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.

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 investigate the clinical value of contrast-enhanced ultrasonography(CEUS) in evaluating treatment response of hepatocellular carcinoma after interventional therapy. Methods One hundred and three patients with 136 lesions of hepatocellular carcinoma confirmed by pathology were examined by common color ultrasound (US), contrast-enhanced CT, CEUS and DSA pre- and post-interventional treatment respectively. Results The sensitivity,specificity and accuracy of CEUS for focus judgment after interventional therapy were 95.8%, 95.6% and 98. 5% respectively. The sensitivity, specificity and accuracy of US in detecting tumor deactivation and residue were 92.3% ,77.4% and 83.1% respectively. CEUS were highly consistent with the results of enhanced CT/DSA (Kappa = 0.93) and significantly higher than those of US (Kappa = 0.66). Conclusions CEUS is useful to monitor the efficacy and guide treatment after interventional therapy.

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.

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 analyze the impact of medical insurance reimbursement mechanism on the income of urban community health centers run by various entities. Methods The data of the baseline survey of community health centers in 28 cities made in 2007 were called into play. These data were used to compare the percentage of the annual medical insurance income from outpatient clinics of three types of community health centers in their gross annual income and their annual outpatient clinic income. Results For 929 community health centers with income from medical insurance reimbursement, the average percentage of their annual income from outpatient clinic accounts for 24% of their gross annual income and 26. 09% of their annual outpatient income;In respect of the reimbursement rates of medical insurance at outpatient clinics, the highest come from those run by enterprises, secondly those by the government,and the least those run by social organizations or individuals. Conclusion The mechanism of medical insurance reimbursement has already affected the income of the third type of community health centers. It is recommended to raise the coverage rate of medical insurance of such type of centers and their reimbursement rates of medical insurance. This may further consolidate the policies of medical insurance reimbursement.

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.

Objective To measure and evaluate slice sensitivity profile(SSP)and the full width at half-maximum(FWHM)for a 64-slice spiral CT system.Methods Using the same CT technique and body mode as those used for clinical CT,delta phantom was scanned with Somatom Sensation 64-slice spiral CT.SSPs and FWHM were measured both with reconstruction slice width of 0.6 mm at pitch = 0.50,0.75,1.00,1.25,1.50 and with reconstruction slice width of 0.6,1.0,1.5 mm at pitch = 1 respectively.Results For normal slice width of 0.6 mm,the measured FWHM,i.e.effective slice width,is 0.67,0.67,0.66,0.69,0.69 mm at different pitch.All the measured FWHM deviate less than 0.1mm from the nominal slice width.The measured SSPs are symmetrical,bell-shaped curves without far-reaching tails,and show only slight variations as a function of the spiral pitch.When reconstruction slice width increase,relative SSP become wider.Conclusions The variation of pitch hardly has effect all on SSP,effective slice width,and z-direction spatial resolution for Sensation 64-slice spiral CT system,which is helpful to optimize CT scanning protocol.