Cytotoxic diaporindene and tenellone derivatives from the fungus Phomopsis lithocarpus / 中国天然药物

Nine new compounds, including five natural rarely-occurring 2, 3-dihydro-1H-indene derivatives named diaporindenes E-I (1-5), and four new benzophenone analogues named tenellones J-M (6-9) were isolated from the deep-sea sediment-derived fungus Phomopsis lithocarpus FS508. All the structures for these new compounds were fully characterized on the basis of spectroscopic data, NMR spectra, and ECD calculation and single-crystal X-ray diffraction analysis. The potential anti-tumor activities of compounds 1-9 against four tumor cell lines SF-268, MCF-7, HepG-2, and A549 were evaluated using the SRB method. Compound 7 exhibited cytotoxic activity against the SF-268 cell line with an IC

Experience of hysteroscopy in a rural tertiary care center of Haryana, India

Background: During the last few decades hysteroscopy has become a tool of choice for evaluation of uterine cavity due to its “see and treat “benefits. It is more accurate and less invasive. Introduction of hysteroscopy in gynecological practice is the need of time. Aim of our study is to share the experience of hysteroscopy, its learning curve and limitations in a rural tertiary care center of Haryana.Methods: We retrospectively analyzed all the hysteroscopy procedure done from January 2016 to December 2018 from the hospital records.Results: Total 118 hysteroscopy were done but record of only 110 was available. Out of 110, 37(33%) were operative and 73(67%) were diagnostic. 36% were done for AUB, 33%  for infertility, 15% for misplaced cu t, 6% for amenorrhea, 2% in cases of RPL and rest for some less common indications. Out of operative hysteroscopy major procedures done were polypectomy and removal of misplaced Cu-T. Septal resection was also done in 3 cases. Number of operative hysteroscopy has increased over the time period of study.Conclusions: Hysteroscopic evaluation of uterine cavity is a reliable method for both diagnostic and treatment purpose. Proportion of hysteroscopy procedures and its learning curve will improve with persistent effort.

Assessment of the non-surgical treatment of patients with rectal cancer who underwent neoadjuvant treatment with chemotherapy and radiotherapy at the oncology department / Avaliação do tratamento não cirúrgico de pacientes com câncer de reto submetido ao tratamento neoadjuvante com quimioterapia e radioterapia no serviço de oncologia

ABSTRACT Objective: To describe the partial results of a study in patients with rectal cancer who underwent neoadjuvant treatment with chemotherapy and radiotherapy regarding the rate of complete clinical response, disease-free survival, anorectal function, and quality of life. Material and methods: This was a prospective study from June 2015 to June 2018, in patients with low- or mid-rectum adenocarcinoma and clinical stage II or III, treated with radiotherapy and chemotherapy (IMRT 54 Gy for six weeks) concomitant with 5-fluorouracil (5-FU) 380 mg/m2 and folinic acid (LV) 20 mg/m2 for five days in the first and fifth weeks and two cycles after radiotherapy (5-FU 400 mg/m2 and LV 20 mg/m2) every 28 days. After the treatment, clinical examination, rectosigmoidoscopy, pelvic magnetic resonance imaging, chest and upper abdomen computed tomography, and CEA testing were performed. Resection surgery was performed in those with incomplete clinical response (iCR). Those with complete clinical response (cCR) are under observation (wait-and-see policy). Manometry and scintigraphic function and quality of life scales were collected before treatment and at 30 and 90 days after the end of treatment. Results: As of June 2018, 11 patients were recruited. One was excluded from the analysis for presenting severe toxicity, suggestive of dihydropyrimidine dehydrogenase (DPD) deficiency, after the first chemotherapy cycle. All others completed the treatment. Two patients presented toxicity grade 3/4 related to chemotherapy and had their doses reduced. Seven patients (70%) presented iRC; three underwent rectosigmoidectomy, and the anatomopathological evaluation indicated complete pathological response in two cases (28.5%). Three (30%) presented cCR and did not present evidence of disease after a mean follow-up of 19 months. Patients presented improvement of anorectal function and quality of life. Conclusions: Advances in the neoadjuvant treatment of rectal tumors contributed to better rates of complete pathological responses. New paradigms promote an increase in the complete clinical response rates, which would allow organ preservation and consequent reduction of surgical morbidity.

RESUMO Objetivo: Descrever os resultados parciais de estudo em pacientes com câncer de reto submetidos a tratamento neoadjuvante com quimioterapia e radioterapia quanto à taxa resposta clínica completa, sobrevida livre de doença, função anorretal e qualidade de vida. Material e métodos: Estudo prospectivo desde junho 2015 até junho de 2018, em paciente com adenocarcinoma de reto baixo ou médio e estadio clínico II ou III tratados com RT/QT (IMRT 54 Gy em 6 semanas) concomitante a 5-Fuorouracil (5-FU) 380 mg/m2 e ácido folínico (LV) 20 mg/m2 por 5 dias nas primeira e quinta semanas e dois ciclos após RT (5-FU 400 mg/m2 e LV 20 mg/m2) a cada 28 dias. Após o tratamento, realizou-se exame clínico, retossigmoidoscopia, RNM de pelve, TC de tórax e abdômen superior e dosagem de CEA. Naqueles com Resposta Clínica Incompleta (iRC) procedeu-se à cirurgia de ressecção. Aqueles com Resposta Completa (cRC) estão em observação (wait and see policy). Manometria e escalas de função esfincteriana e qualidade de vida foram obtidas antes e após 30 e 90 dias do término do tratamento. Resultados: Até junho de 2018, recrutaram-se 11 pacientes. Um foi excluído da análise, pois apresentou toxicidade severa sugestiva de deficiência de DPD após o primeiro ciclo de QT. Todos os demais concluíram o tratamento. Toxicidades graus 3/4 relacionadas à QT ocorreram dois pacientes, reduzindo-se sua dose. Sete (70%) apresentaram iRC, submetendo três à retossigmoidectomia cuja avaliação anatomopatológica evidenciou Resposta Completa (pRC) em dois casos (28,5%). Três (30%) apresentaram cRC e estão sem evidência de doença com seguimento médio de 19 meses. Houve melhora da função anorretal e da qualidade de vida. Conclusões: Avanços no tratamento neoadjuvante dos tumores de reto contribuíram para melhores taxas de pRC. Novos paradigmas promovem crescentes índices de cRC, o que possibilitaria a preservação do órgão e consequente redução da morbidade cirúrgica.

New treatment strategy after neoadjuvant chemoradiotherapy in low rectal cancer / 国际肿瘤学杂志

Rectal cancer is one of the most common malignant tumor in our country,among them with highest incidence of low rectal cancer.With the further study on the biological behavior of rectal cancer and the development of diagnostic and therapeutic techniques,gastrointestinal oncologists have proposed a new treatment strategy-local resection and wait-and-see.This strategy can better preserve anal function and improve the quality of life of patients without losing the good tumor control of the traditional standard treatment model.

Comparison of the Classical Method and SEE-FIM Protocol in Detecting Microscopic Lesions in Fallopian Tubes with Gynecological Lesions

BACKGROUND: The objective of this study was to compare the classical method and Sectioning and Extensively Examining the Fimbriated End Protocol (SEE-FIM) in detecting microscopic lesions in fallopian tubes with gynecological lesions. METHODS: From a total of 1,118 cases, 582 with various parts of both fallopian tubes sampled in three-ring-shape sections and 536 sampled with the SEE-FIM protocol were included in this study. Pathological findings of cases with endometrial carcinoma, non-uterine pelvic malignant tumor, ovarian borderline tumors, premalignancy, and benign lesions were compared. RESULTS: We detected two tubal infiltrative carcinomas among 40 uterine endometrioid adenocarcinomas, 15 serous tubal intraepithelial carcinomas in 39 non-uterine pelvic serous high-grade carcinoma cases, seven papillary tubal hyperplasias in 13 serous borderline tumor cases, and 11 endometriotic foci and four adenomatoid tumors among all cases sampled with the SEE-FIM protocol. Using the classical method, we detected only one serous tubal intraepithelial carcinoma in 113 non-uterine pelvic serous high-grade carcinoma cases and two papillary tubal hyperplasia cases in 31 serous borderline tumors. We did not identify additional findings in 185 uterine endometrioid carcinoma cases, and neither endometriotic focus nor adenomatoid tumor was shown in other lesions by the classical method. CONCLUSIONS: Benign, premalignant, and malignant lesions can possibly be missed using the classical method. The SEE-FIM protocol should be considered especially in cases of endometrial carcinoma, nonuterine pelvic serous cancers, or serous borderline ovarian tumors. For other lesions, at least a detailed examination of the fimbrial end should be undertaken.

Ojo, mirada y pulsión: un recorrido metapsicológico Freudiano / Eye, gaze, and drive / Oeil, regard et pulsion

Este ensayo explora algunas de las bases metapsicológicas sobre el tema de la mirada y de la importancia de la función del ojo en la producción teórica freudiana, a sabiendas de que ojo y mirada no son lo mismo. El presente abordaje se realiza partiendo de la diferencia entre visión y mirada para luego, conceptualmente, rastrear la función del ojo y el impacto de la mirada en la constitución de la subjetividad, sobre todo al nivel de la pulsión. Muy especialmente refiere a la teoría de las pulsiones, y a su repercusión teórica posterior, para inmediatamente aproximarse a sus primeros escritos psicoanalíticos, empezando con “Tres ensayos de teoría sexual”. La sección substancial de este ensayo lleva al problema netamente metapsicológico de la “pulsión de ver” (Schautrieb) expuesto en textos como el mencionado de 1905 y “Pulsión y destinos de pulsión” de 1915.

This essay explores some of the metapsychological foundations about the gaze as well as the importance of the function of the eye in the Freudian theoretical production, aware that the eye and the gaze are not the same. The present approach starts from the difference between vision and gaze so that, conceptually, it can be traced the function of the eye and the impact of gaze in the first Freudian writings, especially at the level of the drive. It specifically refers to the theory of the drives and its later theoretical repercussion, to then immediately approach his first psychoanalytic writings, starting with Three Essays on the Theory of Sexuality. The substantial section of this essay brings the reader to the merely metapsychological issue of the “drive to see” (Schautrieb) exposed in texts such as Three Essays on the Theory of Sexuality from1905 and “Instincts and their Vicissitudes” from 1915.

Cet essai explore quelques-unes des bases méta-psychologiques sur le thème du regard et celui de l’importance de la fonction de l'œil dans la production théorique freudienne, tout en sachant que l'œil et le regard ne sont pas la même chose. Cette analyse est abordée à partir de la différence entre vision et regard, pour ensuite rechercher, de manière conceptuelle, la fonction de l'œil et l’impact du regard dans la constitution de la subjectivité, surtout au niveau de la pulsion. Ce travail vise de façon particulière la théorie des pulsions et sa répercussion théorique postérieure et, par la suite, aborde les premiers écrits psychanalytiques à ce sujet, en commençant par Trois essais sur la théorie sexuelle. La partie essentielle de cet essai développe le problème nettement méta-psychologique de la “pulsion de voir” (Schautrieb) exposé dans des textes tels que Trois essais sur la théorie sexuelle de 1905 et “Pulsions et destins des pulsions” de 1915.

Punica granatum seed oil inhibits malignant behavior of breast cancer cells / 军事医学

Objective To study the effect of Punica granatum( pomegranate) see d oil( PSO) on proliferation and apop-tosis behaviors of breast cancer cells.Methods Fatty acid composition was detected by gas chromatography,breast cancer cells, MCF-7 and MDA-MB-231 were treated with PSO, cell proliferation was observed by MMT, cell apoptosis was analyzed by flow cytometry,and expression levels of proliferation and apoptosis-related proteins were detected by Western blot.Results Punicic acid (PA) was the major fatty acid in PSO(74.41%).PSO could inhibit the proliferation while in-ducing apoptosis in both cell lines in a dose-and time-dependent manner, significantly decrease the expression level of Cox-2 and Bcl-2, increase the expression level of Bax and caspase-3 (cleaved),remarkably upregulate the expression of P53 in MCF-7, and downregulate p53 expression in MDA-MB-231.Conclusion PA may be one of the functional ingredients of PSO which can inhibit proliferation and induce apoptosis in breast cancer cells.These effects are probably mediated by regu-lating the expression of Cox-2, Bcl-2, Bax, caspase-3 (cleaved) and p53.

Research and improvement on the satisfactory degree of foreign clinic service patients aboard hospital ship / 中国实用护理杂志

Objective To upgrade the satisfactory degree of foreign patients by persistently improving medical treatment quality aboard hospital ship.Methods To choose 3 days and 30 foreign cases who accepted ultramarine medical treatment on hospital ship.All the cases were Pakistani or Bangladeshi.Cases were assigned into 3 kinds of queuing program and investigated the satisfactory degree using self-made questionnaire.The program of highest satisfactory degree was used in the next 3 countries.Results Analysis showed that waiting time for preliminary diagnosis,examination and total waiting time were significantly different between program C and A; waiting time for preliminary diagnosis,examination and total waiting time were significantly different between program B and A,but time for return visit increased in program B compared to that of program A.Degree of satisfaction:70.0％～76.7％ for program A,73.3％～80.0％ for program B,96.7％～100.0％ for program C.Conclusions Program C is the best method to shorten waiting time,improve order and upgrade the satisfactory degree.This research has a significant value in the enhancement of efficiency aboard hospital ship and improvement of foreign patients' satisfactory degree.

O índice de um enigma: o inconsciente e o fenômeno da premonição / The index of an enigma: the unconscious and the phenomenon of premonition

Em 1953, Devereux editou uma coletânea de textos de Freud sobre a psicanálise e o ocultismo. Apesar de pouco conhecidos, tais escritos foram fundamentais no debate com a filosofia francesa. Merleau-Ponty, por exemplo, debruçou-se sobre esta questão duas vezes: primeiro, relacionando a premonição com a percepção. Depois, a telepatia ao sentir. Sua conclusão nos leva a repensar o tema central da psicanálise: o inconsciente. Sua proposta é relacioná-lo à indivisão do sentir e à sua reversibilidade: vejo e sou visto...

In 1953, Devereux edited a collection of Freud's texts on psychoanalysis and the occultism. Despite these texts being little known, they were crucial in the debate with the French philosophy. Merleau-Ponty, for instance, addressed this issue twice. At first, relating the premonition with perception. At another time, he links the telepathy with the sense. His conclusion leads us to rethink the focus of psychoanalysis: the unconscious. His proposal is to link it with the unity of the sense and its reversibility: to see and being seen...

Single visit approach for management of cervical intraepithelial neoplasia by visual inspection & loop electrosurgical excision procedure.

Background & objectives: Developing a feasible and sustainable model of cervical cancer screening in developing countries continues to be a challenge because of lack of facilities and awareness in the population and poor compliance with screening and treatment. This study was aimed to evaluate a single visit approach (SVA) for the management of cervical intraepithelial neoplasia (CIN) using visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) along with loop electrosurgical excision procedure (LEEP) in women attending Gynaecology OPD in a tertiary care hospital in north India. Methods: In this hospital-based study, 450 women receiving opportunistic screening by conventional Pap cytology were also screened by VIA and VILI. VIA/VILI positive cases underwent same-day colposcopy and biopsy of all lesions. If the modified Reid score was >3, the patient underwent LEEP at the same visit. Results: Of the 450 women screened, 86 (19.1%) and 92 (20.5%) women were VIA and VILI positive, respectively. Detection rates of VIA, VILI and cytology findings at ASCUS threshold were 33.3, 35.5 and 24.4 per 1000, women, respectively to detect a lesion >CIN1. For detection of CIN2+ lesion, detection rates of VIA, VILI and cytology were 20, 22.2 and 22.2 per 1000 women, respectively. Sixteen patients with Reid score >3 underwent the See-and-treat protocol. The overtreatment rate was 12.5 per cent and the efficacy of LEEP was 81.3 per cent. There were no major complications. Interpretation & conclusions: The sensitivity of VIA/VILI was comparable to cytology. A single visit approach using visual screening methods at community level by trained paramedical personnel followed by a combination of ablative and excisional therapy can help to decrease the incidence of cervical neoplasia.

Toxicology and safety of the tincture of Operculina alata in patients with functional constipation

The tincture of Operculina alata, popularly known as "tincture of jalapa", is used in Northeast Brazil to treat constipation and encephalic vascular accident, but it has not yet been adequately tested for safety and efficacy. The aim of this study was to evaluate the toxicology and safety of the tincture of O. alata in patients with functional constipation. This was a double-blind, randomized, placebo-controlled clinical trial. The study consisted of three phases: pre-treatment, treatment and post-treatment, each phase with duration of seven days. Arterial pressure, heart rate, body weight, adverse events, hematological, metabolic, liver and kidney functions were monitored. Forty patients were randomized to receive tincture of O. alata and 43 patients to receive placebo. There were statistical differences in the clinical aspects between groups, but these changes were not considered clinically significant. Adverse events were considered not serious and of mild intensity, especially dizziness, headache, abdominal pain and nausea. This clinical trial confirmed the safety of the tincture of O. alata in the pharmaceutical form and dosage tested, allowing the product to be safely used in a larger population for the assessment of its clinical efficacy.

A tintura de Operculina alata, popularmente conhecida como "tintura de jalapa", é usada no Nordeste do Brasil para tratar constipação intestinal e acidente vascular encefálico, mas sua eficácia e segurança ainda não foram confirmadas. O objetivo deste estudo foi avaliar a toxicologia e segurança da tintura de O. alata em pacientes com constipação intestinal funcional. Este foi um ensaio clínico duplo-cego, randomizado e controlado por placebo. O estudo consistiu de três fases: pré-tratamento, tratamento e pós-tratamento, cada fase com duração de sete dias. Foram monitorizados a pressão arterial, frequência cardíaca, peso corporal, eventos adversos e funções hematológica, metabólica, hepática e renal. Quarenta pacientes foram randomizados para receber tintura de O. alata e 43 pacientes para receber placebo. Houve diferenças estatísticas nos aspectos clínicos entre os grupos, contudo, estas mudanças não foram consideradas clinicamente significativas. Eventos adversos foram considerados não sérios e de leve intensidade, especialmente, cefaléia, tontura, dor abdominal e náusea. Este ensaio clínico confirmou a segurança da tintura de O. alata na forma farmacêutica e dosagem testada, permitindo que o produto seja testado em população maior para determinar sua eficácia clínica.

Comparison of Wrist Extension Stretching Exercise and a Wait-and-see Policy for Treatment of Lateral Epicondylitis

PURPOSE: The aim of this study was to evaluate the effects of the wrist stretching exercise on the results of treatment for lateral epicondylitis by comparing with wait-and-see policy. MATERIALS AND METHODS: The patients who had lateral elbow pain associated with a lateral epicondyltitis were divided into wrist extension stretching exercise group (group 1) and wait-and-see policy group (group 2). Group 1 pateitns were educated to perform the wrist stretching exercise; maintenance of the position with the elbow extended, the forearm pronated, and the wrist flexed for more than 1 minute, more than 50 times per day. Group 2 patients were educated that they reduced the activities that provoked pain. The end point of follow-up was when symptoms were disappeared completely. RESULTS: Two hundred twenty seven patients were enrolled into this study. One hundred forty eight patients were allocated to group 1, 79 patients to group 2. The mean duration of follow-up of group 1 was 10.2 weeks and group 2 was 22.6 weeks. The median survival time from symptom onset to the time of resolution was 8.0 weeks in group 1, 16.0 weeks in group 2. CONCLUSION: This study suggests that wrist stretching exercise may be more effective than the wait-and-see policy in the patients with a lateral epicondylitis. The wrist stretching exercise can be recommended as the treatment of lateral epicondylitis.

Wait and see in rectal cancer after neoadjuvant chemoradiotherapy / 国际肿瘤学杂志

Neoadjuvant chemoradiotherapy has been used as a standard treatment for patients with locally advanced (T2 and T3 ) rectal carcinoma. Some patients who receive neoadjuvant chemoradiotherapy obtain pathological complete remission, namely, the absence of any tumor cells in the surgical specimens. The patients who obtain pathological complete remission get a better survival rate after canceling operation. Researches are still needed to investigate whether it is safe for patients in order to avoid risk and adverse reaction.

Treatment of the patients with abnormal cervical cytology: a "see-and-treat" versus three-step strategy / 부인종양

OBJECTIVE: To examine the correlation between cervical cytology and final histological results in patients who have undergone loop electrosurgical excision procedure (LEEP) with or without colposcopy-directed biopsy. METHODS: A retrospective review was performed of 829 patients who underwent LEEP for abnormal cervical cytology at Gangnam Severance Hospital between January 2004 and December 2008. Patients were classified to three groups according to cervical cytology and also divided into two groups based on the treatment they received: see-and-treat group and the standard three-step group. Final histological results were compared for the each study group. RESULTS: There were no differences in the final histological results between see-and-treat and three-step group in patients with high-grade squamous intraepithelial lesions (HSIL) cytology (N=523) (p=0.71). However, in patients with low-grade squamous intraepithelial lesions (LSIL)/atypical squamous cells of undetermined significance (ASCUS) (N=257) or normal cytology (N=49), the final histological results were significantly different between see-and-treat and three-step group (p<0.001) and the rate of overtreatment was significantly higher in the see-and-treat group (p<0.001). CONCLUSION: A see-and-treat protocol may be a viable alternative only in patients with HSIL cytology if colposcopic impression is suggestive of cervical intraepithelial neoplasia (CIN) 2 or 3 lesions.

Health seeking behavior and related influential factors on rural reproductive tract infectious among rural women at reproductive age / 中华流行病学杂志

Objective To understand health seeking behavior and its influential factors to reproductive tract infections (RTIs) on women at reproductive age in the rural areas. Methods 54 540 fertile women aged 15-49 were surveyed by a stratified-cluster-random sampling method and gynecological examination were conducted in two steps: converging at the clinics, and then visiting their households, later, 31 624 women who had at least one RTI symptom were chosen. Results Among all the women at reproductive age, the rate of having at least one RTI symptom was 59.8% with the means of RTI symptom as 1.66±0.89. 15 989 women went to see doctors out of the 31 624 women who had RTI symptoms, with a proportion of 50.6 %. The results of logistic regressy showed that those women whose husbands having higher education level, higher income, more RTI symptoms and better knowledge on RTI were more easily to go to the hospitals. However, those women whose husbands working out of the county, having older first bearing age and more numbers of pregnancy were less likely to go to the hospitals. Reasons that refrained them from going to see a doctor would include: 2137(13.7%) did not know that RTI was a disease; 7443(47.6%) of them thought that every woman were bound to have at least one symptom and it did not matter; 1629 (10.4%) of them felt shameful; 349 (2.2%) learned that the diseases were incurable; 975 (6.2 % ) felt the cost of treatment was too expensive; 2101 (13.4 %) had no time; 1001 (6.4 %) would treat themselves through buying medicines over the counter. Conclusion RTI symptoms were quite prevalent among women at reproductive age but the rate of seeing a doctor was low and caused by multi-factors. Health education and gynecological census in increasing the curable rate of RTIs should to be strengthened.

Radiation Dose Calculation in the Surrounding Organs during Brachytherapy of Prostate Cancer / 의학물리

As a part of estimating quantitative radiation treatment doses, we produced a mathematical phantom based on the standard Korean male. Then, with the prostate as the source organ, we calculated the absorbed dose in the prostate and surrounding organs forecasted to occur during brachytherapy for prostate cancer. To simulate the procedure, we selected (25)I and (103)Pd useful in brachytherapy of the prostate as the radionucleids and made an assumption that 1 Ci of initial radioactivity is administered. As a result, we found that the prostate, as the source organ, indicated 101 Gy/Ci and 7.24 Gy/Ci, respectively, in case of (125)I and (103)Pd. With the exception of the prostate, organs with high absorbed doses were found to be in the order of the penis and scrotum, sigmoid colon, testicles and the urinary bladder, which are relatively close to the prostate.

Clinical Observation of Bushenzhuanggutang Combined with Salmon Calcitonin see Calcimar in the Treatment of Renal Osteopathy / 医学研究杂志

Objective To investigate the effect of Bushenzhuanggutang combined with salmon calcitonin see calcimar in the treatment of renal osteodystrophy,and explore the mechanism of treatment.Methods 48 patients with renal osteodystrophy were divided into two groups:combined treatment group and control group.The patients were treated with Bushenzhuanggutang and salmon calcitonin see calcimar in combined treatment group.The patients were treated with salmon calcitonin see calcimar in the other group.Then the levels of serum calcium、phosphorus,PTH and BUN、Scr were detected before and after the treatment.Results The level of serum calcium increased significantly in two groups,while the level of serum phosphorus and PTH decreased(P

The Clinical Characteristics of Hyperthyroidism Combined with Ocular Myasthenia Gravis: Report of Six cases / 대한내분비학회지

Myasthenia gravis is an autoimmune disease characterized by impaired neuromuscular transmission due to circulating antiacetylcholine receptor autoantibodies. The relation between myasthenia gravis and thyroid disease remains unclarified. The association is thought to be uncommon and approximately 0.2% of myasthenia gravis has been reported in patients with autoimmune thyroid disease. Clinical expression of myasthenia gravis varies, ranging from a mild localized disease such as ocular myasthenia gravis (OMG) to a severe generalized disease. A higher frequency of thyroid antibodies has been observed in OMG compared to generalized myasthenia gravis, but the exact mechanisms of this increased association between OMG and thyroid autoimmunity has not been confirmed. The "see-saw" relationship between hyperthyroidism and myasthenia gravis is presented by some authors, while others reported that the optimal maintenance of euthyroid status was essential in treatment. Today many authors agree to the latter and we think that the adequate control of hyperthyroidism is more important. We have experienced six cases of hyperthyroidism combined with OMG and it was somewhat difficult to diagnose myasthenia gravis when the patient have Graves' ophthalmopathy.

Investigation into and analysis of 552 outpatients / 中华医院管理杂志

Objective To find out about patients needs, better deliver patient oriented care, and enhance patients satisfaction towards the service. Methods An investigation by questionnaire was made into 552 randomly selected outpatients with regard to the factors influencing patients selection of hospitals when seeking medical service and the needs of outpatients when waiting to see the doctors. Results Among the major factors influencing patients selection of hospitals when seeking medical service are the medical expertise of doctors and patients confidence in them. Spread of knowledge about health, constant notice to patients waiting of how things are going, introduction to specialists, and provision of signs indicating the service process are areas of service that patients waiting to see the doctors hope to get or see improved. Conclusion Enhancing the medical expertise and the overall quality of the medical staff, intensifying the awareness of quality service and standardizing medical behavior are among the major steps that hospitals can take to deliver patient oriented service.

A Case Report of See-saw Nystagmus Presumed to be Caused by Head Trauma

See-saw nystagmus is a unique torsional vertical eye movement disorder with a characteristic appearance. It is a pendular nystagmus with two distinct components: a conjugate torsional component and a disjunctive vertical component. It is most often associated with suprasellar or chiasmal lesions, especially with the lesion of interstitial nucleus of Cajal. In this report, the author present a 45-year-old man with seesaw nystagmus presumed to be associated with head trauma. He also has bilateral optic nerve atrophy and encephalomalacia of frontal and temporal lobe.