OBJECTIVETo observe the effect differences on post-stroke dysphagia among acupoint injection combined with neural electrical stimulation, acupoint injection, neural electrical stimulation, and swallowing training respectively, so eligible intervention can be applied to this kind of disease.

METHODSOne hundred and eight-three patients of post-stroke dysphagia were randomized into a comprehensive treatment group (42 cases), an acupoint injection group (44 cases), a neural electrical stimulation group (49 cases) and a swallow training group (48 cases) and were treated with the comprehensive therapy of acupoint injection and neural electrical stimulation, acupoint injection, neural electrical stimulation and swallowing training separately. The treatments for 10 days made one session. There were 3 days at the interval among treatment sessions and 3 sessions were required totally. The cases in those treatment groups were blankly controlled with the other 47 patients of post-stroke dysphagia. All the patients received basic rehabilitation treatment. The modified water swallowing test was conducted to assess the efficacy before treatment, 10 days after treatment and 30 days after treatment in each group separately. The clinical efficacy, score of water swallowing test and improvement in water swallow test were compared among the groups.

RESULTSAfter 10-day treatment, the differences in efficacy and score of water swallow test were not significant in each group (all P > 0.05). After 30-day treatment, the effective rate (94.29%, 33/35) in the comprehensive treatment group was apparently better than 68.75% (22/32) in the acupoint injection group, 80.00% (32/40) in the neural electrical stimulation group, 67.50% (27/40) in the swallowing training group and 42.86% (12/28) in the blank group separately. The score in water swallow test in the comprehensive treatment group was lower than that in each of the other groups (1.37 ± 0.60 vs 2.03 ± 1.00, 1.90 ± 0.90, 2.20 ± 0.72, 2.71 ± 0.90, all P < 0.05). The differences in the effective rate and score in water swallow test were not significant among the acupoint injection group, neural electrical stimulation group and swallowing training group (all P > 0.05), which indicated that the improvement in swallowing function in the comprehensive treatment group was significantly superior to the other groups (all P < 0.05).

CONCLUSIONThe comprehensive therapy of acupoint injection and neural electrical stimulation achieves the much better efficacy on post-stroke dysphagia.

Acupuncture Points ; Adult ; Aged ; Combined Modality Therapy ; Deglutition ; Deglutition Disorders ; drug therapy ; etiology ; physiopathology ; therapy ; Electric Stimulation Therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications ; Treatment Outcome ; Vitamin B 12 ; administration & dosage ; Young Adult

Objective This study was performed to assess the clinical feasibility of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer.Methods Between March 2011 and May 2012,we retrospectively analyzed the data from 56 patients who underwent video-assisted mediastinoscopic lymphadenectomy(VAMLA).In patients receiving tumour resection subsequently,radicality of the previous mediastinoscopic dissection was controlled during thoracotomy.Results Mean operative time of video-assisted mediastinoscopic lymphadenectomy was(42.0 ± 13.5) min(range of 26-86 min).Mean number of resected lymph nodes was 12.4 ± 6.7 (range of 5-24).In video-assisted mediastinoscopic lymphadenectomy,the rates of lymph node dissection of stations 2,4,5,7,8 were 54.5％,92.7％,58.2％,100％,61.8％,respectively,there was no operative mortality and morbility.90.9％ patients achieved radical dissection.Conclusion Video-assisted mediastinoscopic lymphadenectomy is a clinically feasible procedure and provides more accurate staging of mediastinal node in lung cancer patients.It also plays an important role in minimal invasive surgery and neoadjuvant therapy.

Objective To evaluate the effectiveness of arthroscopically assisted percutaneous reduction and internal fixation with eannulated screws.Methods The fracture was reduced by closed manipulation or percutaneous leverage force by using the Kirschner wire.Then the patella was temporarily fixed by using a large size towel clamp or Kirschner wires.Under the guidance of knee arthroscopy,a micro-incision was made at the size of cannulated screw placement,the pilot holes were drilled at a proper depth,and the thread was configured.Two titanium screws were inserted parallelly.Results Following-up chekups for 4～24 months in 18 cases showed a satisfactory recovery of knee functions.According to the Bostman' standard,excellent effects were obtained in 16 cases and good effects in 2 cases.Conclusion Treatment of patellar fractures by percutaneous cannulated screw fixation under arrhroscope of- fered advantages of minimal invasion,accurate reduction,reliable fixation,and excellent recovery of joint functions.

Objectives To compare clinical manifestations and electrophysiological features in patients with chron?ic inflammatory demyelinating polyneuropathy (CIDP) and Type-I Charcot Marie Tooth Disease (CMT-I) for guiding dif?ferential diagnosis. Methods Data including clinical manifestations and electrophysiological indexes was collected from thirty-one CIDP cases and 28 CMT-I cases. Correlation analysis was used to assess the association of the severity of electrophysiology with the severity of clinical symptoms. Results There were statistically significant differences in onset site, sensory dysfunction, foot deformity and cerebrospinal fluid protein between these two groups (P<0.05). There were significant differences in indexes of nerve conduction and needle electromyography between these two groups (P<0.05). The severity of clinical symptoms was not related with the severity of electrophysiology in CMT-I group (r=0.27,P>0.05). Conclusions Differential diagnoses of CIDP and CMT-I can be made based on clinical manifestations and electro?physiological features.

Objective To explore the feasibility and efficacy of laparoscopic total mesorectal excision(TME) with preservation of anal sphincter for rectal cancer.Methods From October 2001 to March 2004,54(patients) with rectal cancer underwent laparoscopic total mesorectal excision(TME) with preservation of anal sphincter.In 51 of the 54 cases,the operation was completed laparoscopically,including 14 cases of(laparoscopic) anterior resection(AR) with the anastomosis level above the peritoneal reflection;20 cases of laparoscopic low anterior resection(LAR) with the anastomosis level more than 2cm above the dentate line;16 cases of laparoscopic ultralow anterior resection(ULAR) with the level of anastomosis within 2cm of the dentate line;and 2 cases of laparoscopic coloanal anastomosis(CAA) with the level of the anastomosis at or below the dentate line.whereas conversion to an open approach was required in three cases.Results The average operating time was 145 minutes(range 110~210min),and mean operative blood loss was 50 mL(range 30~80mL).Bowel function was restored and diet was resumed at 48 to 36 hours after operation.The average hospital stay was 9 days(range 7~14d).TME was completed successfully in 51 patients.Postoperative analgesics were used in 20 patients.No intraoperative or postoperative complications were(observed).Follow-up time was from 6~36 months in 51 patiebts,and there was no port-site or local tumor recurrence.Conclusions Laparoscopic TME is feasible and safe.It is a perspective technique with the(benefits) of minimally invasive technique and lower blood loss during operation,and rapid recovery.

BACKGROUND: The cell growth, proliferation and differentiation caused by p38 mitogen-activated protein kinase (p38MAPK) might act as the common pathway in the onset and development of diabetic vascular complication.OBJECTIVE: To investigate the effect of atorvastatin on p38MAPK signal pathway and the influence of atorvastatin on cell proliferation and expression of transforming growth factor-β1 (TGF-β1) at transcriptional level in human glomerular mesangial cells (HGMCs) cultured with oxidative modification of low-density lipoprotein (ox-LDL).DESIGN: A randomized, parallelized, controlled and open trial.SETTING: Endocrinology Department, First Hospital Affiliated to China Medical University; Endocrinology Department,Respiratory Department, Urology Department, the General Hospital of Shenyang Military Area Command of Chinese PLA.MATERIALS: The experiment had been done in the laboratories for Pharmaceutical Department of China Medical University and Respiratory Department of Shenyang Military Area Command of Chinese PLA from May 2004 to May 2005. The sample was cut from renal cortex from the healthy segment of nephroectomy from a tumor patient (Provided by Xiang Jun, Urology Department, the General Hospital of Shenyang Military Area Command of Chinese PLA; Informed consent was obtained). OX-LDL was purchased from biochemistry institute of Peking Union Medical College (Batch No.20040711 ). ox-LDL was 5.3±1.0 nmol in 100 μg protein. Atorvastatin was purchased from Pfizer Pharmaceutical Co. Ltd (No. 45837088); p38MAPK monocloncal antibody was purchased from Santa Cruz.METHODS: ① 6.0-8.0 cm3 blocks of cortex were cut from renal cortex from the healthy segment of nephroectomy from a tumor patient, glomerular mesangial cells were isolated. When grew into 80% confluent monolayer, the cells were digested and performed passage. After the first two passages, the cells were pure based on morphology and characterized by DAB staining for Vimentin antigen and actin antigen was positive, whereas cytokeratin antigen was negative. Oil red "O" staining confirmed that ox-LDL was intaken by HGMCs. The 4-8th passages of cells were used to study. ②HGMCs were seeded into 96-well plates with 5×103 cells per well and grown in 200 μL culture medium. The study was divided into 5 groups (6 wells each group): 1.2, 6,12 mg/L atorvastatin group, ox-LDL group and blank control group. The cells were pre-incubated with atorvastatin for 30 minutes, then exposed to 80 mg/L ox-LDL. The cells in blank control group were untouched. After 24 hours, MTT was added. The absorbance of each sample at the wavelength of 492 nm was measured with immunosorbant assay system. The inhibitory rate of cell proliferation was calculated. ③1×106 to 3×106 cells were seeded into six 200 mL flasks. The trial was divided into 5 groups randomly:control group, 10, 40, 80 mg/L ox-LDL groups and atorvastatin group (12 mL/g). The cells in each group were pre-incubated for 30 minutes, then exposed to 80 mg/L ox-LDL for 24-routine culture. The expressions of TGF-β1mRNA of harvested cells were detected with semi-quantitative reverse transcription-polymerase chain reaction and p38MAPK signal pathway activation was detected by Western blot.MAIN OUTCOME MEASURES: ①Identification results of HGMCs. ② Proliferation of HGMCs. ③ TGF-β1 expression of HGMCs. ④p38MAPK signal pathway activation of HGMCs.RESULTS: ①When the cells were sub-cultured to the second generation, cell volume was big. Most of the cells were spindle-shaped, irregular stellate or branch-like, filled with microfilaments which paralleled axis. Cells overlapped in the intensive area. After DAB staining, cytoplastic actin and vimentin were positive and keratin was negative. Oil red "O"staining confirmed that ox-LDL was intaken by HGMCs with red granules in the cytoplasma, while control group did not.It was proved that the cells cultured for passage were HGMCs. ② As compared with control group, the inhibitory rate of cell proliferation in ox-LDL group was significantly decreased, but that in atorvastatin 1.2, 6 and 12 mg/L groups was significantly increased (0, -17.4%, 6.4%, 22.5%, 61.5%, respectively, P ＜ 0.05 or 0.01) on concentration-dependent manner. ③ As compared with control group, ox-LDL (10, 40, 80 mg/L) increased the expression of TGF-β1 and activation of p38MAPK in concentration-dependent manner, the effect of 80 mg/L ox-LDL group was the most significantly (P ＜ 0.01). Atorvastatin decreased the increment of TGF-β1 expression and the activation of p38MAPK pathway induced by ox-LDL significantly. There was significant difference when compared with 80 mg/L ox-LDL group (P ＜ 0.01).CONCLUSION: Atorvastatin can antagonize the activation of p38MAPK pathway, decrease the secretion of TGF-β1 and inhibit mesangial cell proliferation induced by ox-LDL, suggesting that it may exert beneficial effect in the prevention and treatment of diabetic nephropathy with dyslipidemia.

OBJECTIVETo investigate the clinical effects and operative options for the treatment of Forestier disease.

METHODSFrom June 2005 to May 2012, 8 patients with progressive dysphagia due to Forestier disease were treated through anterior approach, their clinical data were retrospective analyzed. There were 6 males and 2 females, aged from 65 to 83 years old with an average of 73 years. Among the patients, osteophytes removal was performed in 3 cases, osteophytes removal with discectomy and fusion was performed in 2 cases, osteophytes removal with corpectomy and fusion was performed in 3 cases. According to Bazaz dysphagia score to assess the improvement of the patients' symptoms before and after operation.

RESULTSAll patients were followed up from 12 to 40 months with the mean of 18.5 months. Seven cases were asymptomatic and 1 case had mild symptom in the last follow-up. Radiographs showed the space enlargement between vertebral body and trachea.

CONCLUSIONIt is effective to treat patients with progressive dysphagia due to Forestier disease through surgical method. And the operative options depend on the stability of cervical spine and the neurological symptoms of the patients.

Aged ; Aged, 80 and over ; Female ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; diagnosis ; etiology ; surgery ; Male

OBJECTIVETo observe the effect of American Ginseng Capsule (AGC) on the liver oxidative injury and the Nrf2 protein expression in the liver tissue of rats exposed by 900 MHz cell phone electromagnetic radiation.

METHODSTotally 40 male SD rats were randomly divided into the normal control group, the model group, the Shuifei Jibin Capsule (SJC) group, and the AGC group,10 in each group. Rats in the normal control group were not irradiated. Rats in the rest three groups were exposed by imitated 900 MHz cellular phone for 4 h in 12 consecutive days. Meanwhile, rats in the SJC group and the AGC group were intragastrically administrated with suspension of SJC and AGC (1 mL/200 g body weight) respectively. Normal saline was administered to rats in the normal control group and the model group. The histolomorphological changes of the liver tissue were observed by HE staining. Contents of malonic dialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), and glutathione peroxidase (GSH-PX)were detected by colorimetry. The Nrf2 protein expression of hepatocytes was detected by immunohistochemical assay and Western blot.

RESULTSCompared with the normal control group, hepatocyte nucleus was atrophied or partially disappeared, the contents of liver MDA and Nrf2 protein obviously increased (P <0. 05, P <0. 01); contents of liver SOD and GSH decreased (P <0. 05) in the model group. Compared with the model group, karyopyknosis was obviously attenuated and approached to the normal level in the SJC group and the AGC group. The contents of liver MDA and Nrf2 protein expression decreased (P <0. 05), and the contents of liver SOD, GSH, and GSH-PX obviously increased (P < 0.05) in the SJC group. The contents of liver MDA and the Nrf2 protein expression decreased (P < 0.05), and contents of SOD and GSH obviously increased in the AGC group (P <0.01, P <0.05).

CONCLUSIONSThe electromagnetic radiation induced by 900 MHz cell phone could affect the expression of Nrf2 protein, induce oxidative injury, and induce abnormal morphology of liver cells. SJC and AGC could promote the morphological recovery of the liver cells. Its mechanism might be related to affecting the expression of Nrf2 protein and attenuating oxidative damage of liver cells.

Animals ; Cell Phone ; Electromagnetic Radiation ; Glutathione Peroxidase ; metabolism ; Hepatocytes ; metabolism ; Liver ; Male ; NF-E2-Related Factor 2 ; metabolism ; Oxidative Stress ; drug effects ; Panax ; Plant Extracts ; pharmacology ; Rats ; Superoxide Dismutase ; metabolism

OBJECTIVETo compare the efficacy of sublingual immunotherapy (SLIT) combined with inhaled corticosteroids (ICS) versus ICS alone in children with mild and moderate dust mite allergic asthma.

METHODSThirty-two children with mild and moderate dust mite allergic asthma were randomly divided into two groups: SLIT+ICS (n=18) and ICS alone (n=14). A total of 30 children completed the one year clinical observation . The amount of ICS administration, the day and night symptom scores, skin-prick test and pulmonary function test results, serum specific immunoglobulin E (sIgE) and G4 (sIgG4) levels and visual analog scale (VAS) scores were compared between the two groups.

RESULTSBy the end of one year the SLIT+ICS group had significantly decreased amount of ICS administration than the ICS alone group. Compared with the ICS alone group, the day and night symptom scores decreased, FEF25-75% increased significantly, and serum sIgE levels and VAS scores were significantly reduced in the SLIT+ICS group. There were no statistical differences in the skin-prick test results, and FEV1 and sIgG4 levels between the two groups. No severe adverse events occurred in both groups during the follow-up period.

CONCLUSIONSSLIT combined with ICS may produce a better efficacy than ICS alone in the improvement of day and night symptoms, pulmonary function and VAS scores in children with dust mite-allergic asthma.

Administration, Sublingual ; Adolescent ; Animals ; Asthma ; therapy ; Child ; Child, Preschool ; Desensitization, Immunologic ; Female ; Humans ; Male ; Pain Measurement ; Pyroglyphidae ; immunology

OBJECTIVETo study the relationship between insulin resistance and myocardial injury in children with critical diseases in light of the fact that such children usually suffer from noticeable insulin resistance and myocardial injury.

METHODSSixty-three children with critical diseases who were admitted between March 2010 and June 2011 were enrolled to comprise a case group. Fasting blood glucose, serum insulin, myocardial enzyme, and troponin I (CTnI) levels were measured. The insulin resistance index (HOMA-IR) was calculated. The children were classified into two groups: insulin resistance (HOMA-IR>1.0; n=30) and non-insulin resistance (HOMA-IR≤1.0; n=33). Thirty healthy children served as the control group.

RESULTSHOMA-IR, lactate dehydrogenase (LDH), aspartate aminotransferaseaspartate transaminase (AST), creatine kinase (CK), isoenzymes of creating kinase (CK-MB), α-hydroxybuty rate dehydrogenase (α-HBDH) and CTnI in the insulin resistance group were higher than those in the non-insulin resistance and the control groups (all P<0.05). The non-insulin resistance group also showed obviously higher levels in terms of LDH, AST, CK, CK-MB, α-HBDH, and CTnI than the control group (P<0.05). In the insulin resistance group, there exists a positive correlation between HOMA-IR and such indicators as LDH, CK, CK-MB, AST, α-HBDH and CTnI (r=0.697, 0.739, 0.781, 0.642, 0.381, 0.792 respectively; all P<0.05).

CONCLUSIONSInsulin resistance makes myocardial injury more serious; HOMA-IR can serve as a forecast indicator for the degree of myocardial injury.

Aspartate Aminotransferases ; blood ; Cardiomyopathies ; etiology ; Child ; Child, Preschool ; Creatine Kinase, MB Form ; blood ; Critical Illness ; Female ; Humans ; Insulin Resistance ; L-Lactate Dehydrogenase ; blood ; Male ; Troponin I ; blood