Neuromyelitis optica spectrum disorders / 中华神经科杂志

Neuromyelitis optica spectrum disorders (NMOSD) is an immune mediated inflammatory demyelinating disease of the central nervous system. Optic neuritis and longitudinally extensive transverse myelitis are the main clinical signs, and the etiology is mainly related to aquaporin 4 (AQP4) antibody. AQP4 is the target antigen of immune attack. NMOSD is characterized by optic neuritis, longitudinally extended transverse myelitis, medulla area postrema syndrome, brainstem syndrome, diencephalic syndrome and cerebral syndrome. In recent years, the etiological mechanism, clinical diagnosis and monoclonal antibodies targeting new mechanisms of NMOSD have made great progress, which promoted the development of clinical neurology.

Comprehensive treatment of gastric cancer / 中华消化外科杂志

With the deep understanding of gastric cancer and the development of new technology, various comprehensive treatment modes for different stages of gastric cancer have been widely recognized. Endoscopic technology represented by endoscopic submucosal dissection is an important method for diagnosis of gastric cancer and treatment for early gastric cancer. Surgical operation is the preferred treatment for locally advanced gastric cancer, mainly including total gastrectomy, distal gastrectomy, pylorus preserving gastrectomy, proximal gastrectomy and the corresponding regional lymph node dissection. Neoadjuvant chemotherapy, adjuvant chemotherapy and hyperthermic intraperitoneal chemotherapy play important roles in preoperative and post-operative adjuvant therapy of gastric cancer, while the role of radiotherapy needs to be further observed. In recent years, targeted therapy represented by trastuzumab which is positive for human epidermal growth factor receptor-2 and immunotherapy represented by programmed death-1 inhibitors have made important progress in the treatment of gastric cancer. However, they need to be further proved to become the first-line treatment for gastric cancer. The authors believe that with more research results of gastric cancer, the comprehensive treatment of gastric cancer will be more diversified, which will make the treatment of gastric cancer individualized and accurate and finally benefit more patients.

Short-term efficacy of totally laparoscopic distal gastrectomy after endoscopic submucosal dissec-tion versus totally laparoscopic distal gastrectomy for early gastric cancer / 中华消化外科杂志

Objective:To investigate the short-term efficacy of totally laparoscopic distal gastrectomy (TLDG) after endoscopic submucosal dissection (ESD) versus direct TLDG for early gastric cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 623 patients with early gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2014 to December 2019 were collected. There were 405 males and 218 females, aged from 26 to 86 years, with a median age of 62 years. Of 623 patients, 25 cases undergoing TLDG after ESD were divided into ESD+TLDG group and 598 cases undergoing TLDG directly were divided into TLDG group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations of TLDG; (3) stratification analysis of the ESD+TLDG group. The propensity score matching was conducted by 1∶2 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range) and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 75 of 623 patients had successful matching, including 25 in the ESD+TLDG group and 50 in the TLDG group. Before propensity score matching, the body mass index (BMI), cases with tumor diameter ≤20 mm, 21 to 30 mm or>30 mm, cases with tumor classified as stage Ⅰ, stage Ⅱ or stage Ⅲ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1, 0 of the ESD+TLDG group, respectively, versus (24.3±2.7)kg/m 2, 238, 125, 235, 312, 126, 160 of the TLDG group, showing significant differences in the above indicators between the two groups ( t=2.744, Z=?2.834, ?4.209, P<0.05). After propensity score matching, the BMI, cases with tumor diameter ≤20 mm, 21 to 30 mm or >30 mm, cases with tumor classified as stage Ⅰ or stage Ⅱ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1 of the ESD+TLDG group, versus (23.6±2.9)kg/m 2, 29, 12, 9, 48, 2 of the TLDG group, showing no significant difference between the two groups ( t=1.542, Z=?0.597, 0.000, P>0.05). (2) Intraoperative and postoperative situations of TLDG: after propensity score matching, the operation time and time to postoperative drainage tube removal were 180 minutes(range, 124 to 289 minutes) and 6 days(range, 4 to 13 days) of the ESD+TLDG group,respectively,versus 170 minutes(range, 106 to 250 minutes) and 6 days (range, 4 to 9 days) of the TLDG group, showing significant differences between the two groups ( Z=-2.396, -3.039, P<0.05). Cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL, the number of lymph node dissected, duration of postoperative hospital stay, cases with perioperative complications as incision fat liquefaction, delayed gastric emptying, anastomotic bleeding or pulmonary infection were 7, 9, 9,34(range, 16 to 58), 8 days(range, 6 to 31 days), 1, 1, 0, 0 of the ESD+TLDG group,respectively,versus 18, 26, 6, 39 (range, 22 to 68), 8 days (range, 6 to 29 days), 0, 0, 1, 1 of the TLDG group, showing no significant difference between the two groups ( Z=-1.703, -1.958, -1.139, χ2=0.033, P>0.05). Cases with anastomotic bleeding were recovered after hemostasis under endoscopy and cases with other perioperative complications were recovered after conservative treatment. (3) Stratification analysis of the ESD+TLDG group. ① For 5 cases undergoing TLDG ≤14 days after ESD and 20 cases undergoing TLDG >14 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 170 to 289 minutes), 0, 3, 2, 36(range, 9 to 57), 7 days(range, 5 to 9 days), 8 days(range, 7 to 9 days), 1 and 180 minutes (range, 124 to 253 minutes), 8, 6, 6, 34(range, 8 to 78), 6 days(range, 4 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.536, ?1.993, ?0.238, ?0.932, ?0.589, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ② For 13 cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss as <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 145 to 289 minutes), 2, 6, 5, 34(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 11 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 3, 3, 34(range, 16 to 78), 6 days(range, 5 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing a significant difference in the operation time of TLDG between the two groups ( Z=?2.241, P<0.05), while showing no significant difference in the volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay between the two groups ( Z=?1.471, ?0.163, ?0.084, ?0.194, P>0.05) and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ③ For 15 cases undergoing TLDG ≤28 days after ESD and 10 cases undergoing TLDG >28 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 190 minutes (range, 145 to 289 minutes), 2, 7, 6, 33(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 31 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 2, 2, 37(range, 16 to 78), 6 days (range, 5 to 13 days), 8 days(range, 6 to 14 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.619, ?2.000, ?0.667, ?0.370, ?0.057, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). Conclusions:Compared with cases undergoing TLDG directly, the operation time to TLDG and time to drainage tube removal after TLDG for cases undergoing ESD+TLDG are prolonged, but there is no difference in the short-term efficacy. For cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, there is a significant difference in the operation time of TLDG.

Effect of the 20° trendelenburg position on hypotension during induction of general anesthesia of patients undergoing gastrectomy / 临床麻醉学杂志

Objective To explore the effect of 20°trendelenburg position on hemodynamics during induction of general anesthesia of patients under gastrectomy.Methods One hundred and eighteen patients (77 males and 41 females,aged 50-60 years,ASA physical status Ⅰ or Ⅱ),scheduled for elective radical gastrectomy,were randomly divided into group A (n=40),group B (n=38) and group C (n=40).In group A,patients were placed in the supine position during induction of anesthesia,and vasopressors was administered when hypotension occurred.In group B,patients were placed in the supine position during induction of anesthesia and was placed in the 20°trendelenburg position when hypotension occurred,and vasopressor would be administered if blood pressure was not restored.In group C,patients were placed in the 20°trendelenburg position during induction of anesthesia,and vasopressors was administered when hypotension occurred.In all groups Lactated Ringer′s was infused at 15 ml·kg-1·h-1in 30 min before induction.Anesthesia was induced with propofol 2 mg/kg,sufentanil 0.5 μg/kg,rocuronium 0.9 mg/kg.The occurrence of hypotension and the total amounts of drug administrations were doccumented.Results Nineteen patients (47.5%) in group A,fourteen patients (36.8%) in group B and six patients (15.0%) in group C developed hypotention.The incidence of hypotension in group A and B was significantly higher than that in group C (P<0.05).In all groups the total dosage of ephedrine was used.Phenylephine was only used in the group A at a dose of 26.5±0.14 μg.The amounts of drug administrations in group B and C were significantly lower than that in group A (P<0.05).Two patients in group A went into a refractory hypotensive state.However,no patients in all groups fell into a serious arrhythmia state,so atropine was not used.Conclusion The 20°trendelenburg position during induction of general anesthesia of patients during gastrectomy can prevent hypotension during induction.This position is effective in the management of hypotension after the induction of general anesthesia and can decrease the amounts of drug administrations during induction of general anesthesia.

Analysis of clinicopathologic factors affecting formation of lymphovascular invasion in 1 260 patients with gastric cancer / 中华消化外科杂志

Objective To analyze the clinicopathologic factors affecting the formation of lymphovascular invasion (LⅥ) in patients with gastric cancer.Methods The retrospective case-control study was conduted.The clinicopathologic data of 1 260 patients with gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University between January 2014 and December 2015 were collected.All the surgical specimens of patients were detected by hematoxylin-eosin (HE) stain and diagnosed by pathological experts.Stages of patients were evaluated by the seventh TNM staging system for gastric cancer of American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC).Observation indicators:(1) pathologica features:histological differentiation,invasive depth,lymph node metastasis and TNM staging;(2) follow-up situations;(3) influenced factors of the positive LⅥ:sex,age,histological differentiation,invasive depth,number of lymph node metastasis and TNM staging affecting positive LⅥ were analyzed.Follow-up using outpatient examination and telephone interview were performed to detect survival of patients up to June 2016.Univariate analysis was done using the chi-square test,and multivariate analysis was done using the trend chi-square test,and binary Logistic regression model.Results (1) Pathological features:1 260 patients with gastric cancer were diagnosed by postoperative pathological examinations,including 355 with positive LⅥ and 905 with negative LⅥ.Histological differentiation:high-differentiated tumor was detected in 13 patients,moderate-differentiated tumor in 232 patients and low-differentiated tumor in 775 patients.There were 95 patients with mucinous adenocarcinoma and 145 with signet-ring cell carcinoma.Invasive depth:tumor invasion into mucosal layer or submucosal layer (T1 stage) was detected in 242 patients,muscular layer (T2 stage) in 160 patients,gastric wall layer and no invasion into serosal layer (T3 stage) in 37 patients and subserosal layer (T4 stage) in 821 patients.Lymph node metastasis:no regional lymph node metastasis (N0 stage) was detected in 461 patients,1-2 lymph nodes metastases (N1 stage)in 164 patients,3-6 lymph nodes metastases (N2 stage) in 245 patients and more than 7 lymph nodes metastases (N3 stage) in 390 patients.TNM staging:there were respectively 191 patients in Ⅰ A stage,114 in Ⅰ B stage,62 in ⅡA stage,202 in ⅡB stage,132 in ⅢA stage,80 in ⅢB stage,476 in ⅢC stage and 3 in Ⅳ stage.(2)Follow-up situations:1 142 patients (320 with positive LⅥ and 822 with negative LⅥ) were followed up for 4.0-24.0 months,with a meidan time of 11.0 months and a follow-up rate of 90.635％ (1 142/1 260).During the follow-up,154 patients died,including 41 with positive LⅥ and 113 with negative LⅥ.(3) Influenced factors of the positive LⅥ:① results of univariate analysis showed that histological differentiation,invasive depth,number of lymph node metastasis and TNM staging were factors affecting positive LⅥ of patients with gastric cancer (X2=16.930,29.190,64.463,46.539,P＜0.05).② Results of the trend chi-square test showed that histological differentiation,invasive depth,number of lymph node metastasis and TNM staging were factors affecting positive LⅥ of patients with gastric cancer,with a linear correlation (X2 =54.883,69.130,164.618,119.594,r=0.211,0.243,0.365,0.316,P＜0.05).There was a greater correlation between number of lymph node metastasis and formation of lymphovascular invasion.③ Results of the binary Logistic regression model showed that moderate-and low-differentiated tumor and N1-N3 stage of lymph node metastasis were independent risk factors affecting positive LⅥ of patients with gastric cancer (OR=2.572,1.782,95％ confidence interval:0.495-1.494,0.386-0.781,P＜0.05).Conclusion Patients with lower tumor differentiation and / or greater number of lymph node metastasis may have a higher risk of forming LⅥ.

The key points of prevention for special surgical complications after radical operation of gastric cancer / 中华胃肠外科杂志

Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation. The key treatment of this complication is to promt diagnosis and effective hemostasis.(4) Blood supply disorder of Roux-Y intestinal loop: Main preventive principle of this complication is to pay attention to the blood supply of vascular arch in intestinal edge. (5) Anastomotic obstruction by big purse of jejunal stump: When Roux-en-Y anastomosis is performed after distal radical operation for gastric cancer, anvil is placed in the remnant stomach and anastomat from distal jejunal stump is placed to make gastrojejunal anastomosis, and the stump is closed with big purse embedding. The embedding jejunal stump may enter gastric cavity leading to internal hernia and anastomotic obstruction. We suggest that application of interruptable and interlocking suture and fixation of stump on the gastric wall can avoid the development of this complication.

Effects on pancreas islet function in patients undergoing laparoscopic myomectomy during sevoflurane and propofol anesthesia / 临床麻醉学杂志

Objective To investigate the effects on pancreas islet function in patients ubdergoing laparoscopic myomectomy during sevoflurane or propofol anesthesia.Methods Forty pa-tients,40-55 years,ASA Ⅰ or Ⅱ scheduled for elective surgery of laparoscopic myomectomy were randomly divided into two groups (n=20 each group).Propofol 2 mg/kg,sufentanil 0.5 μg/kg and rocuronium 0.9 mg/kg were used for induction,BIS was controlled between 40 and 55 during surgery.The anesthesia was maintained with sevoflurane and MAC was maintained with 0.7-1.3 in group S.The anesthesia was maintained with propofol continuous infusion and the plasma concentra-tion of target was set between 2.0 to 5.0μg/ml in group P.Blood glucose,insulin,c-peptide,gluca-gon and cortisol were measured at 3 time points:before induction of anesthesia (T0 ),start of surgery (T1 ),end of surgery(T2 ).Results Compared with T0 ,blood glucose,insulin,c-peptide,glucagon and cortisol in two groups were increased significantly at T1 and T2 (P <0.05).Compared with T1 , blood glucose,insulin,c-peptide,glucagon and cortisol in two groups were increased significantly at T2 (P <0.05).Compared with group S,blood glucose,glucagon and cortisol were increased indis-tinctively and insulin,c-peptide were increased significantly in group P at T1 and T2 (P < 0.05). Conclusion Compared with sevoflurane,propofol could promote the secretion of insulin and c-pep-tide,and inhibit cortisol and glucagon secretion,thus inhibit the rise of intraoperative blood glucose.

The clinical significance of detecting P16 protein in cervical cell block of ASCUS / 中国医师杂志

Objective Through the cell block technique to detect the expression of P16 protein in the liquid-based cytology with atypical squamous cells of undetermined significance (ASCUS) and high degree of cervical intraepithelial lesions (HSIL),to explore the significance of P16 protein in ASCUS re-evaluate.Methods Collected in our hospital in 2012 cervix liquid based cytology specimens of 45 patients,including of 15 ASCUS,11 HSIL cases,low in 11 cases of epithelial lesions (LSIL) and 2 cases of squamous cell carcinoma,2 cases of atypical glandular cells,4 cases of normal cells as a control.Immunocytochemical analysis of P16 protein control analysis,cytology and histology results.Results The expressing of P16 protein in normal cells,ASCUS,LSIL,HSIL,squamous cell carcinoma,atypical glandular cells in the positive expression rates were 0,20％,27.2％,63.6％,100％,100％.Cytology and biopsy results,cytologic diagnosis of ASCUS 15 cases,biopsy:12 cases of cervicitis,CIN Ⅱ-Ⅲ in 3 cases; cytology the in LSIL11,biopsy:5 cases of cervicitis,CIN Ⅰ 6 cases ; the cytological diagnosis HSIL11 cases,biopsy:cervical four cases of intlammation,CIN Ⅱ-Ⅲ ; cytologic diagnosis of atypical glandular cells in 2 cases,biopsy:adenocarcinoma; cytologic diagnosis of squamous cell carcinoma in 2 cases,biopsy:squamous cell carcinoma.Conclusion Detection of P16 protein on the cell block can be used for ASCUS classification ASCUS reassessment.

Cephalometry study of craniofacial growth in mixed dentition with OSAHS children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the craniofacial growth characteristics in mixed dentition of OSAHS and simple snoring (SS) children.@*METHOD@#Craniofacial morphology was studied by computerized cephalometric analysis in 24 children with OSAHS, 12 children with simple snoring and 34 healthy children.@*RESULT@#In OSAHS children, SNB (75.83 +/- 2.92) was significantly smaller than healthy children (P < 0.05), while ANB (5.83 +/- 2.76), Y axis angle (72.05 +/- 2.99), FH-MP (34.68 +/- 5.05), UI-SN (107.49 +/- 5.04) and LI-MP (98.38 +/- 5.28) were larger in comparison with healthy children (with the P values P < 0.01, P < 0.01, P < 0.01, P < 0.05 and P < 0.05, respectively). The GoGn in OSAHS children (57.20 +/- 5.64) was smaller than healthy children (P < 0. 05). In SS children, the indexes ANB (5.34 +/- 1.86), Y axis angle (67.42 +/- 4.53), FH-MP (31.62 +/- 4.60) and LI-MP (98.46 +/- 5.28) were also significantly larger than healthy children (with the P values P < 0.05, P < 0.01, P < 0.05 and P < 0.01, respectively). The GoGn in SS children (58.92 +/- 5.27) was also smaller (P < 0.05) than healthy children. All these indexes showed no significant differences between OSAHS children and SS children.@*CONCLUSION@#The effects of OSAHS and SS on craniofacial growth of children in mixed dentition include posterior displacement and shortening of mandible, heightening of anterior face and the labial inclination of maxillary central incisors and mandible central incisors. The change of breath mode was the main cause of these malformations.

Exploration on teaching reform of clinical neurology in seven-year program / 中华医学教育探索杂志

The teaching reform of education methods and course contents was carried out for seven-year program medical students in clinical neurology courses.Case-based instruction method,evidencebased medicine and standardized patient were flexibly applied,case discussion mode and multimedia teaching were added,and humanistic education was merged into teaching process.The enthusiasm and creativity of students were fully activated through the comprehensive application of various teaching meth ods,and the teaching quality of neurology course was improved,and the purpose of comprehensive quality education for the culture of long-year program medical students was better achieved.

Median effective concentration of remifentanil by TCI inhibiting cardiovascular response to placement of operating laryngoscopy performed under propofol anesthesia administered by TCI / 中华麻醉学杂志

Objective To determine the median effective concentration(EC50) of remifentanil by TCI inhibiting the cardiovascular response to the placement of operating laryngoscope performed under propofol anesthesia administered by TCI.Methods Twenty ASA Ⅰ orⅡ patients,aged 20-51 yr,weighing 52-83 kg,undergoing extirpation of vocal cord polyps under general anesthesia with remifentanil-pmpofol administered by TCI.were enrolled in the study.The target plasma concentration (Cp) of propofol was set at 4μg/ml.Operating laryngoscope was placed at 3 min after tracheal intubation.HR and MAP were continuously monitored.When HR or MAP increased by 15%,the candiovascular response was defined as positive.The EC50 was determined by up-and-down technique.The initial Cp of remifentanil was set at 5 ng/ml and was increased/decreased by 20%in the next patient if the cardiovascular response was positive or negative.Results No chest wall stiffness and intraoperative awareness occurred in all the patients.The EC50 of remifentanil TCI inhibiting the cardiovascular response to the placement of operating laryngoscope was 3.50ng/ml with confidence interval(CI) between 3.47-3.60 ng/ml.Conclusion Thee EC50 of remifentanil TCI inhibiting cardiovascular response to the placement of operating laryngoscope is 3.50ng/ml with CI between 3.47-3.60ng/ml.

The rapetic analysis of 48 cases with subcutanous fistula excision to long-path low anus fistula / 中国基层医药

Objective To investigate the clinical effects of subeutanous fistula excision for the long-path low anus fistula.Methods Operation for long-path low anus fistula,fistula length＞5cm,divided the pafients into two groups.The therapeutic group:using subcutanous fistula excision;the control group:using fistula icision.Comparing the healing time,arIus malformation,recurrence rate.Results Therapeutic group 47 cases heal,the healing time was 12 days;no anus malformation;no arms ineontenience.In the control group,the healing time was 23 days;anus malformation 23 cases;anus gas incontenience 12 cases.Conclusion To use subcutanous fistula excision for the longpath low anus fistula has the advantages of short healing time,no anus malformation,less pain,and low reccurrent rate.

Radiofrequency aviation treatment for lingual root obstructive sleep apnea-hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To treat OSAHS with radiofrequency ablation and evaluate the effect.@*METHOD@#Thirty four patients with mild and median OSAHS were treated with functional endoscopic sinus surgery, UPPP and RFA. The follow up time was 1 year. PSG was used for diagnosis and evaluation of pre- and post-operation.@*RESULT@#AHI of 34 patients reduced from (20.74 +/- 12.23)/h to (12.23 +/- 8.31)/h (P < 0.01). Effective rate was 85.29%.@*CONCLUSION@#RFA is an effective, safe and simple assistant therapy for OSAHS.

Vertigo:an etiological analysis of 200 patients in department of neurology of polyclinic / 中华神经科杂志

Objective To discuss the causes of diseases presenting vertigo as a chief complaint in patients in department of neurology of polyclinic and to compare the clinical features of these disease in order to draw the attention of the physicians to benign paroxysmal positional vertigo(BPPV)and posterior circulation ischenmia(PCI).Methods Prospective clinical study was carried out.Followed up outpatients (135)and inpatients(65)with a chief complaint of vertigo were followed up in the department of neurology, the second affiliated hospital of Harbin Medical University.Thorough history, especially the timing and duration of vertigo, provoking and aggravating factors, symptoms associated and risk factors for cerebrovascular were obtained.Physical examinations with special attention to neurologic systems and Dix- Hallpike maneuver were performed.Based on the history, the physical examination, Dix-Hallpike maneuver and special techniques, the diagnoses of 200 patients with vertigo was made.Two weeks after each patient' s first consultation, a follow-up was made.Results The main diagnoses for these 200 patients were BPPV (56.0%), PCI(21.5%), neurosis(13.0%), M?ni?re' s disease(2.5%), multiple sclerosis (1.0%), probably cervical disease(1.0%), acoustic neuroma(1.0%), labyrinthine apoplexy(1.0%), brainstem hemorrhage(0.5%), vestibular neuronitis(0.5%), cerebellum cyst(0.5%), unknown causes (1.5%).Such clinical features of the diseases with vertigo, as age, vertigo duration, and provoking factors, associated symptoms, risk factors, the physical examinations, the treatment and so on were summed up.Conclusions Presentations of vertigo can be clinically diagnosed in most cases, with a larger number of patients suffering from BPPV.Combination of these prominent clinical features may guide the general physicians to the likely causes of vertigo.

Associated cell-mediated immune mechanisms of experimental autoimmune neuritis / 中华神经科杂志

Objective To establish P2 or P0 peptide-induced experimental autoimmune neuritis (EAN)in the Lewis rats and to explore the optimal type and doses of antigen inoculated to induce EAN and the associated cell-mediated immune mechanisms.Methods Lewis rats were classified into EAN and control groups.The EAN rats were immunized by injection into both hind footpads of inoculums containing 100 or 200 ?g of P2_(57-81)peptide or 200?g of P0_(180-199)peptide and Freund's complete adjuvant(FCA),and the control rats were immunized with FCA only.Clinical scores were compared when they were at peak time of paralysis.Lymphocyte proliferation assay,the ratio of CD_4~+ T cells to lymphatic monocytes and percentage of CD_4~+ CD_(25)~+ T cells to CD_4~+ T cells obtained on day 14 post-immunization were examined.Histopathalogical assessment of sciatic nerves was made.Results Peak clinical scores of P2_(57-81)200 ?g group were dramatically higher than those in P2_(57-81)100 ?g group and P0_(180-199)200 ?g group(both P

Immunological effects of 1,25-dihydroxyvitamin D_3 on experimental allergic encephalomyelitis in Lewis rats / 中华神经科杂志

Objective To study the effects of 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) on experimental allergic encephalomyelitis (EAE) and its immune-modulating mechanisms. Methods 1,25-(OH)2D3 were given to Lewis rats immunized with myelin basic protein (MBP) in complete Freud’s adjuvant (CFA) respectively on the same day of immunization (the prevented group) and the presenting day of symptoms (the treated group). Then clinical symptoms were scored until the 13th day after immunization, when rats were sacrificed. Mononuclear cells (MNC) in draining lymph nodes were collected for the following studies: (1)Total number of MNC in the lymph nodes were counted. (2) Numbers of CD~+4CD~+ 25 cells and CD~+ 86 cells were determinated by flow cytometry. (3) The concentrations of interferon(IFN)-? and interleukin(IL)-4 in cell culture supernatant were measured by enzyme-linked immuno sorbent assay (ELISA). Results 1,25-(OH)2D3 could delay the peak EAE severity in the prevented group while it could relieve the progression of EAE and lower the peak score in the treated group (3.3?0.6 vs 4.0?0.3, P

Study of Bilingual teaching in Neurology for Seven-year Medical Master / 中华医学教育探索杂志

We investigated the students of a seven-year medical master in the bilingual teaching program in Neurology with a questionnaire.We found that the bilingual teaching program has the following problems:the students don't have a solid foundation of medical English terminology and the content of the English teaching was higher than the ability of the students.So we think that we need to impress upon the students the importance of the program.We can also raise the overall quality of this program through an improvement of teaching methods,regulation of the proportion of English content in all courses and suitable midterm and final examinations.These alterations will effectively improve the bilingual teaching program.

Language Disorders in Patients with PerventricularInfarction / 中国临床心理学杂志

Objective:To study the characteristics and mechanisms of language disorders in predominant periventricular lesion.Methods: 40 Patients with periventricular infarction were assessed on the Aphasia Battery in Chinese (ABC), results were analyzed to determine the relationship between neuroiconography and speech function. Results: lesion of anterial lateral ventricle led to acute mutism, limited spontaneous speech, and disorder of speech initiation. Lesion near medial lateral paraventricle led to aphemia. All these lesions are usually associated with stuttering. Conclusion: The white matter anteromedial lateral paraventricular is an important part in the automatic processes that involved in speech production. Different lesions of these regions may result in different language disorders.

Prophylactic effects of nasal tolerance with dual analogue on experimental autoimmune myasthenia gravis in lewis rats / 中华神经科杂志

Objective To study the prophylactic effects of nasal tolerance with a dual analogue (Lys262-Ala207) on experimental autoimmune myasthenia gravis (EAMG) and observe the underlying mechanisms, the clinical and immunological changes in Lewis rats treated with dual analogue nasally. Methods The effects of the predetermined dosage of a dual analogue Lys262-Ala207 were compared at different time points, and the dual analogues or control peptides were given nasally before (Group A or CA) or on the day (Group B or CB) of immunization with acetylcholine receptor (AChR) in complete Freund's adjuvant for 10 consecutive days. The clinical scores were evaluated for 50 days after immunization. The levels of anti-AChR IgG in serum were tested by RIA. Proliferative responses of lymphocytes to no antigen, Lys262-Ala207, AChR, AChR-?100-116, MBP peptide, or Con A were tested. The numbers of mononuclear cells expressing CD4 and/or CD25 from lymph nodes were enumerated using flow cytometry. Results As compared with the corresponding control groups, Lewis rats in group A or B developed EAMG with reduced severity and loss of AChR within the neuromuscular junction. The levels of anti-AChR IgG (21.96?3.37 and 29.41?4.59) were also decreased. Proliferative responses were suppressed in response to antigen-specific stimulations in rats receiving dual analogue, whereas the numbers of CD4+CD25+ T cells were higher in group A (11.34%?1.62%) and B (8.68%?1.83%) than in their corresponding control groups. Conclusions Nasal administration with a dual analogue Lys262-Ala207, at two different time points before and on the day of immunization ameliorated muscular weakness in EAMG rats associated with decreased levels of anti-AChR IgG in serum, suppressed antigen-specific T cell proliferation and increased numbers of CD4+CD25+ T cells from lymph nodes as compared to rats receiving control peptides. The results of our study suggest that the mucosal tolerance with dual analogue should be served as an alternative maneuver in human MG.

Effect of Ceftriaxone on glutamate-induced cerebral cortical neurocyte injury / 临床神经病学杂志

Objective To study the effect of Ceftriaxone on glutamate-induced neurocyte injury. Methods Cultured rat cerebral cortical neurocytes were divided into Ceftriaxone (A)group, glutamate(B) group ,Ceftriaxone-pretreated (C) group and control (D) group. Observe morphous and MTT colorimetry were used to detect cytoactive. Laser scanning confocal microscope was used to measure the change of Ca2+ in rest state and after brief glutamate-induced Ca2+ loading. RT-PCR was used to determine the change of GLT1 mRNA expression.Results Compared with B group, cellular morphous was closer to normal in C group. Absorptance values of groups A,B,C,D were 0.795?0.010, 0.624?0.028, 0.738?0.021 and 0.813?0.023, respectively, which there were lower in groups B and C compared with group D, but absorptance value was higher in group C than that in group B(allP