Value of BISAP score combined with red blood cell distribution width for the severity of acute pancreatitis / 中国现代普通外科进展

Objective:To investigate the bedside index for severity in acute pancreatitis(BISAP) score combined with red cell distribution width (red cell distribution width,RDW) on acute pancreatitis (AP) and early assessment of the severity of value.Methods:385 patients with acute pancreatitis were collected from October 2015 to November 2017 in our hospital,according to the severity of the disease were divided into mild group (MAP),moderately severe group (MSAP) and severe group (SAP),patients admitted to hospital within 24h,blood urea nitrogen,blood glucose,blood examination,collection of red blood cells in parallel the BISAP score distribution width,using analysis of variance statistical differences between three groups of data,and draw the RDW combined with BISAP score in predicting the progression of AP receiver operating characteristic curve analysis and its predictive value.Results:Mild group,moderately severe group,severe BISAP score and red blood cell distribution 0width increased sequentially.There was a significant difference in RDW and BISAP scores between the three groups (P＜0.05),and RDW was positively correlated with BISAP score (r=0.384,P＜0.01).The area under the curve of BISAP score,RDW combined with BISAP score for predicting AP disease was 0.879 and 0.894 respectively,and the sensitivity was 77.3％,95.5％,and the specificity was 85.3％ and 76.5％.Conclusion:With the aggravation of AP patients,both the BISAP score and the RDW increase.The combination of the two is helpful to predict the patient's condition.

Endoscopic hematoma evacuation and soft channel drainage for hypertensive intracerebral hemorrhage / 中国内镜杂志

Objective?To compare the clinical efficacy and prognosis of neural endoscopic intracranial hematoma evacuation (NEIHE) and soft channel puncture drainage (SCPD) in treatment of hypertensive intracerebral hemorrhage (HICH).?Methods?106 HICH cases from January 2015 to December 2016 were divided into endoscopic group (51 cases, NEIHE scheme) and drainage group (55 cases, SCPD scheme) according to random number, operation and complications indicators were recorded, variations on peripheral inflammatory factors and NIHSS neurological deficit score were compared, meanwhile, clinical efficacies were determined.?Results?Though the endoscopic group with operative time (108.5 ± 33.8 vs 85.8 ± 25.4) min and intraoperative blood loss (54.2 ± 17.7 vs 42.6 ± 14.5) ml were significantly higher than drainage group (P < 0.05), the endoscopic group associated with a higher hematoma clearance 48 h post operation (85.8 ± 7.8 vs 74.7 ± 9.2) % (P < 0.05) and lower overall complication rate (13.7% vs 29.1%) (P < 0.05). After 14 d, the endoscopic group with the decreased value of peripheral blood TNF-α (129.5 ± 33.7 vs 107.8 ± 29.5) pg/ml, IL-6 (74.3 ± 22.8 vs 56.7 ± 18.2) pg/ml, hs-CRP (32.6 ± 7.5 vs 27.2 ± 6.6) mg/L were all significantly higher than the drainage group (P < 0.05). After 14 d, endoscopic group with decreased value of NIHSS score was significantly higher than the drainage group (13.0 ± 3.8 vs 10.3 ± 3.5) (P < 0.05). 6 months after operation, the increased Barthel index in the survivors of endoscopic group was significantly higher than the drainage group (44.8 ± 9.7 vs 39.5 ± 11.2) (P < 0.05).?Conclusion?Though the NEIHE is more complicated than SCPD in treatment of HICH, the hematoma clearance is more complete, the complications are less, and the short-term efficacy and prognosis with obvious advantages.

Clinical efficacy of Tianmeng Capsule combined with paroxetine in treatment of menopausal women with generalized anxiety disorder / 中草药

Objective: To study the effect of Tianmeng Capsule combined with paroxetine in the treatment of menopausal women with generalized anxiety disorder (GAD) and its mechanism of the reaction with oxidative stress. Methods: Totally 120 cases of menopausal patients with GAD, without the use of estrogen replacement therapy, were randomly divided into control group and observation group of 60 cases, the control group were treated with paroxetine, the observation group were additionally treated with Tianmeng Capsule, then the clinical effects were compared. Results: The Hamilton anxiety scale (HAMA) scores and Pittsburgh sleep quality index scale (PSQI) scores were significantly decreased in two groups and the indexes in the observation group were lower than control group (P < 0.05). The total effective rate in the observation group was significantly better than that of the control group (P < 0.05 ). There were no obvious adverse drug reactions in the two groups. The serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) levels had no significant difference between two groups after treatment. The serum superoxide dismutase (SOD) levels increased, and malondialdehyde (MDA) levels decreased in the observation group (P < 0.05). Conclusion: It is safe and effective to treat GAD patients with Tianmeng Capsule, which may not improve the level of hormone but related to oxidative stress.

Clinical Observation of Sitagliptin Combined with Benazepril in the Treatment of Diabetic Nephropathy / 中国药房

OBJECTIVE:To observe the clinical efficacy of sitagliptin combined with benazepril in the treatment of diabetic nephropathy(DN). METHODS:Sixty DN patients admitted to our hospital during Sept. 2014-Jun. 2015 were divided into sitagliptin group,benazepril group,drug combination group according to random number table,with 20 cases in each group. Based on routine treatment,sitagliptin group was given sitagliptin 100 mg orally,qd;benazepril group was given Benazepril 10 mg orally,qd;drug combination group was given sitagliptin 100 mg+benazepril 10 mg orally,qd. The drug dosage would be doubled if the blood pressure of patients in 3 groups had not yet reached the standard. Treatment course of 3 groups lasted for 12 weeks. The levels of 24 h urine protein,IL-6 and Cys-C were measured in 3 groups before and after treatment. Clinical efficacies and the occurrence of ADR were observed. RESULTS:Total response rate of drug combination group(90.00%)was significantly higher than those of sitagliptin group (65.00%)and benazepril group(70.00%);there was statistically significance(P0.05). No obvious ADR was found in 3 groups during treatment. CONCLUSIONS:Both sitagliptin and benazepril can decrease the levels of 24 h urine protein,IL-6 and Cys-C,while drug combination shows better effect and clinical response rate,and does not influence the safety of drug use.

Comparison of neuroendoscopic and microscopic endonasal transsphenoidal pituitary adenoma resection and effects on hormone levels / 中国内镜杂志

Objective To compare the efficacy of neuroendoscopic vs microscopic endonasal transsphenoidal pituitary adenoma resection and effects on hormone levels and clinical symptoms. Methods A retrospective analysis was conducted on 211 cases with pituitary tumor resection patients from January 2012 to June 2016, of which 112 cases with endoscopic endonasal transsphenoidal pituitary tumor resection (group A), 99 cases with microscopic transsphenoidal pituitary tumor resection (group B), and operation related indexes, hormone variations before discharge and symptoms remission 24 weeks after operation were extracted and compared. Results Two groups of patients with different tumor resection extent (Z = 2.14, P = 0.032), group A achieved total resection rate was significantly higher than the group B (79.5% vs 67.7%) (P = 0.037); the operation time of group A was significantly longer than group B [(93.6 ± 26.7) vs (79.8 ± 20.2) min, t = 4.26, P = 0.000], group A with the mean hospitalization stay was significantly less than group B [(7.9 ± 2.5) vs (10.2 ± 4.3) d, t = 4.67, P = 0.000], postoperative complications of group A were significantly lower than those of group B (5.4% vs 14.1%, χ2 = 4.73, P = 0.030). Two groups of postoperative hormone levels decreased in different degree (Z = 2.42, P = 0.016), group A with hormone recovery rate before discharge was significantly higher than group B (82.2% vs 66.7%, χ2 = 6.09, P = 0.014), and decline on prolactinomas, ACTH adenoma, ghrelin hormone were significantly higher than group B [(43.2 ± 10.5) vs (33.5 ± 9.1) ng/ml, (26.0 ± 8.8) vs (20.2 ± 7.0) pmol/L, (11.0 ± 3.9) vs (8.7 ± 3.2) μg/L, t = 3.60, t = 2.65, t = 2.12, all P < 0.05]. There was no significant differences between the two groups in remission of clinical symptoms 24 weeks after operation (P > 0.05). Conclusion Neuroendoscopic endonasal transsphenoidal pituitary adenoma resection is more efficient and less operative complications compared with microscopic surgery, which is more conducive to the recovery of postoperative hormone levels.

Clinicopathological analysis of endoscopic submucosal dissection for esophageal mucosa lesion / 中国内镜杂志

Objective To analyze the endoscopic and clinicopathologic features of early esopheal carcinoma and precancerous lesions and evaluate the necessity, efficacy and safety of ESD in the treatment. Methods From May 2013 to April 2016, 51 consecutive patients underwent high-resolution video endoscopy and biopsy, confirmed diagnosis of early esophageal squamous cell carcinoma or intraepithelial neoplasia were included. There were capillary loops (IPCL), iodine-staining, preoperative and postoperative pathology, and complications to analyze. Results 51 patients had total 58 lesions, Type A, Type B1, Type B2 of IPCL classification were diagnosed in 8 (13.79%), 44 (75.86%), 6 (10.34%). Low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early esophageal carcinoma of preoperative biopsy were diagnosed in 11 (18.97%), 42 (72.41%), 5 (8.62%), low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early esophageal carcinoma of postoperative pathology results were diagnosed in 10 (17.54%), 27 (46.55%), 21 (36.21%), concordance rate of pathological results were 60.34%. Complications included micro-perforations (0.00%), strictures (8.62%) and delayed hemorrhage (3.51%), respectively. Conclusion After endoscopic submucosal dissection, detection rate of early esophageal cancer increased significantly, preoperative biopsy had guidance significance in diagnosis and treatment, ESD treatment can reduce the missed diagnosis of early esophageal carcinoma.

Clinicopathological analysis of endoscopic submucosal dissection for esophageal mucosa lesion / 中国内镜杂志

Objective To analyze the endoscopic and clinicopathologic features of early esopheal carcinoma and precancerous lesions and evaluate the necessity, efficacy and safety of ESD in the treatment. Methods From May 2013 to April 2016, 51 consecutive patients underwent high-resolution video endoscopy and biopsy, confirmed diagnosis of early esophageal squamous cell carcinoma or intraepithelial neoplasia were included. There were capillary loops (IPCL), iodine-staining, preoperative and postoperative pathology, and complications to analyze. Results 51 patients had total 58 lesions, Type A, Type B1, Type B2 of IPCL classification were diagnosed in 8 (13.79%), 44 (75.86%), 6 (10.34%). Low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early esophageal carcinoma of preoperative biopsy were diagnosed in 11 (18.97%), 42 (72.41%), 5 (8.62%), low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early esophageal carcinoma of postoperative pathology results were diagnosed in 10 (17.54%), 27 (46.55%), 21 (36.21%), concordance rate of pathological results were 60.34%. Complications included micro-perforations (0.00%), strictures (8.62%) and delayed hemorrhage (3.51%), respectively. Conclusion After endoscopic submucosal dissection, detection rate of early esophageal cancer increased significantly, preoperative biopsy had guidance significance in diagnosis and treatment, ESD treatment can reduce the missed diagnosis of early esophageal carcinoma.

Antioxidating and energy metabolism improving effects of Qiangjing Decoction on oligospermia and asthenospermia: An experimental study / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the mechanisms of Qianjing Decoction in the treatment of oligoasthenospermia (OAS).</p><p><b>METHODS</b>We randomly divided 100 SPF male rats into five groups of equal number: normal, model, Huangjingzanyu, levocarnitine, and Qiangjing. OAS models were established in the animals followed by intragastrical administration of normal saline, ornidazole, Huangjingzanyu Capsules (200 mg per kg body weight per day), levocarnitine (100 mg per kg body weight per day), and Qianjing Decoction (10 g per kg body weight per day), respectively, qd, for 4 successive weeks. Then, we detected the concentration and motility of the epididymal sperm, obtained the contents of superoxide dismutase (SOD), malonaldehyde (MDA), glutathione peroxidase (GSH-Px), lactate dehydrogenase (LDH), α-glucosidase, and fructose in the epididymis, and determined the mRNA expressions of nuclear factor erythroid 2-related factor 2 (Nrf2) and succinate dehydrogenase (SDH) in the epididymal tissue of the rats by real-time PCR.</p><p><b>RESULTS</b>The concentration and motility of the epididymal sperm in the model, Huangjingzanyu, levocarnitine, and Qianging groups were (35.34 ± 4.22) x 10(6)/ml and (40.04 ± 7.05)%, (48.12 ± 5.56) x 10(6)/ml and (62.46 ± 7.12)%, (47.14 ± 4.87) x 10(6)/ml and (63.23 ± 6.34)%, and (50.25 ± 5.08) x 10(6)/ml and (66.34 ± 7.58)%, respectively, all significantly lower than in the normal group ([53.05 ± 4.55] x 10(6)/ml and [70.20 ± 8.54]%) (P < 0.05), but remarkably higher in the Huangjingzanyu, levocarnitine, and Qiangjing groups than in the model rats (P < 0.05). Compared with the thinned epididymal lumen walls, decreased sperm count, and disorderly and loose arrangement of the lumens in the OAS models, the rats in the Huangjingzanyu, levocarnitine, and Qiangjing groups showed evidently thicker epididymal lumen walls, with the lumens full of sperm cells and arranged regularly and compactly, similar to those of the normal rats. The levels of SOD and GSH-Px were significantly lower but that of MDA markedly higher in the model rats ([84.12 ± 23.25], [10.56 ± 3.02], and [14.04 ± 2.06] nmol/mg) than in the normal group ([110.04 ± 19.56], [17.25 ± 3.56], and [8.87 ± 1.35] nmol/mg) (P < 0.05), while the former two indexes remarkably higher and the latter one significantly lower in the animals treated with Qiangjing Decoction ([120.56 ± 23.68], [16.34 ± 3.12], and [8.45 ± 1.56] nmol/mg), Huangjingzanyu Capsules ([115.34 ± 21.35], [15.23 ± 3.67], and [8.33 ± 1.54] nmol/mg), and levocarnitine ([116.67 ± 22.67], [15.35 ± 3.45], and [8.05 ± 1.78] nmol/mg) than in the models (P < 0.05). The levels of fructose, LDH and α-glucosidase were decreased markedly in the OAS models ([100.22 ± 12.12] mg/[ ml x g], [322 ± 46.13] U/[ ml x g], and [10.48 ± 2.33] U/[ml x g]) as compared with the normal rats ([128.12 ± 13.45] mg/[ml x g], [428 ± 35.12] U/[ml x g], and [15.34 ± 3.12] U/[ ml x g]) (P < 0.05), remarkably higher in the rats treated with Qiangjing ([130.23 ± 13.67] mg/[ml x g] [455 ± 51.50] U/[ml x g], and [18.56 ± 4.67] U/[ml x g]), Huangjingzanyu ([124.16 ± 14.02] mg/[ml x g], [ 419 ± 43.14] U/[ml x g], and [17.64 ± 4.08] U/[ml x g]), and levocarnitine ([123.34 ± 14.02] mg/[ml x g], [430 ± 31.80] U/ [ml x g], and [16.85 ± 5.55] U/[ml x g]) than in the models (P < 0.05). The Nrf2 mRNA expression was significantly reduced in the models as compared with the normal rats (P < 0.05) but remarkably increased in the Huangingzanyu, Qiangjing and levocarnitine groups as compared with the model and normal animals (P < 0.05). The SDH mRNA expression was significantly lower in the model than in the normal rats (P < 0.05) but markedly elevated in the Huangjingzanyu, Qiangjing and levocarnitine groups as compared with the model and normal animals (P < 0.05), remarkably higher in the Qiangjing than in the Huangjingzanyu group (P < 0.05).</p><p><b>CONCLUSION</b>Ornidazole induces OAS in rats, which is closely associated with excessive oxidation and energy metabolism dysfunction. Qiangjing Decoction can improve and even reverse ornidazole-induced OAS in rats as well as improve the ultrastructure of their testicular and epididymal tissues. Antioxidation and improvement of energy metabolism are probably the action mechanisms of Qiangjing Decoction in the treatment of OAS.</p>

Study on diagnosis criteria of fire-heat syndrome based on receiver operating characteristic curve and principal component analysis / 中国结合医学杂志

<p><b>OBJECTIVE</b>To establish the diagnostic quantitative criteria for fire-heat syndrome (FHS) of Chinese medicine (CM) based on the receiver operating characteristic (ROC) curve and principal component analysis (PCA).</p><p><b>METHODS</b>The symptoms and signs of FHS cases and healthy subjects from Guangzhou, Henan and Hunan of China were collected through questionnaire, and the diagnostic quantitative score tables were established for the three regions, respectively, with the method of maximum likelihood analysis. The homogeneity test was then performed on the diagnostic score tables for the three regions with ROC curve, and the diagnostic efficiency of diagnostic score tables for the three regions was compared with the prospective test and retrospective test. The method of PCA was adopted to obtain the analysis matrix for classifying the tapes of FHS.</p><p><b>RESULTS</b>Twenty-seven elements of FHS were confirmed through Chi-square test, and the diagnostic score tables for the three regions were established with the method of maximum likelihood analysis on the basis of the collected case data. According to the ROC curve test, the areas under ROC curve of Guangzhou diagnostic score table assessment with candidates in Guangzhou, Henan and Hunan were 0.998, 0.961 and 0.956, respectively. It showed that the diagnostic efficiency of Guangzhou diagnostic score tables was the highest one. With the prospective test, the area under ROC of Guangzhou diagnostic score table was 0.949, and more than any other diagnostic score table. By PCA, FHS was classified into excess fire and deficiency fire, and then classified into syndrome of flaring up of Heart (Xin) fire, syndrome of Lung (Fei)-Stomach (Wei) excess fire, syndrome of deficiency of Liver (Gan)-yin and Kidney (Shen)-yin, and syndrome of deficiency of Lung-yin from the view of viscera. In the retrospective test, the consistency with clinicians' diagnosis was 69.4%, and in the prospective test, it was 70.1%.</p><p><b>CONCLUSIONS</b>The Guangzhou diagnostic score table could be used as the recommended criteria for the diagnosis of FHS. The classification of FHS was basically in conformity with the clinical situation.</p>

Regression analysis on influence factors of orthokeratology controlling juvenile myopia progression / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM:To explore the influence factors of orthokeratology controlling development of juvenile myopia. ?Methods: A retrospective analysis of 86 cases ( 169 eyes ) who performed orthokeratology from November 2012 to November 2013 in our hospital was carried out. Ater 2a treatment, diopter increased > -0. 25D as invalid control group (54 eyes), diopter increased ≤ -0. 25D as effective control group ( 115 eyes ) . The difference of various factors between two groups were compared. ?RESULTS: Univariate comparison showed that the two groups had no statistical significance (P>0. 05) in terms of gender, whether wear glasses in the past, anterior corneal diameter before treatment, central corneal thickness, intraocular pressure and anterior chamber depth. However, the two groups had statistical significance (P ? CONCLUSlON: lndependent factors affecting orthokeratology control juvenile myopia development is foundation axial length, age and corneal curvature. For juvenile patients, the longer of foundation axial length, the longer the age, the greater the curvature of cornea, orthokeratology can better control the myopia’s development.

The expression and significance of decorin in chronic rejection of liver transplantion / 国际外科学杂志

Objective To investigate expression and significance of decorin(DCN)in liver tissue and serum of liver transplant patients with chronic rejection(CR).Methods Immunohistochemistry(SP method)was used to detect expression of DCN in liver tissue of 16 normal controls, 20 patients with cirrhosis, 46 liver translantion patients without CR and 8 patients with CR.Enzyme-linked immunosorbent assay method(ELISA method)was used to determined the content of DCN in serum of all research subjects.Results The expression of DCN was negative in normal hepatic tissues and with/without CR, cirrhosis tissues showed strong expression of DCN.The positive expression rate and the average optical density value of DCN in liver transplant tissues with CR had significant difference comparing with Cirrhosis tissues(25% vs 55%, 0.1249 ±0.0039 vs 0.2357 ±0.0396, P <0.01,while no statistic siqnificance compared to normal liver tissues and those without CR.The level of DCN in serum was significantly higher in liver transplant patients with CR, with significant difference comparing with normal people, liver cirrhosis and transplant liver patients without CR(54.0833 ± 6.0325)μg/L vs(1.0232 ± 0.9105)μg/L,(12.6202 ± 1.5370)μg/L,(17.7102 ± 2.3562)μg/L, P < 0.01).The concentration of DCN in serum showed a positive correlation with the degree of CR.Conclusions DCN showed negative expression in liver tissue and increased significantly in serum of liver transplantation patients with CR.This suggests that DCN may be involved in occurrence and development of CR.At the same time the determination of DCN in serum maybe become an important indicator of the early diagnosis, development and prognosis of CR for liver transplant patients.

Research on the Policy of Standardized Training Program for the Fundamental Medical Practitioners / 中华医学教育探索杂志

It is crucial to improve the health care quality during the progress of constructing the new health care system in both urban and rural area.On the condition of increasing government commonweal investment for the basic health care,the standardized training program for the district medical practitioners will become the pivotal step to improve district health care in urban and rural area,standardize medical service,reduce the medical cost and optimize the accessibility to medical care for the mass.Taking the consideration on the personal resource of district medical service in the urban and rural area in China,certain strategic proposals related to the standardized training program for the fundamental medical practitioners are discussed.

Relationship between the morphological and functional alterations of pancreatic islets and peripheral insulin resistance in rats with long-term high-fat diet / 中华内分泌代谢杂志

Objective To investigate the effect of long-term high-fat diet on insulin resistance and the morphology and function of islets in rats and the relationship between them.Methods Thirty normal male Wistar rats (8 weeks old) were divided into two groups and fed either with normal chow (NC,n=15),or high-caloric and high-fat diet (HF,n=15).Insulin resistance was assessed by euglycemic hyperinsulinemic clamp technique. The insulin secretory function of islets was evaluated by intravenous insulin releasing test.Morphological and quantitative analysis of pancreatic tissues was performed by double-label insulin and glucagon immunohistochemistry.Proinsulin mRNA was detected by RT-PCR.Results The glucose infusion rate (GIR) in HF rats was significandy lower than that in NC rats [(5.83?0.79)mg?kg~(-1)?min~(-1) vs (7.60?1.29)mg?kg~(-1)?min~(-1),P＜0.05].Immunohistochemistry showed that HF rats had larger islet size [(15168?1327)?m~2 vs (6264?1840)?m~2,P＜0.01] and significantly reduced insulin relative concentration of?cells[(-5.15?0.03) vs (-4.81?0.17),P＜0.01],as compared with NC rats.The islet relative?cell volume was decreased signifieandy (P＜0.01),whereas the relative?cell volume was increased (P＜0.01).So the ratio of?to?were lower in HF [(4.68?1.01) vs (11.84?3.82),P＜0.05].The peak of insulin secretion in intravenous insulin releasing test in HF was at 10 min,whereas that in NC rats was at 5 min.AUC (area under curve) 10-60 rain of insulin in HF was higher than that in NC rats [(152.51?34.53)mIU?L~(-1)?min~(-1) vs (86.40?21.21) mIU?L~(-1)?min~(-1),P＜0.01].There was no difference in proinsulin mRNA levels between two groups. Conclusion Long-term high-caloric and high-fat diet results in early impairment of islet morphology and function, as well as significant insulin resistance,suggesting that the compensation ability of islets has already been impaired in the early course of type 2 diabetes mellitus.