Aged ; Brain Ischemia ; blood ; drug therapy ; pathology ; Female ; Fibrinolytic Agents ; therapeutic use ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stroke ; blood ; drug therapy ; pathology ; Thrombolytic Therapy ; methods ; Treatment Outcome ; Vitamin D ; analogs & derivatives ; blood

Objective To explore the effect of aripiprazole combined with risperidone on serum prolactin and glucolipid metabolism in male patients with schizophrenia. Methods A total of 113 male patients with schizophrenia who were treated with risperidone in the Second Affiliated Hospital of Xinxiang Medical University from October 2016 to May 2017 were select-ed. The patients were randomly divided into observation group and control group. Fifty-nine patients in the control group were given risperidone 4 - 6 mg·d - 1 orally,while fifty-four patients in the observation group were given risperidone 4 - 6 mg·d - 1 combined with aripiprazole 10 mg·d - 1 orally,the course of treatment was 8 weeks. The serum prolactin(PRL)levels were measured before treatment and at 2,4,8 weeks after treatment. Positive and negative syndrome scale(PANSS)was used to eval-uated the psychiatric symptoms in the two groups before treatment and at 4,8 weeks after treatment. The levels of fasting plas-ma glucose(FPG),total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),high density lipoprotein(HDL), body mass index(BMI)were measured in the two groups before treatment and at 4,8 weeks after treatment. Results A total of 113 patients completed the experiment,with 53 cases in the observation group and 59 cases in the control group. There was no significant difference in the level of PRL,FPG,TC,TG,HDL,LDL and the total score,positive symptom score,negative symptom score,general pathologic score of PANSS and BMI between the two groups before treatment(P > 0. 05). At 2,4,8 weeks after treatment,the level of PRL in the control group was higher than that before treatment(P < 0. 05),and in the obser-vation group it was lower than that before treatment(P < 0. 05). Compared between any two time points,there was significant difference in the PRL level at 2,4,8 weeks after treatment in the two groups(P < 0. 05). Compared with the control group,the level of PRL in the treatment group was significantly lower at 2,4,8 weeks after treatment (P < 0. 01). The total score,positive symptom score,negative symptom score,general pathologic score of PANSS in the two groups at 4,8 weeks after treatment were lower than those before treatment and at 4 weeks after treatment (P < 0. 05). The total score,positive symptom score,negative symptom score,general pathologic score of PANSS in the two groups at 8 weeks after treatment were lower than those at 4 weeks after treatment(P < 0. 05). The total score,negative symptom score,general pathologic score of PANSS in the observation group at 4,8 weeks after treatment were lower than those in the control group(P < 0. 05),but there was no significant difference in the positive symptom score of PANSS between the two groups at 4,8 weeks after treatment(P > 0. 05). There was no significant difference in the level of FPG,TC,TG,HDL,LDL and BMI in the control group at 4,8 weeks after treatment compared with that before treatment(P > 0. 05). There was no significant difference in the level of FPG,TC,TG,HDL,LDL and BMI in the observation group at 4 weeks after treatment compared with that before treatment(P > 0. 05). There was no significant differ-ence in the level of FPG,TC,TG,HDL in the observation group at 8 weeks after treatment compared with that before treatment and at 4 weeks after treatment(P > 0. 05). But the level of LDL and BMI in the observation group at 8 weeks after treatment were lower than those before treatment and at 4 weeks after treatment(P < 0. 05). There was no significant difference in the level of FPG,TC,TG,HDL,LDL and BMI between the observation group and the control group at 4 weeks after treatment(P >0. 05). There was no significant difference in the level of FPG,TC,TG,HDL between the observation group and the control group at 8 weeks after treatment (P > 0. 05). But the level of LDL and BMI in the observation group at 8 weeks after treatment were lower than those in the control group(P < 0. 05). At 8 weeks after treatment,the incidence rate of akathisia,thirst,somno-lence,tremor,nausea and salivation in the control group was 5. 08％,10. 16％,10. 16％,15. 25％,6. 77％,11. 86％,respec-tively;the incidence rate of akathisia,thirst,somnolence,tremor,nausea and salivation in the observation group was 3. 70％, 14. 81％,9. 25％,16. 67％,11. 11％,9. 26％,respectively. There was no significant difference in the incidence rate of akathi-sia,thirst,somnolence,tremor,nausea and salivation between the two groups(χ2 = 0. 207,0. 106,0. 159,0. 326,0. 091,0. 162;P > 0. 05). Conclusion Risperidone combined with aripiprazole in the treatment of male schizophrenia patients is beneficial to reduce the level of serum high PRL induced by risperidone and to improve lipid metabolism.

BackgroundPercutaneous transluminal septal myocardial ablation (PTSMA) and modified Morrow septal myectomy (MMSM) are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy (HCM). This study aimed to determine the clinical outcome of these two strategies.

MethodsFrom January 2011 to January 2015, 226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, after operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher's exact tests. Quantitative variables were compared using the paired samples t-test.

ResultsInterventricular septal thickness was significantly reduced in both groups (21.27 ± 4.43 mm vs. 18.72 ± 4.13 mm for PTSMA, t = 3.469, P < 0.001, and 21.83 ± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P < 0.001, respectively). The left ventricular outflow tract (LVOT) pressure gradient (PG) significantly decreased after the operations in two groups (70.30 ± 44.79 mmHg vs. 39.78 ± 22.07 mmHg for PTSMA, t = 5.041, P < 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P < 0.001, respectively). Seven patients (10.29%) in the PTSMA group required a repeat operation in the follow-up. Eight (11.76%) patients were evaluated for New York Heart Association (NYHA) III/IV in the PTSMA group, which was significantly more than the five (3.16%) in the same NYHA classes for the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up.

ConclusionsBoth strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.

Objective To investigate the current situation in Chinese rheumatologic physicians' clinical diagnosis and evaluation of Takayasu's arteritis (TA).Methods Nineteen rheumatology experts and three vascular surgery specialists in China were invited to make the nationwide investigation for the first time about the diagnosis and disease activity evaluation of TA in China,through the questionnaire survey on the internet.Weighted average was used to calculate the average scores of corresponding problems.Results Chinese experts mainly adopted 1990 American College of Rheumatology (ACR) classification criteria for clinical diagnosis of TA.In details,symptoms of age,limb claudication and amaurosis,signs including pulselessness or pulse weakening,vascular bruits,increasing bilateral pulse pressure and hypertension and acute phase reactants (APR) were critical to the clinical diagnosis of TA.Besides,noninvasive imaging examinations,such as computed tomography angiography (CTA),magnetic resonance angiography (MRA),vascular ultrasonography,and positron emission tomography (PET) were also of great importance.In the aspect of disease activity assessment,Chinese experts mainly used Kerr scoring tool.APR and noninvasive radiological examinations were considered with vital value.Some TA patients with carotid artery involvement were recommended using vascular ultrasonography,while others with pulmonary artery and thoracic/abdominal aorta trunk involvement were preferred CTA other than MRA.Conclusions APR and noninvasive imaging examinations were thought with great help to make clinical diagnosis and evaluation of TA for Chinese physicians.

Objective·To explore the value of applying CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors. Methods·A retrospective analysis was performed on the cases with refractory pelvic tumors admitted between March 2014 and December 2016 in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. CT/MRI examinations were performed as a routine pre-surgical procedure, and the resulting images were subject to rapid registration and fusion with the Medraw software in order to accurately determine the tumor boundaries and to be used as references in designing and making patient-specific tumor models, prostheses, and implants by 3D printing technique. Results·A total of 13 cases with refractory pelvic tumors were included in this study (8 cases of chondrosarcoma, 1 case of osteosarcoma with aneurysmal bone cyst, 1 case of dedifferentiated sarcoma, 1 case of fibrous connective tissue hyperplasia, 1 case of solitary fibrous tumor/hemangiopericytoma, and 1 case of metastatic squamous cell carcinoma) with an average age of (50.0±8.5) years. According to the Enneking classification,there were 2 cases in zone Ⅰ , 2 in zones Ⅰ + Ⅱ , 1 in zones Ⅱ + Ⅲ , 3 in zones Ⅰ + Ⅱ + Ⅲ , 1 in zones Ⅰ + Ⅱ + Ⅳ , 1 in zonesⅠ + Ⅱ + Ⅲ + Ⅳ , 1 in zones Ⅰ + Ⅳ , 1 in zones Ⅱ + Ⅳ , and 1 in zone Ⅳ. The mean maximal tumor diameter was (15.15±4.81) cm without implicating the pelvic blood vessels. Results from intraoperative frozen section at resection boundaries and the installation of prosthesis showed that the actual surgical procedure was consistent with the surgical planning based on the reported image fusion technique. Conclusion·CT/MRI image registration and fusion technique combined with 3D printing technique can accurately determine the resection boundary of pelvic tumors and assist in designing of individualized prosthesis model and surgical guide, which has a great value in pre-surgical planning and clinical treatment of refractory pelvic tumors.

Objective To explore the structure changes of white matter of the patients with schizophrenia episode in early adulthood by diffusion tensor imaging(DTI) and in order to provide a structural neuroimaging basis for understanding the pathology of schizophrenia.Methods Twenty-six patients with schizophrenia episode in early adulthood in the Second Affiliated Hospital of Xinxiang Medical University from July 2012 to March 2014 were selected as study group and twenty-eight healthy subjects whose age,sex,education were matched with study group were selected as control group.All subjects received structural magnetic resonance imaging and DTI scans.The fractional anisotropy (FA) and the mean diffusivity (MD) of the white matter of the same encephalic region were compared between the two groups by voxel-based analyses.Results The FA values of the right anterior cingulate gyrusthe,genu of corpus callosum,the right limb of internal capsule,the bilateral external capsule,the bilateral posterior of coronal radiate,the right anterior coronal radiate of patients in the study group were significantly lower than those in the control group (P ＜ 0.05).The MD values of the bilateral limbs of internal capsule,the right cingulate gyrus,left superior longitudinal tract,corpus callosum and right anterior coronal radiate of patients in the study group were significantly higher than those in the control group (P ＜ 0.05).Conclusion Schizophrenia patients who episode in early adulthood exist widespread microstructural damage of white matter.These changes may be related to the pathological change of schizophrenia.

Objective To evaluate the biomechanical properties of 3 D printed individualized titanium alloy pelvicprosthesis in static and gait states by the method of finite element analysis.Methods Three patients with different types of pelvic tumors were treated by hemi-pelvic arthroplasty with resection of hemi-pelvis.CT and MRI were performed before the surgery,and the corresponding individualized titanium alloy pelvic prostheses were designed.The pelvic models were reconstructed with 3D reconstruction technique,and then assembled with the individualized pelvic prostheses.The human skeletal muscle model was established by AnyBody software to perform gait dynamics analysis.The stress distribution and stress concentration areas of 3 reconstructed pelvic models in static and gait states were obtained by ABAQUS.Results Under both static and gait conditions,the maximum stress of the 3 pelvic prostheses was smaller than the yield strength of the titanium alloy.The pelvic ring of the reconstructed pelvis could meet the rule of stress conduction.The patients' daily life returned to normal condition after the surgery.Conclusions The effect of 3D prosthetic titanium prosthesis on recovery of pelvic ring is satisfactory,and its effectiveness and stability can meet the requirement of human biomechanics.The analytic results can provide references for clinicians and prosthesis designers.