Objective To describe a new kind of Y-shaped metallic stent delivery system and evaluate its feasibility and preliminary effect for managing multiple airway stenoses involving the lower trachea and the tracheal carina.Methods The Y-shaped metallic stent delivery system consisted of three- tier structure.The inner-tier was composed of four parallel guiding tubes,which was used for two guidewires and two threads passing through,the middle-tier was delivery catheter,which contained the four guiding tubes,and the outer-tier was introducer sheath.Under the fluoroscopic guidance,15 patients with multiple stenoses involving the lower trachea and the tracheal carina were treated with the new covered self-expandable Y-shaped metallic stents.Results Stent placement in the tracheo-bronchial tree was technically successful in all patients with obliteration of the dyspnea immediately after stent placement,and SaO_2 was increased form preoperative 75%—89% to postoperative 96%—99%.During follow-up a period of 3—58 weeks (M 22 weeks),all stenosis were resolved without stent-related complications,and the general physical of all 15 patents was improved with no occurrence of obviously dyspnea and bleeding.Karnofsky performance status(KPS)was improved from preoperative 26%—45% to postoperative 72%—95%.Five patients died of the following causes unrelated to stent insertion:multiple organ failure(n=3),cachexia(n=1)and pulmonary infection caused by gastrobronchial fistula(n=1),and the remaining 10 patients were alive with no evidence.of dyspnea at the time of this report.Conclusion Deployment of the covered Y-shaped metallic stent with the use of Y metallic stent delivery system in the management of airway stenoses involving the lower trachea and the tracheal earina was a simple and safe procedure and with a good short-term clinical efficacy.

Objective To discuss the clinical feature ,diagnosis and treatment of the occult cerebrospinal fluid rhinorrhea after tracheotomy in patients with severe traumatic brain injury .Methods The clinical data of 18 cases of the occult cerebrospinal fluid rhinorrhea after tracheotomy in patients with severe traumatic brain injury were retro -spectively analyzed .Results 15 cases showed involuntary swallowing movements ,frequent stimulus-likecough, abnormal increased secretions in the oral and nasal;3 cases performance of aspiration ,hypoxemia ,respiratory distress . After a three -dimensional thin skull CT , cisternography , nasal endoscopic examination can confirm the diagnosis . After the treatment with replacing the tracheostomy tube with a balloon ,continuous lumbar drainage ,endoscopic repair leak,the cerebrospinal fluid rhinorrhea were cured .Conclusion Patients with occult cerebrospinal fluid rhinorrhea performance the diversity and easily missed ,early detection and timely treatment can prevent cerebrospinal fluid rhi-norrhea delayed healing and intracranial infection and promote patient recovery .

Objective To investigate the potential relationship between initial 131Ⅰ uptake by lung metastases from differentiated thyroid cancer (DTC) and treatment outcomes. Methods From 1997 to 2009, 41 patients with DTC lung metastases were treated in the authors' department. 131Ⅰ whole body scan (WBS), serum Tg levels and other imaging results were analyzed to evaluate the therapeutic effects. Complete response (CR) or partial response (PR) was considered to be effective. The x2 test and correlation analysis were performed using SPSS 11.5 software package. Results 131 Ⅰ treatment was effective in 63% (26/41) patients with DTC lung metastases, CR in 8 patients and PR in 18 patients. In other 37% ( 15/41 ) patients, 131Ⅰ treatment was ineffective, including one case died of distant metastases. Patients with initial presence of 131Ⅰ lung uptake had higher effective rate than those with 131Ⅰ lung uptake during the second or later 131Ⅰ treatment (76% (22/29)vs33% (4/12),x2 =4.911, P=0.027). Also, significantly higher effective rate was found in patients with lung metastases alone than those with extra-pulmonary metastases (75% (24/32) vs 22% (2/9), x2 = 6. 312, P =0.012). However, the effective rate in patients with diffuse metastases was not significantly different from that in patients with focal metastases (67% (12/18)vs 61% ( 14/23), x2 =0. 146, P=0.702). The positive rate of initial 131Ⅰ uptake by lung metastases was higher in patients with total thyroidectomy than those with partial thyroidectomy (83% (24/29) vs 42% (5/12) ). Those positive rates in patients with papilary DTC and patients with follicular DTC were 72% (23/32) and 6/9, respectively. The surgical mode was correlated with the initial 131Ⅰ uptake by lung metastases (r = 0.411, P ＜ 0.05), but no correlation was found between the histological type and the initial 131Ⅰ uptake by lung metastases ( r = 0. 047, P ＞ 0.05 ). Conclusion Initial uptake of 131 Ⅰ by lung metastases alone is a favorable prognostic factor for DTC patients treated by131Ⅰ, and total thyroidectomy may be beneficial for initial 131Ⅰ uptake by lung metastases.

Objective:To explore the application value of problem-based learning (PBL) controlled by closed-loop feedback in the teaching of respiratory medicine.Methods:In PBL teaching, after students' open inquiry, discussion and PBL self-study, closed-loop feedback was given by organizing PPT report, written summary and mechanism diagram display of medical students. The participation of teachers and students, teaching quality, the degree of students' identification of key knowledge points, the breadth and depth of mastering the characteristics of key symptoms and the satisfaction of PBL teaching work were investigated, and the differences were compared before and after the closed-loop feedback. GraphPad Prism 5.01 was used in the analysis.Results:It was found that closed-loop feedback could improve the self-evaluation of tutor's teaching participation [(7.97±0.91) vs. (8.77±0.64), P < 0.001] and students' evaluation on teaching participation of tutor [(8.09±0.79) vs. (8.74±0.45), P < 0.001]. At the same time, students' evaluation on the teaching quality of tutors was also improved [(88.61±6.53) vs. (92.59±5.44), P < 0.001]. After closed-loop feedback, the students' identification of the required knowledge points in the syllabus was significantly increased [(84.00±21.75) vs. (90.22±16.18), P = 0.017]. The overall satisfaction with PBL teaching was also improved obviously [(8.93±0.67) vs. (9.37±0.64), P < 0.001]. Conclusion:Practice has proved that the closed-loop controlled PBL teaching approach has a good effect on the teaching of respiratory medicine, and it's worth popularizing in clinical teaching.

We typed Yersinia pestis isolated from plague foci of Shaanxi Province using different region (DFR) and analyzed epidemiological characteristics.Twenty-three DFRs primers and PMT1 (plasmid) primer were used to verify the DFR genomovars and 48 Yersinia pestis were involved to analyze DFR profiles and epidemiological characteristics.In the same year,the genotypes of Yersinia pestis isolated from different infected vector and animals were basically the same.Three genomovars named Genomovar 11,17,and 20 were verified in 48 Yersinia pestis strains in Shaanxi Province.The main genotypes were different in different epidemic years.In 1987-1988 and 2000-2001 years,genomovar 17 was major genomovar and genomovar 20 in 2006 year.In conclusion,the dominant genotypes were different in different epidemic years.As time goes on,DFR genomovars of Yersinia pestis undergone the evolution of gene deletion,which changes genomovar 17 into genomovar 20.

BACKGROUNDA new brain region, the marginal division (MrD), was discovered at the caudal margin of the neostriatum. The MrD was shown to be involved in learning and memory in the rat. The aim of this study was to investigate the expression of the immediate-early genes c-fos and c-jun in the MrD of the striatum during learning and memory processes in the rat, immunocytochemical and Western blot methods were used to examine Y-maze trained rats.

METHODSThe rats were divided into three groups, namely the training, pseudotraining, and control groups. After Y-maze training, the expression of the immediate-early genes c-fos and c-jun in the MrD of the rats was investigated using immunocytochemical and Western blot methods.

RESULTSAfter one hour of Y-maze training, the expression of c-jun and c-fos proteins was significantly enhanced in the MrD; the c-jun protein, in particular, was more intensely expressed in this region than in other parts of the striatum. The expression of these two proteins in the training group was significantly higher than in the pseudotraining and control groups. In addition, positive expression was also found in the hippocampus, cingulum cortex, thalamus, and in other areas. Western blot disclosed two immunoreactive bands for the anti-c-fos antibody (47 kD and 54 kD) and two immunoreactive bands for the anti-c-jun antibody (39 kD and 54 kD).

CONCLUSIONSThese results indicate that the immediate-early genes c-fos and c-jun participate in signal transduction during the learning and memory processes associated with Y-maze training in rats.

Animals ; Male ; Maze Learning ; Memory ; Neostriatum ; metabolism ; Proto-Oncogene Proteins c-fos ; biosynthesis ; Proto-Oncogene Proteins c-jun ; biosynthesis ; Rats ; Rats, Sprague-Dawley

Accidents, Occupational ; Adolescent ; Adult ; Arsenic Poisoning ; Child ; Female ; Humans ; Male ; Middle Aged ; Water Pollution, Chemical

Objective To investigate the relationship and clinical significance of blood plasma brain natriuretic peptide (BNP) and Keshan Disease (KD). Methods Seventy KD patients and 30 healthy volunteers in endemic area were investigated with Doppler Echocardiography for the measurement of left ventricular end-diastolic diameter(LVEDD) and left ventricular ejection fraction (LVEF), and the plasma BNP levels were determined with microparticle enzyme immunoassay. Results The BNP levels in plasma in KD patients [(444.61±102.31), (87.21±23.15)ng/L] were significantly higher than that of healthy volunteers [(34.91±15.21)ng/L],the differencesbeing statistical significant (q=39.74,5.82,P<0.01). The BNP levels in chronic KD patients were higher than that of latent KD patients (q=37.62,P<0.01). The plasma BNP levels in KD patients with LVEDD 60 nun [(928.80±134.27)ng/L] were significantly higher than those of patients with LVEDD 55～60 mm [(89.24±52.31)ng/L] and LVEDD<55 nun [(67.14±6.92)ng/L],the differencesbeing statistical significant (q=44.30,48.16, P<0.01), The plasma BNP levels in KD patients with LVEF<35%[(1654.21±421.35) ng/L] were significantly higher than those of patients with 35% ~ 50%[(421.54±112.32)ng/L] and50% [ (81.21±72.85 ng/L)], the differencesbeing statistical significant(q=24.91,72.66, P<0.01), The BNP levels in LVEF 35%～50% were higher than that of 50% (q=11.84,P<0.01). Conclusion The plasma BNP levels were important for the diagnosis, grouping, therapeutic effect and prognostic evaluation of KD.

Oral mucosal drug delivery has the advantages of rapid drug absorption, no first-pass effect and good patient compliance. However, factors such as low drug dissolution, saliva carrying the drug into the gastrointestinal tract and the existence of physiological barriers in the mucosa may affect the mucosal permeation and bioavailability of the drug. Nanotechnology applied to drug oral mucosa delivery can overcome the above disadvantages and obtain efficient absorption effect. This paper describes the physiological structure of oral mucosa and the factors affecting the absorption of drugs in oral mucosa, reviews the application of nanotechnology such as liposomes, solid lipid nanoparticles, nanostructured lipid carriers, nanoemulsions, polymer nanoparticles, polymer micelles and nanohybrid suspensions in oral mucosal drug delivery and the mechanism of promoting drug absorption, summarizes the main problems of current research, and gives an outlook on the application of nano oral mucosal drug delivery system. The main problems of current research are summarized, and the prospects for the application of nano oral mucosal drug delivery systems are discussed.

OBJECTIVETo compare therapeutic effects of traditional moxibustion and moxibustion on temperature-sensitive points for lumbar disc herniation.

METHODSOne hundred and twenty cases were randomly divided into a temperature-sensitive point group and a traditional moxibustion group, 60 cases in each group. The temperature-sensitive point group was treated with moxibustion on the temperature-sensitive points in the temperature-sensitive high incidence area such as waist and lower limbs, once each day; the traditional moxibustion group was treated with warming moxibustion at Jiaji (EX-B 2), Ciliao (BL 32), Zhibian (BL 54), Huantiao (GB 30), Weizhong (BL 40), Yanglingquan (GB 34), Kunlun (BI. 60), once each day, 7 days constituting one course. The therapeutic effect and the recurrence rate were observed after one course treatment and six months later.

RESULTSAfter treatment for one course, the cured-markedly effective rate was 65.00% in the temperature-sensitive point group, superior to 50.0% in the traditional moxibustion group, with a significant difference between the two groups (P < 0.05); all effective cases were followed-up for six months, the cured-markedly effective rate and the recurrence rate were 62.3% and 26.4% in the temperature-sensitive point group, and 34.2% and 46.3% in the traditional moxibustion group, the therapeutic effect of the temperature-sensitive point group being superior to the traditional moxibustion group, and the recurrence rate was lower than the traditional moxibustion group (both P < 0.05).

CONCLUSIONMoxibustion on temperature-sensitive points is a effective therapy for lumbar disc herniation, with stable therapeutic effect and low recurrence rate.

Acupuncture Points ; Adult ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; therapy ; Lumbar Vertebrae ; Male ; Middle Aged ; Moxibustion ; methods ; Temperature ; Treatment Outcome ; Young Adult