Objective To observe the short term curative effect,life quality,adverse reactions of Jianpibufei decoction combined with chemotherapy in the treatment of patients with advanced non small cell lung cenacer.Methods 60 patients with advanced non small cell lung cenacer were randomly divided into the treatment group and the control gnoup,each group 30 cases.The treatment group was treated with TP scheme and Jianpibufei decoction.The contwl group was only treated with TP scheme.The effect,life quality and the injury of liver and kidney function was observed and compared between the two groups.Results The difference of the remission rate between the two groups had no statistical significance(x2 =0.418,P ＞ 0.05).The improving rate of life quality in the treatment group was 70％,and higher than that in the control group(40％)(x2 =6.545,P ＜0.05).The reduction of the white blood cell,the hemoglobin,platelet and the injury of liver function in the treatment group were lower than those in the control group obviously(Z=-2.516,-2.184,-2.059,-2.097,all P＜0.05).Conclusion Jianpibufei decoction combined with chemotherapy in the treatment of patients with advanced non small cell long cenacer could not increase the effect,but could reduce the adverse reaction of the chemotherapy and improve the life quality of patients.

Objective To study the auditory perception and speech ability outcomes after cochlear implantation in prelingually deaf children with extremely severe neurosensory hearing loss and comorbid leukoencephalopathy.Methods Our study included 14 prelingually deaf children with leukoencephalopathy (confirmed by preoperative MRI scanning) who were treated with cochlear implantation in the Department of Otorhinolaryngology Head and Neck Surgery of Hainan Provincial People''s Hospital, including 8 males and 6 females of 1~6 yr with a mean age of 3.8 yr.Sixteen synchronous prelingually deaf children without central nervous system (CNS) diseases were also included as the control group, including 11 males and 5 females of 1~6 yr with a mean age of 4.4 yr.All the patients underwent pre-surgical assessments of audiology, radiology, speech ability and intelligence before cochlear implantation via transmastoid facial nerve recess approach was done, after which rehabilitation was provided at the Hainan Rehabilitation Center for Deaf Children.Categories of auditory performance (CAP) and speech intelligibility rate (SIR) were employed as the assessment criteria for the outcome of surgery, the scores of which at different timepoints after surgery were statistically compared through paired t-test between the two groups.Results All the patients gained post-surgical hearing and speech abilities to different degrees, whereas CAP and SIR scores both chronologically improved in the both groups.No statistical difference was revealed either in CAP or in SIR scores between the two groups at 6, 12 and 24 months after surgery (P>0.05).Conclusion Children with extremely severe neurosensory hearing loss can be reated with cochlear implantation even if they have comorbid leukoencephalopathy.The effects of auditory and speech rehabilitation for the same age patients with leukoencephalopathy are similar to those without leukoencephalopathy in 2 years after surgery.

Objective To study the effects of different types of exercise training on learning and memory, as well as on the expression of synaptophysin (SYP) and on postsynaptic density protein 95 (PSD-95) in rats in which a model of vascular dementia had been created.Methods Forty male Wistar rats were divided randomly into a voluntary exercise group (V-EX) , a forced exercise group (F-EX) , an involuntary exercise group (I-EX) , a vascular dementia group (VD) and a sham-operation group (Sham) , with 8 rats in each group.Two-vessel occlusion (2-VO) of the arteria carotis communis was used to create a model of vascular dementia in all of the rats except those in the sham-operation group.Beginning one week after the surgery, the V-Ex rats were free to run in a running wheel.The F-EX rats were forced to run 270 m a day in an electric wheel.The I-EX rats were stimulated to imitate the gait pattern of their forelimbs running at 9 m/min three times a day for l0 minutes each time.No special training was given to the rats in the other 2 groups.Three weeks after the surgery, their learning and memory were tested using a novel object recognition test.Immediately after the test, their prefrontal cortex was sampled and the expression of SYP and PSD-95 was detected using western blotting.Results The average novel object recognition indices of the rats in the V-EX, F-EX and I-EX groups were all significantly higher than that of the VD group.Average PSD-95 expression was also significandy higher than in the VD group.Conclusion Exercise, whether voluntary, forced or induced by functional electrical stimulation can improve learning and memory in vascular dementia, at least in rats.The mechanism is possibly that the training can increase the expression of PSD-95 in the prefrontal cortex, though not SYP.

Objective To compare the complication and cost-effectiveness of the deep inferior epigastric perforator(DIEP) flap and transverse rectus abdominis myocutaneous(TRAM) flap.Methods From January 2000 to December 2014,all patients who underwent DIEP flap and TRAM flap in the People's Hospital of Tangshan and the Affiliated Hospital of North China University of Science and Technology, were selected.Eleven patients underwent immediate breast reconstruction with TRAM flaps and 19 patients with DIEP flaps.The treatment cost,length of hospitalization, and complication in the two year after surgery for each group were compared.Results For the major complications,there were 5 cases appeared fat necrosis in TRAM group, and 1 case in DIEP group,the differences was statistically significant(P=0.016).One case appeared flap loss in TRAM group,and DIEP group was zero,both of the two group had no abdominal wall hernia, there was no significant difference (P ＞ 0.05).For the minor complications, there were 4 cases appeared postoperative hematoma in TRAM group, and 1 case in DIEP group, the difference was statistically significant(P =0.047).Two cases appeared wound dehiscence in TRAM group,and DIEP group was 1 case, 1 case happened infection in TRAM group,there was no statistically significant difference(P＞0.05).The treatment costs were (14 133.12±1 546.88)yuan for the TRAM group and (16 838.94± 3 006.05)yuan the DIEP group, the difference was statistically significant (P =0.010).The hospital stay was (17.28± 2.08)days for the pedicled TRAM group and (18.39±2.87) days for the DIEP group,the different was not statistically significant(P＞0.05).Conclusion The DIEP flap has a better clinical outcomes,but more expensive.

BACKGROUND: Osteogenic ability of bone morphogenetic protein-2 has been wel documented in many experiments, but a series of factors are involved in osteogenesis induction that is a complex network adjustment process. OBJECTIVE: To quantitatively determine the level of insulin-like growth factor I during the lumbar spinal fusion of rabbits induced by recombinant human bone morphogenetic protein-2. METHODS: Sixty adult male New Zealand white rabbits were randomly divided into three groups: bone autograft, bone al ograft or composite bone (bone al ograft with 75 μg recombinant human bone morphogenetic protein-2) was implanted into the L5-6 intertransverse process of rabbits, respectively. At days 7, 14, 21, 28, 35 after implantation, formed cal us was taken to detect the expression of insulin-like growth factor I using real-time fluorescence quantitative PCR. RESULTS AND CONCLUSION: In the three groups, the expression of insulin-like growth factor I gradual y increased with implantation time, peaked at 28 days and then decreased. At 7 days after implantation, the expression of insulin-like growth factor I was higher in the autograft group than the composite and al ograft groups (P < 0.05); at 14 days, the expression of insulin-like growth factor I was higher in the autograft and composite groups than the al ograft group (P < 0.05); at 21, 28 and 35 days, the expression of insulin-like growth factor I was higher in the composite group than the autograft and al ograft groups (P < 0.05). These findings indicate that recombinant human bone morphogenetic protein-2 can improve the expression of insulin-like growth factor I effectively during the lumbar spinal fusion.

OBJECTIVE: To investigate the clinical characteristics and common etiology of vertigo. METHOD: The clinical data of 168 patients with vertigo in the department of otolaryngolology and neurology from December 2007 to March 2009 were retrospectively analyzed The patients were inquired and examined by pure tone average thresholds, videonystagmography, Dix-Hallpike test, cervical spine X-ray, skull CT and (or) MRI and transcranial Doppler. RESULT: One hundred and thirty-four patients with vertigo were of peripheral origin, with 66 cases benign paroxysmal positional vertigo, 30 cases Meniere's disease, 24 cases sudden deafness, 5 cases vestibular neuritis, 5 cases otitis media ,2 cases ear herpes zosters and 2 cases ototoxicity. Among 26 patients with vertigo of central, 20 patients were vertebrobasilar TIA. CONCLUSION The most common etiology of the vestibular peripheral vertigo is the benign paroxysmal positional vertigo. Detailed history and the features of vertigo, particular about the duration of vertigo and hearing change, may provide the important evidences for the accurate diagnosis and differential diagnosis of vertigo.
Adolescent ; Adult ; Aged ; Electronystagmography ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Vertigo ; diagnosis ; etiology ; physiopathology ; Young Adult

Objective:To investigate the prognosis and influencing factors in critically ill surgical patients of different feeding intolerance trajectories.Methods:The retrospective cohort study was conducted. The clinical data of 354 critically ill surgical patients who were admitted to 69 medical centers in the Chinese Critical Care Nutrition Trials Group -NEED database from March 2018 to July 2019 were selected. There were 247 males and 107 females, aged 58(46,68)years. According to the trajectory model of feeding intolerance change, 354 patients were divided into 3 categories as feeding intolerance, decreased feeding intolerance, continuous feeding intolerance, including 164, 49, 141 cases respectively. Observation indicators: (1) general situations of patients of different feeding intolerance trajectories; (2) treatment of patients of different feeding intolerance trajectories; (3) survival of patients of different feeding intolerance trajectories; (4) analysis of pro-gnostic factors in critically ill surgical patients. Measurement data of normal distribution were expressed as Mean± SD, and one-way analysis of variance was used for comparison between groups. Measurement data of skewed distribution were expressed as M( Q1, Q3), and Kruskal-Wallis rank sum test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and chi-square test was used for comparison between groups. Ordinal data were compared using the Kruskal-Wallis rank sum test. Bonferroni correction was used for pairwise comparison. Group-based trajectory model was constructed according to Traj plug-in in Stata17.0 statistical software, and the optimal trajectory model was evaluated by Bayesian information criterion and average posterior probability parameter. The Kaplan-Meier method was used to draw the survival curve and calculate the survival rate, and Log-Rank test was used for survival analyses. Univariate and multivariate analyses were conducted using the COX proportional hazard regression model. Results:(1) General situations of patients of different feeding intolerance trajectories. Of 354 critically ill surgical patients, 257 cases underwent enteral nutrition and 97 cases underwent enteral plus parenteral nutrition. The acute physiological and chronic health score (APACHEII) was 17(13,21), and the sequential organ failure score (SOFA) was 6(5,8). The modified Critical Illness Nutritional risk score (mNUTRIC) was 4 (2,5), the number of complications was 2(1,3). There were 293, 55 and 6 patients with grade Ⅰ, grade Ⅱ and grade Ⅲ acute gastrointestinal injury (AGI), and there were 224, 17 and 61 patients who were treated with mechanical ventilation, continuous renal replacement therapy and vasoactive drugs, respectively. The incidence of feeding intolerance in 354 patients increased first and then decreased, reaching a peak of 25.42%(90/354) on the third day and 53.67%(190/354) within 7 days. Of 354 critically ill surgical patients, cases with no feeding intolerance, decreased feeding intolerance, continuous feeding intolerance had the APACHE Ⅱ as 16(12,20), 17(14,25), 18(13,22), mNUTRIC as 3(2,5), 4(3,6), 4(3,5), the number of complications as 2(1,2), 2(2,3), 2(2,3). There were 152, 27, 114 cases with grade Ⅰ AGI, 12, 22, 27 cases with grade Ⅱ-Ⅲ AGI, 95, 39, 90 cases with mechanical ventilation. There were significant differences in the above indicators among the three groups ( H=6.14, 13.11, 28.05, χ2=37.96, 7.65, P< 0.05). Further analysis showed that compared with patients with no feeding intolerance, patients with decreased feeding intolerance and continuous feeding intolerance had the higher number of complications and grade of AGI ( Z=60.32, 54.69, χ2=39.72, 9.52, P<0.05), patients with decreased feeding intolerance had the higher mNUTRIC scores and ratio of mechanical ventilation ( Z=53.41, χ2=7.59, P<0.05). (2) Treatment of patients of different feeding intolerance trajectories. Cases with prokinetic drugs use and post-pyloric feeding were 36, 13 of patients with no feeding intolerance, 25 and 10 of patients with decreased feeding intolerance, 46 and 19 of patients with continuous feeding intolerance, respectively, showing significant differences in the above indicators among the three groups ( χ2=15.76, 6.20, P<0.05). Further analysis showed that compared with patients with no feeding intolerance, patients with decreased feeding intolerance had higher ratio of prokinetic drugs use and ratio of post-pyloric feeding ( χ2=15.60, 6.10, P<0.05). (3) Survival of patients of different feeding intolerance trajectories. The 28-day overall survival rates of patients with no feeding intolerance, decreased feeding intolerance, and continued feeding intolerance were 96.96%, 95.92%, and 87.94%, respectively, showing a significant difference ( χ2=10.39, P<0.05). Further analysis showed a significant difference between patents with no feeding intolerance and patients with continuous feeding intolerance ( χ2=9.19, P<0.05). (4) Analysis of prognostic factors in critically ill surgical patients. Multivariate analysis showed that continuous feeding intolerance was an independent risk factor for 28-day death in critically ill surgical patients ( hazard ratio=3.92, 95% confidence interval as 1.43-10.79, P<0.05). Conclusion:For surgical critically ill patients, patients with continuous feeding intolerance have a higher 28-day mortality than patients with no feeding intolerance, and the continuous feeding intolerance is an independent risk factor for 28-day death in critically ill surgical patients.

Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.

Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.

Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.