ABSTRACT
Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases (in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via "peri-ostium incision", which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen's duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with relatively larger operational injury of the gland parenchyma, and should be best reserved for deeper intraglandular stones. Laser lithotripsy has been applied in the treatment of sialolithiasis in the past decade, and holmium ∶YAG laser is reported to have the best therapeutic effects. During the past 3 years, our research group has performed laser lithotripsy for a few cases with intractable salivary stones. From our experiences, withdrawal of the endoscopic tip 0.5-1.0 cm away from the extremity of the laser fiber, consistent saline irrigation, and careful monitoring of gland swelling are of vital importance for avoidance of injuries of the ductal wall and the vulnerable endoscope lens during lithotripsy. Larger calculi require multiple treatment procedures. The risk of ductal stenosis can be alleviated by endoscopic dilation. In summary, appropriate use of various endoscopy-assisted lithotomy helps preserve the gland function in most of the patients with refractory sialolithiasis. Further studies are needed in the following aspects: Transcervical removal of intraglandular submandibular stones, intraductal laser lithotripsy of impacted parotid stones and deep submandibular stones, evaluation of long-term postoperative function of the affected gland, et al.
Subject(s)
Humans , Salivary Gland Calculi/surgery , Constriction, Pathologic , Endoscopy , Salivary Ducts/surgery , Lithotripsy , Treatment OutcomeABSTRACT
The mediastinal lymph node tuberculous abscesses (MLNTAs) are secondary to mediastinal tuberculous lymphadenitis.Surgical excision is often required when cold abscesses form.This study was aimed to examine video-assisted thoracoscopic surgery (VATS) for the treatment of MLNTA.Clinical data of 16 MLNTA patients who were treated in our hospital between December 1,2013 and December 1,2015 were retrospectively analyzed.All of the patients underwent the radical debridement and drainage of abscesses,and intrathoracic lesions were removed by VATS.They were also administered the intensified anti-tuberculosis treatment (ATT),and engaged in normal physical activity and follow-up for 3 to 6 months.The results showed that VATS was successfully attempted in all of the 16 MLNTA patients and they all had good recovery.Two patients developed complications after surgery,with one patient developing recurrent laryngeal nerve injury,and the other reporting poor wound healing.It was concluded that VATS is easy to perform,and safe,and has high rates of success and relatively few side-effects when used to treat MLNTA.
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Aim To investigate the influence of Ramu-lus mori polysaccharides ( RMP) on blood glucose and anti-oxidative effect in streptozotocin ( STZ )-induced diabetic mice .Methods Diabetic mice were induced by intraperitoneal injection with 120 mg? kg -1 STZ and were randomly divided into the following 5 groups with 20 animals per group: model group , valsartan group ( 20 mg? kg -1 ) , low-, medium-, high-dose (0.3,0.6,1.2 g? kg -1 ) of RMP groups.Other 20 normal mice were treated as normal control group .The mice were administered orally for 90 d.On 45 d of ad-ministration , the 24 h urine was collected through met-abolic cages for urine protein detection .Pathological changes of kidney tissues were observed through HE staining .The serum levels of urea nitrogen ( BUN) and creatinine ( Cr ) were detected by automatic biochemical analyzer; and the manganese superoxide dismutase (Mn-SOD), catalase(CAT), malonaldehyde(MDA) and mitochondrial respiratory chain complex Ⅰ,Ⅲac-tivity of kidney tissues were also determined .ELISA method was used to detect ROS content in renal cortex . The SIRT1 , FOXO1 and NF-κB protein expressions were analyzed by Western blot .Results Compared with model group, the FBG, microalbuminuria, BUN and Cr were decreased by RMP medication ( P <0.05).The activities of Mn-SOD, CAT and mitochon-drial respiratory chain complex Ⅰ,Ⅲ in RMP groups were enhanced , while MDA and ROS levels were re-duced. Moreover, the expressions of SIRT1 and FOXO1 were up-regulated by RMP , the expression of NF-κB was down-regulated ( P<0.05) .Conclusion RMP exerts renal protective effect through up-regula-ting the expressions of SIRT1 and FOXO1 in renal cor-tex , which may relate to the improvement of anti-oxida-tive capability .
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Objective To explore the clinical value of the disposable uterine cavity tissue suction tube in diagnosing abnormal u‐terine bleeding .Methods Seventy‐five patients ,who needed an endometrial biopsy because of abnormal uterine bleeding ,were se‐lected for this study .An endometrial biopsy was performed by a disposable uterine cavity tissue suction tube before the conventional suction dilatation and curettage (D&C) .The sample satisfactory rate and the diagnose accordance rate of the two methods were compared .Results The sample satisfactory rate of the disposable uterine cavity tissue suction tube and of the D&C was 85 .3%(64/75) and 94 .7% (71/75) respectively .The difference was not statistically significant(P>0 .05) .The diagnose accordance rate of the disposable uterine cavity tissue suction tube and the D&C was 90 .3% (56/62) and 93 .5% (58/62) respectively .The differ‐ence was not statistically significant(P>0 .05) .Conclusion To a certain extent ,endometrial biopsy performed by disposable uter‐ine cavity tissue suction tube can be a substitute for D&C as the initial inspection to assess abnormal uterine bleeding ,for its econo‐my ,efficiency and safety .
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Objective To explore the application value of plasma sHLA-G in diagnosis of CIN and cervical cancer. Methods The plasma sHLA-G levels were detected by ELISA in 102 cases with cervical cancer( FIGO Ⅰ stage 32 cases, Ⅱ stage 28 cases, Ⅲ stage 25 cases and Ⅳstage 17 cases; tumor size:＜4 cm 63 cases and ≥4 cm 39 cases; squamous cell carcinoma 78 cases and adenocarcinoma 24 cases;cell differentiation:well 57 cases, moderate 29 cases and poor 16 cases; lymph nodes metastasis negative64 cases and positive 38 cases ), 72 cases with CIN( Ⅰ grade 21 cases, Ⅱ grade 25 cases and Ⅲ grade26 cases ) and 20 cases of healthy controls. The diagnostic value of sHLA-G and its correlations with clinical parameters were analyzed. Results The plasma levels of sHLA-G were 193.6( 151.3-287.4 ) kU/L in cervical cancer group, 48.3( 34.6-57.2 ) kU/L in CIN Ⅰ group, 91.3( 68.2-118.6 ) kU/L in CIN Ⅱ group, 106.4( 73.8-165.7 ) kU/L in CIN Ⅲ group and 45.2( 38.0-55.5 ) kU/L in health control group.The level of sHLA-G was significantly higher in cervical cancer group than that in CIN Ⅰ group, CIN Ⅱ group, CIN Ⅲ group and healthy control group( U value of 8.832, 6.456, 4.017, 9.873, P ＜ 0.05,respectively ). The level of sHLA-G was significantly higher in CIN Ⅱ group and CIN Ⅲ group than that in CIN Ⅰ group and health control group( U value of 4.361,4.892, 5.139, 5.485, P ＜0.05, respectively ).The levels of SCC Ag in healthy control group, CIN Ⅰ group, CIN Ⅱ group, CIN Ⅲ group and cervical cancer group were 0.43( 0.38-0.69 )μg/L, 0.47( 0.35-0.72 )μg/L, 0.65( 0.53-0.81 )μg/L, 0.82( 0.54-1.03 )μg/L and 1.02( 0.62-1.87 )μg/L. The level of SCC-Ag was significantly higher in cervical cancer group than that in CIN Ⅰ group, CIN Ⅱ group and healthy control group( U value of 7.926, 4.877, 8.132,P ＜0.05, respectively ). The level of SCC-Ag was significantly higher in CIN Ⅲ group than that in CIN Ⅰ group and health control group( U value of 6.574, 6.763, P ＜0.05, respectively ). The levels of CA125 in healthy control group, CIN Ⅰ group, CIN Ⅱ group, CIN Ⅲ group and cervical cancer group were 14.38 ( 6.14-21.82 ) kU/L, 15.42( 6.25-23.53 ) kU/L, 21.34( 9.82-32.58 ) kU/L, 25.69( 14.47-38.71 )kU/L and 27.72( 14.29-43.87 ) kU/L. The level of CA125 was significantly higher in cervical cancer group than that in CIN Ⅰ group, CIN Ⅱ group and healthy control group( U value of 7.564, 4.522, 7.429, P ＜0.05, respectively ). The level of CA125 was significantly higher in CIN Ⅲ group than that in CIN Ⅰ group and health control group( U value of 5.871, 5.435, P ＜0.05, respectively ). ROC curve analysis showed AUC for sHLA-G was 0.828( 95% CI:0.768-0.879 ), which was high as compared with the AUC of SCC-Ag [ 0.727( 95% CI:0.658-0.788 );Z = 2.294, P ＜ 0.05 ] and the AUC of CA125 [ 0.705( 95% CI:0.636-0.769 );Z =2.842 ,P ＜0.05 ]. There was no significant difference of diagnostic efficiency between SCC and CA125( Z =0.672, P ＞ 0.05 ). When cutoff value of sHLA-G was 109.6 kU/L, the diagnostic sensitivity,specificity, positive predictive value, negative predictive value and accuracy rate were 86.3%, 76.1%,80.0%, 83.3%, and 78.4%, respectively. The levels of sHLA-G in cervical cancer patients were significantly correlated with FIGO stages and lymphoid node metastasis ( U value of 6.085, 4.451, P ＜0.05, respectively ), while there were no significant differences between the levels of sHLA-G and age,tumor size, histological type and cell differentiation( U value of 1.274, 1.956, 1.268, 2.719, P ＞0.05,respectively ). Conclusions sHLA-G can be used for the early screening of cervical cancer and its precancerous lesion. It could also be used as an index for judging progression and lymphoid node metastasis.
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The complete genomic sequence of Duck hepatitis virus 1 (DHV-1) ZJ-V isolate was sequenced and determined to be 7 691 nucleotides (nt) in length with a 5'-terminal un-translated region (UTR) of 626 nt and a 3'-terminal UTR of 315 nt (not including the poly(A) tail). One large open reading frame (ORF) was found within the genome (nt 627 to 7 373) coding for a polypeptide of 2 249amino acids. Our data also showed that the poly (A) tail of DHV-1 has at least 22 A's. Sequence comparison revealed significant homology (from 91.9% to 95.7%) between the protein sequences of the virus in the Picornaviridae family, its genome showed some unique characteristics. DHV-1 contains 3copies of the 2A gene and only 1 copy of the 3B gene, and its 3'-NCR is longer than those of other picornaviruses. Phylogenetic analysis to do sequence homology based on the VP1 protein sequences showed that the ZJ-V isolate shares high sequence homology with the reported DHV-1 isolates (from 92.9% to 99.2%), indicating that DHV-1 is genetically stable.