Effect of inferior vena cava respiratory variability-guided fluid therapy after laparoscopic hepatectomy: a randomized controlled clinical trial / 中华医学杂志(英文版)

BACKGROUND@#After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU).@*METHODS@#This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy.@*RESULTS@#Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D -lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups.@*CONCLUSION@#Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.@*TRIAL REGISTRATION@#ChiCTR-INR-17013093.

Clinical value of split domino donor auxiliary liver transplantation / 中华消化外科杂志

Objective:To investigate the clinical value of split domino donor auxiliary liver transplantation.Methods:The retrospective and descriptive study was conducted. The clinco-pathological data of 3 liver transplantation recipients who were admitted to Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School and 1 liver transplantation recipient who was admitted to external hospital in September 2018 were collected. The first case was male, aged 22 years, who was diagnosed as type II citrullinemia (CTLN2). The second case undergoing liver transplantation in external hospital was male, aged 59 years, who was diagnosed as decompensated alcoholic cirrhosis. The third case was female, aged 52 years, who was diagnosed as hepatocellular carcinoma of right lobe of liver. The fourth case was female, aged 51 years, who was diagnosed as hepatocellular carcinoma of right lobe of liver. The donor liver from a brain and cardiac death donor was split in vitro into the left liver and the right liver, in which the right liver without middle hepatic vein, and the modified piggyback liver transplantation using the left liver and the classical orthotropic liver transplantation using the right liver was conducted on the first and the second case, respectively. The original liver of the first case was split in vivo into the left liver and the right liver, and the piggyback auxiliary liver transplantation using the left liver and the piggyback auxiliary liver transplantation using the right liver was conducted on the third and the fourth case who underwent extended right hemihepatectomy, respectively. Observation indicators: (1) intraoperative situations; (2) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect liver function, liver imaging, complication and survival of recipients up to October 2021.Results:(1) Intraoperative situations. Liver transplantation was conducted successfully on the first, third and fourth case, with the operation time, the volume of intraoperative blood loss, the donor liver cold ischemia time, the graft-to-recipient weight ratio were 400 minutes, 370 minutes, 390 minutes, 600 mL, 1 300 mL, 1 600 mL, 230 minutes, 152 minutes, 135 minutes, 1.2%, 0.8%, 1.1%. (2) Follow-up. B-ultrasound examination of the first, third and fourth case after liver transplantation showed that the blood flow was normal, and all the 3 cases discharged and were followed up at postoperative 1, 6 and 12 month. The liver function, the level of blood ammonia and citrulline were normal of the first, third and fourth case at postoperative 1 week. Imaging examina-tion showed normal liver morphology of the first and third case, and a transplanted liver atrophy caused by portal vein steal of the fourth case. ① The level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil) of the first case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 22.8 U/L, 404.1 U/L, 355.5 U/L, 289.6 U/L, 31.0 U/L, 23.1 U/L, 42.1 U/L and 25.8 U/L, 31.5 U/L, 517.7 U/L, 327.6 U/L, 172.9 U/L, 15.9 U/L, 21.4 U/L, 47.5 U/L and 29.7 U/L, 3.8 μmol/L, 92.1 μmol/L, 87.4 μmol/L, 79.7 μmol/L, 90.1 μmol/L, 130.6 μmol/L, 33.8 μmol/L and 25.4 μmol/L, 2.3 μmol/L, 47.0 μmol/L, 44.1 μmol/L, 47.1 μmol/L, 57.4 μmol/L, 70.9 μmol/L, 24.7 μmol/L and 9.7 μmol/L, respectively. The level of citrulline and blood ammonia of the first case before and after liver transplantation were 999.0 μmol/L, 196.0 μmol/L and 14.6 μmol/L, 9.0 μmol/L, respectively. The first case was followed up for 3 years and survived without any liver transplantation related complication. ② The level of ALT, AST, TBil, DBil of the third case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 21.3 U/L, 143.9 U/L, 182.0 U/L, 132.0 U/L, 17.2 U/L, 10.1 U/L, 17.6 U/L and 16.8 U/L,20.0 U/L, 291.0 U/L, 227.5 U/L, 106.4 U/L, 15.8 U/L, 10.8 U/L, 17.1 U/L and 19.4 U/L, 6.8 μmol/L, 50.9 μmol/L, 45.0 μmol/L, 34.0 μmol/L, 32.4 μmol/L, 22.3 μmol/L, 12.8 μmol/L and 14.9 μmol/L, 2.5 μmol/L, 18.4 μmol/L, 17.2 μmol/L, 14.9 μmol/L, 14.8 μmol/L, 12.1 μmol/L, 3.6 μmol/L and 4.4 μmol/L. The level of citrulline and blood ammonia of the third case after liver transplantation were 24.9 μmol/L and 16.0 μmol/L. The third case was followed up for 3 years and survived without any liver transplantation related complication. ③ The level of ALT, AST, TBil, DBil of the fourth case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 35.0 U/L, 268.7 U/L, 682.0 U/L, 425.8 U/L, 57.5 U/L, 34.0 U/L, 29.4 U/L and 18.1 U/L, 37.0 U/L, 419.1 U/L, 436.2 U/L, 139.5 U/L, 35.2 U/L, 32.4 U/L, 54.7 U/L and 32.8 U/L, 7.1 μmol/L, 64.2 μmol/L, 41.4 μmol/L, 17.6 μmol/L, 34.2 μmol/L, 48.7 μmol/L, 14.1 μmol/L and 21.8 μmol/L, 2.8 μmol/L, 18.9 μmol/L, 16.1 μmol/L, 6.0 μmol/L, 14.6 μmol/L, 26.7 μmol/L, 3.9 μmol/L, 11.8 μmol/L. The level of citrulline and blood ammonia of the fourth case after liver transplantation were 8.4 μmol/L and 47.0 μmol/L. One week after surgery, the transplanted right liver of the fourth case occurred atrophy due to blood stealing from the right branch of the portal vein. B-ultrasound examination showed that the reflux of the hepatic artery and hepatic vein was unobstructed. Immunosuppressants were discontinued 3 months after operation on the fourth case and there was no complication such as rejection, bile leakage, biliary stricture, thrombosis and vascular stricture during follow-up. The fourth case died of lung metastasis 19 months after operation.Conclusion:Split domino donor auxiliary liver transplantation can be used for the treatment of metabolic liver disease and advanced hepatocellular carcinoma.

Expressions of SPNS2 and Lgr5 in laryngeal squamous cell carcinoma and their correlations with prognosis / 国际肿瘤学杂志

Objective:To investigate the expressions of sphingosine-1-phosphate transporter 2 (SPNS2) and leucine-rich repeat-containing G-protein coupled receptor 5 (Lgr5) in laryngeal squamous cell carcinoma and their correlations with clinicopathological features and prognosis.Methods:A total of 82 cases of squamous cell carcinoma were collected from the paraffin-embedded specimens of laryngeal cancer in Taixing People′s Hospital of Jiangsu Province from March 2012 to March 2016. The expressions of SPNS2 and Lgr5 were detected by immunohistochemistry in 82 cancerous tissues and 50 adjacent normal tissues. The relationships between the expressions of SPNS2 and Lgr5 in patients with laryngeal squamous cell carcinoma and clinicopathological features and prognosis were analyzed.Results:The high expression rate of SPNS2 in laryngeal squamous cell carcinoma tissues was 40.24% (33/82), which was higher than 8.00% (4/50) in normal tissues adjacent to cancer. The high expression rate of Lgr5 in cancerous tissues was 46.34% (38/82), which was higher than 12.00% (6/50) in normal tissues adjacent to cancer. The differences were statistically significant ( χ2=16.008, P<0.001; χ2=16.484, P<0.001). The expression status of SPNS2 was related to tumor size ( χ2=5.713, P=0.017), tumor stage ( χ2=7.071, P=0.008), tumor differentiation degree ( χ2=5.722, P=0.017) and lymph node metastasis ( χ2=6.595, P=0.010). There were significant differences in the expression status of Lgr5 in different tumor stage ( χ2=8.200, P=0.004), tumor differentiation ( χ2=9.435, P=0.002) and lymph node metastasis ( χ2=16.188, P<0.001). The 3-year overall survival rate of patients in SPNS2 low expression group was 90.91%, which was higher than that of patients in SPNS2 high expression group (71.43%, χ2=4.975, P=0.026). The 3-year progression-free survival rate of patients in SPNS2 low expression group was 78.79%, which was higher than that of patients in SPNS2 high expression group (55.10%, χ2=6.113, P=0.013). The 3-year overall survival rate of patients in Lgr5 low expression group was 86.84%, which was higher than that of patients in Lgr5 high expression group (65.91%, χ2=5.801, P=0.016). The 3-year progression-free survival rate of patients in Lgr5 low expression group was 78.95%, which was higher than that of patients in Lgr5 high expression group (56.82%, χ2=6.316, P=0.012). Multivariate Cox regression analysis showed that differentiation ( RR=0.199, 95% CI: 0.057-0.691, P=0.011), tumor staging ( RR=0.167, 95% CI: 0.053-0.531, P=0.002), SPNS2 ( RR=0.208, 95% CI: 0.072-0.604, P=0.004) and Lgr5 ( RR=0.198, 95% CI: 0.060-0.655, P=0.008) were risk factors for the prognosis of patients with laryngeal squamous cell carcinoma. Contingency correlation analysis showed a positive correlation between SPNS2 and Lgr5 expressions in laryngeal squamous cell carcinoma ( C=0.591, P<0.001). Conclusion:SPNS2 and Lgr5 are highly expressed in laryngeal squamous cell carcinoma and are closely related to clinicopathological features. And SPNS2 and Lgr5 are risk factors for the prognosis of patients with laryngeal squamous cell carcinoma.

Study of benign bile duct stricture animal model with regulatable characteristic / 医学研究生学报

Objective To investigate precise and regulable animal model of benign bile duct strictures.Methods Mini pigs were divided into four groups as sham surgery group, conventional surgery group, small caliber group and large caliber group according to random number table, with 6 pigs in each group.For the small caliber group, outside diameter 3.0mm catheter were inserted into bile duct and partial sutured.For the large caliber group, outside diameter 6.0mm catheter were inserted into bile duct and partial sutured.Conventional surgery group were treated with 5-0 absorbable suture on distal bile duct and controlled stricture severity visually.For sham surgery group, bile duct were exposed without suture.Observe the general condition of four groups.Test liver function on 1st, 3rd, 7th, 14th, 21st and 28th day postoperative.Perform cholangiography on 30th day postoperative.All four groups were put to death to observe the histological changes of liver and bile duct.Results Liver function of sham surgery group showed no obvious change during observation.On 28th day postoperative, compared to conventional surgery group, the liver enzymes ALT, AST, γ-GT, ALP, bilirubin level of small caliber group elevated(P<0.05)and the liver enzymes ALT, AST, γ-GT, bilirubin level of large caliber group elevated(P<0.05),while ALP level lowered(P<0.05).Cholangiography showed bile duct stenosis of different degree on 6 pigs of small caliber group with average diameter 2.7mm (from 2mm to 4mm).As for large caliber group, 5 pigs showed stenosis with average diameter 5.5mm (from 5mm to 7mm).3 pigs of conventional surgery group showed no obvious bile duct stenosis.The 6 pigs of sham surgery group showed no bile duct stenosis.According to designed stenosis standard, the success rate of small caliber group and large caliber group are both higher than conventional surgery group.(P<0.05).30 days after surgery, all 6 pigs of small caliber group had postoperative intraperitoneal adhesion, hepatomegaly, obvious expansion of intrahepatic bile duct and gallbladder expanded by 4~5 times.5 pigs of large caliber group had hepatomegaly, slight dilation of intrahepatic bile duct, obvious expansion of gallbladder, clear choledochal edema, sutured tissue thickening and visible bile duct stenosis.HE staining with the small caliber group showed hepatocyte spotty degenerative necrosis, expanded cholestatic intrahepatic small bile duct, swelling hepatocyte and fibrous septa.HE staining with the large caliber group showed intrahepatic small bile duct slightly expanded and hepatocyte arranged basically normal.VG staining with the small caliber group showed excessive accumulaton of collagen fibers outside bile duct mucous cells, randomly and densely arranged and irregularly shaped.VG staining with the large caliber group showed increased collagen fibers in bile duct submucosa, densely and banded arranged.Conclusion This animal model of mini pig is an relatively ideal large animal model of biliary stricture with high surgical success rate and few postoperative complications.

Effect evaluation of intervene on healthy behavior of soldiers on platesu area to prevent hemorrhoids based on transtheoretical model / 中国实用护理杂志

Objective To explore the effect of trans theoretical model in changing on healthy behavior of soldiers on plateau area to prevent hemorrhoids. Methods Fifty-four soldiers respectively from the artillery troops and air defenses force troops were selected and divided into control group that received normal healthy education and treatment group that received the healthy behavior intervene based on transtheoretical model and the changes of the behavior at each stage of intervention were observed and contrasted between two groups. Results There was no statistically significant difference in the number of each stage between two groups at 1 and 3 months after intervention (χ2= 1.514, 6.554, P> 0.05). The number of former intention stage, intention stage, preparation stage, action stage, maintain stage at 6 months after intervention in treatment group were respectively 0, 0, 0, 15, 39 cases, and 2, 3, 6, 20, 23 cases in control group respectively, the difference was statistically significant (χ2=15.843, P0.05). The number of daily training of the levator ani less than 5, 6-15, 16-25, 26-35,>35 times at 3, 6 months after intervention respectively was 5, 6, 6, 17 cases and 20, 0, 0, 0, 14, 40 cases in treatment group respectively, 9, 13, 14, 10, 8 cases, and 3, 4, 6, 22, 19 cases in control group,the differences were statistically significant (χ2=13.459, 22.252, P<0.01). The incidence of bloody at 6 months after intervention was 3.70% (2/54) in treatment group and 16.67% (9/54) in control group, the difference was statistically significant (χ2 = 4.960, P < 0.05). Conclusions The intervene based on transtheoretical model can effectively promote the healthy behavior to prevent hemorrhoids and reduce the recurrence rate of hemorrhoids.

Application of health education guided by the trans-theoretical model on the training of the first ;aid in the high altitude troops / 中国实用护理杂志

Objective To study the application effect of health education guided by the theory of cross-theoretical model in the training of the first aid training in the basic units of the plateau. Methods Choosing 386 long-term presence of plateau soldiers, and divided them into the control group and the experimental group, the control group was educated by traditional method, in the experimental group, the health education was carried out with the trans-theoretical model, nursing experts gave them targeted intervention. The number of groups at each stage was analyzed in different stages, the same to examination results and pass rate. Results After 6 months of intervention, there was a significant improvement in the mastering of the battlefield Five emergency technology of the experimental group and the scores were better than those of the control group (P<0.05). Theoretical results showed that pass rate of the control group was 89.1%(172/193), the experimental group was 99.5%(192/193), the difference between the two groups was statistically significant (χ2=7.129, P=0.039). In the survey of technical operation, ventilation, hemostasis, bandaging, fixing and handling examination pass rate of the control group respectively were 88.1%(170/193), 89.1%(172/193), 89.1%(172/193), 88.1%(170/193), 88.6%(171/193), the experimental group were 99.5%(192/193), 97.9%(189/193), 99.5%(192/193), 96.9%(187/193), 97.4%(188/193), there were significant differences between the two groups (χ2=7.896-12.759, P=0.001-0.043). Conclusions Cross theoretical model has good effect on the application ofFiveemergency technology training in the high altitude troops battlefield, and can effectively improve the troops self- help and mutual aid capabilities, it is worthy of popularization and application.

Clinical value of preoperative nutritional support therapy in the hepatectomy of patients with nutritional risk: a prospective study / 中华消化外科杂志

Objective To investigate the clinical value of preoperative nutritional support (PNS) therapy in the hepatectomy of patients with nutritional risk.Methods The prospective study was conducted.The clinical data of 133 patients with nutritional risk who were admitted to the Drum Tower Hospital Affiliated to Nanjing University Medical School from August 2012 to June 2016 were collected.All the patients undergoing PNS and traditional therapy were divided into the PNS group and the control group by random number table method,respectively.Observation indicators:(1) comparisons of laboratory indexes between groups;(2) comparisons of postoperative situations between groups;(3) comparisons of postoperative complications between groups.Measurement data with normal distribution were represented as-x±s.Comparisons between groups were evaluated with the independent-sample t test.Comparisons of count data were analyzed using the chi-square test,and repeated measures data were analyzed by the repeated measures ANOVA.Results All the 133 patients were screened for eligibility,including 68 in the PNS group and 65 in the control group.(1) Comparisons of laboratory indexes between groups:alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin (TBil),cholinesterase,albumin (Alb),prealbumin,transferrin and C-reactive protein (CRP) in the PNS group were respectively (36± 13) U/L,(29± 10) U/L,(18.5±2.4) mmol/L,(5 738± 1 824) U/L,(37.4±5.1) g/L,(155±48) mg/L,(2.2±0.5)g/L,(10±4) g/L at admission and (33 ± 9) U/L,(27 ± 8) U/L,(17.9± 1.8) mmol/L,(5 796± 2 016) U/L,(38.5 ± 4.7) g/L,(181 ± 40) mg/L,(2.4± 0.5) g/L,(8± 4) g/L before operation and (285±100)U/L,(218±93)U/L,(33.5±6.3)mmol/L,(4 847±1 044)U/L,(32.6±3.8)g/L,(105±34)mg/L,(1.3±0.4) g/L,(55±28) g/L at 1 day postoperatively and (149±84) U/L,(76±42) U/L,(22.7±4.9) mmol/L,(3 866±893) U/L,(34.2±2.4) g/L,(125±30) mg/L,(1.6±0.4) g/L,(51±34) g/L at 3 days postoperatively and (64±33) U/L,(44±18) U/L,(19.4±2.8) mmol/L,(4 257± 1 032) U/L,(37.0±2.1) g/L,(148±42) mg/L,(1.9±0.4)g/L,(16±11)g/L at 7 days postoperatively;ALT,AST,TBil,cholinesterase,Alb,prealbumin,transferrin and CRP in the control group were respectively (36± 15)U/L,(31± 12)U/L,(18.3±2.9)mmol/L,(5 762±1 693)U/L,(37.3±6.1)g/L,(162±51)mg/L,(2.3±0.5)g/L,(10±4)g/L at admission and (36±11)U/L,(30±11)U/L,(18.2±2.8)mmol/L,(5 789±1 673)U/L,(37.8±7.1)g/L,(166±57) mg/L,(2.3±0.6) g/L,(9±5) g/L before operation and (305±127) U/L,(246± 104) U/L,(34.2±7.8) mmol/L,(4 842±1 173)U/L,(32.0±4.1) g/L,(83±32) mg/L,(1.2±0.4) g/L,(61 ±31) g/L at 1 day postoperatively and (163±104)U/L,(82±62)U/L,(23.1±6.0)mmol/L,(3 672±937) U/L,(33.8±3.6) g/L,(106±30)mg/L,(1.4±0.4)g/L,(61±40)g/L at 3 days postoperatively and (77±48) U/L,(52±27) U/L,(20.2±3.5) mmol/L,(3 925±987) U/L,(36.6±2.8) g/L,(125±40) mg/L,(1.7±0.4) g/L,(22± 12) g/L at 7 days postoperatively,showing no statistically significant difference in changing trends of above indicators between groups (F =1.007,2.223,0.579,0.014,0.235,3.533,2.970,2.143,P＞0.05).Results of further analysis showed that there were statistically significant differences in the levels of ALT,AST and cholinesterase at 7 days postoperatively between groups (t=1.832,2.073,1.899,P＜0.05),and in the levels of prealbumin before operation and at 1,3 and 7 days postoperatively between groups (t =1.698,3.738,3.625,3.178,P＜0.05) and in the levels of transferrin and CRP at 3 and 7 days postoperatively between groups (t=2.917,2.709,1.667,2.990,P＜0.05).(2) Comparisons of postoperative situations between groups:time to initial exsufflation,time of initial defecation,infused volume of exogenous albumin and duration of postoperative hospital stay were respectively (46± 15)hours,(64±16)hours,(23±10)g,(9.2±2.6)days in the PNS group and (55±18)hours,(78±21)hours,(39±25)g,(11.7±5.3) days,with statistically significant differences in the above indicators between groups (t =2.830,4.157,5.044,3.497,P＜0.05).(3) Comparisons of postoperative complications between groups:23 and 33 patients in the PNS and control groups had postoperative complications,showing a statistically significant difference between groups (x2=3.915,P＜0.05).Eight and 17 patients in the PNS and control groups were respectively complicated with peritoneal effusion,with a statistically significant difference between groups (x2 =4.508,P＜ 0.05).Conclusion PNS therapy in the hepatectomy of patients with nutrition risk can effectively improve pre-and post-operative nutrition statuses,reduce liver damage,accelerate recoveries of liver and gastrointestinal functions,reduce complications,shorten duration of postoperative hospital stay and accelerate patients' recovery.

Embryonal rhabdomyosarcoma of nasopharyngeal: a case report / 临床耳鼻咽喉头颈外科杂志

This case reports of nasopharyngeal embryonal rhabdomyosarcoma mainly for a stuffy nose, runny nose with blood, and without typical clinical manifestations. Electronic laryngoscopy tip: nasopharyngeal neoplasm. MRI tip: nasopharyngeal carcinoma. By pathological and immunohistochemical examinations, it finally was diagnosed with nasopharyngeal embryonal rhabdomyosarcoma.

Nasal endoscopic surgery for osteoid osteoma of the periorbital skull base: a case report / 临床耳鼻咽喉头颈外科杂志

Osteoid osteoma was first reported in 1935 by Jaffe. It is a kind of benign bone disease with the limitation of well-defined lesions. It is rarely seen in the periorbital region. The only symptom of the patient was unilateral proptosis of right. The result of MRI examination was cystic masses in the edge of the right orbit. The tumor was complete removed by the nasal endoscopic approach during the surgery. Pathology result was reported as osteoid osteoma. There was no significant complications of diplopia, visual acuity decreased, enophthalmos, cerebrospinal fluid leakage and others.

Change of CTR1 Expression after Round Window Niche Copper Sulfate and Cisplatin Infusion / 听力学及言语疾病杂志

Objective To study the expression of copper transport protein 1 in the inner ear of rat and the changes of CTR1 expression after those round window niche copper sulfate and cisplatin infusion .Methods 24 male wistar rats were randomly divided into 4 groups :Group I as the normal control group (nontreatment group);Group II as the round window niche cisplatin infusion group(0 .5 mg/ml);Group III as the round window niche cisplatin infusion group (1 mg/ml);group IV as the round window niche copper sulfate infusion (0 .02 mg/kg) .The CTR1 protein was detected by the immunohistochemical (IHC) otaining and Western-blot ,and the CTR1mRNA expres‐sion levels were detected by RT -PCR .Results The expression of CTR1 protein was observed in the cytoplasm and cell membrane of Corti organ cells ,spiral ganglion cells and stria vascularis in all groups .The average optical densi‐ties of CTR1 protein was a downward trend .The expression of CTR1 protein was observed in four different groups . The optical density analysis of CTR1 showed that the optical densities were 0 .532 ± 0 .031 ,0 .394 ± 0 .024 ,0 .234 ± 0 .030 and 0 .191 ± 0 .015 ,respectively .There was a downward trend ,and there were statistically differences among the groups (P<0 .05) .The CTR1 mRNA was observed in all groups .The optical density analysis of CTR1 mRNAshowed that the optical densities were 0 .508 ± 0 .035 ,0 .391 ± 0 .022 ,0 .240 ± 0 .02 and 0 .186 ± 0 .021 ,respective‐ly .It had a downward trend and were statistically differences among the groups (P<0 .05) .Conclusion The CTR1 protein was abundantly expressed in Corti organ ,spiral ganglion cells and stria vascularis of the cochlea .The round window cisplatin and copper sulfate infusion can change the expression of CTR1 proteins in inner ear .

A solitary neurofibroma arising from the temporal fossa / 临床耳鼻咽喉头颈外科杂志

Neurofibromas are benign nerve sheath tumors that arise from the nonmyelinating Schwann cells. Generally, neurofibromas can be categorized into dermal and plexiform subtypes. The former subtype is usually associated with a lone peripheral nerve in the integumentary system, while plexiform tumors are associated with many nerve bundles and can originate internally. Rarely, the plexiform tumors can undergo malignant transformation. Neurofibromas are usually found in individuals with neurofibromatosis, which is an autosomal dominant disease. On occasion, an isolated neurofibroma can transpire without being associated with neurofibromatosis. Mostly, these solitary tumors tend to occur in the gastrointestinal system, and neurofibromas of the head and neck are not uncommon, but very rarely they have been reported to occur in the temporal fossa. In this report, we describe a case of a solitary neurofibroma arising from the temporal fossa.

Mechanism of eosinophil apoptosis and its regulation in allergic reaction / 临床耳鼻咽喉头颈外科杂志

In allergic reaction activated eosinophils have been known to accumulate at the site of inflamma tion. Apoptosis of eosinophils may be involved in the inflammation resolution. In this review, we state that the apoptosis of eosinophils play a direct role in allergic reaction. Regulating the apoptosis of eosinophils can effectively alter the development of allergic inflammatory reaction.

Vacuum sealing drainage techniqueversus traditional repair in treatment of diabetic foot / 中国组织工程研究

BACKGROUND:Studies have shown that the vacuum sealing drainage technology can effectively promote the wound healing, and it has a wide prospect of clinical application, but there are few reports addressing the treatment of diabetic foot. OBJECTIVE:To discuss the clinical effect of vacuum sealing drainage technology in the treatment of diabetic foot wounds. METHODS: Sixty diabetic foot patients were randomly divided into two groups: traditional treatment group, regulating blood sugar level, dressing and traditional debridement; vacuum sealing drainage group, conventional treatment combined with the vacuum sealing drainage technology. The clinical efficacy of two treatments for diabetic foot was evaluated. RESULTS AND CONCLUSION: Compared with the traditional treatment group, the vacuum sealing drainage showed better outcomes in switching frequency, stable blood sugar control, preparation time, wound healing time and cure rate (P < 0.05). It indicates that the vacuum sealing drainage technology in the treatment of diabetic foot ulcers can resolute wound inflammation, stimulate the growth of granulation, create a favorable surgical condition for secondary skin grafting or flap coverage, significantly shorten the treatment time, and exhibit better curative effects than the traditional treatment.

Precise hemihepatectomy guided by middle hepatic vein:a prospective study / 中华消化外科杂志

Objective To investigate the efficacy of precise hemihepatectomy guided by middle hepatic vein(MHV),and to study the value of preoperative hepatic vein evaluation.Methods The clinical data of 68 patients who received hemihepatectomy at the Nanjing Drum Tower Hospital from October 2007 to September 2009were prospectively studied.Of the 68 patients,30 received precise hemihepatectomy guided by MHV(precise group)and 38 received anatomical hemihepatectomy(traditional group).The types of hepatic vein in the precise group were evaluated and classified preoperatively.The operation time,operative blood loss,volume of blood transfusion,liver function,morbidity and length of hospital stay of the 2 groups were compared.All data were analyzed using the t test,rank sum test,chi-square test and Fisher exact probability.Results According to the Nakamura's classification,there were 17(57%)patients with type Ⅰ,8(27%)with type Ⅱ and 5(16%)with type Ⅲ;according to the Kawasaki's classification,there were 11 patients with type Ⅰ(37%)and 19 with type Ⅱ(63%).There were 13 patients received right hepatectomy with MHV preservation,15 received left hepatectomy with MHV preservation,1 received right hepatectomy without MHV preservation and 1 received left hepatectomy without MHV preservation.There were no significant difference in the volume of operative blood loss and blood transfusion,level of alanine transaminase,total bilirubin,cholinesterase at postoperative day 3,total length of hospital stay and length of postoperative hospital stay between the 2 groups(t = 1.07,0.92,0.07,0.21,0.63,0.63,0.75,P ＞ 0.05).The operation time,levels of albumin at postoperative day 3 and complication rate were (342 ± 113)minutes,(35 ±3)g/L and 40%(12/30)in the precise group,and(270 ±73)minutes,(33 ±3)g/Land 66%(25/38)in the traditional group,respectively,with significant differences between the 2 groups(t =2.79,2.19;x2 =4.49,P＜0.05).The positive rates of the resection margin were 5%(1/19)in the precise group and 35%(8/23)in the traditional group,there was a significant difference between the 2 groups(P ＜0.05).ConclusionPreoperative hepatic vein evaluation and precise hemihepateetomy guided by MHV can preserve the functional liver tissues with venous drainage,achieve adequate tumor-free resection margin and reduce the postoperative complication rate.

The effect of the fluticasone propionate to the dynamic process of the nasal mucosal remodeling in allergic rhinitis of the rats model / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the dynamic process of the nasal mucosal remodeling, and the effect of the fluticasone propionate (FP) to remodeling, by establish animal model of allergic rhinitis (AR).@*METHOD@#One hundred and twenty Sprague-Dawley (SD) rats were randomly divided into three groups: the normal Group A used as controls and experimental groups: Group B and C, each group had 40 rats. After the animal model were established successfully by OVA+ Al (OH)3 and disposed, then, the dynamic process of the nasal mucosal remodeling was observed, through HE staining and transmission electron microscopic section in special times.@*RESULT@#The Group B, C nasal epithelium and cilia were not complete, eosinophil-based inflammatory cell infiltration, basement membrane thickening, collagen deposition, and a small amount of fibrosis could be found, but the structure of cells were not damaged. While those changes could not be observed in the Group A. The morphological changes of the nasal mucosa of Group B aggravated gradually under persistent allergen exposure, even stripped to the basement membrane in whole epithelial layers, cell and tissue structure were destroyed seriously. The morphological changes of nasal mucosa of Group C did not further increase, but still showed varying degrees of cilia arranged in uneven fashion, basement membrane thickening, collagen deposition and fibrous hyperplasia after treatment by FP.@*CONCLUSION@#Remodeling happens in the nasal mucosa, which would be aggravated, and even becomes irreversible if the allergen exposure continues persistently. The FP can relieve the clinical symptoms, slow down and even reverse the remodeling of AR. And it is ineffective when the changes become irreversible.

Evaluation of precise hepatectomy for primary liver cancer / 中华消化外科杂志

Objective To evaluate the therapeutic effect and safety of precise hepatectomy for primary liver cancer.nethods A total of 103 liver cancer patients who had been admitted to Drum Tower Hospital from July 2007 to October 2009 were divided into precise hepatectomy group(n=54)and routine hepatectomy group (n=49).Peri-and postoperative conditions and the results of follow-up of patients in the 2 groups were compared.All data were analyzed via t test or Fisher exact test.Results No perioperative mortality was observed in the 2 groups.Mean blood loss was(635±608)ml in precise hepatectomy group and(929±1044)ml in routine hepatectomy group,with no significant difference between the 2 groups(t=1.722,P>0.05).Intraoperative blood transfusion volume,postoperative level of aspartate transaminase,positive rate of resection margin and incidence of postoperative complications were(222±381)ml,(158±121)U/L,2%(1/54)and 7%(4/54)in precise hepatectomy group,and were(542±785)ml,(292±347)U/L,18%(9/49)and 24%(12/49)in routine hepatectomy group,with significant difference between the 2 groups(t=2.590,2.558,P<0.05).The 1-year tumor recurrence rate and 1-year survival were 24%(8/33)and 85%(28/33)in precise hepatectomy group,42%(20/48)and 77%(37/48)in routine hepatectomy group,with no significant difference(P>0.05).Conclusion Precise hepatectomy is safe and effective in the treatment of liver caner without much injury to patients.

A systematic review of vasodilators for sudden sensorineural hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the efficacy and safety of vasodilators for sudden sensorineural hearing loss.@*METHOD@#Based on the principles and methods of Cocharne Systematic Reviews, we searched the cochrane central register of controlled trials, PubMed, Embase, ISI, the China biological medicine datebase, VIP, CNKI and Wangfang database. Randomized controlled trials about using vasodilators to treat sudden sensorineural hearing loss were included. Meta-analysis was performed for the results of homogeneous studies using RevMan software.@*RESULT@#Twenty eight randomized control trials met the inclusion criteria. Seven studies showed vasodilators was not more effective than placebo. From 14 studies comparing vasodilators with vasodilators and 9 studies comparing vasodilators with other drugs, no definite conclusion could be drawn.@*CONCLUSION@#The evidence currently available does not support the use of vasodilators in the treatment of sudden sensorineural hearing loss. Further randomized, double-blind, placebo-controlled trials are needed in order to define the efficacy and acceptability of vasodilators in the treatment of sudden sensorineural hearing loss.

Effects of intranasal corticosteroids on radiated nasal mucosa of guinea pig / 中华放射医学与防护杂志

Objective To investigate a mechanism protected radiation-induce injure for radiated guinea pigs'nasal mucosa treated with intranasal corticosteroids (fluticasone nasal cavity spray). Methods 50 health guinea pigs were divided into 2 groups randomly: the irradiated group (control group) with 25 guinea pigs and the administration group after irradiation (test group)with 25 guinea pigs. The nasal part of all guinea pigs were performed irradiation by the 6 MV X-ray with single 5 Gy, one time each week for three weeks. The guinea pigs of test group received intranasai eorticosteroids with one time every day and one spray each side nasal cavity on the second day after three weeks irradiation. Five guinea pigs in each group were saeritieed randomly at 1 week, 1 month, 2 months, 3 months and 4 months after irradiation, and the histopathologie changes were observed under optical microscope and electron microscope. At the same time, blood were drawn from the heart and the concentration of IL-1, IL-6 and TNF-α in serum were measured by ELISA. Results The early nasal mucosa inllammatory reaction of the test group was less than the control group. The coverage rate of cilia of the test group was much than that of the control group (72.9% vs 50.2%) at four months after irradiation. The atrophy of submucosal glandular organ was lessened and they displayed some extent secretory function. The concentration of IL-1 in serum was increased very much in the test group compared with the control group after irradiation and kept higher level in the first two months. After two months, it began to decrease;on four months, it still kept equivalency level with the control group. The concentration of IL-6 and TNF-α in serum were reduced all the while. Conclusions The intranasal eortieosteroids with fluticasene nasal cavity spray can reduce radiation-induced injury of guinea pigs' nasal mucosa. The concentration change of IL-I, IL-6 and TNF-α in serum may be one of mechanism protected radiation-induce injure of guinea pigs' nasal mueosa.

Investigation of serun lipid levels of professional population in Qingpu District,Shanghai / 中国基层医药

Objective To Investigation of serun lipid levels of professional population in Qingpu District. Methods The serun levels of total cholesterol (TC) , triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured in 9 846 professional individuals. Results The prevalence of abnormal serum lipid levels of 9 846 professional individuals was 20.53%. It was 31.97% among male group, 7.86% among female group(P < 0.01). Conclusion The prevalence of abnormal serum lipid level among the professional population in Qingpu, Shanghai was rather high. The prevalence of abnormal serum lipid levels a-mong men was higher than women.

Effects of intranasal corticosteroids on radiated nasal mucosa of guinea pig / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe histopathologic changes of irradiated guinea pigs' nasal mucosa treated with intranasal corticosteroids and to study the radioprotective effect of intranasal corticosteroids.@*METHOD@#Fifty health guinea pigs nasal parts were performed irradiation by the WDVE-6MeV linear accelerator. They had accepted 5 Gy one time per week for three weeks through X-ray irradiating to establish the animal irradiation injury model. After that, they were divided into 2 groups randomly: the control group and the administration group and each group had 25 guinea pigs. The administration group received intranasal corticosteroids on the second day after three weeks irradiation, 5 animals per one group were sacrificed randomly at 1 W, 1 M, 2 M, 3 M, 4 M after administration, the histopathologic changes were observed under optical, scanning electron and transmission electron microscope respectively.@*RESULT@#Using intranasal corticosteroids after irradiation, the early inflammatory reaction of the administration group was milder than the control group. With the drug being given constantly, the recovery of epithelial cell with irradiated damage was accelerated and the coverage rate of cilia went up obviously; After four months, the coverage rate of cilia had risen to 72.9%; But, for the control group, the coverage rate of cilia is only 50.2%. The atrophy of submucosal glandular organ was lessened and they displayed some extent secretory function. The reparation was accelerated as time went by.@*CONCLUSION@#Irradiation brought about serious injury on guinea pigs' nasal mucosa. But, the injury was lessen after using intranasal corticosteroids. Intranasal corticosteroids play the role of radioprotection for the irradiated nasal mucosa.