OBJECTIVE To investigate the effect of nuclear factor-kappa B ligand-receptor activator of nuclear factor-kappa B-osteoprotegerin(RANKRANKL-OPG)system on bone resorption in middle ear cholesteatoma,and the reasons why middle ear cholesteatoma in children were more aggressive. METHODS The expression of RANKL and OPG in 21 adults cholesteatoma,17 children cholesteatoma and 18 normal external meatal skin was studied with immunohistochemistry. Semiquantitative analysis was used for comparison and statistical analysis. RESULTS RANKL-positive cells and the ratio of RANKL/OPG in cholesteatoma were significantly higher than that in external meatal skin(P

Objective To evaluate the clinical safety and efficacy of Cheatham-Platinum(CP)covered stent in treatment of aortic coarctation.Methods The therapeutic efficacy was retrospectively analyzed in 15 patients with aortic coarctation who were treated by BIB balloon dilation and CP covered stent implantation.Results All patients were well recovered,the stent did not appear displaced,folded,aorta dissection and rupture.The pressure difference was 5-10 mm Hg(1 mm Hg=0.133 kPa)between proximal part and distal end after operation.Following up(20±12)months,the therapy efficacy of all the patients was stable and there was no fracture,removal,aortic stenosis or dysarteriotony.Heart ultrasounds demonstrated good close of the cases with patent ductus arteriosus.Conclusion CP covered stent is a safe and available clinical therapy,featured by minimum aorta injuries.

AIM: To investigate the postoperative changes of binocular visual function in patients with congenital superior oblique palsy.METHODS: Eye position and binocular visual function were examined in 28 patients with congenital superior oblique palsy pre- and post-operatively. The results were statistically analyzed.RESULTS: The normal eye position rate after operation was 89.3%. There were 9 patients who gained simultaneous perception after operation, while 13 patients gained fusion as many as that gained stereoacuity. There was statistically significant difference between postoperative and preoperative eyes (P<0.05). Near stereoacuity was improved after operation. Patients who had better visual acuity and low strabismus degrees as well as fusion had a better recovery.CONCLUSION: The operation could improve the eye position and rebuild the binocular visual function of the congenital superior oblique palsy. The recovery of binocular visual function was related to visual acuity and strabismus degrees of the patients and whether they had fusion function.

Ear, Middle ; abnormalities ; Eustachian Tube ; abnormalities ; Female ; Humans ; Infant

Objective:To investigate the diagnostic value of high resolution CT for temporal bone traumatic facial nerve paralysis and the guidance significance for surgery.Method:Twenty-nine patients of traumatic facial nerve paralysis were investigated.The predictive diagnosis was made according to the clinical data and the image features of HRCT,then a comparative analysis of the preoperative image features and the surgical findings were carried out.Result:The trend of temporal bone fracture displayed on the CT scan was basically consisted with the surgical findings.The direct CT signs of facial nerve injury include the bone fracture line went through the tube,bone tube rupture or continuity interruption,while the indirect CT signs include local incrassation of the facial nerve,lower bone density of the tube,geniculate fossa expansion,oppressed facial nerve,et al.The predictive diagnostic accordance rates of all the image features were above 90%as to the surgical findings.Conclusion:High resolution CT could localize the trend of temporal bone fracture,and is helpful to estimate the extent of facial nerve injury and other complications.High resolution CT could provide reliable basis for clinical diagnosis and trotment.

Objective To investigate the diagnosis and treatment of vertigo associated with changes of head position.Methods 112 patients of vertigo associated with changes of head position were analyzed from June 2006 to December 2007 through the positional tests and imaging examination.Results 45 men and 67 women from ages 12 to 75 (median 50) were included with a total of 112 patients.88 patients were diagnosed as benign paroxysmal positional vertigo(BPPV),76 patients as posterior semicircular canals BPPV,9 patients as horizontal semicircular canal BPPV,3 patients as anterior semicircular canals BPPV,9 patients as suspicious BPPV.They were treated by canalith repositioning procedure,the total improvement rate was 96.9% after 1 week.15 cases of cervical vertigo were treated by physical therapy and medication,the vertigo of 4 patients disappeared and of 11 patients was improved significantly after 2 weeks.Conclusion The positional tests and cervical plain x-ray are the simplest ways to diagnose vertigo associated with changes of head position.Physical therapy and medication are effective.It is suitable to promote in the grass-roots hospitals.

OBJECTIVE To study the clinical features and therapeutic efficacy of middle ear adhesion.METHODS The clinical data of 40 cases of middle ear adhesion collected during 5 years from 2002 to 2007 were studied retrospectively. RESULTS Part or all of the tympanic membrane of the patients did not move under Siegle otoscopy. The lesions of middle ear adhesion were extensive and invaded all middle ear structures including round and oval windows.The lesions were severe, especially in narrow anatomical spaces such as mesotympanum,hypotympanum and interossicular spaces.Pure tone audiometry showed that average air-bone gap (A-B gap) were (35.34?6.99) dB preoperatively.The average A-B gap were (18.47?5.76) dB 6 months after operation.Follow-up observations and postoperative CT scan showed that tympanic membranes and middle ear cavity recovered well.CONCLUSION There are various degrees of tympanic fibrous adhesion and atelectatic tympanum in middle ear adhesion,especially in mesotympanum, hypotympanum and interossicular spaces.The middle ear adhesion can be treated with operation.The key points for a successful operation include preserving normal tympanum mucosa,opening eustachian tubes, making a bigger middle ear cavity,and performing tympanoplasty with perichondrium-cartilage plates.

Objective To investigate the effect of endoscope assisted microincision cholelithotomy(EMC) in the treatment of gallstone. Methods The clinical data of 86 patients with gallbladder stone treated by EMC were analyzed retrospectively.Of them, 63 cases were follwed-up and studied. Results All eighty-six patients were successfully operated on and discharged, no operative complications occurred. Among 63 patient being followed up for 1～3 years,the recurrence rate of gallbladder stones was 3.2%(2/63). No recurrence was noted in 46 patients with single gallstone. In the other seventeen patients with multiple stones, gallstone recurrence was found in 2 patients, the recurrence rate was 11.8%(2/17). Conclusions If selection of the operation idications are strict, endoscope assisted microincision cholelithotomy for treatment of gallstone is simple, safe, effective and less trauma, and can preserves the function of gallbladder, but it can not replace the cholecystectomy.

Objective: To study the impact of ticagrelor on inlfammatory factors in patients with unstable angina pectoris (UAP) after percutaneous coronary intervention (PCI).
Methods: Based on conventional medication, a total of 100 UAP patients after PCI were randomly divided into 2 groups for anti-platelet therapy:Treatment group, the patients received aspirin+ticagrelor and Control group, the patients received aspirin+clopidogrel. n=50 in each group, all patients were treated for 12 months. Plasma levels of inlfammatory factors were examined before treatment and 24h, 7d, 28d after the operation. The patients were followed-up for 12 months for ischemic events, bleeding events and adverse drug reactions.
Results: Before treatment, plasma levels of IL-6, IL-18, TNF-α, PDGF were similar between 2 groups (t=0.1356, 0.1668, 0.2473, 0.5780, all P>0.05). At 24h post-operation, the above inlfammatory factors were signiifcantly increased by peaks in both groups and decreased thereafter. At 24h, 7d and 28d post-operation, the levels of IL-6, IL-18, TNF-a, PDGF in Treatment group were all lower than Control group at each corresponding time point (at 24 post-operation, t=2.0856, 2.4399, 2.2217, 2.2053, all P<0.05), (at 7d post-operation, t=6.0978, 5.9705, 4.4631, 4.3963, all P<0.01) and (at 28d post-operation, t=9.3779, 9.7724, 5.5855, 6.1700, all P<0.01). The follow-up study presented that at 12 months post-operation, the ischemic events in Treatment group was lower than Control group (χ2=4.3956, P<0.05);there were no small hemorrhage or major bleeding events occurred;the slight adverse drug reaction was similar between 2 groups (χ2=0.1773, P>0.05).
Conclusion: Compared to clopidogrel, ticagrelor could better decrease plasma levels of inlfammatory factors, it may reduce ischemic events without elevate bleeding events.

BACKGROUND:The position of median and radial nerves corresponding to elbow is usual y estimated by macroscopical measurements, but there are big data errors when the elbow is bent. OBJECTIVE:To measure and analyze the impacts of elbows in different positions on median and radial nerves under X-ray. METHODS:Ten fresh frozen upper limb specimens were selected. The distance of median and radial nerves to the osseous marks inside the elbow was measured when the elbow was in extension, extension-half pronation, bent at flexion 90 degrees and bent at 90 degrees with the injection of normal saline into the joint capsule, respectively. RESULTS AND CONCLUSION:The positions of median and radial nerves were not influenced when the elbow was in extension or in extension-half pronation (P>0.05). The distance of median and radial nerves to the osseous mark of the elbow was significantly lengthened when the elbow was moved from from extension to was bent at 90 degrees (P<0.05). The intra-articular injection of normal saline when the elbow flexion 90 degrees significantly elongated the distance of median and radial nerves to the osseous mark of elbow (P<0.05). These results suggest that the elbow in different positions can induce the displacement of median and radial nerves. In addition, the distance between median, radial nerves and the osseous marks of the elbow is obviously lengthened when the elbow is in flexion with intra-articular injection of normal saline.