Objective To conduct Meta-analyses on published literatures about the Jianpi Bushen Decoction combined with western medicine for dysfunctional uterine bleeding (DUB), so as to evaluate its efficacy and safety compared with the western medicine treatment. Methods The following databases such as PubMed (1995 to 2011), EMCC (1995 to 2011), CBM (1995 to 2011), CNKI (1995 to 2011), Wanfang (1989 to 2011) and VIP (1989 to 2011) were searched to collect the randomized controlled trials (RCTs) on Jianpi Bushen Decoction combined with western medicine for DUB. The selection of studies, assessment of methodological quality and data extraction were performed independently by two reviewers according to the Cochrane systematic review methods, and Meta-analyses were performed by using RevMan5.0 software. Results A total of 12 RCTs involving 925 cases were included, of which 471 ones were in the experimental group while the other 454 ones were in the control group. Each study was comparable in baseline data, all with reporting of using random methods, but no mention of detailed random methods, blind methods and allocation concealment. The results of Meta-analyses indicated that compared with single therapy of western medicine, Jianpi Bushen Decoction combined with western medicine for DUB was superior in the total effective rate (OR=5.60, 95%CI 3.25 to 9.67, Plt;0.000 01), bleeding recovery rate (OR=3.79, 95%CI 2.70 to 5.32, Plt;0.000 01), and bleeding recurrence rate (OR=0.14, 95%CI 0.05 to 0.42, P=0.000 5), with significant differences. Conclusions The integrated treatment of Jianpi Bushen Decoction and western medicine has certain effects on dysfunctional uterine bleeding, and it may be a promising treatment option. Due to the poor quality and high possibility of bias of the included studies, more well-designed multi-centered RCTs should be performed.
ObjectiveTo investigate the effect of indocyanogen green retention rate (ICGR) measurement and Child-Pugh classification of liver function in the preoperative evaluation of hepatic functional reservation. MethodsThe level of ICGR at 15 min (ICGR15) and the percentage of liver fibrosis in 103 patients with liver cancer were measured before hepatectomy, and the Child-Pugh classification of liver function was evaluated before and after the operations, and their connections were analyzed. ResultsAs the rise of Child-Pugh classification of liver function, the percentage of liver fibrosis increased gradually, there were significant differences between any two Child-Pugh classification (Plt;0.05). There was a linear correlation between the ICGR15 and the liver fibrosis percentage (rs=0.960, Plt;0.05). The value of preoperative ICGR15 in patients with postoperative Child-Pugh classification from grade A to grade B or grade B to grade C was gnificantly higher than that in patients with stabilization of Child-Pugh classification before and after operations (Plt;0.05). ConclusionICGR15 combined with Child-Pugh classification can improve the accuracy for the evaluation of preoperative hepatic functional reservation.
Objective To evaluate the value of medical imaging technology in qualitative and quantitative diagnosis of liver steatosis. Methods To describe the current status and advancement s of medical imaging technology such as sonography , CT and MRI in qualitative and quantitative diagnosis of liver steatosis , and to cont rast their advantages and shortages. Results Sonography could be used as the primary screening and evaluate measures in qualitative and quantitative diagnosis of liver steatosis , and CT was more reliable in quantitative diagnosis , MRI had significant improving with its high sensitivity and specificity. Conclusion Medical imaging technology has significant clinical value in qualitative and quantitative diagnosis of liver steatosis , especially with the help of functional MR imaging techniques such as spect roscopy and chemical shif t Gradient-Echo technic.
The experimental models of chronic hepatic lesion of 40 rabbits were made by intra-abdominal injection of thioacetamide.The chronic hepatic lesion was confirmed by pathological examination and hepatectomies were performed in accordance with different measurements on each rabbit.The observations included indocyanine green retention rate,hepatic resection volume,and the outcomes of operations.The results showed that the mortality was correlative with the change of hepatic functions in the background of chronic hepatic lesion.The indocyanine green retention and the level of serum albumin are important parameters to indicate hepatic impairment.When the former was over 40% or the latter below 2.8g% the operative danger was high and the mortality was over 50%.In accordance with the classification of hepatic function,the preoperative functional state of liver were classified:grade A,B and C.the mortality of posthepatectomy were respectively 16.7%,3O%,and 72%.The multiple progressive regression equation is employed for calculating the postoperative outcome.The equation predicted the postoperative outcome with 88.9% accuracy.
Objective To study the microstructural change of detrusor muscle and neuromuscular junction (NMJ) after bladder functional reconstruction for atonic bladder caused by medullary cone injury and to discuss the feasibility of bladder functional reconstruction for improving the detrusor muscle degeneration. Methods A total of 104 adult female Sprague-Dawley rats (weighing, 200-250 g) were randomized divided into 3 groups: normal group (n=8), control group (n=48), and experimental group (n=48). No treatment was given in normal group; the medullary cone injury was established by sharp transection of spinal cord at L4, 5 levels in control group; and the anastomosis of bilateral L5 ventral root (VR)-S2 VR and L5 dorsal root (DR)-S2 DR was performed for bladder functional reconstruction after modeling of medullary cone injury in experimental group. After operation, the survival condition of rats was observed. At 3 days and 3 consecutive days before 1, 2, 3, 4, 5, and 6 months after operation, the residual urine volume was measured; at 1, 2, 3, 4, 5, and 6 months after operation, the detrusor muscle was harvested to measure the muscle fiber cross-sectional area by HE staining, to calculate the percentage of connective tissue by Masson trichrome staining, and to observe the ultrastructure of the detrusor muscle and the NMJ by transmission electron microscope (TEM). Results Eleven rats were supplemented because of death after operation. In control group, a significant increase of the residual urine volume was observed with the extension of time (P lt; 0.05); in experimental group, an increase was observed at the first 3 months after operation, and then gradually decreased, showing significant differences between the other time point (P lt; 0.05) except between at 3 days and at 5 months after operation (P gt; 0.05); there was significant difference between control and experimental groups at other each time point (P lt; 0.05) except at 3 days, 1 month, and 2 months (P gt; 0.05). HE staining and Masson trichrome staining indicated that the muscle fibers arranged in disorder with gradually aggravated atrophy and gradually increased connective tissue in control group, while the shape of the detrusor muscle recovered with no increased connective tissue at 4, 5, and 6 months after operation in experimental group; there was significant difference in cross-sectional area of detrusor muscle and percentage of connective tissue between normal group and experimental group, and between normal group and control group at each time point (P lt; 0.05). In control group, the cross-sectional area of detrusor muscle decreased and the percentage of connective tissue increased with the extension of time (P lt; 0.05). In experimental group, the cross-sectional area of detrusor muscle decreased at the first 3 months and then increased, and the percentage of connective tissue increased slowly with the extension of time. There was no significant difference of cross-sectional area of detrusor muscle at the first 3 months between control and experimental groups (P gt; 0.05), but the values in experimental group were significantly higher than those in control group at 4, 5, and 6 months after operation (P lt; 0.05). There were significant differences of the percentage of connective tissue between control and experimental groups at each time point (P lt; 0.05). In control group, the amount of synaptic vesicles decreased in the NMJ with time passing; vacuole like structure was observed in NMJ at 3 months; there was almost no nerve ending at 6 months. In experimental group, the amount of synaptic vesicles decreased at 1 and 3 months after operation, but obviously increased at 6 months. Conclusion The reconstruction of bladder function with L5 nerve roots above the paraplegic plane can effectively inhibit the degeneration of detrusor muscle and improve its microstructural changes after medullary cone injury.
【Abstract】 Objective To investigate the feasibility of transpositional anastomosis of C4 anterior trunk and accessory nerve for functional reconstruction of the trapezius muscle so as to provide theoretical basis of repairing accessory nerve defects. Methods Thirty-six adult male Sprague-Dawley rats (weighing 200-250 g) were randomly divided into the experimental group (n=18) and control group (n=18). The transpositional anastomosis of C4 anterior trunk and accessory nerve was performed in the left sides of experimental group; the accessory nerve was transected in the left sides of control group; and the right sides of both groups were not treated as within-subject controls. The electrophysiological and histological changes of the trapezius muscle were measured. The values of the latencies and amplitudes of compound muscle action potential (CMAP) were recorded in the experimental group at 1, 2, and 3 months; the latency delaying rate, amplitude recovery rate, and restoration rate of muscular tension were caculated. The counts of myelinated nerve fibers from distal to the anastomotic site were analyzed. The transverse area of the trapezius muscle was also measured and analyzed in 2 groups. Meanwhile, the muscles and nerves were harvested for transmission electron microscope observation in the experimental group at 1 and 3 months. Results As time passed by, the experimental group showed increased amplitudes of CMAP, shortened latencies of CMAP, and improved muscular tension. At 3 months, the amplitude recovery rates were 63.61% ± 9.29% in upper trapezius muscle and 73.13% ± 11.85% in lower trapezius muscle; the latency delaying rates were 130.45% ± 37.27% and 112.62% ± 19.57%, respectively; and the restoration rate of muscular tension were 77.27% ± 13.64% and 82.47% ± 22.94%, respectively. The passing rate of myelinated nerve fibers was 82.55% ± 5.00%. With the recovery of innervation, the transverse area of the trapezius muscle increased, showing significant differences between experimental group and control group at different time points (P lt; 0.05). The transmission electron microscope showed that the myotome arranged in disorder at 1 month and tended to order at 3 months. Conclusion Transpositional anastomosis of C4 anterior trunk and the accessory nerve can effectively reconstruct the function of the trapezius muscle of rats.
ObjectiveTo evaluate the middle- and long-term effectiveness of primary total hip arthroplasty (THA) in patients with chronic autoimmune inflammatory diseases. MethodsBetween January 1990 and June 2006, 42 patients (51 hips) with chronic autoimmune inflammatory diseases underwent THA. There were 15 males (18 hips) and 27 females (33 hips) with an average age of 36.9 years (range, 22-70 years). The locations were the left side in 29 hips and the right side in 22 hips. Of 42 cases, there were 11 cases of systemic lupus erythematosus (13 hips), 16 cases of rheumatoid arthritis (22 hips), and 15 cases of ankylosing spondylitis (16 hips). The causes of THA included avascular necrosis of the femoral head in 26 cases (34 hips), ankylosis of the hip in 15 cases (16 hips), and fracture of the femoral neck in 1 case (1 hip). The Harris score was 32.49 ± 9.50. The physical component summary (PCS) and mental component summary (MCS) of short form 36 health survey scale (SF-36) scores were 25.53 ± 4.46 and 42.28 ± 6.27, respectively. ResultsAll incisions healed primarily. All 42 patients were followed up 5-21 years (mean, 9.1 years). At last follow-up, the Harris score was 89.25 ± 8.47; PCS and MCS of the SF-36 were 51.35 ± 4.28 and 55.29 ± 8.31, respectively; and significant differences in the scores were found between pre- and post-operation (P lt; 0.05). Complications included limp (4 cases), prosthesis dislocation (2 cases, 2 hips), periprosthetic fracture (1 case, 1 hip), aseptic loosening (2 cases, 2 hips), and ectopic ossification (3 cases, 3 hips). ConclusionTHA seems to be a good choice for patients with chronic autoimmune inflammatory diseases.
Objective To discuss the surgical procedures and curative effect of stiff 2-5 metacarpophalangeal (MP) joints after crash injury in hand. Methods Between January 2006 and June 2009, 7 cases of stiff 2-5 MP joints were treated by releasing the stiff MP joints and reconstructing the function of lumbrical muscle in one stage. There were 6 males and 1 female with an average age of 32 years (range, 18-56 years). All injuries were caused by crash. Six cases suffered from multiple metacarpal fracture or complex dislocation of MP joint and 1 case suffered from complete amputation at level of middle palm of hand. The interval from initial wound heal ing to hospital ization was 3 to 15 months. Before operation, the X-ray films showed fracture healed and the results of nipping paper test were positive. All hands were treated with physical therapy for 1 month. After the plaster external fixation for 6 weeks, the physical therapy and function training were given. Results All wounds healed by first intention. The patients had no joint instabil ity and extensor tendon side-sl ipping with normal finger function. Six patients were followed up from 6 months to 3 years. The extension and flexion of MP joint were 0° and 67-90°, respectively. The average grip strength of injured dominant hand reached 86.70% of normal side and non-dominant hand reached 66.70% of normal side. The average injured dominant tip pinch strength reached 83.52% of normal side and non-dominant tip pinch strength reached 61.30% of normal side. Based on total active motion (TAM) system of Chinese Medical Association for Hand Surgery, the results were excellent in 4 cases, good in 1 case, and fair in 1 case; the excellent and good rate was 83.33%. Conclusion In patients with stiff MP joint and lumbrical muscle defect, releasing stiff MP joint and reconstructing lumbrical function in one stage can recover the function of MP joint and achieve good outcome. Physical therapy plays an important role before operation.
Objective To evaluate proton MR spectroscopy (1H-MRS) for detection of the motor cortex and adjacent brain in amyotrophic lateralsclerosis (ALS) patients with apparent upper motor neuron involvement after olfactory ensheathing cells(OECs) transplantation. Methods From December 2004 to February 2005, 7 patients with clinically definite ALS who could safely undergo MRS were admitted into the perspective study. The neurological status, ALS functional rating scale (ALSFRS), EMG, and 1H-MRS taken before and 2 weeks after operationswere carefully analyzed. The NAA/Cr and Cho/Cr ratios were measured in the cerebral peduncle,genu and posterior limb of the internal capsule, corona radiata and precentral gyrus. Results The ALSFRS in 2 cases mproved obviously whose ALSFRS increased from 30 to 33 and from 29 to 34 respectively. And 5 cases remained stable 2 weeks after OECs transplantation. Statistical analyses for all seven cases showed both theNAA/Cr and Cho/Cr ratios decreased, but in the two cases with ALSFRS improvement the NAA/Cr increased in the certain anatomic position which confirmed the neurological and EMG findings. Conclusion The proton MR spectroscopy is a suitablenoninvasive measure for ALS evaluation. The preliminary study suggests that twoof the seven ALS cases improved apparently shortterm after OECs transplantation. More patients are required for the clinical study and longer followup duration is needed for future research.
The cellular, architectural and functional changes of transplanted mesenteric lymph nodes in the rats were studied.After the lymph nodes were transplanted with interrupting both of afferent and efferent lymphatics, the nodes gradually depleted the celluar content. One month after operation the recirculating lymphoeytes in the transplanted node were 3.5% of that in the host nodes, while the number of cells of the transplanted node was only 28%. The number of macrophages also decreased obviously. In paracortex,the cells of high endothelial venule (HEV) became flattened ahn HEV disappeared geadually. In the cortex, the germinal centers and follicles also diminished considerbly in number and disappered completely in 3 month. It was difficult to distinguish the normal compartments in the operated nodes 3 months after transplantation. NO regenerated afferent lymphatics were identified in the transplanted nodes. Lacking of antigen and stimulated lymphocytes brought histological and functional involution of the transplanted lymph nodes.