Objective:To investigate the etiololgy and pathogenesis of cholesterol granuloma of the marillary sinus. Method:Five patients with cholesterol granuloma of the maxillary sinus were analysed retrospectively. Result: The cholesterol granuloma was a particular form of tissue reactions of granulation. The clinical symptoms of the disease was short of specificity. Conclusion; The pathogenesis of cholesterol granuloma includes hyperlipemia, obstruction of airfilled cavity ventilation and impaired drainage. The final diagnosis was based on pathologic examination. The treatment should begin with the intervention and treatment of hyperilpemia. Radical cure can be a-chieved by operation.

Objective To investigate the relationship among health literacy and treatment compliance and prognosis in patients with diabetes combined tuberculosis.Methods One hundred and eighty-one cases patients with diabetes combined tuberculosis were selected as the objectives and evaluated literacy level,compliance scale by the health literacy scale and compliance questionnaires.The control of tuberculosis,blood glucose control,treatment compliance and prognosis were analyzed in the patients with different health literacy level.Results Of 181 patients,there were 89 cases patients'(basic health literacy group) the total scores of health literacy and compliance were＞80 points,the efficacy of pulmonary tuberculosis control and blood sugar control were respectively 84.2％ (75/89) and 93.2％ (83/89);92 cases patients' the total scores of health literacy and compliance were ≤ 80 points,the efficacy of pulmonary tuberculosis control and blood sugar control were respectively 59.7％ (55/92) and 67.4％ (62/92),the differences were significant (x2 =12.78,18.11;P ＜0.05).Pearson correlation analysis showed that the total scores of health literacy were positive correlated with the scores of treatment compliance (r =0.688,P ＜ 0.001).Logistic regression analysis showed that three dimension of health literacy (health knowledge and concept,healthy lifestyle and behavior,health skills) that can combined predict the variance of rehabilitation compliance(P＜0.01).Conclusion The health literacy level of diabetes combined tuberculosis patients can effectively predict the rehabilitation compliance.Measures should be taken to improve the patient's level of health literacy,so as improve the compliance of rehabilitation and prognosis.

Objective To develop a tool capable of early and exactly predicting various outcomes in comatose survivors who restore spontaneous circulation after cardiopulmonary resuscitation (CPR) and validate its performance.Methods Variables that were both readily available and predictive of outcomes were identified by systematically reviewing published literature on resuscitation.A value was assigned to these variables.We used these variables in combination with APACHE Ⅱ/score to devise a multifactorial prediction score system,which we called PRCSs Prognostication Score (PRCSs-PS).Outcomes in 115 hospitalized comatose survivors after CPR were retrospectively reviewed using PRCSs-PS.Score of patients with different outcomes was compared.The area under the receiveroperating characteristic (ROC) curve was determined to evaluate performance of this tool to identify patients with a poor outcome (CPC4 and 5) and other outcomes (CPC1,2,and 3).Results There were differences of PRCSs-PS score among multiple groups with five different outcomes (CPC1-5)(F=65.91,P=0.000).Pairwise groups with different CPC were compared:no significant difference was noted between CPC 1 and CPC2 (12.41±6.49 vs 17.38±6.91,P=0.092),but difference between other pairwise CPC groups was statistically significant (CPC2 vs CPC3:17.38±6.91 vs 24.50±5.80,P=0.041,CPC3 vs CPC4:24.50±5.80 vs 32.29±5.24,P=0.006).The performance of PRCSs-PS to discriminate patients with a poor outcome from patients with other outcomes went as follows:it had 100% sensitivity,78.6% specificity,and 178.6 diagnostic index at the score cut-off22.5; it had 77.8% sensitivity,100% specificity and 176.4 diagnostic index at the score cut-off32.5.Score 23 and 33 were two key cut-offpoints.The area under the ROC curve was 0.968,showing excellent discrimination.Conclusions The final outcomes in post-resuscitation comatose survivors can be accurately predicted using PRCSs-PS Score.

Objective Parotidectomy and superficial parotidectomy are traditional surgical treatment to the malignant parotid gland tumour although they have many defects.The aim of this study was to analyze the feasibility of individualized treatment to patient according to tumor`s size and TNM stage. Methods Thirty three patients with low grade malignant parotid gland tumours from Dec 2005 to Dec 2010 were recruited in the present study.All the patients received the territorial surgical resection firstly.Then, 9 cases re-ceived the expanded territorial surgical resection (1 case had recurrent probability, accepted adjuvant radiotherapy).Sixteen cases un-derwent parotidectomy with complete tumor resection ( 2 case had envelope invasion, accepted adjuvant radiotherapy) .Eight cases ac-cepted adjuvant radiotherapy(4 cases on T1 and T2 stage preserved facial nerve although the nerves adhering to tumors, and other 4 ca-ses on T4a stage accepted facial nerve excision ) . Results Follow up ranged from 3.5 to 8.5 years and no recurrences were docu-mented.9 patients who accepted territorial surgical resection showed fine facial symmetry.8 cases of them without adjuvant radiotherapy had good salivary secretion.Nine cases of other 24 patients showed temporary facial nerve injury and recovered within 1 to 4 months. Four cases with facial nerve excision showed permanental facial paralysis. Conclusion To protect the function of parotid gland to the greatest extent, the small low grade malignant parotid gland tumors without facial nerve invasion could have territorial surgical resection. Combined territorial surgical resection with postoperative adjuvant radiation therapy is useful to avoid the tumors recurrence and en-croachment of facial nerve to protect the facial nerve function.

Objective To investigate the prognostic factors of cervical high-grade squamous intraepithelial lesions treated by cold knife conization with negative margin.Methods Two hundred and sixty-six women with cervical high-grade squamous intraepithelial lesions treated by cold-knife conization with negative margins at Beijing Hospital between Jan 1999 and Jan 2004 were analyzed retrospectively.All patients were followed up with cytology,high-risk human papillomavirus(HPV)test and eolposcopy if necessary.Results The cervical CIN recurrence rate was 8.6% with no incidence of invasive cervical cancer after a median follow-up of 46 months.The recurrence was related to the grade of lesions and gland involvement pathologically.One of 20(5.0%)cases with cervical intraepithelial neoplasia(CIN)Ⅱ,9 of 164(5.5%)cases with CIN Ⅲ(excluding carcinoma in situ,CIS)and 13 of 82(15.8%)cases with CIS recurred(P

Objective To determine if Shenfu injectio(SFI)has any analeptic action in patients emerging from general anesthesia.Methods Eighty-six ASAⅠorⅡadult patients undergoing elective abdominal surgery under general anesthesia were randomly divided into 2 groups(n=43 each):SFI group and control group.The patients were premedicated with intramuscular phenobarbital 0.1g and atropine 0.5mg.Anesthesia was induced with propofol 2 mg?kg~(-1),fentanyl 4-5?g?kg~(-1) and vecuronium 0.1 mg?kg~(-1) and maintained with propofol infusion(2-4 mg?kg~(-1)?h~(-1)),0.5%-1.0% isoflurane inhalation and intermittent i.v.boluses of fentanyl and vecuronium.The patients were intubated and mechanically ventilated.The propofol infusion and isoflurane inhalation were stopped during skin closure.The patients were still unconscious and on mechanical ventilation at the end of surgery and transferred to PACU with a tube in trachea.As soon as the patients reached the PACU,SFI 1 ml?kg~(-1) in Ringer's solution 100 ml was infused over 10 min.In control group the patients received Ringer's solution 100 ml without SFI.The following times were recorded:(1)the time when the patients opened their eyes on command;(2)the time when mechanical ventilation was stopped;(3)the time when oxygen inhalation was stopped;(4)the extubation time;(5)the time of staying in PACU.Venous blood samples were taken before(T_0) and 5,15 and 45 min(T_(1,2,3))after SFI infusion for determination of plasma?-endorphin concentration.Results The awakening time,the mechanical ventilation time,oxygen inhalation time,extubation time and duration of PACU stay were significantly shorter in SFI group than in control group.There were no significant differences in MAP and HR after SFI between the two groups.The plasma?-endorphin concentration was significantly higher in group SFI than in control group.Conclusion Shenfu injectio can make patients emerging from general anesthesia faster.

Objective: The expression of WNT5A is associated with aggressive tumor biology and poor clinical outcomes of various types of cancer. However, its function in the cell migration of small cell lung cancer (SCLC) should be elucidated. Methods:The expres-sion of WNT5A in SCLC and normal lung tissues was detected by immunohistochemisty. The correlation between the expression and clinical characteristics of WNT5A was analyzed. The function of WNT5A in regulating cell migration was studied in DMS153 cell line in vitro. Small interfering RNA (SiRNA) was used to knock down WNT5A. Wound healing and Transwell tests were used to determine the migration rate of DMS153. The phosphorylated JNK expression was detected by Western blot analysis. Results:The WNT5A expression was higher in SCLC tissues than that of normal lung tissues. WNT5A was correlated with clinical stages, lymph nodes, and distance me-tastasis in SCLC. The high expression of WNT5A was accompanied by abnormal levels of NSE and Pro-GRP. The WNT5A phosphoryla-tion of JNK promoted cell migration in vitro. Conclusion:The expression of WNT5A in SCLC is high and correlated with tumor metasta-sis. The influence of WNT5A/JNK on the cell migration property of DMS153 supports the concept that WNT5A can initiate the cell mi-gration of SCLC, which suggested that WNT5A may be a marker and can be potentially used as an effective therapeutic target for the SCLC metastasis.

Objective: To observe the clinical efficacy of mind-refreshing and balance-restoring needling method combined with Frenkel exercises in treating ataxia after cerebral stroke. Methods: The recruited 120 patients were randomized into an observation group and a control group, with 60 cases in each group. The control group was intervened by mind-refreshing and balance-restoring needling method, while the observation group was given additional lower-limb Frenkel exercises. Before and after treatment and at the follow-up, the ataxic lower-limb function was scored using Berg balance scale (BBS) and international cooperative ataxia rating scale (ICARS), and Barthel index (BI) was adopted to score the activities of daily living (ADL). Results: After treatment, the markedly effective rate was 70.2％ and the total effective rate was 96.5％ in the observation group, versus 39.7％ and 87.9％ in the control group, and the differences in the markedly effective rate and the total effective rate were statistically significant (P<0.01, P<0.05). The intra-group comparisons showed that the BBS, ICARS and BI scores after treatment and at the follow-up were significantly different from those before treatment in both groups (all P<0.01).There were significant differences in the BBS score between the two groups after treatment and at the follow-up (P<0.05, P<0.01); the between-group differences in the ICARS and BI scores were statistically insignificant after treatment (both P>0.05), while the between-group differences in the ICARS and BI scores were statistically significant at the follow-up (both P<0.05). The interaction effects between the scoring time of BBS and BI and the group factor were statistically significant (P<0.01, P<0.05). Conclusion: Mind-refreshing and balance-restoring needling can effectively improve the lower-limb ataxic symptoms and ADL after stroke; when combined with Fenkel exercises, this needling method can produce more significant efficacy.

Background The incidence of brain metastases in patients with breast cancer is approximately 10％-16％,and survival after diagnosis of brain metastases is usually short.This study was designed to evaluate the risk factors associated with brain metastases in advanced breast cancer patients,with a view to help predict patient groups with high risk of brain metastases.Methods In total,295 patients with advanced breast cancer were evaluated.All patients were pathologically confirmed and metastatic lesions were confirmed pathologically or by imaging.All patients were examined at least once every 6 months with head CT or MRI.Patients showing symptoms underwent immediate inspection,and brain metastatic lesions were confirmed by head CT and/or MRI.Results At a median follow-up of 12 months from the occurrence of metastases,brain metastases had occurred in 49 patients (16.6％).In our univariate analysis,variables significantly related to increased risk of brain metastases were hormone receptor-negative tumors,epidermal growth factor receptor 2 (HER2)-positive tumors,and multiple distant metastases.Patients with dominant tumor sites in soft tissue,or defined as Luminal A subtype,tended to have a lower risk of brain metastases than patients with visceral metastases,Luminal B subtype,triple-negative subtype or HER2-enriched subtype tumors.Conclusions Our results strongly suggest that factors such as Luminal B,triple-negative,and HER2-enriched subtypes are high risk factors for brain metastases.These data,therefore,provide pivotal clinical evidence towards a comprehensive understanding of the risk factors of brain metastases in advanced breast cancer patients.

BACKGROUNDPhacoemulsification yields successful outcomes in eyes with standard cataract. Though techniques have been improved, it is still challenging to perform phacoemulsification in cases of hard cataracts for difficulty in nuclear management and much more complications. This study aimed at describing and evaluating the efficacy and safety of a peripheral radial chop technique to remove hard cataracts.

METHODSIn this prospective study conducted between January 2003 and January 2004, 107 consecutive eyes with hard cataract underwent modified phacoemulsification surgery with peripheral radial chop technique by the Bausch & Lomb Millennium phacoemulsifier with preset parameters of power less than 30%; vaccum, 150 mmHg; and bottle height, 85 cm when a DP8145 phaco tip was used, and vaccum, 380 mmHg; bottle height, 95 cm when a DP8245 phaco tip was used.

RESULTSThe mean ultrasonic power was 14.7% (range 9% to 19%), ultrasonic time was 1.98 minutes (range 1.55 to 3.18 minutes). At 1, 7 and 30 days postoperatively, the eyes with uncorrected visual acuity 0.5 or better accounted for 76.42%, 87.16% and 90.67% respectively. At 1 month, the endothelial cell loss rate was 9.74% (range 8% to 17%). There were 6 cases of posterior capsule rupture in an early period of study. No serious intraoperative or postoperative complications were noted.

CONCLUSIONSThe peripheral radial chop technique was effective without serious complications in hands of an experienced surgeon.