Objective To observe the clinical efficacy of moxibustion at B ihuì（百会 GV 20） combined with penetration needling in treatment of intractable facial paralysis. Methods Sixty patients with intractable facial pa...Objective To observe the clinical efficacy of moxibustion at B ihuì（百会 GV 20） combined with penetration needling in treatment of intractable facial paralysis. Methods Sixty patients with intractable facial paralysis included in the study were divided into two groups according to the random number table, with 30 patients in observation group（group A）, and 30 patients in control group（group B）. Moxibustion at GV 20 combined with penetration needling were adopted in group A, and simple penetration needling was applied in group B. Once daily, thirty days of treatment were required. The House Brackmann（H-B） facial nerve function grading and improvement of clinical symptoms were observed. Results The H-B function grading and improvement of clinical symptoms in group A were superior to group B, and the difference was statistically significant（P〈0.05）. Conclusion The clinical efficacy of moxibustion at GV 20 combined with penetration needling in treatment of intractable facial paralysis is definite, and the treatment method is deserving of clinical promotion.展开更多
The congenital dyserythropoietic anemias comprise a group of rare hereditary disorders of erythropoiesis, characterized by ineffective erythropoiesis as the predominant mechanism of anemia and by characteristic morpho...The congenital dyserythropoietic anemias comprise a group of rare hereditary disorders of erythropoiesis, characterized by ineffective erythropoiesis as the predominant mechanism of anemia and by characteristic morphological aberrations of the majority of erythroblasts in the bone marrow. Congenital dyserythropoietic anemia type II is the most frequent type. All types of congenital dyserythropoietic anemias distinctly share a high incidence of iron loading. Iron accumulation occurs even in untransfused patients and can result in heart failure and liver cirrhosis. We have reported about a patient who presented with liver cirrhosis and intractable ascites caused by congenital dyserythropoietic anemia type II. Her clinical course was further complicated by the development of autoimmune hemolytic anemia. Splenectomy was eventually performed which achieved complete resolution of ascites, increase of hemoglobin concentration and abrogation of transfusion requirements.展开更多
Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating Syst...Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating System (MARS) has been reported to reverse severe cholestasis-linked pruritus. Here, we report the first use of MARS during a spontaneous pregnancy and its successful outcome in a patient with PFIC3 and intractable pruritus. Albumin dialysis could be considered as a pregnancy-saving procedure in pregnant women with severe cholestasis and refractory pruritus.展开更多
Gastric varices(GV) are one of the most common complications for patients with portal hypertension. Currently, histoacryl injection is recommended as the initial treatment for bleeding of GV, and this injection has be...Gastric varices(GV) are one of the most common complications for patients with portal hypertension. Currently, histoacryl injection is recommended as the initial treatment for bleeding of GV, and this injection has been confirmed to be highly effective for most patients in many studies. However, this treatment might be ineffective for some types of GV, such as splenic vein thrombosis-related localized portal hypertension(also called left-sided, sinistral, or regional portal hypertension). Herein, we report a case of repeated pancreatitis-induced complete splenic vein thrombosis that led to intractable gastric variceal bleeding, which was treated by splenectomy. We present detailed radiological and pathological data and blood rheology analysis(the splenic artery- after a short gastric vein or stomach vein- gastric coronary vein- portal vein). The pathophysiology can be explained by the abnormal direction of blood flow in this patient. To our knowledge, this is the first reported case for which detailed patho-logy and blood rheology data are available.展开更多
Objective To observe the efficacy of scalp acupuncture combined with oral administration of ènì Tāng（呃逆汤, Hiccup Decoction） for treatment of intractable hiccup. Methods One hundred patients with intrac...Objective To observe the efficacy of scalp acupuncture combined with oral administration of ènì Tāng（呃逆汤, Hiccup Decoction） for treatment of intractable hiccup. Methods One hundred patients with intractable hiccup were divided into treatment group（acupuncture combined with herb decoction group） and control group（western medicine group） according to the random number table method with 50 patients in each group. In treatment group, scalp acupuncture was conducted in the gastric area and thoracic area of patients, and Hiccup Decoction was taken orally. In control group, anisodamine（654-2） was injected intramuscularly in the dosage of l0 mg. The treatment was conducted for once a day in each group, and treatment for three consecutive times was needed. The number of times and the frequency of hiccup were observed after each treatment, and the results were compared. The standard of therapeutic effectiveness was evaluated by the number of hiccups decreased. Results In treatment group, the total cure rate was 54%, and the total effective rate was 84%, in control group, the total cure rate was 32%, and the total effective rate was 66%. According to the comparison between the two groups in the cure rate and total effective rate, the differences were statistically significant（both P〈0.05）. After the first treatment, there was no statistical difference according to the comparison between the two groups in the cure rate and total effective rate（both P〈0.05）, after the second treatment, the differences were statistically significant according to the comparison between the two groups in the cure rate and total effective rate（both P〈0.05）, and the efficacy in treatment group was obviously superior to that in control group, after the third treatment, there was no statistical difference according to the comparison between the two groups in the cure rate and total effective rate（both P〈0.05）. Conclusion In the one course of treatment, the efficacy of acupuncture combined with herb decoction for treatment of intractable hiccup was obviously superior to that of intramuscular injection with anisodamine. The therapeutic effect of intramuscular injection with anisodamine for treatment of intractable hiccup was the best at the first treatment, and the therapeutic effect of acupuncture combined with herb decoction was the best at the second treatment.展开更多
A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular car...A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented.A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection.After hepatectomy,a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy,including numerous infusions of albumin and plasma protein fraction and administration of diuretics.Since the patient's general condition deteriorated,based on the diagnosis of intractable hepatic lymphorrhea,a subcutaneous peritoneovenous shunt was inserted.The patient's postoperative course was uneventful and the ascites decreased rapidly,with serum total protein and albumin levels and hepatic function improving accordingly.For intractable ascites due to hepatic lymphorrhea after hepatectomy,we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.展开更多
Objective： To observe the clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup.Methods： Thirty patients with intractable hiccup were treated by adopting acupuncture combined with cup...Objective： To observe the clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup.Methods： Thirty patients with intractable hiccup were treated by adopting acupuncture combined with cupping therapy. Acupuncture was performed at Cuánzhú（攒竹BL 2）. Nèiguān（内关PC 6）. Zhōngwǎn（中脘CV 12） and Zúsānlǐ（足三里ST 36）, with the time of needle retention for 30 min. Flash cupping was carried out on Fèishū（肺俞BL 13）, Géshū（膈俞BL 17） and Wèishū（胃俞BL 21）, with the time of cup retention for 8-10 min. The treatment was conducted once a day. and 10 treatments were considered as one course of treatment. Clinical efficacy was observed after one course treatment.Results： Among the 30 patients, 22 cases were cured, accounting for 73.33%（22/30）, effective relief was found in 5 cases, accounting for 16.67%（5/30）, and 3 cases had no improvement, accounting for 10.00%（3/30）. The total effective rate was 90.00%（27/30）.Conclusion： The clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup is satisfactory, which is worthy of clinical promotion and application.展开更多
A 66yearold gentleman presented for a cardiovascular evaluation secondary to chest discomfort,right knee pain,and intractable hiccups.The patient also had type 2 diabetes mellitus,hypercholesterolemia,aortic atheroscl...A 66yearold gentleman presented for a cardiovascular evaluation secondary to chest discomfort,right knee pain,and intractable hiccups.The patient also had type 2 diabetes mellitus,hypercholesterolemia,aortic atherosclerosis,and ascending aortic aneurysm.His family history was also significant for premature coronary artery disease in the father.The patient had been compliant with his medical therapy,which included subcutaneous 200 units/mL insulin degludec,18 mg/3 mL subcutaneous liraglutide,daily oral 500 mg metformin hydrochloride,daily oral 100 mg sitagliptin,daily oral 12.5 mg zolpidem,daily oral 5 mg tadalafil,and 20 mg tablet rosuvastatin daily.展开更多
Objective To observe the clinical efficacy of long snake moxibustion on the intractable cough. Methods The moxa and the semen brassicae were laid from ＂Dazhui＇ （大椎 GV 24） to ＂Yaoshu＂ （腰俞 GV 2） along the Go...Objective To observe the clinical efficacy of long snake moxibustion on the intractable cough. Methods The moxa and the semen brassicae were laid from ＂Dazhui＇ （大椎 GV 24） to ＂Yaoshu＂ （腰俞 GV 2） along the Governor Vessel on the patient＇s back. Moxibustion was repeated continuously for three times as a treatment, two treatments a week, two weeks as a therapeutic course, and then the efficacy was assessed after 2 courses. Results Twenty-eight cases were cured accounting to 80.0% （28/35）; 6 cases were improved accounting to 17.1% （6/35）. The total effective rate was 97.1% （34/35）. Conclusion The effect of the long snake moxibustion was significant on the treatment of intractable cough.展开更多
BACKGROUND： Increased expression of multidrug resistance 1 （MDR1） mRNA in peripheral blood of patients with intractable epilepsy is not due to epilepsy drugs, but epilepsy behavior. Monitoring MDR1 expression in pe...BACKGROUND： Increased expression of multidrug resistance 1 （MDR1） mRNA in peripheral blood of patients with intractable epilepsy is not due to epilepsy drugs, but epilepsy behavior. Monitoring MDR1 expression in peripheral blood is a target for MDR1 gene evaluation. OBJECTIVE： To investigate the influence of antiepileptic drugs and seizures on MDR expression in intractable epilepsy, and to analyze the genetic polymorphisms of C3435T in the MDRl gene. DESIGN, TIME AND SETTING： Factorial designs and comparative observations at the experimental center of the Affiliated Hospital of Qingdao Medical College, Qingdao University between October 2003 and October 2004. PARTICIPANTS： A total of 120 subjects were recruited from the epilepsy clinical department of the Affiliated Hospital of Qingdao Medical College. Four groups （n = 30） were classified according to statistical factorial design： intractable epilepsy, treatment response, no treatment, and normal control groups. METHODS： One-step semi-quantitative reverse-transcription polymerase chain reaction technology was used to test expressions of the MDR1 gene in 120 subjects. C3435T polymorphisms in intractable epilepsy group and normal control groups were analyzed by polymerase chain reaction-restriction fragment length polymorphism. MAIN OUTCOME MEASURES： Expression of MDR1 mRNA in the four groups, and C3435T genetic polymorphisms in intractable epilepsy and normal control groups. RESULTS： MDRl gene expression was increased in the intractable epilepsy group, due to the factor seizures, but not the antiepileptic drugs. However, the interaction between the two factors was not statistically significant. Of the 30 subjects in the intractable epilepsy group, the following genotypes were exhibited： 3 （10%） C/C genotype, 9 （30%） C/T genotype, and 18 （60%） T/T genotype at the site of C3435T, while 4 （13%）, 10 （33%）, and 16 （53%） subjects were determined to express these genotypes in the normal control group, respectively. C and T allele frequency were 25% and 75% in the intractable epilepsy group, and 30% and 70% in the normal control group, respectively. However, there was no statistical difference between the groups. CONCLUSION： Results demonstrated that seizures, not antiepileptic drugs, induced MDR1 gene expression in intractable epilepsy. Genetic polymorphisms of C3435T in the MDR1 gene did not contribute to the development of multidrug resistance in patients with intractable epilepsy.展开更多
BACKGROUND Coronary artery disease(CAD)is a leading cause of global cardiovascular morta-lity.Refractory angina pectoris,a manifestation of CAD,requires effective drug treatments.Pericarpium Trichosanthis injection,a ...BACKGROUND Coronary artery disease(CAD)is a leading cause of global cardiovascular morta-lity.Refractory angina pectoris,a manifestation of CAD,requires effective drug treatments.Pericarpium Trichosanthis injection,a traditional Chinese medicine,improves cardiovascular symptoms,while nicorandil alleviates spasms and angina.Both have potential in treating CAD.AIM To investigate the therapeutic effects of combining Pericarpium Trichosanthis injection and nicorandil in elderly patients suffering from refractory angina caused by coronary heart disease.METHODS A retrospective analysis was conducted on the data of 130 patients diagnosed with refractory coronary heart disease.Based on the different treatment regimens administered during hospitalization,the patients were divided into a control group(58 cases)and a study group(72 cases).The control group received conven-tional treatment,which included aspirin,statins,and nitrate vasodilators.In addition to the conventional medication,the study group received a combination treatment of Pericarpium Trichosanthis injection and nicorandil.RESULTS After treatment,the study group showed significantly higher left ventricular ejection fraction and cardiac output,and lower brain natriuretic peptide and C-reactive protein levels compared to the control group.The study group also exhibited improvements in angina,quality of life,exercise endurance,and lipid profiles.Multivariate logistic regression analysis revealed a relationship of lipid levels and heart function with the combined treatment.Some patients in the study group experienced headaches during treatment,but no significant adverse reactions were observed.Follow-up showed that the treatment was well-tolerated,with no drug-related adverse reactions detected.CONCLUSION Combination of Pericarpium Trichosanthis injection and nicorandil is more effective than conventional treatment in improving symptoms and heart function in elderly patients with refractory angina pectoris.展开更多
Objective:To observe the differences of clinical efficacy of intractable lumbodynia after lumbar disc herniation surgery treated by pestle needling at Yāoyángguān Bāzhèn points,electroacupuncture and west...Objective:To observe the differences of clinical efficacy of intractable lumbodynia after lumbar disc herniation surgery treated by pestle needling at Yāoyángguān Bāzhèn points,electroacupuncture and western medication.Methods:A total of 210 patients with intractable lumbodynia after lumbar disc herniation were randomly divided into pestle needle group,electroacupuncture group and western medication group,with 70 cases in each group.The pestle needle group was treated with pestle needle poking Yāoyángguān-Bāzhèn(GV3-Bāzhèn)points.The electroacupuncture group was treated with conventional electroacupuncture,and the western medication group was treated with oral diclofenac sodium dual release enteric-coated capsules(Difene).The pestle needle group and the electroacupuncture group were treated once a day,and there was 1 day of rest after 6 days of treatment,and a course of treatment included 7 days,and a total of 3 courses of treatment were performed.The western medication group took 1 Difene capsule(75 mg)at a time,with once a day continuing for 21 days.Visual Analog Scale(VAS),Pain Rating Index(PRI)and Present Pain Intensity(PPI)were used to observe the improvement of pain before and after treatment,and the waist muscle tone was examined and the clinical efficacy was observed.Results:The post-treatment VAS,PRI,and PPI scores of the three groups were all lower than pretreatment,and the differences were statistically significant(all P<0.05).There were no statistically significant differences in VAS,PRI and PPI scores between pestle needle group and western medication group(all P>0.05).Meanwhile,they were all lower than the electroacupuncture group,and the differences were statistically significant(both P<0.05).After treatment,the waist muscle tone of the three groups was higher than that pre-treatment,and the differences were statistically significant(all P<0.05).After treatment,the waist muscle tone of the pestle needle group was higher than the electroacupuncture group,and the electroacupuncture group was higher than the western medication group,and the differences were statistically significant(both P<0.05).The total effective rate was 88.57%in the pestle needle group,80%in the electroacupuncture group,and 77.14%in the western medication group,and there were no statistically significant differences among the groups(P>0.05).Conclusions:Pestle needle poking GV3-Bāzhèn points can effectively relieve intractable lumbodynia after lumbar disc herniation surgery,decrease VAS,PRI,PPI scores and relieve waist muscle tone,and the effect was remarkable.展开更多
BACKGROUND： The biochemical hypothesis of dopamine hyperfunction in the brain can explain the pathological mechanisms of schizophrenia. Surgery is performed based on limbic system circuit theory correspondence to abo...BACKGROUND： The biochemical hypothesis of dopamine hyperfunction in the brain can explain the pathological mechanisms of schizophrenia. Surgery is performed based on limbic system circuit theory correspondence to above-mentioned hypothesis. Stereotactic surgery for the treatment of mental disorders is related to stereotactic surgery that influences the Papez circuit. OBJECTIVE： To observe the effects of stereotactic multi-target limbic leucotomy on the improvements in memory, intelligence and psychiatric symptoms in the treatment of intractable psychiatric disease. DESIGN： Self-control case analysis and follow-up of therapeutic effects. SETTING： Department of Neurosurgery, First Hospital, Hebei Medical University. PARTICIPANTS： Thirty patients with intractable psychiatric disease, who received stereotactic surgery in the Department of Neurosurgery, First Hospital, Hebei Medical University between July 2002 and August 2005, were included in this study. The patients, 21 males and 9 females, all met the diagnostic criteria of intractable psychiatric disease, determined by the national psychosurgery cooperation team in 1998. Informed consents for surgery and clinical follow-up exams were obtained from patients and/or patients＇ relatives （guardians）. METHODS： In 30 patients with intractable psychiatric disease, limbic leucotomy was performed by stereotactic technique. Multi-target radiofrequency hyperthermia was performed in the intracranial amygdaloid nucleus, anterior limb of internal capsule, callosal gyrus, among other regions. The therapeutic effects of patients were evaluated by Brief Psychiatric Rating Scale （BPRS） before surgery, and 6 months, 1, and 3 years after surgery. The Wechsler Adult Intelligence Scale （WAIS） and Clinical Memory Scale （CMS） were used to assess memory and intelligence before and after surgery. MAIN OUTCOME MEASURES： Memory, intelligence, and psychiatric symptoms of patients before and after operation. RESULTS： Thirty patients were included in the final analysis. （1） Memory and intelligence changes of patients： CMS and WAIS showed there were no significant differences in the changes of brain functions before and after operation （P 〉 0.05）. （2） Improved degree of symptoms： 5 patients were cured, 8 patients significantly improved, 8 patients improved, 3 patients had no changes, and 6 patients had recurrent symptoms. CONCLUSION： Stereotactic multi-target limbic leucotomy can improve the symptoms of patients with intractable psychiatric disease. Follow-up results showed that memory and intelligence were not noticeably improved after surgery.展开更多
BACKGROUND Implant vagus nerve stimulation is an adjunctive treatment for intractable epilepsy when patients are not suitable for resective surgery.AIM To identify the safety and efficacy of vagus nerve stimulation in...BACKGROUND Implant vagus nerve stimulation is an adjunctive treatment for intractable epilepsy when patients are not suitable for resective surgery.AIM To identify the safety and efficacy of vagus nerve stimulation in children with intractable epilepsy and analyze the effects on different epilepsy syndromes.METHODS Eligible children with intractable epilepsy were admitted to the study.We collected data from preoperative assessments as the baseline.During the followup time,we recorded the process of seizures(frequency,duration,and seizure type),the changes of drugs or parameters,the complications,etc.The mean reduction rate of seizures,response rate,and McHugh scale were chosen as the outcomes.RESULTS A total of 213 patients were implanted with Tsinghua Pins vagus nerve stimulators,and the average age was 6.6 years.In the follow-up time of postoperative 3 mo,6 mo,12 mo,18 mo,and 24 mo,the average reduction rate was 30.2%,49.5%,56.3%,59.4%,and 63.2%,while the response rate was 21.8%,62.5%,57.1%,69.2%,and 70.7%.In addition,implanted vagus nerve stimulation had different effects on epilepsy syndromes.The reduction rate of West syndrome increased from 36.4%(postoperative 6 m)to 74.3%(postoperative 24 m).The reduction rate of Lennox-Gastaut syndrome improved from 25.4%to 73.1%in 24 mo.The chi-square test of the five efficacy grades showed P<0.05.The comparison between the 3-mo follow-up and the 6-mo follow-up showed P<0.05,and the comparison between the 6-mo follow-up and the 24-mo follow-up showed P>0.05.CONCLUSION Vagus nerve stimulation is safe and effective in children with intractable epilepsy,and the seizure reduction occurred in a time-dependent manner.Moreover,patients with West syndrome may get the most benefits.展开更多
1 Introduction A hiccup is a sudden involuntary contraction of the diaphragm with a sharp gulp-like sound,often recurring at short intervals[1].Traditional Chinese medicine（TCM）states there is a wide range of reason...1 Introduction A hiccup is a sudden involuntary contraction of the diaphragm with a sharp gulp-like sound,often recurring at short intervals[1].Traditional Chinese medicine（TCM）states there is a wide range of reasons for why hiccups occur.From the view of TCM,the requirement of stomach qi or the vital energy of body is thought to fade when it comes to the patients who are severely weak,and when the illness展开更多
This study looked into the efficacy of a modified titration protocol of intratympanic gentamicin injection（ITG） in the patients with unilateral intractable Ménière＇s disease（MD）. Modified titration prot...This study looked into the efficacy of a modified titration protocol of intratympanic gentamicin injection（ITG） in the patients with unilateral intractable Ménière＇s disease（MD）. Modified titration protocol of ITG at a low dose（20 mg/m L） was administered to 10 patients with definite unilateral intractable MD. After initial first two fixed ITGs on weekly basis,the patients might or might not be given any more injections,depending on the appearance of unilateral vestibular loss（UVL）. ITG was terminated if the patients satisfied the criteria of UVL. All patients were followed-up for at least two years. The effects of ITG on the vertigo attack,functional level scores and postural balance were evaluated. Of the 10 cases,8 showed the sign of UVL after receiving initial two ITGs and were not given any more intratympanic injections,and the other 2 patients were administered three ITGs. A two-year follow-up revealed that complete and substantial vertigo control was achieved in 9 cases,and limited vertigo control in 1 patient. Hearing level was lowered in 2 patients. The posture stability and functional level scores were improved. Our study showed that the modified titration protocol of ITG at a low dose could effectively control vertigo in patients with unilateral intractable MD.展开更多
Intra-abdominal abscess and an intractable abdominal wall sinus forty years after splenectomy is rare, which has not been described previously in the surgical literature. We report the management of a patient who had ...Intra-abdominal abscess and an intractable abdominal wall sinus forty years after splenectomy is rare, which has not been described previously in the surgical literature. We report the management of a patient who had presented with an intractable sinus on his left hypochondrium forty years after having undergone splenectomy and cholecystectomy, which persisted for more than two years despite repeated surgery and courses of antibiotics and compromised quality of life significantly from pain. A sinogram and computerised tomographic scan followed by exploration and laying open of the sinus delivered multiple silk sutures used for ligation of splenic pedicle, led to complete resolution of the sinus. It is important to avoid using non-absorbable silk sutures during splenectomy when splenectomy is undertaken in a contaminated field. Appropriate imaging and exploration is mandatory for its resolution.展开更多
ELECTROCORTICOGRAPHY (ECoG), the intraoperative recording of cortical potentials, has played an important role in the surgical management of patients with medically intractable epilepsy. This technique is useful in ep...ELECTROCORTICOGRAPHY (ECoG), the intraoperative recording of cortical potentials, has played an important role in the surgical management of patients with medically intractable epilepsy. This technique is useful in epilepsy surgery to delineate margins of epileptogenic zones, guide resection,展开更多
To describe the design approaches of IND-CCA2 （adaptive chosen ciphertext attack） secure public key encryption schemes systematically, the gaps between different kinds of intractable problems and IND-CCA2 security a...To describe the design approaches of IND-CCA2 （adaptive chosen ciphertext attack） secure public key encryption schemes systematically, the gaps between different kinds of intractable problems and IND-CCA2 security are studied. This paper points out that the construction of IND-CCA2 secure schemes is essentially to bridge these gaps. These gaps are categorized, analyzed and measured. Finally the methods to bridge these gaps are described. This explains the existing design approaches and gives an intuition about the difficulty of designing IND-CCA2 secure public key encryption schemes based on different types of assumptions.展开更多
Intractable Still’s disease, namely the intractable systemic juvenile idiopathic arthritis (JIA) is a clinical difficulty of pediatrics, and so far there still lacks any special treatment. In virtue of the markedly a...Intractable Still’s disease, namely the intractable systemic juvenile idiopathic arthritis (JIA) is a clinical difficulty of pediatrics, and so far there still lacks any special treatment. In virtue of the markedly anti-inflammatory and immunosuppres-sive effects of tripterygium glycosides (TG, product of Huangshi Pharmaceutical Factory, 10 mg/展开更多
文摘Objective To observe the clinical efficacy of moxibustion at B ihuì（百会 GV 20） combined with penetration needling in treatment of intractable facial paralysis. Methods Sixty patients with intractable facial paralysis included in the study were divided into two groups according to the random number table, with 30 patients in observation group（group A）, and 30 patients in control group（group B）. Moxibustion at GV 20 combined with penetration needling were adopted in group A, and simple penetration needling was applied in group B. Once daily, thirty days of treatment were required. The House Brackmann（H-B） facial nerve function grading and improvement of clinical symptoms were observed. Results The H-B function grading and improvement of clinical symptoms in group A were superior to group B, and the difference was statistically significant（P〈0.05）. Conclusion The clinical efficacy of moxibustion at GV 20 combined with penetration needling in treatment of intractable facial paralysis is definite, and the treatment method is deserving of clinical promotion.
文摘The congenital dyserythropoietic anemias comprise a group of rare hereditary disorders of erythropoiesis, characterized by ineffective erythropoiesis as the predominant mechanism of anemia and by characteristic morphological aberrations of the majority of erythroblasts in the bone marrow. Congenital dyserythropoietic anemia type II is the most frequent type. All types of congenital dyserythropoietic anemias distinctly share a high incidence of iron loading. Iron accumulation occurs even in untransfused patients and can result in heart failure and liver cirrhosis. We have reported about a patient who presented with liver cirrhosis and intractable ascites caused by congenital dyserythropoietic anemia type II. Her clinical course was further complicated by the development of autoimmune hemolytic anemia. Splenectomy was eventually performed which achieved complete resolution of ascites, increase of hemoglobin concentration and abrogation of transfusion requirements.
文摘Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating System (MARS) has been reported to reverse severe cholestasis-linked pruritus. Here, we report the first use of MARS during a spontaneous pregnancy and its successful outcome in a patient with PFIC3 and intractable pruritus. Albumin dialysis could be considered as a pregnancy-saving procedure in pregnant women with severe cholestasis and refractory pruritus.
基金Supported by National Natural Science Foundation of China,No.81401993(to Tang SH)
文摘Gastric varices(GV) are one of the most common complications for patients with portal hypertension. Currently, histoacryl injection is recommended as the initial treatment for bleeding of GV, and this injection has been confirmed to be highly effective for most patients in many studies. However, this treatment might be ineffective for some types of GV, such as splenic vein thrombosis-related localized portal hypertension(also called left-sided, sinistral, or regional portal hypertension). Herein, we report a case of repeated pancreatitis-induced complete splenic vein thrombosis that led to intractable gastric variceal bleeding, which was treated by splenectomy. We present detailed radiological and pathological data and blood rheology analysis(the splenic artery- after a short gastric vein or stomach vein- gastric coronary vein- portal vein). The pathophysiology can be explained by the abnormal direction of blood flow in this patient. To our knowledge, this is the first reported case for which detailed patho-logy and blood rheology data are available.
基金Supported by:Shanghai Municipal Commission of Health and Family Planning:ZJ 2016008
文摘Objective To observe the efficacy of scalp acupuncture combined with oral administration of ènì Tāng（呃逆汤, Hiccup Decoction） for treatment of intractable hiccup. Methods One hundred patients with intractable hiccup were divided into treatment group（acupuncture combined with herb decoction group） and control group（western medicine group） according to the random number table method with 50 patients in each group. In treatment group, scalp acupuncture was conducted in the gastric area and thoracic area of patients, and Hiccup Decoction was taken orally. In control group, anisodamine（654-2） was injected intramuscularly in the dosage of l0 mg. The treatment was conducted for once a day in each group, and treatment for three consecutive times was needed. The number of times and the frequency of hiccup were observed after each treatment, and the results were compared. The standard of therapeutic effectiveness was evaluated by the number of hiccups decreased. Results In treatment group, the total cure rate was 54%, and the total effective rate was 84%, in control group, the total cure rate was 32%, and the total effective rate was 66%. According to the comparison between the two groups in the cure rate and total effective rate, the differences were statistically significant（both P〈0.05）. After the first treatment, there was no statistical difference according to the comparison between the two groups in the cure rate and total effective rate（both P〈0.05）, after the second treatment, the differences were statistically significant according to the comparison between the two groups in the cure rate and total effective rate（both P〈0.05）, and the efficacy in treatment group was obviously superior to that in control group, after the third treatment, there was no statistical difference according to the comparison between the two groups in the cure rate and total effective rate（both P〈0.05）. Conclusion In the one course of treatment, the efficacy of acupuncture combined with herb decoction for treatment of intractable hiccup was obviously superior to that of intramuscular injection with anisodamine. The therapeutic effect of intramuscular injection with anisodamine for treatment of intractable hiccup was the best at the first treatment, and the therapeutic effect of acupuncture combined with herb decoction was the best at the second treatment.
文摘A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented.A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection.After hepatectomy,a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy,including numerous infusions of albumin and plasma protein fraction and administration of diuretics.Since the patient's general condition deteriorated,based on the diagnosis of intractable hepatic lymphorrhea,a subcutaneous peritoneovenous shunt was inserted.The patient's postoperative course was uneventful and the ascites decreased rapidly,with serum total protein and albumin levels and hepatic function improving accordingly.For intractable ascites due to hepatic lymphorrhea after hepatectomy,we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.
文摘Objective： To observe the clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup.Methods： Thirty patients with intractable hiccup were treated by adopting acupuncture combined with cupping therapy. Acupuncture was performed at Cuánzhú（攒竹BL 2）. Nèiguān（内关PC 6）. Zhōngwǎn（中脘CV 12） and Zúsānlǐ（足三里ST 36）, with the time of needle retention for 30 min. Flash cupping was carried out on Fèishū（肺俞BL 13）, Géshū（膈俞BL 17） and Wèishū（胃俞BL 21）, with the time of cup retention for 8-10 min. The treatment was conducted once a day. and 10 treatments were considered as one course of treatment. Clinical efficacy was observed after one course treatment.Results： Among the 30 patients, 22 cases were cured, accounting for 73.33%（22/30）, effective relief was found in 5 cases, accounting for 16.67%（5/30）, and 3 cases had no improvement, accounting for 10.00%（3/30）. The total effective rate was 90.00%（27/30）.Conclusion： The clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup is satisfactory, which is worthy of clinical promotion and application.
文摘A 66yearold gentleman presented for a cardiovascular evaluation secondary to chest discomfort,right knee pain,and intractable hiccups.The patient also had type 2 diabetes mellitus,hypercholesterolemia,aortic atherosclerosis,and ascending aortic aneurysm.His family history was also significant for premature coronary artery disease in the father.The patient had been compliant with his medical therapy,which included subcutaneous 200 units/mL insulin degludec,18 mg/3 mL subcutaneous liraglutide,daily oral 500 mg metformin hydrochloride,daily oral 100 mg sitagliptin,daily oral 12.5 mg zolpidem,daily oral 5 mg tadalafil,and 20 mg tablet rosuvastatin daily.
文摘Objective To observe the clinical efficacy of long snake moxibustion on the intractable cough. Methods The moxa and the semen brassicae were laid from ＂Dazhui＇ （大椎 GV 24） to ＂Yaoshu＂ （腰俞 GV 2） along the Governor Vessel on the patient＇s back. Moxibustion was repeated continuously for three times as a treatment, two treatments a week, two weeks as a therapeutic course, and then the efficacy was assessed after 2 courses. Results Twenty-eight cases were cured accounting to 80.0% （28/35）; 6 cases were improved accounting to 17.1% （6/35）. The total effective rate was 97.1% （34/35）. Conclusion The effect of the long snake moxibustion was significant on the treatment of intractable cough.
文摘BACKGROUND： Increased expression of multidrug resistance 1 （MDR1） mRNA in peripheral blood of patients with intractable epilepsy is not due to epilepsy drugs, but epilepsy behavior. Monitoring MDR1 expression in peripheral blood is a target for MDR1 gene evaluation. OBJECTIVE： To investigate the influence of antiepileptic drugs and seizures on MDR expression in intractable epilepsy, and to analyze the genetic polymorphisms of C3435T in the MDRl gene. DESIGN, TIME AND SETTING： Factorial designs and comparative observations at the experimental center of the Affiliated Hospital of Qingdao Medical College, Qingdao University between October 2003 and October 2004. PARTICIPANTS： A total of 120 subjects were recruited from the epilepsy clinical department of the Affiliated Hospital of Qingdao Medical College. Four groups （n = 30） were classified according to statistical factorial design： intractable epilepsy, treatment response, no treatment, and normal control groups. METHODS： One-step semi-quantitative reverse-transcription polymerase chain reaction technology was used to test expressions of the MDR1 gene in 120 subjects. C3435T polymorphisms in intractable epilepsy group and normal control groups were analyzed by polymerase chain reaction-restriction fragment length polymorphism. MAIN OUTCOME MEASURES： Expression of MDR1 mRNA in the four groups, and C3435T genetic polymorphisms in intractable epilepsy and normal control groups. RESULTS： MDRl gene expression was increased in the intractable epilepsy group, due to the factor seizures, but not the antiepileptic drugs. However, the interaction between the two factors was not statistically significant. Of the 30 subjects in the intractable epilepsy group, the following genotypes were exhibited： 3 （10%） C/C genotype, 9 （30%） C/T genotype, and 18 （60%） T/T genotype at the site of C3435T, while 4 （13%）, 10 （33%）, and 16 （53%） subjects were determined to express these genotypes in the normal control group, respectively. C and T allele frequency were 25% and 75% in the intractable epilepsy group, and 30% and 70% in the normal control group, respectively. However, there was no statistical difference between the groups. CONCLUSION： Results demonstrated that seizures, not antiepileptic drugs, induced MDR1 gene expression in intractable epilepsy. Genetic polymorphisms of C3435T in the MDR1 gene did not contribute to the development of multidrug resistance in patients with intractable epilepsy.
文摘BACKGROUND Coronary artery disease(CAD)is a leading cause of global cardiovascular morta-lity.Refractory angina pectoris,a manifestation of CAD,requires effective drug treatments.Pericarpium Trichosanthis injection,a traditional Chinese medicine,improves cardiovascular symptoms,while nicorandil alleviates spasms and angina.Both have potential in treating CAD.AIM To investigate the therapeutic effects of combining Pericarpium Trichosanthis injection and nicorandil in elderly patients suffering from refractory angina caused by coronary heart disease.METHODS A retrospective analysis was conducted on the data of 130 patients diagnosed with refractory coronary heart disease.Based on the different treatment regimens administered during hospitalization,the patients were divided into a control group(58 cases)and a study group(72 cases).The control group received conven-tional treatment,which included aspirin,statins,and nitrate vasodilators.In addition to the conventional medication,the study group received a combination treatment of Pericarpium Trichosanthis injection and nicorandil.RESULTS After treatment,the study group showed significantly higher left ventricular ejection fraction and cardiac output,and lower brain natriuretic peptide and C-reactive protein levels compared to the control group.The study group also exhibited improvements in angina,quality of life,exercise endurance,and lipid profiles.Multivariate logistic regression analysis revealed a relationship of lipid levels and heart function with the combined treatment.Some patients in the study group experienced headaches during treatment,but no significant adverse reactions were observed.Follow-up showed that the treatment was well-tolerated,with no drug-related adverse reactions detected.CONCLUSION Combination of Pericarpium Trichosanthis injection and nicorandil is more effective than conventional treatment in improving symptoms and heart function in elderly patients with refractory angina pectoris.
基金Supported by Plan of Shanghai Commission of Science and Technology: No. 18401902400)Special Disease Construction Project of Shanghai Traditional Chinese Medicine: No. ZY(20182020)- FWTX-4020Characteristic Diagnosis and Treatment Technology Upgrade Project of TCM:No. ZY(2018-2020)-ZYJS-01
文摘Objective:To observe the differences of clinical efficacy of intractable lumbodynia after lumbar disc herniation surgery treated by pestle needling at Yāoyángguān Bāzhèn points,electroacupuncture and western medication.Methods:A total of 210 patients with intractable lumbodynia after lumbar disc herniation were randomly divided into pestle needle group,electroacupuncture group and western medication group,with 70 cases in each group.The pestle needle group was treated with pestle needle poking Yāoyángguān-Bāzhèn(GV3-Bāzhèn)points.The electroacupuncture group was treated with conventional electroacupuncture,and the western medication group was treated with oral diclofenac sodium dual release enteric-coated capsules(Difene).The pestle needle group and the electroacupuncture group were treated once a day,and there was 1 day of rest after 6 days of treatment,and a course of treatment included 7 days,and a total of 3 courses of treatment were performed.The western medication group took 1 Difene capsule(75 mg)at a time,with once a day continuing for 21 days.Visual Analog Scale(VAS),Pain Rating Index(PRI)and Present Pain Intensity(PPI)were used to observe the improvement of pain before and after treatment,and the waist muscle tone was examined and the clinical efficacy was observed.Results:The post-treatment VAS,PRI,and PPI scores of the three groups were all lower than pretreatment,and the differences were statistically significant(all P<0.05).There were no statistically significant differences in VAS,PRI and PPI scores between pestle needle group and western medication group(all P>0.05).Meanwhile,they were all lower than the electroacupuncture group,and the differences were statistically significant(both P<0.05).After treatment,the waist muscle tone of the three groups was higher than that pre-treatment,and the differences were statistically significant(all P<0.05).After treatment,the waist muscle tone of the pestle needle group was higher than the electroacupuncture group,and the electroacupuncture group was higher than the western medication group,and the differences were statistically significant(both P<0.05).The total effective rate was 88.57%in the pestle needle group,80%in the electroacupuncture group,and 77.14%in the western medication group,and there were no statistically significant differences among the groups(P>0.05).Conclusions:Pestle needle poking GV3-Bāzhèn points can effectively relieve intractable lumbodynia after lumbar disc herniation surgery,decrease VAS,PRI,PPI scores and relieve waist muscle tone,and the effect was remarkable.
文摘BACKGROUND： The biochemical hypothesis of dopamine hyperfunction in the brain can explain the pathological mechanisms of schizophrenia. Surgery is performed based on limbic system circuit theory correspondence to above-mentioned hypothesis. Stereotactic surgery for the treatment of mental disorders is related to stereotactic surgery that influences the Papez circuit. OBJECTIVE： To observe the effects of stereotactic multi-target limbic leucotomy on the improvements in memory, intelligence and psychiatric symptoms in the treatment of intractable psychiatric disease. DESIGN： Self-control case analysis and follow-up of therapeutic effects. SETTING： Department of Neurosurgery, First Hospital, Hebei Medical University. PARTICIPANTS： Thirty patients with intractable psychiatric disease, who received stereotactic surgery in the Department of Neurosurgery, First Hospital, Hebei Medical University between July 2002 and August 2005, were included in this study. The patients, 21 males and 9 females, all met the diagnostic criteria of intractable psychiatric disease, determined by the national psychosurgery cooperation team in 1998. Informed consents for surgery and clinical follow-up exams were obtained from patients and/or patients＇ relatives （guardians）. METHODS： In 30 patients with intractable psychiatric disease, limbic leucotomy was performed by stereotactic technique. Multi-target radiofrequency hyperthermia was performed in the intracranial amygdaloid nucleus, anterior limb of internal capsule, callosal gyrus, among other regions. The therapeutic effects of patients were evaluated by Brief Psychiatric Rating Scale （BPRS） before surgery, and 6 months, 1, and 3 years after surgery. The Wechsler Adult Intelligence Scale （WAIS） and Clinical Memory Scale （CMS） were used to assess memory and intelligence before and after surgery. MAIN OUTCOME MEASURES： Memory, intelligence, and psychiatric symptoms of patients before and after operation. RESULTS： Thirty patients were included in the final analysis. （1） Memory and intelligence changes of patients： CMS and WAIS showed there were no significant differences in the changes of brain functions before and after operation （P 〉 0.05）. （2） Improved degree of symptoms： 5 patients were cured, 8 patients significantly improved, 8 patients improved, 3 patients had no changes, and 6 patients had recurrent symptoms. CONCLUSION： Stereotactic multi-target limbic leucotomy can improve the symptoms of patients with intractable psychiatric disease. Follow-up results showed that memory and intelligence were not noticeably improved after surgery.
文摘BACKGROUND Implant vagus nerve stimulation is an adjunctive treatment for intractable epilepsy when patients are not suitable for resective surgery.AIM To identify the safety and efficacy of vagus nerve stimulation in children with intractable epilepsy and analyze the effects on different epilepsy syndromes.METHODS Eligible children with intractable epilepsy were admitted to the study.We collected data from preoperative assessments as the baseline.During the followup time,we recorded the process of seizures(frequency,duration,and seizure type),the changes of drugs or parameters,the complications,etc.The mean reduction rate of seizures,response rate,and McHugh scale were chosen as the outcomes.RESULTS A total of 213 patients were implanted with Tsinghua Pins vagus nerve stimulators,and the average age was 6.6 years.In the follow-up time of postoperative 3 mo,6 mo,12 mo,18 mo,and 24 mo,the average reduction rate was 30.2%,49.5%,56.3%,59.4%,and 63.2%,while the response rate was 21.8%,62.5%,57.1%,69.2%,and 70.7%.In addition,implanted vagus nerve stimulation had different effects on epilepsy syndromes.The reduction rate of West syndrome increased from 36.4%(postoperative 6 m)to 74.3%(postoperative 24 m).The reduction rate of Lennox-Gastaut syndrome improved from 25.4%to 73.1%in 24 mo.The chi-square test of the five efficacy grades showed P<0.05.The comparison between the 3-mo follow-up and the 6-mo follow-up showed P<0.05,and the comparison between the 6-mo follow-up and the 24-mo follow-up showed P>0.05.CONCLUSION Vagus nerve stimulation is safe and effective in children with intractable epilepsy,and the seizure reduction occurred in a time-dependent manner.Moreover,patients with West syndrome may get the most benefits.
基金supported by Projects for the Third Study Group of National Outstanding Talents in TCM Clinic Area (No. YY41.28.01.05)Shanghai Three Year Action Plan for Chinese Medicine (No. ZYSNXDYL-CTXK)
文摘1 Introduction A hiccup is a sudden involuntary contraction of the diaphragm with a sharp gulp-like sound,often recurring at short intervals[1].Traditional Chinese medicine（TCM）states there is a wide range of reasons for why hiccups occur.From the view of TCM,the requirement of stomach qi or the vital energy of body is thought to fade when it comes to the patients who are severely weak,and when the illness
基金supported by the National Science&Technology Pillar Program during the 12th Five-year Plan of China(No.2012BAI12B02)the 11th Five-year Plan of China(No.2007BAI18B13)National Natural Science Foundation of China(No.30872865)
文摘This study looked into the efficacy of a modified titration protocol of intratympanic gentamicin injection（ITG） in the patients with unilateral intractable Ménière＇s disease（MD）. Modified titration protocol of ITG at a low dose（20 mg/m L） was administered to 10 patients with definite unilateral intractable MD. After initial first two fixed ITGs on weekly basis,the patients might or might not be given any more injections,depending on the appearance of unilateral vestibular loss（UVL）. ITG was terminated if the patients satisfied the criteria of UVL. All patients were followed-up for at least two years. The effects of ITG on the vertigo attack,functional level scores and postural balance were evaluated. Of the 10 cases,8 showed the sign of UVL after receiving initial two ITGs and were not given any more intratympanic injections,and the other 2 patients were administered three ITGs. A two-year follow-up revealed that complete and substantial vertigo control was achieved in 9 cases,and limited vertigo control in 1 patient. Hearing level was lowered in 2 patients. The posture stability and functional level scores were improved. Our study showed that the modified titration protocol of ITG at a low dose could effectively control vertigo in patients with unilateral intractable MD.
文摘Intra-abdominal abscess and an intractable abdominal wall sinus forty years after splenectomy is rare, which has not been described previously in the surgical literature. We report the management of a patient who had presented with an intractable sinus on his left hypochondrium forty years after having undergone splenectomy and cholecystectomy, which persisted for more than two years despite repeated surgery and courses of antibiotics and compromised quality of life significantly from pain. A sinogram and computerised tomographic scan followed by exploration and laying open of the sinus delivered multiple silk sutures used for ligation of splenic pedicle, led to complete resolution of the sinus. It is important to avoid using non-absorbable silk sutures during splenectomy when splenectomy is undertaken in a contaminated field. Appropriate imaging and exploration is mandatory for its resolution.
文摘ELECTROCORTICOGRAPHY (ECoG), the intraoperative recording of cortical potentials, has played an important role in the surgical management of patients with medically intractable epilepsy. This technique is useful in epilepsy surgery to delineate margins of epileptogenic zones, guide resection,
基金the National Natural Science Foundation of China(Nos.60573032,60773092,90604036)
文摘To describe the design approaches of IND-CCA2 （adaptive chosen ciphertext attack） secure public key encryption schemes systematically, the gaps between different kinds of intractable problems and IND-CCA2 security are studied. This paper points out that the construction of IND-CCA2 secure schemes is essentially to bridge these gaps. These gaps are categorized, analyzed and measured. Finally the methods to bridge these gaps are described. This explains the existing design approaches and gives an intuition about the difficulty of designing IND-CCA2 secure public key encryption schemes based on different types of assumptions.
文摘Intractable Still’s disease, namely the intractable systemic juvenile idiopathic arthritis (JIA) is a clinical difficulty of pediatrics, and so far there still lacks any special treatment. In virtue of the markedly anti-inflammatory and immunosuppres-sive effects of tripterygium glycosides (TG, product of Huangshi Pharmaceutical Factory, 10 mg/
