protrusion measured by ultrasound for diagnosing bladder outlet obstruction.Methods A literature search of medline (1966.1-2011.6),embase(1984.1-2011.6),CNKI (1994.1-2011.6) and WEIPU Data (1989.1-2011.6) from 1999 to 2009 was performed by two reviewers independently.QUADAS items was applicated to assess trial quality.Golden standard was BOOI measured by urodynamics (BOOI more than 40 indicates bladder outlet obstruction).Heterogenous studies and meta-analysis were conducted by Meta-Disc 1.4 software.Results Totally 6 studies was included at last,involving 682 subjects.No threshold effect was found,but there was heterogeneity due to other factors.The meta-analysis showed that the sensitivity was 70.8 ％,specificity was 87.6 ％,positive LR was 5.132,negative LR was 0.303,the diagnostic OR was 22.18,the area under SROC curve was 0.8723 and Q index was 0.8028.Conclusions Intravesical prostatic protrusion measured by ultrasound is a good index for diagnosing bladder outlet obstruction in patients with benign prostate hyperplasia when intravesical prostatic protrusion is equal or more than 10mm.

Objective To observe the effect of multidisciplinary rehabilitation on activity of daily living (ADL) and injured nerve function of old stroke patients.Methods 78 old stroke patients were randomly divided into the simple rehabilitation group (36 cases) and multidisciplinary rehabilitation group (42 cases). The patients of the simple rehabilitation group were treated with Bobath method only, those of the multidisciplinary rehabilitation group were added with acupuncture and Chinese herbs. The treatment course of two groups was 6 weeks. All patients in two groups were assessed with Modified Brathel Index (MBI) for ADL before treatment and every week after treatment and the evaluation of National Institute of Health Stroke Scale (NIHSS) was also performed for injured nerve function at same times.Results After 3 weeks treatment, the scores of MBI and NIHSS of all patients improved, but there was no significant difference compared with that before treatment ( P>0.05). After 6 weeks treatment, the NIHSS scores of the patients in the multidisciplinary rehabilitation group was significant superior to that before treatment ( P<0.05), the MBI scores was also superior to that before treatment ( P<0.01); while, the NIHSS and MBI scores of the patients in the simple rehabilitation group also improved compared with that before treatment, but no significant difference ( P>0.05).Conclusion Both multidisciplinary rehabilitation and simple rehabilitation are all effect on ADL and injured nerve function of old stroke patients, but the effect of multidisciplinary rehabilitation is superior to that of simple rehabilitation (using Bobath method only).

ObjectiveTo observe the effects of comprehensive rehabilitation therapy and simple rehabilitation therapy on old acute stroke patients.Methods72 old acute stroke patients were randomly divided into 2 groups: the simple rehabilitation group (n=32) treated with Bobath therapy only, the comprehensive rehabilitation group (n=40) added with acupuncture and Chinese herbs besides Bobath therapy. The courses of two groups were all 6 weeks. The scores of NIHSS (The US NIK Stroke Scale) and activities of daily living (ADL) of patients of two groups were assessed every week.ResultsAfter 3 weeks, scores of NIHSS and ADL of patients in both groups improved, but there were no significant differences between two groups and in each group compared with before. After 6 weeks, there were significant differences in the simple rehabilitation group (P<0.05) and in the comprehensive rehabilitation group (P<0.01), but there was no difference between two groups.ConclusionComprehensive rehabilitation therapy and simple rehabilitation therapy are also effect on old acute stroke patients; there isn't difference on effects of two therapies.

Objective To discuss the combined value of gray-scale ultrasound ( GSUS) and contrast-enhanced ultrasound (CEUS) in the diagnosis of benign and malignant thyroid lesions and to explore the optimal diagnostic point of scoring method .Methods Ultrasound images of 178 thyroid lesions confirmed by pathology were synthetically reviewed by scoring 5 GSUS indicators including shape , orientation, interior echogenicity, halo sign, microcalcification and 6 CEUS indicators including relative arrival time of microbubbles in the periphery and interior, peak periphery and interior echogenicity, peripheral ring-enhancement, and homogeneity of enhancement .One positive indicator scored one point .The optimal diagnostic points and their clinical value were explored according to ROC curves .Results Scores of GSUS, CEUS and the combination of GSUS and CEUS were significantly different (Z =10.188,9.843,10.705,all P <0.001). Areas under ROC curves of GSUS, CEUS and the combination of GSUS and CEUS were 0.936, 0.919 and 0.964, respectively.Three or more positive GSUS indicators of five in a thyroid lesion predicted that the thyroid lesion was malignant , with the sensitivity of 79.6% and the specificity of 91.2%.Two or more positive CEUS indicators of six in a thyroid lesion predicted that the thyroid lesion was malignant , with the sensitivity of 91.8% and the specificity of 81.2%.Five or more positive GSUS and CEUS indicators of eleven in a thyroid lesion predicted that the thyroid lesion was malignant , with the sensitivity of 93.6%and the specificity of 92.3%.The areas under the ROC curve of GSUS and CEUS were 0.936 and 0.919.The area under the ROC curve of the combination of GSUS and CEUS was 0.964, larger than the areas under the GSUS ROC curve and the CEUS ROC curve.Conclusion Ultrasound is valuable in the differential diagnosis of benign and malignant thyroid lesions , and the combination of GSUS and CEUS is the most valuable with 5 points as the optimal diagnostic scoring method .

Objective To retrospectively analyze the clinical epidemiology features of adult idiopathic membranous nephropathy (IMN) in Zhongshan Hospital,and to investigate their therapeutic effect and its possible influence factors.Methods A total of 183 patients admitted to the Zhongshan Hospital of Fudan University and diagnosed as IMN by renal biopsy from January 2013 to December 2015 were involved.Their baseline information including demographics and pathologic was collected.Patients were followed up for at least 12 months.Serum albumin ＜ 30 g/L and 24 h urine protein ＞ 3.5g were defined as nephrotic syndrome (NS).IMN patients were divided into NS and non-NS groups and compared.Furthermore,the baseline data of remission and no remission patients were compared,and the correlations of their baseline data with conservative and immunosuppressive therapy were assessed by logistic regression analysis.Results (1) IMN accounted for 11.1％ of renal biopsy cases in our hospital,with an average age of 57 years and 59.6％ male patients.(2) Compared with patients without NS,IMN patients with NS were older,had a shorter time from the onset to receive renal biopsy,lower estimated glomerular filtration rate,and higher total cholesterol,low density lipoprotein cholesterol,triglyceride and serum creatinine (all P ＜ 0.05).(3) The effective rate of conservative treatment in IMN patients without NS was 65.7％,and the ineffective group had higher triglyceride compared with the effective group (P=0.019).(4) The effective rate of immunosuppressive therapy in IMN patients with NS was 81.2％,and low serum albumin was an independent risk factor for the poor efficacy of immunosuppressive therapy (OR=1.202,95％ CI 1.003-1.440,P=0.046).(5) The effective rate of conservative treatment in IMN patients with NS was 55.5％,and low serum albumin was an independent risk factor for the poor efficacy of conservative treatment (OR=1.629,95％CI 1.047-2.536,P=0.023).Conclusions The detection rate of IMN is increasing year by year,but the remission rate of conservative treatment is still not low in mild and moderate patients.For the patients without NS,high triglyceride may predict a poor effect of conservative treatment.Hypoproteinemia is a predictor of poor effect,no matter what a NS patient takes immunosuppressive therapy or conservative treatment.

Objective To discuss bilateral percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) using inside and outside intravertebral vacuum cleft (IVC) respectively with bone cement injection for the treatment of Kümmell disease.Methods From January 2008 to October 2015,16 cases of Kümmell disease patients were treated with bilateral PVP or PKP with inside and outside IVC perfusion of bone cement respectively.Of 16 cases,6 were male and 10 were female,aged from 63 to 94 years,with a disease duration from 2 to 15 months.The bone mineral density of every patient was measured by dual-energy X-rayabsorptiometry.The T value ranged from-4.3 to-2.6.Fractures located from T10 to L4,including 2 cases of multiple fractures.Postoperative X-ray was used to observe the vertebral bone cement leakage and anterior height changes of affected vertebrae.Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate pain status and functional activity.Results All cases were followed up for 12-96 months.Cement leakage occurred in 4 patients without nerve complications.The anterior height of affected vertebrae before operation,2 d after operation and at the last follow-up was (50.3 ± 8.3)％,(67.1 ± 8.1)％ and (65.2 ± 6.4)％.The anterior height of affected vertebrae 2 d after operation and at the last follow-up were significantly improved compared with those before operation (P ＜ 0.05),but there were no significant differences between 2 d after operation and at the last follow-up (P ＞ 0.05).The scores of VAS before operation,2 d after operation and at the last followup was (8.63-± 1.23),(2.56 ± 3.48) and (1.38 ± 0.92) scores,and the scores of ODI was (82.1 ± 6.7)％,(28.5 ± 7.3)％ and (22.1 ± 8.2)％.The scores of VAS and ODI 2 d after operation and at the last follow-up were significantly decreased compared with those before operation (P ＜ 0.05),but there were no significant difference between 2 d after operation and at the last follow-up (P ＞ 0.05).There was no postoperative in situ or adjacent vertebral fracture.Conclusions Using internal and external IVC bone cement injection for treatment of Kümmell disease has a good clinical curative effect.It can effectively relieve back pain symptoms,reduce intraoperative and postoperative bone cement leakage and recurrent adjacent or in situ vertebral fracture.

ObjectiveTo observe the effect of rehabilitation on post stroke depression with different treatment methods.Methods68 post stroke depression patients were randomly divided into treatment group, who accepted Bobath approach combined with Chinese herbs and acupuncture, and control group, who accepted Bobath approach only. Evaluation was conducted before treatment and 3 and 6 weeks after treatment with Hamilton Assess Depression Scale (HAMD), and activity of daily living (ADL).ResultsThere was no significant difference before the treatment between these two groups. 3 weeks after treatment, the score improved, but no significant enough in the both groups. 6 weeks after treatment, the scores of MBI and HAMD in treatment group significantly improved compared with that before treatment(P<0.05). ConclusionBobath approach combined with Chinese medicine is effective on improving depressive symptoms and ADL in post stroke depression patients.

To develop a parent-metabolite pharmacokinetic model for risperidone (RIP) and its major active metabolite (9-hydroxyrisperidone) and investigate their pharmacokinetics characteristics in healthy male volunteers, twenty-two healthy volunteers were orally given a single dose of 2 mg RIP. Plasma samples were collected in the period of 96 hours and concentrations of RIP and 9-hydroxyrisperidone were measured by a validated HPLC/MS method. CYP2D6 phenotypes were identified by the T1/2 of RIP and 9-hydroxyrisperidone according to the literature. Model structure identifiability analysis was performed by the similarity transformation approach to investigate whether the unknown parameters of the proposed model could be estimated from the designed experiment. Pharmacokinetics parameters were estimated using weighted least squares method, and the final pharmacokinetics model were tested and evaluated by Monte Carlo simulation. Eighteen volunteers were phenotyped as extensive metabolizers (EM) and four volunteers were identified as intermediate metabolizers (IM). The final model included central and peripheral compartment for both parent (RIP) and metabolite (9-hydroxyrisperidone) respectively. Model structure identifiability analysis indicated that the proposed model was local identifiable. However, if the ratio of RIP converted to 9-hydroxyrisperidone was assumed to be 32% in EM, and 22% in IM, the model could be globally identifiable. The predicted time-concentration curve and AUC(0-t), C(max), T(max) of RIP and 9-hydroxyrisperidone estimated by the established model were in agreement with the observations and noncompartment analysis. Rate constant of RIP conversion to 9-hydroxyrisperidone was (0.12 +/- 0.08) h(-1) and (0.014 +/- 0.007) h(-1) for EM and IM, respectively. Elimination rate constants of RIP were (0.25 +/- 0.18) and (0.05 +/- 0.23) h(-1) for EM and IM, respectively. Model validation result showed that all parameters derived from the concentration data fitted well with the theoretical value, with mean prediction error of most PK parameter within +/- 15%. The established model well defined the disposition of RIP and 9-hydroxyrisperidone simultaneously and showed large inter-individual pharmacokinetics variation in different CYP2D6 phenotype. The model also provide a useful approach to characterize pharmacokinetics of other parent-metabolite drugs.
Adult ; Cytochrome P-450 CYP2D6 ; physiology ; Humans ; Isoxazoles ; pharmacokinetics ; Male ; Models, Biological ; Monte Carlo Method ; Paliperidone Palmitate ; Pyrimidines ; pharmacokinetics ; Risperidone ; pharmacokinetics

OBJECTIVETo investigate the feasibility of real-time elastography for quantitative evaluation of liver fibrosis in a rat model.

METHODSA total of 70 male Wistar rats were included in the group for dimethylnitrosamine (DMN)-induced liver injury, and 10 saline-injected rats were used as normal control. Hepatic injury was induced by a single intraperitoneal injection of DMN at a dose of 50 mg/kg of body weight. Nine or ten rats in the group with DNM injected and one or two rats in the normal control group were randomly selected and sacrificed at each of the following post-injection time: day 5, 7, 10, 14, 21, 24, and 28. And their livers were taken for pathology analysis. All the rats underwent real-time elastography before sacrificed in order to acquire area ratio of low-strain region (% AREA) and liver fibrosis index (LF index) which were compared with the stage of liver fibrosis and grade of necroinflammatory pathologically. By the different data, Spearman correlation analysis, rank-sum test or receiver operating characteristic curve was used.

RESULTSAmong 58 successfully modeled rats, there were nine, 13, 14 and 12 rats of S1, S2, S3 and S4 liver fibrosis on pathology, respectively, which were with or without mild necroinflammatory. The other 10 rats were found to be S0 with severe necroinflammatory. Values of LF index and % AREA both increased with liver fibrosis stage (P less than 0.05). There was certain correlation between LF index and liver fibrosis stage (r=0.643, P=0.000), so was % AREA and liver fibrosis stage (r=0.662, P=0.000). As for LF index, Areas under the receiver operating characteristic curve (Az) was 0.943, 0.890, 0.743 and 0.821 for the diagnosis of hepatic fibrosis S1 or higher, S2 or higher, S3 or higher and S4, respectively; as for % AREA, they were 0.948, 0.883, 0.772 and 0.842, respectively. However, we found a significant difference for LF index or % AREA between S0 with and without severe inflammatory activity rats (P=0.005 and P=0.017).

CONCLUSIONReal-time elastography is available for quantitative assessment of liver fibrosis in rats induced by DMN, but severe inflammatory activity can affect its accuracy.

Animals ; Dimethylnitrosamine ; adverse effects ; Elasticity Imaging Techniques ; Liver ; pathology ; Liver Cirrhosis, Experimental ; chemically induced ; pathology ; Male ; Rats ; Rats, Wistar

OBJECTIVETo study the effects of prenatal exposure to Di-(2-ethylhexyl)-phthalate (DEHP) on genome-wide epigenetic alterations in ovary of adult offspring rat.

METHODSPregnant Wistar rats were randomly treated with DEHP (1000 mg/kg) or con oil at 12 - 17 days upon pregnance. DNA methylation changes in the ovary for the adult offsprings which were 70 days old were detected by Rat DNA methylation promoter plus CpG island arrays CpG island chip. Gene ontology (GO) method was performed to analyze the function of genes which were significantly different between exposed group and control group. Gene Igfbp1 (insulin-like growth factor binding protein 1) and Itga3 (integrin alpha 3) were randomly selected and the methylation status were verified by bisulfite genomic sequencing (BSP).

RESULTSThe methylation status were significantly different between exposed and control group in 406 genes (71 genes as hypermethylation and 335 genes as hypomethylation) (P < 0.05). GO analysis revealed that molecular transducer activity, cell part, cell, cellular process, multicellular organismal process, response to stimulus, biological regulation, regulation of biological process, reproduction, reproductive process, and rhythmic process were involved. The sequencing results were consistent with the data obtained by chips.

CONCLUSIONThis study provides evidence that prenatal exposure of DEHP may be associated with methylation changes on the genes in the rat ovary. Genes related to reproductive process have highly significant methylation changes, which may shed new light on mechanisms of reproductive and developmental toxicity after prenatal exposure to DEHP.

Animals ; CpG Islands ; genetics ; DNA Methylation ; Diethylhexyl Phthalate ; toxicity ; Female ; Genome ; Maternal Exposure ; Ovary ; pathology ; Pregnancy ; Prenatal Exposure Delayed Effects ; Rats ; Rats, Wistar