Objective To observe the expression of MMP-1, TNF-a in cholesteatoma and to determine their roles in the destruction of bone and their correlation. Methods Immunohistochemical method and the computer image quantitative analysis were used to examine the expression of TNF-α and MMP-1 in 22 cases of chotesteatomamiddle ear and 20 cases of normal external acoustic meatus skin. Results Positive stainings of MMP-1 and TNF-α were both localized in cytoplasm. The MMP-1 positive cells were found in all strata of cholesteatoma epithelium and active multiplication stromal cell. TNF-α was expressed in both epithlium and stromal cells. The results of the computer image quantitative analysis showed that the mean optical density of MMP-1 (0. 2013±0. 0106) and TNF-α (0.3852±0.0318) in cholesteatoma were higher than that in normal skin epithelial tissue( P＜0.05 ). Conclusion (1)MMP-1 and TNF-α are overexpressed in cholesteatoma. (2)MMP-1 and TNF-α have a correlation in their expression. (3)MMP-1 and TNF-α are both observed in stromal cells which indicates that stromal cells play an irnportant role in bone destruction.

Objective To evaluate the treatment results and side-reactions of esophageal carcinoma treated with late course accelerated hyperfration radiotherapy plus concurrent chemotherapy(LCAHR+C). Methods A prospective randomized trial was carried out on 173 esophagus squamous carcinoma patients whom were randomized into two groups:1. LCAHR group—89 patients treated by conventional fractionated radiotherapy during the first two-thirds of the whole course with 40Gy in 20-22 fractions, then followed by LCAHR with 20-30Gy in 14-20 fractions, 1.5Gy per fraction, 2 times per day, to a total dose of 60-70Gy in 34-42 fractions over 37-42 days; 2.LCAHR+C group—94 patients were received the same radiotherapy as LCAHR, supplement with concurrent chemotherapy from the first day of radiotherapy. The chemotherapy regimen was LFP: intravenous infusion of cisplatin 20mg/d, calcium folinate 100mg/d and 5-fluorouracil 500mg/d for five consecutive days, every 28d as one cycle to totally 4 cycles. Results The short-term effective rate was 85% and 95% in LCAHR and LCAHR+C group,respectively(?~2=4.45,P=0.035).The 1-,2-and 3-year local control rate was 73%,55%,49% and 83%,73%,65% in LCAHR and LCAHR+C group, respectively(?~2=5.32,P=0.021).The 1-,2- and 3-year survival rate was 74%,53%,41% and 84%,65%,52% in LCAHR and LCAHR+C group,respectively(?~2= 2.85 , P= 0.091 ).The leucocytopenia and gastrointestinal tract side-reactions in LCAHR+C group were more severe than those of LCAHR group(?~2=7.85,15.06;P=0.005,0.000). Conclusions Late course accelerated hyperfractionated radiotherapy plus concurrent chemotherapy can be taken as a effective treatment for esophageal carcinoma. It can improve short-term curative effect and local control rate, in spite of increase in leucocytopenia and gastrointestinal tract side-reactions.

OBJECTIVE: To investigate the clinopathological characteristics, differential diagnosis, therapy and prognosis of sinonasal mucosal malignant melanoma. METHOD: Clinopathological data of 18 cases which were diagnosed by pathology and immmunohistochemistry were analyzed retrospectively. All cases were proved by pathology and immmunohistochemistry. All cases were performed operations. 5 underwent single surgery. 4 underwent surgery plus adjuvant radiotherapy. 4 underwent surgery plus adjuvant radiotherapy chemotherapy. 5 underwent surgery plus adjuvant chemoradiation. RESULT: All cases were followed up for a period of 1 to 7 years after operation. Twelve patients died of tumor until the last follow-up, meanwhile 6 patients stayed alive. In Six cases recurrence occurred. In five casescervical lymph node metastasis occurred, of which 3 cases received neck dissection and 2 cases received chemotherapy and radiotherapy due to no surgical indications. In three cases distant metastasis oc- curred. CONCLUSION Sinonasal mucosal malignant melanoma is rare and highly heterogenous. Current diagnosis depends on clinical characteristics and immunohistochemical examination. It still should be differentially diagnosed from other tumors. CT and MRI image examination can provide some helpful information to understand the extent and nature of lesions. The treatment of nasal endoscopic or the surgery under endoscopy has become to be a safe, viable and reasonable alternative to open resection. Appropriate indication must be carefully selected for these lesions.
Chemotherapy, Adjuvant ; Endoscopy ; Humans ; Lymphatic Metastasis ; Melanoma ; drug therapy ; pathology ; surgery ; Mucous Membrane ; Neck Dissection ; Neoplasm Recurrence, Local ; Nose Neoplasms ; Paranasal Sinus Neoplasms ; drug therapy ; pathology ; surgery ; Prognosis ; Radiotherapy, Adjuvant ; Retrospective Studies

Objective To evaluate the feasibility of endoscopic resection and closure for non-intraluminal gastric stromal tumors originating from the muscularis propria layer.Methods Included in the study were 46 patients with gastric submucosal lesions originating from the muscularis propria layer, detected by gastroscopy and endoscopic ultrasonography.The lesions were removed by endoscopic resection and closure, which were further diagnosed as stromal tumor by means of pathologic and immunohistochemical examinations.The patients were followed up with endoscopy for evaluation of therapeutic effect and complications.Results All lesions were successfully removed, with serosa layer remained in 2 cases and full layer resection in other 44, which were all closed by endoscopic clips.Combination managements of acid suppression,gastrointestinal decompression and intravenous antibiotics were applied in all patients.Pathology reports confirmed complete resection of all lesions, with 0.5 to 3.7 cm in diameter.Normal diet was restored in 44 patients 48 ～ 72 h after the procedure.Pneumoperitoneum and focal peritonitis occurred in 2 cases, one of which underwent rupture and was clamped again.The 2 patients recovered after 10-12 days of conservative treatments.Follow-up endoscopy revealed white ulcerous scar in all cases.Conclusion Endoscopic resection and closure therapy is a safe, economic and less invasive treatment for non-intraluminal gastric stromal tumors originating from the muscularis propria layer.

Objective To investigate the effectiveness,safety of the percutaneous transluminal angioplasty and stenting(PTAS) in the management of the vertebrobasilar stenosis.Methods From April 2003 to June 2004,the PTAS was performed in 28 patients with the vertebrobasilar stenosis.Results Among the 28 patients,the unilateral significant stenosis of the dominant vertebral artery was found in 18 patients,the bilateral stenosis of the vertebral artery in 4 patients,the tandem stenosis of the vertebral artery in 1 patient,the stenosis of the basilar artery in 2 patients.According to Mori's division,the type A occurred in 24 patients,the type B in 3 patients,the type C in 1 patient.The successful rate of stent implantation was 100% without any serious complication.Twenty-eight patients underwent PTAS with a mean pre-procedural vertebrobasilar stenosis of 81.3% and the residual stenosis was less than 10%.Over a mean 6-month follow-up in 17 patients,according to Malek's scale,the scale 1 was in 15 patients,the scale 2 in 2 patients.No restenosis was in 3 patients by the cerebral angiography.Conclusion PTAS in the management of the vertebrobasilar stenosis is a safe and effective method.Meanwhile,PTAS may alleviate the vertebrobasilar ischemia and prevent stroke of the vertebrobasilar system.

OBJECTIVE: To investigate the clinical features, therapeutic methods and therapeutic efficacy of imflammatory myofibroblastic tumor(IMT)of the nasal cavity and paranasal sinuses. METHOD: Clinical data of 14 cases diagnosed as IMT by pathology were retrospectively analyzed. There were 8 males and 6 females,age ranging from 18 to 77 years. 12 cases of them were treated by surgery while 2 cases received postoperative radiotherapy. RESULT: All cases were operated. All the patients were followed up for a period of 1 to 7 years after operation and two cases were proved low grade IMT pathologically. Eight cases survived with no recurrence until the last follow-up and 6 cases relapsed, of which 4 cases died and 2 were alive with tumor. CONCLUSION IMT of the nasal cavity and paranasal sinuses is very rare. The diagonosis of IMT is based on pathology and immunohistochemistry. Proper diagnosis is essential to avoid mutilating and disfiguring surgical procedures. Radical excision is still the first choice of treatment for IMT of the nasal cavity and paranasal sinuses. Chemotherapy and radiotherapy may not be helpful to prevent recurrence after operation. Due to high recurrence rate, long-term follow up is necessary after operation.
Adolescent ; Adult ; Aged ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Neoplasm Recurrence, Local ; Neoplasms, Muscle Tissue ; pathology ; radiotherapy ; surgery ; Paranasal Sinus Neoplasms ; pathology ; radiotherapy ; surgery ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Young Adult

Objective To investigate the clinical features,therapeutic methods and therapeutic effects of sinonasal hemangiopericytoma.Methods Clinical data of 6 patients with sinonasal hemangiopericytoma,diagnosed by pathology and immmunohistochemistry between January 1990 and December 2012 were analyzed retrospectively.There were 4 males and 2 females,with a median age of 58 years.Clinical manifestation included epistaxis and nasal obstruction.These patients were operated on by nasal endoscopic surgery or endoscope-assisted surgery,of which 2 cases of tumor located in the nasal cavity underwent nasal endoscopic surgery and 4 cases of tumor located in the nasal cavity and sinuses underwent endoscope-assisted surgery.Results All the patients were followed up for a period of 6 months to 7 years after operation.Two cases recurred and 4 cases didn't recurre.One case recurred 6 months after operation and underwent second operation,with no recurrence by further one year follow-up.Another case recurred 17 months after operation and underwent second operation,with recurrence by further 9 months follow-up.This patient lived with tumor over two years.Conclusions Hemangiopericytomas are rarely found in the sinonasal cavity.Nasal endoscopic or endoscope-assisted surgery provides satisfactory effect.

Objective To investigate the perioperative nursing Methods of minimally invasive occlusion technique via the right subaxillary route for perimembranous ventricular septal defect in children.Methods A total of 119 patients, who were successfully undergoing minimally invasive occlusion via the right subaxillary route for perimembranous ventricular septal defect from June 2013 to June 2016, were divided into inferior position group (82 cases, adjacent to inflow tract) and superior position group (37 cases, adjacent to outflow tract) according to location of perimembranous ventricular septal defect. Postoperatively complications in patients were compared between two groups. Patients with complications were given individually nursing interventions. Results There were 2 patients from superior position group with occluders displacement post operation. The difference was statistically significant between two groups (P<0.05). A total of 5 patients had extensive subcutaneous emphysema in right chest, 3 patients of which were from inferior position group and other 2 patients were from superior position group. There were 2 patients who had moderate pleural effusion with one for each group respectively. A number of 2 patients was found auscultation of cardiac murmur and one per each group. There was no difference between two groups in the rate of above complications. Occluder was extracted and surgical repair was perfomed in the children with occluders displaccment. Patients with complications were treated in time and then were cured and discharged. Follow-up for all patients ranged from 6.1 months to 24.9 months (13.4±5.0). There was no malignant arrhythmia, device dislocation, hemorrhage, thrombogenesis or other complications.Conclusions The cognition of characteristic of different position in perioperative perimembranous ventricular septal defect occlusion and targeted nursing measures are the key points to avoid lethal complications after surgery for patients and assure the safety of children.

Objective:To explore the effects of video education based on multidisciplinary collaboration combined with popular science atlas in pregnant women with fetal congenital heart disease (CHD) .Methods:Taking the establishment time of multidisciplinary collaborative health education team in December 2019 as the boundary, the 60 cases of pregnant women with fetal CHD in the Outpatient Department of Obstetrics and Gynecology and Cardiac Surgery of Henan Provincial People's Hospital and Fuwai Central China Cardiovascular Hospital from February to November 2019 were included in the control group, and the 60 cases from December 2019 to October 2020 were included in the observation group, by convenience sampling method. The control group was given routine nursing, and the observation group was given video education based on multidisciplinary collaboration combined with popular science atlas. The scores of Exercise of Self-Care Agency Scale (ESCA) , State-Trait Anxiety Inventory-Form Y (STAI-Y) , Trait Anxiety Inventory (T-AI) , Beck Depression Inventory (BID) and Disease-Related Knowledge Mastery Questionnaire were compared between the two groups before and after intervention. Apgar score and mode of delivery were compared between the two groups.Results:After the intervention, the scores of self-care skills, self-care responsibility, health knowledge and self-concept of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . The scores of STAI-Y, T-AI and BID of the observation group were all lower than those of the control group, and the differences were statistically significant ( P<0.01) . After the intervention, the scores of each dimension and total score of the disease-related knowledge mastery questionnaire of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . There was no statistically significant difference in the neonatal Apgar scores at 1 min and 5 min and delivery mode between the two groups ( P>0.05) . Conclusions:Video education based on multidisciplinary collaboration combined with popular science atlas can improve the psychological states of pregnant women with fetal CHD to some extent, and enhance the mastery of disease-related knowledge and self-care ability.

Objective:To understand the rate of spirometry examination and its related factors among chronic obstructive pulmonary disease (COPD) patients aged ≥40 years in China from 2014 to 2015, and provide evidence for diagnosis, treatment and management of COPD patients normatively.Methods:Data were obtained from 2014-2015 COPD surveillance, China. The previous lung function examination status and other information of the subjects were collected by face-to-face survey. We defined COPD as a post-bronchodilator FEV 1: FVC less than 70%. A total of 9 130 COPD patients were included in the analysis of this study. The rate of spirometry examination and its 95% confidence interval ( CI) were estimated in COPD patients aged ≥40 years with complicated sampling weights. Meanwhile, the spirometry examination related factors were analyzed. Results:The estimated rate of spirometry examination among COPD patients was 5.9% (95% CI: 4.9%-6.9%), 6.1% (95% CI: 5.2%-7.1%) for men and 5.3% (95% CI: 4.0%-6.6%) for women. The rate was significantly higher in urban population than in rural ( P<0.001). With the increase of education level, the rate of spirometry examination among COPD patients increased gradually ( P<0.001). The rate of spirometry examination was 4.0% (95% CI: 3.1%-4.9%) among COPD patients in agricultural industry. The rate of spirometry examination among COPD patients with awareness of pulmonary function test was 32.3% (95% CI: 26.4%-38.1%). The rate of spirometry examination among COPD patients with previous chronic respiratory disease and respiratory symptoms were 13.7%(95% CI:11.5%-15.9%), 8.8%(95% CI:7.2%-10.4%), respectively. The rate of spirometry examination among COPD patients exposed to occupational dust and/or harmful gases was 5.7% (95% CI: 4.6%-6.9%). The rate of spirometry examination in former smokers among COPD patients was 10.2% (95% CI: 8.0%-12.4%), higher than those in current smokers (4.2%, 95% CI: 3.3%-5.1%) and non-smokers (6.3%, 95% CI: 5.1%-7.6%). Conclusion:The rate of spirometry examination is extremely low among COPD patients aged ≥40 in China, and the standardized diagnosis, treatment and management of COPD patients need to be improved urgently.