The high mortality of paraquat (PQ) poisonings is mainly due to the lack of effective treatments. The optimal method of extracorporeal removal of paraquat is often a matter of debate. Due to the lack of well-designed studies, we are often left with circumstantial evidence, and we must exercise our best clinical judgment as to whether extracorporeal paraquat removal is beneficial and if so, by what method. It is clear, however, that rapidity in paraquat removal is beneficial. Due to the urgent nature of treatment for paraquat poisoning, there may never be well-designed evidence-based studies to help guide us. In the meantime, we must continue to use less than ideal evidence and our own experience to guide our decision-making process. Most toxicologists recommend rapid initiation of charcoal haemoperfusion (CHP) to lower plasma PQ levels and to limit pulmonary and other organs uptake of PQ.

OBJECTIVE: To explore the diagnosis, treatment and surgical approaches of parapharyngeal space tumors. METHOD: This retrospective study consisted of 112 patients with parapharyngeal space tumors underwent surgeries. The data included clinical symptoms and signs, pathological types, imaging examinations, surgical approaches and postoperative complications. RESULT: Computerized tomography (CT), magnetic resonance imaging (MRD and digital subtraction angiography (DSA) made clear the tumor size, localization and its relation to adjacent structures. The postoperative histopathology varied and showed benign in 98 cases consisting of salivary gland tumors (52 cases), neurogenic tumors(33 cases) and other types (13 cases). During the 3 years follow-up period, local recurrence appeared in 3 patients with salivary pleomorphic adenoma and 1 patient with neurofibromatosis. These recurrent tumor cases were cured with second surgery. In 14 patients with malignant tumors reported, 8 cases survived for 5 years, 2 cases (1 adenoid cystic carcinoma and 1 carcinoma in pleornorphic adenoma) recurred in the two and a half years cured with second surgery affiliated radiation therapy through 3 years follow-up time and the rest were followed up 1 to 3 years without recurrence. Peripheral facial paralysis was observed in 25 patients, and 3 patients experienced hypoglossal nerve palsy. Only 1 patient encountered vagus nerve injury, and 2 patients appeared Horner's syndrome, and 4 patients endured Frey syndrome. Gills leakage was discovered in 3 cases and cavity infection was noted in 1 patient. CONCLUSION CT, MRI and DSA were important in the diagnosis and differential diagnosis of parapharyngeal space tumors. The key to successful treatment is knowing the anatomy of the parapharyngeal space, preoperative assessment and appropriate surgical approach.
Adenoma, Pleomorphic ; complications ; Carcinoma, Adenoid Cystic ; complications ; Diagnosis, Differential ; Facial Paralysis ; complications ; Horner Syndrome ; complications ; Humans ; Magnetic Resonance Imaging ; Neoplasm Recurrence, Local ; Pharyngeal Neoplasms ; diagnosis ; therapy ; Pharynx ; pathology ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Salivary Gland Neoplasms ; complications ; Tomography, X-Ray Computed

ObjectiveTo investigate the therapeutic effects of advanced lung adenocarcinoma treated with TCM treatment based on syndrome differentiation combined with Gefitinib.MethodsAll cases were recruited from adenocarcinoma of lung patients in Hunan Province Cancer Hospital from February 2008 to February 2010.These 56 adenocarcinoma of lung patients were randomly divided into a treatment group (30cases) and a control group (26 cases).The control group was treated with Gefitinib,250 mg/d,until the disease getting progress or the patient showing intolerable untoward reaction; while the treatment group was treated with TCM syndrome differentiation based on the control group.ResultsAfter the treatment,the total therapeutic effects was 90.00％ in the treatment group than 65.38％ in the control group (x2=5.40,P＜0.05); symptoms score in both group decreased after the treatment,comparing with the same group before the treatment,with the difference was statistical significance (tthe treatment group=9.2446,tthe control group=2.7778,both P＜0.01) ;non-progressive survival rate of half year,1year and 2year was 66.67％,50.00％ and 30.00％ respectively,and survival rate of lyear and 2yenr was 73.33％ and 46.67％ respectively,in the treatment group,while non-progressive survival rate of half year,lyear and 2year was 38.46％,23.08％ and 7.69％ respectively,and survival rate of 1year and 2year was 46.15％ and 19.23％ respectively,in the control group,showing statistical difference between the two groups (x2 value was 4.46、4.31、5.44、4.31、5.27,P value was 0.03、0.04、0.02、0.04、0.02,all P＜0.05 ) ; the effective power of KPS was 76.67％ and 46.15％ in the treatment and the control group respectively,showing statistical difference(x2=6.24,P＜0.05) ; both groups were absent of such side effects of hematology,heart,liver and kidney toxicity,and interstitial pneumonia,but the incidence rate of Ⅱ ～ Ⅲ degree rash and diarrhea was significantly decreased in the treatment group,comparing with the control group(x2=4.49、4.37,P＜0.05 ).ConclusionThe therapy of TCM treatment based on syndrome differentiation combined with Gefitinib can improve living quality,control aggravation of disease,prolong life span and enhance survival rate of the patients with advanced lung adenocarcinoma.

Objective To study the etiology, clinical features, risk factors of septic shock and multiple organ dysfunction syndrome /multiple organ failure (MODS/MOF) caused by gastroenteritis infection in the pediatric intensive care unit (PICU). Methods Case records of patients with gastroenteritis complicated by septic shock and MODS/MOF admitted to PICU in Children's hospital affiliated to Shanghai Jiaotong University from January 2000 to December 2004 were reviewed for etiology, case fatality rate, prognosis and relationship with MODS/MOF. Univariate analyses were performed to analyse the risk factors associated with septic shock and MODS/MOF. Results During the 5 years, 1 536 patients with critical illness were admitted and MODS/MOF associated with gastroenteriitis infection developed in 28 patients. The overall mortality of patients with MODS/MOF associated with gastroenteriitis was 75%. The mean age was (1.9?3.4)years and 19 cases(67.8%)were under 1 year. The patients with MODS/MOF involved (3.7?0.9)organs or systems on average. The numbers of involved organs systems were circulatory in 28 patients(100%), gastrointestinal system in 21(75%), lung in 20(71.4%), kidney in 14(50%),brain in 9(32.4%),blood in 9(32.4%) and liver in 5(17.9%). The first dysfunctional system was gastrointestinal tract in 13(46.4%),circulatory in 11(39.3%),and lung in 4(14.3%). The average volume of fluid resuscitation was (46.2?12.6)ml/kg and range from 30 ml/kg to 75 ml/kg in the first hour. The average fluid was (92.7?33.9)ml/kg and range from 70 ml/kg to 120 ml/kg in 6 hours. The cases fatality of patients with or without successful volume resuscitation were 66.7% (12 in 18 cases) and 90%(9 in 10 cases) in 6 hours respectively.Univariate analyses indicated the following risk factors: numbers of failed organ and lower pediatric critical illness score(P

The incidence of venous thromboembolism after spinal cord injury is high, and its diagnosis and prevention received much attention in clinical research in recent years. Because of the special characteristics, the prevention of venous thrombosis should be combined with basic prevention, physical prevention and drug prevention. According to the different situations of venous thromboembolism in patients with spinal cord injury, the prevention methods need to adjust to carry out multidisciplinary comprehensive treatment.

Objective To examine an in vivo method for the differentiation of induced pluripotent stem cells (iPSCs) into thymic epithelial cells (TECs) in mice. Methods Green fluorescent protein-expressing iPS cells, derived from C57BL/6 mice, were injected into blastocysts from ICR mice. Chimeric blastocysts were then transferred into uteri of E2.5 pseudopregnant mice. Chimeric mouse could be identified by coat color 10 days after birth. The chimeric thymus was transplanted under the renal capsule of BALB/c nude mice. The spleen was cut out from the thymus-transplanted nude mice and the cells were dispersed and analyzed by a flow cytometer 4 weeks after transplantation. Results Chimeras were born 17 days after embryo transfer and 13 live-born chimeras were obtained. The contribution of iPSC-derived cells in the chimeras ranged from 5% to at most 90%. Typical thymic epithelium structure consisted of green fluorescent protein-expressing cells in chimera. The iPSCs-derived thymic epithelial cells could support the generation of new T cells. Conclusion The results indicate that mouse iPS cells can differentiate in vivo towards normally functioning TECs.

Objective To explore the effects of iPS cells-derived chimeric thymus transplantation on T cells reconstitution and graft versus host disease of murine after allo-BMT. Methods iPS cells-derived chimeric thymus was grafted under the renal capsules of mice after allogeneic IBM-BMT. The mice were divided into three groups:IBM-BMT group, IBM-BMT+TT group and IBM-BMT+DLI group. Four weeks after BMT, T lymphocyte subsets in the peripheral blood were analyzed by flow cytometry, the degree and pathological examination of GVHD were observed, respectively. Results Percentage of CD8+T cells in IBM-BMT group, IBM-BMT+TT group and IBM-BMT+DLI group was(5.52 ± 0.83)%,(11.10 ± 1.49)%and(8.49 ± 0.82)%respectively, there was signifi-cant difference between pairwise comparisons(P<0.05), and percentage of CD4 + T cells of the peripheral blood in IBM-BMT+TT group(9.60 ± 0.69)%was significantly higher than IBM-BMT group(6.42 ± 1.40)%and IBM-BMT+DLI group(8.07 ± 0.65)%(P<0.05) . IBM-BMT group and IBM-BMT+TT group showed less clinical and histopathological scoring of GVHD than IBM-BMT + DLI group. Conclusion iPS cells-derived chimeric thymus transplantation could effectively accelerate T cells reconstitution and prevent GVHD after allo-BMT.

Objective To observe the therapeutic effect of balance cupping therapy on non-specific low back pain.Methods 75 patients with non-specific low back pain were randomly divided into the control group (n=25), cupping therapy group (n=25) and balance cupping therapy group (n=25). The patients in the control group were received diclofenac sodium enteric-coated capsule; the cases in other two groups were treated with cupping therapy and balance cupping therapy separately. After 3 weeks' treatment, the changes of the visual analogous scores and Oswestry disability index of two groups' patients were observed.Results The visual analogous scores and Oswestry disability index of the balance cupping therapy group were significantly lower than that of the control group and cupping therapy group ( P<0.05) after 3 weeks' treatment. But between the control group and cupping therapy group there was no difference.Conclusion Balance cupping therapy is one of effective treatment methods for non-specific low back pain.

Objective To observe the efficacy and safety of the treatment on postoperative pain of anal disease by ear-point taping and pressuring. Methods Using random number table method,118 patients with postoperative pain of anal diseases were divided into 5 groups, namely 26 cases of analgesia group treated by main ear-point, 20 cases of group one treated by analgesia compatibility ear-point, 22 cases of group two treated by analgesia compatibility ear-point, 27 patients of group three treated by analgesia compatibility ear-point, and 23 patients of control group. The main ear-point for analgesia included TF(4) and the sensitive point matching with diseased area;Based on the main ear-point, compatibility ear-point group one add to AT(4)、CO(18)、AH(6a);compatibility ear-point group two add to CO(7)、HX(2)、HX(5);compatibility ear-point group three add to AH(6a)、AT(4)、HX(5);and the control group was treated with oral indomethacin tablets. All five groups were treated for 30 min, and the clinical analgesic efficacy and safety were evaluated. Results Pain scores decreased rates of the main ear-point analgesia group, compatibility ear-point analgesia group one, compatibility ear-point analgesia group two, compatibility ear-point analgesia group three, and the control analgesia group at 10 min after treatment was (6.49±1.98)%, (5.90±1.52)%, (6.10±2.22)%, (6.64±2.25)%, and (7.61± 1.10)%respectively. Compared with the control group , the main ear-point analgesia group or the compatibility ear-point analgesia group one or the compatibility ear-point analgesia group two, the difference was significant (P<0.05) . At 30 min after treatment, integral reduce pain rate of the above groups was (0.45±0.23)%, (0.43±0.18)%, (0.42±0.19)%, (0.38±0.25)%, and (0.38±0.23)%, the difference was not statistically significant between the control group and the other four groups (P>0.05). Conclusion The effects of 10 min treatment of ear-point taping and pressuring treating postoperative pain of anal disease was significantly better than the control group,however the 30 min treatment did not show significant difference.

Objective To evaluate the influence of ultrasound-mediated contrast agent microbubbles carrying kallidinogenase targeted therapy on neurogenesis and angiogenesis after experimental acute cerebral infarction.Methods Kallidinogenase-loaded microbubbles were prepared using mechanical shaking method.Middle cerebral artery occlusion (MCAO) model was established in male Wistar rats by sutureoccluded method.MCAO rats (n =120) were randomly divided into 5 groups:ultrasound-mediated kallidinogenase-loaded microbubbles group (group 1),ultrasound-mediated microbubbles group (group 2),ultrasound-mediated saline group (group 3),kallidinogenase group (group 4),saline group (group 5).Medication was given through tail vein daily for 2-6 consecutive days starting 24 h after MCAO.Ultrasound groups (groups 1,2 and 3) were given 2 MHz pulse ultrasonic irradiation on the ischemia lateral skull for 10 min after injection.Cell proliferation was examined using 5'-bromo-2'-deoxyuridine (BrdU,50 mg/kg).Infarction volume and neurological function were evaluated on the 3rd,7th day after MCAO respectively.Doublecortin (DCX) + cells in the subventricular zone and laminin + in the peri-infarction region were observed at the same time.Results The number of DCX + cells in the subventricular zone (under 20 × ocular) of groups 1-5 was 251.8 ± 13.1,125.7 ± 11.6,130.2 ± 13.7,234.5 ± 12.4 and 123.7 ± 10.0 respectively.The percentage of laminin + cells in the peri-infarction region (× 10 objective) of groups 1-5 was 10.0％ ± 0.8％,5.2％ ± 0.7％,5.0％ ± 1.0％,8.0％ ± 1.8％ and 5.0％ ± 0.9％ respectively.The number of DCX + cells in the subventricular zone and laminin + cells in the peri-infarction region of the group 1 and the group 4 was significantly more on the 7th day after MCAO compared with those of the other three groups (DCX:t values of group 1 vs groups 2,3,5 were 17.88,17.17 and 18.16,all P ＜ 0.01 ; t values of group 4 vs groups 2,3,5 were 15.42,14.78 and 15.70,all P ＜0.01.Laminin:t values of group 1 vs groups 2,3,5 were 7.01,6.71 and 7.11,all P ＜ 0.01 ; t values of group 4 vs groups 2,3,5 were 4.23,3.94 and 4.33,all P ＜0.01).Moreover,the number of DCX+ cells in the subventricular zone (t =2.46,P ＜ 0.05) and laminin + cells in the peri-infarction region (t =2.78,P ＜ 0.05) of the group 1 was much more than those of the group 4.Neurologic scores on the 7th day of groups 1-5 were 1.00 (0.75,1.25),2.0 (2.00,3.00),2.0 (1.00,2.00),1.5 (0.75,2.00),2.0 (2.00,2.50).Compared with other four groups,group 1 showed better functional improvement after stroke (U values of group 1 vs groups 2-5 were 2.0,4.0,7.5 and 2.5,all P ＜ 0.05).While there was no significant difference in infarction volume among five groups at all the time points after MCAO.Conclusions Our study demonstrates ultrasound-mediated kallidinogenase-loaded contrast agent microbubbles targeted therapy promotes neuroblasts proliferation and vascular regeneration compared with mediated and non-medicine-loaded microbubbles therapy,which attributes to functional improvement after MCAO.Therefore,ultrasound-mediated ultrasound contrast agent microbubbles carrying drugs targeted therapy may have a perspective on ischemic stroke.