分期多法治疗周围性面瘫160例体会

笔者于2005年-2010年期间治疗周围性面瘫160例，把该病分成早、中、晚三期，在疾病不同的时期采甩不同的治疗方法，收到较满意的疗效，并把2005年以前治疗的116例周围性面瘫设成对照组，现报告如下。

肛瘘多法联合治疗515例分析

对515例肛瘘患者采用多法联合治疗的效果做了分析.

中医辨证治疗对NAFLD大鼠血脂等影响的实验研究

目的:探讨中医辨证治疗对非酒精性脂肪性肝病(NAFLD)大鼠各时期血脂等指标影响的作用机制,为临床防治NAFLD提供理论依据。方法:取SPF级Wistar大鼠72只,雌雄各半,随机分为正常组、模型组、对照药物治疗组、药物A方治疗组、药物B方治疗组、先A方后B方治疗组、先B方后A方治疗组、先空白后A方治疗组、先空白后B方治疗组,共9组。除正常组给予普通饲料外,其余各组均饲以高脂饲料。造模第4周后,模型组加用生理盐水灌胃;对照组加用对照药物灌胃;药物A方组加用治疗药物A方灌胃;药物B方组加用治疗药物B方灌胃;先A方后B方治疗组即4～8周用A方,8～12周用B方灌胃;先B方后A方治疗组即4～8周用B方,8～12周用A方灌胃;先空白后A方治疗组即先空白,第8～12周用A方灌胃;先空白后B方治疗组即先空白,第8～12周用B方灌胃。实验第12周时,测定大鼠血清TCH、TG、HDL、LDL、FFA、GSH-ST、TNF-α的值。结果:实验第12周时,先A方后B方治疗组(编号为6组)降低NAFLD后期大鼠血清TG、TCH、LDL、FFA、TNF-α及升高血清GSH-ST水平的疗效与其他治疗组相比尤为显著(P<0.01或P<0.05)。结论:在NAFLD的整个病程中,采取早期阶段运用疏肝健脾、活血化瘀、化痰利湿功效的治法,后期阶段运用化痰消瘀、清热利湿、补益肝肾功效的治法的治疗方案,对于降低大鼠血脂等指标及提高大鼠抗氧自由基的疗效显著优于其他治疗措施。

XRCC1 genetic polymorphism Arg399Gln and gastric cancer risk:A meta-analysis

AIM： To evaluate the association between X-ray crosscomplementing gene 1 （XRCCl） genetic polymorphism Arg399Gln and gastric cancer risk by means of metaanalysis. METHODS： We searched PubMed and NCBI up to June 1, 2008. A total of 16 clinical trials and reports were identified, but only 8 trials qualified under our selection criteria. Statistical analysis was performed with the software program Review Manage, version 4.2.8. RESULTS： Of the 8 case-control studies selected for this meta-analysis, a total of 1334 gastric cancer cases and 2194 controls were included. For Arg399GIn, the Gin/Gin genotype carriers did not have a decreased cancer risk compared with those individuals with the Arg/Arg genotype （OR = 0.92, 95% CI, 0.71-1.19; P = 0.51）. Similarly, no associations were found in the recessive and dominant modeling （Gin/Gin vs Arg/GIn ＋ Arg/Arg： OR = 0.96; 95% CI, 0.77-1.19; P = 0.70 and Gin/Gin ＋ Arg/GIn vs Arg/Arg： OR = 0.90, 95% CI, 0.77-1.05; P = 0.18）. CONCLUSION： No association is found between the XRCC1 polymorphism Arg399GIn and gastric cancer risk.

DNMT3B 579 G>T promoter polymorphism and risk of esophagus carcinoma in Chinese

AIM:To investigate the relationship between 579 G>T polymorphisms in the DNMT3B gene, which is involved in de novo methylation and associated with the risk of esophagus cancer (EC) in Chinese. METHODS:DNMT3B 579 G>T genotypes were determined by PCR-RFLP in 194 EC patients and 210 healthy controls matched for age and sex, who did not receive radiotherapy or chemotherapy for newly diagnosed and histopathologically confirmed EC. RESULTS:In control subjects, the frequency of T/T and G/T genotypes, and T and G alleles was 81.4%, 18.1%, 90.05% and 9.55%, respectively. The distribution of genotypes and allelotypes in the EC patients was not significantly different from that in the controls. When stratified by sex and age, there was still no significant association between the risks of EC and GT and GG genotypes. This study also showed a distinct difference in the distribution of DNMT3B and single nucleotide polymorphism (SNP) between Chinese and Koreans.CONCLUSION:DNMT3B 579 G>T polymorphism may not be a stratification marker to predict the susceptibility to EC, at least in Chinese. DNMT3B promoter SNP is diverse in ethnic populations.

Renaldopaminergic system:Pathophysiological implications andclinical perspectives

Fluid homeostasis, blood pressure and redox balance in the kidney are regulated by an intricate interaction between local and systemic anti-natriuretic and natriuretic systems. Intrarenal dopamine plays a central role on this interactive network. By activating specifc receptors, dopamine promotes sodium excretion and stimulates anti-oxidant and anti-inflammatory pathways. Different pathological scenarios where renal sodium excretion is dysregulated, as in nephrotic syndrome, hypertension and renal infammation, can be associated with impaired action of renal dopamine including alteration in biosynthesis, dopamine receptor expression and signal transduction. Given its properties on the regulation of renal blood fow and sodium excretion, exogenous dopamine has been postulated as a potential therapeutic strategy to preventrenal failure in critically ill patients. The aim of this review is to update and discuss on the most recent findings about renal dopaminergic system and its role in several diseases involving the kidneys and the potential use of dopamine as a nephroprotective agent.

The Herpes Simplex Virus Type 1 Multiple Function Protein ICP27

The herpes simplex virus type 1 （HSV-1） infected-cell protein 27 （ICP27） is an essential, highly conserved protein involved in various steps of HSV-1 gene regulation as well as in the shut-off of host gene expression during infection. It functions primarily at the post-transcriptional level in inhibiting precursor mRNA splicing and in promoting nuclear export of viral transcripts. Recently, many novel functions performed by the HSV- 1 ICP27 protein were shown, including leptomycin B resistance, inhibition of the type I interferon signaling, regulation of the viral mRNA translation and determining the composition of HSV-1 virions

Current management of autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease （ADPKD）, the most frequent cause of genetic renal disease affecting approximately 4 to 7 million individuals worldwide and accounting for 7%-15% of patients on renal replacement therapy, is a systemic disorder mainly involving the kidney but cysts can also occur in other organs such as the liver, pancreas, arachnoid membrane and seminal vesicles. Though computed tomography and magnetic resonance imaging （MRI） were similar in evaluating 81% of cystic lesions of the kidney, MRI may depict septa, wall thickening or enhancement leading to upgrade in cyst classification that can affect management. A screening strategy for intracranial aneurysms would provide 1.0 additional year of life without neurological disability to a 20-year-old patient with ADPKD and reduce the fnancial impact on society of the disease. Current treatment strategies include reducing： cyclic adenosine monophosphate levels, cell proliferation and fluid secretion. Several randomised clinical trials （RCT） including mammalian target of rapamycin inhibitors, somatostatin analoguesand a vasopressin V2 receptor antagonist have beenperformed to study the effect of diverse drugs ongrowth of renal and hepatic cysts, and on deteriorationof renal function. Prophylactic native nephrectomy isindicated in patients with a history of cyst infection orecurrent haemorrhage or to those in whom space musbe made to implant the graft. The absence of largeRCT on various aspects of the disease and its treatmen leaves considerable uncertainty and ambiguity in many aspects of ADPKD patient care as it relates to end stage renal disease （ESRD）. The outlook of patients with ADPKD is improving and is in fact much better than that for patients in ESRD due to other causes. This review highlights the need for well-structured RCTs as a frst step towards trying newer interventions so as to develop updated clinical management guidelines.

A case of acute infectious mononucleosis presenting with very high ferritin

Hepatitis is an important but uncommon manifestation of acute Epstein Barr infection. Infectious mononucleosis is usually a disease of young adults. We report a case of infectious mononucleosis in a 72-year old jaundiced gentleman with ferritin level of 2438 that normalised on clinical improvement.

Constitutive renal Rel/nuclear factor-κB expression in Lewis polycystic kidney disease rats

AIM： To determine the temporal expression and pattern of Rel/nuclear factor （NF）-κB proteins in renal tissue in polycystic kidney disease （PKD）. METHODS： The renal expression of Rel/NF-κB proteins was determined by immunohistochemistry, immunofuorescence and immunoblot analysis in Lewis polycystic kidney rats （LPK, a genetic ortholog of human nephronopthsis-9） from postnatal weeks 3 to 20. At each timepoint, renal disease progression and the mRNA expression of NF-κB-dependent genes （TNFa and CCL2） were determined. NF-κB was also histologically assessed in human PKD tissue.RESULTS： Progressive kidney enlargement in LPK rats was accompanied by increased renal cell proliferation and interstitial monocyte accumulation （peaking at weeks 3 and 10 respectively）, and progressive interstitial fibrosis （with a smooth muscle actin and Sirius Red deposition significantly increased compared to Lewis kidneys from weeks 3 to 6 onwards）. Rel/NF-κB proteins （phosphorylated-p105, p65, p50, c-Rel and RelB） were expressed in cystic epithelial cells （CECs） of LPK kidneys as early as postnatal week 3 and sustained until late-stage disease at week 20. From weeks 10 to 20, nuclear p65, p50, RelB and cytoplasmic IκBa protein levels, and TNFa and CCL2 expression, were upregulated in LPK compared to Lewis kidneys. NF-κB proteins were consistently expressed in CECs of human PKD. The DNA damage marker γ-H2AX was also identifed in the CECs of LPK and human polycystic kidneys. CONCLUSION： Several NF-κB proteins are consistently expressed in CECs in human and experimental PKD. These data suggest that the upregulation of both the canonical and non-canonical pathways of NF-κB signaling may be a constitutive and early pathological feature of cystic renal diseases.

Patterns of local recurrence in rectal cancer after a multidisciplinary approach

Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence (LR) rate and when there is LR it tends to appear later and less often in isolation. Moreover, a subtle change in the distribution of LRs with respect to the pelvis has been observed. In general terms, prior to total mesorectal excision the most common LRs were central types (perianastomotic and anterior) while lateral and posterior forms (presa-cral) have become more common since the growth in the use of combined treatments. No differences have been reported in the current pattern of LRs as a function of the type of approach used, that is, neo-adjuvant therapies (short-term or long-course radiotherapy, orchemoradiotherapy versus extended lymphadenectomy, though there is a trend towards posterior or presacral LR in patients in the Western world and lateral LR in Asia. Nevertheless, both may arise from the same mechanism. Moreover, as well as the mode of treatment, the type of LR is related to the height of the initial tumor. Nowadays most LRs are related to the advanced nature of the disease. Involvement of the circumferential radial margin and spillage of residual tumor cells from lymphatic leakage in the pelvic side wall are two plausible mechanisms for the genesis of LR. The patterns of pelvic recurrence itself (pelvic subsites) also have important implications for prognosis and are related to the potential success of salvage curative approach. The re-operability for cure and prognosis are generally better for anastomotic and anterior types than for presacral and lateral recurrences. Overall survival after LR diagnosis is lower with radio or chemoradiotherapy plus optimal surgery approaches, compared to optimal surgery alone.

Evaluation of 5 versus 10 granulocyteaphaeresis sessions in steroid-dependent ulcerative colitis: A pilot, prospective, multicenter, randomized study

AIM： To evaluate the efficacy of 5 compared to ：tO granulocyteaphaeresis sessions in patients with active steroid-dependent ulcerative colitis. METHODS： In this pilot, prospective, multicenter randomized trial, 20 patients with moderately active steroid-dependent ulcerative colitis were randomized to 5 or 10 granulocyteaphaeresis sessions. The primary objective was clinical remission at wk 17. Secondary measures included endoscopic remission and steroid consumption.RESULTS： Nine patients were randomized to 5 granulocyteaphaeresis sessions （group 1） and 11 patients to 10 granulocyteaphaeresis sessions （group 2）. At wk 17, 37.5% of patients in group 1 and 45.45% of patients in group 2 were in clinical remission. Clinical remission was accompanied by endoscopic remission in all cases. Eighty-six percent of patients achieving remission were steroid-free at wk 17. Daily steroid requirements were significantly lower in group 2. Eighty-nine per cent of patients remained in remission during a one year follow-up. One serious adverse event, not related to the study therapy, was reported. CONCLUSION： Granulocyteaphaeresis is safe and effective for the treatment of steroid-dependent ulcerative colitis. In this population, increasing the number of aphaeresis sessions is not associated with higher remission rates, but affords a significant steroid-sparing effect.

Effects of acupoint embedding combined with clomiphene in patients with polycystic ovary syndrome： a randomized controlled trial

Objective： To compare the efficacy of acupoint embedding combined with clomiphene with clomiphene alone in the treatment of patients with polycystic ovary syndrome （PCOS）. Methods： Sixty patients who met the diagnostic criteria of PCOS were randomly divided into the acupuncture-medicine combination （30 cases） and the single medicine （30 cases） groups. For a total of 4 menstrual cycles, patients in the acupuncture-medicine combination group were treated with acupoint embedding combined with oral clomiphene, whereas those in the single medicine group were treated with clomiphene only. Clinical efficacy of the two treatments was observed after 2 months of treatment, and body mass index （BMI）, number of menstrual cycles, luteinizing hormone （LH）, follicle stimulating hormone （FSH）, LH / FSH ratio, and serological levels of testosterone before and after treatment were analyzed. Results： Compared with the single medicine group, patients in the acupuncture-medicine group showed lower BMI （24.3 ± 1.6 vs 26.1 ± 1.8） and higher number of menstrual cycles （3.6 ± 1.5 vs 2.8 ± 1.2）; the differences were statistically significant （P = 0.018, P = 0.025）. LH （9.53 ± 5.46 vs 12.29 ± 5.67） and LH / FSH （1.02 ± 0.57 vs 1.45 ± 0.23） levels were significantly decreased （P = 0.041, P = 0.039）. Compared to before treatment, BMI （24.3 ± 1.6 vs 27.6 ± 1.4） was lower and the number of menstrual cycles was higher （3.6 ± 1.5 vs 1.8 ± 0.8） after treatment; the differences were statistically significant （P = 0.034, P = 0.024）. The levels of LH （9.53 ± 5.46 vs 18.12 ± 11.04） and LH / FSH （1.02 ± 0.57 vs 2.38 ± 1.09） were significantly decreased （P = 0.007 P = 0.005）. Total effective rates were 76.67% and 70% in the acupuncture-medicine combination and single medicine groups, respectively; the difference between the two groups was statistically significant （P = 0.043）. Conclusion： Acupoint embedding combined with clomiphene in the treatment of PCOS could downregulate BMI, LH, and LH / FSH ratio, and increase the number of menstrual cycles.

TREATMENT OF NINETY-FIVE CASES OF MULTIPLESCLEROSIS WITH ACUPUNCTURE

From December of 1998 to August of 2002, the author treated 95 cases of multiple sclerosis with acupuncture. The observation has confirmed that acupuncture is a very effective method for treating this disease, especially to sclerosis patients in the early stage; and furthermore it can slow down the development of the pathological conditions of the patients. Thus it is an important therapeutic method worthy of the choice by European and American clinical doctors.

Multi-analysis with mathematic model of 3125 non-thyrogenous masses of the neck

Objective： To systematically analyze and summarize non-thyrogenous masses of the neck （NTMN） by consideration of new areas, a large sample size and multiple-aspect analysis. Methods： Our research involved 3125 NTMN cases. We summarized the proportion of various NTMN and the distribution of the neck diseases based on the new international classification. The clinical traits such as sexual proportion and age, etc, were analyzed along with the unknown primary cervical metastatic carcinomas （UPCMC）, and built up a mathematical model based on the data above. Results： There were 68 different diseases identified. Among all the NTMN, the percentage of metastatic carcinomas was 63.3%. The neck masses with a focus above the clavicle comprised 62.3% of the metastatic carcinomas whose focuses were clear. Moreover, other results almost supported the ＂rule of 80%＂. There was an obvious distribution of traits at every sub level. For example, there were 23 different diseases in level Ⅲ, of which the most common was lymphoma. UPCMC made up 12.3% of all metastatic carcinomas. The clinic cases could be analyzed by our model even to form a primary diagnosis which showed a high coincident rate with clinic diagnosis. Conclusion： NTMN are complex and various, with a definite distribution in each neck level. Data relating component character, sex ratio and UPCMC et al to the clinical traits of NTMN will provide vigorous support for clinical applications. The mathematical model could be an efficient method to synthetically analyze complicate data of NTMN.

Damage control of multiple injuries headed by cervica spinal cord injury

Objective ： To explore the strategy of damage control in clinical treatment of multiple injuries headed by cervical spinal cord injury. Methods： A retrospective analysis was performed in 32 patients. Cervical fractures associated with tetraplegia occurred in 18 patients, traumatic intervectebral disk hernia associated with tetraplegia in 2 patients, and cervical fractures and dislocation associated with tetraplegia in 12 patients. Seventeen cases were combined with craniocerebral injury, 7 combined with pulmonary contusion, multi-fractures of rib or hemopneumothorax, 2 combined with pelvic fracture and other 8 combined with fracture of limbs. The neural function was assessed by the American Spinal Injury Association （ASIA） scale. Results： Thirty-one patients were followed up for an average of 14 months. Of them, 10 got complete recovery, 13 obtained improvement of more than one ASIA grade, 8 did not improve, and 1 died. Conclusions ： For the emergency treatment of multiple injuries headed by cervical spinal cord injury, the damage control strategy is the principle to follow. The final operations are preferably performed within 5 to 10 days after injury so as to raise the successful rate of remedy.

A prospective cancer chemo-immunotherapy approach mediated by synergistic CD326 targeted porous silicon nanovectors

Combination therapy via nanoparticulate systems has already been proposed as a synergistic approach for cancer treatment. Herein, undecylenic acid modified thermally hydrocarbonized porous silicon nanoparticles （UnTHCPSi NPs） loaded with sorafenib and surface-biofunctionalized with anti-CD326 antibody （Ab） were developed for cancer chemo-immunotherapy in MCF-7 and MDA-MB-231 breast cancer cells. The cytocompatibility study showed no significant toxicity for the bare and antibody-conjugated UnTHCPSi （Un-Ab） NPs at concentrations lower than 200 μg·mL^-1. Compared to the bare UnTHCPSi, Un-Ab NPs loaded with sorafenib reduced the premature drug release in plasma, increasing the probability of proper drug targeting. In addition, high cellular interaction and subsequent internalization of the Un-Ab NPs into the cells expressing CD326 antigen demonstrated the possibility of improving antigen-mediated endocytosis via CD326 targeting. While an in vitro antitumor study revealed a higher inhibitory effect of the sorafenib-loaded Un-Ab NPs compared to the drug-loaded UnTHCPSi NPs in the CD326 positive MCF-7 cells, there was no difference in the anti-proliferation impact of both the abovementioned NPs in the CD326 negative MDA-MB-231 cells, suggesting CD326 as an appropriate receptor for Ab-mediated drug delivery. It was also shown that the anti-CD326 Ab can act as an immunotherapeutic agent by inducing antibody dependent cellular cytotoxicity and enhancing the interaction of effector immune and cancer cells for subsequent phagocytosis and cytokine secretion. Hence, the developed nanovectors can be applied for simultaneous tumor-selective drug targeting and immunotherapy.

The influence of acupuncture on sleep disorders and anxiety

Objective To observe the influence of acupuncture on sleep disorders and anxiety.Methods This is a descriptive study of correlation type.Sixty patients and 60 common people aged from 20 to 40 in Yazd City were selected to answer the questions of Pittsburgh Sleep Quality Index(PSQI) and Beck Anxiety Inventory(BAI) questionnaires.The data were analyzed using correlation coefficient and multiple regressions.Results The results showed that treatment by acupuncture outperforms drug-based medication in decreasing the level of anxiety in people.The medication using chemical drugs has lower effect over the quality of sleeping.The acupuncture method has the best prediction from the sleep quality(53%).Also acupuncture method has the best prediction from lowering anxiety among people(62%).Conclusion Due to the effect of acupuncture on the patients suffering sleep disorders and anxiety,acupuncture can open promising horizons for these patients.Nowadays acupuncture has a special status on treatment of sleep disorders and anxiety.