ObjectiveTo discuss the correlation of BRAFV600E mutation with clinicopathologic characteristics or thyroglobulin (Tg) in papillary thyroid carcinoma (PTC) and its clinical significance. MethodsThe BRAFV600E mutations of 55 patients with PTC were detected by nested PCR. The relations between BRAFV600E mutation and the clinicopathologic characteristics were analyzed. Results①The BRAFV600E mutations happened in 29 patients with PTC, the mutation rate was 52.7% (29/55).②The BRAFV600E mutation rate was related with extracapsular spread, multiple lesions, regional lymph node metastasis or average Tg value > 1.0μg/L during 2 years after standardized treatment (P value was 0.01, 0.02, 0.02, 0.03, respectively), but which not related with the gender, age, tumor diameter, or TNM stage (P > 0.05). ConclusionThe BRAFV600E mutation in PTC might lead to increased tumor aggressiveness and it might be related with increased Tg value after standardized treatment.
An automatic control system was designed to suppress pathological tremor on wrist joint with two degrees of freedom (DoF) using functional electrical stimulation (FES). The tremor occurring in the wrist flexion-extension and adduction-abduction was expected to be suppressed. A musculoskeletal model of wrist joint was developed to serve as the control plant, which covered four main muscles (extensor carpi radialis longus, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris). A second-order mechanical impedance model was used to describe the wrist skeletal dynamics. The core work was to design the controller and a hybrid control strategy was proposed, which combined inverse model based on feed forward control and linear quadratic regulator (LQR) optimal control. Performance of the system was tested under different input conditions (step signal, sinusoidal signal, and real data of a patient). The results indicated that the proposed hybrid controller could attenuate over 94% of the tremor amplitude on multi-DoF wrist joint.
ObjectiveTo identify the clinical significance of epileptic eye movement for localization of posterior epileptic seizures. MethodsThere were 12 posterior epileptic patients, who were undertaken the detailed presurgical evaluation and ictal SEEG recording, and the epileptogenic zone of whom was confirmed restricted within posterior cortex through the boarder of epileptic cortical resection and the result of epileptic surgery, included in the research. ResultsThe cluster analysis of posterior cortical area of interest showed that parieto-occipital sulcus (POS) with the adjacent cortical areas belonged to the Medial Group; intraparietal sulcus (IPS) with the adjacent areas belonged to the Intermediate Group; and the Lateral Group included anterior occipital sulcus (AOS) and posterior temporal cortex. Eyes forced stare had the significant correlation with IPS, POS and related cortical group. Contraversive eye deviation had no significant correlation with cortical eye field with the related cortical areas. ConclusionsForced eye stare was significant eye movement in posterior epilepsy, and had significant correlation with IPS and POS. Ipsiversive eye deviation and convergence binocular movement were rare semiology in posterior epilepsy, and AOS had significant correlation with the two type of epileptic eyes movement.
ObjectiveTo classify and analyze medical audit chargeback of a hospital and to propose management strategies. MethodsWe classified the project audit chargeback of a grade-three class-A comprehensive hospital in Chengdu from June to December 2013, and analyzed the underlying causes of the chargeback. ResultsThe total chargeback of the hospital from June to December 2013 was more than 30 000 items and the general amount involved was about 3 million yuan. The project number of recurring charges, excessive charges, unreasonable charges, anchored fees, inconsistent charges with doctors' advices, non-indications, disproportionate fees and charges over restriction accounts occupied respectively 42.99%, 39.71%, 9.15%, 5.73%, 0.35%, 0.17%, 1.44% and 0.46%; and the amount of money involved for those projects occupied respectively 8.84%, 52.55%, 14.44%, 10.70%, 2.54%, 1.15%, 8.91% and 0.88%. ConclusionThe reasons for project audit chargeback are complicated. By strengthening information technology, management of price and building negotiation mechanism with Medical Insurance and Pricing Management Institutes, we can reduce the amount of chargeback, protect the right of patients and enhance the efficient use of the health insurance fund, so that the hospital, medical insurance and patients can all get benefits.
We present the binding ability of a new peptide (-CMPQVMPMC-) with dental enamel after being evaluated in the present study. Under a standard procedure, the recovery of M13 filamentous phage was greatly enhanced by displaying the peptide in phage coat protein pⅢ. Then the cyclic peptide was synthesized using a solid method. The effect of the cyclic peptide in vitro biomineralization was tested in a single-diffusion microtiter plate gel system. Absorbance at 405 nm of each sample was recorded for 24 h at every 6 h intervals. The relatively increased values of each sample were expressed as percentages relative to the blank group (100%). The cyclic peptide resulted in a concentration-dependent delayed nucleation. In addition, the overall values of peptide groups at the end of 24 h were lower than those in the control group but much higher than those in the BSA control group.
ObjectiveTo discuss the CT imaging differences between mass-forming intrahepatic cholangiocarcinoma (ICC) and poorly-differentiated hepatocellular carcinoma (HCC). MethodThe clinical and CT data of 28 patients with mass-forming ICC (mass-forming ICC group) and 27 patients with poorly-differentiated HCC (poorly-differentiated HCC group), who were confirmed by pathological diagnosis in the West China Hospital from February 2014 to August 2014, were collected and analyzed retrospectively. ResultsThe contour, margin, enhancement patterns in the arterial phase and portal vein phase of the tumor had significant differences between the mass-forming ICC group and poorlydifferentiated HCC group (P < 0.05), in other words, the lobulated shape (15/28, 53.6%), indistinct margin (17/28, 60.7%), peripheral enhancement in the arterial phase (21/28, 75.0%) and prolonged enhancement in the portal vein phase (14/28, 50.0%) were more often seen in the mass-forming ICC group, while the poorly-differentiated HCC group were mainly the round shape (17/27, 63.0%), partially well-defined margin (18/27, 66.7%), diffuse heterogeneous enhancement in arterial phase (20/27, 74.1%) and wash out in the portal vein phase (18/27, 66.7%). The presence of bile duct dilatation in the the mass-forming ICC group was significantly higher than that in the poorly-differentiated HCC group﹝57.1% (16/28) versus 14.8% (4/27), P=0.001﹞. The size and enhancement degree of lymph node in the mass-forming ICC group were significantly bigger or higher than those in the poorly-differentiated HCC group (average lymph node size: 1.7 cm versus 1.3 cm, P=0.009; average enhancement degree of lymph node: 62.6 HU versus 51.8 HU, P=0.031). ConclusionCT features, such as tumor contour, margin, enhancement characteristics, the presence of bile duct dilatation, and the size and enhancement degree of lymph node, might help for differentiating mass-forming ICC from poorly-differentiated HCC, so that more timely selection of appropriate treatment strategies would be made.
ObjectiveTo investigate characteristics of motor semiology of epileptic seizure originated from dorsolateral frontal lobe. MethodsRetrospectively analysis the clinical profiles of patients who were diagnosed dorsolateral frontal lobe epilepsy (FLE) based on stereoelectroencephalography (SEEG) and underwent respective surgeries subsequently. Component of motor semiology in a seizure can be divided into elementary motor (EM, include tonic, versive, clonic, and myoclonic seizures) and complex motor (CM, include automotor, hypermotor, and so on). A Talairach coordinate system was constructed in the sagittal series of MRI images in each case. From the cross point of VAC and the Sylvian Fissure, a line was drawn antero-superiorly, which made an angle of 60° with the AC-PC line, then the frontal lobe could be divided into anterior and posterior portion. The epileptogenic zone, which was defined as ictal onset and early spreading zone in SEEG, was classified into three types, according to the positional relationship of the responding electrodes contacts and the "60° line": the anterior, posterior, and intermediate FLE. The correlation of the components of motor semiology in seizures and the location of the epileptogenic zone was analyzed. ResultsFive cases (26.3%) were verified as anterior FLE, among which there were 2 of EM, one of CM, and 2 of EM+CM. In 7 cases (36.8%) of intermediate FLE, there were one of EM, none of CM, and 6 of EM+CM. In the rest 7 cases of posterior FLE, there were 6 of EM, none of CM, and one of EM+CM. Compared with the cases that the epileptogenic zone involved anterior portion, the posterior FLE is more likely to present EM seizures (85.7%), and less likely to show CM components (P < 0.05). And Compared with the anterior FLE and posterior FLE, the intermediate FLE is more likely to present EM+CM seizures (85.7%)(P < 0.05). ConclusionThe motor seizure semiology of dorsolateral FLE has significant correlation with the localization of the epileptogenic zone. Posterior FLE mainly present a pure elementary motor seizure, and once the epileptogenic zone involved anteriorly beyond the "60° line", the component of complex motor seizure would be seen. Intermediate FLE, as its specialty of transboundary, is more likely to show "comprised semiology" of EM and CM. Construction of the "60° line" with AC-PC coordinate system in the MRI images may play an useful role in semiology analysis in presurgical evaluation of FLE.
ObjectiveTo investigate the age of patients can be the independence factor to affect the feasibility of pancreaticoduodenectomy. MethodsThe cases in the First Affiliated Hospital, Xinjiang Medical University from Feb. 2011 to Feb. 2015 were retrospectively analyzed, and divided into six groups according to age < 50, 50≤age < 60, 60≤age < 70, 70≤age < 75, 70≤age < 80, and≥80 years old. The complications, hospitalization days, and mortality rates for six groups were analyzed. ResultsThe differences in ASA classification (P < 0.001), hypertension (P < 0.001), coronary heart disease (P=0.001), diabetes mellitus (P < 0.001), heart failure (P=0.001), respiratory failure (P=0.037), postoperative hospitalization days (P=0.014), and delayed gastric emptying grade C (P=0.006) had statistical significance, and pancreatic fistula (P=0.058), postoperative bleeding (P=0.786), and mortality (P=0.125) of the different age groups had no significant difference. ConclusionAge is not the independent risk factor to affect the feasibility of pancreaticoduodenectomy, but the strictly preoperative comorbidities assessment is necessary.
ObjectiveTo assesse the effectiveness of anterior cervical discectomy and fusion with Cage alone in treating multi-level cervical degenerative disease. MethodsBetween August 2010 and August 2012, 62 eligible patients with multi-level cervical degenerative disease were treated, and the clinical data were reviewed. Of 62 patients, 32 underwent anterior cervical discectomy and fusion with Cage alone (group A), and 30 underwent anterior cervical discectomy and fusion with plate fixation (group B). Both groups showed no significant difference in gender, age, disease duration, lesion types, and affected segments (P>0.05), it had comparability. Clinical outcomes were assessed using Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) score; the fused segment height, subsidence rates of Cages, global cervical lordosis, and fusion rates were also compared. ResultsThe operation time of group B[(109.7±11.2) minutes] was significantly more than group A[(87.8±6.9) minutes] (t=-2.259, P=0.037). Primary healing of incisions was obtained in all patients of 2 groups. All patients were followed up; the follow-up period ranged from 8 to 27 months (mean, 15.8 months) in group A, and from 9 to 28 months (mean, 16.4 months) in group B. There was no complication and internal fixation failure. The JOA score and VAS score were significantly improved at last follow-up when compared with preoperative scores in 2 groups (P<0.05). According to Robinson standard for axial symptom severity, the results were excellent in 20 cases, good in 9, fair in 2, and poor in 1, with an excellent and good rate of 90.63% in group A; the results were excellent in 19 cases, good in 7, fair in 3, and poor in 1, with an excellent and good rate of 86.67% in group B; and no significant difference was found between 2 groups (χ2=0.765, P=0.382). The fused segment height at immediate after operation and at last follow-up and global cervical lordosis at last follow-up were significantly improved when compared with preoperative ones in 2 groups (P<0.05). There was no significant difference (P>0.05) between groups A and B in the Cage subsidence height[(1.4±0.9) mm vs. (1.2±1.6) mm], Cage subsidence rate[9.52% (8/84) vs. 7.59% (6/79)], and fusion rate[95.24% (80/84) vs. 96.20% (76/79)]. ConclusionAnterior cervical discectomy and fusion with Cage alone can obtain good clinical results and radiologic indexes, avoid plate-related complications and reduce operation time. It is a safe and effective surgical option in the treatment of multi-level cervical degenerative disease.
ObjectiveTo evaluate the effectiveness of hemiarthroplasty combined with greater trochanter reattachment device for intertrochanteric fractures in elderly patients. MethodsA retrospective analysis was made on the clinical data of 34 patients (35 hips) with intertrochanteric fractures underwent hemiarthroplasty combined with greater trochanter reattachment device between February 2010 and April 2013.Of 34 patients,16 were males (16 hips) and 18 were females (19 hips),and the mean age was 85.6 years (range,77-95 years).All fractures were caused by falling.The left hip was involved in 20 cases,the right hip in 13 cases,and the bilateral hips in 1 case.There were 33 cases (34 hips) of fresh fracture,and 1 case (1 hip) of old fracture.Fractures were rated as type Ⅲ in 6 cases (6 hips),type IV in 11 cases (11 hips),and type V in 17 cases (18 hips) according to Evans-Jensen standard.All of the patients had different degree of osteoporosis and internal diseases. ResultsAll patients underwent surgery successfully.The operation time was 70-90 minutes (mean,76.6 minutes);the intraoperative blood loss was 260-400 mL (mean,301.5 mL);the postoperative drainage was 80-530 mL (mean,290.6 mL);and the hospitalization time was 10-12 days (mean,11.7 days).Postoperative infection of incision occurred in 1 case,which was cured after dressing;primary healing of incision was obtained in the other patients.No lower extremity deep vein thrombosis or other complications was observed.Twenty-six cases (27 hips) were followed up 12-48 months (mean,21.3 months).X-ray examination showed fracture healing,and the healing time was 2.5-3.5 months (mean,2.8 months).There was no dislocation,prosthesis loosening,dislocation,loosening of titanium cable,periprosthetic osteolysis,or other complications during the follow-up period.According to Harris hip score,the results were excellent in 8 hips,good in 15 hips,fair in 4 hips,and the excellent and good rate was 85.2% at 1 year after operation. ConclusionThe hemiarthroplasty combined with greater trochanter reattachment device is a feasible and effective method to treat intertrochanteric fractures in the elderly patients.It can allow early ambulation and improve quality of life,but it is necessary to strictly control the indications,and perioperative management should be paid attention.