The course of chronic pancreatitis is prolonged, and pain is the main symptom, which seriously affects the quality of life and work ability of patients. Its treatment is the most important and complex problem. This article systematically describes the theoretical basis, indications, efficacy, selection and balance of drugs, endoscopy, surgery and other measures related to pain treatment.
This paper introduced definition of right care, presented the evidences of overuse and underuse in the world and pointed out the importance of dissemination of evidence-based medicine to right care. Not only evidence production but also concepts of evidence-based practical are important. It is important to disseminate evidence-based medicine not only among academic societies but also among the public. These are critical for achieving right care and preventing overuse and underuse of medical care.
Objective To measure the paraspinal muscle parameters, explore the characteristics of paraspinal muscles, and investigate the influence factors of paraspinal muscle degeneration in healthy people. MethodsEighty-two healthy Chinese people were prospectively recruited between February 2020 and November 2020, including 36 males and 46 females. The age ranged from 21 to 75 years, with a mean of 48.0 years. The height ranged from 150 to 183 cm, with a mean of 165.6 cm. The body mass ranged from 43 to 100 kg, with a mean of 65.4 kg. The body mass index (BMI) ranged from 16.7 to 32.4 kg/m2, with a mean of 23.7 kg/m2. Parameters of the paraspinal muscles (multifidus muscle, erector spinae muscle, and psoas major muscle) at L3, L4, and L5 levels were measured by MRI, including the relative total cross-sectional area (rtCSA), relative fatty cross-sectional area (rfCSA), relative signal intensity (rSI), and fatty infiltration (FI). The differences of paraspinal muscle parameters at different genders and different measurement levels were compared; Pearson or Spearman correlation analysis was used to explore the relationship between paraspinal muscle parameters and age, height, body mass, BMI. Results From L3 to L5 level, the rtCSA and rfCSA of multifidus muscle and psoas major muscle as well as the rfCSA of erector spinae muscle increased, while rtCSA of erector spinae muscle decreased. The FI and rSI of paraspinal muscles increased gradually. The parameters of paraspinal muscles at L4 and L5 levels were significantly different from those at L3 levels (P<0.05). There were significant differences in rtCSA and rfCSA of multifidus muscle, rtCSA, FI, and rSI of erector spinae muscle as well as rtCSA, rfCSA, and FI of psoas major muscle between L4 and L5 levels (P<0.05). Compared with males, the rfCSA and FI of multifidus muscle, FI of erector spinae muscle, and FI of psoas major muscle were significantly higher in females, while the rtCSA of psoas major muscle was significantly lower (P<0.05). Age was significantly negatively correlated with rtCSA of paraspinal muscles (P<0.05), but significantly positively correlated with FI of paraspinal muscles, rfCSA and rSI of multifidus and erector spinae muscles (P<0.05). Height was significantly negatively correlated with rfCSA and FI of paraspinal muscles (P<0.05). ConclusionThe degree of paraspinal muscle degeneration increases gradually along the spine axis from head to tail. Paraspinal muscle degeneration is related to age, height, and gender. The relationship between the body mass, BMI and paraspinal muscle degeneration needs further study.
The single ventricular circulation is notable for coexisting systemic venous hypertension and pulmonary arterial hypotension. The use of mechanical circulatory support (MCS) devices is a viable therapeutic treatment option for patients with congestive heart failure. Ventricular assisted devices, cavopulmonary assisted devices, and total artificial heart pumps continue to gain acceptance as viable treatment strategies for single ventricular physiology patients as bridge-to transplantation, bridge-to-recovery, and longer-term circulatory support alternatives. Patients with single ventricular physiology had the lower survival rates compared with those with biventricular circulation. We present a review of the current and future MCS devices for patients with univentricular circulations.
Postoperative cognitive dysfunction (POCD) is a common and important complication after cardiac surgery. The pathological reactions caused by cardiac surgery, such as traumatic stress reaction, inflammation, hemodynamics disorders, and blood coagulation dysfunction, by triggering central inflammation, ischemia, hypoxia and ischemia-reperfusion injury and other mechanisms, leading to brain function-impairment, causing the development of POCD. According to the above mechanisms, taking corresponding protective measures, reducing the development of POCD, and improving the quality of life after cardiac surgery are of great importance.
ObjectiveTo investigate the management strategies of clavicular fracture combined with brachial plexus injury and its effectiveness. MethodsBetween January 2006 and January 2012, 27 cases of clavicular fracture combined with brachial plexus injury were treated. There were 18 males and 9 females, aged 18-42 years (mean, 25.3 years). The causes of injury were traffic accident in 12 cases, falling from height in 10 cases, bruise in 3 cases, machinery injury in 2 cases. According to the Robinson classification, the clavicular fractures were rated as type Ⅰ in 2 cases, as typeⅡin 20 cases, and as type Ⅲ in 5 cases; there were 12 cases of total brachial plexus root avulsion injury, 10 cases of bundle branch injury, and 5 cases of hematoma formation and local nerve compression or injury. The injury to operation time was 6 hours to 14 days (mean, 4 days). Brachial plexus injury was repaired by epineurium neurolysis, nerve anastomosis, or nerve transposition after the exploration of the plexus; and fracture was fixed after open reduction. Sensory grading standard (S0-S4) by UK Medical Research Council (MRC) was used to evaluate the recovery of sensory function, and muscle strength grading standard (M0-M5) by MRC to evaluate the innervating muscle strength. ResultsThe incisions healed by first intention. All patients were followed up 18-36 months (mean, 26.3 months). All fracture achieved cl inical healing at 12-17 weeks (mean, 15 weeks). No complication of loosening or breakage of internal fixation occurred. The patients had no pain of shoulder in abduction. At 18 months after operation, the shoulder abduction was more than or equal to 60° in 8 cases, 30-60° in 8 cases, and less than 30° in 11 cases. The recovery of biceps muscle strength was more than or equal to M3 in 18 cases and less than M3 in 9 cases; the recovery of wrist flexion or flexor muscle strength was more than or equal to M3 in 13 cases and less than M3 in 14 cases. The sensory function recovery of median nerve was S3 in 14 cases, S1-S2 in 9 cases, and S0 in 4 cases. The shoulder abduction, elbow and wrist flexor motor function did not recover in 2 patients with total brachial plexus root avulsion injury. ConclusionIt is beneficial to the recovery of nerve function to early repair of the brachial plexus injury by exploration of the plexus combined with open reduction and fixation of clavicular fractures, the short-term effectiveness is good.
ObjectiveTo investigate effect of Notch pathway regulating by inhibiting expression of forkhead box protein A1 (FOXA1) on proliferation and invasion of colon cancer SW480 cells. MethodsThe colon cancer tissues and their corresponding paracancerous tissues of 45 patients with colon cancer admitted to the First Affiliated Hospital of Henan University of Science and Technology from June 2019 to February 2021 were selected. The immunohistochemistry and real-time fluorescent quantitative PCR (qRT-PCR) methods were used to detect the expressions of FOXA1 protein and mRNA in the tissues, respectively. In addition, SW480 cells were divided into control group (untreated), shRNA-NC group (transfected with shRNA-NC), sh-FOXA1 group (transfected with sh-FOXA1), sh-FOXA1+sodium valproate group (Add 8 mmol/L Notch pathway activator sodium valproate after transfection with sh-FOXA1). Then the qRT-PCR, MTT, clone formation test, and Transwell methods were used to detect the expressions of FOXA1 mRNA, proliferation, clonogenic ability, invasion and migration of cells in each group. Western blot method was used to detect the proliferation (c-Myc, cyclinD1), invasion and migration [matrix metalloproteinase (MMP）9, MMP2], epithelial-mesenchymal transition (Vimentin, N-cadherin, E-cadherin) and Notch pathway (Notch-1, Hes-1) related protein expressions of cells in each group. Results① In the clinical cases, the expression levels of FOXA1 protein and mRNA in the colon cancer tissues were higher than those in the corresponding paracancerous tissues (protein: 0.085±0.028 vs. 0.034±0.010, t=11.036, P<0.001; mRNA: 1.62±0.34 vs. 1.00±0.09, t=11.671, P<0.001). ② In the cell experiment, compared with the control group and shRNA-NC group, the cell survival rate, and numbers of cloned cells, invasion and migrating cells were significantly reduced (P<0.05), correspondingly, the related proteins expression levels of c-Myc, cyclinD1, MMP9, MMP2, Vimentin, N-cadherin, Notch-1, Hes-1 were significantly reduced (P<0.05) and the protein expression level of E-cadherin was significantly increased (P<0.05) in the sh-FOXA1 group, which were reversed after adding the Notch pathway activator sodium valproate (P<0.05). ConclusionFOXA1 highly expresses in colon cancer tissues and colon cancer cells and it might promote the proliferation, invasion and migration of SW480 cells by activating the Notch pathway.