ObjectiveTo evaluate and compare the prognosis of idiopathic macular holes (IMH) and traumatic macular holes (TMH) treated by pars plana vitrectomy (PPV). Methods The clinical data of 72 IMH eyes and 55 TMH eyes, which were treated by PPV between November 2001 and December 2007,were retrospectively reviewed. The visual outcomes and macular anatomic closure were evaluated, and their relationships with prognostic factors including the size of macular hole (MH), preoperative visual acuity (VA) and duration of disease were analyzed. Results The closure rate of IMH (100. 0%) was significant higher than that of TMH (85.5%) (P=0. 001). The postoperative VA of IMH and TMH were (0. 25±0.02) and (0. 21±0. 21) respectively, both significantly increased compare to their preoperative VA (t=-6. 841, -4. 093; P=0.000). VA-increased IMH and TMH eyes had same VA (χ2=3. 651, P=0.07).Pre-PPV VA≥0. 1 IMH eyes had better outcomes than Pre-PPV VA＜0. 1 IMH eyes (χ2 = 12.04, P=0. 001), while Pre-PPV VA had no effects on TMH outcomes (χ2=0. 371, P=0. 486). IMH eyes with small holes had better outcomes (t=2. 476, P=0. 016), and TMH eyes with small holes had better closure (t= -4. 042, P＜0. 001). The duration of disease had no significant influence on TMH visual (χ2=0. 704,P = 0. 401 ) and anatomic (χ2 = 0. 166, P= 0. 684) outcomes. Conclusions PPV is an effective treatment for MH. The closure rate of IMH is higher than that of TMH. The diameter of MH and preoperative VA are major factors for IMH outcomes, and the duration of disease and preoperative VA have no effects on postoperative VA in TMH.

BACKGROUND: Mini-screw anchorage is an innovation technique applied in the orthodontic field, expanding the treatment ability of orthodontic appliance. Accurate of mini-screw insertion in the target position is a clinical problem which making orthodontist trouble in this technique application. OBJECTIVE: To introduce a kind of three dimensional guide of mini-screw used as anchorage in orthodontic treatment and to evaluate the positioning accuracy. DESIGN, TIME AND SE'I-rlNG: A contrast study was performed at the Department of Orthodontics, Capital Medical University from April to October 2005. PARTICIPANTS: Twenty cases (40 mini-screws) of maxillary critical anchorage requisition were considered as the experimental group, and 15 cases (30 mini-screws) who were not treated with surgical guide were considered as the control group. METHODS: Self-made stent was used as a positioning guide for implantation of mini-screw anchorage between the roots of upper second bicuspid and first molar. Thereafter, the position was measured. MAIN OUTCOME MEASURES: The vertical distance from measure points to the reference middle line were measured. RESULTS: In 40 mini-screws inserted with the aid of surgical guide, the average survival time of mini-screw as anchorage was 10.3 months, 2 were lost, and the success rate was 95%. The average survival time of 30 mini-screws in the control group was 9 months, 9 were loss, and the success rate was 70%. The positioning measurement showed that deviation of mini-screw was not found in the experimental group, but it was found in the control group. CONCLUSION: By aid of surgical guide splint, mini-scraw can be inserted correctly into the target region.

OBJECTIVETo investigate the technique and its therapeutic effect of synchronous correction of lip and nasal deformity in complete bilateral cleft lip.

METHODS29 patients with complete bilateral cleft lip underwent synchronous correction of lip and nasal deformity with the modified Mulliken method for Asians. The philtral flap was 6-7 mm in length, and 3-4 mm in width at the collumellar-labial junction. The distance between the peaks of cupid's bow was 4-5 mm. The bilateral edge of philtral flap was de-epithelialized and advanced to form philtrum column. The lateral lip was advanced to the medial site, and the central vermilion tubercle was constructed with the bilateral vermilion-mucosal flap. Through the alar rim incision, the displaced cartilage was dissected and repositioned to raise the nasal tip. The follow-up period was 6 months to 6 years.

RESULTSSatisfactory results were achieved in all patients. The reconstructed upper lip had invisible scar with natural philtrum and column. The vermilion had good appearance with tubercle. The length of nasal column was not decreased and depression of nasal tip and alar was greatly improved.

CONCLUSIONSOur modified Mulliken method is effective in synchronous correction of lip and nasal deformity in bilateral cleft lip.

Asian Continental Ancestry Group ; Cleft Lip ; surgery ; Follow-Up Studies ; Humans ; Nose ; abnormalities ; surgery ; Rhinoplasty ; methods ; Surgical Flaps ; Time Factors

Objective To explore the surgical safety and clinical efficacy of combined anterograde and retrograde method exposing porta hepatis for the treatment of the intrahepatic cholangiocarcinoma invading porta hepatis.Methods The retrospective descriptive study was conducted.The clinicopathological data of 3 patients with left intrahepatic cholangiocarcinoma invading porta hepatis who were admitted to the Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from February 2015 to May 2016 was collected.All the 3 patients underwent left hemihepatectomy combined with caudate lobectomy after preoperative lab and imaging examinations and the evaluations of liver function and residual liver volume.The surgical procedures followed as:anterograde dissection of porta hepatis,exposure of hilar plate,left hemihepatectomy combined with caudate lobectomy,right artery resection and reconstruction,hilar cholangioplasty and bilioenteric anastomosis.Observation indicators included:(1) surgical situations:operation time,time of hepatic artery~ anastomosis and volume of intraoperative blood loss;(2) postoperative pathological examinations;(3) postoperative situations:postoperative complications (biliary fistula,hemorrhage,abnormal liver function,gastroplegia) and postoperative chemotherapy;(4) follow-up:postoperative patients' survival and carcinoma occurrence.Follow-up was performed to by outpatient examination up to December 2016.The follow-up included clinical symptoms such as abdominal pain,chills,fever and jaundice,liver function and tumor marker examination,and color ultrasound Doppler or abdominal enhanced computed tomography (CT) was performed to detect carcinoma recurrence.Measurement data was represented as average (range).Results (1) Surgical situations:all the 3 patients underwent successful left hemihepatectomy combined with caudate lobectomy using combined antegrade and retrograde method exposing porta hepatis,including 1 combined with right hepatic artery resection and reconstruction,without perioperative death.The average operation time,average time of hepatic artery anastomosis and average volume of intraoperative blood loss of 3 patients were 493 minutes (range,430-570 minutes),11 minutes and 526 mL (range,450-600 mL),respectively.(2) Postoperative pathological examination showed 3 patients were diagnosed with cholangiocarcinoma,2 with nerve bundles invaded and 2 with No.12 lymph node metastasis,with negative margins of bile duct and hepatic artery.(3) Postoperative situations:3 patients are not complicated with biliary fistula and gastroplegia.One patient with postoperative liver dysfunction after right artery resection and reconstruction underwent anti-infection,hepatoprotection and anti-hepatic encephalopathy therapies,and then was improved and discharged from hospital at 4 weeks postoperatively.The other 2 patients recovered steadily without complications such as hypohepatia,and then respectively discharged from hospital at 17 and 20 days postoperatively.All the 3 patients underwent chemotherapy of gemcitabine combined with S-1 for 8 courses at week 4 or 5 postoperatively.(4) Follow-up:all the 3 patients were followed up for 7-20 months,with good general conditions and normal liver function and without cholangitis symptoms.One patient received right artery reconstruction,and CT reexamination at postoperative month 3 showed fine imaging of right hepatic artery.There was no sign of carcinoma recurrence.Conclusion The combined anterograde and retrograde method exposing porta hepatis for the treatment of the intrahepatic cholangiocarcinoma invading porta hepatis can increase the radical resection rate and surgical safety.

Objective To evaluate remedy therapy for biliary restenosis after repair of bile duct injury.Methods Clinical data of 60 patients with bile duct injury including 16 patients with restenosis after repair admitted to Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2000 to December 2012 was retrospectively analyzed.Results 16 patients suffering from biliary duct restenosis included 3 cases of type Ⅱ 1 d,10 cases of type Ⅱ2 d,2 cases of type Ⅱ 3 d and 1 case of type Ⅱ 4 d.The reoperative procedures included hepatic hilar biliary plasty with bilioenteric anastomosis in 15 cases,right hemihepatectomy with left hepatic bilioenteric anastomosis in 1 case.Postoperative bile leakage in 3 cases and pleural effusion in 10 cases were cured by watchful therapy.All of the 16 cases were followed up with an average time of 5.2 years.No occurrence of cholangitis and elevated liver enzymes were observed up to now in 8 patients,increased γ-GT and ALP,no cholangitis but anastomotic stenosis as showed by MRCP in 6 patients with 2 patients neccesitating reoperation to address repeated cholangitis.Conclusions Restenosis after bile duct repair was closely associated with injury type,repair opportunity,repair methods and the surgeon's expertise.Precise preoperative evaluation,the choice of rational surgical approach,the clinging to mucosa-to-mucosa bilioenteric anastmosis principle and the establishment of postoperative long-term followup system centered on ALP,γ-GT and life quality score are required in the reoperation of stenosis after bile duct repair.

Objectives To analyze the risk factors associated with infant wheezing in Zhongshan city. Methods A multi-center, large sample of case-control study was applied and the data related to risk factors was collected by questionnaire survey. T test and chi-square test were firstly used for univariate analysis, and then the multivariate stepwise logistic regression was used to analyze the independent risk factors associated with infant wheezing. Results A total of nine factors were found rele-vant to infant wheezing by univariate analysis including parental allergic history, way of birth, respiratory syncytial virus infec-tion, Mycoplasma pneumoniae infection, personal allergic history, like crying, parents have constant disagreements, home near the road, and factory around (P<0.05). Parental allergic history (OR=3.441, 95%CI:1.914-6.186, P<0.001), respiratory syncy-tial virus infection (OR=2.910, 95%CI:1.793-4.723, P<0.001), Mycoplasma pneumoniae infection (OR=2.277,95%CI:1.110-4.667, P=0.025), home near the road (OR=2.036, 95%CI:1.280-3.239, P=0.003) and like crying (OR=1.521, 95%CI:1.049-2.206, P=0.027) were approved to be the independent risk factors of infant wheezing in ZhongShan. Conclusions Nine factors have relationship with infant wheezing, including parental allergic history, respiratory syncytial virus infection, Mycoplasma pneumoniae infection, home near the road, like crying, personal allergic history, and that the former five factors are the indepen-dent risk factors.

Objective To investigate the clinical efficacy of hydrocortisone sodium succinate for treatment of septic shock patients and their prognoses. Methods A prospective case control study was conducted. 49 patients with septic shock in the Department of Emergency of the First Affiliated Hospital of Xi'an Jiaotong University were enrolled from January 2010 to January 2012,and the patients were sequentially divided into two groups,the treatment group(24 cases)and the control group(25 cases),by the difference in odd or even number. All patients in the two groups accepted the conventional treatment. The treatment group additionally received hydrocortisone sodium succinate injection 200 mg,once a day for 5 days. The levels of serum procalcitonin(PCT),C-reactive protein(CRP)were measured in all the patients before treatment and 24 hours,72 hours and 7 days after treatment. The mortalities were compared in 14 days between the two groups. Results The levels of PCT,CRP before and 24 hours after treatment were not statistically significant different from those of pre-treatment in two groups(all P>0.05). PCT and CRP were decreased at 72 hours and 7 days after treatment in the two groups,and on the 7th day the decline was more significant, and compared with the control group,the levels of PCT and CRP in treatment group were reduced more markedly at 72 hours and on the 7th day〔PCT(μg/L):72 hours 9.73±2.10 vs. 12.36±2.56,7 days 5.33±2.05 vs. 8.76±1.78;CRP(μg/L):72 hours 69.12±13.61 vs. 109.68±16.16,7 days 20.16±9.64 vs. 42.32±13.16,all P<0.05〕. But the mortality in 14 days was not statistically significant different between control group and treatment group(52.0%vs. 45.8%,P>0.05). Conclusion The treatment with hydrocortisone sodium succinate can reduce the inflammation of patients with septic shock,thus it has clinical value in the improvement of the disease situation.

Objective To investigate the cytomegalovirus( CMV) infection in children of Wuhu City. Methods Serum samples from children n=874 were tested for CMV-IgM using commercial ELISA kits. Re-sults The CMV-IgM detective rate of serum samples from 874 children was 4. 46%. The positive rate of CMV-IgM was 4. 89%(26/531cases)and 3. 79%(13/343 cases)in boys and girls,respectively. There was no signifi-cant difference in the positive rate of CMV-IgM between boys and girls(χ2 =0. 37,P>0. 05). The positive rate peaked in children at age of >6 months~1 year(10. 19%). Clinical manifestations included liver dysfunction, neurological diseases,jaundice and pneumonia. Conclusion The positive rate of CMV-IgM in children in local district of Wuhu city is high,which should be given due attention.

Objective To explore the effect and mechanism of intrathecal injecting κ-opioid receptor agonist U50, 488H on the rats with myocardial ischemia/reperfusion injury.Methods 50 Sprague–Dawley rats were randomly divided into five groups (n=10): sham group (Sham), ischemia/reperfusion group (IR), high-dose intravenous injection group (IV1), low-dose intravenous injection group (IV2), and intrathecal injection group (IT).In sham group the rats were followed by the modeling step without ligation of the left coronary and no drug injection by intravenous or intrathecal; in IR group the rats were underwent 30 minutes of myocardial ischemia followed by 120 minutes of reperfusion, and were not treated with any drug.All the rats in IV1, IV2 and IT groups were intravenous injected with U50, 488H at 1 hour before they were underwent myocardial ischemia/reperfusion as in IR group.IV1 and IV2 groups were intravenous injected with U50, 488H respectively at the dose of 0.1 mg/kg and 0.01 mg/kg, while the IT group was intrathecal injected with U50, 488H at the dose of 0.01mg/kg.All the rats from 5 groups were observed with cardiac ultrasound, myocardial sirius staining, serum CGRP and ET level.Results Compared to IR group(EF%=35.4 ±1.1,FS% =21.1 ±1.1), the rats in IT group (EF%=49.1 ±1.2,FS%=27.1 ±1.0) and IV1 group (EF%=46.3 ±2.2,FS%=26.6 ±0.6) showed better myocardial contraction (P<0.05) and reduced myocardial fibrosis (P<0.05).IT group and IV1 group also showed reduced ET but increased CGRP in the serum (P<0.05).There were no difference between IV2 group and IR group in both observation.Conclusion Pretreatment with intrathecal injection of opium κ-receptor stimulant U50, 488H not only protected the myocardial function from myocardial ischemia/reperfusion injury, but also repressed myocardial fibrosis.The protection may result from modulation of CGRP and ET.

Objective To investigate the effects of different doses of sufentanil on the minimum alveolar concentration (MAC) of sevoflurane for sedation in patients undergoing bronchoscopy. Methods ASA physical status I orⅡpatients of both genders, aged 20 ~ 65, undergoing bronchoscopy under general anesthesia,were randomly divided into 4 groups (n=20 each):control group (group C) and different doses of sufentanil groups (Sl, S2 and S3 groups). Sufentanil 0.1, 0.2 and 0.3 μg/kg in 5 mL of normal saline was intravenously infused before induction of anesthesia in groups of SI S2 and S3 respectively. While 5 mL of the normal saline was given instead in the group C The patients were mechanically ventilated after insert laryngeal mask. Anesthesia was maintained with inhalation of sevoflurane. Each time the concentration of sevoflurane at end expiration increased/decreased in the next patient depending on the concentration of sevoflurane at end expiration with which the former had no cough. The ratio between the two consecutive concentrations was 1.1. The middle point between the positive response and negative response served as a crossover pair. After at least 7 independent crossover pairs were observed in each group. The MAC and 95%confidence interval of sevoflurane were calculated. The time of anesthesia induction and analepsis was recorded. Results The MAC (95%CI) of sevoflurane was 3.0%(2.8%~3.3%), 2.3%(2.1%~2.5%), 1.9%(1.6% ~ 2.2%) and 1.6% (1.3% ~ 1.9%) in groups of C, S1, S2 and S3 respectively. The MAC of sevoflurane was significantly lower in groups of S1, S2, S3 than in the group C, and in groups S3 than in the group S1 (P<0.05). The time of anesthesia induction was significantly shorter in groups of S2, S3 than in the group C and significantly longer in groups S3 than in the group C. Conclusion Sufentanil of 0.1, 0.2, 0.3 μg/kg can significantly decrease the MAC of sevoflurane in patients undergoing bronchoscopy in a dose-dependent manner.