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Objective@#To investigate the role of body fat ratio in the evaluation of obstructive sleep apnea(OSA).@*Methods@#A retrospective analysis was made on 174 cases (between November, 2017 and April, 2018 showed that) of sleep monitoring in the Department of Otorhinolaryngology in Peking University Third Hospital. The data included the gender, age, body fat rate, body mass index (BMI), neck circumference, and apnea-hypopnea index (AHI). The above data were analyzed by non parametric correlation analysis, receiver operating characterristic (ROC) curve analysis and multiple factor Logistic regression analysis to study the relationship between the gender,age,body fat rate,BMI,neck circumference and other indexes of the patients with AHI.@*Results@#Nonparametric correlation analysis showed that the correlation from strong to weak to AHI among women was BMI (r=0.621, P<0.001),body fat rate (r=0.602, P<0.001), age (r=0.570, P<0.001), neck circumference (r=0.402, P=0.014), respectively. BMI (r=0.599, P<0.001), neck circumference (r=0.493, P<0.001), body fat rate (r=0.318, P<0.001), and age (r=0.256, P=0.003) among men. ROC curve analysis showed that the strong to weak index (area under curve,AUC) of the AHI>15/h among women was the body fat rate (AUC=0.884, P=0.001), BMI(AUC=0.810, P=0.008), neck circumference (AUC=0.759, P=0.027), age (AUC=0.750, P=0.033), and the male was BMI (AUC=0.765,P<0.001), neck circumference (AUC=0.720, P<0.001), age (AUC=0.634, P=0.008), and body fat rate (AUC=0.632, P=0.010), respectively. Multifactor Logistic regression analysis showed that the body fat rate (OR=1.704,95%CI=1.012-2.870) in women was an independent risk factor for AHI greater than 15/h; the age of male (OR=1. 044, 95%CI=1.005-1.085) and BMI (OR=1.285, 95%CI=1.056-1.562) were independent risk factors for AHI greater than 15/h.@*Conclusion@#Body fat rate can be used as a new indicator for predicting the severity of OSA,especially in adult female population. In adult female moderate to severe OSA patients (AHI>15/h), compared with BMI,neck circumference and age,the body fat rate has the greatest correlation with AHI. Compared with BMI,neck circumference and age,the body fat rate has a decisive role in predicting moderate to severe OSA (AHI>15/h).
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Objective@#To observe and explore the therapeutic efficacy of hyperbaric oxygen (HBO) in the treatment of non-arteritic anterior ischemic optic neuropathy (NAION).@*Methods@#A total of 139 NAION patients were randomly divided into a control group of 72 and a hyperbaric oxygen group of 67. Both groups were given conventional drugs including prednisolone, mecobalamin and compound anisodine, while the hyperbaric oxygen group was additionally provided with hyperbaric oxygen treatment at a pressure of 0.2MPa once a day for 30 days. Each day′s treatment lasted for 110 minutes, including 20 minutes at increasing pressure, 20 minutes decreasing and 60 minutes with the pressure stable at 0.2MPa. Before and after the 30-day treatment, the visual acuity and visual mean sensitivity (MS) of the two groups were observed and compared.@*Results@#There was no significant difference between the control group and the hyperbaric oxygen group in terms of average visual acuity or visual MS before the treatment. Afterward the average visual acuity (4.88±0.25) and visual MS (16.68±1.19) of the hyperbaric oxygen group were significantly higher than before the treatment and significantly better than those of the control group. The total effective rate of the hyperbaric oxygen group was 91%, significantly higher than that of the control group (75%).@*Conclusions@#Conventional treatment combined with hyperbaric oxygen therapy can significantly promote the visual acuity and visual MS of NAION patients.
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Objective@#To examine the relative factors of transmural intestinal necrosis(TIN) during multidisciplinary stepwise management facilitating the decision making in patients with acute superior mesenteric vein thrombosis (ASMVT).@*Methods@#Clinical data of patients with ASMVT admitted to Department of General Surgery, Jinling Hospital from January 2009 to June 2017 were reviewed retrospectively. There were 52 males and 37 females, aging (45.9±12.6) years (range: 20 to 69 years). According to the postoperative pathological results and follow-up, the patients were divided into TIN group (n=31) and non-TIN group(n=58, including 18 cases of intestinal stricture). The related factors were compared between ASMVT patients with TIN and patients without TIN by univariate analysis using t test, U test and χ2 test accordingly, and factors with statistically significance were subsequently submitted to binary Logistic regression analysis. The predictive value and cut-off point of factors were evaluated by receiver operator characteristic(ROC) curve and area under the curve.@*Results@#In univariate analysis, smoking, hypertension, peritonitis, white blood cell count,haemoglobin, international normalized ratio, blood albumin, thrombosis of superior mesenteric branches vein, free intraperitoneal fluid, decrease of bowel wall enhancement and pneumatosis intestinalis were TIN risk factors (all P<0.05). According to the binary Logistic regression analysis, white blood cell count (OR=1.093, 95%CI: 1.010 to 1.182, P=0.027), thrombosis of the superior mesenteric branches vein (OR=11.519, 95%CI: 1.906 to 69.615, P=0.008), pneumatosis intestinalis (OR=11.140, 95%CI: 2.360 to 52.585, P=0.002) were independent relative factors of TIN in patients with AMI, and the area under the ROC curve of the above factors and predictive model was 0.759 (95%CI: 0.647 to 0.871), 0.745 (95%CI: 0.641 to 0.848), 0.737 (95%CI: 0.621 to 0.854), 0.909 (95%CI: 0.847 to 0.971), respectively. The cutoff value of white blood cell count was 18.1×109/L.@*Conclusion@#White blood cell levels, superior mesenteric vein branch thrombosis and pneumatosis intestinalis are independent predictors of TIN in ASMVT.
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Objective@#To evaluate the application of intestinal stomas in mesenteric ischemia (MI) according to the concept of damage control surgery.@*Methods@#Clinical data of 59 MI patients received intestinal stomas at Jinling Hospital, Nanjing University School of Medicine from January 2010 to June 2017 were analyzed retrospectively. There were 41 male and 18 female patients aging of (51±14) years (ranging from 20 to 86 years). All the patients were divided to two groups according to the degree of bowel ischemia: acute MI group (AMI, bowel necrosis, n=43) and chronic MI group (CMI, bowel stricture, n=16). The medium time from onset to consult of AMI was 7(12) days (M(QR)) and the time of CMI was 80(51) days. After the resection of irreversible ischemic intestine, ostomy was carried out for all 59 patients. Patients received oral anticoagulation, enteral nutrition and succus entericus reinfusion therapy for about 6 months after discharge. Then definite surgery to restore digestive tract was preferred.@*Results@#In AMI group, APACHEⅡ score in admission was (16±3). The length of infarcted intestine resected was (160±95) cm, normal bowel left was (220±106) cm. Twelve patients had complications during first post-operation period including sepsis (n=8), acute renal failure (n=4), acute respiratory distress syndrome (n=4), short bowel syndrome (n=4). 30-day mortality was 18.6%. Total 30 patients received operation to restore the continuity of intestinal tract after 202(42) days and APACHEⅡ score was 4±2. Two patients suffered from sepsis and were cured after anti-infection. In CMI group, APACHEⅡ score was 16±3 and NRS2002 score was more than 3. The length of infarcted intestine resected was (43±33) cm. All patients had restored the continuity of intestinal tract after 176 (47) days. No major complications occurred during the first and second post-operation period.@*Conclusions@#According to damage control surgery, after early revascularization, patients with acute intestinal necrosis should be treated with infarcted bowel resection and stomas. Besides, second operation to restore the continuity of intestinal tract should be conducted after nutritional support for 6 months. Patients with ischemic enteropathy who cannot be corrected with severe malnutrition should achieve stomas during first operation.
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Objective@#To explore the possibility of endoscope assisted curved laryngoscopy technique applied in transoral laryngopharyngeal minimally invasive surgery and evaluate the advantages of this technique.@*Methods@#Eight patients with huge benign lesions in larynx and pharynx undergoing transoral microsurgery at Peking University Third Hospital between February 2016 and February 2017 were enrolled in this study.The diagnosis included cyst at the base of tongue in two patients, cysts in the epiglottis in two patients, hemangioma in two patients, multiple masses of the hypopharynx and amyloidosis in supraglottic area in one patient each.The time and exposure during surgery, occurrence rate of complication and conditions of following-up were recorded.@*Results@#The mean time of surgery was 20 min, the exposure was satisfying.There was no obvious complication after surgery.No residual or recurrent lesion was observed after 1 to 12 months follow-up(mean time 4.5 months).@*Conclusion@#The endoscope assisted curved laryngoscopy technique has advantages in shortening the time of surgery, improving exposure and reducing the rate of complication and recurrence.
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Objective To observe the expression of triggering receptor expressed on myeloid cells (TREM),Caspase-3 and interleukin (IL)-6 in optic nerve tissue of ischemic optic neuropathy (ION).Methods Twenty Sprague-Dawley rats were randomly divided into control group and model group,10 rats in each group.The permanent ligation of bilateral internal carotid arteries (BICA) was performed for 14 days to establish subacute ION model as model group.The control group were separated BICA without ligation.The expressions of TREM-1,TREM-2,Caspase-3 and IL-6 in rat retina were detected by reverse transcription PCR and Western blot,respectively.Results Compared with the control group,the expressions of TREM-1,Caspase-3,IL-6mRNA (t=6.058,7.86,6.055) and protein (t=9.671,9.524,14.501) in the optic nerve tissue of the model group were increased,while the expression ofTREM-2 mRNA and protein (t=9.283) was decreased,and the difference was statistically significant (P＜0.05).Conclusion In ischemic optic nerve tissue,TREM-1 mRNA and protein were significantly expressed,the expressions of TREM-2 mRNA and protein decreased significantly.
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Objective To investigate the influential factors of surgical treatment for ischemic enteropathy secondary to portal venous system thrombosis (PVST).Methods Clinical data of 27 patients with ischemic enteropathy secondary to PVST admitted in our department from January 2009 to Jun 2016 were analyzed retrospectively.These patients were divided into two groups according to different surgical procedures:ischemic bowel resection with primary anastomosis or ostomy.Results There were significant differences between the groups in albumin and prealbumin level (t =3.585,4.194,P ＜0.05).There were also significant differences for BMI and body fat (t =2.325,2.430,P ＜ 0.05).The average time from the onset PVST to ischemic enteropathy was 20 d.Conclusion There should be awareness of ischemic enteropathy.Intestinal resection and anticoagulation therapy is necessary.The choice of surgical procedures depends on the preoperative nutrition level (albumin,prealbumin).
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Objective To explore the diagnosis and treatment of mesenteric venous thrombosis secondary to long-term ischemic enteropathy.Methods The retrospective cross-sectional study was conducted.The clinical data of 36 patients with mesenteric venous thrombosis secondary to long-term ischemic enteropathy who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2009 to June 2017 were collected.Diagnostic methods:history inquiry,physical examination,laboratory test and image finding.Treatment methods:parenteral nutrition support,selective stage 1 bowel resection with anastomosis or stage 1 bowel resection and colostomy,definitive stage 2 operation for recovering digestive tract.Anticoagulation therapy was performed.Observation indicators:(1) clinical characteristics;(2) treatment;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to December 2017.Measurement data with skewed distribution were described as M (P25,P75) and M (range).Results (1) Clinical characteristics:① the main clinical manifestations:34,33,27,20,17 and 14 patients showed respectively discomfort after meal,abdominal pain,abdominal distension,nausea with vomiting,stop of analis exhaust and defecation and weight loss of different degree,and the worst patient lost 20 kg within 1 month.The clinical manifestations of 30 patients were more than 3.② The score of acute physiology and chronic health evaluation (APACHE)Ⅱ in 36 patients was 4 (2,6).③ Laboratory test:total protein (TP),albumin and prealbumin were 55.8 g/L (45.2 g/L,59.1 g/L),30.6 g/L (27.3 g/L,37.5 g/L) and 100.0 g/L (86.0 g/L,132.0 g/L),respectively,showing a decreased trend.④ Imaging finding:enhanced scans of abdominal CT showed the portal cavernous in 16 patients,the absence of main trunk of superior mesenteric vein with extensive collaterals in 12 patients,and dovelopment of portal vein and main trunk of superior mesenteric vein in 8 patients.One patients had intestinal edema and stenosis.X-ray contrast examination of digestive tract showed intestinal stenosis with mucosal erosion in 28 patients and complete intestinal obstruction in 8 patients.(2) Treatment:of 36 patients,24 underwent stage 1 bowel resection with anastomosis and other 12 received stage 1 bowel resection and colostomy (11 undergoing definitive stage 2 operation for recovering digestive tract and 1 refusing stage 2 operation due to advanced age).The length of resected bowel was 30 cm (15 cm,80 cm).One patient with stage 1 bowel resection with anastomosis was complicated with small bowel fistula,and was cured by conservative treatment.There was no complication in other patients.(3) Follow-up:all 36 patients were followed up for 3-10 months,with a median time of 6 months.During the follow-up,7 patients were complicated with secondary portal hypertension,5 of 7 were improved by symptomatic treatment,and 2 died of severe digestive tract bleeding;other patients had no related complications.Conclusions The discomfort after meal and bowel obstruction are the main clinical manifestations of mesenteric venous thrombosis secondary to long-term ischemic enteropathy.The abdominal CT with X-ray contrast examination benefits to diagnosis of patients with poor nutrition status and mild infection.The main strategy includes early surgical resection and postoperative anticoagulation therapy after bleeding risk evaluation.
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Objective To study the killing effect of cytokine-induced killer cells (CIK cells) on human lung adenocarcinoma cell line (A549) and the lung adenocarcinoma' s radiation resistant cell line (A549RR).Methods Peripheral blood mononuclear cells (PBMC) of healthy volunteers were stimulated by different cytokines,and were induced into killer activity CIK cells.The phenotype of CIK cells were analyzed by flow cytometer.A549 and A549RR cell lines were cultured separately with the CIK cells.The absorbance value (A) of the cells was measured by CCK8,and the killing rates of all cells which were cultured for 24 and 48 hours with the CIK were calculated.Results The rate of CD3+ CD56+ cell was 45.8 ％ after culture for 14 d.The killing rates of CIK cells to lung adenocarcinoma A549 cells and its radiation resistant cells A549RR were increased with the rise of the ratio of effective cells to target (5∶1-40∶1) and the increasing of culturing time (all P ＜ 0.001).The killing effect of CIK to A549 and A549RR cells had no obvious difference in the same culturing time and the same ratio of effective cells to target(all P ＞ 0.05).Conclusion CIK cells have strong anti-tumor effect against lung adenocarcinoma and its radiation resistant cells with high clinical application value.
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Objective To investigate the effect of different additional filtration thickness of DSA on image quality and radiation dose with cerebral angiography. Methods Prospective collected 90 patients with DSA examination of the whole cerebral artery, patients were divided into A, B and C group according to the time of the examination, each group included 30 cases. Patients underwent conventional DSA, the additional filtration of group A, B and C were (1.0 mmAl+0.1 mmCu), (1.0 mmAl+0.4 mmCu) and (1.0 mmAl+0.9 mmCu), respectively. Dose area product (DAP), air kerma (AK), tube current and tube voltage of anteroposterior and lateral radiography of the whole brain were recorded, and scored the image quality. Eye lens organ dose values were obtained by using simulation phantom and LiF dosemeter under A, B and C groups with three different additional filtrations for cerebral angiography. The image quality scores and the radiation dosewere analyzed by one-way ANOVA tests or Kruskal-Wallis tests. Results The image quality comprehensive score of three groups showed significant difference (F=40.07,P<0. 01), which were (3.8±0.4), (3.6 ± 0.5) and (3.0 ± 0.6), respectively. The DAP and AK value of anteroposterior and lateral radiography of three groups also showed significant difference (P<0.05), B and C group were lower than the A group. Left and right eye lens organ dose were decreased along with the increase of the additional filtration thickness, and the difference between the 3 groups also had significant difference (P<0.01). Conclusion Both the image quality and radiation dose can acquire when conducted the whole brain DSA with 1.0 mmAl+0.4 mmCu additional filtration.
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Objective To investigate the lens and pituitary dose impacted by additional filtration and collection field in head and neck DSA examinations. Methods All images were acquired by a Philips ALLura Xper FD 20 DSA machine. The combination of the different collection fields (48 cm, 42 cm, 31 cm, 22 cm) and additional filtrations (0.9 mmCu+1.0 mmAl, 0.4 mmCu+1.0 mmAl, 0.1 mmCu+1.0 mmAl) were adjusted when the anthropomorphic phantom filled with dosimeter was scanned in anterioposterior and lateral positions with 2D?DSA and 3D?DSA. The dose area product (DAP), air kerma (AK) and the radiation dose values of bilateral lens and pituitary were measured and recorded. The 2D and 3D?DSA regional absorption dose on lens and pituitary were analyzed using t' test, the correlations between DAP and AK parameters and different regional absorption doses were evaluated by Pearson rank correlation coefficient. Results Absorption doses of left lens, right lens and pituitary with 2D?DSA (n=12) were as following:(2.77 ± 0.68), (6.23 ± 3.54), (8.65 ± 2.62) mGy, while the parameters with 3D?DSA (n=12) were (1.78 ± 0.82), (2.18±1.15), (3.32±0.64) mGy, respectively;the results revealed a significant difference (t'=3.20, 3.76 and 6.85, P<0.01). DAP [(8 739±5 731) mGy·cm2] had a relationship with absorption dose of pituitary, left lens and right lens [(5.988 ± 3.299),( 2.258 ± 0.872),( 4.207 ± 3.303) mGy, r values were 0.766, 0.684, 0.727; P<0.01]. AK values was (31 ± 23) mGy and it had a relationship with pituitary absorption dose (r value was 0.894, P<0.01). The lens dose was reduced when the additional filtration was increased and the collection field was decreased, the radiation dose of the pituitary was reduced when both the additional filtration and the collection field were increased. Conclusions In the head and neck DSA examinations, the radiation dose of the lens and the pituitary had different changes with the different additional filters and collecting fields. The organ dose with 3D?DSA was significantly less than that with 2D?DSA.
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Cochlear implantation has gradually been accepted as an effective treatment for many patients with severe to pround sensorineural hearing loss. The traditional cochlear implantation does not exist up to expectations in some respects. With the soft surgery technique brought forward, the idea of minimally invasive cochlear implantation is deely rooted among the people. Now many institutions are carring out a series of clinical researches and practices to improve the results of cochlear implantation surgery and reduce the complications around the world. It includes minimally invasive approach, cochleostomy and electrode insertion techniques, especially the latter two affect the preservation of residual hearing. This article is a review of the advances in minimally invasive cochlear implantation from the above three aspects.
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Humans , Cochlear Implantation , Methods , Cochlear Implants , Electrodes, Implanted , Hearing , Minimally Invasive Surgical Procedures , MethodsABSTRACT
OBJECTIVE@#To study clinical characteristics, diagnosis, pathological types and therapy methods of nonsquamous cell neoplasm in subglottis, in order to improve comprehension of this rare disease.@*METHOD@#To analysis 3 patients' clinical data with noosquamous cell neoplasm in subglottis by reviewing related literature, and to generalize the symptoms, differentiation and treatment experience of nonsquamous cell neoplasm in subglottis.@*RESULT@#Among the 3 patients, one's main complain was hoarseness and the other two's main symptom was inspiratory dyspnea. As diagnosis was definite and acute obstruction of airway was relieved, the neoplasms were removed totally. Two patients were undergone operation through oral cavity by using suspended laryngoscope, and one patient was done surgery by neck approach. Paraffin wax result showed that one patient suffered epithelial-myoepithelial carcinoma, who received radiotherapy after surgery. There is no recurrence in all patients by following up more than 1 year.@*CONCLUSION@#The occurrence of nonsquamous cell neoplasm in subglottis is relatively low, and the subglottis should be inspected carefully to avoid missed diagnosis. Operation is the preferred method to treat this kind of disease. To choose a suitable operational manner according to size, location of the neoplasm is crucial.
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Female , Humans , Male , Middle Aged , Glottis , Pathology , Laryngeal Neoplasms , Diagnosis , Pathology , General SurgeryABSTRACT
Objective To explore the clinical value of wave intensity(WI) in assessing left ventricular systolic function of patients with impaired glucose regulation.Methods 72 people were involved in this study,according to their plasma glucose levels,subjects were categorized as normal plasma glucose group (group A),newly categorized impaired fasting glucose group (group B) and pre-diabetes group (group C).Carotid WI examination was performed and analyzed.The parameters included magnitude of the peak during early systole (W1),amplitude of the peak during late systole (W2),interval between R wave of electrocardiogram and W1 (R-W1),interval between W1 and W2 (W1-W2),stiffness parameter (β),pressure strain elasticity modulus(Ep) and arterial compliance(AC).Echocardiographic indices including left ventricular ejection fraction (LVEF),left ventricular fraction shortening (LVFS) and the peak velocity of mitral annulus at systolic phase(Sm) were determined in each subject.Results Compared to group A,W1,W2,β,Ep increased significantly while AC decreased in group C(P ＜0.05).However,this difference did not persist in group B.Compared to group A,LVEF and LVFS were not observed significantly different in group B and group C.Conclusions WI is a hemodynamic method which not only can evaluate left ventricular systolic function of impaired glucose regulation subjects but also be more sensitive than routine echocardiography.
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Objective To study whether or not CD40 gene is a target of miR-503 in U937 cells,and to observe the regulatory effects of miR-503 on expression of CD40 induced by irradiation in U937cells.Methods The miR-503 sequence was inserted into pcDNA-DEST-47 plasmid to construct the eukaryotic expression vector (pcDNA-DEST-miR-503) and to construct the CD40 gene 3′-UTR luciferase reporter plasmid (psiCHECK2-CD40) at the same time.They were used to transfect U937 cells together for analysis of the regulatory effects of miR-503 on the expression of CD40.Meanwhile the miR-203 and miR-29b were used as controls to observe whether or not CD40 gene was a target of miR-503.The expression change of CD40 after irradiation,and the inhibitory effect of miR-503 on the expression of CD40 was confirmed by Western blot assay.The expression of miR-503 was detected by real-time RT-PCR (qPCR) after irradiation with doses of 5.0 Gy.Results The expression of luciferase in the group of transfected with pcDNA-DEST-miR-503 and psiCHECK2-CD40 plasmids was significantly lower than that in the group transfected with empty plasmid and CD40 gene (t =3.16,P ＜ 0.05).And the miR-203 and miR-29b could not inhibit the activity of CD40 luciferase,but the miR-503 could significantly inhibit the activity of it (t =5.25,P ＜ 0.01 ).The expression of CD40 protein in U937 cells was decreased after the cells were transfected with pcDNA-DEST-miR-503.After irradiation with dose of 5.0 Gy,the expression of miR-503 were increased (t =3.63 - 17.00,P ＜0.01 ) and the expression of CD40 protein decreased.Conclusions The CD40 gene might be the target of miR-503,and miR-503 could regulate the expression of CD40 gene.Irradiation could up-regulate the expression of miR-503 and inhibit the expression of CD40 protein in U937 cells.miR-503 might play a role in the process of regulation of irradiation on expression of CD40 protein in tumor cells.