ObjectiveTo investigate the clinical features of Hirayama disease (HD). MethodsWe analyzed the clinical manifestations and assistant examination results of one patient with HD diagnosed in November, 2010. In addition, we reviewed the related literatures. ResultsThe patient was a young man, and the main symptoms were bilateral hand weakness with muscular atrophy. The muscle bundles trembled when he stretched his fingers. The electromyography showed neurogenic damage of both the thenar muscles and the first interosseous muscles. Brain magnetic resonance imaging (MRI) showed normal; cervical spine flexion MRI showed thinning cervical spinal cord with spinal canal narrowing at C5-C7 plane. In addition, epidural fat gap widened at C4-T1 plane, and enhanced scan showed cord-like changes, patchy strengthening and blood flow void shadow. ConclusionWhen asymmetric distal upper limb muscle weakness with muscle atrophy appears in adolescents, HD should be considered. The combination of neuroelectrophysiological examination and cervical spine flexion MRI scan is helpful for diagnosis. Wearing cervical collar may slow disease progression.
ObjectiveTo investigate and compare the advantages and disadvantages of laparoscopic cholecystolithotomy and laparoscopic cholecystectomy for patients with gallbladder stone. MethodsThe eligible patients with gallbladder stones hospitalized in our department between January 2007 and December 2011 were included, and all of them received either laparoscopic cholecystolithotomy (observation group) or laparoscopic cholecystectomy (control group) minimally-invasive surgery. The operation time, bleeding volume, enterokinesia recovery time, hospital stay, post-operative complication and follow-up results were compared between the two groups. ResultsA total of 148 patients were included, with 68 patients in the observation group and 80 patients in the control group. In this cohort, the success rate of surgery for the observation group and the control group was 100.0% (68/68) and 98.8% (79/80), respectively; and the success rate of complete stone removal was 100% for both two groups. B-ultrasound examination after 2 weeks of treatment showed that gallbladder wall was normal and gallbladder contraction rate was more than 30% for all patients with laparoscopic cholecystolithotomy. The operation time was (49.6±5.2) minutes for the observation group and (50.5±6.2) minutes for the control group, and bleeding volume was (9.5±1.4) mL for the observation group and (50.2±8.1) mL for the control group; the difference in bleeding volume was significant between the two groups (P<0.05). The difference in enterokinesia recovery time[(33.9±2.2) and (34.4±2.6) minutes] or hospital stay[(3.4±1.0) and (3.6±1.2) days] between the observation group and the control group was not significant (both P >0.05). The post-operative complications of bleeding, bile leakage and wound infection were not observed in both two groups, and all patients were followed up for 6 to 12 months with no stone recurrence; and only 2.7% of patients (1/37) had stone recurrence after 3-year follow-up. ConclusionBoth laparoscopic cholecystolithotomy and laparoscopic cholecystectomy procedures are safe and efficient. However, laparoscopic cholecystolithotomy not only reserves gallbladder but also has superiority of less bleeding volume.
ObjectiveTo evaluate the prognosis factors for early death (within 60 days) of acute myocardial infarction (AMI) patients for early identification and prevention of the disease. MethodsWe analyzed the information of AML patients who were admitted to the emergency department between May 2009 and July 2010, and analyzed their clinical data, such as gender, age, prehospital time, myocardial enzyme, electrocardiogram, complications, whether the patients had thrombolysis therapy, time of thrombolysis, end point observation and time of death, ect. Cox multivariate survival analysis was performed with the use of SPSS 18.0 software. ResultsSeventy-one cases were collected with one of them excluded for fragmented data. After analysing, we found that patients' age and isoenzymes of creatine kinase (CK-MB) level were prognosis factors for early death. Further analysis showed that the relative risk (RR) of age was 1.166 (P=0.023), and the RR of CK-MB was 1.001 (P=0.004). ConclusionPatients' age has predictive value for early death of AML. More attention should be paid to AML patients with advanced age. Detecting myocardial enzymes levels, especially the CK-MB level, is significant for predicting early death. Other indicators need to be further explored due to the possible limitation of our study.
ObjectiveTo construct eukaryotic expression vector of pEGFP-N3-TFPI-2, and to provide the base of studying the function of TFPI-2 gene. MethodsExtraction of total RNA from placental tissue was extracted at first, and then reverse transcriptase synthesis of cDNA was carried out. The cDNA fragment of TFPI-2 gene which was obtained by real time PCR (RT-PCR) was inserted into eukaryotic expression vector of pEGFP-N3. After double digestion with XhoⅠand KpnⅠ, the recombinant vector of pEGFP-N3-TFPI-2 was identified in 1% agarose gel electrophoresis and was tested by the sequence analysis. Then, the recombinant vector of pEGFP-N3-TFPI-2 (transfection group) and vector of pEGFP-N3 (blank control group) were transfected into Top10 competent cells with LipofectamineTM 2000, but no transfection-related treatment was performed in cells of untransfection group. Western blot method was used to test the expression of TFPI-2 protein in cells of 3 groups. ResultsThe purity of total RNA which were analysis by agarose gel electrophoresis and spectrophotometry were fit for PCR. After coding of TFPI-2 gene fragment and eukaryotic expression vector of pEGFP-N3, the recombinant plasmid of pEGFP-N3-TFPI-2 were got double digestion with XhoⅠand KpnⅠ, and was identified in 1% agarose gel electrophoresis, of which showing that there were 2 specific amplification of strips at 708 bp and 4 700 bp. Result of sequence analysis confirmed that the size of recombinant vector was consistent with the theoretical value. Results of Western blot showed that the expression of TFPI-2 protein in transfection group (0.657 3±0.032 5) was higher than those of blank control group (0.301 7±0.028 7) and untransfection group (0.314 3±0.026 6), P < 0.01. ConclusionsThe eukaryotic expression vector of pEGFP-N3-TFPI-2 has been constructed successfully, which laiding the foundation for the analysis about function of TFPI-2 gene.
This study aims to explore the effects of alginate-poly ornithine-alginate (A-PLO-A) and barium alginate-poly ornithine-alginate (B-PLO-A) microcapsules as cells carriers during implantation. Mice hepatocytes coated in A-PLO-A and B-PLO-A microcapsules were implanted into rats with acute liver failure caused by intraperitoneal injection of D-galactosamine. The rat survival rate, liver cell growth, proliferation and metabolism within the microcapsules were investigated, as well as its effect on the improvement of rat acute liver failure. The influence of A-PLO-A-free microcapsules, B-PLO-A-free microcapsules, isolated liver cells, A-PLO-A microcapsule-coated and B-PLO-A microcapsule-coated liver cells was studied. It was found that the chemical-free microcapsules showed no positive effect on the rats with liver failures, with a death rate of 100% in both groups 3 days after the implantation. The ALT, AST and ALB levels were all improved in the isolated liver cell group, the A-PLO-A microcapsule-coated and the B-PLO-A microcapsule-coated groups. The survival rate of both microcapsule-coated liver cell groups was significantly higher than that of the chemical-free microcapsule group and the isolated liver cells group. The microcapsules were retrieved after 4 weeks' implantation, which were observed to be smooth with no cells attaching to the surface. No apparent fibrosis was observed. This research demonstrated the physical stability and the biocompatibility of the PLO-based alginate microcapsules and therefore they could be used as liver cell carriers during implantation.
ObjectiveTo investigate whether parecoxib sodium preemptive analgesia reduces inflammatory cytokines and stress hormones production in elderly patients after total hip replacement. MethodSixty patients with American Society of Anesthesiologists Classification Ⅰ-Ⅱ undergoing total hip replacement for femoral neck fracture or aseptic necrosis of the femoral head, aged between 60 and 90 years with a body weight more than 50 kg, were randomly divided into preemptive analgesia group (group P, n=30) and control group (group C, n=30). The patients in group P received parecoxib sodium 40 mg intravenously 30 min before skin incision, and another 20 mg 8 hours after the first administration. All the patients in the two groups received the administration of patient-controlled analgesia sufentanyl. We recorded blood levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), cortisol (COR), adrenaline (AD) and noradrenaline (NAD) 30 min before skin incision, and 1 hour, 6 hours, 12 hours and 24 hours postoperatively. ResultsThe blood levels of IL-6, TNF-α, COR, AD and NAD in group P at 1 hour, 6 hours, 12 hours or 24 hours postoperatively were significantly lower than those in group C (P<0.05). ConclusionsParecoxib sodium preemptive analgesia reduces postoperative inflammatory cytokines and stress hormones production in elderly patients undergoing total hip replacement.
ObjectiveTo discuss the present situation of emergency physicians' communicational ability and the intervention measures. MethodsWe investigated 66 students who participated in continuing medical education of "emergency physicians' communication skills training course" from 2010 to 2013. All students accepted systematic training. After the training, we did the investigation again, and then made a comparison before and after the training. ResultsA major 78.8% of the students in this training had never taken part in the training of communication skills before; 51.5% of the students thought that the improvement of communication ability could be achieved mainly through long-term accumulation of clinical experiences. Students' self-evaluation showed that communication problem occurred 2 times a year in 10.6% of them, 3 times in 22.7%, 4 times in 24.2%, and five or more times in 34.8%. Students' role playing score in the scenario training rose from 5.374±0.686 to 6.717±0.517 after the training, and the difference was statistically significant (P=0.024). ConclusionEmergency physicians lack knowledge of communication skills which needs to be improved. Through training, the skills can be improved significantly.
ObjectiveTo investigate the effect of cyclic stretch stress on the osteogenic differentiation of human cartilage endplate-derived stem cells (CESCs). MethodsCESCs were isolated from the endplate cartilage tissues by the method of agarose suspension culture system. The endplate cartilage tissue was harvested for immunohistochemical staining. Flexercell-4000TM Tension Plus system was used to apply cyclic stretch on CESCs at a frequency of 1 Hz and at a stretch rate of 10% for 1, 6, 12, or 24 hours (experimental group). No stretch stress was performed on CESCs in the same culture condition (control group). After mechanical loading, the protein expression of bone morphogenetic protein 2 (BMP-2) was measured by Western blot, and gene expressions of runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP), and SOX9 were detected by real-time fluorescent quantitative PCR. ResultsImmunohistochemical staining showed BMP-2 protein expression in chondrocytes. The continuous cyclic stretch stress of 10% can increase the expression of BMP-2 protein in CESCs. Significant differences were observed in the expressions of BMP-2 protein (P<0.05) between 2 groups at the other time points except at 1 hour (P>0.05), in a time-dependent manner. The real-time fluorescent quantitative PCR indicated that the gene expressions of Runx2 and ALP showed an increasing tendency with time in the experimental group when compared with the control group, but there was down-regulated expression of SOX9. Significant difference was found in mRNA expressions of Runx2 and ALP at 12 and 24 hours and in mRNA expressions of SOX9 at 6, 12, and 24 hours between 2 groups (P<0.05), in a time-dependent manner. ConclusionCyclic stretch stress may induce osteogenic differentiation of CESCs by regulating the expressions of some genes related osteogenesis in CESCs.
ObjectiveTo compare the effect of intravenous 20% mannitol or dexamethasone (DM) on low back and leg pain after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). MethodsBetween October 2012 and September 2013, 100 patients with degenerative lumbar diseases underwent MI-TLIF and percutaneous pedicle screw fixation. All patients were randomly divided into 3 groups:34 patients received intravenous 20% mannitol after operation (mannitol group); 32 patients received intravenous DM after operation (DM group); and 34 patients received neither dehydrating agent nor steroid after operation (control group). There was no significant difference in gender, age, disease duration, clinical symptoms, lesion types, and lesion segments between groups (P>0.05). The serum levels of inflammatory factors[tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6] were measured by ELISA at pre-operation and 3, 24, 48, 72, and 96 hours after operation. Low back and leg pain was determined by using visual analogue scale (VAS) score after operation. ResultsAll procedures were smoothly performed without major complications of nerve root injury, hematoma, or infection. There was no significant difference in operation time and intraoperative blood loss between groups (P>0.05). The VAS score of low back pain showed no significant difference between groups at all time points after operation (P>0.05); the VAS score of leg pain in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than those in the mannitol group at 3, 24, 48, and 96 hours after operation (P<0.05). The serum level of TNF-α in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than that in the mannitol group at 3, 48, 72, and 96 hours after operation (P<0.05). The serum level of IL-1β in the DM group was significantly lower than that in the control group at 3, 24, 48, and 72 hours after operation (P<0.05), and than that in the mannitol group at all time points after operation (P<0.05). The serum level of IL-6 in the DM group was significantly lower than that in the control group at 3 and 24 hours after operation (P<0.05), and than that in the mannitol group at 3, 24, and 48 hours after operation (P<0.05). ConclusionIntravenous 20% mannitol may has no effect on postoperative low back and leg pain, while DM can markedly relieve leg pain after MI-TLIF.
ObjectiveThe Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model and its Portsmouth (P-POSSUM) modification are used extensively to predict post-operative mortality and morbidity in general surgery. The aim was to analysis the predictive value of these models in patients undergoing hepatobiliary surgery. MethodsEligible articles were identified by searching such electronic databases as PubMed, The Cochrane Library (Issue 10, 2013), Science Citation Index, CNKI, WanFang Data and CBM from 1991 to October 2013. Each study was assessed according to the inclusion and exclusion criteria. Then data were extracted, pooled, and analyzed using Comprehensive Meta Analysis Version 2. ResultsTen studies were included. The morbidity analysis included five studies and 683 patients on POSSUM with a weighted O/E ratio 0.71 (95%CI 0.60 to 0.81). The mortality analysis included seven studies with 1 291 patients on POSSUM and six studies with 1 793 patients on P-POSSUM. Weighted O/E ratios for mortality were 0.42 (95%CI 0.27 to 0.57) for POSSUM and 0.74 (95%CI 0.53 to 0.95) for P-POSSUM. ConclusionPOSSUM significantly overestimates postoperative morbidity in patients undergoing hepatobiliary surgery. Compared with the original POSSUM, P-POSSUM is more accurate for predicting post-operative mortality. Modifications to POSSUM and P-POSSUM are needed for audit in hepatobiliary surgery.