Objective To explore the common bleeding location, disease features, and the management strategies of intractable aged epistaxis. Methods 134 serious epistaxis patients were examined step by step according to nasal anatomic structure and treated by a stepwise way under endoscopy. Results The bleeding location of the intractable aged epistaxis were found as follows:2 cases (1. 49%) in anterosu-perior area, 44 cases (32. 84%) in anteroinferior area, 18 cases (13. 43%) in posterosuperior area, 22 cases (16. 42%) in posteroinferi-or area, 3 cases (2. 24%) in nasopharynx, and the bleeding site of the other 45 cases (33. 58%) were not found. All the patients were healed. The final treatment way were:46 cases (34. 33%) with pharmacotherapy or cauterization (grade Ⅰ~Ⅲ), 88 cases (65. 67%) with anterior nasal packing (grade Ⅳ), 9 cases (6. 72%) with posterior packing(gradeⅤ),1 case (0. 75%) with selective angiographic embolization (grade Ⅵ). There were 82 cases (61. 19%) succeed with the initial hemostasis methods while 52 cases (38. 81%) succeed with the upgrade therapy. Both hemostasis methods and upgrade therapy had statistical significance in different nasal position groups ( hemo-stasis methods:χ2 =16. 35,P=0. 00; upgrade therapy: χ2 =16. 35,P=0. 00). Conclusion Compartmental examination and classified treatment steps by using endoscope may locate and stop nose bleeding promptly while decrease patients' pain and medical cost.

OBJECTIVETo explore the curative effect and adverse reactions of a convenient expiratory positive airway pressure device(EPAPD) in treatment of obstructive sleep apnea/hypopnea syndrome(OSAHS). METHODS74 subjects with OSAHS were treated by EPAPD. Polysomnography(PSG) and Epworth sleepiness scores(ESS) were performed and evaluated before, within 1 week and after 3 months using the EPAPD. The index of PSG and ESS were compared at different time. The adverse reactions were also observed at the same time.RESULTS Compared to baseline, the AHI, LSaO2, ESS were significantly improved both within 1 week and after 3 months(AHI:F=73.62,P=0.00; LSaO2:F=12.65,P=0.00; ESS:F=61.49,P=0.00). The improvement of AHI between different OSAHS groups(divided by the severity of AHI in baseline) was significantly different(within 1 week:F=15.39,P=0.00; after 3 months:F=12.60,P=0.00). There was also significant difference between different hypoxia groups which were divided by the severity of LSaO2 in baseline(within 1 week:F=3.80,P=0.03; after 3 months:F=3.27,P=0.04). Meanwhile, the ESS was significantly improved in different sleepiness groups(divided by the ESS score in baseline) within 1 week(F=6.17,P=0.00). The device-related adverse events were reported by 44.59%(33/74). There were not serious adverse reaction happened. The major adverse reactions were throat and nose dry, nasal obstruction, and nose discomfort.CONCLUSION The EPAPD is an effective, convenient device in treating OSAHS. Meanwhile, the device related adverse reactions are slight. It may be more efficient for serious OSAHS patients than mild ones.

AIM:To observe the effects and mechanisms of hydroxyethylstarch (HES) 130/0.4 on no-reflow phenomenon after myocardial ischemia-reperfusion in rats.METHODS: SD rats were randomly divided into 4 groups:sham operation group , ischemia-reperfusion ( IR, treated with normal saline ) group, normal saline ischemia-reperfusion (NS-IR, treated with NS) group and HES ischemia-reperfusion (HES-IR, treated with HES) group.Myocardial infarct size and no-reflow range were determined by staining methods , and the activities of myocardial enzymes ( CK-MB, cTnI and MPO) were measured .Meanwhile , cardiac microvascular endothelial cells of the rat were cultured and divided into 4 groups:control group, hypoxia/reoxygenation (H/R) group, NS-H/R group and HES-H/R group.Acute ischemia reper-fusion models were simulated , and the concentration of calcium ions was measured .The relative cell activity was evaluated by CCK-8 assay, and the apoptotic rate was detected by flow cytometry .RESULTS:In HES-IR group, the myocardial in-farct size, the no-reflow zone, CK-MB, cTnI and MPO activity were all significantly lower than those in IR group ( P<0.05).In microvascular endothelial cells , the concentration of calcium ions and the apoptotic rate in HES-H/R group were significantly decreased, while the relative cell activity increased compared with H/R group (P<0.05).CONCLUSION:HES reduces no-reflow in acute myocardial ischemia-reperfusion .The mechanism may be involved in the inhibition of both the infiltration of neutrophils and the calcium overload of endothelial cells .