Nuclear factor kappa B(NF-?B) is an important transcription factor in the expression of many inflammatory media. With the recent progress of molecular biological technique, the modulated mechanism of NF-?B in immunity, stress, inflammatory responses, and the differentiation and growth of lymphocyte has been the focus. This review presents the role of NF-?B in ischemia-reperfusion and cardiopulmonary bypass, and the research progression of intervention therapy in inhibition of the activation of NF-?B is also introduced herein after.

Objective To discuss the surgical interference of chronic suppurative otitis media and it's long-term results.Methods In 113 cases of mastoidectomy with tympanoplasty followed up for 3 years,We discuss the results of recurrence and hearing levle of the open-mastoidectomy with tympanoplasty(OMT)and combined approach tympanoplasty(CAT).Results There is no significant difference between OMT(improved 12 dB HL)and CAT(improved 9.5 dB HL)in the improved hearing threshold leve.The recurrence rate of OMT was 5.8%,but the CAT was 24.4%,the difference is significant.Conclusion The effect of OMT is better than that of CAT for the long-term resulls in these cases.

Objective To investigate the clinical effect and immunologic function of Moxifloxacin combined with small dose of hormone in the treatment of Ventilator pneumonia in elder.Methods 64 cases of Ventilator pneumonia in our hospital were collected and randomly divided into experiment group and control group, 32 cases each.Two groups were given conventional treatment, the control group received Methylprednisolone Sodium Succinate 1 mg/kg qd, the experiment group was given Methylprednisolone Sodium Succinate 1 mg/kg qd, and Moxifloxacin Hydrochloride and Sodium Chloride Injection 400 mg qd.Two groups of patients were continuous treated for 10 days.After treatment,T lymphocyte subsets, NK cells, white blood cell count, C reactive protein, clinical symptoms disappeared time, mechanical ventilation time, ICU length of stay and mortality rate were compared. Results After treatment, the total effective rate in the experiment group 75% was higher than the control group 50%( P <0.05 ).The levels CD3 +, CD4 +, CD4 +/CD8 +and NK cell in two groups increased(P<0.05), levels of CD8 +decreased(P<0.05),levels of WBC, CPR and PCT decreased in the two groups(P<0.05), and compared with the control group, the levels CD3 +, CD4 +, CD4 +/CD8 +and NK cell in the experiment group were higher(P<0.05), levels of CD8 + were lower(P<0.05),levels of WBC,CPR and PCT were lower(P <0.05), the rales disappeared time, cough disappeared time, fever disappeared time were significantly shorter than the control group(P <0.05), the duration of mechanical ventilation and the length of hospital stay were significantly shorter(P<0.05).Conclusion Moxifloxacin combined with small dose of hormone in the treatment of Ventilator pneumonia in elder was significantly effective, and it can relieve inflammation, prevention of infection control, enhance immune function.

Objective To evaluate the therapeutic effect of mini-incision surgery for the treatment of varicose vein of lower extremities. Methods 106 limbs of 95 paitnets with varicose vein underwent saphenectomy combined with ligation of communicating veins by way of mini-incision from November 1997 to April 2001. The ascending venography and StethoDoppler examination were performed preoperatively in all of the patients. Results Venous reflux in deep vein of lower extremities were at grade 0 in 62 limbs, at grade Ⅰ in 28 limbs and at grade Ⅱ in 16 limbs demonstrated by ascending venography with Valsalva test. StethoDoppler examination showed that valve insufficiency of great saphenous vein at saphenofemoral junction was in 99 limbs, the insufficiency of small saphenous vein at saphenopopliteal in 5 limbs and incompetent perforating vein in all of the limbs. Postoperative course was uneventful, the average hospitalization days after operation were 2.8 days and no recurrent varicose veins occurred in all the patients during the follow-up period lasting 1-30 months. Conclusions With the help of preoperative StehoDoppler examination, the mini-incision surgery for the treatment of varicose vein of lower extremities is safe, simple, effective and lower costs.

N-terminal pro-brain natriuretic peptide(NT-proBNP) with no biological activity is the best cardiac marker in the diagnosis,risk stratification,prognosis and therapeutic monitoring of the patients with cardiac dysfunction,and is one of the natriuretic peptides.In this review,we aim to the latest progress of NT-proBNP study on its change during peri-cardiopulmonary bypass,and its applications in the diagnosis of preoperative cardiac function and in the guidance of heart failure therapy.

Objective: To seek the direct evidence of myocardial inflammatory activation in a cohort of patient undergoing surgery on cardiopulmonary bypass (CPB). Methods: Twenty patients undergoing surgery on CPB had plasma samples obtained for tumor necrosis factor-? (TNF-?), perioperatively. Myocardial tissue samples were obtained intraoperatively, both pre-and post-CPB. Myocardial nuclear factor ?B (NF-?B) nuclear translocation and plasma TNF-? concentrations were analyzed by standard enzyme-linked immunosorbent assay (ELISA). Cross clamp times, CPB times and the time to extubation were recorded. The change of myocardial NF-?B nuclear translocation and plasma TNF-? concentrations was assessed by analysis of variance (ANOVA). The regression analysis was utilized to define the correlations among the optical densities of NF-?B, concentrations of plasma TNF-?, influencing factors and heart function. Results: (1) Seventeen patients had NF-?B nuclear translocation before initiation of CPB, the optical density (OD) of myocardial NF-?B was significantly increased at the end of CPB in nineteen patients. (2) The correlation between the activity of NF-?B and concentration of TNF-? was signi ficant. (3) The correlation between the activity of NF-?B and clinic outcomes and other influencing factors was not significant. Conclusion: Myocardial inflammatory activation may be present in the patients before CPB. CPB could increase the activity of myocardial NF-?B.

Objective: To investigate the proportion of physical examinations among patients with severe mental disorders and its influencing factors in Shaoxing City, Zhejiang Province, so as to provide the evidence for improving the proportion of physical examinations among patients with severe mental disorders. Methods : The epidemiological and clinical features of patients with severe mental disorders included in community management in Shaoxing City in 2022 were collected from Zhejiang Provincial Severe Mental Disorder Management Information System, including demographics, disease diagnosis and treatment, physical examination, and rescue and assistance. Factors affecting the physical examination were identified among patients with severe mental disorders using a multivariable logistic regression model. Results: A total of 25 468 patients with severe mental disorders were enrolled in Shaoxing City in 2022, including 12 151 males and 13 317 females, with a male to female ratio of 0.91∶1, and the participants had a mean age of (54.34±14.71) years. Schizophrenia was the predominant type of severe mental disorders (15 419 cases, 60.54%), and 21 374 subjects participating in the physical examinations in 2022 (83.92%). Multivariable logistic regression analysis showed that female (OR=0.901, 95%CI: 0.832-0.975), urban areas (OR=0.506, 95%CI: 0.468-0.547), mental disorders due to epilepsy (OR=1.779, 95%CI: 1.104-2.866), hospitalized treatment (6 to 10 times, OR=0.523, 95%CI: 0.401-0.681; 11 times and more, OR=0.177, 95%CI: 0.108-0.288), special diseases in outpatient (OR=1.738, 95%CI: 1.597-1.891), receiving medical assistance (OR=2.851, 95%CI: 2.616-3.107), targets of the community care and assistance groups (OR=1.653, 95%CI: 1.471-1.857) and guardian (spouse, OR=1.777, 95%CI: 1.513-2.086; children, OR=1.277, 95%CI: 1.069-1.526; parents, OR=1.342, 95%CI: 1.143-1.576) were statistically associated with the proportion of physical examinations. Conclusions The proportion of health examinations was 83.92% among patients with severe mental disorders in Shaoxing City in 2022. Gender, residence, guardian, disease diagnosis, times of hospitalized treatment, medical assistance, special diseases in outpatients and target of community care and assistance groups were factors affecting health examinations among patients with severe mental disorders.

Objective To investigate the risk factors of spontaneous rupture of BCLC stage A and stage B hepatocellular carcinoma (HCC),and to review the surgical outcomes.Methods From April 2002 to November 2006,89 patients who suffered from spontaneous rupture of HCC of BCLC stage A and stage B were included into this study.A control group of 171 patients was selected by matching the sex,age and BCLC stage.Clinical data and survivals were collected and analysed.Results On multivariate analysis,hypertension (HR 7.38,95％CI:1.91 ～28.58,P＜0.05),cirrhosis (HR6.04,95％ CI:2.83 ～12.88,P ＜ 0.05) and tumor location in segments Ⅱ,Ⅲ,Ⅵ (HR 5.03,95％ CI:2.70 ～ 6.37,P ＜ 0.05) were predictive factors of spontaneous rupture of HCC.In the study group,the median survival and median disease-free survival were 12 months (range,1 ～ 78 months) and 4 months (range,0 ～ 78 months) respectively.The overall survival rates and disease-free survival rates at 1-,3-and 5-year were 66.3％,23.4％,10.1％ and 57.0％,16.8％,4.5％,respectively.Only radical resection remained predictive of overall survival (HR 0.32,95％ CI:0.08 ～ 0.61,P ＜ 0.05) and disease-free survival (HR 0.12,95％ CI:0.01 ～ 0.73,P ＜ 0.05).Conclusions Tumor location,as well as hypertension and cirrhosis were associated with spontaneous rupture of HCC.One-stage hepatic resection should be recommended to patients with ruptured HCC of BCLC stage A and stage B.

Objective To investigate the dosimetric difference of organ at risk (OAR) for planning and actual estimated during intensity-modulated radiotherapy (IMRT) for patients with nasopharyngeal carcinoma.Methods Thirteen patients were enrolled to accept full course of IMRT.CT scans were acquired in the 10th,20th,and 30th fractions during radiotherapy,respectively.OAR,including brain stem,spinal cord,parotid gland and submandibular gland,were delineated on repeated CT scans.The volume change of OAR were investigated.After that,the plans were copied to the new CT image to calculate the escalated average dose of OAR during radiotherapy (Actual estimated receiving dose minus planning dose).Results The change trend of volume was decreasing gradually for parotid gland and submandibular gland during the 10th,20th,and 30th times radiotherapy (all P =0.000).The maximum dose (Dmax) of brain stem and spinal cord and the 50％ volume receiving dose (D50) of parotid gland increased significantly in the 10th,20th,and 30th times during radiotherapy,respectively.The escalated average dose were 3.76 and 3.68 Gy for Dmax of brain stem and spinal cord (P =0.000,0.000),5.11 and 3.54 Gy for D50 of left and right parotid (P =0.001,0.023),and 0.49 and 0.75 Gy for D50 of left and right submandibular gland (P =0.220,0.230),respectively.Conclusions The volume of parotid gland and submandibular gland significantly decreased after radiotherapy The actual receiving dose of brain stem,spinal cord,and parotid gland increased significantly during radiotherapy.However,there was no significant change for the actual receiving dose of submandibular gland.

Objective To assess the differences in delineation of organs at risk (OAR) and dosimetry between junior and senior physicians during intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) and to evaluate the role of specific training in reducing the differences.Methods Sixteen patients newly diagnosed with NPC were selected in the study.The OAR was delineated separately by three junior physicians and three senior physicians,and the geometric and dosimetric differences were assessed relative to the reference OAR.Delineation was performed again for the two OARs with the biggest difference after specific training in the two groups of physicians,and the differences were evaluated again.The difference was determined by paired t test.Results The maximum dose differences (Dmax) of OAR in the junior and senior physicians were (2.33 ± 12.06) ％ (-48.06％-137.82％) and (0.09 ± 4.72) ％ (-49.54％-42.96％),respectively (P =0.039),and the difference in the optic chiasm was the greatest ((5.85 ± 19.63) ％ ∶ (1.36 ± 4.64) ％,P =0.042).The mean dose differences (Dmean) of OAR in the junior and senior physicians were (3.10 ± 8.07)％ (-46.76％-59.76％) and (-0.93 ± 2.03) ％ (-45.54％-35.69％),respectively (P =0.021),and the difference in the parotid gland was the greatest ((13.23 ± 13.39) ％ ∶ (3.20 ± 6.71) ％,P =0.002).In the secondary delineation after training,the Dmax of the optic chiasm in the junior and senior physicians was (1.68 ± 3.34)％ and (1.50 ± 1.87) ％,respectively (P =0.841),and the difference in junior physicians was reduced significantly compared with before training ((1.68 ± 3.34) ％ ∶ (5.85 ± 19.63) ％,P =0.048) ; the Dmean of the parotid gland in the junior and senior physicians was (2.46 ± 3.06) ％ and (1.35 ± 3.00) ％,respectively (P =0.2 7 4),significantly reduced compared with before training ((2.46 ± 3.0 6) ％ ∶ (13.23 ± 13.39)％,P=0.002; (1.35 ± 3.00)％ ∶ (3.20 ± 6.71) ％,P =0.033).Conclusions The differences in delineation of OAR lead to dose uncertainties during IMRT for NPC,and specific training can improve the accuracy of delineation.