Surgical management of Dandy-Walker syndrome in infants and the literature review / 中国综合临床

Dandy-Walker syndrome is one of the posterior fossa malformations, which is easily confused with arachnoid cyst or cerebellar dysplasia in clinical practice, leading to misdiagnosis. Dandy-Walker syndrome is easy to be combined with hydrocephalus, resulting in increased intracranial pressure, increased head circumference, growth retardation, spastic hemiplegia and other manifestations, and can also be accompanied by other nervous system malformations. On February 27, 2021, a child with Dandy-Walker syndrome with growth retardation as the primary manifestation was admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine. After multiple surgical treatment, the child's hydrocephalus was significantly improved. Through the analysis of the clinical data of the child's operation and the treatment of complications, it is helpful to improve the clinicians' understanding of the surgical treatment of the disease.

Clinical analysis of diversity of defect repair with supraclavicular island flap after head and neck tumor surgery / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the diversity and clinical effect of supraclavicular island flap in repairing the defect after head and neck tumor surgery. Methods:A retrospective analysis was performed on 30 patients who received the repair of head and neck defects with supraclavicular island flaps at Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from January 2017 to March 2023. The sites and types of defects, intraoperative blood loss, time of flaps preparation, areas of flaps, survival of the flaps and other complications were recorded. Results:A total of 30 patients were enrolled, including 26 males and 4 females, aged 36-82 years. Among them, 22 patients with hypopharyngeal partial defect were repaired （19 patients with ipsilateral defect and 3 patients with contralateral defect）. In addition, 2 patients were repaired with contralateral pectoralis major musculocutaneous flap around the hypopharynx, the neck skin defect was repaired in 2 patients, the parotid skin defect was repaired in 2 patients, the temporal bone skin defect was repaired in 1 patient, and the cervical esophageal defect was repaired in 1 patient. The average blood loss during the operation was 8 ml, and the average time was 32 min. The flap areas ranged from 5.0 cm×4.0 cm to 20.0 cm×8.0 cm. 27 of 30 flaps survived（90.0%）, and pharyngeal fistula occurred in 6 patients after operation（4 flaps survived after local dressing）. One patient was complicated with venous thrombosis（the flap necrosis after local dressing）. Shoulder and neck functions（lift, internal rotation and abduction） were not significantly affected in 29 patients, and the function of 1 patient with shoulder infection was not affected after treatment. Conclusion:Supraclavicular island flap is a highly vascularized axial fascial flap. It is easy to make, thin, and soft in texture, and can be used to repair different sites and types of postoperative head and neck tumor defects with a low donor site complication rate. Good results in post-operative repair of head and neck tumors are worth promoting.

Prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer. Methods:A retrospective analysis was conducted on the clinical data of 91 patients with T3 glottic laryngeal cancer. Results:Among the 91 patients, 58 cases （63.7%） had anterior invasion and 33 cases （36.3%） had posterior invasion. The posterior invasion was significantly correlated with invasions of the dorsal plate of cricoid cartilage （P<0.001）, arytenoid cartilage （P= 0.001）, and subglottic region（P = 0.001）. There was no statistical difference in survival outcomes between the total laryngectomy group and the partial laryngectomy group. But in the partial laryngectomy group, the 5-year disease-free survival（DFS） of patients with anterior invasive tumors was better than that of patients with posterior invasion tumors （HR: 4.681, 95%CI 1.337-16.393, P=0.016）, and subglottic invasion was associated with worse loco-regional recurrence-free survival（LRRFS）（HR: 3.931, 95%CI 1.054-14.658, P=0.041）. At the same time, we found that involvement of the dorsal plate of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in partial laryngectomy patients （HR:11.67, 95%CI 1.89-71.98,P=0.008）. Conclusion:Compared with total laryngectomy, selected partial laryngectomy can also achieve favorable oncological outcomes. Posterior invasion and subglottic extension are independent prognostic factors for recurrence of partial laryngectomy in T3 glottic laryngeal cancer, and the involvement of the dorsal plate of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of laryngeal cancer should be further subdivided in order to select a more individualized treatment plan.

Significance of neoadjuvant immunotherapy combined with chemotherapy in the treatment of larynx preservation in locally advanced hypopharyngeal squamous cell carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the clinical significance of neoadjuvant immunotherapy combined with chemotherapy in the treatment of larynx preservation in locally advanced hypopharyngeal squamous cell carcinoma. Methods:Patients with locally advanced HPSCC（cT3-T4aN0-N3M0） were eligible. All received 2 cycles of pembrolizumab combined with docetaxel and platinum neoadjuvant induction therapy. After two cycles, the efficacy was evaluated, followed by radical chemoradiotherapy or surgery and adjuvant chemoradiotherapy according to the efficacy. The primary endpoints were objective response rate（ORR） ，larynx-preservation（LP） rate at 3 months post-treatment and the adverse reactions during neoadjuvant therapy. Results:From December 2021 to December 2022, 10 patients with locally advanced HPSCC（cT3-T4aN0-N3M0） were enrolled. After 2 cycles of the neoadjuvant therapy, 2 patients achieved complete response（CR）, 7 patients achieved partial response（PR）, 1 patient was stable disease（SD）, objective response rate（ORR） was 90%, and disease control rate（DCR） was 100%. 5 patients received radical chemoradiotherapy, 5 patients received surgery and adjuvant chemoradiotherapy, four of them received partial laryngectomy and partial hypopharyngeal resection surgery, and one of them received total laryngectomy and partial hypopharyngeal resection surgery. All patients were able to withstand adverse reactions of neoadjuvant therapy and successfully completed the whole treatment of HPSCC without grade 3-4 treatment-related adverse reactions. There was no recurrence or metastasis during 3-18 months of follow-up. 1 patient died of severe pneumonia 3 months after the completion of radical chemoradiotherapy. At 3 months after treatment, the larynx-preservation rate was 80%. Conclusion:Neoadjuvant immunotherapy combined with chemotherapy has good short-term efficacy and the adverse reactions were tolerable. It can improve the larynx-preservation rate of patients with locally advanced HPSCC, thus improving the prognosis and quality of life of patients.

18F-FDG PET/CT imaging of crossed cerebellar diaschisis induced by supratentorial tumors / 中华行为医学与脑科学杂志

Objective:To investigate the mechanism of crossed cerebellar diaschisis(CCD) induced by supratentorial tumors and the characteristics of 18F-FDG PET/CT imaging. Methods:Eighty-six patients with supratentorial tumors who underwent 18F-FDG PET/CT whole-body imaging from January 2017 to June 2021 were retrospectively analyzed.Placement, number, size, SUVmax, CT values, relationship with basal ganglia, edema, and cerebellar asymmetry index (AI) were observed and recorded.The imaging differences between patients with CCD and patients without CCD were compared, and the correlations between SUVmax, maximum diameter and cerebellar AI were analyzed.SPSS 21.0 software was used for statistical analysis.Chi-square test, independent sample t-test and Pearson correlation analysis were used for data statistics. Results:Among the 86 patients, 14 were patients with CCD and 72 were patients without CCD.The incidence of CCD was 16.3%.There were statistically significant differences in whether the primary lesions involved the basal ganglia region between patients with CCD and patients without CCD ( χ2=7.637, P=0.006). The cerebellar AI ((0.27±0.09), (0.05±0.02), t=6.847, P=0.003)and maximum diameter of primary lesions((3.98±1.09)cm, (2.36±1.61)cm, t=2.011, P=0.040) in patients with CCD were both larger than those in patients without CCD.There was a significant positive correlation between cerebellar AI and the maximum diameter of primary lesions in patients with CCD ( r=0.375 P=0.028). Conclusion:18F-FDG PET/CT imaging can assist in the diagnosis of crossed cerebellar diaschisis.The primary lesion of supratentorial tumor involving the basal ganglia is more likely to cause crossed cerebellar diaschisis, and the size of the primary lesion is correlated with cerebellar AI.

Genetic diversity and molecular epidemiology of Bordetella pertussis isolates / 中华微生物学和免疫学杂志

Objective:To investigate the genetic diversity and molecular epidemiology of Bordetella pertussis in Shaanxi province, and analyze the possible reasons of resurgence in this region. Methods:We characterized clinical isolates collected during 2012-2017 using multilocus antigen sequence typing (MAST) and multilocus variable-number tandem repeat analysis (MLVA).Results:The circulating strains and vaccine strains were different in molecular characteristics. The majority (95%) of the isolates were typed as prn1/ ptxP1/ ptxA1/ fim3-1/ fim2-1. In addition, eight MLVA types (MTs) and eight PFGE profiles were identified, respectively. MT195, MT55 and MT104 were dominant and MT195 continually increased annually. Conclusions:The genetic characteristics of the current strains in Shaanxi province were different from those of the vaccine strain. The evolution through genetic variation might be one of the reasons for the recurrence of pertussis in this region.

Application of self fixing mesh with " Y-shaped" placement in laparoscopic transabdominal preperitoneal repair of inguinal hernia of female inguinal hernia / 中国综合临床

Objective:To investigate the effect of self fixing mesh with " Y-shaped" placement in laparoscopic transabdominal preperitoneal repair of female inguinal hernia.Methods:From February 2019 to September 2020, a total of 40 female patients who underwent TAPP (Keyhole method) in Shaanxi Provincial People′s Hospital were researched.Random number table method was used.According to different patch placement methods, the patients were divided into the self fixing mesh with " Y-shaped" placement group (21 cases) and with normal placement group (19 cases). The operative time, placement time, length of stay, Visual Analogue Scale (VAS), postoperative complication were compared between two groups.Results:All 40 patients completed TAPP, and all patients were followed up successfully, with a median follow-up time of 12.5 months.The operation time and patch placement time were (54.9±9.0) min and (10.8±2.5) min in the Y-shaped placement method group and (62.8±11.2) min and (20.3±3.5) min in the conventional placement method group, respectively; the differences between the two groups were statistically significant ( t=2.490, P=0.017; t=.925, P<0.001). There was no statistically significant difference between the two groups in length of stay, VAS score 1 day after surgery and postoperative complications(all P>0.05). Conclusion:In laparoscopic female inguinal hernia repair (keyhole method), the " Y" shape placement method can effectively shorten the time of self fixing patch placement, thus shorten the operation time, and does not increase the risk of complications.

Macrolide resistance, molecular characteristics and PFGE types of Bordetella pertussis strains / 中华微生物学和免疫学杂志

Objective:To analysis the macrolide resistance, molecular characteristics and plused-field gel electrophoresis(PFGE) type of Bordetella pertussis ( Bp), explore the possible resistance mechanism and the relationship between PFGE types and macrolide resistance profiles. Methods:Erythromycin, azithromycin and clarithromycin susceptibility of clinical isolates during 2016 to 2018 was determined by E-test. PCR was used to detect the drug-resistant genes and mutation sites. PFGE were employed to do molecular typing for the strains.Results:Thirty-five strains were isolated, of which 27 strains were resistant to all three antibiotics, two strains were resistant to erythromycin and azithromycin, and six strains were sensitive to all three antibiotics. Partial macrolide resistant strains carried the methylase gene ermA (27.6%, 8/29) and ermB (31.0%, 9/29); A2047G site mutation was detected in macrolide-resistant strains, while no drug-resistant genes or mutation sites were found in sensitive strains. Resistant strains were classified into BPSR23 and BPFINR9 types, while sensitive strains were other profiles. Conclusions:The clinical isolated Bp were seriously resistant to erythromy and showed signs of resistance to other macrolides. The acquisition of methylase gene and mutation of A2047G site might be the main mechanism of resistance. The macrolide resistance might have has a certain correlation with PFGE profile.

Gut microbiome and ischemic stroke / 国际脑血管病杂志

In recent years, the concept of " microbiome-gut-brain axis" has been proposed to reveal the wide connection between gut microbiome and nervous system diseases. As a common and frequently occurring disease of nervous system, the occurrence and outcome of ischemic stroke are closely related to gut microbiome. This article reviews the relationship between gut microbiome and risk factors of ischemic stroke and immune inflammation after stroke.

Characteristics of cervical lymph node metastasis of cN0 laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the incidence of occult cervical lymph node metastasis and the common neck level of metastases in cN0 laryngocarcinoma, and the relationship between the clinicopathologic features of laryngocarcinoma and cervical lymph node metastasis.@*Methods@#A total of 506 cases with cN0 laryngocarcinoma treated at the First Affiliated Hospital of Chongqing Medical University between March 2011 and March 2018 were enrolled, and their medical records and follow-up data were retrospectively analyzed. Of them, 211 cases of were glottic carcinoma in stage T1 without neck dissection and they were observed by clinical follow-up; other 295 cases, including glottic carcinoma, supraglottic carcinoma and hypopharyngeal carcinoma in stage T2-T4 were treated with surgical resection of the primary lesions and selective neck dissection. SPSS 22.0 software was used to analyze the data.@*Results@#The total incidence of cervical lymph node metastasis was 10.87%(55/506), with a lower incidence in T1 stage glottic carcinoma(6/211,2.84%) than that in other cases(49/295,16.61%). The incidence of cervical lymph node metastasis in glottic carcinoma (29/426, 6.81%) was lower than those in supraglottic carcinoma (22/71,30.99%) and subglottic carcinoma (4/9) (χ2=35.810,P<0.01).The pN+ rates of glottic carcinoma at T1, T2, T3 were 2.84%(6/211), 5.31%(6/113), 16.05%(13/81), and 19.05%(4/21), respectively (χ2=18.572, P<0.01). The pN+ rates of supraglottic carcinoma at T2, T3 and T4 were 3/13, 32.50%(13/40) and 6/13, respectively (χ2=3.649,P>0.05). The incidence of cervical lymph node metastasis in poorly differentiated carcinoma (17/42, 40.48%) was higher than those in moderately differentiated carcinoma (26/205, 12.68%) and high differentiated carcinoma(12/246, 4.88%)(χ2=36.356, P<0.01). Moreover, 85 pN+ lymph nodes were obtained by selective neck dissection, respectively 43(50.59%) in level Ⅱa, 30(35.29%) in level Ⅲ, 1(1.18%) in level Ⅳ and 11(12.94%) in level Ⅵ.@*Conclusions@#The occult cervical lymph node metastasis was frequently found in cN0 laryngocarcinoma. Selective neck dissection should be performed with surgery for the primary lesions in T3-T4 glottic laryngeal cancer, T2-T4 supraglottic laryngeal cancer and subglottic carcinoma, and the neck dissection for level Ⅱa and Ⅲ is appropriate. It is required to detect pre-laryngeal and pre-tracheal lymph nodes in patients with subglottic laryngeal carcinoma.

Effect of lentivirus vector-mediated RNA interference dbpA gene silencing on the biological behavior of colorectal cancer cells / 中华普通外科杂志

Objective To investigate the effects of lentivirus-mediated RNA interference (RNAi) targeting DNA binding protein A (dbpA) on the proliferation and the biological behavior of colorectal cancer cell line SW620.Methods The experiment was divided into 3 groups:KD group (siRNA-dbpA,lentivirus interference group),CON group (non-specific sequence group) and NC group (blank control group).The lentiviral vector siRNA-dbpA was constructed and verified by PCR and DNA sequencing.SW620 cells were transfected with siRNA-dbpA plasmid,nontargeting siRNA plasmid,or empty plasmid.After 48 h the transfection,the cells were examined for dbpA expression using Western blot.After 72 hrs transfection,flow cytometry was used to detect the cell apoptosis and cell cycle changes.The cell growth inhibition rate was detected by MTT (4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide) assay,and then clone formation was detected,and the ability of SW620 cells to form tumors in vivo after dbpA was silenced was studied in nude mice.Results PCR analysis and DNA sequencing demonstrated that the RNAi sequence targeting dbpA gene was successfully inserted into the lentiviral vector.siRNA-dbpA transfection resulted in reduced expression of dbpA in SW620 cells.After transfection,the apoptosis rate of siRNA-dbpA-transfected cells increased to 26.60％ ± 0.38％,significantly higher than that in cells transfected with the nontargeting plasmid or the empty plasmid 12.54％ ± 0.25％ and 4.46％ ± 0.19％,respectively (F =28.159,P ＜0.01).The growth inhibition test indicate that the OD value of the fifth day in siRNA-dbpA group was 0.194 ±0.037,significantly lower than that in the other two groups 0.814 ±0.043 and 1.625 ±0.061,respectively(F =23.214,P ＜ 0.01).The colony formation number is 37 ± 3,64 ± 5and 175 ± 10 respectively,siRNA-dbpA is significantly higher than that in the other two groups(F =40.254,P ＜ 0.01).After the completion of nude mouse transplantation tumor model,through the detection of tumor volume,KD group (group siRNA-dbpA) tumor volume after 14 d and CON and NC group had obvious difference (F =38.256,P ＜ 0.05),and after 21d is more significant difference in tumor size (F =40.241,P ＜ 0.01),can be clearly observed after 35 d KD group (group siRNA-dbpA) growing tumors had differences with the control group (F =30.257,P ＜ 0.05).Conclusion Lentivirus-mediated RNAi targeting dbpA can effectively suppress the expression of dbpA in colorectal tumor in nude mice,it is proved that dbpA silencing has a significant inhibitory effect on the growth of living tumor cells and decrease the proliferation of the colorectal cells.

Relationship between different levels of central venous pressure and blood loss during pediatric living donor liver transplantation / 中华麻醉学杂志

Objective To evaluate the relationship between different levels of central venous pres-sure (CVP) and blood loss during pediatric living donor liver transplantation (LDLT). Methods Pediat-ric patients underwent LDLT in Renji Hospital from 2006 to August 10, 2016 were retrospectively reviewed. The patients were divided into 2 groups according to the different CVP levels before peritoneum closure:central venous pressure<10 mmHg group ( group L) and CVP≥10 mmHg group ( group H) . The primary outcome measure was intraoperative blood loss. The secondary outcome measures were duration of mechani-cal ventilation in intensive care unit (ICU), duration of ICU stay, length of postoperative hospital stay, intraoperative blood loss, intraoperative blood transfusion, intraoperative volume of liquid infused, opera-tion time and anesthesia time. Results A total of 442 pediatric patients were enrolled in this study, with 209 cases in group L and 233 cases in group H. Compared with group H, the intraoperative blood loss was significantly decreased, the anesthesia time, operation time and length of postoperative hospital stay were shortened ( P<0. 05) , and no significant change was found in intraoperative blood transfusion, intraopera-tive volume of liquid infused, duration of mechanical ventilation in ICU or duration of ICU stay in group L ( P>0. 05) . Conclusion Maintaining intraoperative CVP<10 mmHg can markedly reduce the blood loss during LDLT and is helpful for postoperative recovery in pediatric patients.

Effect of high rosuvastatin dose on outcome in patients with large artery atherosclerotic stroke / 中华老年心脑血管病杂志

Objective To study the effect of high rosuvastatin dose on outcome in patients with large artery atherosclerotic stroke (LAAS).Methods Eighty-two LAAS patients were randomly divided into high rosuvastatin dose group (n=39) and routine rosuvastatin dose group (n=43).Their serum blood lipid level and inflammatory indexes were measured and their clinical outcome was assessed.Results No significant difference was found in mortality,recurrence and hemorrhagic transformation between the two groups (P＞0.05).The rate of improved outcome was significantly higher in high rosuvastatin dose group than in routine rosuvastatin dose group (84.62％ vs 65.12％,P=0.04).The serum hs-CRP level was significantly lower in routine rosuvastatin dose group and high rosuvastatin dose group after treatment than before treatment (0.56±0.60 mg/L vs 0.70±0.68 mg/L,P=0.01;0.22±0.29 mg/L vs 0.69±0.58mg/L,P=0.00) and in high rosuvastatin dose group than in routine rosuvastatin dose group after treatment than before treatment (0.22±0.29 mg/L vs 0.56±0.60 mg/L,P=0.00).The rate of LDL C＜1.8 mmol/L and non HDL-C＜2.6 mmol/L was significantly higher in high rosuvastatin dose group than in rosuvastatin dose group after treatment (69.23％ vs 46.51％,P=0.04;66.67％ vs 41.86％,P=0.03).No significant adverse reactions occurred in both groups.Conclusion High rosuvastatin dose can effectively increase the blood lipid level,reduce the serum hs-CRP level,and improve the clinical outcome in LAAS patients.

Gut microbiota and stroke-associated pneumonia / 国际脑血管病杂志

Recent studies have shown that there is a mutual influence between gut microbiota and stroke. Stroke-associated pneumonia (SAP) is a common complication of stroke, which is closely associated with death and poor prognosis of patients. Gut microbiota translocation may be the source of infection of SAP, but the specific mechanism of gut microbiota and SAP remains unclear. This article reviews the relationship between gut microbiota and SAP in order to provide reference for the prevention and treatment of SAP.

Integrated multimedia presentation in multidisciplinary head and neck oncology clinical teaching / 中华医学教育探索杂志

Multidisciplinary team is the basic model of modern head and neck oncology treatment. We try to integrated multimedia presentation in multidisciplinary head and neck oncology clinical teaching. Through building a multidisciplinary platform for discussion , on the basis of teacher's instruction and student's self-learning, we integrate the related knowledge with multimedia presentation and computer net-work to guide the learning of core knowledge and key problems of head and neck cancer, thus forming a new clinical teaching mode combining theory study with practice training. In the process of implementation, we should pay attention to arranging the learning tasks in advance, and highlight the key learning content in the multidisciplinary discussion, so as to improve the students' interest and enthusiasm in learning.

β2-Microglobulin and ischemic stroke / 国际脑血管病杂志

β2-Microglobulin is a small molecule protein, consisting of a polypeptide chain.Previous studies have confirmed that serum β2-microglobulin is a biomarker that reflects early renal function injury, and renal function injury is closely correlated with ischemic stroke.Studies in recent years have shown that the level of serum β2-microglobulin increases significantly in patients with ischemic stroke.Thus, it can be used as a biomarker for the risk of ischemic stroke.

The efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis: a randomized, controlled, double-blind, multi-center clinical trial / 中华普通外科杂志

Objective To assess the efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis.Methods Double-blind randomized controlled multicenter clinical trial was designed and conducted.Totally 437 patients were included,219 in the control group and 218 in the experimental group.Cases of purulent or gangrenous appendicitis were enrolled and assigned to each of the two groups.The control group received ornidazole injection for 5 to 7 days while the experimental group received morinidazole injection.Both groups underwent appendectomy.Clinical response,micrombiological outcomes,overall response were evaluated.Adverse events and side effects were recorded.Results No significant difference was observed between the two groups regarding the clinical healing rate at 5-10 days after medicine withdrawal,anaerobia clearance and overall healing rates.Adverse events occurred in 140 patients (32.1％).Incidence of adverse events in the control group and the experimental group was 34.7％ and 29.4％,respectively (P ＞ 0.05).The overall incidence of side effects was 15.1％ (66 cases).Side effects were less seen in the experimental group compared with that in the control group (11.5％ vs.18.7％,P ＜ 0.05).The most frequent side effects were aminotransferase rising,thrombocytosis,nausea,vomiting and electrocardiographic abnormality.Conclusions The effect of morinidazole plus operation was comparable with ornidazole in treating purulent or gangrenous appendicitis.The safety of morinidazole is better than ornidazole.

Clinical Observation of Tiotropium Bromide Combined with Salmeterol Fluticasone Aerosol in the Treat-ment of Elderly Severe COPD / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of tiotropium bromide combined with Salmeterol flutica-sone aerosol in the treatment of severe COPD in elderly patients. METHODS:A total of 90 elderly patients with severe COPD se-lected from May 2013 to May 2015 in our hospital as research objects were divided into control group and observation group ac-cording to random number table,with 45 cases in each group. Control group was given Salmeterol xinafonate and fluticasone propi-onate aerosol 1 press/time,bid;observation group was additionally given Tiotropium bromide powder for inhalation 18 μg,qd,on the basis of control group. Both groups were treated for 8 weeks. The short-term clinical efficacy,dyspnea score,pulmonary venti-lation function indexes [FVC,EFV1,EFV1%],blood gas analysis indexes [p(O2),p(CO2)] and QLI score before and after treat-ment were observed in 2 groups. The re-hospitalization time and the occurrence of ADR were compared between 2 groups. RE-SULTS:The total response rate of short-term treatment in observation group was 97.78%,which was significantly higher than 80.00% of control group,with statistical significance (P0.05). After treatment,dyspnea scores and p(CO2) of 2 groups were decreased significantly,while pulmonary ventilation function indexes,p??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????(O2)and QLI scores were increased significantly;the observation group was significantly better than the control group,with statis-tical significance(P<0.05). The re-hospitalization time of observation group was significantly less than that of control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P<0.05). CON-CLUSIONS:Tiotropium bromide assisted with Salmeterol fluticasone aerosol show significant therapeutic efficacy for elderly se-vere COPD,and effectively relieve dyspnea symptom,improve pulmonary ventilation function and quality of daily life,reduce the re-hospitalization risk and do not increase the incidence of ADR.

Keyhole craniotomy for cholesteatmas in the cerebellopontine angle region presenting as trigeminal neural-gia / 中国神经精神疾病杂志

Objective To investigate the clinical utility of keyhole craniotomy for Cholesteatmas in the cerebello-pontine angle region presenting as Trigeminal neuralgia by using keyhole craniotomy. Methods Clinical data of 35 pa-tients with Cholesteatmas in the cerebellopontine angle region presenting as Trigeminal neuralgia was analyzed retrospec-tively. All patients received suboccipital retrosigmoid keyhole craniotomy. Thirty cases who received conventional craniot-omy group were served as control group. A comparative analysis was conducted to assess the difference between these two groups in microsurgical methods, effects and complications. Results All patients were confirmed with MR diagnosis. In keyhole group, all patients had no pain symptoms of trigeminal neuralgia after surgical operation. The symptoms disap-peared immediately in 33 cases and gradually disappeared in 2 cases within one month following keyhole craniotomy. The tumors were totally removed in 25 cases and almost completely in 10 cases. The surgical duration was shorten in key-hole group than in conventional group (126±48 vs. 216±66 min;t=2.536, P<0.05). The amount of bleeding was smaller in keyhole group than in conventional group (91.3±52.2 vs. 186.3±65.4 mL;t=2.163, P<0.05). Postoperative neurologi-cal function was assessed in House-Brackmann. In keyhole group, there were 32 cases in class Ⅰ and 3 in grade Ⅱ. Two patients had hearing loss which was improved gradually in three months. In conventional group, there were 25 cases in class Ⅰ and 5 in grade Ⅱ (χ2=4.158, P<0.05). Postoperative hearing evaluation (AAO-HNS) revealed that there were 33 cases in grade A , and 2 in grade B in the keyhole group, whereas there were 27 cases in grade A and 3 in grade B in the conventional group(χ2=5.167, P<0.05). There were no relapse of tumors and death during 3 month to 5 years follow-up. Conclusions The suboccipital retrosigmoid keyhole craniotomy is a valid choice for Cholesteatmas in the cerebellopontine angle region presenting as Trigeminal neuralgia.

Expression of DNA binding protein A in colorectal carcinoma tissues and cells and its clinical significance / 肿瘤研究与临床

Objective To investigate the expression of DNA binding protein A (dbpA) in patients with colorectal carcinoma of different stages and its significance.Methods Expression of dbpA protein and mRNA in specimens of normal tissues and colorectal cancer were detected by immunohistochemistry,expression of dbpA mRNA and protein of colorectal cancer cell lines SW480,RKO,SW620,DLD-1,HT-29,SW1463 and tissues were detected by immunohistochemistry,RT-PCR and Western blot.Results There was no positive staining dbpA protein and mRNA in normal colorectal tissues.However,dbpA was expressed in epithelial cells of colorectal mucosa [dbpA mRNA:80.0 ％ (48/60),10.0 ％ (6/60);dbpA protein:83.3 ％ (50/60),10.0 ％ (6/60),P ＜ 0.01].And there was no expression in normal colorectal cell,but its expression was high in 6 colorectal cancer cells (P ＜ 0.05).The high expression of dbpA was correlation with the infiltration depth,lymph node metastasis and type of histology (P ＜ 0.05),and had effect in prognosis of colorectal cancer (P ＜ 0.05).Conclusion Elevated dbpA may be related to the pathogenesis and development of colorectal carcinoma,and dbpA may be a prognostic factor of colorectal carcinoma.