Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Middle Ear Ventilation ; methods ; Otitis Media with Effusion ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore the efficacy of the cognitive behavior therapy (CBT) for the treatment of chronic subjective tinnitus. METHOD: One hundred and fifty-seven patients were randomly divided into two groups. Sixty-eight patients of the control group were treated by masking therapy; and the other 89 patients of the experimental group were treated by CBT therapy. The score of tinnitus handicap inventory (THI) was utilized to analyze the treatment efficacy in the two groups respectively. RESULT: The effective rate assessed by of THI score in the experimental group was not significantly higher than the control group 2 months after treatment (P > 0.05), but was significantly higher than the control group 6 months and 12 months after treatment (P < 0.05 respectively). CONCLUSION The CBT therapy contributed to achieve rapid adaptation of tinnitus feeling, which shows great value of further clinical application.
Cognitive Behavioral Therapy ; Humans ; Tinnitus ; psychology ; therapy ; Treatment Outcome

A growing body of diversified antibiotic resistances raises a significant challenge to anti-infection clinical therapeutics. The emergence of superbugs carrying MCR-1/2 or NDM-1 determinants underlines the importance and urgency in elucidation of molecular mechanisms shared by antibiotic resistances. It is aware that different classes of bactericidal antibiotics consistently stimulate the production of deleterious reactive oxygen species (ROS), which are accompanied with metabolic disturbance. The different destinations of ROS determine its consequence on bacterial fate. Here, we review antibiotic-induced production, progression and transformation of ROS, as well as its role in the development of antibiotic resistance. Additionally, we anticipate that mesosome-like structures-aided exclusion of hydrogen peroxide might represent a previously-unknown mechanism for antibiotic resistance. This mini-review is aiming to present an update overview on antibiotic resistance and provide clues to the development of novel antibiotics.

Objective To investigate the activity of recombinant Vibrio vulnificus hemolysin (rVvhA) on the apoptosis of J774A.1 cells and the related mechanism. Methods The cytotoxic effect of rVvhA on the growth of J774A.1 cells was identified by MTT, celluar and mitochondrial morphology were observed by transmission electron microscopy, apoptosis or necrosis and mitochondrial membrane potential in J774A.1 cells were measured by flow cytometry, activities of caspase-3 ,-8,-9 were detected by spectrophotometry. Results The viability of J774A.1 cells exposed to rVvhA was inhibited, and it is dependent on dose. Celluar and mitochondrial uhrastructure both occurred to change obviously observed by transmission electron microscopy in J774A.1 treated by 2.0 HU/ml and 3.0 HU/ml rVvhA after 8 hours; and 3.0 HU/ml rVvhA group had a better cytotoxic effect on J774A.1 than that of 3.0 HU/ml rVvhA group. The percentage of apoptosis is (7.80±0.62)%, (12.33±0.12)%, respectively. Besides, the mitochondriai membrane potential also reduced, because the rate of fluorescence which is green increase 1.0% (normal) to 9.8% (2.0 HU/ml rVvhA) and 39.2% (3.0 HU/ml rVvhA). At the same time, the caspase-3, -9 activity increased gradually, but caspase-8 remained unchanging. In J774A.1 cells treated by 3.0 HU/ml rV-vhA + caspase-3 inhibitor(Ac-DEVD-FMK) or caspase-9 inhibitor(Ac-LEHD-FMK), The apoptosis of was reduced to(6.23±3.95)% ,(9.60±3.14)%, and the activity of caspase-3, -9 reduced, too. Conclusion The rVvhA has cytotoxic effect on J774A.1. Mitochondria-mediated apoptosis pathway which is dependent on caspase may be related to apoptosis induced by rVvhA in J774A.1.

Objective To investigate changes of GP73 after hepatectomy and its correlations with hepatocellular carcinoma (HCC) recurrence. Methods Perioperative serum GP73 was monitored in hepatic hemangioma and HCC patients undergoing hepatectomy. Clinicopathologic features and follow-up results were collected to evaluate the relationship between serum GP73 level and patients' prognosis.Results There was no statistical difference between preoperative GP73 and postoperative GP73 in hepatic hemangioma group.While preoperative GP73 in HCC group was 9.9(3.7 - 15.8) relative unit (RU),and that on POD3 (postoperative day 3 ) was 9.1 ( 3.4 - 13.3 ) RU,on POD7 was 74.3 ( 1.7 - 9.0) RU,on POD14 was 3.3(2.1 -5.4) RU ( F =72.606,P ＜ 0.001 ).HCC recurred in 21 cases during follow-up,GP73 in recurrent cases [ 11.0 (8.4 - 13.8 ) RU ] was significantly higher than postoperative trough values while it was not different from their preoperative GP73 level [ 9.9 ( 2.9 - 15.0) RU ] ( Z =1.185,P ＞0.05). The preoperative GP73 level between recurrent subgroup and nonrecurrent subgroup was not significantly different (Z =- 1.546,P ＞ 0.05 ).Preoperative GP73 did not correlate to patients' survival.Conclusions Hepatectomy for HCC leads to a significant decrease of GP73 and postoperative HCC recurrence accompanies reelevation of GP73. GP73 could be used as a postoperative monitor for HCC recurrence.

Objective To identify the hemolysin BL(HBL) gene from Bacillus cereus of patients with endophthalmitis comfirmed by API bacterial identification test strip,and detect its biological activity in vitro.Methods Three pairs of specific primers were designed according to the gene sequence of HBL(B,L1 and L2 components),then the PCR assay were established through condition optimization,and to further detect five Bacillus cereus strains isolated from clinical patients with endophthalmitis.HBL with biological activity was extracted by salt fractionation from a randomly selected strain,and a series of different concentrations of HBL were prepared and acted on sheep red blood cells(SRBC),Vero cells and Hela cells; virulence of HBL was also assessed through observating lethal effect of which on mice with intraperitoneal injection.Results Three genes of HBL were detected in all B.cereus strains from clinical patients; Strong hemolytic activity of HBL showed obvious time-and dose-dependent.In the study,we found the morphological changes of Vero and Hela cells caused by HBL were different,but cell death were the same result with contents released; Within 48 h after infection,lethality of HBL for mice showed 100％ with the concentration of more than 2.0 HU/ml,and was also in a time-and dose-dependent manner.Conclusion HBL isolated from B.Cereus had high hemolysis activity and low concentration.The expression of all BL genes provided a strong basis for the clinical feature of B.Cereus infection,which was developed rapidly and with a poor prognosis.It also provided a new method for rapid diagnosis and molecular epidemiology investigation in clinical.

Objective To summarize the clinical results of the surgical treatment for Stanford B aortic dissection patients with proximal aortic aneurysm(including aortic root,ascending,arch) by enblock technique.Methods From Jun.2011 to Oct.2015,20 patients with Stanford type B aortic dissection and proximal aortic aneurysm underwent open surgery by enbloc technique in our center.Among them,there were 15 male and 5 female.Average age of patients was(40.65 ± 13.55) years (range:22-65 years).The comorbidities of proximal aortic diseases are ascending aortic aneurysm in 10,aortic root aneurysm in 8,and aortic arch aneurysm in 2.All the surgeries were accomplished by hypothermic cardiopulmonary bypass assist.The combined surgery includes:extra-anatomy bypass grafting in 16,Bentall procedure in 15,ascending aortic repair in 5.Before surgery and discharged from hospital computed tomography angiography(CTA) was performed in each patient.All patients except 2 were followed.During the follow-up,CTA was performed and recorded.Results The average operation time,cardiopulmonary bypass time,aortic clamping time and selective cerebral perfusion (SCP) time are (6.47 ± 1.01)h (4.5-9 h),(173.60 ± 43.39) min (109-303 min),(91.25 ± 28.63) min (51-165 min),(27.25 ± 6.80) min (17-43 min),respectively.The mean nasopharyngeal temperature during SCP is(23.77 ± 1.27)℃ (21.6-26℃).There were no operative deaths.The mean follow-up time is (32.44 ± 17.27)months (range:8-60 months).Two patients underwent aortic re-intervention during follow-up.And 2 patients were lost follow-up(The follow-up rate is 90％).One late death was found.The patient succumbed to sudden distal aortic rupture.Other patients are survived without any complications.Conclusion Enblock technique is a relatively simple procedure in total aortic arch repair surgery.And it can be a safely surgical treatment for type B aortic dissection patients with proximal aortic aneurysm.The indications of enblock technique for Stanford B aortic dissection patients are those who combined with proximal aortic aneurysm.

Objective:To study the risk factors of massive bleeding in patients with acute Stanford type A aortic dissection undergoing moderate hypothermic circulatory arrest repair.Methods:From January 2016 to October 2017, 486 consecutive patients with acute type A aortic dissection were included in the study. All operations were performed with moderate hypothermic circulatory arrest. The basic clinical data of patients were collected retrospectively. Massive bleeding was defined according to definition of Universal Definition of Perioperative Bleeding(UDPB) 4 class and the Blood Conservation Using Antifibrinolytics in a Randomized Trial(BART). Significant variables in univariate analysis were included in multivariate logistic regression analysis. Results:Thirty-four patients(7.00%) died in hospital. A total of one hundred and eighty-seven patients(38.48%) fulfilled criteria of the definition of BART massive bleeding. Forty-five patients(9.26%), 8 patients(1.65%), 114 patients(23.46%), 147 patients(30.25%) and 172 patients(35.39%) were in grade 0, grade 1, grade 2 and grade 4, respectively. With BART as the end point, the result of multivariate logistic regression showed that female gender( OR=3.32, P<0.001), anemia( OR=2.24, P=0.04), clearance creatine≤85 ml/min( OR=1.93, P=0.01), D-dimer level(every 500 ng/ml increase, OR=1.02, P=0.003), cardiopulmonary bypass(CPB) time( OR=1.01, P<0.001), total arch replacement(TAR, OR=2.40, P=0.02) were independent risk factors for massive bleeding, and the time from onset to operation( OR=0.86, P=0.01) was protective factor. With UDPB 4 class as the end point, multivariate logistic regression showed that creatinine clearance≤85 ml/min( OR=2.05, P=0.001), CPB time( OR=1.01, P=0.04) were independent risk factors for massive bleeding. The time from anset to operation( OR=0.85, P=0.002) and Bentall procedure( OR=0.65, P=0.04) were the protective factors. Conclusion:Massive bleeding was more common in acute Stanford type A aortic dissection. Female gender, poor preoperative renal function, high D-dimer level, early time accepting surgical operation and long CPB were independent risk factors. For high-risk patients, simple and effective surgical methods should be taken to reduce the risk of bleeding.

Objective To summarize our experience of surgical repair for cervical aortic arch(CAA) aneurysm and eval-uate early and midterm results of these patients.Methods From January 2010 to December 2014, 22 patients with left-sided CAA aneurysm admitted in our center.There were 6 male and 16 female patients with a mean age of(34.09 ±13.14) years. Comorbidities included pseudocoarctation in 9 patients, hypertension in 4 patients, and aortic valve insufficiency, Stanford type B aortic dissection and middle cerebral artery aneurysm each had 1 patient.All of the patients underwent surgical aortic arch re-construction using artificial graft replacement.Among them, 4(4/22, 18.18%) were performed under moderate hypothermic circulatory arrest(MHCA) combined with selective antegrade cerebral perfusion(SACP) via a median sternotomy, and concom-itant aortic valve replacement(AVR) was implemented in 1 patient.18(18/22, 81.82%) were performed via posterolateral left thoracotomy through the 4th intercostal space, and adjunct methods applied included partial CPB and “simple clamping” in 10 and 8 of these patients respectively.Results The average mechanical ventilation time and ICU stay time was (13.05 ± 4.73)h and(19.14 ±8.08) h respectively.1 patient required repeat thoracotomy for bleeding, 1 patient with delayed wound healing and 1 patient suffered transient liver dysfunction.There were no in-hospital deaths.Mean follow-up time was 34.73 months, and 3 patients were lost during follow-up.There were no late deaths during follow-up.Conclusion Repair of CAA is indicated for the patients with arch aneurysm formation .According to the locations and types of aneurysms and other concomi-tant proximal cardiovascular diseases, performing one-stage surgical aortic arch reconstruction with individualized incisions , ad-junct methods and operative procedures can obtain satisfactory clinical outcomes in patients with CAA aneurysm .

Objective To establish a Chinese expert consensus of the surgical management for type A aortic dissection (TAAD) by using the Delphi method.Methods A systematic review of the previously published literature related to management of TAAD at home and abroad was conducted to formulate a questionnaire of clinical consensus of the surgical treatment for TAAD.This questionnaire including seven aspects of surgical management for TAAD,namely contraindications to operative management,cannulation site,target temperature during circulation arrest,cerebral perfusion strategy,surgical procedure,distal anastomotic technique and surgical management for patients with connective tissue disease such as Marfan syndrome.From October 2015 to April 2016,we performed two rounds Delphi survey in which the current professional opinions from 55 experienced and representative cardiovascular surgeons in China,were gathered and analysed.Results The responses rates of two rounds were 80.0％ (44/55) and 77.27％ (34/44).The scores of authoritative coefficient was 0.87 and 0.83.The coefficient of concordance were 0.31 (P ＜ 0.05) and 0.32 (P ＜ 0.05).After two rounds of consultation,consensus of the surgical management for TAAD was reached on 16 items of seven aspects.Conclusion This Delphi study established an initial Chinese expert consensus concerning the surgical management for TAAD,which drew credible results and reliable conclusions.This study will helo to standardize the surgical management of TAAD in China.