Objective:We probe more direct operation pathways in sphenoidal sinus and saddle area, and take proper measures for correlated diseases which surpass scope of sphenoidal sinus by combining image data, which could prevent serious complication.Method:Under nasal endoscope, the operation approaches we adopted included trans-anterior ethmoid sinus-posterior ethmoid sinus-sphenoidal sinus pathway, trans-meatus nasi superior-posterior ethmoid sinus-sphenoidal sinus pathway, trans nasal septum-sphenoidal sinus pathway and trans-natural opening of sphenoid sinus anterior into sphenoid sinus pathway by taking upper edge of posterior naris as a consistent surgical landmark. Forty-six cases who had sphenoidal sinus mass with bone erosion recieved surgical treatment.Result:Twenty-one cases with cyst and pus cyst of sphenoidal sinus had been healed by trans-meatus nasi superior pathway;1 case with hematoma and organization in sphenoidal sinus had been cleared by trans-meatus nasi superior pathway;3 cases had hematoma and organization in sphenoidal sinus and pseudoaneurysm in internal carotid artery,one of them suffered fatal hemorrhage in surgical exploration, and cured by endovascular embolization, the other two only underwent nasal endoscopic examination,the diagnosis was established by DSA and they received interventional therapy;4 cases with papilloma in sphenoidal sinus had been treated by trans-natural opening of sphenoid sinus approach,and 3 cases were cured,1 case had only partial mass resection as the papilloma offended the outer wall of sphenoidal sinus diffusely;2 cases with cholesteatoma of sphenoid sinus have been removed completely by trans-meatus nasi superior approach;1 case with encephalomeningocele of sphenoidal sinus underwent sphenoidotomy by trans-natural opening of anterior of sphenoidal sinus, and intraoperative puncture showed characteristic cerebrospinal fluid,the exposed meninges were then repaird surgically;1 case with mycosis of sphenoidal sinus had been cured by thorough clearing of the leision in sphenoidal sinus combined with antifungal therapy;3 cases with malignancy of sphenoidal sinus had received major mass resection of sphenoidal sinus by trans-anterior ethmoid sinus-posterior ethmoid sinus approach, and followed with radio therapy and chemotheraphy;5 cases with NPC in-volving sphenoidal sinus had been treated by radio therapy and chemotherapy after pathological examinacation;5 cases with post-operative cerebrospinal rhinorrhea and granulation hyperplasia of sphenoidal sinus had been repaired successfully by trans-meatus nasi superior approach or tans-nasal septum approach.Conclusion:There are various surgical pathways to deal with sphenoidal sinus and correlated diseases under nasal endoscope.The operation will be direct, safe and minimal invasive if we choose the pathway properly. Thin slice CT scan and 3D reconstruction of sella, and DSA or angiography of brain before operation is one of effective means to prevent surgical complications for leisions beyond scope of sphenoidal sinus.

Objective To investigate the changes of follicular regulatory T cells ( Tfr cells) and follicular T helper cells ( Tfh cells) in peripheral blood of children with myasthenia gravis ( MG) . Methods We recruited 28 MG patients and 20 healthy subjects in this study. The percentages of Tfh and Tfr cells in peripheral blood samples were measured by flow cytometry. Real-time PCR was performed to detect the ex-pression of transcription factors and regulatory factors of Bcl-6, c-MAF, Blimp-1 and PD-1 at mRNA level. ELISA was used to detect the levels of IL-2, IL-6, IL-10 and IL-21 in plasma samples and the titers of Ach-Rab and PsMab. Results Compared with the healthy subjects, the MG patients showed higher percentages of Tfh cells and lower percentages of Tfr cells before receiving treatment. The expression of Bcl-6 and c-MAF on CD4+T lymphocytes cells at transcriptional level were significantly enhanced, while the expression of Blimp-1 on CD4+T cells and the expression of PD-1 on Treg cells at transcriptional level were inhibited in the MG patients in comparison with those in healthy subjects. Moreover, decreased levels of IL-2 and increased levels of IL-21 were found in plasma samples collected from the MG patients. Conclusion The decreased percentages of Tfr cells and increased percentages of Tfh cells in patients with MG resulted in abnormal ratios of Tfr/Tfh cells, which might be involved in the immunological pathogenesis of MG. Several changes in the patients with MG might be responsible for the imbalanced ratio of Tfr/Tfh cells, which included changes of IL-2 and IL-21 in microenvironment, enhanced expression of Bcl-6 and c-MAF at mRNA level and inhibited expression of Blimp-1 at mRNA level on CD4+T cells as well as over-expression of PD-1 at mRNA level on Treg cells.

Objective To investigate the quality of life (QOL) and its influential factors in the aged patients with ulcerative colitis (UC).Methods A cross-sectional survey of the UC patients was conducted by Chinese version of inflammatory bowel disease questionnaire (C-IBDQ).The influential factors for QOL in elderly patients with UC were evaluated and analyzed by correlation analysis and multiple linear regression analysis.Results A total of 90 aged UC patients finished the questionnaire study.The overall score of QOL in the aged UC patients was (175.7±37.6),and the score of each item was decreased,especially in the aspect of economic burden,emotional function and systemic symptoms.Multiple linear regression analysis indicated that the influential factors for QOL were sex,disease severity,duration,disease activity and the payment.The scores of bowel symptoms were higher in men than in women [(53.9±12.1) vs.(49.1±10.5),P=0.049].The QOL scores were lower in patients with the duration less than one year than over one year (P＜ 0.05).The QOL scores were lower in severe patients than in mild patients (P＜ 0.05).The QOL scores were lower in patients during active period than during remission period [(149.7 ± 35.1) vs.(193.9 ± 27.3),t=6.731,P=0.000].The QOL scores of patients whose medical cost was mainly paid by themselves were lower than those paid by insurance.And there were significant differences in systemic symptom,social function and economic burden (all P＜ 0.05).Conclusions The QOL of the aged UC patients is impaired in varying degree.The influential factors for QOL are sex,disease severity,duration,disease activity and the payment.The QOL in UC patients is obviously affected by economic burden.

Objective:To explore the influence of mindfulness on perceived stress in psychiatric nurses and the mediating effect of resilience.Methods:A total of 427 psychiatric nurses from a psychiatric hospital in Beijing were selected.Five-facet mindfulness questionnaire(FFMQ), Chinese-version perceived stress scale (CPSS) and Connor-Davidson resilience scale (CD-RISC) were used in this survey.Pearson correlation analysis and multiple stepwise regression analysis were performed using SPSS 24.0.And mediating effect was performed using AMOS 24.0.Results:The total score of psychiatric nurses' perceived stress was (37.89±7.16). Among all psychiatric nurses, 66.74% were under high pressure and 20.84% were under great pressure.The perceived stress was negatively correlated with mindfulness(123.69±10.82, r=-0.65, P<0.01) and resilience(85.40±17.87, r=-0.67, P<0.01), and mindfulness was positively correlated with resilience ( r=0.50, P<0.01). The direct effect of mindfulness on perceived stress was -0.15, the indirect effect was -0.34, and the total effect was -0.49. Conclusion:Resilience plays a partial mediating role between mindfulness and perceived stress psychiatric nurses.

Objective To explore the sensitivity of using NT,combined with serum biochemical markers (Free-βhCG,PAPP-A) for Down's Syndrome screening in early stage of pregnancy.Methods Collect pregnant women aged 17-45 years old voluntary antenatal screening in our hospital from March 2009to October 2010,a total of 11882 cases.Serum Free-βhCG and PAPP-A were measured NT value was determined by ultrasound at 11-13w+64 of gestation.Calculating combined screening (NT,Free-βhCG,PAPP-A),and serum integrated screening (Free-beta hCG,PAPP-A) risk,respectively,using the risk calculation software for the same person.Results Early pregnancy screening was performed in 11 882patients,18 had a fetus with Down's syndrome,a rate of 0.15％.The detection rates of Down's syndrome in combined screening and serum integrated screening were 83.3％ and 72.2％ respectively.The specificities were 98.4％ and 97.3％ and detection efficiency were 7.18％,3.90％ respectively.Areas under the curve (AUCs) of fhst-trimester combined screening and serum integrated screening were 0.975 (95％ CI:0.943,1.007),0.901 (95％ CI:0.789,1.013) respectively.Conclusion In early stage of pregnancy,combined screening for Down's syndrome has higher sensitivity and specificity than serological screening,has higher detection rate in the same false-positive rate case,which can effectively reduce the pregnant women to receive invasive puncture.

Objective:In order to prevent misdiagnosis and degrade death rate, we explored the early diagnosis and correct treatment methods of traumatic pseudoaneurysm of internal carotid artery in sphenoid sinus,. Method: The clinic data of 6 cases who had traumatic pseudoaneurysm of internal carotid artery in sphenoid sinus and were admited in our hospital were analyzed retrospectively. Large numbers of literature about the disease were re-viewed. Some early diagnosis methods and optimal treatment schemes were proposed. Result: All patients had a history of cranium trauma and recurrent attacks nasal hemorrhage. There are two patients with a complication of sight loss in single eye. In the six cases, one case was treated with unilateral common carotid artery ligation, three cases were treated with aneurysm and internal carotid artery embolism by using sacculus proprius which is able to shedding , one case was treated with internal carotid artery embolism by using tiny circlip ring . These five pa-tients were crued with no severe complication. One patient death of hemorrhea. His nasal cavity was tamponaded repeatly because repeat nasal hemorrhage. However, he had never treated with internal carotid artery embolism. Conclusion:The patients who have traumatic pseudoaneurysm of internal carotid artery usually die of unmanageable hemorrhea. The patients may be cured if they could obtain an early diagnosis and correct treatment.

Objective:To explore more reliable standards for identifying vestibular hair cells of saccule and utricle prepared in studies with patch clamp technique under inverted phase contrast microscope. Method:The length and width of two types hair cells were measured besides the length of cilia,and all datas were analyzed statistically.Result:The width and length of cilia of two types hair cells in saccule and utricle from guinea pig were similar. The length of type Ⅰ was longer than that of type Ⅱ,SO the ratio between length and width was larger and the ratio of the length between cilia and cell body was small.Conclnsion:Two type'S hair cells of saccule and utricle from guinea pig may be distinguished through the ratio of cell body's length and width even the ratio of the length between cilia and cell body,besides the standards before.

Objective To observed the expression of serum TNF-α and IL-10 in rats with severe acute pancreatitis (SAP) at different altitudes,and to explore the relationships between TNF-α and IL-10,the pathological changes of the pancreas,and the experimental basis for clinical diagnosis and treatment of SAP.Methods 72 specific pathogen free (SPF) Wistar male rats were divided randomly into three groups:1 500 meters altitude (group L),3 300 meters altitude (group M),and 4 300 meters altitude (group H).These three groups were then each divided randomly into four subgroups:control (group n),6 hours after pancreatitis (group p 6 h),12 hours after pancreatitis (group p 12 h),and 24 hours after pancreatitis (group p 24 h).Pancreatitis was induced by intraductal administration of 5％ sodium taurocholate hydrate (NaTc).The rats were killed at 6,12,and 24 hours after NaTc injection in groups p.The group n rats were killed after 6 hours of pancreas observation.Blood samples and pancreatic tissues were collected post mortem and enzyme-linked immunosorbent assay (ELISA) measured serum TNF-α and IL-10.Results Compared with the control (group n),histopathological scores,IL-10,and TNF-α in the same altitude had a significant difference (P ＜ 0.05) in group p at each time point.In the same altitude of group p,histopathological scores and IL-10 were increased with time elapsed (P ＜ 0.05),while TNF-α was decreased with time elapsed (P ＜ 0.05).There was a significant difference between group Mp and Lp in histopathological scores,IL-10,and TNF-α (P ＜ 0.05),and the same result between group Hp and Lp (P ＜ 0.05),but there was no significant difference between group Hp and Mp (P ＜ 0.05).Meanwhile,IL-10 had a positive relationship with histopathological score,but TNF-α had a negative relationship with histopathological score.Conclusions The level of TNF-α increased with increasing altitude but significantly reduced with elapsed time.The level of IL-10 increased with both increasing altitude elapsed time.These results suggested that TNF-o and IL-10 might play a important role at different times in severe acute pancreatitis.

Objective With Pregnant women weight correction for serum marker Multiple of Median (MoM) of First trimester and second-trimester,integrated screen-ing for Down's syndrome (DS),can reduce the false positive rate.Methods The same pregnant woman were taken venous blood vessels with sterile vacuum during the first trimester (11-13 W(+ 6) d) and the second trimester (15-20 W(+ 6) d),Alpha-fetoprotein (AFP),serum free beta-human chorionic gonadotrophin (Free beta hCG) and pregnancyassociated protein-A (PAPP-A) of three kinds of serum marker screening indicators were assayed by Using Time-resolved fluoroimmunoassay (TRFIA).Screening for risk assessment software was used to calculate serum marker Multiple of Median,To assess the risks of 7 997 cases of local pregnant women DS,To construct the weight equation of local population using nonlinear weighted regression method,With maternal weight correction for serum marker Multiple of Median (MoM) of local pregnant women,Comparing the changes of screening index MoM before and after correction,chi square test to compare the detection rate and false positive rate.Results MoM values of three kinds of serum markers (al-pha-fetoprotein,free beta subunit of human chorionic gonadotropin,pregnan-cy-associated plasma protein A) decreased with the weight increasing,Screening index MoM after correction weight equation,the screening of false positives for crowd from 4.12％ down to 3.86％ (x2 =0.021,P ＞ 0.05).Setting threshold (cut-off) at 1/270,and no change detection rates were 71.4％ the local population before and after correction weight equation.Conclusion Maternal weight may affect the results of Down's syn-drome sereening.When screening proposal to set up,it is worth making weight cor-rections for serum maker multiple of median in order to get accurate risk calculation results.

Objective To explore the anti-tumor effects of Egr-IFNγ gene therapy combined with 125I-UdR radionuclide therapy in mice bearing H22 hepatocarcinoma and its mechanism. Methods The recombinant plasmid pcDNAEgr-IFNγ mixed with liposome was injected into tumor. 48 h later, 370 kBq 125I-UdR was injected into tumor. The tumor growth rates at different times were observed. After 3 d gene-radionuclide therapy, the concentration of IFNγ in cytoplasm of H22 cells and cytotoxic activities of splenic CTL of the mice in different groups were examined. Results The tumor growth rates of pcDNAEgr-IFNγ +125 I-UdR group were obviously lower than those of control group, 125I-UdR group and pcDNAEgr-1 +125I-UdR group 6-15 d after gene-radionuclide therapy. IFNγ protein was found in cytoplasm of H22 cells in PcDNAEgr-1FNγ+125I-UdR group after 3 d gene-radionuclide therapy. Cytotoxic activity of splenic CTL in pcDNAEgr-IFN7 + 125I-UdR group was significantly higher than that in the other groups (P<0.01). Conclusions The anti-tumor effects in vivo of pcDNAEgr-IFNγ gene therapy combined with 125I-UdR radionuclide therapy are better than those of 125I-UdR therapy.