Objective To investigate and evaluate the feasibility and analgesic effect of ultrasound guided intercostobrachial nerve (ICBN) blockade in patients with persistent pain after radical mastectomy with ICBN preservation.Methods In a total of 53 following-up female cases,aged 18-55 years,ASA Ⅰ or Ⅱ,receiving radical mastectomy with ICBN preservation during January,2014 to February,2016,19 patients complained persistent pain in the lateral chest,axilla and/or upper arm more than 3 months after the surgery were enrolled.ICBN blockade was performed using 0.5% ropivacine 10 mL injected in the potential space between the superior of pectoralis minor muscle and the inferior of serratus anterior muscle in the second intercostal space guided by ultrasound.Visual analogue scale (VAS) was applied to assess the pain intensity at rest,on movement,and with 100 kPa pressure before blockage and 30 min thereafter,and then the pain intensity (SPI) was calculated.All nerve blockade-related adverse events including local anesthetic-related allergy,central nervous system and cardiovascular toxicity were recorded.Seven-day follow-ups were required in all patients to assess the pain intensity.Results All 19 cases completed ICBN blockade guided by ultrasound,of which 17 cases completed the seven-day follow-ups.The mean difference in SPI was-9.19 VAS points (95%CI-11.24--7.14,P<0.01).Compared with each mean VAS and SPI before block,all that after block at day 1-6 were significantly decreased (P<0.01 or P<0.05).There were 14(82.4%),13(76.5%),7(41.2%) and 3(17.6%)cases that SPI was decreased over 5 points after block at day 1-4.No nerve blockade-related adverse event was observed.Conclusion Ultrasound guided ICBN blockade can relieve persistent post-mastectomy pain safely and effectively.

Objective To discuss the diagnosis and treatment of carcinoma of renal pelvis ac-companied with kidney stones. Methods Twenty-one cases of carcinoma of renal pelvis with kidney stones were reviewed. The urinary stones history was from 10 d to 24 years with an average of 27 months. Four cases had recurrent fever, weight loss. Seventeen cases had gross hematuria. CT scan-ning was performed in 17 cases, which indicated 9 cases of carcinoma of renal pelvis, 4 cases of possi-ble renal mass and enlarged renal hilum lymph nodes. MRU was performed in 10 cases, which showed 9 cases of stones concomitant with carcinoma of renal pelvis. IVU indicated 13 cases of light filling of contrast and 8 cases of complete negative filling. Nine cases who had been diagnosed before surgery were performed radical nephrectomy and local lymph nodes dissection. Five cases were carried out ne-phrostomy first because of pyonephrosis, then secondary subcapsule nephrectomy was performed, 2 of them who were diagnosed with carcinoma of renal pelvis after surgery were performed with ureterecto-my and excision of bladder cuff. Three cases were performed with subcapsule nephrectomy because of dense perinephric adhesion. Three cases with complicated calculi and nonfunctional kidney were per-formed with nephroureterectomy, 2 of them who were diagnosed with carcinoma of renal pelvis were carried out with ureterectomy and excision of bladder cuff. One case who was performed PCNL under ultrasound guidance was found a mass in the renal pelvis. The pathological examination indicated ade-nocarcinoma. Radical nephrectomy and lymphadenectomy of renal hilum were performed afterwards. Resnlts Twenty-one cases were performed with pathological examination, in which there were 4 ca-ses of transitional cell carcinoma, 16 cases of squamous cell carcinoma and 1 case of adenocarcinoma. All the 21 cases were discharged after surgery. Nine of them were followed up with 4 to 28 months. Six cases were dead. The post-surgery survival time was 3 to 21 months. Two of them died of heart infarction, 4 died of metastasis. Conclusions The carcinoma of renal pelvis should be considered be-fore surgery in the patients with long history of renal calculi, hydronephrosis and infection. CT scan-ning and MRU are helpful for the diagnoses of renal calculi concomitant with carcinoma of renal pel-vis. Earlier diagnosis, earlier management of renal calculi can extend survival time of the patients with renal calculi concomitant with carcinoma of renal pelvis.

Objective To detect the prevalence of hyperuricemia and its relationship to chronic kidney disease(CKD) in the residents of Guangxi, and to discuss the risk factors for the hyperuricemia associated renal damage. Methods The residents aged 18-75 years old(n=6 273) in Xiangshan community,Guilin, were screened by means of cross-sectional study. Blood pressure was measured at 8:00-9:00.Fasting blood and urine samples were collected to determine blood glucose, lipid, insulin, creatinine, and urine albumin. Results The prevalence of hyperuricemia in the community residents was 23.5% in all cohort, being significantly higher in male residents than in female(28.4% vs 19.7%,P＜0.01). The prevalence of CKD was 21.6% in all cohort, and was 24.9% in males and 19.0% in females(P＜0.01). The prevalence of CKD was 30.4% and 18.9% respectively in residents with and without hyperuricemia(P＜0.01).The prevalence of CKD in males with hyperuricemia(34.3%) was significantly higher than in males without hyperuricemia(21.2%) and females with hyperuricemia(25.9%, all P＜0.01). CKD was only positively related to low-density lipoprotein cholesterol, blood glucose, and systolic blood pressure shown by logistic regression analysis. Conclusions The prevalence of hyperuricemia markedly increases in the urban residents, which contribute to the raised prevalence of CKD. Slightly elevated blood uric acid level is associated with raised prevalence of CKD.

OBJECTIVE: To explore a method for locating the area of lacrimal sac in dacryocystorhinostomy under endoscopy. METHOD: Sixty-eight patients were performed dacryocystorhinostomy under endoscopy. Take light spot of ocular optic fiber as the lacrimal sac projection to the lateral wall of the nasal cavity position. RESULT: With the guiding of ocular optic fiber, lacrimal sac can be located accurately. The operating time of dacryocystorhinostomy under endoscopy was shortened significantly, and the operation procedure was simplified. All patients were followed up for 2 years, only 2 recurrent cases were found. The success rate reach to 97.06% (66/68). CONCLUSION Ocular optical fiber used in locating the lacrimal sac in dacryocystorhinostomy under endoscopy is simple and feasible, and can be widely used.
Adult ; Dacryocystitis ; surgery ; Dacryocystorhinostomy ; methods ; Endoscopy ; Female ; Fiber Optic Technology ; Humans ; Male ; Middle Aged ; Nasolacrimal Duct ; surgery ; Recurrence ; Treatment Outcome

Objective:To investigate the relevant situation of the emergency departments (ED) of general hospitals at all levels in Zhejiang Province participating in the prevention and control of Corona Virus Disease 2019 (COVID-19), and to provide a reference for further improving the capacity of emergency services.Methods:A multi-center cross-sectional investigation study was jointly initiated by the Zhejiang Provincial Emergency Medicine Quality Control Center, the Emergency Medicine Branch of Zhejiang Medical Association, and the Emergency Physicians Branch of Zhejiang Medical Doctors Association. Before investigation, experts were organized to develop a special questionnaire. Then the ED of general people's hospitals or Chinese Medicine hospitals at the county/district-level or above were included and their participations in the prevention and control of COVID-19 epidemic between March 9, 2020 and March 15, 2020 were investigated. The collected information included: basic information of the hospitals; participation of ED in fever clinics; the number of COVID-19 patients admitted to ED; the situation of ED support to the anti-epidemic front-line; and the epidemic prevention facilities of ED, and the early supply of medical protective equipments.Results:A total of 181 hospitals from 11 prefectures and cities across the province were finally included, including 52 (28.7%) Grade-A tertiary hospitals, 45 (24.9%) Grade-B tertiary hospitals, 64(35.4%) Grade-A secondary hospitals, and 20 (11.0%) Grade-B secondary or lower hospitals. Among them, 93 (51.4%) were COVID-19 designated hospitals, and 49 (27.1%) had the ability to detect COVID-19 nucleic acid; 177 (97.8%) set up independent fever clinics and 33 (18.6%) were managed by ED alone or mainly. The medical staffs of 65 (36.7%) fever clinics were all or mainly from ED. A total of 213 cases of COVID-19 were received/treated in 40.3% ED, accounting for 17.3% of the total number of cases in Zhejiang Province. A total of 3 848 doctors and nurses supported the front-line of epidemic prevention, of them, 253 supported Hubei Province (accounting for 12.5% ??of the total number). There were 68.5% and 76.8% ED having spare separate clinic and ordinary rescue single room to deal with the COVID-19. In addition, at the early days of anti-epidemic, more than 50% ED were in short supply or even had no medical protective equipment.Conclusions:The ED of Zhejiang Province plays an important role and has made a great contribution to the prevention and control of the COVID-19 epidemic. It is necessary to improve the conditions of ED to effectively respond to the prevention and control of daily infectious diseases.

Clouston syndrome (OMIM #129500), also known as hidrotic ectodermal dysplasia type 2, is a rare autosomal dominant skin disorder. To date, four mutations in the GJB6 gene, G11R, V37E, A88V, and D50N, have been confirmed to cause this condition. In previous studies, the focus has been mainly on gene sequencing, and there has been a lack of research on clinical manifestations and pathogenesis. To confirm the diagnosis of this pedigree at the molecular level and summarize and analyse the clinical phenotype of patients and to provide a basis for further study of the pathogenesis of the disease, we performed whole-exome and Sanger sequencing on a large Chinese Clouston syndrome pedigree. Detailed clinical examination included histopathology, hair microscopy, and scanning electron microscopy. We found a novel heterozygous missense variant (c.134G>C:p.G45A) for Clouston syndrome. We identified a new clinical phenotype involving all nail needling pain in all patients and found a special honeycomb hole structure in the patients' hair under scanning electron microscopy. Our data reveal that a novel variant (c.134G>C:p.G45A) plays a likely pathogenic role in this pedigree and highlight that genetic testing is necessary for the diagnosis of Clouston syndrome.
Humans ; Connexin 30/genetics* ; Connexins/genetics* ; East Asian People ; Ectodermal Dysplasia/pathology* ; Phenotype