Objective Molecular targeted drugs have anti-angiogenesis and anti-tumor effects.The study was to investigate the role of sunitinib on treating metastatic renal cell carcinoma ( mRCC) and its long-term efficacy and adverse reactions. Methods From November 2007 to March 2013, 281 mRCC patients were divided into two groups according to their own willingness.102 patients in the experimental group received sunitinib 50 mg per day.Pain score, metastatic focuses before and after targeted therapies were compared.179 patients in control group was treated by immunotherapy.Kaplan-Meier survival analysis was used to draw the survival curves and Cox regression model was applied in multivariate analysis. Results There was no difference between the two groups on baseline (P>0.05).In the experimental group, 78 cases were clear cell carcinoma, with remission rate 29.4%, stablity rate 53.8%and total effective rate 83.2%after treatment;15 cases were papillary renal cell carcinoma, with remission rate 33.3%, stablity ratio 46.7%and total effective rate 80.0% after treatment;9 cases were collecting duct carcinoma, with the remission rate 22.2%, the stablity ratio 55.6% and the total effective rate 77.8% after treatment.The bone scan after 1 cycle of treatment showed 2 cases progressed(10.5%), 5 cases relieved(26.3%) and 12 cases sta-blized(63.2%), the total effective rate of bone metastasis amounting to 89.5%, the effective rate of lung metastasis 81.7%, the effective rate of liver metastasis 60.0%and the effective rate of lymph node metastasis 72.8%.The median overall survival in the experimental group was 28.9 months, 20.7 months in control group(P<0.05).Cox regression analysis showed age, tumor classification, liver, lung, bone and lymph node metastasis were prognostic factors influencing mRCC.The common averse events were white blood cells, thrombocytopenia, neutropenia and hypoalbuminemia. Conclusion Sunitinib for the treatment of mRCC can diminish the metastatic focuses , ease the pain , improve the quality of life, delay the progression of the disease, and prolong the overall survival.

A total of 210 female patients with overactive bladder (OAB) were divided into M receptor blockage (M,n =71),pelvic floor muscle stimulation physiotherapy (S,n =70) and combination (C,n =69) groups.After one course of treatment,the OAB symptom scores were compared to pretreatment values (P ＜ 0.05).After a second course,the overall response rate was 69％ in group S.Pelvic floor muscle stimulation physiotherapy provided excellent sustained outcomes.

OBJECTIVETo explore the mechanism of the aging deformity of tear trough through the anatomic study of the tear trough region.

METHODS13 adult cadaveric heads (26 sides), including 9 male heads (18 sides) and 4 female heads (8 sides), aged 22-78 years old, were used. Anatomic study was performed around the orbital, especially tear trough region, with microsurgery instrument under microscope( x 10 times). The lower orbicularis retaining ligament was dissected and exposed. The anatomic location was recorded and photographed.

RESULTS(1) The anatomic layers of the tear trough region contains skin, subcutaneous tissue, orbicularis oculi muscle, periosteal membrane. There is no subcutaneous fat above the tear trough, while it exists below the tear trough, called malar fat pad. (2) There is a natural boundary between the septal and the orbital portions of the orbicularis oculi muscle of lower eyelid at surface of the orbital bone. The natural boundary, projected on the body surface corresponds to tear trough. The width of boundary is (2.06 +/- 0.15) mm on the vertical line through inner canthus and (3.25 +/- 0.12) mm on the vertical line through the lateral margin of the ala. The septal portion and the orbital portion of the orbicularis oculi muscle began to merge in (16.56 +/- 0.51) mm to inner canthus. (3) There is ligament attachment in the medial, upper and lower orbital and no ligament attachment in the lateral orbital. Orbicularis retaining ligament of lower eyelid is divided into two layers. (4) The medial of the upper layer of the orbicularis retaining ligament in lower eyelid originates from orbital margin and from preorbital walls laterally in (16.10 +/- 0.43) mm to the medial of lateral orbital margin, through orbicularis oculi muscle and ends at the skin. The lower layer of the orbicularis retaining ligament of lower eyelid originates from preorbital walls through orbicularis oculi muscle and its superficial fat, then ends at the skin.

CONCLUSIONSThe length of tear trough is (16.56 +/- 0.51) mm, the width of tear trough is (2.06 +/- 0.15) mm and (3.25 +/- 0.12) mm on the vertical line through inner canthus and the lateral margin of the ala nasi respectively. The main reason of the aging deformity of tear trough attributes to the increased distance between the upper and lower layers of the orbicularis retaining ligament in lower eyelid, which is caused by loose of the orbicularis retaining ligament and its underlying fat atrophy or decline.

Adult ; Aged ; Aging ; Cheek ; anatomy & histology ; Eyelids ; anatomy & histology ; Facial Muscles ; anatomy & histology ; Female ; Humans ; Lacrimal Apparatus ; anatomy & histology ; Male ; Middle Aged ; Young Adult

Objective To identify the anatomical basis for aging orbit-malar fold forming orbitmalar groove and its underlying mechanism.Methods Thirteen cadavers (26 hemifaces) were dissected in this study (9 male and 4 female heads).All specimens were fixed in 10％ formalin,with age ranges from 22 to 78 years.The lateral orbital region was dissected in layers by mieroinsrument using 10 X loupe magnification,especially at the palpebral and the lateral orbital part,and then the anatomy layer was described; the lateral orbital thickening (LOT) was performed carefully to evaluate whether there were multiple anatomical contributions to anatomy.Anatomic observations were systematically recorded,sketched,and photographically documented.Results The lateral orbital layers included skin,subcutaneous adipose tissue,orbicularis oculi muscle,middle temporal fascia,and periosteum.The lateral orbital thickening was a triangular condensation of fascia,which extended over the lateral orbital rim onto the adjacent medial tem~ral fascia,the lateral orbital thickening was measured (9.28 ±0.45) mm in transverse width from Vertex triangle to lateral canchal,the inner part of the LOT sanwiched between orbibularis and obital septum,which consisted of upper lid and lower lid part,the lower lid part presented transverse V shape,the top part of the transverse V was adhesive to fascial tissue over tarsal plate.The distance to lateral canthus angular was 21.69-37.21 mm,and the under part was adhesive to low orbital rim the low arm distance to lateral canthus angular was (13.55 ±0.52) mm.Vertex of.V to lateral canthus angular vertical distance was (11.35±0.27) mm.Conclusions The reason why aging orbit-malar fold forms orbital-malar groove is the atrophy of the subcutaneous adipose tissue and the middle temporal fascia fat.

Objective To investigate the forming mechanism of smile anatomically,and to analyze the changes of aging characteristics of mid-lower face.Methods Ten (with 20 sides) adult fresh cadaveric heads were fixed by formalin,and then nasolabial fold morphology was observed under 10X operating magnifying glass,and compared with alteration of the middle and lower face aging features under the state of smiling and static according to observation from 50 doctors' and out-patients' photos.Results The nasolabial fold was the boundary between fatty and fat-free zone in the middle face,the lateral side of which was malar fat pad.The nasolabial fold was the linear area,which was formed by the insertions of seven mimetic muscles on the skin.When smiling,the nasolabial fold and cheek groove,got deep and extended,cheek stripe became obvious.While smiling,malar fat pad shifted up,and tear trough became deformity..64％ disappeared and 36％ getting shallow and appearance improved; orbit-malar fold showed 100％ horizontal part disappeared,74 ％ vertical part became shallow and improved,and 26％ stayed stable; mid-cheek fold showed 78％ dissovled,22％ getting shallow and improved; Labiomandibular fold showed 100％ Ⅲ degree disappeared,100％ Ⅱ degree dissovled,74％ Ⅰ degree disappeared,and 26％ getting shallow and ameliorated; submaxilla line showed 18％ getting smooth and 82％ remained.Conclusions Smiling is produced by movement of mimetric muscles,and its orgin is from nasolabial fold.A smile could make malar fat pad upwards to mask some aging characteristics of middle and lower face,which is helpful to form a younger face.

Objective To explore the methodology of reconstruction of a three-dimensional model of lid/cheek junction through continuous paraffin sections and stained lid/cheek junction three-dimensional visualization,and to further explore the feasibility and reliability to provide anatomical basis for clinical teaching of plastic and reconstructive surgery.Methods The full size of lid/cheek junction was cut from the specimens,the size of 25 mm× 15 mm× 10 mm,and then embedded in paraffin,and sectioned in thickness of 15 μm for 200 slices;the experimental HE staining and Masson staining were conducted,Sony camera photos using Adobe Photoshop CS 5.1 image processing software for image registration and 3D-Docter software image segmentation were used to give different colors for establishment of complete three-dimensional model.Results Histologically the LOT of the fascia area,the existence of reconstruction and the LOT model were confirmed.It showed the histological characteristics:the Masson stain displayed red,blue and white tissues in color;fascia tissue staining infered intertexture of elastic fibers and collagen fibers in LOT.LOT was the bottom edge of the triangle toward the orbital base with length of 26 mm,31 mm in high,0.8 mm in thick,and area of approximately 4.03 cm2 in size.Layers of skin,orbicularis oculi muscle,orbicularis retaining ligament,middle temporal fascia,periosteum and LOT were visible in the 3D model.By the three-dimensional model of lid/cheek junction,adjacent relationship could be rotated to any angle.Conclusions This initial establishment of a three-dimensional model of the lid/cheek junction confirms that the histological characteristics of lid/cheek junction and the feasibility of the fine structure of soft tissue within the three-dimensional model can be used as a new method for further research.

OBJECTIVETo discuss the roles of serum interleukin-18 (IL-18), interleukin-10 (IL-10) and soluble interleukin-2R (sIL-2R) in the pathogenesis of chronic hepatitis C and to observe the effects of interferon (IFN) on the above- mentioned serum cytokines.

METHODSThe levels of above- mentioned cytokines were detected in 10 healthy individuals, 24 asymptomatic hepatitis virus C (HCV) carriers and 27 patients with chronic hepatitis C (before and after IFN treatment) using enzyme linked immunosorbent assay (ELISA).

RESULTSThe levels of the cytokines in patients with chronic hepatitis C are higher than in healthy people (P < 0.05) and in asymptomatic HCV carriers (P < 0.05). The values of the cytokines show a significant positive correlation to ALT (P < 0.05). Levels of tested cytokines decreased observably after IFN treatment (P < 0.05). The grades of the serum levels for sIL-2R and IL-10 before IFN treatment (from high to low) were categorized accordingly: non-response group > partial- response group > complete- response group (P < 0.05).

CONCLUSIONSThe tested cytokines co-participate in the pathogenesis of chronic hepatitis C, and can be used to evaluate the effect of IFN on the immune state of organisms. Furthermore, sIL-2R and IL-10 are important for predicting the anti-viral efficacy of IFN.

Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; Female ; Hepatitis C, Chronic ; blood ; drug therapy ; Humans ; Interferon-alpha ; therapeutic use ; Interleukin-10 ; blood ; Interleukin-18 ; blood ; Male ; Middle Aged ; Receptors, Interleukin-2 ; blood ; Recombinant Proteins

The clinical pathological data of a patient large cell undifferentiated bladder carcinoma was retrospectively analyzed and understand.The clinical and imaging findings of large cell undifferentiated bladder carcinoma was nonspecific.Diagnosis depended on the pathological and immuno-histochemical staining.The tumor is aggressive with high risk of recurrence.It is mainly treated with radical resection.

Objective:To investigate the effect of the liquid resuscitation therapy strategy using intra-abdominal pressure (IAP) and oxygenation index (PaO 2/FiO 2) as the end point in patients with severe acute pancreatitis (SAP). Methods:A retrospective study was performed, including 84 patients with SAP in emergency intensive care unit of Qingzhou Hospital Affiliated to Shandong First Medical University from January 2018 to August 2021. According to the status of fluid balance at admission, all patients were divided into the positive fluid balance group (43 cases) and the negative fluid balance group (41 cases). The clinical data including gender, age, etiology, underlying disease, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) of all patients were collected. Fluid balance, PaO 2/FiO 2, IAP, compliance rate, new mechanical ventilation rate and overall hospital stay of 1 week after admission were recorded and compared between the two groups. Results:After 72 hours of treatment, the cumulative fluid balance was (5 219.5±1 038.4) mL in the positive fluid balance group; IAP was higher than that before treatment [mmHg (1 mmHg≈0.133 kPa): 11.9±2.0 vs. 11.7±2.1], but no significant difference was found ( P > 0.05); PaO 2/FiO 2 was significantly higher than that before treatment (mmHg: 299.8±51.4 vs. 220.5±50.4, P < 0.05). After 72 hours of treatment, the cumulative fluid balance in negative fluid balance group was (-3 542.4±1 310.6) mL; IAP was significantly lower than before treatment (mmHg: 11.4±1.8 vs. 15.2±1.9, P < 0.05); PaO 2/FiO 2 was significantly higher than that before treatment (mmHg: 309.9±50.9 vs. 215.4±49.7, P < 0.05). In the fluid resuscitation goals, after 72 hours of treatment, the compliance rate in the negative fluid balance group was significantly higher than that in the positive fluid balance group [82.93% (34/41) vs. 62.79% (27/43), P < 0.05]; 1 week after admission, the new mechanical ventilation rate in the negative fluid balance group was significantly lower than that in the positive fluid balance group [21.95% (9/41) vs. 41.86% (18/43), P < 0.05]; however, there was no significant difference in overall hospital stay between the two groups (days: 41.2±10.9 vs. 39.1±11.5, P > 0.05). After treatment, 70 patients survived and 14 patients died (including 9 cases in the positive fluid balance group and 5 cases in the negative fluid balance group). Conclusions:Using IAP and PaO 2/FiO 2 to guide liquid therapy could result in effective fluid resuscitation in SAP. The treatment strategy effectively improved prognosis of patients with SAP.

Objective:To explore the effect of the new model of "5G cloud plus medicine" network and linkage in improving the therapeutic effect for patients with severe trauma.Methods:A retrospective cohort study was conducted to analyze the clinical data of 410 patients with severe trauma admitted to Qingzhou People′s Hospital affiliated to Shandong First Medical University from November 2016 to November 2020. There were 258 males and 152 females, aged 16-80 years [(45.7±16.1)years]. The injury severity score (ISS) ranged from 17 to 55 points [(28.1±7.6)points]. A total of 210 patients with severe trauma were rescued by using the new model of "5G cloud plus medicine" network and linkage from November 1, 2018 to November 30, 2020 (observation group), and another 200 patients with severe trauma were rescued by the traditional treatment mode from November 1, 2016 to October 31, 2018 were selected as the control group. Time to start rescue (time from admission to the start of rescue), CT examination time (time from consultation to completion of CT scan), time to receive blood transfusion (time from blood transfusion request to execution), residence time in emergency room, ISS at postoperative 28 days, proportion of patients with blood transfusion, success rate of rescue and mortality rate were compared between the two groups.Results:Time to start rescue [(2.4±1.1)minutes], CT examination time [(29.1±10.3)minutes], time to receive blood transfusion [(28.1±10.2)minutes] and residence time in emergency room [(3.0±1.1)hours] in observation group were significantly shorter than those in control group [(5.5±1.2)minutes, (42.8±10.1)minutes, (48.5±13.1)minutes, (5.0±1.4)hours] (all P<0.05 or 0.01). ISS was (18.7±2.8)points in observation group, significantly lower than (22.1±3.4)points in control group ( P<0.05). Proportion of patients with blood transfusion was 49.5% (104/210) in observation group, similar with 42.5% (85/200) in control group ( P>0.05). Success rate of rescue was 99.0% (208/210) in observation group, significantly higher than 93.0% (186/200) in control group ( P<0.05). The mortality rate was 4.3% (9/200) in observation group, significantly lower than 8.5% (17/200) in control group ( P<0.05). Conclusion:For patients with severe trauma, the new model of "5G cloud plus medicine" network and linkage can effectively shorten the time to start rescue, CT examination time, time to receive blood transfusion and residence time in emergency room, improve the success rate of rescue and reduce the mortality rate, which is worthy of further promotion.