OBJECTIVE: To observe the correlation between referred pain distribution and acupoint sensitization in patients with intestinal diseases. METHODS: In clinical research, 443 patients from 8 hospitals were recruited, including the outpatients and inpatients of Crohn's disease (=143), ulcerative colitis (=108), chronic appendicitis (=87) and other intestinal diseases (=105). The site with tenderness on the body surface and the morphological changes of local skin were observed and recorded in the patients. Using a sensory tenderness instrument, the pain threshold at the sensitization point was measured in 60 patients with ulcerative colitis. In animal experiment, SD rats were used and divided into a enteritis group (=8), in which the enteritis model were established, and a control group (=3), in which no any intervention was given. After the injection of Evans blue (EB) at caudal vein, the blue exudation points on the body surface were observed and the distribution rule was analyzed statistically. RESULTS: The referred pain on the body surface in the patients with intestinal diseases was mainly located in the lower abdomen (93.9%, 416/443), the lumbar region (70.9%, 314/443) and the lower legs (33.0%, 146/443). The diameter of tenderness region was 1.5 to 2.5 cm. Compared with the region without sensitization, the pain threshold of the sensitization point in the patients with ulcerative colitis was reduced significantly (<0.001). The referred pain on the body surface in the patients with appendicitis was located in the right lower abdomen (97.7%, 85/87), the waist and back (54.0%, 47/87) and the right lower limbs on the medial side (71.3%, 62/87). The tenderness region was 1 to 2 cm in diameter and was irregular in form. After modeling of enteritis in the rats, the EB exudation points were visible from T to L. CONCLUSION Intestinal diseases induce referred pain on the body surface where is the same as or adjacent to the location of the spinal segment corresponding to the affected intestinal section. These sensitization regions are related to the locations of acupoints.
Acupuncture Points ; Animals ; Colitis, Ulcerative ; Humans ; Intestinal Diseases ; Pain Threshold ; Pain, Referred ; diagnosis ; therapy ; Rats ; Rats, Sprague-Dawley ; Sensation

OBJECTIVE: The accuracy of the occlusion vertical dimensions of edentulous Han patients from Yunnan province was compared and analyzed on the basis of cone-beam computed tomography (CBCT)-synthesized cephalograms, closest speaking space method, and interocclusal distance. METHODS: A database correlating the CBCT head lateral images of Han patients from Yunnan province with normal occlusal conditions was first constructed. Then, five edentulous Han patients aged 63-78 years old from Yunnan Province were selected. NNT.View software was used to measure and analyze hard tissue cephalometric radiographs that had been transformed by the CBCT marker. The radiographs were then combined with the normal population database for the assessment of occlusion vertical dimensions. The occlusion vertical dimensions determined on the basis of CBCT-synthesized cephalograms, the closest speaking space method, and the free-way space were analyzed. RESULTS: The closest speaking space method was used as the standard control group, the differences between seven methods and the closest speaking space method were analyzed. The seven methods include free-way space method and six CBCT-synthesized cephalograms methods (N-ANS/ANS-Me, S-Go/N-Me, ANS-Gn/N-ANS, ANS-FH/Me-FH, ANS-Xi-Pm, and CA/LA). The seven methods were highly consistent with the closest speaking space method (intraclass correlation coefficient>0.986). The absolute values of the differences between the methods of free-way space, N-ANS/ANS-Me, S-Go/N-Me and the closest speaking space method were lower than those of the other four groups (P<0.05), while the differences between ANS-FH/Me-FH and the closest speaking space method was higher than those other groups (P<0.05). CONCLUSIONS CBCT-synthesized cephalograms, with the exception of ANS-FH/Me-FH, can provide references for the clinical evaluation of the occlusion vertical dimensions of patients with edentulous jaws.
Aged ; Cephalometry ; China ; Cone-Beam Computed Tomography ; Humans ; Imaging, Three-Dimensional ; Middle Aged ; Mouth, Edentulous ; Vertical Dimension

Due to the critical correlation between inflammation and carcinogenesis, a therapeutic candidate with anti-inflammatory activity may find application in cancer therapy. Here, we report the therapeutic efficacy of celastrol as a promising candidate compound for treatment of pancreatic carcinoma naïve neutrophil membrane-coated poly(ethylene glycol) methyl ether--poly(lactic--glycolic acid) (PEG-PLGA) nanoparticles. Neutrophil membrane-coated nanoparticles (NNPs) are well demonstrated to overcome the blood pancreas barrier to achieve pancreas-specific drug delivery . Using tumor-bearing mice xenograft model, NNPs showed selective accumulations at the tumor site following systemic administration as compared to nanoparticles without neutrophil membrane coating. In both orthotopic and ectopic tumor models, celastrol-loaded NNPs demonstrated greatly enhanced tumor inhibition which significantly prolonged the survival of tumor bearing mice and minimizing liver metastases. Overall, these results suggest that celastrol-loaded NNPs represent a viable and effective treatment option for pancreatic carcinoma.

Objective To explore the relationship between sleep duration and different ischemic stroke (IS) subtypes. Methods Participants in the study were recruited from rural communities in Beijing. The survey questionnaires, physical examination and biochemical tests were performed. Sleep duration was categorized into 5 groups, namely ≤5 hours/day, 6 hours/day (5.5-6.5 h/d), 7 hours/day (6.5-7.5 h/d), 8 hours/day (7.5-8.5 h/d) and ≥9 hours/day(≥8.5 h/d). Classification of ischemic stroke was based on Trial of org 10172 in acute stroke treatment(TOAST)classification. Logistic models were used to evaluate the associations between sleep duration and different IS subtypes. Results A total of 6 370 participants were recruited. The average age was (58.34±9.37) years old. Logistic regression analysis showed that after adjusting for age, sex, behavioral lifestyle, socioeconomic status and health status, compared to subjects with 7 hours/day, subjects with sleep duration ≤5 hours/day was significantly associated with increased risk of IS (OR=1.75, 95% CI: 1.42-2.15, P<0.001), large-artery atherosclerosis (OR=1.98, 95% CI:1.46-2.70, P<0.001), small-artery occlusion lacunar (OR=5.73, 95% CI:3.34-9.83, P<0.001) and stroke of undetermined etiology (OR=4.43, 95% CI:1.86-10.53, P=0.001). Subjects with sleep duration 8 hours/day and ≥9 hours/day was only found to be significantly associated with IS and large-artery atherosclerosis (P<0.05). Conclusions Short sleep duration is associated with increased risk of IS, large-artery atherosclerosis, small-artery occlusion lacunar and stroke of undetermined etiology. But long sleep duration is only associated with increased risk of IS and large-artery atherosclerosis.

Objective The aim of this study was to investigate associations of overall obesity (OO) and abdominal obesity (AO) with brachial-ankle pulse wave velocity (baPWV) among type 2 diabetes(T2DM) patients. Methods A community-based study for T2DM patients was conducted in rural communities in Beijing．Every patient completed a questionnaire to collect demography, lifestyle and diseases history, and underwent physical examinations, baPWV assessments and blood biochemical tests. Multivariate linear regression was used to assess the relationship between obesity index and baPWV. Abnormal baPWV was defined as patients with baPWV≥1,700 cm/s. Logistic regression model was performed to explore the risk of abnormal baPWV after adjusting for poetential confounders step by step. Results A total of 2 048 T2DM patients were recruited. The average age was (59.2±8.3) years and total prevalence of abnormal baPWV was 49.7%. After multivariable adjustment, linear regression showed that there was a negative correlation between body mass index(BMI) and baPWV and a positive correlation between waist-to-hip ratio (WHR) and baPWV. Compared to normal weight group, those with BMI≥28 kg/m2 had lower risk of abnormal baPWV (OR=0.59, 95% CI: 0.44-0.78，P<0.001), but there was an increased risk of 46% among patients with obesity in WHR (OR=1.46, 95% CI:1.07-2.00，P=0.018). Compared to those without OO and AO, patients without OO but with AO had a 1.67-fold increasesd risk of abnormal baPWV (OR=1.67, 95% CI: 1.19-2.35，P=0.003). Conclusions Abdominal obesity is related with arterial stiffnening among T2DM patients, and it is critical to evaluate arterial stiffness of T2DM patients with abdmonal obesity and normal BMI in order to reduce future risk of cardiovascular diseases.

Objective: To introduce a new method for assessing coronal balance in surgical treatment of scoliosis, and to explore its effectiveness in preventing postoperative coronal imbalance. Methods: The data of forty-six consecutive patients, who underwent posterior surgery for spine deformity correction from January 2016 to December 2016, were retrospectively analyzed. The series included 19 males and 27 females with an average age of 28.24±21.16 years (7-76 years), and with lower instrumented vertebra (LIV) located at the level of L3 or below. Point-line method was used to evaluate coronal balance by determining whether the center of upper instrumented vertebra was located at the measuring rod passing through the centers of symphysis pubis and LIV among all patients during surgery. Preoperative, postoperative 1 week and 3 months Cobb angle, coronal balance distance (CBD), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and Scoliosis Research Society Questionnaires-22 (SRS-22) were measured and recorded, and statistical analysis was conducted. And then, subgroup analysis was performed according to preoperative coronal imbalance classification to further evaluate the effectiveness of the new method. Results: Among 46 patients in this study, the prevalence of preoperative coronal imbalance was 47.82% (22/46). Of them, ten patients were type B coronal imbalance and eleven patients were type C coronal imbalance. The prevalence of coronal imbalance at one week after operation was 17.39% (8/46), and the prevalence of coronal imbalance at final follow-up was 10.87% (5/46). The results showed that the mean main Cobb angle was 57.24°±26.51° and 14.71°±10.17° at pre-operation and immediate post-operation, respectively. The difference was statistically significant compared to preoperative value (t=13.211, P=0.000), and the average improvement rate was 73.53%±1.88%. Preoperative coronal balance distance CBD ranged from 2.76 mm to 66.73 mm, with an average of 22.54±13.97 mm; the mean CBD was 16.00±14.85 mm at immediate post-operation. The difference was statistically significant (t=3.665, P=0.001), with an average correction rate of 25.58%±52.39%. Our clinical outcome analysis showed that among 46 patients, the preoperative VAS was 8.11±0.89, and the final follow-up VAS was 4.15±0.79. There was a significant difference between pre-operation and the last follow-up (t=21.529, P=0.000). The preoperative ODI score was 49.76±5.84, and the final follow-up ODI score was 25.74±3.92. The difference was statistically significant (t=44.434, P=0.000). The preoperative SRS-22 was 10.57±2.13, and the final follow-up SRS-22 was 21.89±2.35. Compared to pre-operation, the difference was statistically significant (t=24.023, P=0.000). The subgroup analysis showed that in patients with type B coronal imbalance, the mean Cobb angle correction rate was 70.34%±6.02% at immediate post-operation, and there was a significant difference compared to pre-operation (t=5.437, P=0.000); the average CBD correction rate was 37.45%±29.03%, and significant difference was found (t=2.607, P=0.028). In type C patients, the average Cobb angle and CBD correction rate at immediate post-operation was 72.92%±3.67% and 44.79%±5.63%, respectively, and significant difference was found (t=7.319, P=0.000; t=7.545, P=0.000). Conclusion Point-line method was a simple and effective technique for intraoperative assessment of coronal balance, which could assist surgeons to objectively evaluate the result of restoration of the coronal alignment. The use of point-line method is contributed to improve clinical outcomes of spinal deformity correction surgery, and to prevent the occurrence of postoperative coronal imbalance.

OBJECTIVETo observe the multiple symptom distribution, severity and quality of life of female pelvic floor dysfunction(FPFD) patients with constipation as chief complaint.

METHODSOne hundred FPFD patients with constipation as chief complaint from Speciaty Outpatient Clinic, Pelvic Floor Center of Nanjing Municipal Hospital of Traditional Chinese Medicine between September 2015 and February 2017 were retrospectively enrolled in this study. A comprehensive medical history questionnaire survey and systematical evaluation of severity and quality of life of these patients with constipation was conducted. Constipation scoring system scale (CSS) and patient-assessment of constipation quality of life questionnaire (PAC-QOL) were applied to evaluate the constipation. Other scales included: (1)pain visual analogue scale (VAS) and short form-36 questionnaire (SF-36): if combined with chronic functional anal rectal pain; (2) international consultation on incontinence questionnaire-short form (ICIQ-SF) and urinary incontinence quality of life questionnaires (I-QOL):if combined with urinary incontinence; (3) fecal incontinence severity score scale (Wexner-FIS) and fecal incontinence quality of life questionnaire (FI-QOL):if combined with fecal incontinence.

RESULTSThe mean age of 100 FPFD patients was (57.9±13.9) (24-89) years and the mean disease course was (7.0±8.2)(0.5-40.0) years. Seventy-five cases (75%) were complicated with anal pain, 70 with urinary incontinence, 37 with rectocele, 19 with nocturia, 11 with urinary frequency, 10 with defecation incontinence. Complication with only one symptom was observed in 20 cases (20%), and with two or more symptoms was observed in 80 cases (80%). Pelvic floor relaxation syndrome patients were dominant (58 cases, 58%). The severity of constipation (CSS) was 6-22 (13.89±3.79) points and the quality of life (PAC-QOL) was 45-133 (87.13±18.57) points in FPFD patients. VAS and SF-36 of patients combined with chronic functional anal rectal pain were 1-8 (3.0±1.9) points and 14.4-137.0(71.5±31.4) points respectively. ICIQ-SF and I-QOL of patients combined with urinary incontinence were 1-17 (6.1±3.6) points and 52-110 (90.0±15.8) points respectively. Wexner-FIS and FI-QOL of patients combined with fecal incontinence were 1-11 (4.4±3.0) points and 52-116 (83.4±23.3) points respectively.

CONCLUSIONSThe symptoms of FPFD patients with constipation as chief complaint are complex. They are mainly complicated with anal diseases, then urinary incontinence, and mostly with more than 2 symptoms. Their quality of life is poor.

Adult ; Aged ; Aged, 80 and over ; Constipation ; etiology ; Fecal Incontinence ; etiology ; Female ; Humans ; Middle Aged ; Pelvic Floor ; Pelvic Floor Disorders ; complications ; diagnosis ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; Young Adult

Objective To summarize the clinical features and outcomes of paraduodenal pancreatitis (PP). Methods Five clinically or pathologically diagnosed PP patients in Peking Union Medical College Hospital and 31 other PP cases reported in Chinese literature since 1988 were retrospectively analysed. Results Most PP patients were young or middle-aged males with a history of alcohol abuse. The clinical symptoms included upper abdominal pain,vomiting,weight loss,and fluctuating jaundice. Serum pancreatic enzymes were normal or elevated. Radiological features in most cases included thickening of the duodenal wall and duodenal stenosis (88.9%,32/36),cysts in the duodenal wall and groove area (47.2%,17/36),dilated bile duct (36.1%,13/36),and dilated pancreatic duct (16.7%,6/36). The main pathological finding was chronic pancreatitis,which could be accompanied by local acute inflammation,which was limited in the groove-duodenal area in most cases. The disease can be well controlled by conservative treatment,although surgery was needed in a small number of cases. Conclusion sPP typically occurs in young or middle-aged males. Radiological examination is valuable for diagnosis. Conservative treatment is the mainstream treatment in most patients.

Objective To discuss the clinical efficacy and surgical indications of one-stage posterior debridement,Smith-Petersen osteotomy(SPO), compressive fusion and instrumentation for treatment of thoracolumbar tuberculosis. Methods All of 32 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed,treated by one-stage posterior debridement,SPO, compressive fusion and instrumentation from March 2010 to October 2016,including 23 males and 9 females,aged 2 to 77 years old,average(39.2±17.8)years.All patients were treated by preoperative quadruple anti-tuberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months.Preoperative and postoperative changes in clinical symptoms,nervous func-tion,the situation of the erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)with strict follow-up,as well as other re-lated complications were observed.The spinal fusion rate and fusion situation,changing of the physiological curvature,as well as loosening or breaking of the internal fixation device were detected through regular imaging examination.Results The surgery du-ration time was 90-150 min,average(120±19.6)min,and the blood loss was 150-600 ml,average(320±88.9)ml.Postoperative follow-up time was 1 to 3 years,average 2.3 years.The symptoms of tuberculosis poisoning in all patients were obviously relieved and the nutritional status was improved gradually. The visual analogue scale(VAS) improvement rate was about 92%. The VAS score in the preoperative and the last follow-up was statistically significant.All patients'ESR and CRP returned to normal levels at the last follow-up.The Kirkaldy-Willis function score showed that the total fine rate was 93.75%.9 patients with spinal neurologi-cal impairment were postoperative improved significantly.Except 1 patient's Asia grade improved from the B to C,others returned to normal condition.30 cases recovered.Pleural effusion was observed in 3 cases treated with closed thoracic drainage and antibi-otics.The drainage tube was removed after 5-7 d.Incision fistula were observed in 1 patient at 1 month after discharge and recov-ered after debridement and drugs adjustment.Internal fixation loosening was found in 1 elderly patient after 6 months after surgery which was treated with hyperextended brace and anti-osteoporosis drugs.No tuberculosis recurrence was found.Conclusion One-stage posterior debridement, SPO, compressive fusion and instrumentation is a simple, effective and safety surgical approach, which has great application value for surgical treatment of patients with thoracolumbar spinal tuberculosis.

Mechanical stimulation widely exists in the body and participates in adjusting biological behavior of many kinds of cells. As a common stress pattern in the body, the tensile strain widely exists in many organs, such as bone and cartilage, muscle tendon, cardiac and pulmonary vessels, and so on. In recent years, with the development of the researches of biomechanics, a variety of mechanical loading devices, which are used to simulate the complex mechanical stimulation in the body to provide the tensile strain including the isometric, uniaxial and various types of mechanical waveform, came into being. This is a huge boost to biomechanical research. Many researchers have found that the tensile strain stimulation can lead to the transformation of proliferation, differentiation and apoptosis of cells and change of cell matrix. However, for the same kind of cells, different kinds of tensile strain stimulation can lead to different and even the contrary results. In this paper, the effects of the tensile strain on the proliferation, differentiation and matrix of cartilage were reviewed. Understanding these characteristics will have important implications for the mechanism of cell proliferation and differentiation under the biomechanic stimulation and the prevention and treatment of diseases.