OBJECTIVE: To assess the diagnosis and therapeutic effects for fungal otitis externa by clinical symptoms, endoscopic findings, and fungus culture of the ear discharge. METHOD: Sixty outpatients diagnosed with otitis externa were enrolled in the study. All patients were treated with a thorough debridement of the ear and one antifungal medication regimens (compound resorcinol solution) in case of a positive fungus culture. One subgroup of patients treated with daub glycerol during 2 weeks of follow-up. RESULT: Positive cultures were found in 42 cases. The efficacy was observed in all patients even in those who received only ear endoscopy. CONCLUSION Fungal otitis externa could be easily diagnosed by ear endoscopy. A thorough debridement of the ear and utility of compound resorcinol solution is an easy and effective approach for treatment of fungal otitis externa.
Antifungal Agents ; therapeutic use ; Debridement ; Fungi ; Glycerol ; Humans ; Otitis Externa ; diagnosis ; microbiology ; Otomycosis ; diagnosis ; Outpatients

Objective To exam the expression and the distribution difference between melatonin membrane receptor subtype Mel 1a and Mel 1b in the central nervous system of rats. Methods In situ hybridization technique was used. Results (1)The Mel 1a mRNA positive cells were mainly detected in the hippocampus,cerebral cortex,supraoptic nucleus,paraventricular nucleus,suprachiasmatic nucleus,inferior olivary nucleus,cortex and fastigial nucleus of cerebellar,ventral horn of the spinal cord,facial nerve nucleus,gigantocellular reticular nucleus,striatum cortex and trigeminal nerve nucleus,etc.(2)The Mel 1b mRNA positive cells were mainly observed in the cerebellar cortex,fastigial nucleus,global nucleus,emboliform nucleus of the medullaris cerebelli,hippocampus,cerebral cortex,ventral horn of the spinal cord,supraoptic nucleus and suprachiasmatic nucleus.Conclusion\ Mel 1a mRNA positive neurons were abundant and distributed widely in the CNS,while Mel 1b mRNA\|positive neurons distributed comparatively localized.However,the hippocampus and the cortex were two regions which were rich in both Mel 1a and Mel 1b mRNA positive neurons.\;[

AIM: To observe the survive, differentiation and therapeutic effect of neural precursor cells (NPCs) differentiated from mouse embryonic stem cells (ESc) when transplanted in the frontal cortex of Alzheimer's disease (AD) rats. METHODS: NPCs were induced from mouse ESc with serum-free methods. The differentiation of transplanted NPCs was observed with immunohistochemistry methods and memory of rats was evaluated with Morris water maze test. RESULTS: About 85% of mouse ESc were differentiated into NPCs 5 days after the embryoid bodies cultured in the N2 medium. 4 and 6 weeks after transplantation, the memory impairment of AD rats was relieved, most of the grafted NPCs were kept undifferentiated and proliferated in clone shape, neuron-like long processes was observed. CONCLUSIONS: The NPCs derived from ESc survive and differentiate into neurons after grafted into the frontal cortex of AD rats, which produces therapeutic effects on AD.

Objective To summarize the condition of surgical treatment and prognosis of 54 cases of jugular foramen tumors in the past 5 years.Methods All 54 cases were treated with operation by Fisch approach.Thirty-eight cases underwent total or near total resection of the tumor.Most resection of the tumor was underwent in 16 cases,in which,7 cases underwent postoperative radiotherapy or gamma knife therapy.The facial nerve monitoring was used in all cases.The facial nerve was anatomized and shifted in 35 cases,was just anatomized like a bridge in 10 cases,and was excised partly in 9 cases,in which,4 cases underwent facial-hypoglossal nerve anastomosis and 3 cases underwent transplantation of facial nerve and great auricular nerve.Results The external auditory canal was closed in 41 cases.The near pedicled temporalis muscle flap was obliterated in the operating cavity in 35 cases.Six cases underwent fat filling in the operating cavity.Eighteen patients showed facial palsy in varying degrees after operation.Among them,14 cases improved to different extents in 2 weeks to 9 months and 4 cases did not improve.One case showed recurrent laryngeal nerve paralysis in the same side before operation and improved in half a year after operation.Postoperative subcutaneous hematoma occurred in 2 cases,wound infection in 1 case.All the cases improved by debridement suture and anti-infective therapy.The cavity filling necrosis occurred in 2 cases,which recovered after debridement and dressing.For half a year after operation,except 9 cases of residual or recurrent,and the rest showed no recurrence.Conclusion The Fisch approach of surgical treatment of jugular foramen tumors can provid good exposure,clear vision,facilitate hemostasis.The skills of intraoperative facial nerve monitoring,facial nerve anatomy like a bridge or anatomy and shift when necessary are beneficial to the total or nearly total resection of tumor and reduce the injury of facial nerve.The operating cavity filling and selective external auditory canal closure can effectively reduce the surgical cavity effusion and the incidence of postoperative infection.

BACKGROUND:With the development of modern pathological techniques, the misdiagnosis rate has been reduced remarkably, but special stains are still the most important method for pathological diagnosis. OBJECTIVE:To compare the advantages and disadvantages of different special stains used for observing the structure of human lumbar facet joints. METHODS:The specimens of facet joint cartilage at L4/5 level were collected from patients undergoing lumbar surgery, and then stained with hematoxylin-eosin, safranin O, toluidine blue, Masson, and saranin-O-fast green for structure observation. RESULTS AND CONCLUSION:The structure of the articular cartilage could be observed clearly through hematoxylin-eosin, toluidine blue, and saranin-O-fast green staining. The cartilage surface, tidemark, and subchondral bone were shown by the hematoxylin-eosin staining, with the presence of violet chondrocyte nuclei. Safranin-O-fast green staining showed the four layers of the cartilage clearly, including the shallow layer (cartilage surface), middle layer (spherical cells arranged in disorder), columnar cell layer (large and multinucleated chondrocytes arranged neatly), tidemark, subchondral bone layer; and the cartilage matrix was reddish uniformly, the subchondral bone was green, and the cartilage and bone tissue showed a striking contrast. The cartilage structure was unclear in toluidine blue staining, with clear nuclei and almost no coloring cytoplasm, but the matrix appeared with slight purplish blue. Safranin O staining showed that the cartilage was red, which had no obvious boundary with the cartilage matrix, and chondrocytes were stained lightly. Masson staining showed clear collagen fibers, but the structures of the cartilage and subchondral were obscure. To conclude, safranin-O-fast green staining can achieve the best results, followed by hematoxylin-eosin staining and Masson staining in turn.

This study was conducted to evaluate the relationship between serum insulin levels and the production of insulin antibody (IA) in type 2 diabetes (T2DM).A total of 647 T2DM were included.Among them,20.9％ patients were IA positive,who were elder and had a longer duration,lower BMI,a higher positive rate of glutamic acid decarboxylase antibody(GADAb) and higher serum insulin levels during an insulin secretion test.More patients were treated with insulin in IA positive group than in IA negative group (65.9％ vs 41.0％,P =0.000).Fasting serum insulin level was associated with occurrence of IA in all patients (OR =1.02,P =0.001) and insulin treated patients (OR =1.033,P =0.002).The cut-off point of fasting serum insulin level for predicting IA positive was 17.87 mIU/L (sensitivity 55.1％,specificity 89.0％).Exogenous insulin use is associated with the presence of IA.Fasting serum insulin level can be used as a predictor for the production of IA in insulin-treated patients.

Objective To explore the value of automated function imaging (AFI) based on two-dimensional speckle tracking imaging (2D-STI) technique longitudinal strain for predicting severe stenosis of left anterior descending (LAD) coronary artery in patients with suspected coronary heart disease (CHD).Methods Ninety-two patients with suspected CHD were divided into two groups according to the coronary angiography (CAG) results.There were 49 cases in group A (LAD stenosis rate ＜70％) and 43 cases in group B (LAD stenosis rate ≥70％).The two dimensional gray scale dynamic images were obtained in apical four-chamber view,apical two-chamber view and long axis of left ventricle (LV) view.Eighteen segments of LV longitudinal peak systolic strain,global longitudinal strain (GLS) and territorial longitudinal strain (TLS) supplied with LAD were measured with AFI software.The conventional ultrasonic parameters and the two-dimensional longitudinal strain parameters were compared between the two groups and ROC curve analysis of these parameters was used to predict LAD severe stenosis.Results There was no significant difference in the conventional ultrasonic parameters between the two groups (all P＞0.05).The group B had lower GLS,TLS than group A (both P＜0.001).GLS and TLS showed the highest area under ROC curve (0.715 and 0.705) for predicting LAD severe stenosis.The cut-off value,sensitivity and specificity for predicting LAD severe stenosis were-19.58 ％,63.3 ％,67.4 ％ in TLS,and-20.85 ％,74.4 ％,61.2 ％ in GLS respectively.Conclusion The longitudinal strain parameters measured with AFI based on 2D-STI technique can be used to predict LAD severe stenosis in patients with CHD,and GLS is more sensitive than TLS.

Objective To analyze territorial and global longitudinal layer-specific strain of left ventricle by two-dimensional speckle tracking imaging (2D-STI) in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) and to explore the value of layer-specific strain parameters for prediction of significant coronary artery stenosis. Methods Seventy-five patients with suspected NSTE-ACS in People′s Hosptial of Subei from September 2016 to January 2017 were enrolled and all patients underwent coronary arteriography (CAG). Among them, there were 24 subjects in control group (coronary artery without stenosis or stenosis rate <50%) and 51 subjects in coronary atherosclerotic heart disease group (coronary heart disease, CHD). According to whether coronary artery occlusion, the CHD group was divided into coronary stenosis group (32 subjects) and coronary occlusion group (19 subjects). Using EchoPAC software, two-dimensional dynamic images were analyzed to obtain left ventricle 18-segment systolic longitudinal layer-specific strain and to calculate the territorial longitudinal strain (TLS) of endocadium, mid-myocardium and epicardium (TLSendo, TLSmid, TLSepi) and left ventricle global longitudinal strain (GLS) of endocadium, mid-myocardium and epicardium (GLSendo, GLSmid, GLSepi). The differences of left ventricle territorial and global longitudinal layer-specific strain parameters among 3 groups were compared by one-way analysis of variance and the differences between two groups were compared by LSD-t test. The receiver operating characteristic (ROC) curve of each parameter was constructed to predict significant coronary stenosis by using the results of CAG as the gold standard. Results Compared with control group and coronary stenosis group, TLSendo, TLSmid, TLSepi and GLSendo, GLSmid, GLSepi all decreased in patients with coronary occlusion, and the differences were statistically significant (coronary occlusion group vs. control group: t values were -5.819, -5.049, -4.845, -5.955, -5.036 and -4.724, respectively, P values were all less than 0.01;coronary occlusion group vs.coronary stenosis group:t values were-2.983,-3.059, -2.903, -2.989, -3.192 and -3.387, respectively, P values were all less than 0.01). And compared with control group, only TLSendo and GLSendo decreased in patients with coronary stenosis, and the differences were statistically significant (t values were -3.981 and -4.164, respectively, P values were all less than 0.01). TLSendo, TLSmid, TLSepi and GLSendo, GLSmid, GLSepi showed a gradient decrease in all 3 groups, but only in the control group the comparison between two of the three layers showed statistically significant differences(TLSepi vs. TLSendo,GLSepi vs. GLSendo:t values were both-10.083,P values were all less than 0.01;TLSepi vs.TLSmid,GLSepi vs.GLSmid:t values were both-4.559,P values were all less than 0.01;TLSmid vs.TLSendo,GLSmid vs.GLSendo:t values were both-5.549,P values were all less than 0.01). The absolute differences between endocardial and epicardial TLS and GLS (?TLS and?GLS) decreased gradually from the control group, to coronary stenosis group and to coronary occlusion group,and the differences were statistically significant(coronary occlusion group vs.control group:t values were 6.915 and 7.489, respectively, P values were all less than 0.01; coronary stenosis group vs. control group: t values were 4.923 and 7.202, respectively, P values were all less than 0.01; ?TLS of patients in the coronary occlusion group vs.coronary stenosis group:t value was 2.250,P value was less than 0.05),which reflected a pronounced decrease in endocardial function. By ROC curve analysis, GLSendo and TLSendo showed the highest area under the curve in predicting significant coronary artery stenosis, which were better than strain parameters of mid-myocardium, epicardium and the entire wall thickness of the myocardium. Conclusions Left ventricle showed systolic dysfunction in all three layers in suspected NSTE-ACS patients with CHD, especially the endocardium. The longitudinal layer-specific strain parameters by 2D-STI can be used for quantitative evaluation of the territorial and global systolic dysfunction differences of left ventricle in all layers in suspected NSTE-ACS patients with CHD, which can also be used for prediction of significant coronary artery stenosis.

Objective:To evaluate the association of HbA 1C level and variability with annual decline in glomerular filtration rate in elderly patients with type 2 diabetes. Methods:A total of 527 elderly type 2 diabetic patients with baseline estimated glomerular filtration rate(eGFR)≥60 mL·min -1·(1.73 m 2) -1 at the diabetes center of a tertiary hospital in Jiangsu province were included and followed up. The mean value and the variability of HbA 1C, including standard deviation(HbA 1C-SD), variation coefficient(HbA 1C-CV), and adjusted standard deviation(Adj-HbA 1C-SD) were calculated. According to the annual decreased rate of eGFR, the patients were divided into △eGFR>5% group and △eGFR≤5% group. Cox proportional risk regression model was used to evaluate the relationship between HbA 1C variability and the risk of decreased glomerular filtration rate. Results:With a mean follow-up time of 19 months, there were 176 patients whose △eGFR>5%. Compared with △eGFR≤5% group, the HbA 1C-mean and HbA 1C variability were significantly higher in △eGFR>5% group( P<0.05). Cox regression analysis showed that HbA 1C-mean, HbA 1C-SD, HbA 1C-CV, and Adj-HbA 1C-SD were significantly correlated with decreased glomerular filtration rate. After adjustment for age, gender, HbA 1C-mean, and other factors, only Adj-HbA 1C-SD was correlated with renal insufficiency [ HR=3.32(1.68-6.57)]. Conclusions:HbA 1C variability is independently associated with annual decline in glomerular filtration rate in elderly patients with type 2 diabetes. The Adj-HbA 1C-SD is the most sensitive indicator in predicting decreased glomerular filtration rate.

Objective To explore the value of real-time three-dimensional echocardiography (RT-3DE) in evaluating right ventricular structure and hemodynamic parameters of patients with pulmonary hypertension (PH).Methods A total of 89 PH patients in Subei People′s Hospital from July 2014 to December 2016 were selected as PH group, and 49 subjects with health examination were designed as control group. According to pulmonary arterial systolic pressure (PASP), the 89 patients with PH were divided into mild PH group (n=29), moderate PH group (n=32) and severe PH group (n=28). The indexes of right heart structure such as right ventricular diameter (RVTD), left ventricular diameter (LVTD), right ventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV) and right ventricular ejection fraction (RVEF) as well as hemodynamic parameters such as pulmonary systolic pressure (SPAP), pulmonary artery diastolic pressure (DPAP), mean pulmonary artery pressure (MPAP) and right ventricular output (RCO) were detected by RT-3DE in all the subjects. The indexes of right heart structure and hemodynamic parameters were compared by independent-samplet test between PH group and control group, and indexes of right heart structure and hemodynamic parameters were compared by variance analysis among different PH groups. The SNK-q test was used for the further comparison between any two groups.Results The RVTD, EDV and ESV in the PH group were significantly higher than those in the control group, while LVTD, SV and RVEF were significantly lower than those in the control group (t=-2.73,P=0.003;t=-4.37,P=0.001;t=-4.57,P=0.002;t=-3.49,P=0.039;t=-2.01,P=0.043;t=6.36,P=0.001). The RVTD, EDV and ESV in moderate PH group and severe PH group were significantly higher than those in the mild PH group, while the LVTD, SV and RVEF were significantly lower than those in the mild PH group (q=4.318, 4.713, 3.873, 3.921, 5.127, 5.347, 5.618, 5.903, 4.318, 4.501, 5.327, 5.981, allP<0.05). The LVTD, EDV, ESV, SV, RVEF in the severe PH group were significantly lower than those in the moderate PH group, while the RVTD was significantly higher than the moderate PH group (q=3.708, 3.249, 4.807, 3.953, 3.197, 3.764, allP<0.05). The SPAP, DPAP and MPAP in PH group were significantly higher than those in control group, while RCO was significantly lower than that that in the control group (t=0.637,P=0.001;t=0.875,P=0.001;t=0.783, P=0.001;t=0.691,P=0.035). The SPAP, DPAP and MPAP in moderate PH group and severe PH group were significantly higher than those in the mild PH group, and the SPAP in the severe PH group was significantly higher than that in the moderate PH group (q=4.349,P=0.041;q=5.871,P=0.039;q=4.201,P=0.042;q=4.869,P=0.043;q=3.981,P=0.034;q=3.991,P=0.035;q=0.421,P=0.039). There were no significant differences in DPAP and MPAP between the moderate PH group and the severe PH group. The RCO decreased gradually in the mild PH group, the moderate PH group and the severe PH group, and there were significant differences between any two groups (q=3.541,P=0.033;q=3.204,P=0.030;q=0.391,P=0.043). Conclusion In PH patients, the right ventricular function declined, and RT-3DE can accurately evaluate the right ventricular function in patients with different degrees of pulmonary hypertension.