Objective To investigate the effects of levodopa/carbidopa plus entacapone (LCE) and levodopa/carbidopa (LC) on anxiety, depression, and quality of life (QOL) between patients with Parkinson disease (PD). Methods In total, 120 patients with idiopathic PD were enrolled in this trial and randomized into the experimental (LCE) and control (LC) groups in a 1∶1 ratio to receive treatment for12 weeks. The Hamilton anxiety scale score (HAMA), Hamilton depression scale score (HAMD), 39-item PD QOL questionnaire score (PDQ-39), Unified PD rating scale score (UPDRS), "on" time (h/d), and "off" time (h/d) were measured at each visit (baseline 0, 4, 8, and 12 weeks). Results At the end point (12 weeks), the decrease in the HAMA score from baseline was higher in the LCE group compared with that in the LC group (3.6±1.3, 95％ CI:3.3-3.9 vs 1.3±0.7, 95％ CI:1.1-1.5, P＜0.001), as well as the HAMD score (5.2±1.9, 95％ CI:4.7-5.7 vs 1.2±0.7, 95％ CI:1.0-1.4, P ＜0.001). Similarly, the changes in the PDQ-39 score were evaluated, and the change was compared between the LCE group and the LC group (14.1±7.8, 95％ CI:12.1-16.1 vs 6.9±4.2, 95％ CI:5.8-8.0, P＜0.001). In addition, the LCE group presented better improvement in the UPDRS score (Ⅰ-Ⅳ), "on" time, and "off" time from the baseline than that in the LC group (P ＜ 0.05). Conclusion Entacapone combined with levodopa/carbidopa could significantly improve anxiety, depression, and QOL in patients with PD experiencing wearing-off.

Objective To investigate the features of time distribution in the onset of aortic dissection (AD).Methods The retrospective cross-sectional study was conducted.The clinical data of 476 AD patients who were admitted to the First Affiliated Hospital of Anhui Medical University from January 2009 to June 2017 were collected.The patients were divided by the following criteria:gender,age [youth(＜45 years),middle-age (45-59 years) and elderly (≥ 60 years)],Stanford types (type A and type B),with or without hypertension.All variables were analyzed by circular distribution statistics to illuminate the features of time distribution in the onset of AD (monthly rhythm and circadian rhythm).Observation indicators:(1) overall time distribution of AD;(2) time distribution of subgroups with different genders;(3) time distribution of subgroups with different age;(4) time distribution of subgroups with different Stanford types;(5) time distribution of subgroups with or without hypertension.Measurement data with normal distribution were represented as (x)±s and count data were described as constituent ratio.The circular distrbution statistics were used to calculate time data of onset after trigonometric function transformation.The monthly rhythm and circadian rhythm were done using the Rayleigh test (Z value).Results (1) Overall time distribution of AD:the AD patients had the monthly rhythm and circadian rhythm (Z=14.79,31.60,P＜0.05).The months with the maximum and minimum cases were November (59 cases) and August (24 cases) respectively,the peak day was on January 12.AD often occurred from 16:00 to 17:00 (37 cases) but barely occurred from 3:00 to 4:00 (8 cases),with a peak of 14:55.(2) Time distribution of subgroups with different gender:male subgroup had the monthly rhythm and circadian rhythm (Z =11.28,27.81,P＜0.05);female subgroup had the monthly rhythm and circadian rhythm (Z=3.48,4.37,P＜0.05).(3) Time distribution of subgroups with different age:patients in the youth subgroup had no monthly rhythm (Z=1.33,P＞0.05),and there was the circadian rhythm (Z=4.29,P＜0.05);patients in the middle-age subgroup had the monthly rhythm and circadian rhythm (Z =7.48,17.41,P＜0.05);patients in the old-age subgroup had the monthly rhythm and circadian rhythm (Z =6.62,11.04,P ＜ 0.05).(4) Time distribution of subgroups with different Stanford type:patients inthe type A subgroup had no monthly rhythm (Z=1.60,P＞0.05),and there was the circadian rhythm (Z=10.51,P＜0.05);patients in the type B subgroup had the monthly rhythm and circadian rhythm (Z=13.94,21.70,P＜0.05).(5) Time distribution of subgroups with or without hypertension:subgroups with hypertension had the monthly rhythm and circadian rhythm (Z =12.08,29.81,P＜ 0.05).Subgroups without hypertension had no monthly rhythm (Z=3.84,P＞0.05),showing a statistically significant difference in the circadian rhythm (Z=4.78,P＜0.05).Conclusion AD often occurs in cold months and afternoon.

Aortic dissection (AD) is one of the disastrous cardiovascular diseases.Due to the uncertain,varied clinical manifestations of the AD,clinical misdiagnosis or missed diagnosis may occur occasionally.Doctors should carefully and thoroughly evaluate clinical manifestations,and raise awareness and vigilance on acute AD.After suspecting or diagnosing acute AD,specialists of vascular surgery should be contacted as soon as possible so that they could successfully treat patients.By briefly describing the different clinical manifestations of the AD in various human systems,this paper aims to promote the recognition of the atypical AD.

Objective To explore clinical implications of pleural effusion in thoracic endovascular aorta repair (TEVAR) of type B aortic dissection.Methods Clinical data of 28 patients (23 males,5 females) hospitalized from Jan 2015 to Dec 2016 were analyzed retrospectively.There were ruptured aortic dissection (RAD) (n =7) and the contained aortic dissection (CAD) (n =21).26 patients underwent TEVAR,and two patients received conservative treatment.Results 26 patients received TEVAR and operations were successful.2 patients treated conservatively died.Six patients had bilateral pleural effusion,while 20 had left pleural effusion and two had right pleural effusion.The distribution of pleural effusion was significantly different between CAD and RAD group (x2 =10.4,P ＜ 0.05),and the rupture risk was the highest in right sided pleural effusion.The median volume of pleural effusion on right side in RAD group are higher than that in CAD group (Z =-3.293,P =0.001).One patient died of sudden death on post-op 9th day.Pleural effusion disappeared in all 24 patients who were followed-up for more than 3 months.There were no ensuing pleural thickening,pulmonary atelectasis,and lung consolidation.Conclusious Pleural effusion on left side are common in type B aortic dissection,while bulk right pleural effusion may indicate impending rupture.Endovascular therapy is a feasible,safe and effective therapy for aortic dissection with pleural effusion.

Standard endovascular repair of iliac/aortoiliac pathologies can lead to complications, such as buttock claudication, colon ischemia and erectile dysfunction. Branch grafts have been developed but require at least 6 weeks for customization and are not currently available in China; they are also quite expensive. To our knowledge, modified fenestrated stent grafts (MFSGs) are a safe and effective alternative for treating patients with juxtarenal aneurysms. Most MFSGs are used for the preservation of renal and left subclavian arteries. Few cases of MFSGs have been reported in the treatment of iliac pathologies. The use of an MFSG is decided on a case-by-case basis. This report presents our first clinical use of an MFSG for preservation of the internal iliac artery.
Aneurysm ; Blood Vessel Prosthesis* ; Buttocks ; China ; Colon ; Erectile Dysfunction ; Humans ; Iliac Artery* ; Ischemia ; Male ; Pathology ; Stents* ; Subclavian Artery ; Transplants

Objective To study the correlation between male primary varicose vein of the lower extremity and varicocele.Methods 100 male patients with varicose vein of the lower extremity were compared with 100 male adults without varicose vein of the lower extremity for the prevalence of varicocele by using ultrasonography.Results There is no difference of demographic data between the two groups (t =1.78,P ＞ 0.05).There were 49 (49.0％) patients found with varicoele in study group compared with 19 (19.0％) patients with varicoele in control group (x2 =20.05,P ＜ 0.01).We compared the rate of varicoele and the mean diameter of spermatic vein between the patients having reflux in the saphenofemoral junction or not,and found there was no statistical difference between themn (rate of varicose P ＞ 0.05,diameter P ＞ 0.05).In patients with both lower extremity varicose vein and varicocele there was a linear correlation between spermatic vein diameter and that of varicose vein (rs =0.407 2,P ＜ 0.01).When patients in study group were classified into six grades by Clinical-Etiology-Anatomy-Pathophysiology (CEAP) trend chi-square found no difference in the incidence of varicoele (x2 =0.879 8,P ＞ 0.05),nor the mean diameter of spermatic vein in different grades (F =1.59,P ＞ 0.05).Conclusion There is a correlation between varicose vein of the lower extremity and the pathogcnesis of varicocele.

Objective To evaluate outcomes of endovascular procedures for atherosclerosis obliterans (ASO) patients with diabetes mellitus (DM).Methods Data of patients undergoing endovascular procedures for atherosclerosis obliterans at the First Affiliated Hospital of Anhui Medical University from January 2012 to December 2014 were retrospectively analyzed,disease characteristics,technical success rate,perioperative complications,ankle brachial index (ABI) improvement,clinical success rate,rest pain alleviating rate,limb salvage rate and survival rate were compared between the two groups.Results There were 144 patients (153 limbs) who received endovascular procedures,including 52 patients (56 limbs) with DM and 92 patients (97 limbs) without DM.Mean follow-up was 15 months.All patients experienced significant ABI improvement (P ＜ 0.05).There was no significant difference in technical success rate (80.4％ vs 90.7％),perioperative complications rate(19.6％ vs 24.7％),1 year rest pain alleviating rate (75.0％ vs 85.6％),1 year limb salvage rate (91.1％ vs 95.6％) and 1 year survival rate (92.3％ vs 90.2％) between diabetic and non-diabetic groups (P ＞ 0.05),but there was less 1 year clinical success rate in diabetic group (78.6％ vs 88.6％,P ＜ 0.05).Conclusions Compared to nondiabetic paitents,endovascular procedures for patients with DM has similar efficacy,when the procedures are properly undertaken and postoperative correct medication are given.

OBJECTIVETo explore the value and safety of the application of enteral nutrition in pediatric surgery.

METHODSClinical data of 56 children patients who could not undertake oral feeding or those who required enteral nutrition by nasojejunal tube over 7 days in our ward from June 2007 to May 2013 were retrospectively analyzed. Children younger than one year old received enteral nutritional formulation Ai Er Shu mainly composed of short peptides or amino acids, and children over one year received Small peptide or Nengquansu mainly composed of short peptide.

RESULTSAmong these 56 children patients, primary disease was pancreatitis in 20 cases, lacerated wound in 10, duodenal perforation in 6, duodenal septum-shape stenosis in 9, annular pancreas in 6, and hepatoblastoma in 5. All the patients successfully completed the enteral nutrition therapy within 7-37 (18±9.9) days with good recovery. During the treatment, 5 cases (8.9%) developed diarrhea, 3 cases (5.4%) nausea and vomiting, 2 cases (3.6%) mild abdominal distension, 5 cases(8.9%) mild abdominal pain, and the symptoms were relieved after adjustment of nutrient solution concentration and infusion rate. After enteral nutrition for 10 days, the nutritional status of children was improved, and weight, blood red cell count, hemoglobin, serum albumin, prealbumin increased significantly (P<0.05).

CONCLUSIONApplication of enteral nutrition in pediatric surgery is safe and effective, which can improve the nutritional status of children and promote the recovery.

Abdominal Pain ; Child ; Diarrhea ; Enteral Nutrition ; Humans ; Infant ; Nutritional Status ; Pancreas ; abnormalities ; Pancreatic Diseases ; Pancreatitis ; Retrospective Studies

Objective To investigate the early diagnosis and rational treatment of popliteal artery injury so as to im-prove the lower limb salvage rate. Methods The clinical and follow-up data integrity of 25 patients with popliteal artery injury was systematically studied. In these patients , 19(76%)cases were blunt injury and 6(24%) cases were penetrating injury. The combined injury included open fracture in 10 cases(40%) ,the knee joint dislocation with closed fracture of lower limb in 13(52%),nerve injury in 5(20%) and venous injury in 3(12%),respective-ly. The cause of delayed diagnosis and relationship between prognosis and type of injury, complications, the dura-tion from injured to treatment time were analyzed. Results 20 cases were operated to repair the popliteal artery. Endovascular treatment in 5 cases, the blood supply completely recovered (64%) in 16 cases, improved in 3 cases (12%) , 6 cases (24%) amputed, respectively. Rate of amputation within 6~8 hours was significantly lower than that of the more than 8 hours from the injuried to treatment time ( P<0. 05 ) . Amputation rate in blunt injury and combined injury was significantly higher than that of sharp injury ( P<0. 05 ) . Conclusion The duration from inju-ry to surgery more than 8 h, combined with knee joint dislocation and wound around knee is a major cause of mor-bidity. Operation with arterial thrombectomy is the main treatment, while endovascular treatment is a complementa-ry treatment to save the lower limb.

Objective To explore the effect and technical consideration of placement of inferior vena cava filter (IVCF) in the treatment of low extremity deep venous thrombosis (DVT).Methods From Jun 2011 to Jun 2013,73 consecutive DVT cases were for IVCF placement.There were 47 males and 26 females with a mean age of (51 ± 23) years (ranging from 36 to 80 years).Results Procedures were successful in 70 out of 73 cases.There were 18 permanent and 52 temporary IVCFs deployed.The indications for filter insertion were pulmonary embolism (PE) (25 cases,34％),perioperative prophylactic implantation (18 cases,24％),contraindication to anticoagulation therapy (15 cases,20％) and iliofemoral vein thrombosis(10 cases,13％).17 filters were successfully removed with a successful rate of 33％.After the follow-up of mean 24 months (4 to 36 months) of 68 patients,no pulmonary embolism occurred,but symptomatic DVT recurred in 5 patients,and the conditions were improved after anticoagulation treatment.No serious complication of post thrombotic syndrome occurred.Conclusions IVCF placement is effective for prevention of PE,when the therapeutic indications and contraindications are properly controlled.