Sleep plays an important role in the modulation of endocrine function and energy metabolism;hormone levels are markedly different during a sleepless night compared with a night of normal sleep.Sleep deprivation may change the levels of cortisol,growth hormone(GH)and thyrotropin(TSH)at night.In addition,sleep curtailment disturbs the balance of anorexi- genic(leptin)and orexigenic(ghrelin)factors,and does harmful to glucose tolerance.

Objective To investigate the values of computed tomography(CT) and endoscopic retrograde cholangiopanc reatography(ERCP) in acute biliary tract obstruction associated with Clonorchiasis. Methods The image features of 47 patients with acute biliary tract obstruction associated with Clonorchiasis proved by operation (27 cases) and ERCP (20 cases) were reviewed retrospectively. Results Fourty-three cases showed equal intrahepatic bile duct diffuse dilatation from porta hepatis to capusle with different levels in CT, and 39 cases showed extrahepatic bile duct dilatation. There was no significant relationship for the extent of intra and extrahepatic bile duct dilatation. It showed the end of intrahepatic bile duct shaped like a bag in 41 cases, a enlarged gallbladder in 38 cases, and 9 cases with a soft intralumenal masses. There were 13 patients with pancreas swelling and 8 with pancreatic duct dilatation. Of the 20 patients underwent ERCP, eighteen cases showed intrahepatic bile duct diffuse dilatation with the end shaped like a bag, and 16 showed extrahepatic bile duct dilatation. Irregular filling-defect was seen in the common bile duct in 9 cases. The obstruction were relieved after Oddi's muscle endoscopic sphincrectomy(EST). Conclusion The patients with acute obstructive jaundice can be diagnosed as Clonorchiasis, if CT or ERCP showed equal intrahepatic bile duct diffuse dilatation with the end shaped like a bag and with extrahepatic bile duct dilatation, which can be confirmed by the worms and eggs found in the drawing-out bile, and the obstruction can be relived by EST.

Objective To investigate the CT imaging feature of EHCC associated with Clonorchiasis. Methods The CT image features of 18 patients with EHCC associated with Clonorchiasis proved by operation and pathology were reviewed retrospectively. Results CT depicited the level and cause of obstruction in all eigthteen patient. Most tumors( n =14,77.8%)were located in the proximal third of the extrahepatic bile duct. The gross morphologic pattern was an intraluminal soft tissue mass leision in 14 patients(77.8%), infiltrating in two patients and exophytic types in two patients. Contrast enhancement of the tumors relative to the liver parenchyma showed isoattenueation in 10 tumors(55.6%), hyperattenuation in seven tumors(38.9%) and hypoattenuation in one tumor(5.6%). Severe,uniform dilation of the intrahepatic bile duct was identified in 14 patients (77.8%) and central dilation was seen in four patients (23.2%).Male preponderance was found( n =15,83.3%). Conclusion It is concluded that the EHCC associated with Clonorchiasis is located predominantly in the proximal third of the extrahepatic bile duct and detected more readily than non Clonorchiasis-associated cholangiocacinoma.

Objective:To obverse the therapeutic effect of superficial needling with different frequencies for intractable facial paralysis. Methods: A total of 120 patients with intractable peripheral facial paralysis were allocated into a superficial needling with high frequency group (150 times/min), a moderate frequency group (100 times/min) and a low frequency group (50 times/min) according to the random number table method. The Toronto facial grading system (TFGS) was used to evaluate facial nerve functions before treatment and after 2 weeks and 4 weeks of treatment respectively. The electromyography (EMG) test of the mandibular branch of facial nerve was used to compare the motor nerve conduction velocity (MCV), sensory nerve conduction velocity (SCV) and monophasic action potential (MAP) among different groups, and was done before treatment and after 4 weeks of treatment. The clinical efficacy was also compared. Results: After 2 weeks and 4 weeks of treatment, the changes of TFGS scores in the three groups all showed statistical significance (all P＜0.05), and the TFGS score in the low frequency group was substantially higher than that in the other two groups. After treatment, the changes of the MCV and SCV in the three groups all showed statistical significance (all P＜0.05), and the results in the low frequency group were higher than those in the other two groups; the change of MAP in the three groups showed no statistical significance (P＞0.05). The total effective rate was 65.0%, 80.0% and 95.0% in the high frequency group, moderate frequency group and low frequency group respectively, and the between-group differences showed statistical significance (P＜0.05). Conclusion: Compared with the superficial needling with high and moderate frequencies, superficial needling with low frequency can produce more significant clinical efficacy for intractable facial paralysis.

Objective To investigate the protective effects of ambroxol on lung during perioperation in elderly patients with myasthenia gravis.Methods 58 elderly patients diagnosed as myasthenia gravis combined with thymic disease were divided into treatment group and control group randomly.During the perioperation,the treatment group was treated with ambroxol,while the control group was not.Comparative analysis of pulmonary complications,pulmonary ventilation indexes,blood gas indexes,and serum concentration of C-reactive protein (CRP),tumor necrosis factor-α (TNF-α),interleukin 1β (IL-1β) and IL-10 was performed.Results The incidence rate of postoperative pulmonary complications (pulmonary atelectasis,pneumonia and bronchitis) was significantly lower in the treatment group in the control group (9.4％ vs 15.6％,P＜0.05).Peak inspiratory pressure (PIP) and resistance of air way (RAW) were lower in treatment group than in control group [(22.32±3.43) cmH2O vs (26.54±4.81) cmH2O,(29.17±5.74) cmH2O· L-1s-1vs (34.47±7.94) cmH2O · L-1 · s-1 both P＜0.05],while compliance of lung (CL) washigher in treatment group than in control group [(106.04±-14.73)ml/cmH2O vs (95.11±9.50) ml/cmH2O,P＜0.05].Two days after operation,PaO2,SaO2 and PaO2/FiO2 were significantly higher in treatment group than in control group [(89.66 ±13.23) mmHg vs (70.94±12.75) mmHg,(96.95±2.65)％ vs (89.44±2.78)％,(219.47±54.05)mmHg vs (187.38±37.72) mmHg,respectively,all P＜0.05].Serum concentration of CRP,TNF-α,IL-1β were lower and serum level of IL-10 was higher in treatment group than in control group [(29.37 ± 14.87)mg/L vs (43.94 ±21.42) mg/L,(35.55±4.74)μg/L vs.(52.80±6.63) μg/L,(17.06±6.85)μg/L vs.(28.62±7.72) μg/L],[(132.84± 12.91)μg/L vs.(87.18± 16.37)μg/L,respectively,all P＜0.05].Conclusions Ambroxol hydrochloride can effectively reduce the incidence rate of postoperative pulmonary complications after thymectomy,improve the pulmonary ventilation function,and inhibit the inflammatory reaction in elderly patients with myasthenia gravis,which is worthy of wide application in the perioperation.

Anemia, Aplastic ; therapy ; Cytomegalovirus Infections ; etiology ; Fatal Outcome ; Humans ; Immunotherapy ; adverse effects ; Male ; Pneumonia, Viral ; etiology ; Young Adult

Objective To evaluate the early outcomes of mini-open lumbar microdiscectomy. Methods There were 38 cases in each group of mini-open lumbar mierodiscectomy and conventional discecto- my.Operating time,blood loss,time of leaving the bed and length of hospital stay were compared in two groups.MacNab criteria were used to evaluate the outcomes.Results To compare the conventional discec- tomy group,microdiscectomy group spent similar operating time,but had less blood loss(P

AIM:To investigate the influence of matrine (MA) on the phenotype switching of mouse mono-cytes and alveolar macrophages induced by bleomycin ( BLM) .METHODS:All mice were randomly divided into normal saline (NS) group, BLM group, BLM+NS group and BLM +MA group.The mice were administered with BLM at 2.5 mg/kg via oropharyngeal instillation .The mice in BLM+MA group were treated with MA (15 mg· kg-1 · d-1 ) by oral gavage following BLM administration .The mice were sacrificed on days 3, 7, 14, and 21.The lungs were removed for pathological analysis .The circulating monocyte subsets and polarization state of bronchoalveolar lavage fluid ( BALF)-de-rived alveolar macrophages were analyzed by flow cytometry .RESULTS:The results of HE and Masson trichrome staining in BLM and BLM+NS groups exhibited classical pathological stages of lung fibrosis , including acute inflammation phase and later fibrosis phase .Compared with BLM +NS group, MA treatment alleviated the inflammatory response and the de-gree of fibrosis induced by BLM (P<0.05).There was a rapid change of circulating Ly6Chi monocytes and its magnitude was positively associated with the pulmonary inflammatory response .An expansion of M2-like alveolar macrophages was positively correlated with the magnitude of lung fibrosis .Moreover , MA treatment partially normalized the phenotype switc-hing of monocytes and alveolar macrophages .CONCLUSION:Matrine treatment attenuates BLM-induced pulmonary injury partially via modulating the phenotype switching of monocytes and alveolar mocrophages .

Objective To evaluate the clinical effects of voice training on the speech ability in patients with oral cancer af. ter free flap reconstruction. Methods Fifty-five patients with oral cancer after free flap reconstruction were assigned to the voice training group(28 cases)and control group(27 cases)from the third week after operation. Their speech function was eval-uated by Chinese Speech Definition Word Table before operation and 2 weeks,3 months and 6 months after the operation. Results The score of speech definition was significantly higher in the voice training group than that of the control group (P< 0.01). Conclusion Postoperative voice training can effectively improve the speech definition for the patients with oral cancer after free flap reconstruction.

BACKGROUND:Knowledge of retropedtoneal space communications might influence catheter placement,and understanding the normal anatomy of the retroperitoneal space is a prerequisite for predicting the distribution of inflammation or other fluid collections in this region. Until recent years,the media/ attachment of the posterior renal fascia remained controversial. The multiple detector spiral CT can show the abdominal anatomic details. So,using the multiple-detector spiral CT to study the anatomy of posterior renal fascia has clinical significance. OBJECTIVE:To describe the medial attachment of the posterior renal fascia by using multiple-detector spiral CT. DESIGN,TIME AND SETTING:A retrospective case analysis was performed at Department of Radiology,Affiliated Hospital of Weifang Medical College between June 2003 and November 2007. PARTICIPANTS:A total of 52 patients with retropedtoneal inflammatory diseases were retrospectively reviewed through analysis of their CT data. METHODS:Toshiba Akuilion 16-detector spiral CT was employed for scanning. Of the 52 patients,15 were proved by clinical and laboratory findings and 37 were proved by surgery and pathology. Among the 52 patients,17 suffered from appendicitis,1 from ureteritis,2 from abscesses in the perirenal space,3 from abscesses in the posterior pararenal space,and 29 from pancreatltis. MAIN OUTCOME MEASURES:Medial attachment of the bilateral posterior renal fascia. RESULTS:At the level of the upper pole of kidney,the posterior renal fascia fused with the fascia of the ipsilateral quadratus lumborum muscle. Forty-six patients manifested the attachment site of the left posterior renal fascia transforming from the quadratus lumborum muscle fasciae to the psoas major muscle fascia at the level of the lower pole of kidney or the infrarenal space. Fifty patients showed the attachment site of the right posterior renal fascia transforming from the quadratus lumborum muscle fascia to the psoas major muscle fascia at the level of the lower pole of kidney or the infrarenal space. CONCLUSION:The posterior renal fascia attachment site is not the same all the time. At different levels,the attachment site of the posterior renal fascia is distinct.