Clinical data of 14 patients with iatrogenic duodenal injuries treated in hospital from January 2000 and January 2010 were retrospectively reviewed.Iatrogenic duodenal injuries were found intraoperatively in 9 cases,in whom repair or additional jejunostomy was performed and all were cured and discharged.In 2 patients the duodenal injuries were found within 24 hours postoperatively,1 was cured,another had low flow duodenal fistula and cured with conservative treatment.Duodenal bypass and extraoral drainage were performed in 2 patients whose duodenal injuries was found 72 hours after surgery and died from severe infection of retroperitoneal space and multiple organ failure respectively.One patient whose duodenal injury was found 7 d postoperatively suffered from septic shock and died in 4 h after admission.The results suggest that early detection and early management would result in satisfied outcome for patients with iatrogenic duodenal injuries,the first 24 hours are crucial.

Objective To investigate the effect of voice training therapy on the voice improvement in patients with vocal nodules .Methods Twenty one patients with vocal nodules were recruited and were evaluated by the GRBAS perpetual evaluation ,voice handicap index (VHI)-30 subjective assessment ,vocal laryngostroboscopy , maximum phonation time (MPT) and acoustic analysis pre- and post-therapy .These patients completed 5 cour‐ses of voice training .Results The VHI value(29 .48 ± 21 .21) of post-therapy was less than the value (52 .95 ± 24 . 30)of pre -therapy (P< 0 .01) .There were significantly differences in voice perpetual evaluation between pre -training and post-training ,especially for G (grade) (P<0 .01) and R (roughness) (P<0 .01) .The post-training laryngostrobescopy vocal vibration improved comparing with pre-therapy in the closure of vocal cords ,symmetry of vibration ,the mucosal wave and vibration regularity of the vocal cords .After therapy ,three patient nodules dis‐appeared ,thirteen patient nodules became smaller ,and five patient nodules remained the same .The maximum pho‐nation time (MPT) (12 .54 ± 3 .68)of post-therapy was longer than MPT(8 .87 ± 3 .75) of pre-therapy MPT(P<0 .01) .The jitter value (0 .18% ± 0 .08% ) of post -therapy was less than that of pre-therapy(0 .43% ± 0 .31% ) (P<0 .01) .The shimmer of post -therapy (2 .10% ± 0 .98% ) was less than that of pre -therapy (4 .55% ± 1 .80% )(P<0 .01) ,The ratio of noise to harmonic(NHR)(0 .0034 ± 0 .0022 dB) of post-therapy was significantly less than NHR(0 .0184 ± 0 .028 dB)(P<0 .05) of pre-therapy .Conclusion The voice therapy could significantlyimprove voice of patients with vocal nodules .

Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing ischemic-type biliary lesion (ITBL) and analyze the relation between the enhancement patterns of bile duct wall of ITBL and its outcome.Methods 36 patients confirmed with ITBL (24 cases),anastomotic biliary stricture (3 cases),cholangitis (4 cases),biliarysludge (1 cases),and acute rejection (4 cases),who underwent CEUS examination,were enrolled in this study.The images were retrospectively analyzed in consensus by 2 readers.After reviewing the images,the readers were asked to make a diagnosis of ITBL.The diagnostic standard was hypo-or non-enhancement of hilar bile duct wall in arterial phase on CEUS.Results The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 66.7％,83.3％,72.2％,88.9％,and 55.6％ for reader 1;62.5％,83.3％,69.4％,88.2％,and 52.6 ％ for reader 2,respectively.The interobserver agreement was good (κ =0.83).In 24 ITBL patients,the ratio of mortality or retransplantation with non enhancing hilar bile duct wall in arterial phase was much higher than that with enhancing hilar bile duct wall (non-enhancement 54.5％,hypo-enhancement 20％,hyper-or iso-enhancement 12.5％).Conclusions CEUS had diagnostic value of ITBL.Non-enhancing hilar bile duct wall in arterial phase on CEUS predicated the poor outcome.

BACKGROUND:Generally,orthognathic surgery is used for skeletal mandibular retrusion.As the fulcrum of the masticatory loads on the temporomandibular joint,the mandible connects orthognathic surgery on itself with temporomandibular joint closely.However,the influence of orthognathic surgery on temporomandibular joint has not yet been fully unified.Finite element method has been widely used in the research concerning stomatology in recent years.OBJECTIVE:To establish a finite element model of temporomandibular joint and mandible with masticatory muscles before and after orthognathic surgery on the mandible and to investigate the long-term influence of orthognathic surgery on the biomechanics of temporomandibular joint.METHODS:The data of CT scan and three-dimensional reconstruction of a patient with skeletal mandibular retrusion were used to simulate surgical mandibular advancement with sagittal split ramus osteotomy,and the distance of advancement was 4,8 and 10 mm,respectively.The Von Mises stress of the condyles and articular fossae were obtained based on finite element method.RESULTS AND CONCLUSION:The finite element models of temporomandibular joint and mandible with masticatory muscles before and after orthognathic surgery of the patient with skeletal mandibular retrusion were established successfully,the stress nephograms and maximum Von Mises stress in each region of the condyles and articular fossae were obtained.To conclude,the finite element models are successfully established by Mimics,Geomagic Studio,Unigraphics NX and Workbench synthetically.The standard orthognathic surgery generally does not affect the condyle and glenoid fossa of the patient with skeletal mandibular retrusion negatively in the long-term.

AIM To observe the effects of Zuogui Pills and Yougui Pills on the proliferation of BMSCs and the expression of apoptosis after osteogenic and adipogenic differentiation in ovariectomized rats.METHODS Of sixty female SD rats,forty rats followed by bilateral ovariectomy were randomly divided into ovariectomy group (1.0 g/kg distilled water),Zuogui Pills group (9.45 g/kg Zuogui Pills) and Yougui Pills group (10.26 g/kg Yougui Pills) and Bujiale group (0.09 mg/kg estradiol valerate),another ten rats as control group (1.0 g/kg distilled water),ten rats bilateral excision of a small amount of fat around the ovary was treated as sham operation group (1.0 g/kg distilled water).After 12 weeks of administration,the rats were killed,BMSCs were cultured in vitro.Cell proliferation was detected by MTT assay.Western blot was used to detect the protein expressions of Caspase-3 and Bcl-2.RE-SULTS MTT assay showed that the proliferation of BMSCs were promoted in Zuogui and Yougui Pills groups,and the proliferation effect in Zuogui Pills group was better than that in Yougui Pills group.After osteogenic differentiation,as compared with the control group,the Caspase-3 expression of ovariectomy group was up-regulated (P ＜0.05) and the expression of Bcl-2 was down-regulated (P ＜0.01).As compared with ovariectomy group,the expression of Caspase-3 was decreased and the expression of Bcl-2 was up-regulated in Zuogui Pills group and Yougui Pills group.After adipogenic differentiation,as compared with the control group,the expressions of Caspase-3 were significantly up-regulated and Bcl-2 were down-regulated in the ovariectomy group,Zuogui Pills group and Yougui Pills group (P ＜ 0.05).After osteogenic and adipogenic differentiation Zuogui Pills group and Yougui Pills group were significant different (P ＜ 0.05).CONCLUSION Zuogui Pills and Yougui Pills both can inhibit the apoptosis of BMSCs after osteogenic and adipogenic differentiation in ovariectomized rats.Zuogui Pills can promote BMSCs osteogenesis differentiation while Yougui Pills can promote adipogenic differentiation.

OBJECTIVETo investigate the role of renal sympathetic nerves in renal sodium transport in ouabain-hypertensive rats (OHR).

METHODSSixteen male SD rats with sham renal denervation (Sham-RDNX) and 16 with renal denervation (RDNX) were randomly into normal control group and ouabain group to receive intraperitoneal injection of normal saline (1 ml/kg) and ouabain (27.8 µg/kg) once a day, respectively. Systolic blood pressure (SBP), heart rate and body weight were recorded weekly. Food consumption of the rats was determined twice a week. After a 4-week treatment, blood and 24 h urine samples were collected to measure the serum and urinary concentration of sodium, trace lithium and creatinine. Endogenous creatinine clearance rate (Ccr), fractional excretions of sodium (FENa), fractional excretions of lithium (FELi) and fractional reabsorption of sodium in the postproximal tubules (FDRNa) were calculated. Plasma renin activity was determined by radioimmunoassay. Norepinephrine was extracted from the renal tissue and assayed for norepinephrine content by HPLC.

RESULTSThe body weight, food intake and heart rate showed no significant difference among the 4 groups (P > 0.05). After 4 weeks, the SBP of control RDNX group (CDNX) was significantly lower than that of the control Sham-DNX group (Csham)(P < 0.05); the SBP of ouabain RDNX group (ODNX) was also significantly lower than that of ouabain Sham-DNX group (Osham) (P < 0.05); RNDX lowered SBP by about 10 mmHg in both ouabain groups and control groups. The SBP was significantly higher in Osham and ODNX groups than in the corresponding control groups (P < 0.01), also significantly higher in ODNX group than in Csham group (P < 0.01). Ccr showed no significant difference among the 4 groups(P > 0.05). FENa, FELi and FDRNa were significantly lower in ouabain groups than in the corresponding control groups (P < 0.05, P < 0.01, P < 0.05), but FENa, FELi and FDRNa of ODNX group were similar with those of Osham group (P > 0.05); FENa , FELi and FDRNa were similar between CDNX and Csham groups (P > 0.05). The plasma renin activity was comparable between the 4 groups (P > 0.05). Renal norepinephrine level was markedly reduced in RDNX group compared with that in Sham-RDNX group in both ouabain and control groups (P < 0.01).

CONCLUSIONThe increase of proximal tubule sodium reabsorption in OHR is not dependent on the renal sympathetic nerve.

Animals ; Hypertension ; chemically induced ; metabolism ; Kidney ; innervation ; Male ; Ouabain ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Sodium ; metabolism ; Sodium Channels ; metabolism ; Sympathetic Nervous System ; physiology

OBJECTIVETo investigate renal sodium handling of ouabain-hypertensive rats and the role of renal sodium handling in pathogenesis of hypertension using endogenous trace lithium as a marker of proximal sodium reabsorption.

METHODSForty male Sprague-Dawley (SD) rats weighting 180-220 g were equally divided into normal control group and ouabain group randomly. Rats were infused with normal saline 1 ml/ (kg x d) or ouabain 27.8 microg/ (kg-d) intraperitoneally once a day respectively. Systolic blood pressure (SBP) and body weight were recorded weekly. Rats were sacrificed after 2 and 6 weeks respectively. Blood and 24 hour urine sample were collected to measure the serum and urinary concentration of sodium, potassium, trace lithium, and creatinine. Endogenous creatinine clearance rate (Ccr), fractional excretions of sodium (FE(Na)), and fractional excretions of lithium (FE(Li)), the ratios of urinary lithium to sodium (U(Li)/U(Na)), the ratios of urinary potassium to sodium (U(K)/U(Na)), and fractional reabsorption of sodium in the postproximal tubules (FDR(Na)) were also calculated. All were studied on their normal diet and ate salt freely.

RESULTSBlood pressure had no significant difference in these two groups after 2 weeks (P > 0.05); After 4 weeks, however, blood pressure was significantly higher in ouabain group than in control group (P < 0.01). Body weight of rats had no significant difference during the experiment period (P > 0.05). Ccr and FE(Na) were similar in these 2 groups (P > 0.05). FE(Li), U(Li)/U(Na), U(K)/U(Na), and FDR(Na) of ouabain group were significantly lower than control group after 2 and 6 weeks (P < 0.05, P < 0.01, P < 0.001 respectively).

CONCLUSIONThe reabsorption of sodium increases in the proximal tubule in ouabain-hypertensive rats, and such increase occurs before the development of hypertension. Therefore, increase of proximal reabsorption of sodium may be involved in the pathogenesis of ouabain-induced hypertension.

Animals ; Hypertension ; chemically induced ; metabolism ; Kidney Tubules, Proximal ; metabolism ; Lithium ; metabolism ; Male ; Natriuresis ; Ouabain ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Sodium ; metabolism

OBJECTIVETo observe effect of formula of removing both phlegm and blood stasis (TYTZ) in improving hemorheology and blood fat of mini-swine with coronary heart disease of phlegm-stasis cementation syndrome.

METHODThirty-six Chinese mini-swine were randomly divided to six groups: the normal control group, the model group, the Shujiangzhi group and TYTZ groups with doses of 2.0, 1.0 and 0.5 g x kg(-1), with six mice in each group. Except for the normal control group, all of other groups were fed with high-fat diet for 2 weeks. Interventional balloons are adopted to injure their left anterior descending artery endothelium. After the operation, they were fed with high-fat diet for 8 weeks to prepare the coronary heart disease model of phlegm-stasis cementation syndrome. In the 8th week after the operation and administration, the changes in hemorheological parameters, serum lipid level, myocardial ischemia level and range were observed.

RESULTCompared with the normal control group, the model group showed significant increase in serum TC, TG, LDL-C and VLDL-C levels (P < 0.01), whole blood viscosity under the shear rate of 5 s (-1) and 60 s (-1) (P < 0.01), and myocardial ischemia degree and range (P < 0.01). Compared with the model group, TYTZ groups revealed significant decrease in myocardial ischemia degree and range (P < 0.01), serum TC, TG, LDL-C and VLDL-C levels (P < 0.05 or P < 0.01) and whole blood viscosity under the shear rate of 5 s(-1) and 60 s(-1) (P < 0.05).

CONCLUSIONTYTZ could improve the abnormal hemorheology in Chinese mini-swine with coronary heart disease of phlegm-stasis cementation syndrome, and regulate serum lipid, with a certain efficacy for coronary heart disease of phlegm-stasis cementation syndrome.

Animals ; Coronary Disease ; blood ; metabolism ; physiopathology ; therapy ; Female ; Hemorheology ; Lipids ; blood ; Male ; Medicine, Chinese Traditional ; methods ; Mucous Membrane ; secretion ; Swine ; Swine, Miniature

OBJECTIVETo detect beta-catenin mRNA levels in sporadic colorectal cancers (SCRC) and adjacent normal colorectal mucosa, and to investigate the association between the beta-catenin mRNA level and its aberrant expression and clinicopathological parameters.

METHODSThe concentration of beta-catenin mRNA in 81 SCRCs and 28 adjacent normal colorectal mucosa specimens was determined by TaqMan real-time quantitative RT-PCR. The ratio of beta-catenin cDNA copies/GAPDH cDNA copies was used to represent the mRNA expression level in different tissues. The beta-catenin protein expression was determined by the EnVision two-step immunohistochemical method.

RESULTSbeta-catenin mRNA levels in SCRCs (2.527 +/- 2.284) were lower than those in the adjacent normal colorectal mucosa (5.003 +/- 3.326), P < 0.05. In addition, beta-catenin mRNA levels in lymph node-positive cases and tumors with ulcerative and infiltrating growth types were significantly lower (1.827 +/- 1.288, 2.202 +/- 2.035) than those in lymph node-negative cases and polypoid growth type tumors (3.359 +/- 2.881, 3.108 +/- 2.610), P < 0.05. No significant difference of beta-catenin mRNA level was found between cases with aberrant beta-catenin cytoplasm or nuclear expression and those without.

CONCLUSIONSSCRCs express lower levels of beta-catenin mRNA than normal colorectal mucosa. Such lower level expression is associated with lymph node metastasis and tumors with ulcerative and infiltrative growth pattern. Aberrant cytoplasmic and nuclear expression of beta-catenin appears unrelated to the lower mRNA levels. Quantitative detection of beta-catenin mRNA may be a useful approach to monitor the biological behavior of SCRCs.

Adenocarcinoma ; genetics ; metabolism ; pathology ; Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; genetics ; metabolism ; pathology ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Immunohistochemistry ; Intestinal Mucosa ; metabolism ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; RNA, Messenger ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; methods ; beta Catenin ; biosynthesis ; genetics

BACKGROUNDOver past two decades, vagus nerve stimulation (VNS) has been widely used and reported to alleviate seizure frequency worldwide, however, so far, only hundreds of patients with pharmaco-resistant epilepsy (PRE) have been treated with VNS in mainland China. The study aimed to evaluate the effectiveness of VNS for Chinese patients with PRE and compare its relationship with age cohort and gender.

METHODSWe retrospectively assessed the clinical outcome of 94 patients with PRE, who were treated with VNS at Beijing Fengtai Hospital and Beijing Tiantan Hospital between November 2008 and April 2014 from our database of 106 consecutive patients. The clinical data analysis was retrospectively examined.

RESULTSSeizure frequency significantly decreased with VNS therapy after intermittent stimulation of the vagus nerve. At last follow-up, we found McHugh classifications of Class I in 33 patients (35.1%), Class II in 27 patients (28.7%), Class III in 20 patients (21.3%), Class IV in 3 patients (3.2%), and Class V in 11 patients (11.7%). Notably, 8 (8.5%) patients were seizure-free while &ge;50% seizure frequency reduction occurred in as many as 60 patients (63.8%). Furthermore, with regard to the modified Engel classification, 12 patients (12.8%) were classified as Class I, 11 patients (11.7%) were classified as Class II, 37 patients (39.4%) were classified as Class III, 34 patients (36.2%) were classified as Class IV. We also found that the factors of gender or age are not associated with clinical outcome.

CONCLUSIONSThis comparative study confirmed that VNS is a safe, well-tolerated, and effective treatment for Chinese PRE patients. VNS reduced the seizure frequency regardless of age or gender of studied patients.

Adolescent ; Adult ; Child ; Child, Preschool ; Drug Resistance ; Epilepsy ; therapy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Vagus Nerve Stimulation ; methods ; Young Adult