OBJECTIVE: This study was to investigate the clinical symptoms, characterization of imaging technique and the effect of endonasal endoscopic surgery. METHOD: Following 38 cases of isolated sphenoid sinus disease patients, among whom 35 cases treated with nasal sinus CT (including 5 cases of MRI at the same time), 3 cases undergoing sinus MRI, 1 cases going through the CT cisternography. All patients underwent endoscopic sphenoid otomy, of which 33 cases underwent nasal olfactory cleft approach, 5 cases anterior ethmoid sinus and posterior ethmoid sinus approach (Messerklinger technology). RESULT: All patients were followed up for more than half a year, of which 34 were recoverd and 4 were improved. No obvious complications came up during or after endoscopic surgery. CONCLUSION Isolated sphenoid sinus disease clinical symptoms are not typicaland without specialty; nasal examination had no positive sign, only with headache as the chief neurological symptom, often difficult to diagnose at an early stage. The CT and MRI are the best methods for the diagnosis of isolated sphenoid sinusitis. The nasal endoscopic operation is the preferred method for treatment of this disease.
Adolescent ; Adult ; Aged ; Child ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paranasal Sinus Diseases ; diagnosis ; surgery ; Retrospective Studies ; Sphenoid Sinus ; Treatment Outcome ; Young Adult

Objective To explore the application of Trinity new model home nursing on continuous control of blood sugar in patients with type 2 diabetes mellitus. Methods Totally 98 patients with type 2 diabetes were selected from January 2016 to December 2017 in our hospital, who were divided into study group and control group by random number table, and there were 49 cases in each group. The control group was given conventional nursing until the hospital was discharged, and the routine follow-up was given after discharge. The study group was given conventional nursing until the hospital was discharged, and the new type of new home nursing mode was given after discharge. The levels of fasting blood glucose (FBG), postprandial 2h blood glucose (2h PBG) and glycated hemoglobin (HbAc1) were compared between the 2 groups at 1d before discharge, 1 months and 3 months after discharge, and the patients compliance were compared, then the quality of life of patients at discharge and 3 months after discharge were assessed by the diabetes specific quality of life scale (DSQL). Results The levels of FBG, 2h PBG and HbAc1respectively were(7.08 ± 0.58) mmol/L, (10.06 ± 0.72) mmol/L, (6.11 ± 0.40)％of the study group at 1d before discharge, of which the control group respectively were(7.07±0.61) mmol/L, (10.07±0.74) mmol/L, (6.10±0.42)％.The levels of FBG, 2h PBG and HbAc1respectively were(6.13±0.44) mmol/L, (9.51 ± 0.55) mmol/L, (5.51 ± 0.30)％of the study group at 1 months after discharge, of which the control group respectively were (6.58 ± 0.56) mmol/L, (9.75 ± 0.53) mmol/L, (5.82 ± 0.34)％ .The levels of FBG, 2h PBG and HbAc1 respectively were(5.69±0.42) mmol/L, (9.03±0.44) mmol/L, (5.22±0.23)％of the study group at 3 months after discharge, of which the control group respectively were (6.17±0.40) mmol/L, (9.46±0.48) mmol/L, (5.51±0.20)％. The levels of FBG, 2h PBG and HbAc1 had significant differences in the interaction between groups and time (F=2.892-5.749, P<0.05). The complete compliance rate of the study group(79.59％, 39/49) was significantly higher than that of the control group (61.22％, 30/49) (χ2=3.967, P=0.046), and then on-compliance rate of the study group (2.04％) was significantly lower than that of the control group (14.29％) (χ2=4.900, P=0.027).The scores of the physiological function, psychology or spirit, social relationship, treatment and DSQL total score of the study group at discharge respectively were (26.62 ± 4.35), (20.21 ± 3.19), (10.36 ± 2.32), (7.42 ± 0.54), (64.61 ± 9.27),of which the control group respectively were(26.49 ± 4.18), (20.17 ± 3.25), (10.45 ± 2.44,(7.35 ± 0.57), (64.46 ± 10.38).The scores of the physiological function, psychology or spirit, social relationship, treatment and DSQL total score of the study group at3 months after discharge respectively were (17.33±3.96), (11.97±2.84), (5.01±1.14), (4.25± 0.49), (38.07±7.12), of which the control group respectively were (21.72±3.51), (15.46±3.08), (7.18±1.85), (5.13 ± 0.48), (49.49 ± 8.74).The scores of the physiological function, psychology or spirit, social relationship, treatment and DSQL total score of the 2 groups at 3 months after discharge were significantly lower than those at discharge (t = 6.117-30.432, all P<0.01), and the scores of each dimension and total score of the study group were significantly lower than those of the control group at 3 months after discharge (t=5.087-8.981, 7.091, all P<0.01). Conclusion The Trinity new model home nursing can obviously improve the blood sugar indexes of patients with type 2 diabetes after discharge, improve the compliance and the quality of life, which has the value of popularization and application.

Objective:To explore the relationship between the vitamin D receptor ApaⅠ and BsmⅠ gene polymorphisms and the risk of benign paroxysmal positional vertigo(BPPV).Methods:The 98 patients with BPPV admitted to the Neurology Clinic of our hospital from March 2020 to March 2021 were selected as vertigo group, and 100 healthy individuals were selected as a healthy control group.The gene polymorphism of ApaⅠ(rs7975232)and Bsm Ⅰ(rs1544410)were detected by polymerase chain reaction-based restriction fragment length polymorphism(PCR-RFLP). Binary Logistic regression was used to analyze the influencing factors of benign paroxysmal positional vertigo.Results:The serum levels of total cholesterol and uric acid were significantly higher in the BPPV group than in a healthy control group( P<0.05). The actual and predicted values of the ApaⅠ and BsmⅠ gene distribution were compared between the BPPV group and a healthy control group, and the difference was not statistically significant( P>0.05). The ApaⅠ and BsmⅠ genotypes of the BPPV group and the control group were stable and consistent with the Hardy-Weinberg equilibrium law.The ApaⅠ gene rs7975232 and the BsmⅠ gene rs1544410 genotype and allele frequency distribution[n(%)]showed statistically significant difference(all P<0.05)between control vs BPPV groups.The locus genotype and allele frequency distribution[n(%)]showed statistically significant difference between control vs BPPV group( P<0.05). The total cholesterol, blood uric acid, rs7975232CC, rs7975232AA, rs1544410 CC, and rs1544410 CT were risk factors for the occurrence of benign paroxysmal positional vertigo. Conclusions:Gentic polymorphisms at the cleavage sites of restriction endonuclease of vitamin D gene ApaⅠ rs7975232 and BsmⅠ gene rs1544410 have certain correlation with the occurrence of(BPPV)disease.Population with type CC and AA in ApaI rs7975232 and type CC and CT in BsmⅠ rs1544410 are more prone to BPPV.

Objective: To discuss the clinical effect of small dose of botulinum toxin injection in cricothyroid muscle and thyroarytenoid muscle on patients with incomplete bilateral recurrent laryngeal nerve paresis. Methods: Six patients were selected with Ⅰor Ⅱ or Ⅲ degree of dyspnea diagnosed as bilateral recurrent laryngeal nerve injury by laryngeal electromyography, and small dose of botulinum toxin injection was performed in cricothyroid muscle and thyroarytenoid muscle as a treatment. Degree of dyspnea was assessed one month before and after the treatment, and the stroboscopic laryngoscope results, acoustic parameters and CT image of the patients were collected in the 6 patients. The relevant parameters were also collected one month before and after treatment, including the degree of dyspnea, stroboscopic laryngoscope results, acoustic parameters and CT image of the patients. The angle between bilateral vocal cords in stroboscopy at full inspiratory was calculated, acoustic parameters (F0, jitter, shimmer) were analysed, and vocal length, width and the vocal region were measured. Then, the paired t test was performed for statistical analysis between before and after one month injection, the one way analysis of variance was performed among vocal parameters in CT image. Result: Botulinum toxin injection was successfully completed in the 6 patients, followed without any serious complications. The degree of dyspnea was alleviated to some extent after treatment in all 6 patients; the angle between bilateral vocal cords at the end of a deep inspiration was significantly increased (t=2.44, P<0.05) after the treatment. The changes of F0 and jitter between before and after treatment were not statistically significant (t=0.72, t=1.42, P>0.05). Shimmer was significantly decreased after treatment (t=2.61, P<0.05). Vocal fold length, width and vocal region increased with F0, there was a statistically significant difference between different F0 before injection, and there was no statistically significant difference between different F0 after injection. The follow-up time was respectively seven months, 1 year, 1 year, 18 months, 22 months and 2 years respectively. Conclusion Small dose of botulinum toxin injection in bilateral cricothyroid muscles and thyroarytenoid muscles can relieve the dyspnea caused by bilateral vocal cords paresis to some extent, accompanied without serious complications, despite the sound quality was slightly worse.

Objective:To evaluate the optimization efficacy of anterior quadratus lumborum block at supra-arcuate ligament (SA-AQLB) combined with general anesthesia for laparoscopic gynecological surgery.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 28-64 yr, weighing 52-78 kg, with height of 154-166 cm, scheduled for elective laparoscopic gynecological surgery, were divided into general anesthesia group (group G, n=40) and SA-AQLB combined with general anesthesia group (group SG, n=40) using a random number table method.In group SG, bilateral SA-AQLB was performed under ultrasound guidance before anesthesia induction, and 0.4% ropivacaine 25 ml plus dexamethasone 5 mg was injected into both sides.Combined intravenous-inhalational anesthesia was applied in both groups.Patient-controlled intravenous analgesia (PCIA) with sufentanil 2 μg/kg (in 150 ml of normal saline) was performed after surgery.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analogue scale (VAS) scores for abdomen, pelvis and shoulder pain were recorded at 1, 6, 12, 24 and 48 h after operation.Flurbiprofen was used for rescue analgesia when VAS score >4.The occurrence of intraoperative cardiovascular events and amount of sufentanil used during operation were recorded.The time to first pressing the analgesia pump, effective pressing times of PCA, requirement for rescue analgesia and consumption of sufentanil after operation were recorded.The extubation time, time to first flatus after operation, first ambulation time, length of hospital stay and development of postoperative adverse reactions such as nausea and vomiting, urinary retention and respiratory depression within 48 h after operation were recorded. Results:Compared with group G, the incidence of intraoperative hypertension and tachycardia was significantly decreased, the incidence of intraoperative hypotension and bradycardia was increased, the intraoperative consumption of sufentanil was reduced, the extubation time was shortened, the time to first pressing the analgesia pump was prolonged, the effective pressing times of PCA, requirement for rescue analgesia and postoperative consumption of sufentanil were reduced, the time to first flatus, first ambulation time and length of hospital stay were shortened, VAS scores for abdomen, pelvis and shoulder pain were decreased at each time point after operation, and the incidence of nausea and vomiting, urinary retention and respiratory depression after operation was decreased in group SG ( P<0.01). Conclusions:Compared with general anesthesia, the combination of SA-AQLB and general anesthesia can reduce the opioid consumption, inhibit intraoperative stress responses and postoperative hyperalgesia and promote early postoperative recovery when used for the patients undergoing laparoscopic gynecological surgery.