Objective To observe the anagesia effectof PCIA (patient-controlled intravenous analgesia)with flurbiprofen anddezocine on obstructivesleep apnea sydrome (OSAS)patients under-going uvula palatopharyngoplasty.Methods Sixty OSAS patients,aged 26-59 years,using PCIA af-ter UPPP were randomly divided to three groups (n=20 each):patients in group FD started the PCIA with flurbiprofen 1 mg/kg+dezocine 0.4 μg/kg+Azasetron in 100 ml saline after surgery, while these in group D with dezocine 0.4μg/kg+Azasetron,group S with sulfentanyl 2μg/kg+Aza-setron (background infusion 2 ml/h,single lose 0.2 ml/h,load doses 5 ml/h,lock time 15 min)VAS scores of 1,2,6,12,24,48 h after surgery and the incidence of nausea,vomiting,drowsiness,pruri-tus,were recorded.Results All group patients showed good pain relieve.There were no significant differences in VAS scores observed in three groups.The side effect incidence for group FD,D and S was 5%,10% and 30%.Conclusion PCIA with flurbiprofen and dezocine can provide good anagesia effect and mild side effects on UPPP patients.

Paget's disease of the breast is an uncommon disorder that accounts for 1% to 3% of all mammary tumors. The incidence of underlying carcinoma associated with Paget's disease has been reported in 82% to 100% of cases. The finding of underlying carcinoma reaches almost 100% when a palpable lump is also present. In this rare case, we described a patient presenting with Paget's disease but no palpable lump. However, we found 11 independent regions which were all invasive ductal carcinoma after the operation. Considering this patient, we should pay more attention to a multifocal and multicentric breast carcinoma associated with Paget's disease. Furthermore, we believe the mammography examination and a modified radical mastectomy are the most appropriate treatments for this population in clinical practice.

Objective To investigate the correlation of previous hepatitis B virus (HBV) infection with the incidence risk of chronic pancreatitis (CP).Methods This was a case control study.Five hundred and seventy-one patients with CP admitted in the Department of Gastroenterology, Changhai Hospital, Second Military Medical University between January 2015 and October 2016 were enrolled, and 1216 sex and age matched health individuals were also enrolled as the control group.The 5 serum HBV markers(HBsAg,HBsAb, HBeAg, HBeAb and HBcAb) were detected and their correlation with CP incidence was analyzed.Results The positive rate of HBsAg in the CP group and the control group were 3.0% and 3.8%, respectively, and the difference was statistical significant.(OR=0.039, 95% CI 0.02~0.80, P<0.00), but in all the HBsAg positive models (HBVM) the difference of CP and control groups was not statistical significant.HBsAb positive rate in CP group and the control group were 51.8% and 75.0%, respectively, and the difference was statistical significant(P<0.000).HBeAg positive rate in CP group and the control group were 1.1% and 0.1%, the difference was statistical significant (P<0.05), but in all the HBeAg positive models, the CP group and the control group had no statistical difference (P>0.05).The positive rate of HBeAb in the CP group and the control group were 24.3% and 10.8%, respectively, and the difference was statistical significant(P<0.00).The positive rate of HBcAb in the CP group and the control group were 50.1% and 16.5%, respectively,and the difference was statistical significant(P<0.000).In the(HBsAb+, HBeAb+, HBcAb+), (HBsAb+, HBcAb+), (HBeAb+, HBcAb+), (HBcAb+) models, the positive rate in CP group was significantly higher than that of the control group(P<0.000).Multivariate regression analysis showed that the positivity of HBsAb and HBeAb were the protection factors for the occurrence of CP(P<0.05),and HBcAb positivity was the independent risk factor for CP (OR=6.931,P<0.000).Conclusions HBsAb and HBeAb poitivity were the protectors for CP, while HBcAb positivity could be considered as an independent risk factor for CP.

[ABSTRACT]OBJECTIVETo evaluate the diagnostic value and curative effect of keyhole neurovascular decompression with local anesthesia for vestibular paroxysmia.METHODSOf 40 patients with trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia, 8 of them combined with vestibular paroxysmia underwent keyhole neurovascular decompression under local anesthesia to explore the vascular compression of acoustic nerve root and have the neurovascular decompression. The evaluation of the vertigo after operation was performed with symptom report card. The patients were followed-up for 36 to 61 months. RESULTSThe vessels compressing the root zone of the vestibular nerve were found in 8 patients with vestibular paroxysmia, of whom 7 patients had the vascular compression vertigo induced during operation and the vertigo was disappeared after operation, moreover, one patient had no vascular compression vertigo induced during operation and the vertigo was not changed after operation. With the average follow-up of 57 months, of 8 patients with vestibular paroxysmia, 7 patients had no recurrence of the vertigo, and the effective control rate was 87.5%.CONCLUSION Local anesthesia keyhole neurovascular decompression was not only an effective way for treating vestibular paroxysmia and controlling the vertigo, but also had certain clinical significance in the diagnosis of vestibular paroxysmia.

ObjectiveTo investigate the effects of the imbalance between regulatory T cells (Treg) and T helper 17 cells (Th17) in patients with chronic hepatitis B virus (HBV) infection.MethodsThe serum concentration of Treg/Th17 differentiation-related cytokines in 34 patients with chronic hepatitis B (CHB),20 patients with HBV related acute on chronic liver failure (ACHBLF),and 20 healthy controls (NC) were measured by enzyme-linked immunosorbent assay (ELISA) and proportion of peripheral Th17 and Treg cells were analyzed by flow cytometry.Numeration data was analyzed by Fisher's exact propability method and measurement data was tested by one-factor analysis of variance or Turkey multiple comparison.Results The levels of Th17 differentiation-related cytokines,II-1β (3.97±2.85) pg/mL,IL-6 (12.75±-8.87) pg/mL,and IL-21 (360.0±335.7) pg/ mL in patients with ACHBLF were significantly increased than those in NC,which were (1.87 ±0.94) pg/mL(q=4.559,P＜0.01),(5.28±0.72) pg/mL(q=7.309,P＜0.01) and (46.68±20.17) pg/mL(q=6.946,P＜0.01 ),respectively.The proportion of Th17 increased markedly in patients with ACHBLF than that in NC(q=3.972,P＜0.05).However,compared to NC and patients with ACHBLF,the Treg differentiation-related cytokine,TGF-β,in patients with CHB,increased significantly (q=4.536 and 5.323,respectively; both P＜0.01).And the population of Treg also increased markedly in CHB patients.The level of IL-17A which was the characteristic effector cytokine of Th17 was the highest in patients with ACHBLF.The peripheral Th17 cell proportion was positively correlated with the level of serum total bilirubin in patients with ACHBLF (γ=0.74,P＜0.01).Conclusions Th17 and Treg imbalance including cytokine profiles and cell numbers exists in patients with chronic HBV infection.The Th17 are active in patients with ACHBLF and Treg are active in patients with CHB.

Objective To explore the relationship between the distribution of infected snails and transmission of acute schistosomiasis in hilly regions.Methods The data concerning the distribution of the infected snails and acute schistosomiasis in Shitai County,Anhui Province from 1999 to 2008 were collected and analyzed.Results The sehistosome infection rate of human increased as the distance between the settings with infected snails and activity sites of humans shortened.Conclusions Acute infection of schistosome of human is associated with the distance between the settings with infected snails and activity sites of them.Strengthening the measures of snail control in key regions,protecting key populations and carrying out health education for schistosomiasis control are important approaches to control the transmission of acute schistosomiasis in hilly regions.

Objective To identify the relationship between viral factors and disease progression in patients with acute hepatitis B virus (HBV) infection. Methods Ninety-seven adult patients with acute HBV infection in Shanghai Changhai Hospital were enrolled in this study and followed up for 24 weeks. Epidemiological, biochemical and virological parameters of all patients were collected. HBV S region from sera of 54 patients with acute HBV infection were genotyped using direct nucleotide sequencing. Differences of means between groups were compared by t-test, and frequency between groups was compared by X test. Results The clinical manifestations of all patients were mild and the 83 patients spontaneously developed HBeAg and HBsAg seroconversion. However, 14 patients had a tendency of chronicity, with HBV DNA level higher than patients without chronicity tendency [(6. 17 ±1. 04) 1g copy/mL vs (3. 86±1. 85)1g copy/mL;t = 5. 95, P<0. 01]. Among the 14 patients, 6 obtained HBsAg seroconversion after antiviral therapy and the other 8 developed to be sustained HBV carrier who had not received antiviral therapy. The main genotypes of acute HBV infection were genotypes B and C. There were no statistically significant differences of epidemiological factors and biochemical results between patients with the two genotypes of HBV infection. High viral load at baseline was the risk factor of chronicity tendency. Conclusions The main genotypes of acute HBVinfection in Changhai Hospital in the year from 2003 to 2007 are genotypes B and C. There is no significant relationship between genotype and clinical outcome. While high viral load at baseline is significantly associated with chronicity tendency. Proper antiviral therapy can decrease sustained HBV infection rate.

Objective To investigate the distribution of genotypes in chronic HBV infection (CHB) and acute HBV infection (AHB) patients in Shanghai. Methods Sixty-two patients with AHB and 73 patients with CHB admitted to ('hanghai Hospital of Shanghai between 2003 and 2007 were studied. Viral genotypes of all the patients were determined by direct gene sequencing.Meanwhile, epidemiological, clinical and biochemical parameters of all patients were collected. Mean values of different groups were compared by t test while frequency was compared by chi square test. Results The major prevalent genotypes in both AHB and CHB patients were genotype B and C (48.4% vs 51.6% in AHB patients and 26.0% vs 74.0% in CHB patients). The proportion of genotype B was higher in AHB patients compared to CHB patients (P= 0.02). Epidemiological factors and clinical outcomes were not statistically different among patients with different viral genotypes. The proportion of genotype C was much higher in CHB patients compared to AHB patients (P=0.006). The main transmission route of AHB was heterosexual interaction which was 18 out of 62 (29.0%), but in CHB patients, it was prenatal transmission which was 38 out of 73 (52.1%). Conclusions In shanghai, the main HBV genotypes in both AHB and CHB patients are genotype B and C. The proportion of genotype B is relatively high in AHB patients while proportion of genotype C is more common in CHB patients. There is no significant relationship between genotypes and the clinical outcomes of AI-IB patients.

Objective To observe the feasibility of 125I intra-operative implantation plus palliative resection of gastric carcinoma for treatment of advanced gastric cancer infiltrating pancreas. Methods 125 I was implanted intraoperatively into the residual pancreatic cancer tissues after gastric carcinoma was palliatively removed. Results From Feb. 2005 to Jun. 2009, 15 cases (9 male, 6 female) advanced gastric cancer patients were treated with 125 I intra-operative implantation. The patients' ages ranged from 41 to 78 years, with the median age of 64 years old. There were 10 cases of gastric cancer infiltrating the neck or body of pancreas and 5 cases infiltrating pancreatic head. No severe post-operative complications were recorded. The follow-up showed that there were 5 cases of CR (33.3%), 9 cases of PR (60%), 1 case of NC (6.7%) and no PD patients were found. Conclusion 125I intra-operative implantation plus palliative gastric resection is feasible and effective for patients of advanced gastric cancer infiltrating the pancreas.

Objective: To study the effect of the sharp marginal ridge of the abutment on the casting of the fit metal full crown in dental preparation.Methods: We established the models of the designed crown-based-teeth(American Dental Association style,No2 trail) with a sharp or smooth marginal ridge,and cast a metal crown for each model.We injected silicone into the crown and immediately fixed it onto each model.Then we took out the solidified silicone and measured its thickness between the crown and the occlusal face of each model.The thinner the thickness,the better the fitness.Results: The average silicone thickness was 250 ?m in the smooth marginal ridge group and 1 660 ?m in the sharp marginal ridge group,with significant difference in between(P