Objective To study the effect of transcutaneous electrical acupoint stimulation (TEAS) on emergence agitation in children undergoing cochlear implantation.Methods Sixty patients (age range,1-4 years) scheduled to undergo pediatric cochlear implantation were enrolled and randomized into the TEAS group (group T,n =30) that received continuous TEAS and the control group (group C,n =30) that did not receive TEAS.Anesthesia time,operation time,change in blood flow dynamics during the perioperative period,extubation time,and PACU stay time were recorded.The incidence of emergence agitation and postoperative nausea and vomiting (PONV) was monitored.Results No significant intergroup differences were observed in age,sex,weight,operation time,and PACU stay time (P ＞ 0.05).The MAP and HR in group T were lower than those in group C at different time points such as 30 min after the start of surgery,the end of the surgery,the extubation and 5 min after extubation,and the difference was statistically significant (P ＜ 0.05).The FPS-R,FLACC,and PAED scores in group T were lower than those in group C at different time points within 30 min after exmbation (including the time of extubation),and the difference was statistically significant (P ＜ 0.05).Extubation time,anesthesia time,and incidence of PONV were lower in group T than in group C,and the difference was statistically significant (P ＜ 0.05).Conclusion TEAS combined with general anesthesia significantly reduces the incidence of emergence agitation in children undergoing surgery for congenital hearing loss;it also helps control hypotension,reheve dramatic hemodynamic changes during the waking period,and reduce the incidence of PONV.

Objective To investigate the effect of Probucol combined with Enalapril-folic acid tablets on endothelial function in elderly patients with H-type hypertension.Methods A total of 180 elderly patients with H type hypertension were randomly divided into three groups (n =60,each):Group A (conventional treatment),Group B (conventional treatment + a tablet containing 10 mg enalapril and 0.8 mg Folic acid/day) and Group C (conventional treatment + 500 mg Protocol twice daily + a tablet containing 10 mg Enalapril and 0.8 mg folic acid/day).Plasma hemocyanin (Hcy) and asymmetric dimethylarginine (ADMA) levels and serum nitric oxide (NO) and endothelial NO synthase (eNOS) levels were measured before treatment,and 1 and 6 months after treatment.Results In Group A,plasma Hcy and ADMA levels and serum NO and eNOS levels had no significant differences before treatment versus 1 and 6 months after treatment (P＞0.05).Plasma Hcy and ADMA levels decreased and serum NO and eNOS levels increased in Group B 6 months after treatment,compared with those at pretreatment or 1 month after treatment,which were either lower or higher than those in Group A 6 months after treatment (all P＜0.05).Plasma Hcy and ADMA levels decreased and serum NO and eNOS levels increased in Group C 6 months after treatment,compared with those at pretreatment or 1 month after treatment,which were either lower or higher than those in Groups A and B 6 months after treatment (all P＜0.05).After adjustment for other risk factors,partial correlation analysis showed that plasma ADMA was positively correlated with plasma Hcy,while plasma ADMA and Hcy were negatively correlated with serum eNOS and NO (all P＜0.05).Conclusions Probucol in combination with Enalapril-folic acid tablets may be beneficial in improving endothelial function and mitigating the development of atherosclerosis.

Objective To observe the histological features of muscular layers in different parts of esophagus of patients with achalasia (AC) and to explore the distribution and function of eosinophils in esophageal muscular layer in patients with AC.Methods From June 2015 to February 2016,21 patients diagnosed with AC by endoscopy,barium meal and esophageal high resolution manometry,accepted peroral endoscopic myotomy (POEM) were enrolled.At the same period,nine patients with esophageal carcinoma who received esophagectomy were selected as controls.Muscular tissues of lower esophageal sphincter (LES),distal esophagus (5 cm above LES) and middle esophagus (10 cm above LES) of patients with AC and controls were taken for regular haematoxylin-eosin (H-E) staining to analyze degree of eosinophils infiltration.Nonparametric analysis and Chi-square analysis were used for statistical analysis.Spearman correlation analysis was used for analyzing correlations.Results The results of H-E staining indicated that different degree of eosinophil infiltration was found in 18(85.7％) patients with AC,and eosinophil counts in muscular layer were over 15 per high power field in five patients with AC (23.8％,5/21).However,no eosinophils infiltration was found in esophageal carcinoma patients.Median numbers of eosinophil in muscular layer of LES,distal esophagus and middle esophagus were all higher than those of esophageal carcinoma group (4.0,2.0 to 10.0 vs 1.0,0 to 1.5;4.0,1.0 to 17.0 vs 1.0,0.5 to 1.5；6.0,0.5 to 15.0 vs 0,0 to 1.0),and the differences were statistically significant (Z=2.997,2.476 and 2.504,all P＜0.05).The distribution of eosinophils in muscular layer of LES,distalesophagus and middle esophagus between the two groups were statistically significant (x2=2.710,2.543and 2.313,all P＜0.05).The differences in eosinophils distribution in muscular layer of LES,distal esophagus and middle esophagus in patients with AC were not ststistically significant (x2 =0.110,P＞0.05).Additionally,number of eosinophils in muscular layer of different parts of esophagus was not correlated with age and disease course (r=0.434 and 0.639；P =0.282 and 0.088).Conclusion The wide distribution of eosinophils in muscular layer of esophagus in patients with AC may involve in the genesis and development of AC.

Objective Large-conductance culcium-activated potassium (BKCa) channel modulates vascular smooth muscle tone. In the present study, we tested the hypothesis that salt, one of the factors which significantly influence bleed pressure (BP), can regulate BKCa activity and then elevate blood pressure. Methods Male Spragne-Dawley rats aged 6 weeks were randomized into high salt diet group (HS) and control group, fed with high salt diet (containing 5% NaCi) and standard rat chow (containing 0.4% NaCl) respectively for 16 weeks. Tail systolic blood pressure (SBP), body weight (BW) and 24-hour urinary output were tested every 4 weeks. Content of urinary Na+ was detected using flame spectrophotometrical method. At the end of 16 weeks, all the rats were killed, the mesenteric arteries were obtained, and single mesenteric smooth muscle cells were isolated at once. The resting membrane potential (Em), the total potassium currents and the currents after perfusion with TEA solution of the cells were all recorded by whole cell patch clamp. The transcriptions of BKCa channel α and β1 sobunits in mesenteric arterial vascular smooth muscle cells (VSMC) of each group were calculated by real-time RT-PCR. Results There was no difference in SBP and BW at each stage between control group and HS group; the urinary Na+ level in HS animals was elevated significantly after 4 weeks.The negative values of Em in HS group VSMCs were reduced compared with these in the control group. Transcriptions of β1 subanit of BKCa channels were decreased in HS group, but α subunit transcriptions did not differ between the two groups. Whole cell potassium currents did not differ hetween HS and control groups, but BKCa currents of HS group VSMCs were lower than these of control group ones. Conclusion Even without elevating SBP, salt-loading can still modulate the expression and activity of BKCa channel in the mesenteric arterial VSMC and elevate vascular tone.

Objective To observe the clinical effect of Xiaoke-Yuzu decoction on diabetic peripheral neuropathy (DPN). Methods A total of 100 DPN inpatients were recruited and randomly divided into the treatment and control groups. The two groups were both received basic therapy, while the treatment group additionally received Xiaoke-Yuzu decoction. Toronto clinical scores and Chinese medicine symptom scores of both groups were collected to evaluate the clinical effect before and after the therapy. Results The Toronto scores of treatment group were significantly lower than control group after treatment (symptoms score 1.50 ± 0.94 vs. 2.23 ± 1.01, reflection score 3.60 ± 1.77 vs. 4.27 ± 1.72, feeling test score 1.53 ± 0.63 vs. 2.10 ± 0.84,all P<0.05). Meanwhile, the Chinese medicine symptom scores of treatment group were also significantly lower than the control group (main symptom score 1.77 ± 1.17 vs. 3.17 ± 1.82, posterior symptom score 2.23 ± 1.59 vs. 4.27 ± 1.57, the tongue and pulse score 1.83 ± 0.65 vs. 2.47 ± 0.51, all P<0.05). Conclusion Xiaoke-Yuzu decoction plus basic therpy could improve the clinical symptoms of DPN patients.

OBJECTIVE: To Study the clinical features of congenital microtia and atresia . To evaluate the methods and results of the same microtia surgery, ear canal and middle ear reconstruction. METHOD: Statistically analysis of the data of the hospitalization microtia 62 ears of 58 cases of patient in our department from January 2005 to October 2010 waw conducted. These patients with congenital ear malformations are associated with aural atresia, ossicular chain abnormalities, severe conduction Deafness. All patients received preoperative temporal bone CT examination and reconstruction, hearing examination. Operation was given in two phases, first operation aim to form a line of ear, ear canal reconstruction, ear reconstruction, the second one aim to line of ear skin graft, cranial angle of the ear reconstruction. The preoperative and postoperative data were retrospectively analyzed. RESULT: The auricle plus external auditory canal, middle ear reconstruction came out with a good shape of the ear and the ear canal in close proximity to the normal population. Most patients' hearing were improved after surgery. CONCLUSION Surgeries of patients with congenital ear malformations and aural atresia should be carefully designed according to the three-dimensional reconstruction of multislice spiral CT reconstruction, which can provide information about surgery approach and middle ear abnormality. The whole ear shape and hearing ear after reconstruction are improved after the surgery.
Adolescent ; Angioplasty ; Congenital Microtia ; surgery ; Ear ; Ear Auricle ; abnormalities ; surgery ; Ear Canal ; abnormalities ; surgery ; Ear, External ; abnormalities ; surgery ; Hearing ; Hearing Loss ; surgery ; Humans ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skin Transplantation ; Tomography, X-Ray Computed

Objective: To investigate the effect of nicorandil on ventricular arrhythmia in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with emergent percutaneous coronary intervention (PCI). Methods: A total of 120 acute STEMI patients treated with emergent PCI in our hospital from January 2015 to June 2016 were randomly divided into control group and experiment group (n=60 each). Patients in both groups received conventional therapy.Patients in experiment group took 10 mg nicorandil orally before PCI and received oral nicorandil treatment (15 mg/d, three times daily) for 3 days.QT disperse(QTd), correct QTd(QTcd) and the occurrence rate of ventricular arrhythmia were compared between two groups. Results: QTd at 6, 24, 48 and 72 hours((70.6±4.4), (67.2±5.3), (55.7±8.5), (48.2±8.2) ms, respectively) after PCI was significantly lower in the experiment group than those of control group ((77.1±7.1), (71.3±6.5), (65.1±8.1), (57.2±5.4) ms, all P<0.05). The level of QTd was also significantly lower in the experiment group at 6, 24, 48 and 72 hours((77.5±7.7), (67.7±8.6), (61.2±7.5), (52.9±8.4) ms, respectively) after PCI comared to those of control group ((88.6±8.1), (79.2±7.8), (74.4±7.4), (69.6±8.6) ms, all P<0.05). There was no significant difference in the incidence of reperfusion arrhythmia during PCI procedure between the two groups.The prevalence of the ventricular premature beat in the experiment group (25/60, 41.7%) was significantly lower than in the control group(45/60, 75.0%) within 3 days after PCI(P<0.01), the prevalence of the no sustained ventricular tachycardia and ventricular fibrillation in the experiment group(6/60, 10.0%) was also significantly lower than in the control group (18/60, 30.0%, P<0.01) within 3 days after PCI. Conclusions Nicorandil use prior and post PCI could decrease the occurrence rate of ventricular arrhythmia in STEMI patients undergoing emergent PCI, and this effect might be related with reduced QTd and QTcd post medication.

This paper reports a case of a male patient with diabetes for more than 20 years who came to see doctor due to weakness, poor appetite and significantly elevated blood glucose. At first, it was considered that the poor blood glucose control of diabetes was the reason, and the possibility of diabetes related complications already existed. Hospital routine examination indicated a globulin increase and immunologic examination indicated that IgM was mainly increased. Subsequent imageological diagnosis revealed a small amount of bilateral pleural effusion, and after 2 weeks of hypoglycemic treatment, the blood glucose was significantly improved, but the symptoms still existed. In combination with the patient′s laboratory examination, considering the combination of blood system diseases, the hematology department was invited for consultation. Immunoelectrophoresis, bone marrow cytology, and flow cytometry were further conducted, and the patient was diagnosed with Waldenstrom macroglobulinebia. Bortezomib + dexamethasone regimen was given for chemotherapy. Currently, the patient has received 1 course of chemotherapy, and the symptoms of poor appetite were significantly improved. Coexistence of diabetes mellitus and Waldenstrom macroglobulinebia is very rare in clinical practice, and it is easy to be misdiagnosed as a complication of diabetes mellitus, both of which can be manifested as poor appetite, weakness, peripheral neuropathy and other symptoms. When diabetic patients have abnormal immunoglobulin increases and other abnormal test results that cannot be well explained by diabetes, other potential disorders, such as hematological diseases, should be considered to avoid missed diagnosis.

Objective: To evaluate the short-term efficacy of Broström-Gould repair combined with Internal Brace artifi-cial ligament reinforcement under arthroscopy for anterior talofibular ligament injury in overweight and poor ligament quality popu-lation. Methods: A total of 12 patients with anterior talofibular ligament injury treated by arthroscopy were enrolled from October 2017 to May 2018, involving 7 males and 5 females aged from 16 to 57 years old (mean 32.4 years). Patients were with ankle insta-bility, and their BMI was 28.0-30.7 kg/m² (average, 28.8±0.91 kg/m²), among which there were 2 cases of poor ligament quality (Beighton score ≥4). The anterior tibiofibular ligament injury and the quality of the ligament stump were intraoperatively evaluated under arthroscopy. A 4.75 mm diameter anchor with Internal Brace artificial ligament was inserted into the fibula insertion site, and non-absorbable suture was placed at the talus under total arthroscopy. Firstly, the non-absorbable line on the anchor was per-formed under the standard Broström-Gould procedure to repair the anterior talofibular ligament, and the other end of the ligament was fixed near the distal end of the talus. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and foot and ankle ability measure (FAAM) was compared before and after surgery. Results: All the incisions were healed in the first stage after operation, and no operative complications such as infection occurred. All the 12 patients were followed up for 7 to 12 months (average 9.1 months). After 2 weeks, the patient began functional exercise and could walk with ankle braces. At the latest follow-up, the anterior drawer test was negative. The ankle-posterior foot score of AOFAS was increased from 61.3±7.9 (preopera-tive) to 85.0±6.0 (latest follow-up) (t=21.422, P< 0.01), and the FAAM score was increased from 57.5±10.1 (preoperative) to 86.3±4.8 (latest follow-up) (t=15.032, P< 0.01). AOFAS score was excellent in 1 case and good in 11 cases. The excellent and good rate was 100% (12/12). No complications such as infection and re-rupture occurred after operation. Conclusion For anterior talofibu-lar ligament injury patients with overweight or poor quality of ligament, the Broström-Gould procedure can be applied to strengthen under arthroscopic Internal Brace ligament without additional tendon reconstruction, which can also obtain good results.

Objective To study the features and clinical value of 18F-fluorodeoxyglucose (FDG) PET/CT in prosthetic vascular graft infections (PVGIs) after endovascular aortic repair (EVAR).Methods Data of 27 patients (22 males and 5 females,age range:21-77 years,average age:42 years) who underwent PET/CT imaging after EVAR from October 2011 to January 2017 were studied retrospectively.A total of 11 cases were finally diagnosed as PVGIs (PVGIs group),and the remaining 16 cases were defined as the negative group.PET/CT imaging features were compared between two groups.The detection rates of PET/CT and aortic CT angiography (CTA) for PVGIs were calculated and compared.Two-sample t test and Fisher exact test were used for data analysis.Results Significant uptake of FDG around the stents was detected by PET/CT in all patients in PVGIs group.The maximum standardized uptake value (SUVmax) of 11 patients in early imaging was 14.9±3.3 (10.8-21.8) and that of 9 patients in delayed imaging was 13.8±3.4 (10.6-19.1).Six patients of the negative group underwent the delayed imaging.No uptake or mild uptake of FDG around the stents was observed in negative group,with the SUVmax of 1.7±0.8(1.0--2.9) in early imaging and 1.6±0.7(1.1-2.5) in delayed imaging.SUVmax in negative group was significantly lower than that in PVGIs group (t values:12.6 and 11.8,both P＜0.001).Five patients in PVGIs group were diagnosed as graft infections by the aortic CTA,while the remaining 6 cases showed no definitive infection signs on aortic CTA.The detection rate of aortic CTA was 5/11,which was significantly lower than that of PET/CT (P＜0.05).In negative group,6 patients had abnormal FDG uptakes in other areas and were finally confirmed as infectious lesions (n=3) or malignant tumors (n=3).Conclusion Compared with aortic CTA,18F-FDG PET/CT is more sensitive and accurate in detection and diagnosis of PVGIs after EVAR.