OBJECTIVE To describe the surgical experience in the repair of cerebrospinal fluid (CSF)rhinorrhea treated by endoscopic transnasal approaches. METHODS From Oct. 2003 to Dec. 2008, 38 patients with CSF rhinorrhea were treated. Endoscopic endonasal approaches and surgical techniques in repair of CSF leaks were reviewed in a series of 38 patients included 21 patients with traumatic CSF leakage, 10 patients with spontaneous CSF leakage, and 7 patients with other reasons. RESULTS Followup of 6 months to 3 years after operation, successful rate at first attempt was 92.1%. Two patients needed a second surgical repair and one patient a third surgical repair. The complications included meningitis and acute obstructive hydrocephalus in two patients respectively. CONCLUSION The endoscopic endonasal approaches is the first choice for repair of CSF leakage for its minimal invasive injury and high successful rate. Leakage site identification, site preparation, accurate graft placement and postoperative management are critical to the success of operation.

Humans ; Oral Surgical Procedures ; education ; methods ; Surgery, Oral ; education ; manpower ; trends

From the aspects of advantages, barriers, opportunities and challenges, this paper analyzed the environmental factors of Shanghai medical resources serving people in the Pan-Yangtze River Delta. As envisaged by the author, such services will provide medical resources information to patients from outside Shanghai, probe into feasible ways to medical insurance based on experiences drawn from serving such patients, help with the resources integration of medical systems in Shanghai, and probe into the potentials of telemedicine and distant medical e-learning, as well as improve hospital management levels and service functionality.

Objective Through the analysis of the characteristics of serum lipids metabolism and plasma fi‐brinogen levels in patients with sudden hearing loss ,to investigate the relationship between them with sudden deaf‐ness .Methods A retrospective analysis of 180 cases of patients with sudden deafness (SHL group) ,depending on the type of auditory threshold curve divided into low intermediate frequency drops group (low intermediate frequency group) and 40 cases ,the high frequency drop group (high frequency) 90 cases ,all frequency drop group (group all frequency) 50 cases ,and drawing 180 cases in the same period of hospitalization deviated septum ,vocal cord polyp patients as control group .All patients'triglyceride (TG) ,total cholesterol (TC) ,low -density lipoprotein choles‐terol (LDL -C) ,high density lipoprotein cholesterol (HDL -C) ,glucose (Glu) ,plasma fibrinogen (FIB ) levels were analyzed .Then a meaningful factor multivariate Logistic regression analysis was made .Results There was a statistically significant difference between the two groups'TC ,HDL -C ,LDL -C ,Glu ,and FIB(P<0 .05) .There was no significant difference of TG (P>0 .05) .There was a statistically significant difference between the groups'all frequency and low frequency group and control group TC ,HDL -C ,LDL -C ,FIB(P<0 .05) .There was no sig‐nificant difference between each group of Sudden deafness group and the high frequency group and control group (P>0 .05) .The Logistic regression analysis showed that the LDL ,FIB was the major risk factors associated with the onset of sudden deafness .Conclusion Lipid levels in patients with sudden hearing loss is higher than that of in the normal hearing group .High levels of LDL - C and FIB have close correlations with the patients with sudden deafness ,and the related risk factors for the onset of sudden deafness ,according to threshold curve type ,should choose targeted treatment options .

Objective: To investigate the effects of arginine enriched TPN on proliferation and apoptosis of intestinal epithelial cells. Methods:24 young rabbits were divided into 3 groups: control group,standard TPN group and arginine-enriched TPN group.Rabbits in the control group received free chow and water ad libitum after ligation of the right jugular vein;animals in the other two groups received standard TPN(175kcal/kg?d,200 ml/kg?d) or arginine enriched(2% of total energy) TPN.After 7 days of TPN administration,plasma and ileum were collected for the following tests: ①intestinal morphological changes;②incidence of bacterial translocation;③D-lactic acid level in plasma;④expression of proliferating cell nuclear antigen(PCNA) of epithelial cells;⑤apoptosis of epithelial cells. Results:①The mucosal thickness,villus height and villus surface area in argnine enriched TPN group were significantly higher than those in standard TPN group(P0.05).②The incidence of bacterial translocation in arginine enriched TPN group was significantly lower than that in standard TPN group(P0.05).③The plasma D-lactic acid level in arginine enriched TPN group was significantly lower than that in standard TPN group(P0.05). Conclusion:Arginine plays an important role in maintaining the integrity of gut barrier,reducing the apoptosis of epithelial cells and improving the intestinal cells proliferation.

Objective To investigate the ex pr ession of nm23-H1 protein and proliferating cell nuclear antigen (PCNA) in huma n glioma cells. Methods Expression of nm23-H1 and PCNA in 53 br ain gliomas were detected by immunohistochemistry. Results The immunohistochemistry staini ng of nm23-H1 protein in low-grade astrocytomas (grades Ⅰ and Ⅱ) was significantly higher than that in high-grade astrocytomas (grades Ⅲ and Ⅳ). The immunohistochemistry staining of PCNA in high-grade astrocytomas was s ignificantly higher than that in low-grade astrocytomas. Conclusion The lower expression of nm23-H1 protein and the higher expression of PCNA are correlated with the pathological grade of glioma cells. The expression of nm23-H1 may be used as a hopeful marker for predicting the metastastic potential of gliomas.

OBJECTIVE: Through the analysis of coagulation convention and blood routine parameters of sudden hearing loss (SHL) patients, further prove the correlation of sudden deafness and the the inner ear microcirculation, to guide clinical diagnosis and treatment. METHOD: Select 424 patients (448 ears) with sudden deafness in our department to SHL group. According to hearing curve is classified into low intermediate frequency descent group, high frequency drop and full frequency group, and drawing 244 cases in the same period of hospitalization deviated septum, vocal cord polyp patients as control group. All patients' coagulation detection, D-dimer, blood leukocytes, neutrophils and platelet count percentages were analyzed. Then a meaningful factor multivariate Logistic regression analysis was made. RESULT: There was a statistically significant difference between the two groups' prothrombin time, international normalized ratio, activated partial thromboplastin time, thrombin time measurement, fibrinogen, D-dimer, platelet count, white blood cell, neutrophil ratio(P<0.05); Logistic regression analysis showed that the prothrombin, thrombin time measurement, fibrinogen, D-dimer, neutrophil incidence of sudden hearing loss associated risk factors. CONCLUSION SHL in patients with coagulation dysfunction may be involved in the occurrence of SHL development mechanism, and there is a correlation of the SHL and the dysfunction of inner ear microcirculation.
Blood Coagulation Disorders ; complications ; Ear, Inner ; blood supply ; Fibrin Fibrinogen Degradation Products ; analysis ; Fibrinogen ; Hearing Loss, Sudden ; blood ; complications ; Humans ; Incidence ; Risk Factors

Cerebral hyperperfusion syndrome (CHS) is one of the complications after stenting in patients with carotid stenosis.Although its incidence is lower,it may result in serious disability or death in patients.Full awareness and understanding of CHS and its related risk factors may contribute to its prevention and treatment.

Objective To observe the characteristics of multiple evanescent white dot syndrome (MEWDS) with modern multimodal imaging modalities.Methods This was a retrospective case study.Eleven patients (11 eyes) diagnosed with MEWDS were enrolled.There were 10 females and 1 male,mean age was 27.6 years (range 15-41 years).The period between disease onset and visiting to the hospital was between 2 to 13 days,the average time was 4.7 days.All the patients underwent examinations of best corrected visual acuity,slit-lamp biomicroscope,indirect ophthalmoscope,fundus color photography,fundus autofluorescence (FAF),fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (SD-OCT).The mean follow up duration was 3.2 months.The imaging characteristics were compared.Results Fundus color photography showed foveal orange-red granularity in all eyes.FAF showed strong autofluorescence with a vague boundary.FFA showed a variable number of highly fluorescent fine needle-like dots arranged in a ring in the early stage,and fluorescence remained in the late stage.ICGA showed advanced lesions of vague boundary merged into a large plaque of deep retinal hypofluorescence.SD-OCT showed the hyperreflectant material deposit over the retinal pigment epithelium and extending anteriorly through the interdigitation zone,ellipsoid layer,and toward the external limiting membrane.At the site of extrafoveal lesions,SD-OCT revealed the presence of discontinuities or disruptions centered on the ellipsoid zone to include the interdigitation.Conclusions In MEWDS patients,fundus photography showed foveal orange-red granularity;FFA showed early fluorescent dots distributed in a ring pattern;ICGA showed hypofluorescent lesions in the later stage;SD-OCT showed disruption of the interdigitation zone and ellipsoid zone and accumulations of hyperreflective material that was of variable size and shape;FAF showed strong autofluoresce areas that correlated to spots observed with FFA and ICGA.

Objectives To explore the relationship between serum leve ls of hepatocyte growth factor (HGF) and matrix metalloproteinase-9 (MMP-9) and the disease activity of systemic lupus erythematosus (SLE), and study the mechan isms of these two factors in the pathogenesis of SLE. Methods The serum levels of HGF and MMP-9 were measured by ELISA. The growth curve of normal ECV304 cell line was obtained, and the action concentration of recombinant human hepatocyte growth factor (rhHGF) was determined. MMP-9 expression level in cells was detec ted by flow cytometric analysis. Results The serum level of HGF increased sign ificantly in SLE patients as compared with that in healthy controls (P 0.05). The area of ROC curve was 0.707 and the sensitivity was 66 .7% when using the serum level of HGF as diagnostic standard. The area under ROC curve was 0.984 and the sensitivity was 97.2% when using the serum level of MMP-9 as diagnostic standard. The sensitivity was 66.7% (24/36) when two markers (H GF and MMP-9) were examined simultaneously. Additionally, the action concentrati on of rhHGF was 8 ng/mL, and the expression level of MMP-9 was 39.74% in normal ECV304 cells and increased to 40.32% after rhHGF stimulation. Conclusions It i s suggested that HGF and MMP-9 may be involved in the pathogenesis of SLE, and s erum levels of HGF and MMP-9 might be used as markers for monitoring the disease activity, renal damage, disease progression and improvement in SLE. The sensiti vity might be higher when serum level of MMP-9 is used as diagnostic standard, a nd rhHGF can enhance MMP-9 expression in ECV304 cell line.