Objective To evaluate the effectiveness of wechat-based transitional care in the acoustic neuroma patients with postoperative facial palsy.Methods 90 acoustic neuroma patients with postoperative facial palsy were randomly enrolled into 2 groups by tossing coin,45 cases in each group.Control group received routine discharge education,while the experimental group received wechat-based transitional care for three months.The rehabilitation adherence,the level of facial palsy,the ocular infection and the quality of life at patients discharged and three months after operation were compared between the two groups.Results Three months after operation,the cases of high,middle,low level of rehabilitation in the experimental group were 28,12,5,which were more than the control group whose cases were 15,21,9 (x2=7.528,P＜ 0.05).Facial palsy and the quality of life of the experimental group were 66.7％ (30/45) and (71.62±6.36) points,which was significantly higher than 42.4％ (19/45) and (63.75±11.28) points in the control group (x2=5.421 and 4.073,P ＜ 0.01).The incidence of ocular infection in the experimental group was 8.9％ (4/45) which was significantly lower than 31.1％ (14/45) in the control group (x2=6.671,P ＜0.05).Conclusions Wechat-based transitional care achieves good effectiveness in patients with postoperative facial palsy,which could improve the level of rehabilitation,facial palsy and the quality of life,and reduce the incidence of ocular infection,is worthy of promotion.

Objective To investigate the impact of simvastatin on blood lipid and the incidence of atrial fibrillation and ischemic-related events in patients with acute myocardial infarction accompanied by paroxysmal atrial fibrillation. Methods One hundred and three patients with acute myocardial infarction and paroxysmal atrial fibrillation were selected as subjects, and were divided into a simvastatin group and a control group. Forty-five patients were in the simvastatin group, who took simvastatin 20mg/d orally for 18 months; fifty-eight patients were in the control group, and received conventional therapy except for statins. All patients were followed up for 18months. The level of blood lipid, recurrence rate of paroxysmal atrial fibrillation, incidence rate of persistent or permanent atrial lipids did not change significantly in the control group (P＞0.05); concentrations of total cholesterol (TC) and low density lipoprotein five patients during 18 months follow-up in the simvastatin group (11.1%), whereas it occurred in 14 patients of the control group(24.1%, P＜0.05); the occurrence rate of persistent or permanent atrial fibrillation in the simvastatin group was 4.4%, which was lower than (6.6%), two rehospitalizations for deterioration of coronary heart diseases (4.4%), three cardiac deaths (6.6%), and one cerebral stroke (2.2%), which was lower evidently than in the control group (41.4%, P＜0.05). Conclusions Simvastatin can not only decrease the levels of serum TC and LDL-C but also prevent the occurrence of atrial fibrillation and ischemic-related events.

Objective To compare the curative effect of conservative treatment and surgical treatment for bronchiectasis. Methods 60 patients with bronchiectasis were randomly divided into observation group and control group,30 cases in each group,they were treated with surgery and medical therapy respectively,the clinical efficacy,length of stay, costs, remission time of symptoms and signs, changes of blood gas index and ESR, CRP,TNF-α, WBC,NEUT of the two groups after treatment were compared. Results The curative rate of observation group was significandy higher than control group, while the length of stay, remission time of symptoms and signs and hospitalization costs were significantly lower than control group, the difference was statistically significant (all P ＜0.05) ;After treatmenit,the blood gas index of both groups improved significantly than before treatment(all P ＜ 0.05), and the blood gas index of observation group improved significantly than the control group (all P ＜ 0. 05); After treatment, ESR, CRP,TNF-α,WBC and NEUT of both groups were significantly decreased compared with those before treatment(all P ＜0. 05); Between the two groups, the index value of the observation group decreased significantly (all P ＜ 0.05).Conclusion Surgical treatment for bronchiectasis was superior to conservative treatment with better curative effect,lower cost, shorter hospital stay and faster relief of symptoms and signs, it had good prospects to be applied.

Objective To explore the feasibility and effect of spleen-preserving distal pancreatectomy in patients with distal pancreatic injures and its outcome.Methods Retrospectively analysed the follow up results of 18 patients undergoing spleen-preserving distal pancreatectomy in Clinical Medical College of Yangzhou University from March 2008 to November 2012.Results The operations were successful in all of these 18 patients,B-mode ultrasonography and CT scan follow-up revealed that there were no significant changes in the size and structure of the spleens.The operation time was 152 to 188 minutes (mean,172 minutes),and the intraoperative blood loss was 155 to 356 mL (mean,191 mL).The length of postoperative hospital stay was 13 to 19 days (mean,15 days).No bleeding after operation,no pancreatic leakage,and no intraabdominal infection occurred.Conclusions Distal pancreatectomy with spleen and supply vessel preserving is effective and feasible methods for the patients with distal

Objective To explore the practical ways on establishing fine course of oral and maxillofacial surgery effectively. Methods Relying on the advantages of the discipline,great efforts had been made in step-by-step enhancement of the quality of teachers,teaching contents,teaching methods and administration. Results Through the establishing of fine course,we could improve the curriculum system,enhance the force of education team,and improve the quality of education. Conclusion Establishing fine course of oral and maxillofacial surgery depends on the environment of sharing educational resources,adjusting the curriculum system and establishing an excellent educational team.

AIM: To seek a small interfering RNA ( siRNA ) sequence targeting rat inhibitor of nuclear factor kappa Bα ( IκBα) that can specifically and effectively suppress IκBα mRNA expression of rat ciliary muscles in vivo.METHODS:Three IκBα specific double stranded siRNAs were designed and synthesized. They were transfected into rat A7r5 cells which express IκBα gene. Flow cytometry was used to assess transfected efficiency. The mRNA and protein levels of IκBα were examined by Real Time quantitative polymerase chain reaction ( Real Time-PCR ) and western blot to screen a candidate valid sequence with the highest inhibitory rate. The Cy3 labeled non-specific control siRNA or the candidate valid siRNA was then injected into rat anterior chamber. Distribution of Cy3- siRNA in rat ciliary muscles was viewed by fluorescence microscopy, and the inhibitory effect in vivo of the valid siRNA was identified via Real Time-PCR and immunofluorescence. RESULTS: The suppression effect of the siRNA targeting the CTACGATGACTGTGTGTTT of IκBα gene was most obvious by vitro screening. By anterior chamber injection, this valid siRNA could reach rat ciliary muscles and effectively suppress IκBα gene expression with the highest inhibitory rate of 59. 0% on mRNA level at 24h after RNAi, and 52. 3% on protein level at 72h after RNAi (P<0. 01).CONCLUSION: It proves that the siRNA targeting the CTACGATGACTGTGTGTTT of IκBα gene is the valid sequence to suppress rat IκBα expression of ciliary muscles by RNAi in vivo.

BACKGROUND:Antibiotics are widely given for surgical patients to prevent infection. Because of the lack of study on the rational use of antibiotics in patients with human immunodeficiency virus (HIV) -infected during surgical procedures, we analyzed the risk factors affecting postoperative infectious complications in HIV-infected patients and explore the rational use of perioperative antibiotics. METHODS:This retrospective study consisted of 308 HIV-infected patients, 272 males and 36 females, who had undergone operation at the Shanghai Public Health Clinical Center from November 2008 to April 2012. The patients were divided into postoperative infection and non-infection groups. Their age and clinical variables were compared. The correlation between surgical incision, surgical site infection (SSI) and postoperative sepsis was analyzed. Prophylactic antibiotics were used for patients with type I and II incisions for less than 2 days. Patients with type III incisions were given antibiotics until the infection was controlled. Antiretroviral therapy (ART) was prescribed preoperatively for patients whose preoperative CD4 count was <350 cells/μL. For those patients whose preoperative CD4 count was <200 cells/μL, sulfamethoxazole and fluconazole were given preoperatively as prophylactic agents controllingPneumocystis carinii pneumonia and fungal infection. RESULTS:A total of 196 patients developed postoperative infectious complications, and 7 patients died. Preoperative CD4 counts, ratio of CD4/CD8 cels, hemoglobin level, and postoperative CD4 counts, hemoglobin and albumin levels were risk factors of perioperative infection in HIV-infected patients. Patients with a preoperative CD4 count <200 cel/μL, anemia, a postoperative CD4 count <200 cel/μL or albumin levels <35 g/L were correlated with a higher rate of perioperative infection. There was a significant correlation between SSI and the type of surgical incision. The rate of SSI in patients with type I surgical incision was 2％ and in those with type II surgical incision was 38％. Allthe patients who received type III surgical incision developed SSI, and they were more likely to develop postoperative sepsis. CONCLUSIONS:HIV-infected patients are more likely to develop postoperative infectious complications. The rational use of antibiotics in HIV-infected patients could help to reduce the rate of postoperative infectious complications in these patients.

Objective To explore the key points of observing and nursing for patients with acute aortic dissection during the different stages postoperatively.Methods The nursing methods by stages were performed on 25 patients with acute aortic dissection.The stages included early stage(1 to 2 days after the operation), intermediate stage(3 to 14 days after the operation) and advanced stage(14 days after the operation and later).The key points of each stage were different.In the early stage,it needs to closely observe the circulation,the amount of blooding,the respiration system,the nerve system,and the occurrence of complications;and it also needs to do the syndrome-based nursing well,including calming,dropping blood pressure,blood transfusion,suction of phlegm and et al.In the intermediate stage,it needs to guide the daily life of the patients,including taking diet and drinking,activities,excretion and et al．In the advanced stage,it needs to do directions of discharging from the hospital and to prevent the recrudescence of aortic dissection. Results A total of 25 patients were improved in term of their symptoms or cured by our nursing care.The diagnosis was timely and the operation Was suitable.The observation and nursing by stages after the operation were reasonable.All the patients were discharged from the hospital after being healed,no death and no occurrence of serious complications.Conclusions It is helpful to improve the restoration of patients with acute aortic dissection by observing and nursing care by stages,which will play an important role in promoting the smooth healing of the patients and preventing the accidents and the reoccurrence of aortic dissection.

OBJECTIVETo investigate the changes of vascularized fibular bone height after transplantation for mandibular reconstruction.

METHODSThirty-two patients with mandibular defects were reconstructed with vascularized fibular bone. Postoperative follow-up pantomography was used to evaluate the changes of bone height.

RESULTSAt different distance from the vessel pedicles, the changes of bone height showed no significant difference. The height of fibular bone decreased gradually with time and reduced by 6.64% at 1 year postoperatively.

CONCLUSIONSMultiple segmental osteotomies had no effect on blood flow and the different pieces of graft after modeling by osteotomy experienced the similar reconstruction. The volume of grafted fibular bone almost remained stable.

Adolescent ; Adult ; Aged ; Bone Remodeling ; Bone Transplantation ; Child ; Female ; Fibula ; anatomy & histology ; blood supply ; transplantation ; Follow-Up Studies ; Humans ; Male ; Mandible ; pathology ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; Young Adult

Objective To evaluate the clinical effect of edaravone injection on patients with early cerebral ischemia (ECI) after clipping of intracranial aneurysm.Methods Seventy-eight patients with intracranial aneurysms were randomly divided into control group and treatment group,with 39 cases in each group.Patients in two groups were given the treatments of high blood volume,high perfusion pressure,blood dilution and others.On the basis of control group,treatment group was intravenously dripped edaravone 30 g mixed in 0.9％ NaCl 100 mL,finished within 30 min.Control group was intravenously dripped 0.9％ NaCl 100 mL.The treatment was lasted for 14 d.The neurological function recovery and prognosis of two groups were compared.Results After treatment,the neurologic function defect (NFD) scores in treatment and control groups were (7.36 ± 5.42),(10.71 ± 4.39) points (P ＜ 0.05).Barthel scores in treatment and control groups were (49.20 ± 13.32),(37.58 ± 11.46) points (P ＜0.05).The blood flow velocity in brain and incidence of cerebral vasospasm (CVS) in treatment group were (95.38 ± 19.60)cm · s-1,12.82％ (5/39 cases).In control group,blood flow velocity in brain and incidence of CVS were (118.25 ± 17.94)cm · s-1,33.33％ (13/39 cases).There was significant difference between the two groups (P ＜ 0.05).The Glasgow outcome score (GOS) of 5 points in treatment group was 79.49％ (31/39 cases),had significant difference with that in control group,which was 58.97％ (23/39 cases,P ＜ 0.05).Serum super oxide dismutase (SOD),nitric oxide (NO) and malonaldehyde (MDA) in treatment group were (93.26 ± 13.71) U · mL-1,(5.29 ±0.53) nmol · mL-1 and (63.29 ± 10.58) mol · L-1 after treatment.Cerebrospinal fluid SOD,NO and MDA in treatment group were (61.34 ±4.26) U · mL-1,(4.40 ± 0.25) nmol · mL-1 and (1.83 ± 0.37) mol · L-1 after treatment.Serum SOD,NO and MDA in control group were (80.20 ± 11.59) U · mL-1,(6.74 ±0.32) nmol · mL-1 and (50.91 ±9.37) mol · L-1 after treatment.Cerebrospinal fluid SOD,NO and MDA in control group were (54.29 ± 6.64) U · mL-1,(5.12 ± 0.83) nmol · mL-1 and (1.50 ± 0.24) mol · L-1 after treatment.There was significant difference between the two groups (P ＜ 0.05).There were no obvious adverse drug reactions in two groups.Conclusion The scavenging effect of edaravone on oxygen free radical in serum and cerebrospinal fluid could significantly reduce cerebral artery blood flow and CVS incidence in patients with ECI after clipping of intracranial aneurysm.