Short-term effect of intensity-modulated radiotherapy for children with high-risk neuroblastoma: an analysis of 24 cases / 中国当代儿科杂志

OBJECTIVE@#To study the efficacy and safety of intensity-modulated radiotherapy (IMRT) in children with high-risk neuroblastoma (NB).@*METHODS@#A retrospective analysis was performed on the medical data of 24 children with high-risk NB who were diagnosed and treated with IMRT in the Department of Hematology and Oncology, Hunan Provincial People's Hospital, from April 2018 to December 2020. The medical data included age, radiotherapy dose, times of radiotherapy, laboratory examination results, adverse reactions, and survival.@*RESULTS@#All 24 children (14 boys and 10 girls) received IMRT, with a mean age of (65±23) months and a median age of 59 months. The primary tumor was located in the abdomen in 23 children and 1 child had primary tumor in the mediastinum. The median age was 41.5 months at the time of radiotherapy. The radiation dose of radiotherapy ranged from 14.4 to 36.0 Gy, with a mean dose of (22±3) Gy and a daily dose of 1.8-2.0 Gy. The radiotherapy was performed for a total number of 8-20 times, with a mean number of 11.9 times. Among these children, 6 received radiotherapy for the residual or metastatic lesion. Of all the 23 children, 3 experienced cough, 2 experienced diarrhea, and 1 experienced vomiting during radiotherapy. At 2 weeks after radiotherapy, serum creatinine ranged from 2.3 to 70.1 μmol/L and alanine aminotransferase ranged from 9.1 to 65.3 μ/L. Ten children experienced grade Ⅲ bone marrow suppression and 2 experienced grade Ⅳ bone marrow suppression 1 to 2 weeks after radiotherapy. Four children experienced grade Ⅲ bone marrow suppression and 1 experienced grade Ⅳ bone marrow suppression 3 to 4 weeks after radiotherapy. During a median follow-up time of 13.5 months, 23 children (96%) achieved stable disease and 1 died. Up to the follow-up date, second malignant tumor or abnormal organ function was not observed.@*CONCLUSIONS@#IMRT can improve the local control rate of NB. IMRT appears to be safe in the treatment of children with NB.

Exploration and practice of the closed-loop health management system of the West China Women and Children Alliance / 中华医院管理杂志

As one of the main forms of the medical alliance, the specialty alliance functions as a service carrier for hierarchical medical service and resources integration in the region. The authors introduced the exploration and practice of the West China Women′s and Children′s Alliance, the first pediatric specialty alliance in Sichuan, established by the West China Second Hospital of Sichuan University. Based on family doctor contracted services, the West China Women′s and Children′s Alliance took such measures as differentiated functional positioning, assessment of certified physicians, continuous online quality control, construction of referral platforms, and innovative payment mechanisms. Such efforts effectively integrated the three stages of pre-hospital " preventive care" , in-hospital " disease diagnosis and treatment" , and post-hospital " follow-up management" , exploring the homogenization of medical services within the alliance, and forming a pediatric closed-loop health management system, hence improving the primary medical services.

Effect of expandable pedicle screw fixation on the fixation strength of osteoporotic thoracic and lumbar vertebrae / 中国组织工程研究

BACKGROUND: Studies have shown that osteoporosis often leads to a failure in pedicle screw fixation. Considering that the use of ordinary pedicle screw fixation cannot achieve a strong and stable fixation of the osteoporotic vertebra,special measures to strengthen the internal fixation is indispensable.OBJECTIVE: To evaluate the effect of bone cement augmentation combined with expandable pedicle screw fixation on the fixation strength of osteoporotic thoracolumbar vertebrae.METHODS: Twenty osteoporotic thoracolumbar vertebral specimens were randomly divided into four groups: conventional pedicle screw group implanted with normal pedicle screw, and the other three groups implanted with expandable pedicle screw. Bone cement augmentation with polymethylmethacrylate (PMMA) and calcium sulfate was done in the PMMA group and calcium sulfate group, respectively, followed by expandable pedicle screw implantation. No bone cement was used in the expandable pedicle screw group. The maximum axial pull-out strength and yield energy absorption value of the unilateral pedicle were detected, and the maximum removal torque of the contralateral pedicle was determined. Bone cement leakage after augmentation was observed.RESULTS AND CONCLUSION: Compared with the conventional pedicle screw group, the other three groups showed a significant increase in the maximum pull-out strength, maximum removal torque and yield energy absorption values (P 0.05). No leakage of bone cement was found in all the groups. To conclude, the combined use of expandable pedicle screw and can significantly enhance the stability of the osteoporotic thoracolumbar vertebrae, and the PMMA and calcium sulfate cements have similar effects.

COMPARISON OF SHORT SEGMENTAL FIXATION WITH AND WITHOUT FUSION IN TREATMENT OF THORACOLUMBAR BURST FRACTURE BY POSTERIOR APPROACH / 中国修复重建外科杂志

OBJECTIVE: To compare the effectiveness of short segmental pedicle screw fixation with and without fusion in the treatment of thoracolumbar burst fracture. METHODS: A retrospective analysis was made on the clinical data of 57 patients with single segment thoracolumbar burst fractures, who accorded with the inclusion criteria between February 2012 and February 2014. The patients underwent posterior short segmental pedicle screw fixation with fusion in 27 cases (fusion group) and without fusion in 30 cases (non-fusion group). There was no significant difference in gender, age, cause of injury, time between injury and admission, fracture segment and classification, and neurologic function America Spinal Injury Association (ASIA) classification between 2 groups, which had the comparability (P>0.05). The operative time, blood loss, and hospitalization days were compared between 2 groups. The height of the injured vertebra, the kyphotic angle, and the range of motion (ROM) were measured on the X-ray film. The functional outcomes were evaluated by using the Greenough low-back outcome score and the visual analogue scale (VAS) for back pain. The neurologic functional recovery was assessed by ASIA grade. RESULTS: The operative time was significantly shortened and the blood loss was significantly reduced in the non-fusion group when compared with the fusion group (P0.05). The patients were followed up for 2.0-3.5 years (mean, 3.17 years) in the fusion group and for 2-4 years (mean, 3.23 years) in the non-fusion group. X-ray films showed that 2 cases failed bone graft fusion, the fusion time was 12-17 weeks (mean, 15.6 weeks) in the other 25 cases. Complication occurred in 2 cases of the fusion group (1 case of incision deep infection and 1 case of hematoma at iliac bone donor site) and in 1 case of the non-fusion group (fat liquefaction); primary healing of incision was obtained in the others. The Cobb angle, the height of injured vertebrae showed no significant difference between 2 groups at pre-operation, immediate after operation, and last follow-up (P>0.05). The ROM of injured vertebrae showed no significant difference between 2 groups at 1 year after operation (before implants were removed) (P>0.05). The implants were removed at 1 year after operation in all cases of the non-fusion group, and in 11 cases of the fusion group. At last follow-up, the ROM of injured vertebrae in the non-fusion group was significantly higher than that in the fusion group (P0.05). CONCLUSIONS: Fusion is not necessary when thoracolumbar burst fracture is treated by posterior short segmental pedicle screw fixation, which can preserve regional segmental motion, shorten the operative time, decrease blood loss, and eliminate bone graft donor site complications.

Characteristics and treatments of spinal fractures associated with dural tears / 中华创伤杂志

Objective To investigate the characteristics and treatment effects in patients with spinal fractures associated with dural tears.Methods A retrospective analysis was made on 185 patients with spinal fractures presenting to hospital from February 2013 to February 2015.There were 103 males and 82 females,aged 17-73 years (mean,58 years).Causes of injury were high falls in 72 patients,traffic collisions in 58,hitting by heavy objects in 41,ground-level falls in 12,and collision events in two.Cervical spine fractures were seen in 65 patients,thoracic vertebra fractures in 51,and lumbosacral vertebral fractures 69.Neurologic deficit was assessed using the American Spinal Injury Association (ASIA) score,including grade A in 24 patients,grade B in 22,grade C in 26,grade D in 37 and grade E in 76.Eighty patients were managed by simply anterior surgery,97 by posterior surgery,and eight by anterior-posterior surgery.Twenty-one patients were found with dural tears (group A) and 164 patients without dural tears (group B).Incidence of dural tears in cervical,thoracic and lumbosacral vertebral fractures were recorded and compared.Preoperative neurologic deficit,laminar fracture and spinal canal encroachment rate were compared between groups.Neurological function and complications associated with dural repair were detected.Results In group A,ten patients were rated ASIA grade A,five grade B,three grade C,one grade D and two grade E.In group B,14 patients were rated ASIA grade A,17 grade B,23 grade C,36 grade D and 74 grade E.Group A accounted for 11％ (7/65) of cervical,10％ (5/51) of thoracic,and 13％ (9/69) of lumbosacral spine fractures (P ＞ 0.05).Nineteen patients (91％) in group A were complicated with neurological deficit,compared to ninety patients (54.9％) in group B (P ＜ 0.01).Eighteen patients (86％) in group A had laminar fractures,compared to fifteen patients (9.1％) in group B (P ＜ 0.01).In group A,rate of spinal canal encroachment was (62.3 ± 12.1)％ and 17 patients (81％) showed spinal canal encroachment of greater than 50％.While in group B,rate of spinal canal encroachment was (36.2 ± 15.6)％ and 25 patients (15.2％) showed spinal canal encroachment of greater than 50％ (P ＜ 0.01).For dural tears in group A,11 patients were treated by direct suturing,four by thoracolumbar fascia repair,three by artificial dural coverage and three by fibrin glue sealing.In group A,19 patients were followed up and one of them presented persistent cerebral spinal fluid leak that necessitated an irrigation and debridement to cure.ASIA score was improved from grade A to B in two patients,grade B to C in one,grade C to D in one and grade D to E in one at the final follow-up.Conclusions Majority patients with spinal fractures associated with dural tears exist severe neurologic deficit,spinal canal encroachment and laminar fractures.Incidence of dural tear in cervical,thoracic and lumbosacral vertebral fractures is similar.Incidence of complications related to dural tear repair is low,but the neurological function recovery is poor after operation.

Nonsurgical correction of a severe anterior deep overbite accompanied by a gummy smile and posterior scissor bite using a miniscrew-assisted straight-wire technique in an adult high-angle case / 대한치과교정학회지

In the present report, we describe the successful use of miniscrews to achieve vertical control in combination with the conventional sliding MBT™ straight-wire technique for the treatment of a 26-year-old Chinese woman with a very high mandibular plane angle, deep overbite, retrognathic mandible with backward rotation, prognathic maxilla, and gummy smile. The patient exhibited skeletal Class II malocclusion. Orthodontic miniscrews were placed in the maxillary anterior and posterior segments to provide rigid anchorage and vertical control through intrusion of the incisors and molars. Intrusion and torque control of the maxillary incisors relieved the deep overbite and corrected the gummy smile, while intrusion of the maxillary molars aided in counterclockwise rotation of the mandibular plane, which consequently resulted in an improved facial profile. After 3.5 years of retention, we observed a stable, well-aligned dentition with ideal intercuspation and more harmonious facial contours. Thus, we were able to achieve a satisfactory occlusion, a significantly improved facial profile, and an attractive smile for this patient. The findings from this case suggest that nonsurgical correction using miniscrew anchorage is an effective approach for camouflage treatment of high-angle cases with skeletal Class II malocclusion.

Effect of HBP-A on meniscal injury and pathological hypertrophy and calcification of the meniscus / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of HBP-A on meniscal injuries and the expressions of genes associated with pathological hypertrophy and calcification of the meniscusinduced by abnormal loading.</p><p><b>METHODS</b>Bovine meniscus explants were subjected to 25% strain at 0.3 Hz for 3 h and treated with 0.6 mg/mL of HBP-A. The cell viability in the meniscus explants after 72 hin culture was determined using live/dead staining and the expression levels of genes associated with pathological hypertrophy and calcification of the meniscus (ANKH, ENPP1, ALP, MMP13, and IL-1) were measured using real-time PCR and Western blotting. The conditioned medium was collected for testing sulfated glycosaminoglycan (GAG) release.</p><p><b>RESULTS</b>The number of dead cells, loss of proteoglycan content, and the expressions of ANKH, ENPP1, ALP and MMP13, and IL-1 at both the mRNA and protein levels were all significantly lower in the meniscus explants treated with 0.6 mg/mL HBP-A than in the explants with only 25% abnormal pressure stimulation (n=3, P<0.05).</p><p><b>CONCLUSION</b>HBP-A can effectively alleviate meniscal injuries induced by abnormal loading and suppress the expressions of genes related with pathological hypertrophy and calcification of the meniscus, and can serve as a potential drug for treatment of knee osteoarthritis.</p>

In vitro transdermal delivery of Qingfei Xiaocuo gel based on principal component analysis / 中国中药杂志

The objective of the present study was to establish a method based on principal component analysis (PCA) for the study of transdermal delivery of Chinese medicinal formulae, and to choose the best penetration enhancers for Qingfei Xiaocuo gel depend on this method. Using improved Franz type diffusion cell and excised rat skin in vitro as transdermal barrier, the receptive solution fingerprint was established by HPLC, harvesting the areas of the common peaks in the fingerprint, then the total factor scores of the concentrations at different times were calculated using PCA and were employed instead of the concentrations to compute the cumulative amounts (Q12) and enhancement ratio (ER), the latter of which were considered as the indexes for optimizing penetration enhancers. Compare to the control group, the ER of the other groups increased significantly and furthermore, 2.5% azone with 2.5% menthol manifested the best effect. PCA represent most information in the receptive solution, the method above could choose the best penetration enhancers, it could be a reference for the study of transdermal delivery of Chinese medicinal formulae.

Effect of spinal cord extracts after spinal cord injury on proliferation of rat embryonic neural stem cells and Notch signal pathway in vitro

OBJECTIVE@#To investigate the effect of the spinal cord extracts (SCE) after spinal cord injuries (SCIs) on the proliferation of rat embryonic neural stem cells (NSCs) and the expressions of mRNA of Notch1 as well as of Hes1 in this process in vitro.@*METHODS@#The experiment was conducted in 4 different mediums: NSCs+PBS (Group A-blank control group), NSCs+SCE with healthy SD rats (Group B-normal control group), NSCs+SCE with SD rats receiving sham-operation treatment (Group C-sham-operation group) and NSCs+ SCE with SCIs rats (Group D-paraplegic group). Proliferative abilities of 4 different groups were analyzed by MTT chromatometry after co-culture for 1, 2, 3, 4 and 5 d, respectively. The expressions of Notch1 and Hes1 mRNA were also detected with RT-PCR after co-culture for 24 and 48 h, respectively.@*RESULTS@#After co-culture for 1, 2, 3, 4 and 5 d respectively, the MTT values of group D were significantly higher than those of group A, group B and group C (P0.05). Both the expressions of Notch1 and Hes1 mRNA of group D were significantly higher than those of other 3 groups after co-culture for 24 h and 48 h as well (P0.05). There was no difference in expressions of Notch1 and Hes1 mRNA between 24 h and 48 h treatment in group D.@*CONCLUSIONS@#SCE could promote the proliferation of NSCs. It is demonstrated that the microenvironment of SCI may promote the proliferation of NSCs. Besides, SCE could increase the expression of Notch1 and Hes1 mRNA of NSC. It can be concluded that the Notch signaling pathway activation is one of the mechanisms that locally injured microenvironment contributes to the proliferation of ENSC after SCIs. This process may be performed by up-regulating the expressions of Notch1 and Hes1 gene.

The role of actigraphy in monitoring sleep and sleep disorders / 生物医学工程学杂志

The use of actigraphy, which can be used to estimate sleep-wake patterns from activity levels, has become common in sleep research. Actigraphy is a simple, cost-effective and non-invasive method for healthcare providers and researchers to assess patients sleep quality and screen for potential sleep disorders in recent years. But, there is no wide recognition and application of actigraphy in China up till now. This review summarized the application of actigraphy in evaluation of sleep and diagnosis of sleep disorders.

Early signs of cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome: an event-related potential study / 生物医学工程学杂志

This study seeks to explore the early signs of cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). According to polysomnography, twenty patients diagnosed with OSAHS and twenty normal controls underwent event-related potential (ERP) examination including mismatch negativity (MMN) and P300. Compared with normal controls, OSAHS patients showed significantly prolonged latency of MMN and P300 at Cz. After controlling age and body mass index (BMI), MMN latency positively correlated with apnea hypopnea index (AHI), oxygen reduction index, stage N1 sleep and arousal index, while MMN latency negatively correlated with stage N3 sleep and mean blood oxygen saturation; and P300 latency positively related to AHI and oxygen reduction index; no relationships were found among MMN latency, MMN amplitude, P300 latency and P300 amplitude. These results suggest that the brain function of automatic processing and controlled processing aere impaired in OSAHS patients, and these dysfunction are correlated with nocturnal repeatedly hypoxemia and sleep structure disturbance.

Effect of realgar on induction of apoptosis in DLBCL cell line SU-DHL-4 and its possible mechanisms / 中国实验血液学杂志

This study was aimed to explore the effect of realgar (As4S4) on growth inhibition and apoptosis induction of DLBCL cell line SU-DHL-4 and its mechanisms. The inhibitory effect of realgar on the cell growth were detected by MTT method. The morphological changes of SU-DHL-4 were observed by transmission electron microscopy (TEM). The apoptosis of SU-DHL-4 cells treated with realgar were detected by flow cytometry with Annexin V-FITC/PI double staining and DNA agarose gel electrophoresis. The cell cycle was examined by flow cytometry with PI staining. The expressions of apoptosis-related proteins (BCL-2 , Caspase-3,BAX) were detected by Western blot. The results showed that the realgar at the concentration of 20, 40, 80 µmol/L all could inhibit the proliferation of SU-DHL-4 (P < 0.05), and in a certain time and concentration range, the inhibition rate was enhanced in a time and dose dependent manner(r = 0.982). Flow cytometric test results showed that realgar could induce SU-DHL-4 cell apoptosis after treating for 48 hours, and the apoptosis rate increased with the increasing of drug concentration (P < 0.05). After treating SU-DHL-4 cells with Realgar for 48 h, the cell cycle was blocked in the S phase (P < 0.05). TEM results revealed that when treated with realgar for 48 h, the typically apoptosis morphology-apoptotic bodies were observed in all drug-treated group, furthermore, some necrotic cells in the 80 µmol/L group were observed. After intervened by realgar for 48 h, the DNA Ladder pattern was seen according to agarose gel electrophoresis. Western blot showed that the expression of Bcl-2 protein was down-regulated while the expressions of BAX and Caspase-3 protein were up-regulated when treating SU-DHL-4 cells with realgar for 48 h. It is concluded that realgar can inhibit cell growth and induce cell apoptosis, which may be related with up-regulation of Caspase-3 and BAX expression and down-regulation the of BCL-2 expression.

Observation on the therapeutic effects of ACCF and ACDF on cervical spondylotic myelopathy and evaluation on the postoperative complications / 重庆医学

Objective To investigate the clinical therapeutic effects of different surgical treatments on cervical spondylotic my-elopathy and the occurrence of postoperative complications .Methods 65 patients with cervical spondylotic myelopathy admitted in our department between January 2010 and January 2013 were retrospectively analyzed ;and among them ,31 underwent anterior cer-vical discectomy and fusion(ACDF) and 34 underwent anterior cervical corpectomy and fusion (ACCF);the general surgical condi-tions ,JOA scores and functional grades of Nurick ,incidences of dysphagia and so on in the patients of the two groups were investi-gated .Results The operative time and intra-operative blood loss of the patients of the ACDF group were better than those of the ACCF group[(88 .70 ± 9 .03)min ,(125 .46 ± 12 .62)min ,(94 .26 ± 10 .34)mL ,(133 .98 ± 12 .09)mL] ,and the differences were sta-tistically significant(P0 .05);but the differences between the preoperative and postoperative JOA scores and functional grade of Nurick in 6 months after the surgeries and those before the surgeries of the same groups were statistically significant (P<0 .05) .At the same observation time points ,the incidences of dysphagia and the thicknesses of soft tissue before the cervical vertebra in the operated segment of the observation group were all lower than those of the control group ,and the differences were statistically significant (P<0 .05);in the patients of either group ,no loosening ,translocation or non-fusion of the bone graft was observed .Conclusion The two surgeries in treatment of cervical spondylotic myelopathy van both obtain satisfying clinical therapeutic effects ,but ACDF has a lower incidence of postop-erative complications ,and doctors should choose a suitable surgery based on the actual conditions .

Influence of ketogenic diet on the clinical effects and electroencephalogram features in 31 children with pharmacoresistant epileptic encephalopathy / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the effect of ketogenic diet (KD) on the clinical and electroencephalogram features in children with pharmacoresistant epileptic encephalopathy.</p><p><b>METHOD</b>Thirty-one children (19 boys, 12 girls) aged 7 months to 7 years (mean 2 years 5 month) with epilepsy refractory to conventional antiepileptic drugs (AEDs) were included in this study. In addition to their original AED treatment, the children were assigned to different ketogenic diets based on their age. The prospective electro-clinical assessment was performed prior to the KD and then one week, one month and again 3 months after the initiation of therapy, respectively.</p><p><b>RESULT</b>The reduction of seizure frequency in 52%, 68% and 71% of all patients exceeded 50% one week, one month and three months after KD treatment respectively. KD is particularly effective in myoclonic astatic epilepsy (MAE; Doose Syndrome) and West syndrome with 100% and 81.25% of the patients having a greater than 50% seizure reduction, respectively. After 3 months of KD treatment, more than 2/3 patients experienced a reduction in interictal epileptiform discharges (IEDs) and improvement in EEG background.</p><p><b>CONCLUSION</b>The clinical and electroencephalographic improvement confirms that KD is beneficial in children with refractory epilepsy.</p>

Effects of in vitro cultured adipose-derived stem cells of rats on the tympanic membrane fibroblasts / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the effects of rats adipose-derived stem cell (ASC) on the proliferation and migration of fibroblasts from the tympanic membrane, and to discuss the possibility and significance of therapy with ASC for tympanic membrane (TM) healing and regeneration.</p><p><b>METHODS</b>Wistar rats were sacrificed, and then the isolation, culture and identification of both ASC and the TM fibroblasts were performed respectively. To verify the effect of ASC on fibroblasts proliferation, transwell co-culture system was used. To examine the effect of ASC on fibroblasts migration, cell migration assay with transwell was also applied. All the data were analyzed under a confocal laser scan microscopy system.</p><p><b>RESULTS</b>Immunofluorescence of cell surface markers indicated that rats ASC were positive for both of CD44 and CD29, but negative for CD34. The rat TM fibroblasts were positive for vimentin. The fibroblasts co-cultured with ASC proliferated faster than the fibroblasts of control group, and the difference of the cell counting number between the two groups was significant (t = 6.75, P = 0.003). Compared with the control group, the fibroblasts cultured with ASC conditioned culture medium migrated significantly faster, and the space between the fibroblasts and the polycarbonate membrane pore was significantly shortened at different time point (1, 2.5 and 4 h, P < 0.05). The cell number of the fibroblasts that had migrated through the polycarbonate membrane had been significantly increased 5 h after migration (P < 0.05).</p><p><b>CONCLUSION</b>ASC might promote TM fibroblasts proliferation and migration by paracrine activation, and it will facilitate the regeneration of TM fibrous layer.</p>

Evidence-based quality assessment of 10-year orthodontic clinical trials in 4 major dental journals / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To assess the quality of orthodontic clinical trials published in 4 major dental journals in the past 10 years and establish the reference standard for orthodontic clinical trials and quality control of dental journals.</p><p><b>METHODS</b>All the clinical trials published in Chinese Journal of Stomatology, West China Journal of Stomatology, Journal of Practice Stomatology and Chinese Journal of Orthodontics from 1999 to 2008 were searched. The demographic information of the papers was extracted and the quality of the clinical trials according to the consolidated standards of reporting trials (CONSORT) was assessed.</p><p><b>RESULTS</b>Four hundred and ninety-four clinical trials were retrieved, and 21.3% (105/494) of them were supported by grants. For the study design, only 26.1% (129/494) were prospective studies, and 3.8% (19/494) were randomized clinical trials. It was hard to evaluate precisely due to the lack of information about the details of the study designs. For the randomized clinical trials, the lack of details for randomization, allocation concealment, blinding and intention to treat compromised the quality.</p><p><b>CONCLUSIONS</b>The general quality of clinical trials in orthodontics is poor. It needs to be improved both in the clinical study design and the paper writing.</p>

Otoendoscopic treatment of hidden lesions in otomastoiditis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surgical treatments for chronic suppurative and cholesteatoma otitis media have been discussed for several decades, but recurrences still occur because of the complex dissection required and hidden lesions associated with otomastoiditis. This study investigated the technology and strategy behind the use of otoendoscopic-assisted otosurgery.</p><p><b>METHODS</b>We reported on hidden lesions in 32 ears of patients with otomastoiditis between November 2006 and January 2009. All the patients were treated with the aid of an otoendoscope. The advantages of otoendoscopy, including multi-angle light scattering, aperture illumination, and magnification of the local operative field, were utilized in otologic microsurgery, and otoendoscopic operative techniques were introduced for operative sites such as the epitympanum, aditus of the antrum, facial recess, sinus tympani and the mastoid tip.</p><p><b>RESULTS</b>All patients were followed up from 3 months to 2 years after surgery. All patients recovered well within 3 months following surgery, except for one case of epithelialization of the mastoid cavity occurring 6 months after surgery for cholesteatoma on the cerebellar surface and another case with Bezold's abscess, hyperplastic granulation tissue developed at the antrum.</p><p><b>CONCLUSIONS</b>Otoendoscopy can overcome the technical deficiency of rectilinearity of the visual axis associated with otomicroscopic illumination, which presents a problem when dealing with otomastoiditis lesions in hidden areas. This technique allows such lesions within the complex three-dimensional structure to be visualized and cleaned. Otoendoscopy thus has significant potential for improving the quality of surgery and reducing the risk of postoperative recurrence.</p>

Relationships Between Health-Related Quality of Life and Social Support in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome / 中国呼吸与危重监护杂志

Objective To study the relationships among health-related quality of life(HRQL), social support, excessive daytime sleepiness (EDS) and PSG parameters in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods Eighty-five patients were recruited who were diagnosed as OSAHS by overnight po]ysomnography from August 2007 through November 2007 in West China Hospital.The Calgary sleep apnea quality of life index (SAQLI) was used for HRQL, social support rating scale (SSRS) was used for social support,and Epworth sleepiness scale(ESS) was used for EDS.The Pearson linear correlation and stepwise multiple regression analysis were used to analyze the correlation among SAQLI, SSRS, ESS, and PSG.Results The SAQLI was correlated with SSRS score (r = 0.402, P < 0.01) ; ESS score (r =-0.505 ,P <0.01) ; apnea-hypopnea index (AHI) (r =-0.269,P <0.05) and lowest artery oxygen saturation (ISaO2) (r = 0.226, P < 0.05).Stepwise muhiple regression analysis determined two variables,the SSRS and ESS score,as independent factors for predicting the total score of SAQLI which accounted for 37.3% of the total variance in the total score on SAQLI (R2 = 0.373, P < 0.001).Conclusions The HRQL of patients with OSAHS was correlated with the SSRS score, ESS score and PSG parameters.The former two were the more important factors to affect the HRQL of patients with OSAHS.

Magnetic resonance myocardial perfusion imaging for evaluating myocardial viability after myocardial infarction / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the value of magnetic resonance (MR) myocardial perfusion imaging (MRMPI) in evaluating the myocardial viability in patients with myocardial infarction.</p><p><b>METHODS</b>MRMPI was performed in 51 patients with myocardial infarction using a 1.5 T MR scanner. All the patients were examined using IR-turbo FLASH sequence during the first-pass and delayed phase 5-30 min after injection of 0.1 mmol/kg Gd-DTPA at the rate of 4 ml/s. The short axis images were acquired during the first-pass, and both the short axis and long axis images were obtained during the delayed phase. The left ventricular wall on the short-axis slice was divided into 8 segments. A correlative study of the results of the rest and stress (99m)Tc single photon emission computed tomography (SPECT) was carried out in 21 patients.</p><p><b>RESULTS</b>In the 51 patients with myocardial infarction, 42(82.3%) showed hypoperfusion during the first-pass imaging and 50(98%) had delayed hyperenhancement. In the 21 patients receiving SPECT, 48 nonviable segments was detected among the 168 segments scanned by (99m)TcSPECT, and MRMPI showed delayed hyperenhancement in all the infracted areas. Of the 120 viable segments detected by rest and stress (99m)Tc SPECT, 97 segments (80.8%) were found to be free of delayed hyperenhancement by MRMPI. With the rest and stress (99m)Tc SPECT as the reference, the sensitivity and the specificity of MRMPI were 100.0% and 80.8%, respectively.</p><p><b>CONCLUSION</b>MRMPI allows effective identification of the myocardial viability and nonviability as well as the severity and extent of the myocardial infraction.</p>

Effects of minimal persistent inflammation on nasal mucosa of experimental allergic rhinitis in guinea pigs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establish an animal model of minimal persistent inflammation (MPI) of allergic rhinitis in guinea pigs and to investigate the changes of nasal mucosa. The expression of transforming growth factor-beta1 (TGF-beta1) and matrix metalloproteinases-9 (MMP-9) were discussed.</p><p><b>METHODS</b>Thirty male Hartley guinea pigs were randomly divided into two groups: MPI model group and control group randomly, with fifteen animals in each group. Guinea pigs from MPI model group were sensitized intraperitoneally by injection of suspension of ovalbumin (OVA) and aluminum hydroxide in 0.9% physiological saline. Then, repeated local booster sensitization with low concentration of OVA suspension into the nasal cavity was performed to establish MPI models. Alcian blue-periodic acid-Schiff (AB-PAS) staining and Masson's trichrome (MT) staining were used to determine the number of goblet cells and collagen deposition within the basement membrane of epithelium. The expression and distribution of TGF-beta1 and MMP-9 in nasal mucosa were estimated by double immunofluorescence under a confocal laser scan microscopy system.</p><p><b>RESULTS</b>Compared with the control group, the increased goblet cells (t = 13.720, P < 0.05) in nasal epithelium together with the increased collagen fibrils (t = 4.542, P <0.05) within the basement membrane of epithelium were observed in the MPI model group. There was nearly no expression of TGF-beta1, in the control group and the expression of MMP-9 was only found in the epithelium cell. In contrast, there was significantly higher expression of TGF-beta1 and MMP-9 (t = 25.218, P <0.05) in nasal mucosa of MPI model group than that in control group. TGF-beta1 mainly expressed in the epithelium cell, the infiltrated inflammatory cell and extracellular matrix, while MMP-9 expressed in the epithelium cell and the infiltrated inflammatory cell.</p><p><b>CONCLUSIONS</b>Long time MPI in allergic rhinitis resulted in some changes of tissue remodeling in nasal mucosa. TGF-beta1 and MMP-9 may play an important role in disease progression.</p>