OBJECTIVE: To evaluate the preoperative virtual CT endoscopy about the simple congenital middle ear malformations and its clinical application. METHOD: Thirteen cases (16 ears) with simple congenital middle ear malformations were undergone high resolution CT scannig to collect the original image data, followed by 3-dimensional reconstruction to process the images to evaluate the possible lesions of the ossicular chain. Then, a comparative analysis was made between the finding of virtual CT endotoscopic and the finding that actually found during the operation of the ossicular chain lesions. RESULT: We found malleus and upper strcture of incus abnormity or embeded in upper inner wall of atticus in 5 ears; malleus, incus and stape all abnormity or absence in 3 ears, in the former two conditions we both selected auricular incision through attic pathway remaining intact canal wall; we found crus longum incudis hypoplasia orstructure suprastapedialis absence,stapes aberrance or absence in 8 ears, then we selected vestibular window fenestration and artificial stapes surgery. Postoperative external auditory canals and tympanic membranes were intact in 16 ears,and speech frequency hearing improved by average of 25-45 dB. The coincidence between virtual CT endoscopy and the ossicular chain abnormity under operating views were 100% in cases with congenital ear deformity. CONCLUSION Virtual CT endoscopy is a reliable reference for preoperative evaluation on congenital middle ear malformations.
Adolescent ; Adult ; Ear, Middle ; abnormalities ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Tomography, X-Ray Computed ; Young Adult

The general system of clinical engineering professional certification in Germany was introduced from the aspects of history, certification authority, requirement of certification, skills and knowledge points, methods of implementation and so on. Through comparative study, some suggestions were proposed to promote clinical engineering staff technology level assessment and certification, which might provide some references for the further improvement of clinical engineering certification system in China.

Objective To evaluate the effect of wild feces detection in Oncomelania hupensis environments on the surveil?lance of infection source of schistosomiasis,and find the weakness in schistosomiasis control in Hubei Province,so as to put for?ward the targeted strategies and measures. Methods Four environments with O. hupensis snails in endemic areas of Hubei Provinces,where human and livestock often haunted,were selected according to the river systems,namely the Juzhanghe River beach in Jingzhou City,Changjiang River beach in Jiayu County,Hanbei River beach in Tianmen City,and Changshou River beach in Zhongxiang City,then the snail survey and wild feces detection were implemented in the selected environments. Re?sults There were O. hupensis snails,livestock,wild feces of cattle or sheep as well as positive cattle feces found in all the 4 environments,and the positive rate of schistosome miracidium incubation was 47.62%. Conclusion The schistosome miracidi?um positive rate of wild feces of cattle is high in the environments with snails in endemic areas of Hubei Province ,which has high risk for schistosomiasis transmission.

Objective To explore the correlation of patient-controlled sedation of dexmedetomidine and Narcotrend values. Methods Forty patients with lower limb surgery were enrolled. Until CSEA block fixed , the electronic pump ran the patient-controlled sedation of dexmedetomidine. The parameter of electronic pump was set as follows: load dose 2 mL + background dose 1.5 mL/h + single dose 0.5 mL + locktime 20 s. The heart rate , mean arterial pressure, pressing times, effective times, OAA/S sedation scores and NI values were determined. Results At T4 point, the patients reached appropriate sedation. At T4 ~ T9 OAA/S scores kept 3 to 4. From T5 point, NI values showed significant decrease. After the T7 point. OAA/S scores and NI values reached the plateau time of (7.5 ± 1.8) min and (13.1 ± 3.4) min, OAA/S scores of 1, 2, 3, 4, respectively, corresponding roughly with NI values 95 to 100, 90 to 94, 65 to 89, 40 to 64. The correlation coefficient was 0.58. The time of NI values significant decreased in the younger group and in the elderly group, with (10.2 ± 1.6) min and (14.4 ± 2.2) min. In T5~ T9 point, NI values of the younger group were significantly lower than those in the elderly group. Conclusion Relevant relationships are observed between dexmedetomidine patient-controlled sedation depth and the narcotrend values under CSEA.

Objective To investigate the value of conventional ultrasound combined with contrast‐enhanced ultrasound in qualitative diagnosis of benign and malignant cervical lymph nodes (LNs) .Methods Totally 129 enlarged LNs in 112 cases were performed the 2‐dimensional ,color Doppler ultrasound ,and grey‐scale contrast‐enhanced ultrasound(CEUS)examinations .LNs were divided into the benign group and malignant group according to pathologic results .The aspect ratio ,eccentric medulla or medulla de‐fect ,echo type ,blood supply distribution ,contrast‐enhancement pattern and distribution equilibriuym of contrast agent were com‐pared between the two groups .Results The most of aspect ratio in the benign LNs group were ≥ 2 ,the cortex and medulla were uniform with symmetric increase and without microcalcification ,the blood supple was mainly the non‐blood flow type or hilar type , in contrast‐enhanced ultrasound ,the majority were the early hilar and medullar enhancement ,showing the centrifugally full filling ;the most of aspect ratio in the malignant LNs group were <2 ,medulla was eccentric or loss ,partial of LNs showed the increased parenchymal echo accompanied with cystic lesion and microcalcification ,the blood supply was mainly the peripheral and mixed types ,and the non‐hilar and medulla started enhancement pattern .The ultrasonographic parameters mentioned above were statisti‐cally different between the two groups ,in which the non‐hilar and medulla started enhancement patterns had the highest sensitivity and accuracy for diagnosing malignant LNs ,the positive predictive values of these parameters were higher ,whereas the negative predictive values were lower .Conclusion The conventional ultrasound combined with contrast‐enhanced ultrasonography has a higher practical value in qualitative diagnosis of cervical LNs ;the comprehensive judgment of multiple indicators can increase the differentiating ability for benign from malignant LNs .

Objective To understand the schistosomiasis endemic situation at a national surveillance site in Gong an Coun-ty Hubei Province. Methods According to The Scheme of Schistosomiasis Surveillance in China the schistosome infection rates of residents and cattle and the Oncomelaniahupensissnail status were investigated yearly in Zhangjiahu Village a nation-al surveillance site in Gong an County from 2004 to 2013. Results From 2004 to 2013 the human schistosome infection rates decreased from 10.66%to 0.58% and the cattle schistosome infection rates from 12.75%to 0. Meanwhile the snail areas and densities reduced and the schistosome infected snails were eliminated. Conclusion The schistosomiasis endemic situa-tion declined dramatically at the surveillance site and schistosomiasis is well-controlled.

Objective To investigate the effects of target-controlled infusion (TCI)of dexme-detomidine on the median effective concentration of effect-site (Ce50 )of propofol at loss of conscious-ness (LOC)in patients.Methods Sixty-four patients,28 males and 36 females,aged 20-60 years, ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery,were randomly allocated to receive dexmedetomidine of 0 ng/ml (group P),dexmedetomidine of 0.4 ng/ml (group D1),dexmedetomi-dine of 0.6 ng/ml (group D2)and dexmedetomidine of 0.8 ng/ml (group D3)for 1 5 min before TCI of propofol,n =1 6 in each group.The propofol infusion was started to provide an effect-site concen-tration of 1.0 μg/ml,and increased by 0.2 μg/ml when propofol effect-site concentration and target concentration were equilibrium until LOC.Results The Ce50 (95%CI )at loss of consciousness in groups P,D1,D2 and D3 were 2.30 (2.24-2.36)μg/ml,1.92 (1.87-1.96 )μg/ml,1.60 (1.55-1.65)μg/ml and 1.41 (1.35-1.45 )μg/ml,respectively.There was a negative correlation between the effect-site concentration of propofol-induced LOC and target concentration of dexmedetomidine (r=-0.84,P <0.01).Compared with groups P,D1 and D2,the incidence of bradycardia was higher in group D3 (P <0.05).Conclusion The Ce50 of propofol-induced LOC gradually decreases with in-creasing target concentration of dexmedetomidine.Combining propofol with dexmedetomidine of 0.4 or 0.6 ng/ml that can reduce the Ce50 of propofol-induced LOC,which is suitable for induction of an-esthesia with a lower incidence of bradycardia.

Objective To evaluate the sedative interaction between dexmedetomidine and propofol.Methods Sixty-four American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 20-60 yr,with body mass index of 19.0-25.0 kg/m2,scheduled for elective surgery under general anesthesia,were allocated into 4 groups (n =16 each) using a random number table:different target concentrations of dexmedetomidine groups (D1-4 groups).Dexmedetomidine was administered by target-controlled infusion (TCI) with the Markku model.The target plasma concentrations of dexmedetomidine were 0,0.4,0.6 and 0.8 ng/ml in D1-4 groups,respectively.At 15 min of dexmedetomidine TCI,propofol was given by TCI with Schnider model,and the initial target effect-site concentration was set at 1.0 μg/ml.After the target effect-site and plasma concentrations were balanced,the target effect-site concentration of propofol was gradually increased in increments of 0.2 μg/ml until loss of consciousness (Observer's Assessment of Alertness/Sedation Scale score was 1).The model of pharmacodynamic interaction was used to analyze the sedative interaction between the two drugs.Results There was no statistically significant difference in residual sums of squares fitted by using the model of pharmacodynamic interaction between the target effect-site concentration of propofol and target plasma concentration of dexmedetomidine at loss of consciousness (P＞0.05).The linear dimensionless parameter of pharmacodynamic interaction was 0.The median effective effect-site concentration of propofol was 2.38 μg/ml at loss of consciousness,and the median effective plasma concentration of dexmedetomidine was 2.03 ng/ml at loss of consciousness.Conclusion Dexmedetomidine and propofol interact additively in terms of sedation.

The effect of triptolide (TP) on the expression of receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) was explored in rat adjuvant induced arthritis (AA). AA was induced in Wistar rats. Arthritis rats were treated with TP and methotrexate (MTX) at the onset (day 9) of arthritis. On the peak of arthritis (day 24), the expression of RANKL and OPG protein in the joints and RANKL mRNA in peripheral blood mononuclear cells (PBMC) was detected. TNF-alpha and IL-1beta levels in peripheral blood were determined. Bone erosion scores were also evaluated. The results showed that bone erosion scores in TP and MTX groups were lower than in AA group (P < 0.01); The expression levels of RANKL in the synovium (P < 0.01) and bone (P < 0.05), and OPG level in synovium (P < 0.05) were lower in TP group than in AA group (P < 0.05). In TP group, the expression levels of RANKL mRNA and TNF-alpha, IL-1beta in PBMC were lower than in AA group (all P < 0.01). It was concluded that TP could inhibit rat adjuvant arthritis bone erosion by suppressing the expression of RANKL.

Helicobacter pylori(Hp) infection plays an important role in the development of gastric carcinoma. Colonization of CagA-positive Hp is a great risk for intestinal gastric carcinoma. The mechanism of Hp infection changing the gastric epithelium at the molecular level is complex and through multiple pathways. Animal models can be of great help in exploring the role of Hp infection in gastric cancer development. This paper reviewed the latest studies of epidemiology, animal model and molecular pathogenesis of Hp associated gastric cancer.