Transcutaneous Electrical Acupoint Stimulation Combined with Warm Acupuncture for Breast Cancer Related Upper Limb Lymphedema: A Retrospective Cohort Study / 中国结合医学杂志

OBJECTIVE@#To observe the clinical efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with warm acupuncture in treating breast cancer associated with upper limb lymphedema (BCRL).@*METHODS@#This was a retrospective cohort study using a paired control design. Fifty-two BCRL patients were assigned to the control group (27 cases) and the treatment group (25 cases). The patients in the control group were treated with lymphedema comprehensive detumescence treatment (CDT) for 4 weeks, including systematic therapy composed of manual lymphatic drainage, compression bandage, skincare, and functional exercise. The patients in the treatment group were treated with TEAS combined with warm acupuncture based on the control group methods. Each treatment lasted for 30 min and was applied twice a week for 4 weeks. The arm circumference (AC) of different positions of the affected limb and the degree of swelling of the affected limb were evaluated before the first treatment and after the last treatment. The clinical efficacy was evaluated according to the degree of edema before and after treatment. All adverse events during treatment were recorded.@*RESULTS@#The patients' AC and the swelling feeling of the affected limb in the treatment group and the control group were both reduced compared with those before treatment. Compared with the control group, AC of the wrist joint transverse stria, the midpoint between the wrist joint transverse stria and the elbow joint transverse stria in the treatment group were significantly reduced (P<0.05). The decrease in AC diameter at the midpoint between the elbow joint transverse stria and the axillary transverse stria was the most significant (P<0.01). The swelling degree of the affected limbs in the treatment group was significantly lower than before treatment, and was significantly lower compared with the control group after treatment (P<0.01). The total effective rate was 72% in the treatment group, significantly higher than that in the control group (55.56%, P<0.05). No serious adverse events occured in either group.@*CONCLUSIONS@#TEAS combined with warm acupuncture can effectively reduce AC and swelling feeling of the affected limb in patients with BCRL. The effect is better than that of CDT therapy alone. (Registration No. ChiCTR2200062075).

Narrow band imaging for the evaluation of short-term effect of radiotherapy on esophageal carcinoma / 医学研究生学报

Objective The purpose of this study was to investigate the value of narrow band imaging (NBI) in evaluating the short-term effect of radiotherapy on esophageal carcinoma.Methods This study included 86 patients with esophageal squamous carcinoma treated in the Department of Oncology of Jiangyin People's Hospital from December 2013 to December 2016. All the patients underwent NBI, barium meal examination (BME) and CT scanning before and after radiotherapy. We compared the lesion contour sharpness shown by conventional endoscopy with that by NBI, analyzed the consistency between the two standards in evaluating the short-term effect of radiotherapy, and assessed the influence of NBI-based lesion grades on the prognosis of esophageal carcinoma, followed by a multivariate regression analysis of the prognostic factors with a Cox model.Results The total score on the lesion contour sharpness by NBI was significantly higher than that by conventional endoscopy (249 vs 195, P<0.05), and a significant consistency was found between the two standards in evaluating the short-term effect of radiotherapy (Kappa=0.772, P=0.000). Both the 3-year overall survival and 3-year progress-free survival rates were remarkably higher in the patients with NBI-based grades Ⅲ+Ⅳ than in those with grades Ⅰ+Ⅱ lesion (71.9% vs 37.5%, P<0.05; 58.1% vs 24.9%, P<0.05). Clinical stages (HR=1.63, 95% CI: 1.14-2.66) and NBI-based lesion grades (HR=1.42, 95% CI: 1.13-1.72) were independent prognostic factors for both the 3-year overall survival (P<0.05) and 3-year progress-free survival (P<0.05) of the esophageal carcinoma patients.Conclusion NBI presents a higher lesion contour sharpness of esophageal carcinoma than conventional endoscopy, NBI-based lesion grading has a significant value in the prognosis of esophageal carcinoma, and NBI combined with BME and CT can effectively evaluate the short-term effect of radiotherapy on the malignancy.

Therapeutic effect of different doses of atorvastatin on patients with diabetic cardiomyopathy and its influence on blood lipids and cardiac diastolic function / 心血管康复医学杂志

Objective: To explore therapeutic effect of different doses of atorvastatin on patients with diabetic cardiomyopathy (DCM) and its influence on levels of blood lipids, glycosylated hemoglobin A1c (HbA1c), advanced glycosylation end product (AGEs) and cardiac diastolic function. Methods: A total of 96 DCM patients treated in our hospital were selected, randomly and equally divided into routine dose group (received atorvastatin of routine dose, 20mg/d) and double dose group (received atorvastatin of double dose, 40mg/d), and both groups were treated for four weeks. Levels of blood glucose, blood lipids, HbA1c, AGEs and cardiac diastolic function were measured and compared between two groups before and after treatment, and clinical therapeutic effect and safety were assessed. Results: After treatment, total effective rate of double dose group was significantly higher than that of routine dose group (91. 67％ vs. 72. 92％, P=0. 032); compared with routine treatment group after treatment, there were significant reductions in levels of blood glucose, blood lipids [except high density lipoprotein cholesterol (HDL-C)], HbA1c [(7. 58±1. 47) ％ vs. (6. 18±1. 35) ％], AGEs [(12. 45±2. 36) μg/ml vs. (7. 62±1. 54) μg/ml]and mitral early diastolic peak flow velocity/early mitral annulus diastolic peak velocity [E/Ea: (7. 54±1. 36) vs. (5. 27± 1. 09)], and significant rise in HDL-C level and mitral early diastolic peak flow velocity/mitral late diastolic peak flow velocity [E/A: (1. 25±0. 32) vs. (1. 57±0. 41)] in double dose group, P=0. 001 all. There was no significant difference in incidence rate of adverse reactions between two groups, P=0. 712. Conclusion: In DCM patients, double dose atorvastatin can more effectively regulate blood lipid level, reduce serum levels of HbA1c and AGEs, and improve cardiac diastolic function with more significant therapeutic effect.

Comparison of Efficacy of Spiral Nasointestinal Tube and Nasogastric Tube in Patients with Severe Traumatic Brain Injury / 中国医科大学学报

Objective To compare the effects of nasogastric tube and spiral nasointestinal tube on patients with severe brain injury. Methods Pa?tients receiving enteral nutrition with spiral nasointestinal tube or nasogastric tube were collected and investigated to evaluate the two schemes of en?teral nutrition from aspects of coma score,nutrition improvement,and catheter complications and so on. Results Detection of levels of total protein and prealbumin were conducted for all patients at 7 and 15 days after intubation. Each index was higher in the spiral nasointestinal tube group than in the nasogastric tube group. The reflux and aspiration rate was lower in the spiral nasointestinal tube group than in the nasogastric tube group. The dif?ferences were significant(P<0.05). Conclusion Using spiral nasointestinal tube to give enteral nutrition in patients with severe brain injury can improve the nutritional status,reduce complications,which is more contributory to the recovery.

Fever burden independently contributes to increased poor outcome of patients with traumatic brain injury / 中华急诊医学杂志

Objective To investigate the prognostic value of fever burden in traumatic brain injury (TBI) patients.Methods A retrospective analysis of 355 TBI patients admitted to the emergency department and intensive care unit from November 2010 to October 2012 was performed,and the Glasgow outcome scale (GOS) was followed-up 6 months after the injury.The patients were divided into two groups according to the GOS:good outcome group (4 to 5) and poor outcome group (1 to 3).Relevant clinical findings were studied by statistical description,logistic regression analysis,Spearman correlation analysis and ROC curve analysis.Results Fever burden level was continuously increased with the decrease of GOS from score 5 to 2,except for score 1 of GOS,which was corresponding to a significant lower fever burden.There were significant differences in age,pupil reactivity,Glasgow coma scale (GCS) and fever burden between two groups (P ＜ 0.05).Compared to the good outcome group,the poor outcome group was featured with more advanced average age (P =0.000),poorer pupil reactivity (P =0.000),lower GCS score (P =0.000) and higher fever burden level (P =0.000).Univariate logistic regression analysis suggested that age,GCS,pupil reactivity and fever burden level (OR 1.166,95％ CI:1.117-1.217) were associatedwith poor outcome.The fever burden level and the other independent prognostic predictors as age,GCS and pupil reactivity were further included in the multivariate logistic regression model,and the adjusted OR of fever burden level was 1.098 (95％ CI:1.031-1.169,P =0.003).ROC curve analysis showed the respective AUC for fever burden was 0.713 (95％ CI:0.663-0.760).The relevant analysis revealed a significant negative correlation between the fever burden and the GOS score (r =-0.376,95％ CI:-0.462--0.283,P =0.000).Conclusions Fever burden can be considered as an independent predictor of poor outcome of patients with TBI.The TBI patients with early onset of high levels of fever burden will have increased poor outcome risk.

Clinical applications of PET imaging in patients with traumatic brain injury / 中华核医学与分子影像杂志

Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide,particularly in young adults.Conventional imaging modalities such as CT or MRI can show most of the morphological changes of the brain in TBI.PET/CT and PET/MR can acquire both functional and morphological images compared with CT or MRI alone,which might be helpful for the diagnosis,management and prognosis evaluation of TBI.This review summarizes the applications of PET imaging in TBI patients.

The predictive value of serum uric acid in the outcome of traumatic brain injury / 中华急诊医学杂志

Objective To investigate the predictive value of serum uric acid for patients with traumatic brain injury.Methods A total of 330 patients with traumatic brain injury (Glasgow Coma Scale score,GCS:3-14) admitted to the First Affiliated Hospital of Soochow University between November 2010 and October 2012 were enrolled.They were divided into a survival group (GOS:2-5) and a non-survival group (GOS:1).The levels of serum uric acid were measured from venous blood in the morning of the second day after admission.Clinical data were analyzed by logistic regression model,spearman correlation,and ROC curve analysis.Results Spearman correlation analysis showed that serum uric acid was significantly correlated with GCS (r =-0.270 1,P =0.000) and GOS (r =-0.251 2,P =0.000).Age,GCS,pupil reaction and serum uric acid were determined as independent predictors for death by logistic model.The adjusted OR of uric acid was 1.0048,(95％ CI:1.001 9-1.007 6,P =0.001).The area under the ROC curve was 0.718,(95％ CI:0.666-0.766),the optimal cut-off value determined by the Youden index was 304 μmol/L (sensitivity:60.24％,specificity:78.14％,correctly classified:73.64％).In the core model (Age + GCS + Pupil reaction),theR2 value was 0.476 4.With uric acid added into,the predictive power of the model increased to R2 =0.510 5 (7.2％ increased).Conclusions The level of serum uric acid is significantly correlated with the severity of TBI and could be used as an independent predictor for death.

Protective effects of high-dose ambroxol hydrochloride on traumatic brain injury patients treated by mild hypothermia / 中华老年医学杂志

Objective To explore the effects of high-dose ambroxol hydrochloride (Mucosolvan) on pulmonary protection and anti-inflammatory in traumatic brain injury patients treated by mild hypothermia.Methods From June 2008 to June 2012,40 elderly traumatic brain injury patients aged 60-70 years treated by mild hypothermia in our hospital were selected.Patients were randomly divided into two groups:low-dose ambroxol hydrochloride group and high dose ambroxol hydrochloride (n=20,each).Patients in low-dose ambroxol hydrochloride group were treated with ambroxol 30 mg plus saline infusion,3 times/day; while patients in high-dose ambroxol hydrochloride group were treated with ambroxol 300mg plus saline infusion,3 times/day; both groups were treated for 7 days.The changes of characteristic and quantity of sputum,PaO2and PaO2/FiO2,and serum TNF α level were analyzed at day 1,3,7.Duration of mechanical ventilation,tracheotomy proportion,and mortality were compared between the two groups 3 months after treatment.Results At day 3-7 after the intervention,the sputum got thinner and less,and more easy to suck in highdose group than in low-dose group (thin sputum proportion:75％ vs.40％,P =0.025; clean proportion by once suction:65％ vs.25％,P=0.011).The improvement of PaO2,PaO2/FiO2 were more significant in high dose group than in low dose group (PaO2 ∶ 3d,(92.3±12.3) mm Hg vs.(83.3±15.2) mm Hg,P=0.046;7d,(95.9±12.5) mm Hgvs.(87.1±11.7) mm Hg,P=0.028;PaO2/FiO2∶3d,(290.8± 15.8) mmHgvs.(221.8± 16.4) mm Hg,P=0.000;7d,(296.3±16.9)mm Hg vs.(238.4±15.0) mm Hg,P=0.000).Serum concentrations of TNF α was lower in highdose group than in low dose group [3d,(54.1± 4.9) ng/L vs.(71.4± 5.6) ng/L,P=0.000;7d,(35.1± 2.7) ng/L vs.(63.3±4.3) ng/L,P 0.000].Duration of mechanical ventilation was shorter and tracheotomy proportion was lower in high dose group than in low dose group [(116.8±18.7) hrsvs.(178.4±35.5) hrs,P=0.000; 25％ vs.60％,P=0.025].There was no significant difference in mortality between groups 3 months after treatment.Conclusions The application of high dose ambroxol can improve respiratory function,decrease duration of mechanical ventilation and tracheostomy proportion,and reduce the systemic inflammatory response in elderly traumatic brain injury patients treated by mild hypothermia,but without long-term survival benefit.

Prevalence of low back pain among soldiers at an army base / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Low back pain (LBP) is a major medical and social problem among working populations and is associated with high medical expense, loss of productivity, and disability. The aim of this study is to investigate the prevalence of LBP among soldiers and evaluate the possible causative factors in military training. The results may provide an insight into changes needed in military training that will reduce the occurrence of LBP among soldiers.</p><p><b>METHODS</b>A cross-sectional survey was conducted in a group of young soldiers in China to estimate the prevalence of LBP and evaluate possible causative factors in military training.</p><p><b>RESULTS</b>The survey was distributed to 1659 soldiers, of whom 1624 responded. LBP was reported by 425 of the 1624 (26.2%) soldiers. The prevalence of LBP was higher in the armored force (51.3%) than in the artillery (27.5%) or infantry (11.9%). A multivariate logical regression analysis identified night training, 5 km cross-country race, and grenade-throwing training as military training risk factors for LBP.</p><p><b>CONCLUSIONS</b>The relatively high incidence of LBP among soldiers was related to night training, 5 km racing, and grenade throwing. Modifications in these training methods should enhance the health of recruits and lower the incidence of LBP.</p>

Effect of miR-21 on the proliferation and migration of human hepatoma BEL-7402 cells through AKT/ERK pathway / 肿瘤

Objective: To investigate the effects of miR-21 on the proliferation, invasion and migration of human hepatoma BEL-7402 cells and explore the possible mechanism. Methods: MiR-21 over-expression vector pGL3-miR21-EGFP (enhanced green fluorescent protein) was transfected into BEL-7402 cells. The expression level of miR-21 was detected by real-time fluorescence quantitative-PCR and the expression levels of phospho-AKT (p-AKT) and phospho-extracellular signal response kinase (p-ERK) were detected by Western blotting. The cell viability was examined by MTT assay. The cell migration and invasion abilities were evaluated by wound-healing assay and Transwell assay, respectively. The pGenesil-shAKT was transfected into BEL-7401 cells, and then the expression level of miR-21 was detected by real-time fluorescence quantitative-PCR, the expression levels of AKT and p-AKT were detected by Western blotting, the cell viability was examined by MTT assay, and the cell migration ability was evaluated by wound-healing assay. Results: As compared with the blank control (without transfection), the expression levels of miR-21 (P < 0.01), p-AKT and p-ERK (both P < 0.05) were up-regulated in BEL-7402 cells after transfection with pGL3-miR21-EGFP. As compared with the blank control, over-expression of miR-21 significantly promoted the proliferation, migration and invasion of BEL-7402 cells (all P < 0.05). After transfection with pGenesil-shAKT vector, the expression levels of AKT and p-AKT were down-regulated and the proliferation and migration abilities of BEL-7402 cells were inhibited (P < 0.05), but the expression level of miR-21 had no significant change. Conclusion: MiR-21 may contribute to the enhancement of proliferation and migration abilities of BEL-7402 cells through AKT/ERK signal pathway. Copyright © 2013 by TUMOR.

The individualized surgical treatment of transposition of the great arteries / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the effectiveness of individualized strategy of surgical management on the great arteries (TGA).</p><p><b>METHODS</b>From March 1998 to October 2009, 127 cases (97 males and 30 females) with TGA were treated. There were 97 male and 30 female, aged from 4 hours old to 17 years old with a mean of (25 ± 37) months, weighted from 2.7 to 47.5 kg with a mean of (8 ± 8) kg. The palliative operations included Glenn operation in 14 cases (3 cases double Glenn procedure), Balalock-Taussing shunt in 14 cases, Banding operation in 8 cases, and atrial septal defect enlarge/Banding/Balalock-Taussing shunt in 15 cases. The end-stage operation included Senning procedure in 5 cases, Switch procedure in 32 cases, 2(nd)-stage Switch procedure in 11 cases, Switch procedure with VSD repairing in 20 cases, Switch procedure with Hybrid in 1 case, Nikaidoh procedure in 3 cases, Rastelli procedure in 13 cases, Fonton procedure in 18 cases, other procedure in 4 cases. Twenty-one cases underwent 2 operations, and 5 cases underwent 3 or more operations. Sixty-six cases underwent delayed sternal closure.</p><p><b>RESULTS</b>There were 12 cases of death operatively in 127 cases. The total operative mortality was 9.4%. There were 5 cases dying of low cardiac output during the operation, 2 of pulmonary hypertension crisis, 2 of hemorrhage, 1 of grafting problem of coronary artery deformation, 1 of renal failure after Fonton procedure and 1 case of newborn dying of spontaneous rupture of liver post-operatively. The patients were followed up for 1 month to 12 years. There were 10 patients with vary degrees complications such as pulmonary stenosis, residual shunt and narrow channel. Three cases underwent reoperation. The rest of survived cases had normal heart function, good growth and development state.</p><p><b>CONCLUSIONS</b>Individualized strategy of surgical management based on anatomical conditions of TGA can significantly improve the success rate of surgery and long-term survival.</p>

Comparative study of myocardial perfusion imaging and 64 multi-slice spiral CT for the diagnosis of coronary artery disease / 中华核医学杂志

Objective To compare the diagnostic value of myocardial perfusion imaging (MPI) and 64 multi-slice spiral CT (64-MSCT) for coronary artery disease (CAD). Methods Fifty-two patients with suspected or known CAD were included in the study. Each patient underwent both stress and rest MPI,MSCT as well as conventional coronary angiography (CAG) within 1 month. The stress and rest MPI were scored by a 5-grade criteria (0 ～ 4) based on 17 coronary artery segments. The difference between summed stress and rest scores ＞ 1 was defined as myocardial ischemia. Stenosis in one main vessel or one main branch of the main vessel ≥50% was defined as myocardial ischemia by MSCT. CAG was used as the reference for comparison. Statistical analysis was performed using SPSS 13. 0 software. Kappa value was used to test the accordance of MPI and MSCT results. X2 test was used to evaluate the difference between MPI and MSCT results. Results The patient-based sensitivity, specificity, positive and negative predictive values and accuracy of MPI and MSCT for the diagnosis of CAD were 86.7% (26/30), 77.3% ( 17/22),83.9% (26/31), 81.0% ( 17/21), 82.7% (43/52) and 83.3% ( 25/30), 86.4% ( 19/22), 89.3%( 25/28), 79.2% ( 19/24), 84.6% (44/52), respectively. The vessel-based sensitivity, specificity, positive and negative predictive values and accuracy of MPI and MSCT were 74.5% (38/51), 81.0% (85/105 ), 65.5% (38/58), 86.7% ( 85/98), 78.8% ( 123/156 ) and 90.2% (46/51 ), 88.6% ( 93/105 ),79.3 % (46/58), 94.9% (93/98), 89.1% ( 139/156), respectively. There was no statistically significant difference between MPI and MSCT for either patient or lesion-based diagnosis (X2 =0.44, 0.21, both P ＞0.05 ). 96.0% (24/25) patients with both abnormal MPI and MSCT positive were valified by CAG while 83.3% (15/18) patients with both MPI and MSCT negative were excluded by CAG. Conclusions Both MPI and MSCT are reliable diagnostic modalities for CAD. They also provide complementary diagnostic value to each other.

Influence of distal tibiofibular synostosis on ankle function / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the influence of distal tibiofibular synostosis on ankle function.</p><p><b>METHODS</b>From October 1998 to October 2004, a total of 281 consecutive patients underwent operations because of ankle fractures or distal fractures of the tibia and fibula. Distal tibiofibular synostosis occurred after operation in 8 patients. The duration of follow-up averaged 20.6 months (14-44 months). The ankle function was assessed on the basis of functional rating system described by Mazur.(1)</p><p><b>RESULTS</b>According to Mazur's ankle evaluation system, 4 patients achieved an excellent result, 2 a good result and 2 a fair result. The dorsiflexion of the synostosis ankle reduced by 8.26 degrees as compared with that of the contralateral ankle, and there was little influence on the plantar flexion. All the patients had a normal gait.</p><p><b>CONCLUSION</b>The distal tibiofibular synostosis after the operation of ankle fractures or distal fractures of the tibia and fibula usually gives rise to few symptoms and needs no specific treatment.</p>

Diagnosis and management diseases caused by Whitmore bacterium (Pseudomonas pseudomalei)

2 cases whose sepsis due to Whitmore bacterium with liver abscess were investigated in etiology, diagnoses (clinical, type of sepsis and microbiological diagnosis) and management. It was found that to reduce the mortality related to this rare medical condition, special high-dose antibiotics should be used early when Whitmore bacteria infection was suspected and the liver pus lesions (if exist) should be managed early. The disease should be considered in the patients with prolonged, fluctuated high fever, especially in high-risk subjects, and is should be repeated blood culture to find the bacteria.