OBJECTIVE:To observe the clinical efficacy and safety of flupirtine maleate combined with amitriptyline in the treatment of thalamic pain after stroke. METHODS:A total of 70 patients with thalamic pain after stroke in our hospital during Jan. 2016-Aug. 2017 were divided into control group(34 cases)and observation group(36 cases)according to random number table. Both groups received secondary prevention therapy of stroke. Based on it,control group was given Amitriptyline hydrochloride tablet 25 mg/time orally,tid. Observation group was additionally given Flupirtine maleate capsule 0.1 g/time orally,tid,on the basis of control group. Treatment course of 2 groups lasted for 4 weeks. VAS,HAMD17 and HAMA14 scores of 2 groups evaluated before treatment,after 1,2,3,4 weeks of treatment Clinical efficacies and the occurrence of ADR were observed in 2 groups. RESULTS:Before treatment,there was no statistical significance in the scores of VAS,HAMD17 or HAMA14 between 2 groups(P>0.05). VAS score and HAMD17 score of observation group after 1,2,3,4 weeks of treatment,those of control group after 2,3 and 4 weeks of treatment were significantly lower than before treatment;the observation group was significantly lower than the control group at different time periods(P<0.05 or P<0.01). HAMA14 score of 2 groups after 2,3,4 weeks of treatment were significantly lower than before treatment;the observation group was significantly lower than the control group at different time periods(P<0.05 or P<0.01). Total efficiency rate(91.67%)of observation group were significantly higher than that(67.65%)of control group(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (11.76% vs. 11.11%)(P>0.05). CONCLUSIONS:Flupirtine maleate combined with amitriptyline can effectively relieve thalamic pain after stroke,and improve post-stroke,anxiety depression,which are better than control group,and the incidence of ADR is familar to control group.

Objective To investigate the preventive effect of endoclips and endoloops on postpolypectomy bleeding of large colorectal polyps.Methods Data of patients,who underwent polypectomy during January 2013 to March 2016,were retrospectively collected.The diameters of all polyps were more than 10 mm.Cases were divided into 4 groups.Before large pedunculated (with thick stalks) polyps were resected,endoclips were used to ligate the pedicles of polyps in Group A,and endoloops were used in Group B.After large sessile and pedunculated (without thick stalks) polyps were resected,endoclips were used to close the incision of polypectomy in Group C,but not in Group D.The immediate and delayed postpolypectomy bleeding rate and clinicopathologic features were studied.Articles about endoclip or endoloop on preventing post-polypectomy bleeding in PubMed in last five years were searched and analyzed.Results A total of 2 006 polyps were included.The immediate bleeding rate was 3.4％ (5/147) and 3.8％ (5/132) of Group A and B,respectively.The delayed bleeding rate was 6.1％ (9/147) and 7.6％ (10/132) of Group A and B,respectively.The delayed bleeding rate of Group C and D was 3.2％ (28/888) and 1.9％ (16/839),respectively.None of the bleeding cases needed a surgical operation.And no perforation occurred.Six articles were included for analysis.Most of articles revealed that endoclip and endoloop were effective tools in prevention of post-polypectomy bleeding.Conclusion Endoclips and endoloops are useful to prevent bleeding after resection of large pedunculated (with thick stalks) polyps.For large sessile and pedunculated (without thick stalks) polyps (diameter＞ 10 mm),the effect of endoclips to prevent postpolypectomy bleeding still needs further discussion.

Objective To explore the influence of citalopram on early recovery of motor function in patients with acute cortical infarction.Methods A total of 276 patients with acute cerebral infarction were randomly divided into observation group and control group,138 cases in each group.Patients in control group were treated with anti-platelet,blood lipid,protective nerve and rehabilitation therapy.The observation group was given citalopram hydrobromide tablets on the basis of control group.Results The incidence rate of depression in the observation group was 18.1％,which was significantly lower than 42.7％ in the control group (P ＜ 0.05).After treatment,HDRS score and NIHSS score in the observation group were significantly lower than the control group (P ＜ 0.05).In the observation group,after treatment of 30 days and 90 days,the increasing scores of hand motor function of FMA were 4.1 ± 1.0 points and 6.5 ± 2.5 points,which were significantly higher than 1.4 ± 0.7 points and 2.5 ± 1.5 points (P ＜ 0.05).After treatment of 30 days,the BI score of observation group was significantly higher than control group (P ＜ 0.05).Conclusion Early application of citalopram can effectively reduce the incidence rate of post-stroke depression in patients with acute cerebral infarction,promote the recovery of motor function and improve the quality of prognosis.

Objective To explore the influence of citalopram on early recovery of motor function in patients with acute cortical infarction.Methods A total of 276 patients with acute cerebral infarction were randomly divided into observation group and control group,138 cases in each group.Patients in control group were treated with anti-platelet,blood lipid,protective nerve and rehabilitation therapy.The observation group was given citalopram hydrobromide tablets on the basis of control group.Results The incidence rate of depression in the observation group was 18.1％,which was significantly lower than 42.7％ in the control group (P ＜ 0.05).After treatment,HDRS score and NIHSS score in the observation group were significantly lower than the control group (P ＜ 0.05).In the observation group,after treatment of 30 days and 90 days,the increasing scores of hand motor function of FMA were 4.1 ± 1.0 points and 6.5 ± 2.5 points,which were significantly higher than 1.4 ± 0.7 points and 2.5 ± 1.5 points (P ＜ 0.05).After treatment of 30 days,the BI score of observation group was significantly higher than control group (P ＜ 0.05).Conclusion Early application of citalopram can effectively reduce the incidence rate of post-stroke depression in patients with acute cerebral infarction,promote the recovery of motor function and improve the quality of prognosis.

Objective To investigate the effect of blood pressure control for early enlargement of hypertensive intracerebral hemorrhage.Methods A total of 96 patients were divided randomly into intensive blood pressure lowering group (n = 48 )and standard antihypertensive group(n=48).Patients were checked head CT and was evaluated defect of nerve function score immedi-ately when they arrive at hospital and after 24 hours.Then the clinical curative effect was evaluated.Results The defect of nerve function score in intensive blood pressure lowering group was lower than that of the standard antihypertensive group(P <0.05 ). The hematomas volume within 24 hours of admission and the rate of hematoma enlargement of intensive blood pressure lowering group were sharply smaller than those of standard antihypertensive group(P <0.05).Conclusion Controlling blood pressure ac-tively could decrease ratio early enlargement of hematoma and defect of nerve function score in patients with hypertensive cerebral hemorrhage.

ObjectiveTo analyze the risk factors for false negative diagnosis of obscure gastrointestinal bleeding (OGIB) by capsule endoscopy.MethodsA total of 133 OGIB inpatients,104 in true positive group and 29 in false negativc group,were reviewed.The features of demography,diseases and capsule endoscopy were collected and then analyzed,which included 10 variables like age,sex,time of bleeding,diseases accompanied,type and location of the disease,hemoglobin concentration,transit time of CE,quality of CE pictures and type of purgative agents.All data were analyzed with t test,and all the enumeration data were analyzed with chi square test.Logistic regression was used to analyze the correlation between the factors and results of diagnosis.ResultsAge ( t =2.095,P =0.038 ),concentration of hemoglobin ( t =2.143,P=0.034),type (X2 =20.222,P ＜0.001) and location (X2 =33.732,P ＜0.001) of the diseases,image quality of the CE (X2 =9.219,P =0.002 ) and the type of purgative agents (X2 =6.999,P =0.024) were found to have statistical differences between the two groups.Chi-square and partition Chi-square test revealed the occurrence of civerticulosis and lesion location,i.e.lower ileum and ileumcecum,were of statistical difference between the two groups (X2 =22.233,P ＜ 0.001 and x2 =24.412,P ＜ 0.001 ).Univariate logistic regression showed diverticulosis ( OR =0.102,P ＜0.001 ),lower bowel diseases ( OR =0.110,P ＜0.001 ),poor quality of CE pictures ( OR =0.258,P =0.004 ) and the use of sodium phosphate agent ( OR =0.367,P =0.027) were risk factors for false negative diagnosis,while older age facilitated diagnosis ( OR =1.024,P =0.041 ).However,multivariate logistic regression showed no statistic significance in type of purgative agent ( P =0.05 ) or the concentration of hemoglobin ( P =0.394).Furthermore,elder age facilitated positive diagnosis ( OR =1.031,P =0.032),while diverticulosis ( OR =0.118,P =0.001 ),lower bowel diseases ( OR =0.145,P =0.001 ) and poor quality of CE pictures ( OR =0.245,P =0.016) were correlated with higher probability of false negative diagnosis.ConclusionAge,disease type,disease location and image quality exert great influence on CE diagnosis.Diverticulosis,lower location of the diseases and poor CE image quality are risk factors for false negative diagnosis.

Objective To investigate whether the colonoscopy skills could be retained after the endoscopy simulator training,and to find evidence for curriculum design.Methods A total of 14 trainees received virtual reality simulator colonoscopy training and took a standardized VR colonoscopy test at the end of training and at 6 months later without practice during the time period.Results Scores drastically decreased at 6 months after training when compared to those right after the training.Although there was no difference in safety or accuracy,there was significant difference in the residual air volume,intestinal loop and procedure time.Conclusion Some skills acquired by using the Endoscopy Simulator can be retained,but other skills may be lost,which requires more practice.

ObjectiveTo investigate the diagnostic value of transgastic peritoneoscopy for ascites of unknown aetiology.MethodsTransgastric peritoneoscopy was performed on 7 patients with ascites of unknown aetiology.Diagnosis and complications were both recorded.ResultsDiagnosis of all the 7 patients were confirmed after transgastric peritoneoscopy,among whom 6 ( 85.7％ ) were found to have tuberculosis peritonitis,and 1 ( 14.3％ ) with liver disease.All patients recovered after the operation.No intraoperative or postoperative complications occurred.ConclusionTransgastric peritoneoscopy is a valuable diagnostic method for ascites of unknown aetiology.

ObjectiveTo evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of laterally spreading tumors (LST).MethodsESD was applied to remove 32 colorectal LSTs larger than 2 cm.The characteristics of the tumors and clinical results including en bloc resection rate,procedure time,complication and recttrrence rates were retrospectively evaluated.Results The lesions ranged from 2.5 cm to 8.0 cm,with a mean diameter of 4.1 ± 2.1 cm.En bloc resection wasachieved in 29 patients (90.6％ ) with a mean operation time of 75.7 ±66.0 min.Immediate arerial bleeding occurred in 5 ( 15.6％ ) cases but was stopped successfully by clips or coagulations.Late bleeding occurred in 2 ( 6.2％ ) and perforations in 3 (9.4％ ),which were closed successfully by clips without surgery.Pathological diagnosis revealed low-grade intraepithelial dysplasia in 19 (59.4％ ),high-grade intraepithelial dysplasia in 6 ( 18.8％ ),and carcinomas in 7 (21.9％).The lesions were restricted in mucosal layer in 25 (78.1％ ),infiltrating into sm1 layer in 5 ( 15.6％ ) and sm2 layer in 2 (6.2％ ),and the later 2 were referred to surgery.Twenty patients were followed up for 3-12 months,and no local recurrence was found..ConclusionESD was an effective and safe therapy for colorectal LST larger than 2 cm.

Objective To compare the diagnostic value of magnifying chromoendoscopy with probebased confocal laser endomicroscopy (pCLE) for differentiation of neoplastic from non-neoplastic colorectal polyps. Methods A total of 16 consecutive patients, who were diagnosed as having polyps with endoscopy between December 2009 and January 2010 at Nanfang Hospital, were included in this study. The pit pattern of the polyp was first determined with magnifying chromoendoscopy in all patients. Then, confocal images of the polyps were recorded and subsequently analyzed offline. Using pathological diagnosis as golden standard,the sensitivity and specificity of the two methods were compared. Results A total of 26 polyps from 16 patients were found. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of magnifying chromoendoscopy was 94. 1%, 77.8%, 88. 8%, 87. 5% and 88.4%, respectively,while those of pCLE were 100. 0%, 88. 8%, 94. 4% ,100. 0% and 96. 1%, respectively. There was no significant difference between pCLE and magnifying chromoendoscopy. Conclusion In differentiation between neoplastic and non-neoplastic colorectal lesions, pCLE shows higher sensitivity and specificity than does magnifying chromoendoscopy, although without significant difference. pCLE can be used as a new real time method to determine the property of colorectal polyps.