OBJECTIVE: To explore the application of endoscopic endonasal approach in surgery for skull base tumor. METHOD: From August 2000 to February 2009, retrospective analyses were performed on clinical data of 21 patients with skull base lesions treated by endoscopic endonasal surgery. There were 3 chordoma, 6 olfactory neuroblastoma, 4 squamous cancer, 5 malignant melanoma, 1 mucoepidermoid carcinoma, 2 sphenoidal malignant adenoma. RESULT: Total tumor removal was obtained in 21 cases,subtotal removal in 2 cases. With follow up of 24 to 108 months, 4 cases were recurred, 5 cases were dead. The complications included cerebrospinal fluid (CSF) leak in 2 patients, intracranial infection after the endoscopic surgery in 1 patient. In the two patients with CSF leak, one case cured by internal medicine and another cured by endoscopic surgery. CONCLUSION The endoscopic endonasal surgery could provide sufficient treatment for skull base tumor, and is a safe, minimally invasive and efficient procedure, but indication should be exactitude selected.
Adult ; Aged ; Chordoma ; surgery ; Endoscopy ; Esthesioneuroblastoma, Olfactory ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Retrospective Studies ; Skull Base Neoplasms ; surgery

Objective:To investigate the clinical curative effect of closed reduction and internal fixation of Jakob type II lateral humeral condyle fractures in children under ultrasound guidance.Methods:A retrospective case series analysis was made on clinical data of 59 patients with Jakob type II lateral humeral condyle fractures treated at Children's Hospital of Chongqing Medical University from August 2016 to August 2017. There were 30 males and 29 females, with the age of 1.5-8.1 years [(4.0±1.8)years]. There were 34 patients treated by open reduction and internal fixation and monitored by the X-ray (control group), and 25 patients treated by closed reduction and internal fixation and monitored by ultrasound (study group). The operation time, bleeding volume, fracture healing time, and incidence of complications were compared between the two groups. The elbow joint function was evaluated by Broberg and Morrey standard at the latest follow-up.Results:All patients were followed up for 17-31 months[(23.2±4.2)months]. The operation time and bleeding volume in control group were (50.7±22.2)minutes and (6.1±3.8)ml, obviously higher than those in study group [(21.4±3.3)minutes, (1.1±0.3)ml] ( P<0.05). The fracture healing time was (8.0±0.8)weeks in control group and (7.8±0.7)weeks in study group ( P>0.05). According to the Broberg and Morrey standard, the good and excellent rate of elbow joint function in control group was 97%, with excellent results in 31 patients, good in 2, fair in 1, and poor in 0; the good and excellent rate of elbow joint function in study group was 100%, with excellent results in 22 patients, good in 3, fair in 0 and poor in 0 ( P>0.05). In study group, wound infection or malunion was not seen, and only two patients showed postoperative wire tail irritability and recovered after the removal of wires. While in control group, wound infection was seen in 3 patients and malunion was observed in 2 patients, but all patients were with distal humerus lateral bone formations. The incidence of complications was 15% in control group, higher than 0% in study group ( P<0.05). Conclusion:Compared to open reduction internal fixation, ultrasound-guided closed reduction and internal fixation of Jakob type Ⅱ lateral humeral condyle fractures in children has similar therapeutic effect, but it can shorten operation time and reduce bleeding and complications.

Objective To assess the predictive value of bedside diaphragmatic ultrasound in predicting pulmonary complications(PPCs)after thoracoscopic lobectomy.Methods The patients who had undergone elective thoracoscopic lobectomy in Henan Provincial People's Hospital were collected.General information and perioperative indicators were recorded.Diaphragmatic motility was detected by bedside ultrasound preoperatively and on postopera-tive days 1,3,and 5.The patients were divided into two groups(PPCs group and non-PPCs group).Statistically different parameters in univariate analysis were included in multivariate logistic regression analysis to screen inde-pendent influencing factors of PPCs.Receiver operating curve(ROC)was drawn,and the performance of diaphragm ultrasound for predicting PPCs was evaluated by the area under the curve(AUC).Results 949 patients were included in this study.PPCs occurred in 537 patients(57.5% ).Univariate analysis showed that as compared with the non-PPCs group,the proportion of diabetic patients and postoperative VAS score in the PPCs group increased,time to chest tube removal and one-lung ventilation,and postoperative hospital stay were longer.PPCs group had a lower DE value on the operative side and healthy side on postoperative days 1 and 3 and on the operative side alone on day 5(P<0.05).Multivariate logistic regression analysis showed that prolonged one-lung ventilation time,diabetes mellitus,DE values on the operative side and unoperative side on postoperative days 1 and 3,and decreased DE value on the operative side on day 5 were independent risk factors for PPCs.The ROC curve shows that the efficacy of DE for pre-dicting PPCs on the operative and healthy sides on postoperative days 1 and 3 was relatively high(AUC of 0.797,0.821,0.933,and 0.929;respectively).The efficacy of DE for predicting PPCs on the operative side was poor on postoperative day 5(AUC of 0.703 and 0.512,respectively).Conclusions A decrease in postoperative DE,prolonged one-lung ventilation time,and diabetes are independent risk factors for PPCs after thoracoscopic lobectomy.Bedside ultrasound evaluation of DE has a higher value in predicting PPCs three days after surgery.

OBJECTIVETo study the duration of prourokinase gene expression in vein grafts and the role of the prourokinase gene in protecting vein grafts from neointimal hyperplasia.

METHODSFifty-four Wistar rats were used in this study. In each rat, the jugular vein was excised and distended for 30 minutes using a solution containing either Adv(5)-CMV (control group) or Adv(5)-CMV/Pro-UK (treatment group). Next, the jugular vein was reversed and interposed into the divided carotid artery of the same rat. On the 14th day after transfection, vein grafts of the control group were collected in order to perform a fibrinolysis test for prourokinase (Pro-UK) activity. On the 2nd, 7th, 14th, 28th, and 60th day, the vein grafts of the treatment group were likewise collected in order to detect prourokinase activity. On the 28th day, the vein grafts of both groups were explanted to evaluate the (3)H-TDR incorporation so that pathologic analysis could be performed.

RESULTSPro-UK activity could not be detected in the control group, while in the treatment group, the Pro-UK activity could be detected from the 2nd day onwards, peaking on the 7th day and declining from the 14th day, but yet persisting at a low level for a further month. The amount of (3)H-TDR incorporated in the control group was higher than that in the treatment group. Pathologic analysis demonstrated that vein grafts of both groups exhibited wall thickening, but that the degree of graft neointimal hyperplasia and reduction of the graft lumen was greater in the control group than that in the treatment group. The occlusion rate of grafts in the control group was 20%. All grafts in the treatment group were patent.

CONCLUSIONSPro-UK gene transfer before vein grafting in vitro results in a high level of gene expression in the vein graft from the 7th day to 14th day. And its gene expression in the vein graft could reduce neointimal hyperplasia in the vein graft.

Animals ; Gene Expression ; Gene Transfer Techniques ; Hyperplasia ; Jugular Veins ; transplantation ; Male ; Rats ; Rats, Wistar ; Recombinant Proteins ; genetics ; Tunica Intima ; pathology ; Urokinase-Type Plasminogen Activator ; genetics ; Veins ; pathology ; transplantation

Objective:To evaluate the effects of intraoperative fluid therapy guided by different stroke volume variation (SVV)s on bleeding during laparoscopic hepatolobectomy and postoperative renal function.Methods:A total of 135 American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes, aged 25-64 yr, scheduled for elective laparoscopic hepatolobectomy under general anesthesia, were divided into 3 groups ( n=45 each) using a random number table method: low SVV group (group L), medium SVV group (group M) and high SVV group (group H). In group L, group M and group H, SVVs were maintained at 10%-15%, 16%-20% and more than 21%, respectively.Before surgery and at 1, 3 and 5 days after the surgery, blood samples from the peripheral vein were taken for determination of serum blood urea nitrogen, creatinine and procalcitonin (PCT) concentrations.The occurrence of conversion to laparotomy, intraoperative volume of blood loss, volume of blood transfused, urine volume, operation duration, length of hospital stay and time to first flatus were recorded.On admission to the operating room (T 0), at skin incision (T 1), at the beginning of resection of the liver (T 2), after resection of the lobes of the liver (T 3) and at the end of the surgery (T 4), mean arterial pressure (MAP), heart rate (HR) and lactic acid (Lac) were recorded.The consumption of intraoperative norepinephrine, hypotension, arrhythmia and postoperative adverse reactions were recorded. Results:Compared with group L, the intraoperative volume of blood loss and consumption of intraoperative norepinephrine in group M and intraoperative volume of blood loss, the total amount of fluid infused and urine volume in group H were significantly decreased, consumption of furosemide and nitroglycerin in group H and the total amount of red blood cells infused in M and H groups were increased, length of hospital stay and time to first flatus in group M were shortened, concentration of serum PCT at 1 day after surgery was decreased in group M, MAP at T 3, 4 was increased in group M, and Lac at T 2-4 was increased in group H ( P<0.05). Compared with group M, the intraoperative volume of blood loss, consumption of intraoperative norepinephrine and consumption of furosemide and nitroglycerin were significantly increased, the total amount of fluid infused and urine volume were decreased, length of hospital stay and time to first flatus in group M were prolonged, concentration of serum PCT at 1 day after surgery was increased, MAP at T 3, 4 was decreased in group M, and Lac at T 2-4 was increased in group H ( P<0.05). There was no significant difference in the incidence of postoperative adverse reactions and intraoperative hypotension and arrhythmia among the 3 groups ( P>0.05). Conclusion:Intraoperative fluid therapy guided by SVV at 16%-20% during laparoscopic hepatolobectomy can decrease the intraoperative volume of blood loss and has less effect on renal function, which is helpful for postoperative outcomes.

Objective:To investigate the relationship between common functional gastrointestinal diseases symptoms with psychological factors, diet and lifestyles by using the network analysis method which has achieved great success in the field of psychology in recent years.Method:A questionnaire survey was conducted in two military units using the cluster sampling method during July 2020, and a total of 1 805 subjects were included. Functional gastrointestinal disease symptoms were evaluated with the Gastrointestinal Symptom Rating Scale (GSRS). The state, trait anxiety scale and stress response scale were used to evaluate the mental and psychological state by self-evaluation. R was used to build the network and calculate statistical parameters.Results:1 486 of the 1 805 subjects (82.3%) had experienced functional gastrointestinal diseases symptoms within 2 weeks, but most of them were mild. Network analysis shows that there was a strong interaction between digestive system symptoms with different clinical manifestations (Spearman coefficient ranges 0.31-0.56). There was a clear relationship between functional gastrointestinal symptoms and mental and psychological factors (Spearman coefficient ranges 0.16-0.27), but there was no clear interaction with diet, age, education level, body mass index, etc. Functional gastrointestinal diseases symptoms were connected with mental and psychological factors through two nodes: stress and indigestion. The stability coefficient of node strength correlation was 0.75, indicating that the network was stable.Conclusions:The current study revealed the network structure and features of functional gastrointestinal diseases symptoms with mental and psychological factors. The key linking nodes provided potential interfering target for controlling functional gastrointestinal symptoms related to mental and psychological factors.

Objective:To compare the efficacy of volume therapy guided by inferior vena cava ultrasound and lung ultrasound at different sites in patients undergoing grade four hysteroscopic surgery.Methods:A total of 90 patients, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classificationⅠ or Ⅱ, undergoing elective grade four hysteroscopic surgery under general anesthesia, were divided into 3 groups ( n=30 each) using a random number table method: conventional group (C group), ultrasound at the subcostal area group (S group) and ultrasound at right mid-axillary line group (R group). When the inferior vena cava distensibility index<15% or pulmonary ultrasound B-line score>8.5 or arterial blood gas Na + concentrations <125 mmol/L, surgeons were advised to speed up the process of surgery and decrease the pressure of uterine distention, furosemide 10-20 mg was intravenously injected, and the speed of infusion was adjusted at the same time.On admission to the operating room (T 0), at 20 min after induction (T 1), 40 min after induction (T 2), and at the end of operation (T 3), the B-line score of lung ultrasound, concentrations of Lac and Na + and PaO 2/FiO 2 were recorded, and the postoperative complications, amount of uterine distention fluid, volume of fluid infused and time of laryngeal mask airway removal were recorded. Results:Compared with group C, the pulmonary ultrasound B-line score was significantly decreased, the concentrations of Na + and PaO 2/FiO 2 were increased, the time of laryngeal mask airway removal was shortened, and the amount of uterine distention fluid was decreased in S and R groups, and the total incidence of complications was significantly decreased in group R ( P<0.05). Compared with group S, the lung ultrasound B-line score was significantly decreased, PaO 2/FiO 2 was increased, and the amount of uterine distention fluid was decreased in group R ( P<0.05). Conclusions:Compared with subxiphoid process, the volume therapy guided by inferior vena cava ultrasound on the right mid-axillary line and lung ultrasound has more advantages in the patients undergoing grade four hysteroscopic surgery.

Maturity onset diabetes of the young (MODY) is a monogenic autosomal dominant inherited disease. Its clinical manifestations are asymptomatic with slightly elevated fasting blood glucose and few complications. This paper reports a novel mutation W257R in glucokinase () gene from a Chinese patient with MODY. Heterozygous mutation c.769T>C (p.W257R) in exon 7 of gene (Chr744187343) was found in the proband, her father and brother. This W257R mutation was first reported in Chinese population.
China ; Diabetes Mellitus, Type 2 ; genetics ; Female ; Glucokinase ; genetics ; Humans ; Male ; Mutation ; Pedigree