Current situation on knowledge, attitude, practice of hypertension management patients in Huamu Street, Shanghai / 上海预防医学

Objective To investigate the knowledge, attitude, practice (KAP)status of patients under hypertension management in Huamu Street, Shanghai. Methods According to the method of cluster random sampling, 220 hypertension patients in Huamu Street were selected and investigated by questionnaire, and the latest weight and blood pressure monitoring data were obtained from the patients of the hypertension management information system. Results Of the respondents, 59.55% were hypertension patients complicated with diabetes or other cardiovascular diseases.Overweight or obesity (BMI≥24) accounted for 47.72%, and the blood pressures between overweight and normal weight patients were significantly different(χ2 =4.05, P < 0.05).It was found that there were significant difference in prevention and treatment of hypertension among patients with different cultural levels; 28.18% of respondents did not know the diagnostic criteria of hypertension; 36% of respondents did not know that poor blood pressure control could cause a variety of systemic diseases; 33.18% of the respondents did not know the risk factors of hypertension, and 6.36% of respondents could not keep on regular blood pressure measurement.However, 45% of the subjects started to concern their eating habits.85.91% of respondents were willing to improve their lifestyle and control blood pressure by participating in self-management activities for hypertension. Conclusion Hypertensive patients in Huamu Street have poor basic knowledge of hypertension.According to the needs of patients, self-management team construction should be further strengthened to rapidly improve the effect of hypertension management.

Current situation on knowledge, attitude, practice of hypertension management patients in Huamu Street, Shanghai / 上海预防医学

Objective To investigate the knowledge, attitude, practice (KAP)status of patients under hypertension management in Huamu Street, Shanghai. Methods According to the method of cluster random sampling, 220 hypertension patients in Huamu Street were selected and investigated by questionnaire, and the latest weight and blood pressure monitoring data were obtained from the patients of the hypertension management information system. Results Of the respondents, 59.55% were hypertension patients complicated with diabetes or other cardiovascular diseases.Overweight or obesity (BMI≥24) accounted for 47.72%, and the blood pressures between overweight and normal weight patients were significantly different(χ2 =4.05, P < 0.05).It was found that there were significant difference in prevention and treatment of hypertension among patients with different cultural levels; 28.18% of respondents did not know the diagnostic criteria of hypertension; 36% of respondents did not know that poor blood pressure control could cause a variety of systemic diseases; 33.18% of the respondents did not know the risk factors of hypertension, and 6.36% of respondents could not keep on regular blood pressure measurement.However, 45% of the subjects started to concern their eating habits.85.91% of respondents were willing to improve their lifestyle and control blood pressure by participating in self-management activities for hypertension. Conclusion Hypertensive patients in Huamu Street have poor basic knowledge of hypertension.According to the needs of patients, self-management team construction should be further strengthened to rapidly improve the effect of hypertension management.

Application and evaluation of the "1+2+X" model in community-based hypertension self-management / 上海预防医学

Objective To evaluate the new model of "1+2+X" in the self-management of hypertension in community. Methods A total of 205 patients with hypertension were enrolled in the hypertension self-management group in Huamu subdistrict of Pudong New Area, Shanghai.The patients were randomly divided into intervention group and control group.The control group used the traditional self-management group model, whereas the intervention group implemented a new mode of "1" group leader plus "2" deputy group leaders plus "X" social resources to participate in the self-management.Changes in the patients′ knowledge, awareness, behavior, blood pressure control, and group activity satisfaction were collected by questionnaires and then compared before and after the implementation of the self-management. Results After one-year implementation, the proportion of the patients being aware of knowledge in the intervention group and control group was 92.23% and 70.59%, respectively; the qualified proportion of patients′ confidence on blood pressure control was 77.67% and 60.78%, respectively; the qualified proportion of health behavior was 77.67% and 72.55%, respectively; and the proportion of being satisfied with self-management was 76.70% and 61.76%, respectively.In all the results, the intervention group was better than the control group, with statistical significance (P < 0.05). Conclusion The new management model of "1+2+X" effectively improves the efficiency of hypertension self-management, which could be recommended in community-based hypertension self-management.

Relationship between inferior turbinate outfracture and the improvement of nasal ventilatory function / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the relationship between structural change in nasal cavity and the change of nasal ventilatory function after outfracture of the inferior turbinate.</p><p><b>METHODS</b>The inferior turbinate outfracture surgery was performed on 50 chronic hypertrophic rhinitis patients who suffered inferior turbinate hypertrophy according to endoscopy and CT scan. Preoperative and postoperative nasal endoscopy was carried out on all patients, by which the distance from the inferior turbinate front mucous membrane to nasal septum (DTNS) was measured. In addition, CT was used to measure the minimal distance between the inside edges of the bilateral inferior turbinate soft tissue (MDTT) and the minimal distance between the bilateral inferior turbinate bones (MDTB) at the central layer of coronal sectional infundibulum; the minimal distance between the inferior turbinate at asial nasal limen (NLDT); inferior turbinate thickness (ITT). In this way, the change in the structure of nasal cavity was evaluated. Acoustic rhinometry and rhinomanometry were utilized to evaluate the ventilatory function of the nasal cavity objectively. Visual analogue scale (VAS) was applied to evaluate the severity of preoperative and postoperative nasal obstruction subjectively. The test data were used to perform match t-test; Spearman rank correlation was adopted to evaluate the relationship between patients' bilateral VAS and nasal inspiratory effective resistance (IER),nasal expiratory effective resistance (EER) and DTNS. The relationship between the total resistance of nasal inspiratory phase as well as the total resistance of nasal expiratory phase and MDTT and MDTB was analyzed. SPSS 20.0 software was used to analyze the data.</p><p><b>RESULTS</b>The preoperative data showed that rightward DTNS was (0.12 ± 0.07) cm, leftward DTNS was (0.10 ± 0.07) cm and MDTT was (0.70 ± 0.13) cm, and postoperative data showed that rightward DTNS was (0.47 ± 0.27) cm, leftward DTNS was (0.43 ± 0.15) cm, and MDTT was (1.05 ± 0.15) cm. Significant differences existed in rightward DTNS, leftward DTNS and MDTT between pre-and post operative data (t values were -8.827, -8.590, -17.525, all P < 0.05). According to the preoperative and postoperative comparison, the difference in MDTB, NLDT, rightward ITT, leftward ITT, IER, EER, 0-5 cm nasal cavity volume (0-5 cm NCV), nasal minimal cross-sectional area (NMCA), rightward VAS and leftward VAS had statistical significance (t values were -23.562, -8.374, 8.693, 6.684, 12.021, 14.510, -6.074, -2.285, 14.042 and 9.925, respectively, all P < 0.05). Patients' bilateral VAS grades had a positive relationship with IER and EER (left side: r values were 0.541 and 0.660, respectively,right side: r values were 0.940 and 0.688, respectively, all P < 0.05). Additionally, patients' VAS had a negative relationship with DTNS (r value was -0.861, P < 0.05). Besides,the total resistance of nasal inspiratory phase had a negative relationship with both MDTT and MDTB (r values were -0.565 and -0.546,respectively, all P < 0.05). The total resistance of nasal expiratory phase had a negative relationship with both MDTT and MDTB (r values were -0.562 and -0.546, all P <0.05).</p><p><b>CONCLUSION</b>The inferior turbinate outfracture surgery was an ideal surgical method by which nasal cavity could be broadened and nasal ventilatory function improved.</p>

MicroRNAs regulate epithelial-mesenchymal transition of supraglottic laryngeal cancer / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study microRNAs (miRNAs) expression profiles associated with epithelial-mesenchymal transition (EMT) in lymph node metastasis of supraglottic laryngeal squamous cell carcinomas(SGLSCC).</p><p><b>METHODS</b>Primary tumor tissue samples of 12 SGLSCC patients were collected, including 6 patients clinically diagnosed with lymph nodes metastasis (N(+)) and 6 patients with lymph nodes metastasis-free (N0), for miRNA microarray gene-expression profiling to identify the differences between N(+) and N0 groups. Differentially expressed miRNAs was verified using quantitative real-time PCR in 20 patients with N(+) and 20 patients with N0. Target genes for the miRNAs associated with EMT in SGLSCC metastasis were analyzed.</p><p><b>RESULTS</b>Ten miRNAs differentially expressed between N(+) group and N0 group were determined. Comparing with N0 group, nine miRNAs were over-expressed and one miRNA was expressed at lower level in N(+) group. The genes for miR-192, miR-143, miR-409 and miR-634 were predicted as target genes that could promote EMT of laryngeal cancer cells by targeted inhibiting Krüppel-like factor 17(KLF17), E-cadherin and phosphatidylinositol 3 kinase (PI3K).</p><p><b>CONCLUSIONS</b>The miRNAs over-expressed in group N(+) can be used to predict cervical lymph node metastasis in SGLSCC. The miRNAs as new markers could improve the diagnosis and treatment of SGLSCC.</p>

Influence on cell proliferation by small interfering RNA of Cyclin Y expression in laryngeal cancer cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The effects of lentivirus-mediated suppression of Cyclin Y (CCNY) expression on the proliferation of laryngeal cancer cells were investigated in vitro.</p><p><b>METHODS</b>The lentivirus vectors containing a small hairpin RNA (shRNA) to target CCNY were constructed.Hep-2 cells were divided into the following two experimental groups:the negative control group (control lentivirus infected cells) and CCNY knockdown group (CCNY shRNA-expressing lentivirus infected cells). After Hep-2 cells were infected, Real-time PCR was used to measure CCNY expression. The influence of CCNY on the proliferation of laryngeal cancer cells were assessed using MTT and colony formation experiments.Each experiment was performed in triplicate and repeated three times.</p><p><b>RESULTS</b>Lentiviruses expressing shRNA against CCNY were constructed and Hep-2 cells were infected with above mentioned lentivirus at MOI (Multiplicity of infection) of 120.Real-time PCR analysis showed that the mRNA expression of CCNY in Hep-2 cells in the knockdown group was significantly decreased (P < 0.05); the mRNA level of CCNY was 75.3% lower in the si-CCNY group than in the si-CTRL group. After 5 days of lentiviral infection, the cell viability was significantly lower in cells infected with the CCNY-shRNA lentivirus compared to cells infected with the control lentivirus following a 6-day incubation. The colony number was decreased by 60% in Hep-2 cells infected with the CCNY-shRNA-lentivirus infected cells following a 10-day incubation.</p><p><b>CONCLUSIONS</b>The results suggested that lentivirus-mediated downregulation of CCNY expression decreased the proliferation and growth potency of laryngeal cancer cells.Lentiviruses delivering shRNA against CCNY may be a promising tool for laryngeal cancer therapy.</p>

Complications of CO₂ laser surgery in the treatment of laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the complications of CO2 laser surgery in the treatment of laryngeal carcinoma, to analyze related factors and to propose preventive measures.</p><p><b>METHODS</b>Retrospective analysis of 912 cases of laryngeal carcinoma (35 cases of supraglottic cancer and 877 cases of glottic cancer) treated only with laser surgery in Tongren Hospital was carried out. Among the glottic cancer, carcinoma in situ (Tis), T1, T2 and T3 were 53, 659, 158 and 7 cases. The follow-up period ranged from 2 to 18 years, with a median follow-up time of 9.3 years.</p><p><b>RESULTS</b>Of 912 cases, 824 cases were still alive, 29 cases failed to be followed-up (taken into dead number), and 59 cases were dead. The recurrent rate was 9.4% (86/912). Three year survival rate was 95.6% (775/811) and five year survival rate was 87.9% (518/589). The incidence of surgery complications was 9.1% (83/912). Incidence of complications in supraglottic carcinoma and glottic carcinoma were 17.1%(6/35) and 8.8% (77/877), respectively, with no difference between the two groups (χ(2) = 2.85, P > 0.05). Incidence of complications of Tis, T1, T2 and T3 cases of glottic cancer were 5.7%(3/53), 7.8% (51/659), 13.3% (21/158) and 28.6% (2/7) respectively, with significant difference (χ(2) = 8.97, P < 0.05). Incidence of complications of glottic carcinoma with and without anterior commissure incision were 12.8%(31/242) and 7.2%(46/635) respectively, with significant difference between the two groups (χ(2) = 6.78, P < 0.05). Incidence of complications in the patients underwent type II, III, IV, V cordectomy were 3.8% (4/105), 7.0% (20/287), 9.7% (22/226) and 12.0% (31/259) respectively, with significant difference (χ(2) = 7.96, P < 0.05).</p><p><b>CONCLUSIONS</b>There are some potential risks and complications intra- and post-operatively, according to the sites and extent of the primary tumors and the range and depth of removed tissues. It needs to take active preventive measures to reduce the incidence of complications.</p>

Total thyroidectomy: indications and complications / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the indications and complications of the total thyroidectomy in the management of thyroid cancer.</p><p><b>METHODS</b>Fifty-one patients with thyroid cancer operated with total thyroidectomy in a period from April 2007 to June 2010, were retrospective analyzed. There were 48 cases of papillary adenocarcinoma, 1 follicular adenocarcinoma, and 2 medullary carcinoma as well, 2 cases with hyperthyroidism, 3 cases with remote metastasis. There were 17 males and 34 females who in their age ranged from 5 years old to 82 years old with a middle age of 50 years old. Among the 45 cases who were initial surgical management patients, there were 17 T1, 13 T2, 7 T3, 8 T4; and there were 31 N0, 11 N1a, 3 N1b, 2 M1. The recurrent laryngeal nerve and the parathyroid gland, and supper laryngeal nerve were exposed routinely. Lymph nodes in Level VI were dissected in all patients, and Level II-IV dissected in 25 patients. ¹³¹I were administrated in 8 patients.</p><p><b>RESULTS</b>Patients were followed up from 1 month to 36 months. There were no patients died and lost of follow up. The two years survival rate was 100.0% (15/15). Pathological examination showed that the multiple focal disease rate was 42.2% (19/45), the cervical lymph nodes metastases rate was 51.0% (26/51). There was no permanent paralysis of recurrent laryngeal nerve and outer branch of supper laryngeal nerve. The permanent hypoparathyroidism rate was 3.9% (2/51). One case with contralateral lymph node metastasis was reoperated and survived without disease. Two cases with remote metastasis were alive with steadied disease.</p><p><b>CONCLUSIONS</b>Under the skilled hand, total thyroidectomy is a safe procedure in the management of thyroid cancer. Totally exposing the parathyroid gland and laryngeal nerve is the key point to prevent the major complications.</p>

Reconstruction of mid-face defects following the removal of malignant neoplasms: A review of 80 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the reconstructive methods of outcome of midface defects following the removal of malignant neoplasms.</p><p><b>METHODS</b>Eighty cases(54 males, and 26 females, age ranging from 23 - 79, with a median age of 53.5 years), of midface malignant tumors from 1997 - 2006 in Beijing Tongren Hospital were retrospectively reviewed. The clinical data including the type of midface region defects, reconstructive methods and the therapeutic outcome were analyzed. Of the 80 patients, 6 cases were with type I (external nasal) defect, 56 with type II (maxillary) defect, 14 with type III (naso-facio-maxillary) defect and 4 with type IV (maxillary defect combined with naso-facio-orbital cutaneous deficiency).</p><p><b>RESULTS</b>The defects after the removal of malignant tumors were repaired with pedicle tissue flaps in 31 cases and free tissue flaps in 49 cases, respectively, one-stage reconstruction accounting for 73 cases (91.2%). Kaplan-Meier analysis showed total 3-year and 5-year survival rates were 63.8% and 40.6%, respectively.</p><p><b>CONCLUSIONS</b>One-stage reconstruction is a satisfactory method for the repair of midface defect after the removal of malignant tumor, with good clinical outcome. Selection of repair methods should be based on defect types.</p>

Application of modified pectoralis major myocutaneous island flap in head and neck surgeries / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To preserve the function of the donor site and good cervical shape, a modified pectoralis major myocutaneous island flap was designed.</p><p><b>METHODS</b>The modified pectoralis major myocutaneous flaps were used to repair primarily the defect in head and neck surgery. In all 17 cases, six cases were patients with recurrence of larynx or hypopharynx cancer, four cases with hypopharynx cancer, three cases with base of tongue cancer, two cases with recurrence of maxillary cancer, one case with tonsillar cancer and one case with pharyngeal fistula after hypopharyngeal cancer surgery. Before operation, ultrasound was used to mark the projection of the pectoral branches of thoracoacromial artery, and the pectoralis major myocutaneous were designed according to the axle between lowest entering muscle point of the artery and the fourth intercostals perforator spot of mammary artery; the incision was designed to turn laterally in an oriental direction at the top of the flap and upward along the anterior axillary line; the internal pectoral nerve was reserved, as well as the partial lateral pectoral nerve. The flaps were transferred to recipient site either above or below the clavicle on the premise of the integrity of clavicular part.</p><p><b>RESULTS</b>The distance of the lowest entering muscle point of pectoral branche measuring during operation, which was all in sternocostal part, to the midpoint of inferior clavicula margin was (4.9 +/- 1.2) cm (average +/- s), and in 76.5% (13/17) of the patients, the location was coincidence by ultrasound. The length between entering muscle point and the fourth intercostals perforator spot of mammary artery was (1.8 +/- 0.5) cm. All the myocutaneous flaps were alive except one case. The flap was given up as a result of the vessel pedicle injure. The distal end of the flap was dehisced from the residual tongue in one case with base of tongue cancer and healed with changing dressing. Two pharyngeal fistulas in another two cases were healed with conserved treatment. The rate of the flap survival was 94.1% (16/17). Functions as adduction and adtorsion of major pectoral muscle were integrated within 4 weeks to 3 months. Also, the good looking of the neck and upper chest was maintained.</p><p><b>CONCLUSIONS</b>The location of pectoral branches of thoracoacromial artery and the site of the lowest entering muscle point marked by ultrasound detection could help the design of the flap. The modified pectoral' s major myocutaneous flap designing presented better functional protection and reach longer distance and left a better looking for neck and upper chest.</p>

Complications of transsphenoidal surgery for sellar region: intracranial vessel injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intracranial vessel injury is a severe complication of transsphenoidal surgery (TSS) for lesions of sellar region. The purpose of this study was to improve recognition of the complication.</p><p><b>METHODS</b>The clinical data of 400 cases of TSS for sellar region from 1964 to 2004 were reviewed retrospectively. Ten patients with complications of intracranial vessel injury were included in this study, 7 underwent transsphenoidal microsurgery and 3 underwent endoscopic TSS. Subarachnoid hemorrhage (SAH) occurred in 8 cases, hemorrhage of cavernous sinus in one, and post-operative cerebral hemorrhagic infarction caused by thrombosis of injured right internal carotid artery in one. The clinical data of all the patients were analyzed.</p><p><b>RESULTS</b>The SAH resulted from hemorrhage of residues of tumor in 2 patients and from damaged sellar and arachnoidea in 6 patients. The cause of hemorrhage of anterior intercavernous sinus was malformation of anterior intercavernous sinus. The reason of thrombus of internal carotid artery was manipulation of operation. Three patients died and six patients were cured. One patient lived with hemiplegia.</p><p><b>CONCLUSIONS</b>The cause of intracranial vessels injury of TSS is complicated. Detailed anatomic knowledge of seller and skilled operation is helpful to reduce the complication.</p>

Transoral carbon dioxide laser surgery for treatment of hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and curative effects of transoral CO2 laser in treatment of hypopharyngeal carcinoma.</p><p><b>METHODS</b>The retrospective analysis included 24 cases of hypopharyngeal carcinoma from 1994 to 2005 in the Department of Head and Neck. All cases were treated with endoscopic laser surgery and adjuvant selective neck dissection or radiotherapy. The follow-up period was more than 3 years. Twenty-four patients (21 male, 3 female) were classified as follows: 14 cases were T1N0M0, 4 were T1N1M0, 1 was T1N2bM0, 3 were T2N0M0 and 2 were T2N2bM0.</p><p><b>RESULTS</b>Kaplan-Meier survival analysis showed the overall 5-year survival rate was 74.9%, and the 5-year survival rate of T1 lesions and T2 lesions was 78.8% and 60.1%, respectively. The overall 5-year local control rate was 82.1% and 5-year larynx preservation rate was 87.0%. Six of 7 patients with local-regional recurrences underwent salvage surgery and radiotherapy. Finally 4 of them died of recurrence again and 2 were survival. The other one of 7 patients had distant metastasis, and died after radiochemotherapy. One patient died of non-neoplastic diseases. Two patients experienced minor complications with conventional ambulatory treatment without sequelae. All survival patients had laryngeal preservation except the one who received salvage surgery of the hypopharynx and larynx.</p><p><b>CONCLUSIONS</b>Endoscopic CO2 laser surgery with adjuvant selective or modified radical neck dissection and radiotherapy is an alternative for the treatment of selected hypopharyngeal carcinoma, associated with satisfying curative effects and a high larynx preservation rate.</p>

Treatment of supraglottic carcinoma with carbon dioxide laser / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and curative effects of CO2 laser in treatment of supraglottic carcinoma.</p><p><b>METHODS</b>The retrospective analysis included 32 case of supraglottic carcinoma from February 1995 to June 2005, TNM classified as follows: T1N0M0: 20 cases, T1N1M0: 2 cases, T2N0M0: 8 cases and T2N1M0: 2 cases. The patients were treated with endoscopic laser surgery and selective neck dissection (12 cases) or functional neck dissection (4 cases). The follow-up period was more than 3 years.</p><p><b>RESULTS</b>Kaplan-Meier survival analysis shows the overall 5-year survival rate was 90.6%, and the 5-year survival rate of T1 lesions and T2 lesions was 95.6% and 78.2%, respectively. The overall 5-year local control rate was 96. 8%. The 5-year local-regional control rate was 90.3%. With T1 90.9% and T2 89.0% respectively. Two patients had local recurrences, one underwent salvage supraglottic horizontal laryngectomy, another one underwent total laryngectomy. Two cases with regional recurrences underwent radical neck dissection. One of them with concurrent local recurrence was survival after salvage operation. Another one with only regional lesion died of recurrence and pulmonary metastasis after treatment. Four patients experienced minor complications without sequelae. All survival patients had laryngeal preservation except the one who received total laryngectomy.</p><p><b>CONCLUSIONS</b>The results of this study show that endoscopic CO2 laser surgery is highly effective in the treatment of selected supraglottic carcinoma. It shows reliable curative effects and a high larynx preservation rate.</p>