OBJECTIVETo explore the feasibility of endoscopic modified agger nasi approach for the surgical treatment of frontal sinus diseases.

METHODSThe data of patients undergoing modified agger nasi approach for frontal diseases were prospectively collected since January 2009, including demographic data, findings at surgery, presence of postoperative symptoms, endoscopic appearance of the frontal recess and sinus, and complications.

RESULTSNineteen patients were enrolled from January 2009 to August 2010. Seventeen patients had chronic rhinosinusitis, in which 13 patients (76.5%) completely healed, 3 patients (17.6%) improved and 1 patient (5.9%) failed. Two patients had frontal sinus and anterior ethmoid sinus inverted papilloma, with no recurrence. The patients were followed up from 6 to 24 months, medium 16 months. No severe complication occurred. No frontal recess adhesion was found. Four sides of frontal recess showed stenosis caused by tissue hypertrophy.

CONCLUSIONThe modified agger nasi approach provides excellent access to frontal recess and frontal sinus, with good effect for preventing re-stenosis after surgery.

Adult ; Endoscopy ; Female ; Frontal Sinus ; surgery ; Frontal Sinusitis ; surgery ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Otorhinolaryngologic Surgical Procedures ; methods ; Prospective Studies ; Young Adult

Objective To study the anatomical classification and surgical management of communicating tumors invading the anterior or middle skull base. Methods According to the location and growth direction of the tumors, the communicating tumors invading the anterior or middle skull base in 29 patients were classified into 4 types, namely fronto-naso-orbital tumors in 16 cases, middle-lateral cranial base tumors in 8 cases, central-medial skull base tumors in 4 cases and petrous bone-jugular foramen tumor in 1 case. Based on this classification, extended transbasal approach (13 cases), supraorbital-pterional approach (9 cases), fronto-temporal approach (3 cases), ffontotemporal-orbitozygomatic approach (3 cases) and transpetrol approach (1 case) were adopted for tumor resection and skull base defect reconstruction. In the transbasal approach group, the surgery was performed also through transnasal endoscopic approaches. Results Twenty-four patients underwent total tumor resection and 5 had subtotal tumor resection. No operative death or serious complications (e.g. intracranial infection, cerebrospinal fluid leakage or meningoencephalocele) occurred after the operations. Conclusion Classification of the communicating tumors invading the anterior or middle skull base according to their location and growth direction facilitates planning of the surgical approaches for tumor resection and skull base defect reconstruction.

Objective: To explore the clinical characteristics, diagnosis, treatment and prognosis of patients with hematological diseases that complicated by mucormycosis, and to improve the understanding and clinical diagnosis and treatment of the disease. Methods: The clinical data of 7 patients suffering from mucormycosis during September 2012 and September 2018 were retrospectively analyzed, and their clinical characteristics, treatment process and prognosis were analyzed. Results: Of 7 patients, there were 4 males and 3 females, with a median age of 36 (19-79) years old. Two patients were diagnosed as acute myeloid leukemia as the underlying disease, the other 5 patients suffered from acute B lymphoblastic leukemia, peripheral T cell lymphoma, chronic myelocytic leukemia in blastic phase, myeloproliferative neoplasm and severe aplastic anemia after transplantation, respectively. Among them, disease types of mucormycosis were pulmonary in 4 patients, rhino-orbital-cerebral in 1 patient, cutaneous in 1 patient and disseminated in 1 patient. All the cases were confirmed by biopsy histopathology. The treatment drugs were amphotericin B or liposomal amphotericin B, and posaconazole. Surgical treatment was performed in 4 patients, 3 out of 4 achieved radical debridement, and the other one had local debridement. Two patients were cured, 1 patient was improved and 4 patients died. Conclusions: The clinical manifestation and image feature of mucormycosis in patients with hematological diseases were diverse, and the mortality rate is high, diagnosis mainly depends on histopathology. Early diagnosis, control of underlying disease, improvement of immunosuppressive status, timely effective antifungal therapy and radical surgical debridement are the key points for improving the survival rate of patients with hematological diseases complicated by mucormycosis.
Adult ; Aged ; Antifungal Agents ; Debridement ; Female ; Hematologic Diseases ; Humans ; Male ; Middle Aged ; Mucormycosis ; Retrospective Studies ; Young Adult

The healing training was an important method to improve living ability and quality of life of patients with schizophrenia.This article introduced a living skill training scheme applied in out-patients whose course of disease shorter than 5 years.

BACKGROUNDWhether an addition of OAC to double antiplatelet therapy for patients with an indication of chronic oral anticoagulation undergoing PCI-S may improve clinical outcomes is still debated. This meta-analysis aimed to update and re-compare the benefits and risks of triple antithrombotic therapy (TT) with double anti-platelet therapy (DAPT) after in patients who requiring oral anticoagulation after percutaneous coronary interventions with stenting (PCI-s).

METHODSTen reports of observational retrospective or prospective studies were retrieved, including a total of 6296 patients, follow-up period ranging from 1 year to 2 years.

RESULTSBaseline characteristics were similar in both groups. The main finding of this study is the overall incidence of major adverse cardiovascular events (MACE), myocardial infarction (MI) and stent thrombosis was comparable between two groups. Patients with TT was associated with significant reduction in ischemic stroke (OR: 0.27; 95%CI: 0.13 - 0.57; P = 0.0006) as compared to DAPT. We reaffirmed triple therapy significantly increased the risk of major bleeding (OR: 1.47; 95%CI: 1.22 - 1.78; P < 0.0001) and minor bleeding (OR: 1.55; 95%CI: 1.07 - 2.24; P = 0.02).

CONCLUSIONSTriple therapy is more efficacious in reducing the occurrence of ischemic stroke in PCI-s patients with an indication of chronic oral anticoagulation (OAC), compared with DAPT. However, it significantly increased major and minor risk of bleeding. It is imperative that further prospective randomized controlled trials are required to defne the best therapeutic strategy for patients with an indication of chronic OAC undergoing PCI-s.

Aged ; Anticoagulants ; therapeutic use ; Drug Therapy, Combination ; Female ; Fibrinolytic Agents ; administration & dosage ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors ; administration & dosage ; Publication Bias ; Stents

OBJECTIVETo observe the effects of different concentrations of PPAR gamma agonist rosiglitazone on hypoxia/reoxygenation-induced oxidative stress, cell viability and apoptosis in rat cardiac myocytes.

METHODSCultured rat cardiac myocytes were divided into 5 groups, namely group I (normal group), group II (20 micromo/L ROS group), group III (I/R group), group IV (I/R+20 micromo/L ROS group), and group V (I/R+80 micromo/L ROS group). Group IV and group V were treated with rosiglitazone 12 h before hypoxia/reoxygenation. The changes in cell morphology were observed under optical and transmission electron microscopy, and levels of malondialdehyde (MDA), superoxide dismutase (SOD) activity, and lactate dehydrogenase (LDH) content were determined after the treatment. MTT assay was performed to assess the cell viability and flow cytometry was used to analyze the cell apoptosis.

RESULTSHypoxia/reoxygenation resulted in significantly increased MDA and LDH contents and apoptosis of the cardiac myocytes (P<0.05), but lowered SOD activity and the cell viability (P<0.05). The MDA and LDH contents and apoptotic rate were significantly lower but SOD content and cell vitality significantly higher in groups IV and V than in group III (P<0.05). Group V showed significantly lower MDA and LDH contents and apoptotic rate but higher but SOD content and cell vitality than group IV (P<0.05). Electron microscopy revealed obvious apoptotic changes in group III, and only mild changes were found in group V.

CONCLUSIONRosiglitazone can significantly reduce hypoxia/reoxygenation-induced oxidative stress in cardiac myocytes, improve the cell viability and dose-dependently reduce the apoptotic rate of the cardiac myocytes.

Animals ; Apoptosis ; drug effects ; Cell Hypoxia ; Cell Survival ; drug effects ; Immunohistochemistry ; L-Lactate Dehydrogenase ; metabolism ; Malondialdehyde ; metabolism ; Microscopy, Electron, Transmission ; Myocytes, Cardiac ; cytology ; drug effects ; metabolism ; ultrastructure ; Oxidative Stress ; drug effects ; Oxygen ; metabolism ; PPAR gamma ; agonists ; Rats ; Rats, Sprague-Dawley ; Superoxide Dismutase ; metabolism ; Thiazolidinediones ; pharmacology

OBJECTIVETo systematically evaluate the efficacy of intranasal antihistamine in the treatment of allergic rhinitis.

METHODSThe randomized controlled trials (RCT) about intranasal antihistamines for the treatment of allergic rhinitis between January 1985 and January 2014 were searched in OVID, PubMed, EMBASE, CNKI, WanFang Data and Cochrane Library. Two reviewers independently screened the literatures, extracted the data, and evaluated the methodological quality, then meta-analysis was performed by using RevMan 5.1 software.

RESULTSA total of thirteen RCTs were included. The results of meta-analysis showed that the efficacy of intranasal antihistamine group was superior to the placebo group in total nasal symptom scores (TNSS), the difference was significant[WMD = -1.96, 95%CI (-2.06;-1.85), P < 0.01], and individual nasal symptom scores (blocked nose, rhinorrhea, and sneezing) [WMD = -0.18, 95%CI (-0.28;-0.08); WMD = -0.45, 95%CI (-0.52;-0.38); WMD = -0.41, 95%CI (-0.58;-0.24), all P < 0.01], with significant differences. There was no significant difference between the intranasal antihistamine group and the corticosteroid group in TNSS [WMD = -1.51, 95%CI (-3.51;0.49), P = 0.14], but the intranasal antihistamines group was superior to the corticosteroid group in individual nasal symptom scores (blocked nose, rhinorrhea, and sneezing) [WMD = -0.23, 95%CI (-0.40;-0.06); WMD = -0.35, 95%CI (-0.65;-0.05); WMD = -0.25, 95%CI (-0.42;-0.08), all P < 0.05], with significant differences. The intranasal antihistamine group was superior to the oral antihistamines group in TNSS [WMD = -0.88, 95%CI (-1.51;-0.25), P < 0.01].

CONCLUSIONIntranasal antihistamine is effective in the control of nasal symptoms in AR patients.

Administration, Intranasal ; Adrenal Cortex Hormones ; Anti-Allergic Agents ; administration & dosage ; therapeutic use ; Histamine Antagonists ; Histamine H1 Antagonists ; Humans ; Nasal Obstruction ; Rhinitis, Allergic ; drug therapy ; Rhinitis, Allergic, Seasonal ; Software

This study was aimed to explore the effects of interleukin 21 (IL-21) on the anti-leukemia activity of cytotoxic T lymphocytes (CTL) induced by dendritic cells (DCs) in vitro. The peripheral mononuclear cells from leukemia patients in complete remission were cultured with the specific cytokines to induce the production of DCs. The DCs loaded with RNA from autologous leukemic cells as antigen, and co-cultured with autologous T lymphocytes to get leukemia specific CTL. The cytotoxic activity of CTL against autologous leukemic cells was measured by LDH release method. The concentration of IFN-gamma and TNF-alpha in the culture supernatant was measured by enzyme immunoassay. The effects of IL-21 on the mature DCs were also studied by the measurement of the phenotype of DC and the allogenic mixed lymphocytic reactions induced by DCs. Experiments were divided into 2 groups: test group in which IL-21 (200 ng/ml) was added in coculture of DC/CTL and control group in which no IL-21 (200 ng/ml) was added. The results showed that when cultured with IL-21, the quantity of CTL increased from (56.73 +/- 10.21)% (control group) to (73.43 +/- 18.01)% (p < 0.01); The concentration of IFN-gamma and TNF-alpha in the culture supernatant increased from (154.91 +/- 67.20) ng/L (control group) to (310.62 +/- 141.15) ng/L (p < 0.01) and from (8.77 +/- 5.09) microg/L (control group) to (15.25 +/- 6.56) microg/L (p < 0.01) respectively. At the effector: target ratio of 20:1, the cytotoxic activity against autologous leukemic cells by CTL increased from (50.22 +/- 5.07)% (control group) to (75.38 +/- 9.47)% (p < 0.01). IL-21 had neither effect on the phenotype (CD1a, CD83, CD86, CD80 and HLA-DR) of mature DCs nor the allogeneic mixed lymphocytic reactions induced by DCs. It is concluded that IL-21 can strengthen the proliferation of CTL, and improve the production of IFN-gamma and TNF-alpha, thus enhance the anti-leukemia activity of CTL. Nevertheless, there is no effect of IL-21 on the function of mature DCs. These data indicate that IL-21 has a potential clinical value in the enhancement of anti-leukemia immunotherapy.
Adult ; CD8-Positive T-Lymphocytes ; drug effects ; Cell Proliferation ; Cytotoxicity, Immunologic ; drug effects ; Dendritic Cells ; cytology ; drug effects ; Female ; Humans ; Interferon-gamma ; immunology ; Interleukins ; pharmacology ; K562 Cells ; Leukemia ; drug therapy ; immunology ; Male ; Middle Aged ; T-Lymphocytes, Cytotoxic ; drug effects ; Tumor Necrosis Factor-alpha ; immunology ; Young Adult

Objective To explore the reliability and validity of the Children' s Impact of Event Scale (Chinese version, CRIES-13) and to determine the value and the optimal cutoff point of the score of CRIES-13 in screening posttraumatic stress disorder(PTSD), so as to provide evidence for PTSD prevention and identify children at risk in Wenchuan earthquake areas. Methods A total of 253 children experienced the Wenchuan earthquake were tested through Stratified random cluster sampling. The authors examined CRIES-13's internal consistency, discriminative validity and predictive value of the cut-off. PTSD was assessed with the DSM-Ⅳ criteria. Area under the curve while sensitivity, specificity and Youden index were computed based on the receiver operating characteristic curve analysis. Optimal cutoff point was determined by the maximum of Youden index. Results 20.9% of the subjects were found to have met the DSM-Ⅳ criteria for PTSD 7 months after the Wenchuan earthquake accident. The Cronbach' s coefficient of CRIES-13 was 0.903 and the mean inter-item correlation coefficients ranged from 0.283 to 0.689, the correlation coefficient of the three factors with the total scale scores ranged from 0.836 to 0.868 while the correlation coefficient among the three factors ranged from 0.568 to 0.718, PTSD cases indicated much higher scores than non-PTSD cases, the Youden index reached maximum value when the total score approached 18 in CRIES-13 with sensitivity and specificity as 81.1% and 76.5% respectively. Consistency check showed that there were no significant differences between the results of CRIES-13 score ≥32 and clinical diagnosis (Kappa=0.529) from the screening program. Conclusion CRIES-13 appeared to be a reliable and valid measure for assessing the posttraumatic stress symptoms among children after the earthquake accident in the Wenchuan area. The CRIES-13 seemed to be a useful self-rating diagnostic instrument for survivors with PTSD symptoms as a clinical concern by using a 18 cut-off in total score. Consistency check showed that there was no significant difference between the screening result of CRIES- 13 score ≥ 32 and clinical diagnosis.

OBJECTIVETo observe the efficacy of Qilin Pills in the treatment of oligoasthenospermia.

METHODSWe conducted a multi-centered open controlled clinical trial by including 220 oligoasthenospermia patients in a trial group and another 110 as controls. The patients in the trial group were treated with Qilin Pills at the dose of 6 g tid, and the controls given Wuziyanzong Pills at 6 g bid, both for a course of 12 weeks. Then we evaluated the clinical effects of Qilin Pills with sperm concentration, the numbers of grade a and grade a + b sperm, and sperm motility as the primary, and the pregnancy rate of the patients'spouses as the secondary therapeutic indexes.

RESULTSA total of 310 patients accomplished the clinical trial, 208 in the trial and 102 in the control group. Compared with the baseline, significant improvement was observed in the semen parameters after 4, 8 and 12 weeks of treatment in both the trial and control groups except sperm density and the number of grade a sperm in the control after 4 weeks (P < 0.01), and the improvement was even more significant in all the semen parameters at the same time points in the trial than in the control group (P < 0.01).

CONCLUSIONQilin Pills can evidently improve the seminal quality of oligoasthenospermia patients with no obvious adverse events.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Oligospermia ; drug therapy ; Phytotherapy ; Pregnancy ; Pregnancy Rate ; Sperm Count ; Spermatozoa ; drug effects ; Young Adult