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Objective A retrospective study to evaluate the feasibility of the sequential treatment of extrahepatic bile duct calculus and acute gallstone pancreatitis using the technique of combination of duodenoscope, laparoscope and choledochoscope in one anesthetic session. Methods 112 patients with extrahepatic bile duct calculus (including 23 patients associated with acute gallstone pancreatitis) were treated using this technique. The data were analyzed. Results The technique was successfully carried out in 102 patients but 10 patients had to be treated by conventional open operation.For the patients treated by this technique, 16 patients were treated by endoscopic sphincterotomy (EST) plus choledochotomy. The stones were removed through a choledochoscope, and the bile duct was drained by a T-tube (LCTD). 18 patients were treated by endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy (LC). The choledocholiths were removed by a choledochoscope through the cystic duct. 22 patients were treated by choledochotomy, and the calculus was removed through a choledochoscope and the bile duct was primarily sutured. 46 patients were treated by endoscopic nasobiliary drainage (ENBD) plus LC, choledochotomy. The calculi were through a choledochoscope and followed by primary suture of the bile duct. The mean time of endoscopic treatment, LC and postoperative hospital day were 35 min, 110 min and 6.5 d respectively. None of the 102 patients died after operation. 9 patients developed complications of ERCP or EST including acute pancreatitis (n=6), hemorrhage of papilla duodeni (n=2) and duodenal perforation (n= 1). 11 patients developed biliary fistula after primary suturing of the choledochus and they recovered with drainage; 2 patients developed residual or recurrent biliary fistula after the T tube was removed and they recovered after drainage via a [aparoscope. During follow-up for 1 to 3 years using ultrasonic or MRCP examinations, 3 cases of stones were found and they were removed by EST. There was no stenosis of common bile duct. Conclusions Our results suggested that the three-endoscope-combination in one anesthetic session for the treatment of extrahepatic bile duct calculi and acute gallstone pancreatitis was safe and efficacious. Moreover, this technique reduced the complications of EST. This technique increased the success rate using minimal invasive surgery.
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Objective In order to explore the effects of rehabilitation training and acupuncture on the neural function deficit and motor function in patients with ischemic streke.Methods Eighty patients with ischemic stroke were randomly divided into rehabilitation and acupuncture groups.According to different recovery stages,the rehabilitation group received purposeful rehabilitation training for 28 days while the acupuncture group received scalp needling combined with body acuptmcture.The neural deficit scores(NDS)and motor fimction comprehensive assessment(FCA) were evaluated at the recruitment(M_0),the 28~(th)(M_1)and 56~(th)(M_2)days after treatment.Results No significant difierences were found in the NDS and motor FCA between the rehabilitation and the acurluncture groups at the recruitment.The significant differences appeared at the 28~(th) and the 56~(th) days comparing with baseline assessments in each group.There was no significant difference in the changes of NDS and motor FCA between the two groups at 28~(th) day,however,the NDS and motor FCA in rehabilitation group revealed better outcome than the acupuncture group at the 56~(th) day.Conclusion The study indicated that both rehabilitation training and acupuncture could improve the neural function and enhance the motor function in patients with ischemic stroke.
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Objective To determine the level and clinical significance of 5-hydroxytryptamine (5-HT) and intestinal fatty acid binding protein (iFABP) in patients of severe acute pancreatitis (SAP) with intestinal dysfunction. Methods The serum and urine in 42 cases of SAP with intestinal dysfunction were collected at day 1, 3 and 7 after admission, respectively. The numbers of bowel sounds were recorded. 20 health subjects were selected as the control. Results The numbers of bowel sounds in health subjects were 5.6 ± 2.3/min. The numbers of bowel sounds in SAP patients at day 1,3 and 7 were 2.3 ± 0.7/min, 1.7 ± 0.2/min and 3.1 ± 1.1/min, respectively;which were significantly lower than that in the control group (P < 0.01). The level of 5-HT in the control group was(86.7 ± 9.5)ng/ml, while the levels of 5-HT in the SAP patients at day 1, 3 and 7 were (112.0 ± 17.8) ng/ml, (130.5 ± 19.7) ng/ml, (107.9 ± 16.3) ng/ml. The level of urine iFABP in the control group was (90.5 ± 19.8) pg/ml, while the levels of urine iFABP in the SAP patients were (1250.2 ± 425.3) pg/ml, (1586.9 ± 523.4) pg/ml, (1154.6 ± 394.0) pg/ml. The levels of 5-HT and urine iFABP in the SAP patients all were significantly higher than those in the control group (P <0.01). The levels of 5-HT and urine iFABP in the SAP patients at day 3 were significantly higher than those in the day 1 and day 7, while there was no significant difference between the two groups. Conclusions Determination of serum 5-HT and urine iFABP in patients with early SAP could effectively evaluate the intestinal function, and it may have potential clinical significance.
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Objective To investigate the effect of Da-Cheng-Qi decoction on enteric functional disturbance in rats with acute experimental pancreatitis and its potential mechanism. Methods Seventy-two SD rats were randomly divided into sham operation group, acute pancreatitis (AP) group and Da-Cheng-Qi decoction treated group with 24 each. The AP model was induced by retrograde injection of sodium taurocholate (0.1 ml/100 g) into bitiopancreatic duet. Before modeling, the rats in treatment group received Da-Cheng-Qi decoction (2 g/100 g), and the rats in other two groups received 0.9% NaCl solution. The rats were sacrificed at 3, 6 and 12 hours with 8 each, and the blood samples were taken for detecting the level of amylase and the contents of 5-hydroxytryptamine (5-HT) by enzyme-linked immunosorbent assay. The colonic tissues 10 cm apart from trans-ligament incluing jejunum, terminal ileum and sigmoid colon were collected for examining the expressions of 5-HT_3 and 5-HT_4mRNA and proteins by RT-PCR and Western blotting respectively. Results ① The levels of serum amylase and 5-HT in AP group and treatment group were significantly higher than those in sham operation group (P<0. 01), but they were lower in treatment group than in AP group at each time points (P<0. 05). The level of 5-HT was increased in the initial stage and then decreased gradually both in AP group and treatment group. ③ The expressions of 5-HT_3 and 5-HT_4 mRNA and proteins were significantly decreased in the jejunum, terminal ileum and sigmoid colon in AP group compared with sham operation group (P<0. 01). Whereas the expressions of 5-HT_3 mRNA and protein,but not 5-HT_4, were increased in the treatment group in comparison with AP group (P<0.05). Conclusions The level of 5-HT is significantly increased in acute pancreatitis, but its receptors (5-HT_3 and 5-HT_4) are decreased, which may induce enteric functional disturbance. The Da-Cheng-Qi decoction may improve enteric dynamic failure by increasing the expression of 5-HT_4 and may be a choice for treatment of acute pancreatitis with enteric dynamic failure
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Objective:Needling lumbosacral acupoints could regulate unstable bladder (USB).The present study is to observe the ambulatory urodynamics changing of needling Huiyang (BL 35) on USB to provide scientific basis for the relative theory of acupoint and Zang-fu organs,and the rule of acupuncture treatment.Methods:Unstable bladder model were prepared in 80 Wistar rats,and then they were randomly divided into treatment group (n=40) and model group (n=40).The urodynamics were monitored respectively at 2 h,6 h,12 h and 24 h after acupuncture and the results were analyzed.Results:After acupuncture Huiyang (BL 35),the compliance of bladder were superior to that of model group at 2 h,6 h and 12 h,respectively (P＜0.05),and the bladder volume were superior to that of model group at 2 h and 12 h,respectively (P＜0.05).After acupuncture Huiyang (BL 35),the compliance and Volume of bladder at 12 h were superior to those at other time (P＜0.05).Twenty-four hours later,the effect of acupuncture on urodynamics decreased.Conclusion:Needling Huiyang (BL 35) could improve the urodynamics of USB,including improving the compliance of bladder and increasing the volume of bladder.Acupuncture Huiyang (BL 35) had the most effect at 12 h.
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Objective To investigate the therapeutic effect of Da-Cheng-Qi Decoction on gut dysfunction in patients with severe acute pancreatitis (SAP). Methods Forty-eight SAP patients complicated with gut dysfunction were randomly divided into two groups according to the number of admission, which were treatment group and control group. The therapy in t reatment group was Da-Cheng-Qi Decoction infusion through gastric tube (one paste/day, b. i. d), however the therapy of control group was normal saline infusion through gastric tube (the amount was the same as the former, b. i. d), and other management in the two groups was similar. The first passage of gas by anus and defecation after treatment was observed. Serum amylase, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-6 were examined before and one week after treatment;complications and mortality were compared between the two groups. Results The first passage of gas by anus and defecation in the treatment group was ( 12.3 ± 5.7 ) h and ( 24.8 ± 11.2 ) h, respectively, and shorter than ( 22. 1 ± 9.7 ) h and 46.2 ± 17.4) h of control group ( P <0.01) ;the numerical values of serum amylase, CRP, TNF-α and IL-6 one week after treatment were ( 120.3 ± 35.8 ) U/L, ( 10.8 ±2.0) ng/ml, (36.3 ± 5.8) U/L and (4.8 ± 1.0) U/L, which were significantly decreased when compared with the values before treatment, and these values were significantly lower than (267.2 ± 78.9 )U/L, ( 19.5 ± 2.7 ) ng/ml, (80.1 ± 9.0) U/L, ( 10.5 ± 1.2 ) U/L of the control group ( P < 0.05 ). The total complications and mortality of treatment group was 12.5% and 4.4%, respectively, which were significantly lower than those in the control group (37.5% and 25%, P <0.05). Conclusions Treatment with Da-Cheng-Qi Decoction in SAPpatients complicated with gut dysfunction was effective to reverse gut dysfunction and reduce total complications and mortality.
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Objective:To investigate the effects of acupuncture of Shenshu(BL 23),Huiyang (BL 35)and Shenshu(BL 23)plus Huiyang(BL 35)on the main symptoms of unstable bladder (USB)and explore the specificity of different points in treating USB through a clinical randomized controlled trial.Methods:Eighty-nine USB patients were allocated to three groups:Shenshu(BL 23),Huiyang(BL 35)and Shenshu(BL 23)plus Huiyang(BL 35).I-PSS was used as an observation index.The effects were evaluated and a comparison was made between the groups after three and six treatments.Resuits:I-PSS significantly improved in all Shenshu (BL 23),Huiyang(BL 35)and Shenshu(BL 23)plus Huiyang(BL 35)groups of USB patients (P＜0.05).The effect was significantly beaer in the Huiyang(BL 35)and Shenshu(BL 23)plus Huiyang(BL 35)groups than in the Shenshu(BL 23)group(P＜0.05).The efficacy rate was 50.0% in the Shenshu(BL 23)group,82.8% in the Huiyang(BL 35)group and 90.0% in the Shenshu(BL 23)plus Huiyang(BL 35)group.It was significantly higher in the Huiyang(BL 35)and Shenshu(BL 23)plus Huiyang(BL 35)groups than in the Shenshu(BL 23)group(P＜0.05).Conclusion:Points Shenshu(BL 23),Huiyang(BL 35)and Shenshu(BL 23)plus Huiyang(BL 35)can all regulate voiding dysfunction and improve quality of life in USB patients.Shenshu (BL 23)plus Huiyang(BL 35)has the most marked therapeutic effect.
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OBJECTIVE: To observe the effects of electroacupuncture treatment on nitrergic neurotransmitter in bladder neck and detrusor of rats with unstable bladder. METHODS: Rat models of unstable bladder were established by operation to induce urethral obstruction. Electroacupuncture treatment was given by acupuncturing Huiyang and Zhonglushu points for a week. Then the neuronal nitric oxide synthase (nNOS)-, endothelial nitric oxide synthase (eNOS)- and inducible nitric oxide synthase (iNOS)-positive cells in bladder neck and detrusor of the rats were observed. RESULTS: The nitrergic neurotransmitter in bladder neck and detrusor were obviously decreased in rats with unstable bladder. The electroacupuncture treatment could significantly increase the contains of NOS in bladder tissue. CONCLUSION: To promote the synthesis and secretion of nitrergic neurotransmitter in bladder tissue may be one of the mechanisms of acupuncture in adjusting bladder function.