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Fibromyalgia syndrome （FMS） is a refractory， chronic non-articular rheumatic disease characterized by widespread pain throughout the body， for which there are no satisfactory therapeutic drugs or options. There are rich Chinese medical therapies， and some non-drug therapies， such as acupuncture， Tai Chi， and Ba-Duan-Jin， have shown satisfactory efficacy and safety and definite advantages of simultaneously adjusting mind and body. FMS is taken as a disease responding specifically to traditional Chinese medicine （TCM） by the National Administration of Traditional Chinese Medicine in 2018. In order to clarify the research progress in FMS and the clinical advantages of TCM/integrated Chinese and Western medicine， the China Academy of Chinese Medicine organized a seminar for nearly 20 experts in Chinese and Western medicine， including rheumatology， psychology， acupuncture and moxibustion， and encephalopathy， with the topic of difficulties in clinical diagnosis and treatment of FMS and advantages of TCM and Western medicine. The recommendations were reached on the difficulties in early diagnosis and solutions of FMS， mitigation of common non-specific symptoms， preferential analgesic therapy， TCM pathogenesis and treatment advantages， and direction of treatment with integrated Chinese and Western medicine. FMS is currently facing the triple dilemma of low early correct diagnosis， poor patient participation， and unsatisfactory benefit from pure Western medicine treatment. To solve the above problems， this paper suggests that rheumatologists should serve as the main diagnostic force of this disease， and they should improve patient participation in treatment decision-making， implement exercise therapy， and fully utilize the holistic and multidimensional features of TCM， which is effective in alleviating pain， improving mood， and decreasing adverse events. In addition， it is suggested that FMS treatment should rely on both TCM and Western medicine and adopt multidisciplinary joint treatment， which is expected to improve the standard of diagnosis and treatment of FMS in China.
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Objective:To investigate the currentstatus of the diagnosis of fibromyalgia syndrome (FMS), and analyze the related factors in order to improve the diagnostic level of the disease.Methods:A survey was carried out, A "FMS diagnosis table" was developed. The demographic data and past medical experience of patients were recorded. The rates of misdiagnosis and missed diagnosis were calculated. The specific misdiagnosed cases were recorded and analyzed. According to the previous diagnosis history, patients were divided into misdiagnosed group, missed diagnosis group and correct diagnosis group. The demographic characteristics, medical history and disease severity in the misdiagnosis group and missed diagnosis group were statistically analyzed, and compared with the correct diagnosis group. The reasons for missed diagnosis or misdiagnosis were explored.Results:A total of 277 patients were included in the survey. Only 19.1%(53 cases) of patients were correctly diagnosed, 22.7%(63 cases) of patients were misdiagnosed, 58.1% of patients were missed. The mean time from first symptom to disease diagnosis was (51.0±81.2) months. They were often misdiagnosed as osteoarthritis ( n=21, 33.3%), rheumatoid arthritis ( n=13, 20.6%), lumbar disease ( n=12, 19.0%), and anxiety and depression ( n=11, 17.4%). Patients' social and economic status such as age, income, educational level and the diagnosis level of pain related clinicians in medical institutions at all levels were factors that might influence misdiagnosis and missed diagnosis rate. In terms of demographic characteristics, the correctly diagnosed group had a lower average age of (44±13) years ( t=8.64/9.20, P<0.05), a higher proportion of employees, a higher monthly income ( χ2=7.10/6.87, P<0.05), and a higher education level ( χ2=7.12, P<0.05). In terms of visits, the rate of visits to other medical institutions (private hospitals) in the missed diagnosis group was higher, and the number of doctors visited was also lower. In terms of illness, the diffuse pain index (WPI) score and FMS symptom severity (SSS) score were lower in the missed diagnosis group. Conclusion:The current situation of the diagnosis of FMS in China is not optimistic, and the diagnosis should be differentiated from osteoarthritis, rheumatoid arthritis, cervical and lumbar diseases, and cardiac diseases. In order to reduce the misdiagnosis and missed diagnosis of this disease, it is necessary to strengthen the public education, improve the understanding of this disease in primary care doctors, and physicians in orthopedics, acupuncture and pain departments.
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Objective@#To explore effectiveness of Tai Ji exercise on the shoulder, neck and back pain caused by sedentary lifestyle among college students.@*Methods@#Totally 350 college students with shoulder, neck or back pain were divided into two groups by random number table method (n=175). The control group received no exercise prescription intervention, while the intervention group received Taijiquan exercise for 12 weeks. The changes of cervical Japanese Orthopaedic Association (JOA) score, lumbar JOA score and VAS score before and after intervention were compared between the two groups.@*Results@#The scores of upper limb motor function, lower limb motor function, sensory function, subjective symptoms, clinical signs and daily activity limitation in the intervention group were significantly higher than those in the control group (P<0.05). The VAS score of the intervention group after intervention was (1.51±0.63), which was significantly lower than that of the control group (3.49±0.75, P<0.05). The improvement in frequency and duration of pain in the intervention group were more significant than those in the control group(P<0.05). The rate of symptom improvement was significantly higher in the intervention (86.86%), than that of the control group (4.00%, P<0.05).@*Conclusion@#For the shoulder, neck and back pain caused by sedentary lifestyle, the practice of Tai Ji exercise can effectively relax the muscles and the joint tissue. The results show effectiveness in alleviating shoulder, neck and back pain among college students.
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Objective To analyze the relationship between ferritin, carbohydrate antigen (CA)125, CA153, lactic dehydrogenase (LDH), albumin and progression and prognosis of Sj?gren's syndrome with inter-stitial pneumonitis (pSS-IP). Methods Five hundred and twenty-seven primary pSS patients from 2011 to 2017 were analyzed retro-spectively. According to the lung imaging and clinical features, they were divided into groups. The differences of ferritin, CA125, CA153, LDH and albumin (ALB) levels in each group were analyzed by Mann-Whitney U test. Logistic regression was used to analyze the risk factors of pSS complicated with interstitial pneumonitis. Results ① Among the 527 pSS patients, 206 (39.1％) were diagnosed with IP. Compared with 321 patients without interstitial pneumonitis (pSS-N-IP), ferritin, CA125, CA153 and LDH in pSS-IP were relatively higher [189(116, 380) ng/ml vs 138(75, 258) ng/ml, Z=-3.777, P<0.05;19(12, 36) U/ml vs 12(9, 19) U/ml, Z=-5.974, P<0.05;22(12, 34) U/ml vs 9(6, 14) U/ml, Z=-4.582, P<0.05;206(165, 258) U/L vs 161(139, 195) U/L, Z=-8.770, P<0.05], while albumin was lower [34(31, 37) g/L vs 36(34, 39) g/L, Z=5.210, P<0.05]. ② pSS-IP were divided into pSS-IP progression group (46 cases) and pSS-IP stable group (60 cases) according to their lung imaging characteristics. Compared with pSS-IP stabilization group, pSS-IP progression group had higher ferritin [254(129, 693) ng/ml vs 161(104, 259) ng/ml, Z=-2.437, P<0.05]. ③ Logistic regres-sion analysis showed that there was correlation between ferritin and the progress of pSS-IP (OR=1.002). Conclusion Ferritin, CA125, CA153, LDH, albumin are related to pSS-IP. Ferritin isrelated to the progress of pSS-IP, and is a risk factor for the progress of pSS-IP.
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Objective To investigate the clinical diagnostic value of plasma soluble leukocyte differentiation antigen 14 (presepsin) in patients with rheumatoid arthritis (RA) complicated with pulmonary bacterial infection.Methods A total of 133 patients with RA and 60 healthy controls were enrolled in this study.Fifty-eight RA patients were infected with lung bacterial infection and 75 patients were non-infected with RA.Among them,RA activity was performed in 43 patients and RA was stable in 32 patients.Chemilluminescence immunoassay was used to detect presepsin (P-SEP) in all subjects,and its correlation with inflammatory markers such as white blood cells,blood sedimentation rate and C-reactive protein was analyzed.Results The P-SEP of RA (561 ±142) pg/ml combined with pulmonary bacterial infection group was significantly higher than that of active RA group (378±100) pg/ml (t=8.12,P＜0.01),higher than that of stable RA group (197±68) pg/ml (t=8.51,P＜0.01) and healthy control group (113±9) pg/ml (t=13.75,P＜0.01).There was a positive correlation between P-SEP and leukocyte count in patients with RA complicated with pulmonary bacterial infection (r=0.627,P＜0.01).The degree of the disease activity was correlated with CRP (r=0.63,P＜O.O1),regardless of the P-SEP level (r=0.47,P=0.521).The optimal threshold value of P-SEP in diagnosing RA patients with bacterial infection was 458.9 pg/ml,with a sensitivity of 79.3％ and a specificity of 81.4％.Conclusion P-SEP has an important diagnostic value for the identification of bacterial infection in RA patients,which is not related to RA disease activity.
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Objectives In order to evaluate the difference of the clinical effect of the knee joint function recovery and the quality of life by the massage and manipulation combined external application of Chinese medicine for the patients after knee arthroscope surgery of osteoarthritis. Methods A total of 160 hospitalized patients after knee joint arthroscope surgery of osteoarthritis from Tongchuan People's Hospital, Shanxi Tongchuan, were randomly divided into manipulation treatment group and control group. The manipulation treatment group revieved the manipulation combined with external application of Chinese medicineafter arthroscope surgery, and the control group received the regular massage combined with external application of Chinese medicine. Both groups were treated for two weeks. The WOMAC scale, ISOA scale and KPS rating scale were evaluated before and after treatment.The joint fluid IL-1β, TNF-α, the content of NO were detected before and after treatment of 3 months.Results After treatment,the WOMAC(21.26 ±13.16 vs.31.19 ± 12.67, t=8.967), ISOA (3.28 ± 1.52 vs. 6.45 ± 2.31, t=5.261) of the manipulation group were significantly lower than those of the control group(P<0.05);the KPS(88.26 ±7.42 vs.76.39 ±8.59,t=6.164)of the manipulation group was significantly higher than the control group (P<0.05); the TNF-α (21.31 ± 10.43 ng/ml vs. 28.29 ± 11.74 ng/ml, t=6.219), IL-1β (11.36 ± 4.22 pg/ml vs. 16.57 ± 6.44 pg/ml, t=5.645) of the manipulation group were significantly lower than the control group (P<0.05); the NO (33.15 ± 10.28 μmol/ml vs.34.22 ± 11.05 μmol/ml, t=1.364) of the manipulation group was higher than the control group without significance(P>0.05). Conclusions Manipulation combined with external application of Chinese medicine can reduce the content of joint fluid IL-1β, TNF-α, and the NO after knee joint arthroscope surgery of osteoarthritis, and can improve the function of knee joint, reduce pain, improve the quality of life.
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Objective To trace human umbilical cord mesenchymal stem cells (MSCs)labelled by USPIO-PLL which were transplanted into mouse subcutaneous xenotransplanted lung cancer by using 3.0T MR,to investigate the relationship between MSCs and VEGF expression and tumor angiogenesis by using SABC immunohistochemical method and to comprehensively analyze the effect of MSCs transplantation on lung cancer.Methods Cultured MSCs and poly lysine (PLL)was as a transfection agent which was magnetically labeled by USPIO and implanted into mice with subcutaneous xenotransplanted lung cancer through the tail vein.MRI was performed at pre-transplantation, 1 d and 10 d after transplantation and the tissues were performed by immunohistochemistry respectively.Results (1)MSCs could reach the tumor area at the first day after the transplantation and be monitored by MRI.MSCs increased at the 10th day.MRI signal intensity was reducedand the difference was statistically significant (P <0.05).The inhibitory rate of the 1st day and 10th day was positive;(2)At the 10th day after the transplantation,the rate of the VEGF positive expression in MSCs group was 86.67％,the value of MVD was 44 .22 ± 12 .36 ,and the rate of the VEGF positive expression in NS group was 26 .67 ％ ,the value of MVD was 20 .29 ±8.47 (P <0.05).Conclusion Tracing stem cell transplantation in vivo can be proceeded effectively by using 3.0T MR.Stem cell has bidirectional effect on lung cancer which inhibites the tumor growth by directional chemotaxis and differentiation,and also enhances expression of VEGF and angiogenesis at a certain extent.
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Objective To trace human umbilical cord mesenchymal stem cells (MSCs)labelled by USPIO-PLL which were transplanted into mouse subcutaneous xenotransplanted lung cancer by using 3.0T MR,to investigate the relationship between MSCs and VEGF expression and tumor angiogenesis by using SABC immunohistochemical method and to comprehensively analyze the effect of MSCs transplantation on lung cancer.Methods Cultured MSCs and poly lysine (PLL)was as a transfection agent which was magnetically labeled by USPIO and implanted into mice with subcutaneous xenotransplanted lung cancer through the tail vein.MRI was performed at pre-transplantation, 1 d and 10 d after transplantation and the tissues were performed by immunohistochemistry respectively.Results (1)MSCs could reach the tumor area at the first day after the transplantation and be monitored by MRI.MSCs increased at the 10th day.MRI signal intensity was reducedand the difference was statistically significant (P <0.05).The inhibitory rate of the 1st day and 10th day was positive;(2)At the 10th day after the transplantation,the rate of the VEGF positive expression in MSCs group was 86.67％,the value of MVD was 44 .22 ± 12 .36 ,and the rate of the VEGF positive expression in NS group was 26 .67 ％ ,the value of MVD was 20 .29 ±8.47 (P <0.05).Conclusion Tracing stem cell transplantation in vivo can be proceeded effectively by using 3.0T MR.Stem cell has bidirectional effect on lung cancer which inhibites the tumor growth by directional chemotaxis and differentiation,and also enhances expression of VEGF and angiogenesis at a certain extent.
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Objective To investigate the relationship between nucleo-tide-binding domain leucinerich-containing family pyrin domain-containing-3 (NLRP3) and the pathogenesis of arthritis.Methods The collagen-induced arthritis (CIA) mouse were divided into two groups:the model group (CIA,n=16) and the control group (n=8).The arthritis score and imaging evaluation (X-rays,Micro-CT) were performed;Synovial tissue NLRP3 expression were analyzed by immunohistochemical staining.Joint clinical score,radiographic score and joint NLRP3 expression were analyzed suing Pearson correlation analysis.Results The arthritis score (6.0±2.5),imaging score (4.6±0.9) and synovial tissue NLRP3 expression (4.0±2.0) were significantly increased in the CIA mice.The expression of synovial NLRP3 was positively correlated with arthritis clinical and radiographic scores (r=0.792,P＜0.05;r=0.669,P=0.005,respectively).Conclusion Synovial NLRP3 expression level is correlated with the clinical arthritis severity and extent of radiological destructions,suggesting that NLRP3 is involved in the pathogenesis of CIA.
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Objective To study the characteristics of granulomatosis with polyangiitis (GPA) accompanied by pneumothorax.Methods We described a case of GPA accompanied by hydropneumothorax who was successfully treated.Relevant literature was also reviewed.Results A total of 25 cases were identified,consisting of 18 males and 7 females [the average age was (44±16)(16-70) years old].The time from disease onset to pneumothorax was 26±51 (0.83-216) weeks.Pneumothorax,hydropneumothorax,pyopneumothorax and hemopneumothorax occurred in 11,5,8 and 1 respectively.Nodules or excavated nodules on chest radiography or CT were seen in 22 cases.Erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were elevated in all cases.Sixteen cases received glucocorticoid and immunosuppressive agents treatment.Sixteen cases received drainage and 7 received open operation.Pseudomonas aeruginosa was the most commonmicrobiology findings.Granulomatosis with active vasculitis,bronchopleural fistula,pleural bleb with intensefibrosis,rupture of subpleural nodule were seen on lung biopsy or autopsy.Nine cases died of infections,respiratory failure,sepsis and respiratory arrest.Conclusion Pneumothorax in GPA can be caused by multiple factors such as rupture of subpleural nodule and with high mortality.Patients always died of infections and respiratory failure.Regular treatment of the underlying disease,apply sensitive antibiotics for infection and reasonable surgical intervention should be considered.
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Objective We investigated the effect of VX-765 on collagen induced arthritis (CIA).Methods Twenty-four mice were divided into three groups:the VX-765 prophylaxis group (VX-765),the CIA model group (CIA) and the wild-type control group (Normal).Each group has 8 mice.Mice with CIA were in-tra-peritoneally injected with VX-765 (100 mg/kg,twice a day),mice with CIA and controls were treated with 0.9％ saline.At the end of the study,clinical scores,radiographic scores and histological scores of joints were calculated.Serum cytokine levels including interleukin (IL)-1β,IL-18,IL-33 were assessed by enzyme linked immunosorbent assay (ELISA).The serum cytokines levels between the CIA group and the VX-765 groups were compared using F test.The clinical scores,radiographic scores and pathological scores between the CIA group and the VX-765 group were compared using the Mann-Whitney test.Results The clinical scores of arthritis and the radiographic scores were significantly lower in the VX-765 group (1,1) than the CIA group (6.5,3.5;Q=4.5,2.75,P＜0.05).Compared with the CIA group,the histological analysis (1,5.5;Q=4.75,P=0.000),serum cytokine levels [IL-1β (2.0±1.0) vs (6.9±2.4) pg/ml,IL-18 (75±42) vs (129±48) pg/ml,IL-33 (145.46 vs 287.22) pg/ml] were significantly lower in the VX-765 group (F=27.98,F=17.27,Q=89.72,P＜0.01).Conclusion These findings suggest that caspase-1 is a potential therapeutic target for rheumatoid arthritis.
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BACKGROUND:Although core decompression can contribute to the reconstruction of necrotic bone, its single use appears to have some deficiencies and cannot completely realize the reconstruction of the femoral head. OBJECTIVE:To explore the effect of arthroscopic core decompression with autologous bone marrow induction material combined with titanium rod in the repair of stage II femoral head necrosis METHODS:A retrospective analysis was performed on clinical data of 79 cases of stage II femoral head necrosis admitted at the South Branch of Tongchuan People’s Hospital from February 2011 to February 2013. According to the therapeutic methods, these cases were divided into control group (40 cases) and observation group (39 cases), and were given conventional core decompression and arthroscopic core decompression with autologous bone marrow induction material combined with titanium rod. Patients were fol owed up for 24 months, and the range of hip flexion and Harris scores on hip function and adverse events were observed and compared between two groups. RESULTS AND CONCLUSION:Al the 79 patients successful y completed the 24-month fol ow-up. By the last fol ow-up, the range of hip flexion and Harris score were significantly higher in the observation group than the control group (P<0.05). There was no failure case due to surgical material rejection. To sum up, arthroscopic core decompression with autologous bone marrow induction material combined with titanium rod is safe and effective for repair of stage II femoral head necrosis.
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Objective The objective of this study is to describe the clinical features and outcomes of connective tissue disease (CTD) patients with mycophenolate mofetil (MMF) and with Pneumocystis jirovecii pneumonia (PJP).Methods We retrospectively reviewed the characteristics,clinical features,treatment and outcomes of PJP in patients with CTD.The clinical variables were compared between groups using t-test.Results ① A total of 17 cases were reviewed.② Sixteen patients were treated with glucocorticoids(GCs) plus immunosuppressive drugs.Only one patient had GCs without immunosuppressive drugs.Sixteen patients were with PJP,10 (63％) patients had MMF.③ Ten MMF patients and 7 non-MMF patients had absolute lymphocyte counts with the average being (557±170)/` and (926±162)/μl,respectively (t=-4.481,P＜0.05).④ Six of 17 patients died during the hospitalization.Five patients of 10 patients with MMF died 1 of 7 patients without MMF died.Fifteen of 17 patients were treated by trimethoprim-sulfamethoxazole (TMP-SMX).Conclusion MMF may be risk factors of PJP in CTD.
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Objective The aim of this study was to detect the serum 25-hydroxyvitamin D (25-OH-D)and anti-vitamin D levels in new cases of systemic lupus erythematosus (SLE),and to investigate their clinical significance.Methods Fifty patients who fulfilled the ACR criteria for the classification of SLE and 36 healthy donors were included.Enzyme-linked immunosorbent assay was performed for serum 25 [OH] D and anti-vitamin D level measurement.Statistical methods used were t-test and Pearson's correalation analysis.Results The serum 25-OH-D level in SLE was (13±6) ng/ml,and the level in healthy donors wase (17±8)ng/ml,P =0.007); the difference was statistically significant.A significant negative correlation was demonstrated between the serum level of vitamin D and the 24 h urinary protein excretion (r=-0.314,P＜0.01),and the level of serum creatinine (r=-0.322,P＜0.01).Anti-vitamin D antibody was detected in 6 of 50 patients with SLE,in 10 of 36 sera from healthy donors.There was no difference of 25-OH-D level between the anti-vitamin D antibody positive group and anti-vitamin D antibodu negative group [(13±6) and (14±6) ng/ml in the SLE group; (17±6) and (18±9) ng/ml in the healthy control group].Conclusion The serum 25-OH-D level in SLE is low; however,it is not correlated with Anti-vitamin D antibody,but is correlated with renal lesions.So the serum 25-OH-D level may be important in the pathogenesis of SLE.
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ObjectiveTo observe the effect of mycophenolate mofetil(MMF) on systolic pulmonary arterial pressure (SPAP), right ventricle index (RVI), cytokines, receptors of pulmonary artery hypertension (PAH) rat models. MethodsThe rat models of monocrotaline (MCT)-PAH were developed. Thinty-two Sprague-Dawley male rats were divided randomly into four groups: the control group, the MCT, the MCT +low-dose MMF (20 mg·kg-1·d-1, MMF 20) and the MCT + high-dose MMF(40 mg·kg-1·d-1, MMF 40).There were eight rats in each group. SPAP, RVI, cytokines and receptor in the serum and lung tissue were measured in all rats. Comparisons between multiple groups were performed with q test and rank sum test.Results① Low-dose and high-dose MMF group were compared with the MCT group, SPAP[(40±13),(53±10) vs (68±10) mm Hg]and RVI(0.36±0.06, 0.38±0.03 vs 0.44±0.05) were reduced and showed statistically significant difference respectively(P＜0.05). (②) Compared with the MCT group, basic fibroblast growth factor(bFGF) of serum in both low-dose and high-dose MMF group were reduced and showed statistical difference respectively[(2.3±1.9), (2.7:t±1.3) vs (6.9±5.4) pg/ml, P＜0.05]. ③ Low-dose and high-dose MMF group were compared with the MCT group and showed that MA was decreased and the musculization of arterial wall was improved. ConclusionMMF can reduce SASP, RVI, number of MA. The inhibitory effect of MMF in PAH is possibly by inhibiting cytokines and receptors.
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BACKGROUND: Current methods of stem cell separation are mainly based on their cell markers.A method for stem cells separation which is not based on cell markers developed in recent years,that is fluorescence activated cell sorting method,has been applied for stem cells and mature cells separation.OBJECTIVE: To isolate side population cells from newborn mice small intestinal mucosa,and to investigate the feasibility of constructing the murine intestinal stem cell population by fluorescence activated cell sorting.METHODS: Small intestine mucosa organoids of mice were isolated and dissociated into single cells.The side population cells were stained with Hoechst 33342 and propidium iodide,then sorted using fluorescence activated cell sorting.Total RNA and protein were purified from sorted fractions to detect Musashi-1 expressions by RT-PCR and Western-blotting.RESULTS AND CONCLUSION: Single cell suspension from mouse small intestine mucosa contained a viable population of cells,which showed the side population phenotype and were sensitive to verapamil.These cells were enriched for Musashi-1 mRNA and MSI-1 protein expression.Results demonstrated that the side population fraction separated from mice intestinal mucosa is enriched for intestinal stem cells,the murine intestinal stem cell population can be successfully constructed with fluorescence activated cell sorting.
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Objective To study the clinical value of VACORA vacuum-assisted rotation system in the treatment of benign breast lesions. Methods Under the screening of dynamic ultrasound,122 beast lesions in 93 patients diagnosed as benign lesions from ultrasound were treated with VACORA vacuum-assisted rotation system,and all the patients were examined for follow-up. Results All the lesions were totally rotated and 119 lesions demonstrated to be benign and 3 lesions were atypical hyperplasia from pathologic examination. In the benign lesions, 72 cases were demonstrated to be fibroadenoma, 39 cases were demonstrated to be fibrosis adenosis,4 cases were intraductal papilloma,2 cases were duct inflammation, 1 case was epithelial hyperplasia of the duct and 1 case was lymphode. In 8 cases,bleeding was seen along the needle tract,which was stopped after compression. Small hematoma was formed in 10 patients in the second day of follow-up, which was disappeared in the 3 to 6 months of the follow-up. And all patients had no remnant lesions in the local area and the incisions were not clear in the skin 3 to 6 months of the follow-up. Hypoechoic focuses were detected out at the original location in the 3 benign cases, which were possibly residual focuses. Conclusions Benign breast lesions could be clearly resected with VACORA rotation system under the screening of ultrasound, which is safe, minimal invasive, prosthetic, and has little complications.
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Objective To investigate the manifestations of esophageal motility disorders and evaluate the association between them and dysphagia, laboratory tests and other accessory examinations in patients with Sj(o)gren's syndrome (SS). Methods Esophageal manometry was performed in 31 patients with SS and 18 healthy volunteers by the step pull-through method. Results Decreased upper esophageal sphincter pressure was detected in 19 of the 31 patients (61%) with SS, while 4 of 18 (22%) in controls. The frequency was significantly higher in patients than in healthy controls (P=0.008). Fifteen of 31 patients (48%) showed various patterns of esophageal dysfunction including ineffective esophageal motility in 6 patients, nutcracker esophagus in 3 patients and nonspecific dysmotility in 6 patients. No major differences were found in esophageal parameters (peak amplitude, wave duration and velocity) when comparing primary SS with secondary SS. These esophageal abnormalities were not correlated with clinical manifestations, laboratory examinations and other auxiliary examinations. Conclusion Patients with SS may have esophageal motility disorders, which can presents with different patterns.
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BACKGROUND: Tiantai I consists of gastrodia, Chinese angelica root, areca seed. It has been considered as the roles of invigorating the liver, nourishing marrow, heightening the intelligence and causing resuscitation. OBJECTIVE: To observe the effects of Tiantai Ⅰ on the abilities of learn ing and memory and the activity of central cholinergic system in mice withspontaneous Alzheimer disease. DESIGN: A randomized control observation. SETTING: Shenzhen Institute of Integrated Chinese and Western Medicine. MATERIALS: Male Kunming mice of 13 months old were raised to 21 months old, of which 52 with spontaneous Alzheimer disease werescreened. They were randomly divided into blank control group, westerndrug control group, Tiantai Ⅰ 6.80 and 20.41 g/kg groups, 13 mice in eachgroup. Another 13 aged mice with normal learning and memory abilitieswere selected as the normal control group at the same time. METHODS: Mice in the western drug control group were treated with0.6 mg/Kg Hydergine, those in the Tiantai Ⅰ 6.80 and 20.41 g/kg groupswere given intragastric administration of Tiantai Ⅰ of 6.80 and 20.41 g/kg, respectively, and those in the normal control group and blank control groupwere given double distilled water of the same volume. The learning andmemory results were examined by the step-down test. Freezing sections ofbrain tissue were prepared, acetylcholinesterase (AChE) fiber was showedaccording to the Hedreen method, and choline acetyltransferase (ChAT) was detected with Burt and Silver methods, the automatic image analysissystem for biomedical application was applied in the quantitative analysisof AChE fiber and ChAT activity. MAIN OUTCOME MEASURES: ① Effect of Tiantai Ⅰ on the abilities of learning and memory in mice with Alzheimer disease; ② AChE fiberarea density in temporal cortex and hippocampal CA1 region; ③ ChAT ac tivity in Meynert nuclei of basal forebrain. RESULTS: ① Tiantai Ⅰ in ameliorating the abilities of learning and mem ory in mice with spontaneous Alzheimer disease: The error times in theTiantai Ⅰ 6.80 and 20.41 g/kg groups, normal control group and westerndrug control group were obviously fewer than that in the blank controlgroup (5.08±2.18, 3.77±1.48, 3.25±1.27, 6.17±3.12, 9.31±3.65, P ＜ 0.05). ② AChE fiber area density: The AChE fiber area densities in temporalcortex were obviously higher in the Tiantai Ⅰ 6.80 and 20.41 g/kg groups, normal control group and western drug control group than in the blankcontrol group (20.19±4.18, 25.01±6.44, 26.38±6.52, 19.44±4.33, 14.36±3.21, P ＜ 0.05). The AChE fiber area densities in hippocampal CA1 region were obviously higher in the Tiantai Ⅰ 20.41 g/kg groups and nor mal control group than in the blank control group, western drug controlgroup and Tiantai Ⅰ 6.80 g/kg group (13.88±3.07, 14.11±4.36, 6.57±2.30, 10.13±2.94, 9.63±2.40, P ＜ 0.05). ③ ChAT activity: It was obviously high er in the TiantaiI 20.41 and 6.80 g/kg groups, western drug control groupand normal control group than in the blank control group (0.683±0.179, 0.589±0.179, 0.552±0.173, 0.705±0.141, 0.354±0.131, P ＜ 0.05). CONCLUSION: Tiantai Ⅰ can significantly improve the disturbances oflearning and memory in mice with spontaneous Alzheimer disease, and itcan increase the activity of central cholinergic system in a dose-dependentmanner.
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Objective To explore the methods of cultivating 7-year-program medical students' clinical practice ability and scientific research ability in gynecology. Methods We carried out a training system,in which clinical groups and scientific research groups were guided by tutors,assisted with strict examining measures and reasonable incentive mechanisms. Re-sults According to a practice cycle of 2 years,medical students'overall quality was improved obviously,such as clinical thoughts,basic skills,humanistic qualities,scientific research thoughts and the ability of literature retrieval. Also the teaching enthusiasm and teaching level of the teaching group were improved corresponding. Conclusion Construction and implementation of the training system of clinical groups and scientific research groups under the leadership of the tutors is obviously beneficial to the overall quality of medical students and the integrated teaching capabilities of the professional teaching team.