Objective To study the effects of the duration and degree of the peripheral facial paralysis due to middle ear cholesteatoma on the recovery of postoperative nerve functions.Methods The clinical data of 30 cases (single ear) of patients with cholesteatoma complicated with facial paralysis were retrospectively analyzed.The mean age was 54.7±8.9 years old (range 21~77years old) including 17 males and 13 females.The duration of facial paralysis, degree and location of facial nerve injury,surgical timing of facial nerve decompression,recovery of facial paralysis after surgery were followed up.According to the course of paralysis, the patients were divided into ≤2 months group (14 cases) and >2 months group (16 cases).According to the degree of paralysis, the patients were divided into the incomplete facial paralysis group (III-IV grade,14 cases) and the complete facial paralysis group (V-VI grade,16 cases).The influence of the course and degree of paralysis on the postoperative recovery of neurological function were analyzed by the Fisher exact probability test.Results Three cases underwent open radical surgery with no facial nerve damage confirmed by intraoperative exploration, and their postoperative facial nerve functions were fully restored.Facial nerve canal damage was found in 27 cases, accompanied by facial nerve congestion, edema or granulation formation.Among them, the facial nerve damage location was the tympanic segment in 20 cases.The open radical operation and local facial nerve decompression were carried out, and the postoperative facial paralysis recovery rate was 46.67%(14/30).The facial nerve function recovery rate in less than 2 months group was higher than the >2 months group (P<0.05).The facial nerve function recovery rate of the incomplete paralysis group was higher than the complete facial paralysis group (P<0.05).Conclusion This study suggests that facial nerve damage most occurred in the tympanic segment of the facial nerve.Radical mastoidectomy and local facial nerve decompression are effective for the treatment of middle ear cholesteatoma complicated with facial paralysis.The shorter course and lighter degree of paralysis lead to the better postoperative recovery of neurological function.

Ischemic stroke is one of the most important complications of malignant tumors. The etiology and pathogenesis of ischemic stroke in patients with cancer are very complicated, it includes either traditional vascular risk factors such as hypertension, diabetes and hyperlipidemia or the risk factors associated with the pathophysiological state of tumors such as hypercoagulable state, tumor emboli, and thrombotic endocarditis. In addition, various treatment methods associated with tumors, such as radiotherapy, chemotherapy and endocrine therapy, can also increase the risk of ischemic stroke. Because of the complexity of the etiology and pathogenesis, the treatment methods for ischemic stroke in patients with cancer are also different with common practice. Identification of the causes and selection of targeted therapies are crucial for the prevention ad treatment of tumor-associated ischemic stroke. With the increase of the survival rate in patients with cancer, ischemic stroke in patients with cancer is also receiving increasing attention. This article reviews advances in etiology, pathogenesis and treatment of ischemic stroke in patients with cancer.

BACKGROUND:Nasolabial fold flap has been widely used in clinical surgery. The facial artery anatomy has been widely used in clinical research. Angular artery dissection is becoming more and more important to nasolabial groove area surgery, but at present, there is a lack of anatomical analysis of internal angular artery.
OBJECTIVE:To study the anatomy of the angular artery, and to provide anatomical data for protecting the nasolabial flap during surgery.
METHODS:Twenty sides of adult cadaver specimens on head and face were dissected. A reference coordinate system was made based on the line between the connection of two medial angles of eyes (axis X) and the facial midline line (axis Y). The location of the angular artery was measured taking A-F as reference points.
RESULTS AND CONCLUSION:(1) The slant angles of the angular artery on BC section, CD section, DE section and EF section were (11.1±4.3)°, (34.1±8.8)°, (21.5±10.5)°, and (17.0±4.7)°, respectively. (2) The angular artery sourced from facial artery was more than it sourced from ophthalmic artery. The diameter of right blood vessel was larger than that of left side. (3) The angular artery sourced from ophthalmic artery comes from the location which extended 8.1 mm to both sides from the point which was 10 mm up from the intersection of facial medial angle of eyes connection and midline. The blood vessel diameter of the starting point was (0.7±0.2) mm. The whole range was 20.1 mm. (4) The angular artery sourced from facial artery comes from the location which extended 25.8 mm to both sides from the point which was 40 mm down to the intersection of facial medial angle of eyes connection and midline. The blood vessel diameter of the starting point was (0.9±0.3) mm. Point to the wing of nose the lateral distance was (5.0±1.2) mm. The whole range was 68.7 mm. The surface projecting of angular artery coming from research results provided anatomic basis for surgery of nasolabial flap.

Purpose To discuss the clinical,histopathological characteristics,diagnosis,differential diagnosis and prognosis of malignant intraductal papillary lesions of the breast.Methods 28 cases of malignant intraductal papillary lesions of the breast were analyzed by histology and immunobistochemistry.Clinical and follow-up information was obtained.The published relevant literatures were reviewed.Results All the patients were females with a mean age of 55.7 years.The clinical features were a palpable mass or nipple discharge.28 cases were diagnosed including 22 cases of intraductal papaillary carcinoma,2 cases of encapsulated papillary carcinoma and 4 cases of solid papillary carcinoma.Microscopically,the tumor showed solid and papillary area inside the capsule wall with fine delicate fibrovascular septa.The tumor cells usually displayed low-grade nuclear features.Immunohistochemistry,the tumor cells revealed diffusely strong positive ER and PR in almost all cases and HER-2,CK5/6 were negative positive.All cases were negatiive for CK5/6,p63 and SMA in the celluar nodules.CD56,Syn and CgA were found positively in some solid papillary carcinoma cases.The average positive rate of Ki-67 in tumor cells was 5.3 ％.27 patients were available for follow-up examination from 10 to 79 months and all the patients were alive.Conclusion Malignant intraductal papillary lesions of the breast most occurs in postmenopausal women.The diagnosis should be based on the clinical information,histopathological features and immunohistoehemistry stain due to its diverse histology.The main differential diagnosis is intraductal papilloma.This kind of lesion is a low grade malignant tumor with favorable prognosis.

Objective:To analyze influencing factors for sarcopenia in people of advanced age, in order to provide insight and evidence for the prevention and treatment of sarcopenia in people belonging to this age group.Methods:Data from 167 people of advanced age seeking care at our department from December 2014 to July 2017 were retrospectively analyzed.According to the diagnostic criteria for sarcopenia of the Asian Working Group for Sarcopenia, subjects were divided into the sarcopenia group( n=46, 27.5%)and the non-sarcopenia group( n=121). Differences in body composition, energy intake, quantities and proportions of three major nutrients were analyzed between males and females.Related influencing factors for sarcopenia were analyzed by using multiple linear regression. Results:Compared with the non-sarcopenia group, the sarcopenia group had lower body mass index, waist-hip ratio, fat mass, total energy intake and protein( P<0.05)but higher age and fat intake( P<0.05). Values for grip strength, muscle mass, index of skeletal muscle, adjusted muscle mass by body mass index, total energy intake, carbohydrates, fat and protein were lower and the percentage of body fat was higher in females than in males( P<0.05). Multiple Logistic regression analysis showed that insufficient intake of protein( β=-0.290, OR=0.748, 95% CI: 0.569-0.984, P<0.05), reduction of body fat mass( β=-2.673, OR=0.069, 95% CI: 0.010-0.488, P<0.05)and excessive visceral fat accumulation( β=0.739, OR=2.094, 95% CI: 1.219-3.597, P<0.01)were correlated with sarcopenia in people of advanced age. Conclusions:The occurrence of sarcopenia is higher in people of advanced age and is related to insufficient intake of protein, reduction of body fat mass and excessive visceral fat accumulation.Individualized nutrition evaluation and support should be carried out as early as possible for people in this age group.

Objective:To investigate the muscular quality and its related influencing factors in elderly with sarcopenic obesity.Methods:The internalized 696 elderly subjects meeting inclusion and exclusion criteria were divided into four groups including the sarcopenic obesity(n=55), sarcopenia(n=8), simple obesity(n=481)and normal control(n=152)groups.The intergroup difference was retrospectively analyzed in the parameters of body composition, dietary intake of total energy and three major nutrients and their proportions.Multiple linear regression analysis was used to analyze the influencing factors related to the occurrence of sarcopenic obesity in the elderly.Results:The sarcopenic obesity group versus normal control group showed a higher level or value in age, body mass index, waist-hip ratio, fat mass, percentage of body fat, visceral fat area, fasting blood glucose, estimated glomerular filtration rate( P<0.01 or 0.05), and showed a lower level or value in grip strength, skeletal muscle, skeletal muscle index, muscle quality(grip strength/limb skeletal muscle), intake of energy, carbohydrate, fat and protein, body weight-adjusted intake of energy and protein, as well as ideal body weight-adjusted intake of energy and protein( P<0.01). The detection rate of sarcopenic obesity was 7.90%(n=55), including 7.60% in males(n=48)and 11.48% in females(n=7 cases). The detection rate of sarcopenic obesity was increased along with increasing age with 0.07%(2/287)in 60-69 years old group, 4.94%(12/243)in 70-79 years old group, and 24.70%(41/166)in ≥80 years old group( χ2=87.76, P<0.01). Taking the median point of grip strength/limb skeletal muscle volume as the cutoff point, the decrease rate of muscle quality was 12.36%(86/696)in total elderly subjects, 2.63%(4/152)in the control group, 11.64%(86/635)in the obesity group, 37.5%(3/8)in the sarcopenia group and 41.82%(23/55)in the sarcopenic obesity group, with an increasing trend of the decrease of muscle quality, which had significant differences( χ2=62.25, P<0.01). Multiple logistic regression analysis showed that aging, excessive visceral fat area, insufficient protein intake and decreased basal metabolism were the independent risk factors for sarcopenic obesity in elderly people( P<0.01 or P<0.05). Conclusions:The incidence of decrease of muscle quality is higher in the elderly with sarcopenic obesity than other elderly groups.Sarcopenic obesity is correlated with aging, insufficient intake of protein, decreased basal metabolism and excessive visceral fat accumulation.Individual evaluation and support is necessary in elderly people with sarcopenic obesity.

Objective To establish a mouse model of aorta dissection (AD) by β-aminopropionitrile (BAPN) in drinking water + subcutaneously pumped angiotensin II (Ang II) infusion.Methods Forty 3-week-old C57B1/6J male mice were randomly divided into two groups.All animals received 0.1 g/kg/d BAPN in drinking water for 4 weeks.Then the BAPN drinking + saline infusion group and BAPN drinking + Ang II infusion group received continuous saline or Ang II (1,000 ng/kg/min) infusion, respectively, via subcutaneous osmotic minipump for 72 hour.The mice were restricted in a noninvasive computerized tail-cuff system and their arterial systolic blood pressure and heart rate were monitored.Autopsy was performed if a mouse died during the experiment.At the end of the experiment, mice were sacrificed by injection with an overdose of sodium pentobarbital and the aortas were harvested.The formation of aortic false lumen was observed by pathology using hematoxylin-eosin staining.Results The overall incidence of AD in the BAPN drinking administration +Ang II infusion group was 95%, whereas the incidence of AD in the BAPN drinking administration +saline infusion group was only 5%.The mortality from dissecting aneurysm rupture was 24% in the BAPN drinking administration +Ang II infusion group during the experiment.Pathological examination of the aortic cross-sections clearly showed the formation of blood-filled false lumens induced by Ang II.Conclusions A mouse model with high incidence of aortic dissection is successfully established.

Objective To explore the relationship between lipids profile and body composition in the young and middle?aged adults. Method The relationship between body composition and lipids profile was examined in 642 adults (21-60 years, 178 male, 464 female). According to the result of body composition assessment, they were assigned to three groups: Normal (N, n=272), Obesity (O, n=245), Sarcopenic Obesity (SO, n=125). The lipids profile among three groups and its related factors were analyzed. Results In groups N, O and SO, the levels of total cholesterol (TC), triglycerides (TG), low density lipoprotein?cholesterol (LDL?C) increased gradually (P<0.01), and the high density lipoprotein?cholesterol (HDL?C) level decreased gradually (P<0.01). In a multiple logistic regression analysis, the odds ratio for high levels of TC, TG, LDL?C and low level of HDL?C risk increased gradually in groups N, O and SO [compared to group N, the odds ratio of the four kinds of dyslipidemia in group O were 2.617 (1.117-6.132), 3.549 (1.481-8.503), 4.618 (1.288-16.564), 1.222 (0.529-2.822), respectively, and in group SO were 5.915 (2.512-13.926), 10.430 (4.400-24.722), 9.522 (2.637-34.388) , 4.253 (1.957-9.242) , respectively]. After adjusting for age, sex, waist?to?hip ratio and visceral fat area, the odds ratio for high level of TG risk still increased gradually in group N, O and SO [compared to group N, the odds ratio of group O was 3.565 (1.319-9.632), and of group SO was 8.173 (2.685-24.881)]. Moreover, the odds ratio for high TC and low HDL?C levels of group SO were higher than those of group N [compared to group N, the odds ratio in group SO were 5.658 (1.871-17.111), 6.823 (2.119-21.969) respectively]. With stepwise multivariate logistic regression analysis, for male, the related factors for high levels of TC, TG and low level of HDL?C were high percentage of body fat;sarcopenia, sarcopenia obesity;sarcopenia, respectively. For female, the related factors for high levels of TC, TG and LDL?C were sarcopenia, aging;high percrntage of body fat, aging;sarcopenia, aging, respectively. Conclusion SO was the main risk factor for dyslipidemia in young and middle?aged adults, even more severe than obesity alone and sarcopenia was the risk factor of high TG, low HDL?C levels for male;and the risk factor of high TC, high LDL?C levels for female.

Objective To investigate the role of calcium/calmodulin-dependent protein kinase Ⅱ (CaMK Ⅱ) in the primary somatosensory area (S1 area) and hippocampi in reduction of remifentanil-induced hyperalgesia by lidocaine in rats.Methods One hundred fifty-six male Sprague-Dawley rats,aged 8-10 weeks,weighing 240-260 g,were randomly allocated into 4 groups using a radom number table:control group (group C,n=6),remifentanil group (group R,n=50),lidocaine group (group L,n=50),and remifentanil+lidocaine group (group RL,n =50).Remifentanil was given as a bolus of 6 mg/kg followed by an 2 h infusion of 2.4 μg · kg-1 · min-1 in group R.Lidocaine was given as a bolus of 6 mg/kg followed by an infusion of 200 μg · kg-1 · min-1 for 2 h in group L.In group RL,drug administration was similar to those previously described in R and L groups.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured before administration and at 0.5,2,5 and 24 h after the end of administration.The rats were then sacrificed immediately after administration and at 0.5,2,5 and 24 h after the end of administration in R,L and RL groups,or at the corresponding time point in group C.The S1 area and hippocampi were isolated for determination of phosphorylated CaMK Ⅱ (p-CaMK Ⅱ) expression by Western blot.Results Compared with the value before administration,the MWT was significantly decreased at 0.5 and 2 h after the end of administration (P＜0.05),and no significant change was found in TWL at each time point after the end of administration in R,L and RL groups (P＞0.05).Compared with group C,p-CaMK Ⅱ expression in the S1 area and hippocampi was significantly up-regulated immediately after administration and at 0.5 and 2 h after the end of administration in group R (P＜0.05).Compared with group R,p-CaMK Ⅱ expression in the S1 area and hippocampi was significantly down-regulated immediately after administration and at 0.5 and 2 h after the end of administration in group RL,and p-CaMK Ⅱ expression in the S1 area was significantly down-regulated immediately after administration,and at 0.5 and 2 h after the end of administration,and p-CaMK Ⅱ expression in the hippocampi was down-regulated immediately after administration,and at 0.5,2 and 24 h after the end of administration in group L,and MWT was increased at 0.5 and 2 h after the end of administration in groups L and RL (P＜0.05).There was no significant difference in TWL at each time point among the three groups (P＞0.05).Conclusion The mechanism by which lidocaine mitigates remifentanil-induced hyperalgesia is associated with inhibited activity of CaMKII in the S1 area and hippocampi of rats.

Treatment resistant depression is a common and severe mental disorder associated with significant burden of disease .Most individuals receiving conventional pharmacotheraphy fail to achieve and sustain remission.So this is still one of the difficult challenges for the psychiatrist .Much of the research pro-vided indications that the efficacy of treatment for the disease was not optimistic, but the treatment was still made great progress .The common treatments for this disease included pharmacotherapy,psychotherapy,elec-troconvulsive therapy(ECT),transcranial magnetic stimulation (TMS),magnetic resonance guided focused ultrasound surgery( MRgFUS) ,deep brain stimulation ( DBS) ,aerobic exercise,light therapy and so on.Each therapeutic strategy has its own features, and could be suitable or unsuitable in some situations.The high rates of non-remission with first-line treatment strategies make the combination of antidepressant and non-drug treatments to be the new trend of the treatments for treatment resistant depression in the future.