were improved, the foot deformity was corrected and foot arch restored to normal. After a follow-up of 6 months,no obvious recurrence was observed.

CONCLUSIONThe diagnosis of post traumatic spasmodic flat foot is based on the careful inquiry of traumatic history,physical examination and X-ray results. Manipulative reduction under common peroneal nerve block anesthesia and cast immobilization is a simple and effective method to treat this disease.

Adolescent ; Adult ; Anesthesia ; Female ; Flatfoot ; diagnosis ; etiology ; therapy ; Foot Injuries ; complications ; Humans ; Male ; Middle Aged ; Spasm ; diagnosis ; etiology ; therapy

Objective To investigate the expression of caspase-10 in differentiated thyroid carcinoma and association with its development and metastasis. Methods Thyroid samples from 37 patients in a period from January 2006 to December 2007, with differentiated thyroid carcinoma were retrospectively analyzed for caspase-10 by immunohistocbemistry(streptavidin-perosidase, S-P), compared to control group of 46 cases with nodtdar goiter. The relationship between the expression of caspase-10 and the clinical pathologic characteristics of thyroid carcinoma were also explored simultaneously. Results caspase-10 were observed as brown or yellow particles located in the cytoplasm or cell membrane of nodular goiter but there were no significant evidence for its positive expression in thyroid carcinoma, caspase-10 expression was markedly down-regulated in differentiated thyroid carcinoma(29.73%,11/37) compared with benign nodules(71.74%,33/46, χ2=14.528, P<0.01). The positive expression in 18 cases with lymph node metastasis(11.11%,2/18) was significantly lower than those in 19 patients without lymph node metastasis(47.37%,9/19; χ2=4.210, P<0.01). There was no significant correlation(P> 0.05) between the expression of caspase-10 and the clinical pathologic characteristics including male, age, TNM stage and pathologic type. Conclusion Down-regulation of caspase-10 may play a critical role in carcinogenesis and development of differentiated thyroid carcinoma.

BACKGROUNDAdiponectin, secreted by adipocytes, has been found to be associated with diabetes, obesity and some cardiovascular diseases. Obstructive sleep apnea hypopnea syndrome (OSAHS) is also closely related to obesity and easily complicated with diabetes and some cardiovascular diseases. This study was carried out to explore the change of serum adiponectin level in patients with OSAHS.

METHODSPolysomnography was performed in 71 patients with OSAHS (OSAHS group) and 26 simple obese controls (control group). The two groups had no significant difference in age and body mass index (BMI). Radioimmunoassy was used to test serum adiponectin level.

RESULTSSerum adiponectin level was significantly lower in OSAHS group [(5.03 +/- 1.01) mg/L] than that in the control group [(7.09 +/- 1.29) mg/L, P < 0.05]. The differences between two groups were independent of gender. In OSAHS groups, serum adiponectin levels were negatively correlated with apnea hypopnea index (AHI) (r = -0.78, P < 0.01), BMI (r = -0.13, P < 0.05), waist circumference (r = -0.36, P < 0.01), and neck circumference (r = -0.42, P < 0.01), but positively correlated with the minimal pulse oxyhemoglobin saturation (r = 0.48, P < 0.01).

CONCLUSIONOSAHS may contribute to the decrease of serum adiponectin level independent of obesity.

Adiponectin ; Adult ; Body Mass Index ; Female ; Humans ; Intercellular Signaling Peptides and Proteins ; blood ; Male ; Middle Aged ; Neck ; anatomy & histology ; Sleep Apnea, Obstructive ; blood ; Waist-Hip Ratio

BACKGROUNDEpidermic studies have suggested a pathophysiological link between obstructive sleep apnea hypopnea syndrome (OSAHS) and atherosclerosis (AS); for which carotid intima-media thickness (IMT) has been considered as an early marker. The pathogenesis by which OSAHS can induce AS has not been elucidated. This study was conducted to investigate the association among plasma interleukin-18 (IL-18) levels, carotid IMT and the severity of OSAHS.

METHODSBased on the apnea hypopnea index (AHI) during sleep monitored by polysomnography, 52 male patients with OSAHS were recruited as the OSAHS group which was further divided into mild OSAHS (n = 16), moderate OSAHS (n = 18), and severe OSAHS (n = 18) subgroups. Eighteen healthy subjects were selected as the control group. Of all OSAHS patients, 20 with moderate-to-severe OSAHS underwent continuous positive airway pressure (CPAP) treatment for 90 days. HDL5000 color Doppler ultrasonography was used to measure carotid IMT. Plasma IL-18 levels were measured by ELISA.

RESULTSCompared with the plasma IL-18 levels in the control group ((250.27 +/- 76.48) pg/ml), there was a significant increase in the mild OSAHS subgroup ((352.08 +/- 76.32) pg/ml), the moderate subgroup ((600.17 +/- 83.91) pg/ml), and the severe OSAHS subgroup ((9797.64 +/- 109.83) pg/ml) (all P < 0.01). Moreover, there was a significant difference in plasma IL-18 levels among the three OSAHS subgroups (P < 0.01). Carotid IMT was significantly greater in the severe OSAHS subgroup than in the mild OSAHS subgroup (P < 0.01). Before CPAP treatment, plasma IL-18 levels were positively correlated with carotid IMT (r = 0.486, P < 0.001) and with AHI (r = 0.865, P < 0.001). On day 90 of CPAP treatment, plasma IL-18 levels were significantly declined but carotid IMT was not changed significantly.

CONCLUSIONSIn untreated OSAHS patients carotid IMT and plasma IL-18 were positively correlated and were significantly higher than in normal controls; the elevation of plasma IL-18 levels was correlated with the severity of OSAHS. Inflammatory response associated with OSAHS may be related to the development of AS. By improving AHI, miniSaO(2), and reducing plasma IL-18 levels, CPAP treatment may slow down or prevent the development of AS in OSAHS patients.

Adult ; Carotid Arteries ; pathology ; Electrocardiography ; Electroencephalography ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-18 ; blood ; Male ; Middle Aged ; Sleep Apnea, Obstructive ; blood ; diagnosis ; pathology ; therapy ; Tunica Intima ; pathology

BACKGROUNDCongestive heart failure (CHF) is associated with Cheyne-Stokes respiration (CSR), which may hasten CHF. Adaptive servoventilation (ASV) is a novel method of ventilatory support designed for removal of CSF in CHF patients. This study compares the efficacy of ASV in patients with CHF and CSR with the efficacy of oxygen therapy.

METHODSFourteen patients with CHF and CSR were recruited. During sleep, nasal oxygen therapy and ASV treatment were each performed for two weeks. Comparison before and after each treatment was made for the following items: a) parameters of sleep respiration, sleep structure and quality; b) left ventricle ejection fraction (LVEF) and 6-minute walk distance.

RESULTSCompared with the baseline levels of apnoea hypopnoea index of 34.5 +/- 6.1 before treatment, the apnoea hypopnoea index significantly decreased following oxygen therapy to 27.8 +/- 8.2, P < 0.05 and further reduced following ASV treatment to 6.5 +/- 0.8, P < 0.01. The minimal pulse oxygen saturation markedly increased following oxygen therapy from a baseline of (84.3 +/- 2.6)% to (88.6 +/- 3.7)%, P < 0.05 and further increased following ASV treatment (92.1 +/- 4.9)%, P < 0.01. Stages I + II sleep as percentage of total sleep time decreased from (81.9 +/- 7.1)% to (78.4 +/- 6.7)% following oxygen therapy and further to (72.4 +/- 5.0)% following ASV treatment. Stages III + IV sleep as percentage of total sleep time decreased from (8.4 +/- 5.5)% to (6.0 +/- 3.0)% following oxygen therapy and but increased to (11.9 +/- 5.4)% following ASV treatment. The arousal index of 30.4 +/- 8.1 before treatment significantly decreased following oxygen therapy to 25.6 +/- 5.7, P < 0.05 and further declined following ASV treatment to 18.2 +/- 6.1, P < 0.01. No significant difference was shown in above percentages between day 14 of oxygen therapy and before treatment (P > 0.05). LVEF was significantly higher on day 14 of ASV treatment (37.2 +/- 4.1)% than on day 14 of oxygen therapy (33.2 +/- 5.1)% and before treatment (30.2 +/- 4.6)% (all P < 0.05). Six-minute walk distance was the shortest before treatment (226 +/- 28) m, longer on day 14 of oxygen therapy (289 +/- 26) m, and the longest on day 14 of ASV treatment (341 +/- 27) m (all P < 0.01).

CONCLUSIONASV treatment is of better efficacy and greater clinical significance in improvement of CHF by eliminating CSR than oxygen therapy.

Adult ; Cheyne-Stokes Respiration ; physiopathology ; therapy ; Female ; Heart Failure ; complications ; physiopathology ; Humans ; Male ; Middle Aged ; Oxygen Inhalation Therapy ; Positive-Pressure Respiration ; methods ; Sleep ; physiology ; Stroke Volume ; Ventricular Function, Left

OBJECTIVETo identify whether Radix Bupleuri (Bupleurum chinense) was fumed with sulfur.

METHODA static headspace GC-MS method was used to detect sulfur in the fumatory Radix Bupleuri, the authentic samples free of sulfur was detected as reference.

RESULTSulfur was detected in six samples from nine samples collected in different locations.

CONCLUSIONThe method can be used to detect sulfur rapidly in the fumatory Radix Bupleuri with sulfur.

Bupleurum ; chemistry ; Drug Contamination ; Gas Chromatography-Mass Spectrometry ; methods ; Hot Temperature ; Plant Roots ; chemistry ; Plants, Medicinal ; chemistry ; Sulfur ; analysis ; Technology, Pharmaceutical

BACKGROUNDObstructive sleep apnea syndrome (OSAS) is an important risk factor for cardiovascular diseases. Chronic intermittent hypoxia (CIH) is considered to be one of the most important causes of cardiovascular diseases in OSA patients. This repeated hypoxia and reoxygenation cycle is similar to hypoxia-reperfusion injury, which initiates oxidative stress. In this study, we observed cardiocytes injury induced by CIH and the effect of N-acetylcysteine (NAC).

METHODSThirty ICR mice were randomly assigned to 3 groups: control, CIH and NAC (CIH + NAC) groups. Malondialdehyde (MDA) and superoxide dismutase (SOD) of cardiocyte homogenates were measured. Serum lipids were measured by an instrument method. Serum cardiac troponin I (cTnI) was detected by enzyme-linked immunosorbent assays (ELISA). Myocardium pathological sections were observed.

RESULTS(1) The SOD activity and MDA concentration of cardiocyte homogenates in the CIH group were significantly higher than in other groups (P < 0.005). The MDA concentration of the NAC group was lower than that of the control group (P < 0.01). (2) The serum cTnI concentration of the CIH and NAC groups was significantly higher than that of the control group (P < 0.01). (3) Serum triglyceride levels in the NAC group were lower than in the other groups (P < 0.01), while there were no significant differences in low density lipoprotein and high density lipoprotein among the three groups. (4) The degeneration of myocardium, transverse striation blurred, and fabric effusion were observed in tissue sections in the CIH and NAC groups. However, normal tissue was found in the control group.

CONCLUSIONThe oxidative stress induced by CIH can injure cardiocytes and the injury effect can be partially inhibited by NAC.

Acetylcysteine ; pharmacology ; Animals ; Free Radical Scavengers ; pharmacology ; Heart ; drug effects ; Hypoxia ; physiopathology ; Malondialdehyde ; metabolism ; Mice ; Mice, Inbred ICR ; Myocardium ; metabolism ; pathology ; Oxidative Stress ; physiology ; Random Allocation ; Superoxide Dismutase ; metabolism

BACKGROUNDContinuous positive airway pressure (CPAP) treatment has been proven to be effective in improving the symptoms of coexisting coronary heart disease (CHD) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However, it is still unclear whether such improvements are linked to changes in vascular endothelial function. This research was carried out to investigate the effects of CPAP treatment on vascular endothelial function in patients with OSAHS and CHD.

METHODSThirty-six patients with moderate or severe OSAHS and CHD undergoing three months of CPAP treatment were recruited for this study. The changes in their morning plasma nitric oxide (NO) and endothelin (ET) levels, NO/ET ratio, total ischemic burden (TIB) of the myocardium, apnea hypopnea index (AHI), and minimal and mean pulse oxygen saturation (SpO2) were compared and analyzed before and during CPAP treatment.

RESULTSCompared with the plasma levels of ET [(51.39 +/- 11.69) ng/L] and NO [(36.67 +/- 11.86) micromol/L], NO/ET (0.71 +/- 0.14), AHI (32.4 +/- 7.9), minimal SpO2 [(68.9 +/- 11.4)%], and myocardial TIB [(66.29 +/- 16.37) mm.min] before treatment, there were significant decreases in ET [(33.41 +/- 10.03) ng/L] (P < 0.05), increases in NO [(59.89 +/- 10.26) micromol/L] and NO/ET (1.79 +/- 0.38) (P < 0.01), decreases in AHI (1.9 +/- 0.5), and increases in minimal SpO2 [(90.6 +/- 1.8)%] (all P < 0.01) and myocardial TIB [(36.42 +/- 10.87) mm.min] (P < 0.05) after three months of CPAP treatment.

CONCLUSIONCPAP treatment may play an important role in the improvement and protection of vascular endothelial dysfunction and myocardial ischemia in OSAHS patients with CHD.

Adult ; Continuous Positive Airway Pressure ; Coronary Artery Disease ; complications ; therapy ; Endothelium, Vascular ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Sleep Apnea, Obstructive ; physiopathology ; therapy

Objective To study the clinical significance of bone reconstruction at cranial base for severe traumatic comminuted fractures of anterior skull base. Methods Forty-six bone defect cases were divided into treatment group and control group randomly. Treatment group was treated with the bone reconstruction therapy, while the control group was not. All the patients received the follow-up ranging 6 months to 1 year, and examined with CT and/or MRI to observe leakage of cerebrospinal fluid,intracranial infection and encephalomeningocele. Results In the treatment group, one of the 18 survivals developed mild cerebrospinal fluid leakage, which was cured later. In the control group, 5 of the 17 survivals had cerebrospinal fluid leakage, 3 had intracranial infection and 3 encephalomeningocele.The total incidence of complications of the treatment and control groups was 1/18 and 5/17, respectively,and the former was significantly lower than the latter (P＜0.05). Conclusions Bone reconstruction can avoid intracranial infection, cerebrospinal fluid leakage and encephalomeningocele during the operation for traumatic comminuted fractures of anterior skull base.

We report here a case of pentastomiasis infection in a 3-year-old girl who had high fever, abdominal pain, abdominal tension and anemia. Ultrasound scanning of the abdomen revealed disseminated hyperechoic nodules in the liver and a small amount of ascites. Abdominal MRI showed marked hepatomegaly with disseminated miliary nodules of high signal intensity throughout the hepatic parenchyma on T2-weighted images; retroperitoneal lymphadenopathy and disseminated miliary nodules on the peritoneum were also noted. Chest CT showed scattered small hyperdense nodules on both sides of the lungs. The laparoscopy demonstrated diffuse white nodules on the liver surface and the peritoneum. After the small intestinal wall and peritoneal biopsy, histological examination revealed parenchymal tubercles containing several larvae of pentastomids and a large amount of inflammatory cell infiltration around them. The pathological diagnosis was parasitic granuloma from pentastomiasis infection.
Abdomen, Acute/*parasitology ; Animals ; Biopsy ; Child, Preschool ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Parasitic Diseases/*diagnosis ; *Pentastomida ; Tomography, X-Ray Computed/methods