Objective:To investigate the difference of amplitude and duration in submental muscles and infrahyoid muscles activities during pharyngeal swallowing between normal adults and post-stroke dysphagia by using surface electromyography technique and analysis system.Method:The clinical data from 30 cases of PSD and 30 healthy controls were collected.ME6000-T8-type sEMG machine was used to collect sEMG of two groups in resting state,saliva swallow and wet swallow,and therefore calculate the average amplitude and duration.Result:①In resting state:there were no statistical difference in the average amplitude of submental and infrahyoid muscles between PSD group and control group(P＞0.05);In PSD group:statistical differences were not observed in the amplitude between submental muscles and infrahyoid muscles;In control group:there were no statistical difference in the average amplitude between submental muscles and infrahyoid muscles;②During dry swallowing:the results indicated that the average amplitude of submental and infrahyoid muscles in PSD group were significantly lower than that in control group;and the duration of submental and infrahyoid muscles was significantly lower with statistical difference(P＜0.05).③During wet swallowing(swallowing5ml water):the average amplitude of submental and infrahyoid muscles in control group were significantly higher than that in PSD group(P＜0.005);and the duration of submental and infrahyoid muscles were also significantly prolonger (P＜0.001);④Intra-group comparison:statistically differences were not observed in the amplitude and duration between submental muscles and infrahyoid muscles for both PSD group and control group(P＞0.05).Conclusion:sEMG could be used as a non-invasive、simple、rapid tool in detecting the sEMG activities of related muscles during pharyngeal swallowing.The average amplitude and duration of submental and infrahyoid muscles can not only preliminarily screen and evaluate swallowing function,but also reflect the complexity and the elevation persistence time of the hyoid bone and the larynx in elevation movement,which were used to evaluate the neuromuscular function and predict the risk of aspiration of patients.

Objective To investigate the relationship between the average amplitude of swallowing-related muscles during pharyngeal swallowing and age and swallow model of healthy adults in different age groups.Methods A total of 200 healthy adults were recruited and divided into 4 age groups:group A (18 ～ 30 years old,n =59),group B (30～50 years old,n=50),group C (50 ～70 years old,n=49) and group D (70 years old,n=40).Surface electromyography was used to acquired the average amplitude of electrical activity of the muscles during three swallow models:resting state,voluntary single swallows of saliva (dry swallowing),voluntary single swallows of 5 ml water at once(wet swallowing)and voluntary single swallows 20 ml water at once.The mean value of the average amplitude of normal adults of different ages were calculated and analyzed.Results ①Intergroup comparison showed no difference in the average amplitude of submental muscles and infrahyoid muscles among the 4 age groups (P ＞ 0.05) in all the three swallowing models ;②Intra-group comparison showed that,there were no statistical differences in the average amplitude of submental muscles among the three swallow models between groups A and B (P ＞ 0.05).In group C,there were no statistical differences between dry swallowing and wet swallowing of 5 ml of water in terms of the average amplitude of submental muscles and infrahyoid muscles during dry swallowing.(P ＞ 0.05),however,but there existed statistical differences in terms of the average amplitude of submental muscles and infrahyoid muscles,when comparing dry swallowing with voluntary single swallowing 20 ml water at once(P ＜ 0.05).The average amplitude of submental muscles and infrahyoid muscles during swallowing of 20 ml water were significantly higher than that during wet swallowing(P ＜0.05).In group D,there was no difference between drying swallow and wet swallowing(P ＞ 0.05)in terms of the mean sEMG amplitude of the muscles,but all lower than swallowing 20 ml of water,with a statistically significant differences(P ＜ 0.05).Conclusions The sEMG amplitude in swallowing-related muscles during pharyngeal swallowing is not related to age,but swallowing models.

As the key phase for medical students to be doctors,clinical internship plays a vital role in the whole medical education process.Interns in the department of gastrointestinal surgery face series of difficulties,such as wide variety of diseases and emergence of new technology and new concepts.In addition,because of the uneven levels of teachers and low enthusiasm of interns,the result of clinical practice teaching is not satisfactory.Based on the above-mentioned problems,measures have been introduced during the process of clinical practice teaching,including selection of typical diseases and surgical procedures,construction of clinical practice teaching team,adoption of pluralistic teaching methods,reinforcement of participation of interns during the clinical practice.Finally,the quality of teaching in our department has been irmproved significandy.

Adolescent ; Cardiomyopathy, Dilated ; diagnosis ; etiology ; physiopathology ; Diagnosis, Differential ; Female ; Graves Disease ; complications ; diagnosis ; physiopathology ; Humans

Asthma ; blood ; Child ; Child, Preschool ; Complement Membrane Attack Complex ; analysis ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Intercellular Adhesion Molecule-1 ; blood ; Male ; Vascular Cell Adhesion Molecule-1 ; blood

Objective To compare the serum metal ion levels and host immunologic response of patients received non-modular,large-head metal-on-metal total hip arthroplasty (THA,Durom) with those received modular titanium acetabular component (Trilogy) using conventional head sizes and metal-on-highly cross-linked polyethylene articulations at mean 2-year follow-up interval.Methods A continuous series of 32 consecutive patients (32 hips) accepted THA with a Durom large head metal-on-metal articulation between January 2008 and December 2010 was as study group (Durom Group).From all the patients who received THA with Trilogy prosthesis at the same period,32 patients matched the Durom group in age,gender and body mass index (BMI) were chosen to form the Trilogy group.Another 32 healthy volunteers also matched the Durom group were chosen to form the control group.At the final follow-up,the serum metal ion levels,host immunologic response were evaluated.Results The mean follow-up time for Durom group was 24.9 months (range,15-34 months) compared to 25.53 months (range,15-48 months) for Trilogy group.Co and Cr levels in Durom group were 4.33 and 1.95 times as high as those in Trilogy group.There was no statistically significant difference in serum C3,C4,IgA,IgG,IgM value in three groups.CD3+,CD4+ and CD8+cells in Durom group decreased significantly compared with Trilogy and control groups.The interferon-γ(IFN-γ) level in Durom group was significantly higher than that in Trilogy and control groups.Conclusion The serum cobalt and chromium levels in patients received Durom metal-on-metal THA elevated significantly in early period.Meanwhile,some amount of impact on host cell mediated immunity occurred.

Objective To investigate the clinical features and microsurgical outcomes of patients with parasellar cavernous hemangiomas.Methods The clinical data and prognosis of 12 patients with parasellar cavemous hemangiomas treated with microsurgery were retrospectively analyzed.Magnetic resonance imaging showed that cavernous hemangiomas appeared slight hypointensity on T1WI,hyperintense on T2WI,and significant contrast on enhancing.Results Total resection and sub-total resection was achieved in 9 and 3 patients.No death occurred postoperatively.After operation,all patients were released from intracranial hypertension.In 6 patients who had visual disorder,5 patients improved and 1 patient had no change.In 5 patients who had eyeball motor disorder,3 patients improved and 2 patients had no change.In 4 patients who had pituitary gland dyshormonism,2 patients improved and 2 patients had no change.At postoperative early stage,diabetes insipidus and serum electrolyte disorder occurred in 3 patients,2 patients developed oculomotor paralysis.Patients were followed up (30.51 + 2.57) months.Three patients recovered from diabetes insipidus and serum electrolyte disorder,and 1 patient recovered from oculomotor paralysis.No patient suffered tumor recurrence or regrowth.Conclusions The correct diagnosis of parasellar cavernous hemangiomas can be achieved according to the preoperative MRI.Microsurgery is the first-line therapy for parasellar cavernous hemangiomas.

Objective To investigate the relationship of nodal skip metastasis(NSM) and clinicopathological factors of middle thoracic esophageal squamous cell carcinoma patients.Methods Between January 1999 and December 2007,695 patients with middle thoracic esophageal squamous cell carcinoma who had lymph node metastasis were reviewed.All patients received McKeown esophagectomy.We retrospectively analyzed the clinical characteristics and NSM status.Survival rates were compared using the Kaplan-Meier method and Log-Rank test.Multivariate analysis were also performed to assess the element which affect the survival by Cox regression.Results NSM were present in 226 (32.5％) patients.No significant differences in age,gender,tumor differentiation and extent of lymph node dissection depth of tumor invasion were found between skip metastasis group and continuous metastasis group.The NSM group included more patients with earlier T stage and N stage.Univariate analysis displayed that NSM was beneficial for patients with middle thoracic esophageal tumors (P ＜ 0.001).Cox-proportional multivariate analysis showed NSM was not a significant prognostic factor in overall survival.The overall survival did not differ according to NSM status in subgroups with different N stage.T1-2 patients,no significant difference of 5-year survival rate was found between skip metastasis group and continuous metastasis group(P =0.059).T3-4 patients,significant difference of 5-year survival rate was found between skip metastasis group and continuous metastasis group(P =0.001).NSM patients were then separated into 3 groups based on the extent of metastasis lymph nodes:both cervical and abdominal NSM (n =45,19.9％),cervical NSM (n =120,53.1％) and abdominal NSM (n =61,27.0％).The number of metastasis lymph nodes was significantly different among the three groups.No survival differences were observed among the three groups.Conclusion NSM is more frequently in the earlier stage compared to continuous metastasis.Three field lymphadenectomy can reduce the recurrence of T3-4 patients,and improve the survival rate of five years.The presence of NSM does not predict prognosis.

Objective To evaluate the performance of the Sysmex XE-5000 analyzer for analyzing atypical lymphocytes ,baso-philic granulocytes and their abnormalities warnings .Methods A total of 197 specimens with both atypical lymphocytes and baso-philic granulocytes warnings and 914 specimens with single warning of atypical lymphocytes indicated by Sysmex-5000 blood cell analyzer were collected and inspected by microscope simultaneously .Results Using microscopic examination as a standard ,baso-philic granulocytes within the normal range ,the coincidence rate of samples with both atypical lymphocytes and basophilic granulo-cytes warnings was 64 .9% ,while the coincidence rate of samples with single warning of atypical lymphocytes was 72 .5% .The for-mer was significantly lower than the latter(P<0 .05) .Conclusion When Sysmex XE-5000 indicates atypical lymphocytes and baso-philic granulocytes simultaneously ,there is interference between each other .It should be combined with microscopic examination in order to reduce the probability of missed diagnosis and misdiagnosis .

Objective To compare survival according to the extent of lymph node dissection in patients with thoracic esophageal squamous cell carcinoma.To identify the subgroups of patients that could get survival benefit from three-field lymph node dissection.Methods Between January 1999 and December 2007,1551 patients with thoracic esophageal squamous cell carcinoma received esophagectomy plus three-field lymph node dissection (3 FL) (n =1131) or two-field lymph node dissection (2FL) (n =420).We retrospectively analyzed the clinical characteristics and patterns of lymphatic spread of thoracic esophageal squamous cell carcinoma.Survival rates between 3FL and 2FL were compared using the Kaplan-Meier method and Log-Rank test.Multivariate analysis were also performed to assess the element which affect the survival in 3FL and 2FL group by Cox regression.Results No significant differences in age,gender and depth of tumor invasion were found between 3 FL group and 2FL group.The 3FL group included more patients with upper thoracic esophageal tumors(17.6％ vs.9.8％) and patients with lymph node metastasis(LNM) (62.7％ vs.52.9％).Cox-proportional multivariate analysis showed that extent of lymph node dissection(3FL vs 2FL) was a significant prognostic factor in overall survival; 3 FL was beneficial for patients with upper thoracic esophageal tumors(P =0.002,5-year survival rate 53.2％ vs.34.1％).The 3FL group in patients with middle/lower thoracic esophageal tumors who had no LNMs(N0) had better 5-year survival than the 2FL group(5-year survival rate 77.5％ vs.70.7％),but no significant differences were found (P =0.235).or; Among patients with middle/lower thoracic esophageal tumors who had 1-6 LNMs (N1-N2),3 FL was beneficial for patients with mediastinum LNMs (P =0.006,5-year survival rate 41.1％ vs.32.8％) For patients with ≥7 LNMs(N3),cervical lymphadenectomy did not show additional survival benefits.Conclusion Our findings suggest that extent of lymph node dissection(3FL vs 2FL) is a significant prognostic factor for thoracic esophageal squamous cell carcinoma.3FL offers survival benefit over 2FL in patients with upper thoracic esophageal tumors or patients with middle/lower thoracic esophageal tumors who have 1-6 LNMs with mediastinum lymph node metastasis.