Evaluation of the microbiological efficacy of cleaning agents for tracheostomy inner cannulas.

PURPOSE: Biofilms are a significant cause of morbidity in patients with indwelling medical devices. Biofilms pose a potential risk with reusable inner cannulas by increasing the risk of infections. Effective decontamination is thus vital in decreasing bioburden. The current guidelines for cleaning inner cannulas are varied, with multiple techniques being recommended, which are not supported by strong evidence. This randomized, controlled, cross-over study attempted to enumerate the bacterial count of inner cannulas used in tracheostomy patients (n = 60) pre-and post-decontamination with detergent (A) or sterile water (B). MATERIALS AND METHODS: The patients were randomly allocated to sequence A > B or B > A in 1:1 fashion. The saline flushing of the inner cannulas was plated on trypticase soy agar with 5 % sheep blood to enumerate the bacterial count. RESULTS: The mean ratio [Log (CFU)post/Log (CFU)pre]A/[Log (CFU)post/Log (CFU)pre]B based on 53 samples was 0.918 ± 0.470, two-sided 90 % confidence interval (CI) 0.812, 1.024. The equivalence criterion was met as the mean ratio after cleaning fell within the equivalence region of 0.8 and 1.25. CONCLUSION: This study demonstrated the microbiological efficacy of both detergent and sterile water in the decontamination of inner cannulas, and that sterile water was not less effective than detergent in reducing the bacterial load for safe re-use of inner cannulas. This has the potential to promote cost savings for patients with tracheostomy, both in the hospital and the community. The study findings may also be relevant in formulating tracheostomy care policies.

Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly (version 2023) / 中华创伤杂志

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Protective Effect of Huazhuo Jiedu Huoxue Tongluo Prescription on Cerebral Ischemia-reperfusion Injury via Regulating Autophagy Based on JNK Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the mechanism of Huazhuo Jiedu Huoxue Tongluo prescription in alleviating cerebral ischemia-reperfusion injury via regulating nerve cell autophagy based on c-Jun N-terminal kinase（JNK）signaling pathway . MethodSixty SD rats were randomly divided into 6 groups： sham group， middle cerebral artery occlusion/reperfusion （MCAO/R） group （model group）， Huazhuo Jiedu Huoxue Tongluo prescription group ［traditional Chinese medicine （TCM） group（25.0 g·kg-1）］， JNK inhibitor SP600125 （SP） group（5 mg·kg-1）， TCM+SP group and JNK agonist Anisomycin （Ani） group（15 mg·kg-1）. After 24 h of modeling， TCM group and TCM+SP group were given TCM decoction （ig） for 3 consecutive days， and the other groups were given equal volume of normal saline （ig）. Neurological deficit was evaluated by neurological function score and cerebral infarct volume was determined by 2，3，5-triphenyltetrazole chloride （TTC） staining. Hematoxylin-eosin （HE） staining and Nissl staining were used to observe the structural changes of brain tissue and the damage of neurons， respectively. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay （TUNEL） was performed to detect cell apoptosis. The ultrastructure of autophagosomes was observed by transmission electron microscope. Western blot was employed to detect the protein expressions of microtubule-associated protein 1 light chain 3A/B （LC3A/B）， autophagy related 5 （Atg5）， the ortholog of yeast Atg6 （Beclin1）， p62， B-cell lymphoma 2 （Bcl-2）， JNK， phosphorylated （p）-JNK and c-Jun in brain tissue. The mRNA expressions of LC3A/B， Beclin1， p62， Atg5， Bcl-2， JNK and c-Jun were detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the sham group， the model group had elevated neurological deficit score （P<0.05）， enlarged cerebral infarct volume （P<0.05）and typical infarction manifestations formed in hippocampal region and its surrounding brain tissue. In addition， there were a large number of neuronal cell degeneration， necrosis， liquefaction， nucleus pyknosis and deep staining， and inflammatory cell infiltration in the cortex in the model group， and severe swelling of mitochondria， lysosomes， autophagosomes and autophagolysosomes were clearly seen under electron microscope. TUNEL positive cells were increased （P<0.05）， and cell apoptosis was severe. The nuclear membrane and nucleolus of neurons in brain tissue were blurred with discontinuous processes， and Nissl bodies in cytoplasm were stained light with reduced number. Western blot revealed that the model group had up-regulated protein expressions of LC3A/B， Beclin1， Atg5， JNK， p-JNK and c-Jun in brain tissue （P<0.05）， while down-regulated protein expressions of p62 and Bcl-2 （P<0.05）as compared with the sham group. Real-time PCR indicated that the mRNA expressions of LC3A/B， Beclin1， Atg5， JNK and c-Jun in the model group were higher （P<0.05） while the mRNA expressions of p62 and Bcl-2 were lower （P<0.05） than those in the sham group. Compared with the conditions in model group， the neurological deficit scores of TCM， SP and TCM+SP groups were lowered （P<0.05）， and the cerebral infarct volume was reduced （P<0.05）， with improved pathological status of brain tissue， especially in the TCM group. Furthermore， there were abundant and basically normal mitochondrial cristae， slightly dilated endoplasmic reticulum， slightly swollen golgi apparatus， slightly fused nuclear membrane， and few visible lysosomes， autophagosomes and autophagolysosomes. TUNEL positive cells were decreased （P<0.05）， displaying reduced apoptosis， especially in the TCM group. The nucleolus and nuclear membrane of neurons in brain tissue were discernible， and Nissl bodies in cytoplasm was reduced to a certain degree as compared with those in the model group. Western blot showed a decrease in the protein expressions of LC3A/B， Beclin1， Atg5， JNK， p-JNK and c-Jun in the TCM group ，the SP group，and the TCM+SP group（P<0.05），while an increase in the protein expressions of p62 in the TCM group and SP group（P<0.05），and an increase in the protein expressions of Bcl-2 in the TCM group and TCM+SP group. By Real-time PCR， the mRNA expressions of LC3A， LC3B， Beclin1， Atg5， JNK and c-Jun had a down-regulation（P<0.05） while the mRNA expression of p62 a up-regulation in the TCM group ，the SP group，and the TCM+SP group（P<0.05），and the mRNA expression of Bcl-2 a up-regulation in the TCM group and the TCM+SP group（P<0.05）.Scores of the Ani group were raised （P<0.05）， and infarct volume was increased significantly， with aggravated neuronal cell necrosis and obvious inflammatory infiltration. Moreover， there were neuronal nuclear membrane fusion with abnormal protrusion， increased heterochromatin aggregation in edge， severe mitochondrial swelling， endoplasmic reticulum expansion， increased lysosomes， increased intracytoplasmic vesicles， and visible autophagosomes and autophagolysosomes. TUNEL positive cells were increased （P<0.05）， representing severe apoptosis. The number of Nissl bodies dropped with light staining， and the nucleolus and nuclear membrane were blurred. Real-time PCR found that the mNRA expressions of Atg5， c-Jun， JNK were up-regulated （P<0.05），while Beclin1， p62， Bcl-2 were were down-regulated in the Ani group （P<0.05）. Compared with the TCM group and SP group，the protein expressions of LC3A/B， Beclin1， Atg5， JNK， p-JNK， c-Jun were decreased，and p62， Bcl-2 were increased in the Ani group（P<0.05）. Compared with the TCM group，the mRNA expressions of JNK mRNA had a down-regulation in the SP group and TCM+SP group，while LC3A， LC3B， Atg5， c-Jun， JNK had an up-regulation（P<0.05） and Bcl-2 had a down-regulation in the Ani group（P<0.05）. Compared with the SP group，the mRNA expressions of Atg5， c-Jun， JNK had an up-regulation（P<0.05）， and Beclin1， p62， Bcl-2 had a down-regulation in the Ani group（P<0.05）. ConclusionHuazhuo Jiedu Huoxue Tongluo prescription significantly up-regulates the protein and mRNA expressions of LC3A/B， Beclin1， Atg5， JNK， p-JNK and c-Jun， and down-regulates the protein and mRNA expressions of p62 and Bcl-2， suggesting that the prescription can inhibit autophagy through JNK signaling pathway to reduce ischemia/reperfusion injury in rats.

Effect of Huazhuo Jiedu Huoxue Tongluo Prescription on Brain-gut Axis of Rats with Cerebral Ischemia-reperfusion Injury Based on 16S rRNA Sequencing of Intestinal Flora / 中国实验方剂学杂志

ObjectiveTo study the effect of Huazhuo Jiedu Huoxue Tongluo （HJHT） prescription on the intestinal flora in rats with cerebral ischemia-reperfusion injury， and to explore the mechanism of Chinese medicinal prescription regulating intestinal flora to restore the balance of brain-gut axis. MethodFifty male SPF SD rats were randomly assigned into sham group， model group， high-dose HJHT group （25.0 g·kg-1）， medium-dose HJHT group （12.5 g·kg-1）， and low-dose HJHT group （6.25 g·kg-1）， with 10 rats in each group. The rat model of permanent middle cerebral artery infarction was established according to Longa method and previous research experience， and reperfusion was performed 2 h after ischemia. The recovery of neurological function deficit and the percentage of cerebral infarction area were detected 72 h after administration. Real-time PCR was performed to detect the mRNA levels of Occludin and zonula occludens-1 （ZO-1） in rat colon. Hematoxylin-eosin （HE） staining was conducted to reveal the intestinal damage. The feces of 6 rats in each group were collected for 16S rRNA sequencing. The expression of Treg and Th17 in intestinal tissue， peripheral blood， and brain tissue were detected. ResultCompared with the sham group， the model group showed obvious neurological deficit （P<0.05） and large cerebral infarction area （P<0.05）. High-dose and medium-doses HJHT alleviated the symptoms of neurological impairment （P<0.05） and reduce the cerebral infarction area （P<0.05） compared with the model group. Compared with the sham group， the model group showed destroyed structure of colonic mucosa and incomplete epithelial cells and goblet cells， while high-dose and medium-doses HJHT alleviated such changes. The mRNA levels of Occludin and ZO-1 in the model group were lower than those in the sham group （P<0.05），and the high-dose HJHT groups were higher than the model group （P<0.05）. The intestinal flora structure was significantly different between the model group and the sham group while similar between the high-dose HJHT group and sham group. Compared with the sham group， the model group showed down-regulated expression of Treg and up-regulated expression of Th17 in the intestinal tissue， peripheral blood， and brain tissue， and high-dose and medium-dose HJHT alleviated the changes in the expression of Treg and Th17 in the model group （P<0.05）. ConclusionHuazhuo Jiedu Huoxue Tongluo prescription may improve the permeability of intestinal wall by adjusting the abundance and diversity of intestinal microorganisms to reduce the migration of intestinal Th17 cells toward the ischemic lateral brain tissue， mitigate the inflammatory response， and thus alleviate the cerebral ischemia-reperfusion injury in rats.

Expert consensus on rehabilitation strategies for traumatic spinal cord injury / 中华创伤杂志

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Research advance on the interaction of pharmaceutical molecules with target proteins / 药学实践杂志

The function of drugs is based on the interaction between drug molecules and their targets.Qualitative analysis and quantitative detection of drug-target interactions run through the whole process from drug discovery to clinical practice.After decades of development, the study methods on the interaction between drug molecules and target proteins have been transformed from traditional biochemical experiments to a diversity of efficient and accurate technology systems supported by advanced molecular biology and biophysics theory.In this review, representative methods and techniques were introduced from aspects of target discovery and validation, affinity determination, interaction sites and structural analysis, which might provide some references for drug discovery and mechanism exploration.

Effects of tonsillectomy on sleep study parameters in adult patients with obstructive sleep apnea--a prospective study.

OBJECTIVE: The objective of this study is to evaluate the efficacy of tonsillectomy in reduction of respiratory disturbance index (RDI) and other sleep study parameters in patients with obstructive sleep apnea (OSA). METHODS: This study involves 34 adults with OSA and Friedman grade 3 or 4 tonsils. All 34 patients were treated with tonsillectomy, as the only surgical treatment for OSA from 2007 to 2011. Pre- and postoperative polysomnography were performed in all these patients. RESULTS: Prior to tonsillectomy, 21 patients had severe, 9 had moderate, and 4 had mild OSA. Surgical response rate (defined as 50% or more reduction in apnea-hypopnea index (AHI) and a postoperative AHI of less than 20) was 71.4% among patients with severe OSA, 77.7% among patients with moderate, and 75% among patients with mild. Among all the 34 patients, there was a reduction of 24.6 (p = 0.000) in the RDI postoperatively. In our sub-analysis, we arbitrarily divided the patients into three groups: patients with RDI less than 30, patients with RDI between 30 and 60, and patients with RDI above 60. It showed that, in the group with RDI >60, an average reduction of RDI by 57.6 (p = 0.000) was achieved and was the greatest reduction in RDI. CONCLUSIONS: Tonsillectomy alone may be considered as an effective first line surgical procedure in the treatment of OSA in selected patients. Patients with Friedman grade 3 or 4 tonsils may be considered for tonsillectomy as the initial surgical procedure, reserving other upper airway procedures at a later stage if necessary.

Hyoid expansion with titanium plate and screw: a human cadaveric study using computer-assisted airway measurement.

IMPORTANCE: Hyoid expansion with suspension can potentially increase the upper airway at the hypopharyngeal level, benefitting patients with sleep-related breathing disorder. OBJECTIVES: To document the effect of hyoid expansion using titanium plate and screw on retrolingual hypopharyngeal airway dimension and to compare the airway dimension after isolated hyoid expansion with hyoid expansion + hyomandibular suspension. DESIGN: Anatomical cadaveric dissection study. SETTING: This study was performed in a laboratory setting using human cadavers. INTERVENTION: This is an anatomical feasibility study of hyoid expansion using titanium plate and screw on 10 cadaveric human heads and necks. The hyoid bone is trifractured with bony cuts made just medial to the lesser cornu. The freed hyoid body and lateral segments are expanded and stabilized to a titanium adaptation plate. Computer-assisted airway measurement (CAM) was used to measure the airway dimension at the hypopharynx at the level of the tongue base before and after the hyoid expansion. The expanded hyoid bone was then suspended to the mandible, and the airway dimension was measured again with CAM. MAIN OUTCOMES AND MEASURES: Airway dimension after isolated hyoid expansion with hyoid expansion with hyomandibular suspension. RESULTS Hyoid expansion with titanium plate and screw resulted in statistical significant increase in the retrolingual hypopharyngeal airway space in all of the 10 human cadavers. The mean (SD) increase in retroglossal area was 33.4 (13.2) mm² (P < .005) (range, 6.0-58.7 mm²). Hyoid expansion with hyomandibular suspension resulted in a greater degree of airway enlargement. The mean (SD) increase in retroglossal area was 99.4 (15.0) mm² (P < .005) (range, 81.9-127.5 mm²). CONCLUSIONS AND RELEVANCE: The retrolingual hypopharyngeal airway space increased with hyoid expansion using titanium plate and screw in our human cadaveric study, measured using CAM. The degree of increase is further augmented with hyomandibular suspension.

Submandibular mass excision in an Asian population: a 10-year review.

OBJECTIVES: The objectives of this study were to compare the prevalence of submandibular gland neoplasia in an Asian population with a Western population and to evaluate the accuracy of fi ne needle aspiration cytology (FNAC) and computed tomography (CT) scan in the study of submandibular gland pathologies. MATERIALS AND METHODS: We conducted a 10-year retrospective review of 101 submandibular mass excisions. Data on the demographic profi le of patients, clinical features, correlation of fi ne needle aspiration cytology, CT scans and histology and morbidities related to surgery were collected. RESULTS: The prevalence of submandibular gland neoplasia was 27.1%. Most (78.9%) of these were benign. FNAC and CT scans were accurate for benign neoplasia. However, the accuracy of FNAC and CT scans for sialadenitis without sialolithiasis was low. CONCLUSION: The prevalence of submandibular gland malignancy was lower in the Asian population. FNAC and CT scans were accurate for benign neoplasia of the submandibular gland.

Submandibular mass excision in an Asian population: a 10-year review

<p><b>OBJECTIVES</b>The objectives of this study were to compare the prevalence of submandibular gland neoplasia in an Asian population with a Western population and to evaluate the accuracy of fi ne needle aspiration cytology (FNAC) and computed tomography (CT) scan in the study of submandibular gland pathologies.</p><p><b>MATERIALS AND METHODS</b>We conducted a 10-year retrospective review of 101 submandibular mass excisions. Data on the demographic profi le of patients, clinical features, correlation of fi ne needle aspiration cytology, CT scans and histology and morbidities related to surgery were collected.</p><p><b>RESULTS</b>The prevalence of submandibular gland neoplasia was 27.1%. Most (78.9%) of these were benign. FNAC and CT scans were accurate for benign neoplasia. However, the accuracy of FNAC and CT scans for sialadenitis without sialolithiasis was low.</p><p><b>CONCLUSION</b>The prevalence of submandibular gland malignancy was lower in the Asian population. FNAC and CT scans were accurate for benign neoplasia of the submandibular gland.</p>

Benefits and efficacy of tonsillectomy for recurrent tonsillitis in adults.

CONCLUSIONS: Tonsillectomy is an effective procedure that provides medical and social benefits for adult patients with recurrent tonsillitis. OBJECTIVE: To evaluate the benefits, impact and overall efficacy of tonsillectomy for recurrent tonsillitis in adults. PATIENTS AND METHODS: Analysis of medical records with postoperative survey analysis of patients who underwent tonsillectomy in 1 work year with at least 1 year of follow-up. RESULTS: A total of 105 patients returned completed surveys. Their mean age was 26.25 years. The mean frequency of tonsillitis per year decreased from 8.37 (SD=3.75) to 1.43 (SD=1.86), p<0.005. The mean duration in days of each episode of tonsillitis decreased from 5.91 (SD=2.67) to 1.23 (SD=1.42), p<0.005. The mean number of work days missed decreased from 8.92 (SD=6.85) to 0.65 (SD=1.49), p<0.005. The mean pain score (1-10) was 6.88 (SD=5.75). An average of 14.17 (SD=5.75) days of medical leave was required postoperatively. In all, 37.1% of patients noticed postoperative voice changes; 92.4% would still choose tonsillectomy again for the same condition and 98.1% would recommend tonsillectomy to family or friends if they had recurrent tonsillitis.

Uvulopalatopharyngoplasty outcome assessment with quantitative computer-assisted videoendoscopic airway analysis.

CONCLUSION: Quantitative digital imaging upper airway analysis enables surgeons to assess the pre- and postoperative upper airway morphology quantitatively, objectively and accurately, and to correlate these changes in surgical parameters with improvement of obstructive sleep apnea. OBJECTIVE: This was a prospective study using a new method of quantitative computer-assisted digital-imaging videoendoscopic upper airway analysis to quantify objectively and correlate the changes in surgical parameters with improvement of obstructive sleep apnea following uvulopalatopharyngoplasty. PATIENTS AND METHODS: Nineteen male patients underwent uvulopalatopharyngoplasty for obstructive sleep apnea after continuous positive airway pressure trial. All had undergone pre- and postoperative digital imaging upper airway examination, Epworth scores, and polysomnographic studies. Postoperative static and dynamic changes in upper airway parameters were compared, analyzed and correlated with improvement of the apnea-hypopnea index (AHI) by statistical regression. RESULTS: There were 65.12% and 64.37% improvements in the AHI and Epworth scales, respectively, after uvulopalatopharyngoplasty. Retropalatal areas measured were significantly correlated with improvement of the AHI. A 1 cm2 increase in retropalatal area during Mueller's maneuver in the supine position resulted in an improvement of 32.65 in the AHI; a 1 cm increase in the transverse diameter of the retropalatal area in the erect position resulted in an improvement of 31.83 in the AHI.

Coblation vs electrocautery tonsillectomy: postoperative recovery in adults.

OBJECTIVE: Comparison of coblation and monopolar electrocautery tonsillectomy in terms of postoperative pain and recovery. STUDY DESIGN: Prospective double-blind randomized controlled trial. METHODS: Patients with recurrent tonsillitis requiring tonsillectomy were randomized to 2 groups: coblation or monopolar electrocautery tonsillectomy. Postoperative pain, complications, and days taken to return to work and normal diet were compared and analyzed with the aid of a pain diary, given to the patient. RESULTS: 67 patients were recruited. Patients undergoing coblation tonsillectomy were able to return to normal diet in a shorter space of time following surgery. Patients undergoing coblation tonsillectomy were more likely to recommend the surgery than patients undergoing electrocautery tonsillectomy. No significant differences in the daily visual analog score for pain were seen for both groups of patients. CONCLUSIONS: Our results showed that coblation tonsillectomy has a faster recovery period and may offer advantages when compared to monopolar electrocautery tonsillectomy.

Three-dimensional reconstruction and visualization of internal microstructure of median nerve / 中国矫形外科杂志

[Objective]To explore the application of computer in dealing with two-dimensional image information of human median nerve series freezing tissue sections,in order to develop nerve three-dimensional visualization system(3D Nerve),and finally to reconstruct 3D internal microstructure of human median nerve and realize 3D visualization.[Method]One fresh cadaver median nerve was taken,located with human hair and embedded in OCT.Series freezing tissue sections were made and stained with ACHE histochemistry method,and 2D image information was obtained through high resolution scanner.Microstructure of median nerve was finally reconstructed with 3D Nerve.[Result]Different cross sections of median nerve had quite different number and positions of fasciculi.In addition,characters of fasciculus' s internal nerve fiber were also quite different.Scross sections observation showed that all fasciculi were mixed fasciculi.With the 3D Nerve,the microstructure of median nerve was able to be observed in magnifying visual field at any cross section,and the tracking of stereo course of fasciculi in median nerve became possible.[Conclusion]Reconstructed 3D visualization can reveal the whole microstructure of median nerve and the three dimensional stereo-structure of fasciculi and fasciculus groups exactly and truly.It can provide exact topographic atlas and facilitate precise clixical repair of median nerve injury.

Self-extrusion of a foreign body from the upper digestive tract to the skin.

Migrated ingested foreign bodies from the upper digestive tract have the potential to cause life-threatening complications. Cases of spontaneous expulsion to the skin of the neck are very rare. We present an unusual case of an ingested foreign body that migrated out of the upper digestive tract and self-extruded via the skin of the neck. An approach to the safe management of such seemingly innocuous foreign bodies is discussed. This report highlights the message that non-found ingested foreign bodies should be treated seriously due to the possibility of migration and resulting complications.

Preserving confidentiality when sharing medical database with the Cellsecu system.

We propose a computer system called Cellsecu that maintains the anonymity and the confidentiality of each cell containing sensitive information in medical database. Cellsecu attains this by automatically removing, generalizing, and expanding information. It is designed to enhance data privacy protection so a data warehouse can automatically handle queries. In most cases, health organizations collect medical data with explicit identifiers, such as name, address and phone number. Simply removing all explicit identifiers prior to release of the data is not enough to preserve the data confidentiality. Remaining data can be used to re-identify individuals by linking or matching the data to other database, or by looking at unique characteristics found in the database. A formal model based on Modal logic is the theoretical foundation of Cellsecu. As well, a new confidentiality criteria called "non-uniqueness" is defined and implemented. We believe modeling this problem formally can clarify the issue as well as clearly identify the boundary of current technology. Base on our preliminary performance evaluation, the confidentiality check module and the confidentiality enhancing module only slightly degrade system performance.