OBJECTIVE: To analyze the recurrencerelative factors of early glottic carcinoma after carbon dioxide laser treatment. METHOD: A retrospective analysis of 134 early glottic carcinoma patients' clinical data was taken to analyze the relationships between recurrence and gender, age, pathologic degree, T stage, involvement of anterior commissure and involvement of thyroarytenoid muscle. RESULT: Recurrent ratio of well-differentiated, middle-differentiated and poorly-differentiated squamous cell carcinoma were 11.83%, 18.42% and 33.33% (P > 0.05) respectively. Recurrent ratio of T1a, T1b, T2 were 13.24%, 18.92%, 23.08% (P > 0.05) respectively. The recurrent rate was 33.33% of tumors offended the anterior commissure, versus 5.43% with no involvement of anterior commissure (P < 0.01). The recurrent rate was 59.09% of tumors offended the thyroarytenoid muscle, versus 5.36% with no involvement of thyroarytenoid muscle (P < 0.01). Unvaried and multivariate analysis indicated that the involvement of anterior commissure and the involvement of thyroarytenoid muscle were the factors of recurrence. CONCLUSION Recurrence of early glottic carcinoma after carbon dioxide laser treatment is effected by the involvement of anterior commissure and the involvement of thyroarytenoid muscle. Resection can be performed conservatively according to evaluation of macroscopic tumour extension.
Carcinoma, Squamous Cell ; surgery ; Glottis ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; Laser Therapy ; Lasers, Gas ; Microsurgery ; Neoplasm Recurrence, Local ; Retrospective Studies

Objective To study the clinical effects of tearing pediatric diarrhea with traditional Chinese and western medicine.Methods Altogether 520 patients with pediatric diarrhoea were recruited into three groups:the group treated with combined traditional Chinese and western medicine,the group treated with Chinese medicine and the group treated with western medicine.Observe clinical effects of each group.Results In 175 cases of the group treated with combined traditional Chinese and western medicine,66 cases show significant effects,64 cases are effective,45 eases are ineffective,and the effective rate is 74.30%;In 171 cases of the group of treated with traditional Chinese medicine,32 eases show significant effects,42 eases are effective,97 cases are ineffective,and the effective rate is 43.30%;In 174 eases of the group of treated with western medicine,35 eases show significant effects,43 eases are effective,96 eases are ineffective,and the effective rate is 44.80%.The effective rate of the group treated with combined Chinese medicine and western medicine was significantly better than the other two groups (P＜0.01).Conclusion Combined Chinese and western medicine is more effective in treating the patients with pediatric diarrhea,and it is worthy of spread.

Objective To discuss the liver function recovery affected by the portal vein flow in patients who underwent adult-to-adult living donor liver transplantation using the right lobe. Methods Seventy-four donors and recipients were included in this study. Intraoperative Doppler ultrasound (IOUS)were performed before splitting the donor liver and 1 hour after the graft reperfusion. The diameter and velocity of portal vein were measured and recorded for calculation of portal vein flow(PVF). Liver function tests were undertaken at the day 2nd,7th, 15th and 30th postoperative,respectively. Results One hour after reperfusion of 74 grafts,the PVF were significantly increased (2. 84 ± 0. 93) fold. Seventy-four grafts were divided into 4 groups according to the different degrees of the increase of PVF. The levels of blood bilirubin total(TBIL) among 4 groups were differently at the day 2nd,7th, 15th and 30th postoperative. High PVF contributed to recipient's prolonged hyperbilirubinemia ( P ＜0. 001 ). The levels of ALT, AST among 4 groups were differently at the day 7th, 15th and 30th postoperative( P ＜0. 001). Conclusions Detection of portal vein hemodynamics in living donor liver transplantation by IOUS may assist surgeon to anticipate the graft's function and take surgical therapies to secure the graft and the recipient.

Objective To evaluate the safety and efficacy of Centurion Vision System for subhixated cataract surgery.Methods Clinical data of 15 eyes with lens subluxation treated with Centurion Vision System were retrospectively reviewed.Ocular variables including visual acuity,intraocular pressure,corneal endothelial cell counts (CEC),central foveal retinal thickness (CFRT),intraocular lens (IOL) position,as well as intraoperative and postoperative complications were observed.Results The best corrected visual acuity (BCVA) was 0.6 or better in 10 eyes (66.7％) 3 months after surgery,while the BCVA of the other 5 eyes was between 0.2 and 0.6 mainly due to pre-existing macular degeneration caused by high myopia or trauma.CEC and CFRT values demonstrated a statistically significant difference between the preoperative and all postoperative follow-ups (all P ＜ 0.05).Three months after surgery,no serious surgeryrelated complications,such as retinal detachment,IOL dislocation,suprachoroidal hemorrhage,macular edema,were observed.Conclusion Centurion Vision System can facilitate phacoemulsification in eyes with subluxated lenses,and this technique is safe and effective due to providing excellent outcomes and avoiding vitreoretinal complications.

Objective To understand the available preventive strategies of unplanned endotracheal extubation (UEX) among adult patients.Methods Twelve nurses were in-depth interviewed and data were processed and analyzed using categorization analysis method.Results Major themes were identified as follows:the incidence rate of UEX,tube fixation,efficacious physical restraint,appropriate sedation and training for younger nurses.Conclusions Nursing leaders should further standardize nursing process related to prevention of UEX,strengthen training for nurses,choose appropriate fixation method for patients and promote physical restraint and sedation care to prevent UEX and improve patient clinical outcomes.

BACKGROUND: The study on the mechanism of force conduction of Ilizarov bone external fixator is of great significance for clinical orthodontics of the knee varus, the knee valgus and the tibial fracture. OBJECTIVE: To explore the force conduction mechanism of Ilizarov bone external fixator and the force changes of each orthopedic force in the process of tibia correction, and to objectively evaluate the overall use effect of the external fixator. METHODS: According to the structure of the external fixator, the coordinate transformation matrix relations were established, and the mathematical transformation relationship between the holding force and the pulling tension was obtained. A special laboratory bench was set. The experiment of tibia correction was conducted. The load on the external fixator and the variation of the orthotic force were measured. The theoretical value of the tension at the broken bone is calculated and compared with the actual value of the tension measured by the six-dimensional force sensor. The curve of efficiency of force transmission during correction was obtained. RESULTS AND CONCLUSION: (1) During the correction, the structure of the Ilizarov bone external fixator resulted in the interaction and restriction of its adjustment rod and support rod. When one adjustment force increased, the other adjustment force would decrease. (2) The efficiency of force transmission was increased greatly in the early stage, and then stabilized at about 50%. The experimental results could evaluate the overall correction effect of the external fixator. (3) Theoretical calculation and experiment of the tension at the broken bone due to the loss during the force transmission process were different in the result curves, but from the experimental results, it could be indicated that the overall force change trend of the adjustment force, supporting force, the theoretical value of the tension and the actual value of the tension was basically the same, indicating the validity of the theoretical calculations and experimental results. The evaluation results can provide a reference for the optimal design of Ilizarov’s external fixation architecture and the precise control of tibial orthopedic surgery.

Objective To investigate whether amniocentesis may increase the risk for mother-tochild transmission of hepatitis B virus (HBV).Methods Totally 40 children born to HBV-infected mothers who had amniocentesis performed in Nanjing Drum Tower Hospital, Nanjing University Medical School from January 2010 to December 2013, were followed up and screened for HBV markers.Amniotic fluid samples were collected and stored at-80 ℃ were tested for HBV markers.Among the 40 carrier mothers, three (7.5％) were hepatitis B e antigen (HBeAg)-positive.Relevant data such as antiviral history, administration of hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) in infants were collected.Chi-square test or Fisher's exact test was used for statistical analysis.Results The mothers were 21-41 years old, with a mean age of (31.5±5.5) years at the time of amniocentesis and mean gestational age of (21.2± 1.6) weeks (18.4-24.9 weeks).Indications for amniocentesis were mainly abnormal maternal serum alpha-fetoprotein levels (65.0％, 26/40)and maternal age over 35 years (10.0％, 4/40).None of the mothers received antiviral therapy and 14 (35.0％)underwent transplacental amniocentesis.Among 28 cases who had a store of amniotic fluid sample and were followed-up, one (7.1％) was positive for both hepatitis B surface antigen (HBsAg) and HBV DNA, and another was positive for HBsAg only.The average age of 40 children at follow-up was (2.0± 1.0) years (seven months to four years old), among which 23 were boys and 17 were girls.All of them received hepatitis B vaccine and HBIG.Positive rate of HBsAg and HBV DNA in HBeAg(+) mothers are higher than those in HBeAg(-) mothers [4.7％(2/43) vs 3/5, x2=14.705;0/43 vs 2/5, x2=17.948;both P ＜ 0.05].Thirty-seven children born to HBsAg(+)/HBeAg(-) mothers were negative for both HBsAg and hepatitis B core antibody (anti-HBc), and the other three born to HBsAg(+)/HBeAg(+) mothers were also negative for HBsAg and anti-HBc.Additionally, the positive rate of hepatitis B surface antibody in children was 90.0％ (36/40).Conclusions For those HBsAg(+)/HBeAg(-) mothers, amniocentesis does not elevate the risk for mother-to-child transmission of HBV, even performed transplacentally.However, further studies are needed for HBeAg-positive mothers.HBsAg or HBV DNA positive in amniotic fluid should be diagnosed as intrauterine infection of HBV.

Objective To study vascular anatomy between the pancreatic head and duodenum,providing anatomy basis for performing surgery of pancreatic head,duodenum and distal common bile duct in surgical practice. Methods Anatomy study was performed in 30 formaldehyde fixed and 10 fresh bodies in reference to blood supply to duodenum,the distal common bile and Vater ampulla. Results The anterior and posterior pancreaticoduodenal arterial arcade gives off branches to descending and horizontal portion of the duodenum. The posterior superior pancreaticoduodenal artery goes to distal common bile duct. The papilla artery arising from the posterior superior pancreaticoduodenal artery goes to Vater ampulla. Conclusions The pancreaticoduodenal anterior and posterior arterial arcades are main arteries that give off branches to the descending and horizontal portion of the duodenum,distal common bile duct and the Vater ampulla,hence should be carefully protected in duodenum-preserving resection of the pancreatic head.

Objective To investigate the effect of different amplification methods and probes with various length on the results of comparative genomic hybridization (CGH) analysis of pre-implanted single blastomere and to establish the basis for preimplantation genetic diagnosis.Methods Twenty blastomeres of embryo at 6-8 cells stage were randomly divided into A and B group with 10 in each.Twenty peripheral blood lymphocytes from a healthy man were similarly divided into C and D group with 10 in each.Degenerate oligonucleotide primed polymerase chain reaction (DOP-PCR) was used to amplify whole genomic DNA in group A and C,and multiple displacement amplification (MDA) was used in group B and D for whole genome amplification (WGA).The specificity of resultant products was confirmed by amplification of TBX1 gene exon 2.CGH was performed respectively with 250-750 bp and 750-2000 bp probes prepared from the amplified whole genomic DNA.The result of CGH was verified by sex-determining region of Y (SRY).Results (1) Nine of the 10 samples in group A and all in group C were amplifiable by DOP-PCR,but there were multiple non-specific bands in the amplification of TBX1 exon 2 when WGA products were used as templates.When 250～750 bp probe was used in CGH,1 of the 5 blastomeres was failed and another one had different karyotype from that analyzed by SRY.(2) All samples in group B and D were successfully amplified by MDA,and the non-specific bands were significantly less in the amplification of TBX1 exon 2.All 5 blastomeres were successful in CGH with the 250～750 bp probe.Moreover,the karyotype was in agreement with that of SRY.(3) When 750 ～ 2000 bp probe was used,the CGH results were suboptimal.Conclusions In WGA of single blastomere,MDA is superior to DOP-PCR in the stability and specificity.The karyotype image detected by CGH with the 250～750 bp probe is clear and homogenous.

Objective To investigate and analyze the current status of adult unplanned endotracheal extubation in China,understand the preventive strategies of unplanned endotracheal extubation,and supply reference for future research.Methods All publications concerning unplanned endotracheal extubation from CBMdisc,CNKI and Wangfang Database were analyzed by establishing the reference manage and appraisal databases with Noteexpress and SPSS software.Results The publications concerning unplanned endotracheal extubation grew steadily year by year.The major study type was case series report(36.4％)followed by review(16.7％) and experience introduction(14.6％).Most literature focused on risk factors,preventing strategies,patients' outcomes and so on.Lacking of effective physical restraint and patients' anxious were the most common factors leading to unplanned endotracheal extubation.Conclusions Unplanned endotracheal extubation has got much attention from the clinical faculties recently.However,the domestic researchers focused on this topic lacked strict research design and efficient statistical methods.So it is imperative to develop the best practice information sheet for preventing unplanned endotracheal extubation by evidenced-based and scientific method.