Objective To report the preliminary experiences in the treatment of old unstable thoracolumbar vertebral fractures by using anterior decompression, bone graft or titanium mesh and internal fixation with Z-plate system. Methods There were 23 cases (18 males and 5 females) with age range of 25-66 years (mean 41.7 years) as well as thoracolumbar vertebral fracture history for 1.2-28 years (mean 5.6 years). All cases complained of severe lower back pain, 17 of whom had slight neurological deficits (Frankel Grade D). Preoperative radiographic evaluation showed that all 23 cases had various degrees of kyphosis (25?-40?, averaged 34?), spinal cord compression and vertebral instability. Of 23 cases, 15 were treated with anterior decompression, full-thickness iliac crest autograft and internal fixation with Z-plate and the other 8 with titanium mesh instead of full-thickness iliac crest autograft. Results No severe complications happened during and after operation. The lower back pain and neurological deficits were improved or disappeared 2-3 months postoperatively. The average kyphotic correction degrees ranged from preoperative 34? to postoperative 12?. No patients' symptoms worsened during follow-up. In three cases with preoperative Frankel Grade D, the myodynamia recovered slightly but the Frankel Grade remained unchanged. The postoperative MRI examinations showed that vertebral canals were well decompressed. Conclusions Anterior decompression, autograft or titanium mesh and internal fixation with Z-plate are proved to be safe and effective techniques for clinical management of old thoracolumbar fractures, for they have advantages in effective decompression of neural structures, high healing rate of autograft and correction of kyphotic deformity.

Objective To observe the effects of bolus volume on pharyngeal and upper esophageal sphincter pressures and durations in healthy volunteers by using high-resolution manometry (HRM).Methods Twentyfour health subjects were recruited and asked to swallow three volumes of bolus (3 ml,5 ml and 10 ml) in the neutral head position.Pressure and duration measurements were acquired by utilizing a high-resolution solid-state manometer,with an emphasis on the hypopharynx and upper esophageal sphincter (UES).Variables including UES residual pressure,UES relaxation duration,maximum hypopharygeal pressure and hypopharyngeal pressure duration were analyzed across bolus volumes and consistencies by using three-way repeated measures analysis of variance (ANOVA) to investigate influence of bolus volume.Results UES residual pressure [-1.71 mmHg(3 ml thick liquid)vs.-4.68 mmHg(10 ml thick liquid)],UES relaxation duration[590.45 ms(3 ml thick liquid) vs.702.49 ms (10 ml thick liquid)],maximum hypopharygeal pressure [169.91 mmHg (3 ml thick liquid) vs.204.42 mmHg (10 ml thick liquid)] and hypopharyngeal pressure duration(P ＜0.05) varied significantly across bolus volumes when swallowing water or thick liquid.The UES relaxation duration,UES residual pressure and maximum hypopharyngeal pressure had a direct positive relationship with bolus volume.There was significant differences with regard to UES relaxation duration [685.75 ms(3 ml paste)vs.772.27 ms (10 ml paste)] but not to UES residual pressure (P ＞ 0.05) and maximum hypopharyngeal pressure (P ＞ 0.05) across bolus volume when swallowing paste.Conclusions Difference in hypopharyngeal pressure and duration,UES residual pressure and duration were detected across varying bolus volumes.Consideration of these variables is paramount in understanding normal and pathological swallowing.

Objective To evaluate the swallowing function of patients with dysphagia after brainstem injury using manofluorography (MFG),analyzing the abnormal biomechanical and kinematic parameters as well as any correlation between changes in the pharynx and the upper esophageal sphincter (UES) measured manometrically and changes in the kinematics of the hyoid bone.Methods Thirteen patients with dysphagia after brainstem injury (the patient group) and 13 healthy participants (the control group) underwent manofluorography.Kinematics and biomechanical changes during swallowing were compared between the two groups and the correlations between the observations were analyzed.Results The patient group showed significantly lower maximum pressure and rate of pressure change at the base of the tongue and in the hypopharynx,as well as less hyoid anterior displacement,smaller and briefer UES opening,but significantly higher minimum pressure at UES relaxation.The duration of tongue root elevation and hypopharynx pressure was also shorter than in the control group,on average.There was a negative correlation between hyoid anterior displacement and the minimum pressure on UES relaxation in the control group,and a positive correlation between hyoid anterior displacement and the maximum pressure at the base of the tongue and in the hypopharynx in the patient group.Conclusions The concurrent use of manometry and video-fluorography for evaluating dysphagia can be an objective and effective diagnostic tool for the comprehensive evaluation of swallowing function.

BACKGROUND:Mongolian Pharmaceutical Betel Shisanwei Ingredients Pil has achieved good clinical efficacy, but the underlying mechanism remains unclear. OBJECTIVE: To study the effects of Mongolian Pharmaceutical Betel Shisanwei Ingredients Pil on the hypothalamic-pituitary-adrenal axis negative feedback function in the chronic depressed rats, and to explore anti-depression mechanisms of Mongolian Pharmaceutical Betel Shisanwei ingredients pil. METHODS: Eighty male Wistar rats were randomly divided into ten groups according to the sugar consumption test (with eight rats in each group): normal control group, model group, fluoxetine group, high-, medium- and low-dose Betel Shisanwei Ingredients Pil groups, RU486 group, high-, medium- and low-dose Betel Shisanwei Ingredients Pil plus RU486 groups. Except normal control group, the other groups were treated with the chronic unpredictable mild stress stimulation combined with lonely rising, to establish depression models. In the meantime, rats of the high-, medium- and low-dose Betel Shisanwei Ingredients Pil groups were given oral gavage of Betel Shisanwei Ingredients Pil (0.2, 0.4, 0.8 g/kg) for 28 days; rats of the normal control group and model group were intragstricaly administered with sodium carboxymethyl celulose; rats of RU486 group were given abdominal subcutaneous injection of RU486 from day 21 after modeling; rats of the high-, medium- and low-dose Betel Shisanwei Ingredients Pil plus RU486 groups were intragstricaly administered with Betel Shisanwei Ingredients Pil (0.2, 0.4, 0.8 g/kg) and subcutaneous injection of RU486 from day 21. RESULTS AND CONCLUSION:Compared with normal control group, cortisone content increased significantly (P < 0.05), the expression of glucocorticoid receptor mRNA in hippocampus, hypothalamus and pituitary gland decreased significantly, and hypothalamic corticotrophin releasing hormone mRNA expression increased significantly in the model group and RU486 group. Compared with model group, cortisone content decreased, the expression of glucocorticoid receptor mRNA in hippocampus, hypothalamus and pituitary gland increased significantly, and hypothalamic corticotrophin releasing hormone mRNA expression decreased significantly in rats treated with Betel Shisanwei Ingredients Pil. Compared with RU486 group, Betel Shisanwei Ingredients Pil administration led to changed in cortisone content, glucocorticoid receptor mRNA expression in hippocampus, hypothalamus and pituitary gland, as wel as hypothalamic corticotrophin releasing hormone mRNA expression. Experimental findings indicate that, Betel Shisanwei Ingredients Pil can directly regulate excessive secretion of glucocorticoid, and improve the dysfunction of hypothalamic-pituitary-adrenal axis central negative feedback through increasing glucocorticoid receptor mRNA expression and decreasing corticotropin releasing hormone mRNA expression. After the hypothalamic-pituitary-adrenal axis negative feedback pathway is blocked, the effect of Betel Shisanwei Ingredients Pil is weakened.

Objective To evaluate the roles of Toll-like receptor 2 (TLR2),TLR4 and myeloid differentiation factor 88 (MyD88) in immune recognition and immune mediation in sporotrichosis by detecting their expressions in skin lesions of sporotrichosis.Methods Biopsy specimens were obtained from the skin lesions of 19 patients with sporotrichosis and normal skin of 12 healthy human controls.Immunohistochemistry was performed to observe the expressions of TLR4 and MyD88,and real-time fluorescence-based quantitative PCR to quantify the expressions of TLR2 and MyD88 mRNAs.Data were expressed as mean ± standard error.Statistical analysis was done with the SPSS17.0 software.Independent samples t-test was conducted to compare the parameters between the lesional and control specimens.A p-value of less than 0.05 was considered to be statistically significant.Results TLR4 and MyD88 were mainly observed in the whole epidermis except the stratum corneum as well as plasma cells and lymphocytes in the dermis and subcutaneous tissue in lesional skin.However,TLR4 was nearly absent and MyD88 was weakly expressed in the dermis and subcutaneous tissue in normal skin.The expression levels of TLR4 and MyD88 were significantly higher in the lesional skin than in the control skin (TLR4,63.767 ± 3.829 vs.5.167 ± 3.246,t =4.82,P ＜ 0.05; MyD88,57.236 ± 4.744 vs.10.588 ± 1.640,t =3.30,P ＜ 0.05).Similarly,the lesional skin showed significantly stronger expressions of TLR2 and MyD88 mRNAs compared with the normal skin (TLR2,1.974 ± 1.452 vs.1.430 ± 1.073,P ＜ 0.05; MyD88,2.028 ± 2.061 vs.0.688 ± 0.422,P ＜ 0.05).Conclusion Sporothrix may induce the development of sporotrichosis by interacting with host immune system via TLR signaling pathways.

The renal toxicity of rats after a single dose ofMeng-Gen-Wu-Su (mercury) processed products,Meng-Gen-Wu-Su (mercury)-18-composition pill, mercuric sulfide, mercuric chloride, and mercurous chloride was studied. Fifty-four male Wistar rats were randomly divided into nine groups according to body weights (6 rats in each group): normal control group, low and high dose groups (0.033, 0.33 g·kg-1·d-1) ofMeng-Gen-Wu-Su (mercury) processed products, low and high dose groups (0.29, 2.9 g·kg-1·d-1) ofMeng-Gen-Wu-Su (mercury)-18-composition pill, simplified prescription ofMeng-Gen-Wu-Su (mercury)-18-composition pill group (0.26 g·kg-1·d-1), mercuric sulfide group (17.39 mg·kg-1·d-1), mercuric chloride group (4.06 mg·kg-1·d-1) and mercurous chloride group (35.3 mg·kg-1·d-1). After acclimation for one week, once oral administration was given to each group of rats. After 24 h, function and morphological changes of liver and kidney were detected. Mercury accumulation in kidney was determined by inductively coupled plasma optical emission spectroscopy (ICP-OES) and inductively coupled plasma source mass spectrometer (ICP-MS). Apoptosis of renal cell was determined by terminal-deoxynucleoitidyl transferase mediated Nick End Labeling (TUNEL). Renal typeⅢ collagen protein's expression was determined by immunohistochemical (HIC) method and expression changes of MT-1, MT-2 mRNA in kidney were also determined by real-time fluorescence quantitative PCR (real-time-PCR). There was no significant difference of ALT, AST in serum between normal control group and other groups (P>0.05). CREA and UREA in mercurous chloride group were apparently higher than normal control group and low dose group of Meng-Gen-Wu-Su processed products (P<0.01). Hepatic and renal pathologic examination results showed that liver cell of low dose groups ofMeng-Gen-Wu-Su processed products andMeng-Gen-Wu-Su-18-composition pill swelled to a low degree and glomerular disease was not obvious. In high-dose groups ofMeng-Gen-Wu-Su processed products,Meng-Gen-Wu-Su-18-composition pill and mercuric sulfide group, liver and kidney appeared some pathological changes and such changes were more significant in mercuric chloride and mercurous chloride groups. Compared with normal control group and low dose group ofMeng-Gen-Wu-Su processed products, the mercury kidney volume in mercuric chloride and mercurous chloride groups increased significantly (P<0.01). The apoptosis rate of renal cell and expression of typeⅢ collagen protein increased significantly in the groups of mercuric sulfide, mercuric chloride and mercurous chloride (P<0.01). MT-1and MT-2 mRNA gene expression rised significantly in the groups of mercuric chloride and mercurous chloride (P<0.05 orP<0.01). In summary, the rats renal toxicity after a single dose ofMeng-Gen-Wu-Su (Mercury) processed products or MongolianMeng-Gen-Wu-Su (Mercury)-18-composition pill were both far less than that of mercuric chloride or mercurous chloride.

Objective:To explore the influence of Shenhong Tongluo Granules in the lipid levels,atherosclerosis plaques and apoptosis in the plaques of atherosclerotic apolipoprotein E (ApoE)-knokout mice,and to clarify the mechanism of Shenhong Tongluo Granules in anti-atherosclerosis.Methods:Forty SPF male mice aged six-week old were randomly divided into normal control group,model group,low dose of traditional chinese medicine (TCM) group and high dose of TCM group (n=10)after fed adaptively for 1 week.The mice in normal control group were fed with normal diet continuously, the mice in other three groups were fed with high fat diet to establish atherosclerosis model,and then the mice in low and high doses of TCM groups were respectively given Shenhong Tongluo Granules (5.06 and 10.12 g·kg-1 · d-1 )by gavage for 6 weeks. The levels of serum total cholesterol (TC),triglycerides (TG),low density lipoprotein cholesterol (LDL-C)and high density lipoprotein cholesterol (HDL-C)of the mice in various groups were measured after the eyeball blood was collected.The aortic arch tissue was separated,and the morphotogy and the areas of atherosclerotic plaques were observed and calculated by HE staining;the apoptosis in plaques of the mice was evaluated by TUNEL method, and the apoptosis index was calculated. The expressions of apoptosis-assoicated gene Bcl-2 and Bax protein were measured by immunohistochemical staining.Results:The serum level of TG in low dose of TCM group was lower than that in model group (P <0.05);the serum levels of HDL-C in low and high doses of TCM groups were lower than that in model group (P <0.05 or P <0.01);the serum levels of TG and HDL-C in high dose of TCM group was higher than that in low dose of TCM group (P <0.05).The areas of atherosclerotic plaques of the mice in low and high doses of TCM groups were significantly smaller than that in model group (P <0.01).The apoptosis index of mice in low and high doses of TCM groups were significantly lower than that in model group (P <0.01);the expression levels of Bcl-2 protein in atherosclerosis plaques of the mice in low and high doses of TCM groups were lower than that in model group,while the expression levels of Bax were significantly higher than that in model group (P <0.05 or P <0.01).Conclusion:Shenhong Tongluo Granules could effectively reduce the serum lipid level of ApoE-/-mice,meanwhile it could inhibit apoptosis by regulating the expressions of Bcl-2 and Bax protein,and then inhibit the progression of atherosclerotic plaques.

Objective To evaluate the efficacy and safety of clip traction in endoscopic submucosal dissection (ESD) for heterotopic pancreas in stomach.Methods Data of 62 patients with pathologically confirmed heterotopic pancreas treated by ESD between May 2013 and February 2016 were retrospectively studied in Department of Gastroenterology of Xinqiao Hospital,whose lesions were single and origins were submucosal.Thirty-six cases underwent ESD with clip traction (clip group,n=36),and 26 cases underwent ESD without clip traction (non-clip group,n =26).The procedure time,visualization of the submucosal during dissection,complications and the result of follow-up were evaluated between the two groups.Results ESD was successful in all cases.The procedure time was significantly shorter in the clip group than in the non-clip group (19.35±10.34 min VS 27.02± 14.27 min,t'=2.333,P=0.023),and good visualization was obtained by applying clip traction.The rate of bleeding in the clip group was 55.6％ (20/36),and that in the non-clip group was 61.5％ (16/26).There was no significant difference between the two groups(x2 =0.222,P =0.638).Moreover,perforation did not occur in the clip group,but occurred in one patient in the non-clip group (3.8％,1/26).There was no significant difference between the two groups (P =0.419).All patients were followed up,there was no recurrence.Conclusion ESD is effective and safe for heterotopic pancreas in stomach.Clip traction can shorten the operation time and reduce complications of ESD.

Purpose To develop a national registry and reporting system of individual monitoring for workers occupationally exposed to ionizing radiation.Methods In accordance with the relevant law,regulations,standards and the current health supervision practice for radiation workers in China,to ensure more effective collection of information on individual monitoring from all levels of service providers across the country and an easy query and analysis of the collected information for both service providers and administrative institutions,the register consisted of an offline-system and a web-based information system.The off-line system consisted of 8 tables,which could easily make annual and period monitoring reports,and upload individual monitoring data in compressed and encrypted format.Web-based system consisted of 6 modules,could easily make S customized tabulations of monitoring data and show 2 trend figures.SSLVPN secure remote access was used in the system.Arranged by the Ministry of Health,training courses provided to all individual monitoring service providers and provincial administrative institutions.Results A new and individual-based national register and reporting system of individual monitoring for workers occupationally exposed to ionizing radiation was successfully developed,and would be officially run soon.Conclusions The establishment and running of the register would be great improvement on the national radiological health reports and produce a far-reaching impact on the individual monitoring in China.

OBJECTIVETo observe the efficacy and safety of Qizhi Jiangtang Capsule (QJC) in treating stage 3b diabetic kidney disease (DKD) patients with macroalbuminuria.

METHODSPatients who conformed to the diagnostic criteria of stage 3b DKD were randomly assigned to two groups according to random digital table, the experiment group and the control group, 84 in each group. All patients received a two-week elution period, and then were treated with basic Western therapy. Patients in the experiment group took QJC, 5 pills per time, 3 times a day, while those in the control group took Valsartan Capsule 160 mg each time, once daily. The observation period of follow-ups was limited within 6 months, and the time points were set as the baseline, 1st month, 3rd month, and 6th month. Systolic blood pressure (SBP), diastolic blood pressure (DBS), 24 h urine protein quantitative (24 h UPQ), plasma albumin (ALB), and serum creatinine (SCr) were detected and recorded, and estimated glomerular filtration rate (eGFR) was calculated. The occurrence of hypoglycemic reaction, coagulation disorder, gastrointestinal tract reaction, allergy, hyperkalemia, doubling of creatinine, and overall adverse events were observed and recorded at same time.

RESULTSFinally 81 patients in the experiment group and 80 patients in the control group were effectively included. Compared with the baseline level, SBP and DBS obviously decreased in the control group at month 1 of treatment (P < 0.05), and more significantly decreased at month 6 of treatment (P < 0.01). SBP at month 1, 3, and 6 of follow-ups; DBS at month 6 of follow-ups was lower in the control group than in the experiment group (P < 0.05). At month 1, 3, and 6 of follow-ups, 24 h UPQ of the experiment group was significantly lower than the baseline level (P < 0.01). It was also significantly lower than the level of the control group at the same time point (P < 0.05). There was no significant difference in 24 h UPQ at month 1, 3, and 6 of follow-ups between the control group and the baseline level (P > 0.05). ALB of the experiment group showed an increasing trend. It was significantly higher than the baseline level at month 6 (P < 0.05), which was also higher than that of the control group at same period (P < 0.05). There was no significant difference in the ALB level in the control group (P > 0.05). SCr of two groups showed an increasing trend. SCr of the experiment group was significantly higher at month 1, 3, and 6 follow-ups than the baseline level (P < 0.05). But the increment of SCr was higher in the control group than in the experimental group, and obviously higher than the baseline levels (P < 0.05). eGFR of both groups showed a decreasing trend. The decrement was higher in the control group than in the experimental group (P < 0.05). The proportion of progression of renal functions at month 1, 3, and 6 of follow-ups in the experimental group was 0.0% (0 case), 9.55% (8 cases), and 21.4% (18 cases), while they were 8.3% (7 cases), 21.4% (18 cases), and 40.5% (34 cases) in the control group. There was no statistical difference in the proportion of progression of renal functions between the two groups at month 3 and 6 of follow-ups (P < 0.05). There was no statistical difference in the incidence of adverse reactions between two groups (P > 0.05).

CONCLUSIONQJC could effectively reduce urinary protein of patients with stage 3b DKD, and delay the progression of renal functions.

Adult ; Albumins ; analysis ; Albuminuria ; drug therapy ; Blood Pressure ; drug effects ; Creatinine ; blood ; Diabetic Nephropathies ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Glomerular Filtration Rate ; Humans ; Male ; Middle Aged ; Tetrazoles ; therapeutic use ; Treatment Outcome ; Valine ; analogs & derivatives ; therapeutic use ; Valsartan