Objective To analyze the feasibility and the diagnostic yield of double-balloon enteroscopy (DBE) examinations for small bowel bleeding (SBB). Methods A retrospective analysis was conducted on 52 cases with small bowel bleeding between June 2015 and July 2016,and all was treated with DBE. therapeutic outcome, complications and follow-up were compared. Results The study included 52 patients (28 males and 24 females) with an average age of (51.0 ± 17.0) years (16~82 years) and onset time (8.3 ± 4.0) days (1~14 days) . 25 using oral route and 21 using the anal route, 1 using the colon ifstula route, a combination of using oral and anal (n=4).The bleeding source was identiifed in 40 of 52 patients (76.9%), complication rate was 5.8%(3/52), and rebleeding rate was 16.7%(2/12). The endoscopic treatments included polypectomies (n=5), argon plasma coagulation (APC, n=2), surgical treatment (n=14, 26.9%), and foreign-body extraction (n=1). Patients were diagnosed with the following:tumors (n=9, 17.3%), ulcers (n=9, 17.3%), Crohn’s disease (n=7, 13.5%), polyps (n=5, 9.6%), diverticulum (n=4, 7.7%). Patients with small bowel bleeding were followed up for a mean period of (8.3±2.0) months (range 4~10 months), 2 deaths were dying from small bowel cancer. Conclusions DBE is a safe endoscopic technique for patients with small bowel bleeding and can be safely carried out even after Roux-en-Y operation. Tumors, ulcers and Crohn’s disease are very common causes of SBB. The rebleeding rate after a negative DBE is considerable, especially small bowel vascular lesions.

OBJECTIVE: To report the experience of canalplasty in treatment of stenosis or atresia of the external auditory canal. METHOD: A retrospective review was performed on 10 patients (10 ears) that underwent canalplasty. The lesions located in bony segment in 1 case, cartilaginous segment in 3 cases, both in cartilaginous and bony segments in 6 cases, in which 4 cases accompanied with the middle ear diseases. All patients received the canalplasty surgery, and tympanoplasty was applied simultaneously if the patient had otitis media. RESULT: Follow-up was conducted for 8-50 months respectively, 8 of the external auditory canal was wide and tympanic membrane gained a good shape, 2 case had stenosis or atresia reoccurrence after the operation. CONCLUSION Appropriate approach and elimination of the lesions thoroughly are key points for the canalplasty.
Adult ; Aged ; Constriction, Pathologic ; surgery ; Ear Canal ; abnormalities ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVE: To assess the treatment outcome after endoscopic sinus surgery (ESS) in patients with recurrent sinusitis and to research which factors could influence the clinical outcome. METHOD: Endoscopic sinus surgery was performed in 55 patients. The clinical outcome and epithelization of mucosa after ESS were evaluated by Chinese ENT Association criteria. RESULT: The total cure rate was 81.82%, effective rate was 92.73%. The mean period of epithelization after operation was 13.2 weeks. No serious complication occurred. CONCLUTION The treatment efficacy can be greatly improved by the normative combined therapy which include the standard and orderly perioperative treatment ,the overall shape and nasalization of nasal cavity, postoperative follow-up and clearing cav ity after ESS.
Adult ; Aged ; Combined Modality Therapy ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Sinusitis ; therapy ; Treatment Outcome ; Young Adult

Objective To study the relationships among resilience, self-awareness, personality, stress level and mental health in the warship soldiers. Methods Resilience Scale for Adults ( RSA), Eysenck Personality Questionnaire ( EPQ), Self Acceptance Questionnaire( SAQ), General Self-Efficacy Scale( GSES), Wallance Self Concept Scale (WSCS), Psychological Stress Self-evaluation Test (PSET) and Symptom Checklist (SCL-90)were used to survey 1451 warship soldiers. Results ① 2.5％ of the warship soldiers reported obvious psychological stress. Mental health of warship soldiers was worse than the norm of China population, except for obsessivecompulsive and interpersonal sensitivity factor. While the scores of other factors were significantly higher than the norm of Chinese soldiers(P＜0.01). ②The total scores of SCL-90, psychological stress and resilience, internal/external had negative correlation with self-awareness, and positive correlation with neuroticism. Compared to the SCL-90-negative group,SCL-90-positive soldiers (SCL-90 total score ＞ 160) had higher scores of nervousness and PSET and lower scores of RSA, internal/external and self-awareness (P ＜ 0.01 ). ③Regression analysis showed that stress levels, emotional stability,self-awareness and resilience were able to predict 35.1％ of mental health in warship soldiers. Mental health, emotional stability, internal/external and resilience were able to predict 33.2％of individual's stress level. Conclusion To some extent, warship soldiers have psychological stress and mental health problems. Resilience, personality, self-awareness are important factors affecting psychological stress and mental health.

BACKGROUND:Prefabricated customized bone flaps have the advantages of few trauma, good vascularization, ossification with predetermined shape, and can be used to restore bone defects with compromised blood bed.
OBJECTIVE:To establish animal models of mandibular reconstruction with prefabricated, customized bone flaps.
METHODS:After computed tomography scanning of nine rhesus’ head, customized meshes were made. After loading with recombinant human bone morphogenetic protein-2-incorporated demineralized freeze-dried bone al ograft (DFDBA) or coral ine hydroxyapatite (CHA), the constructs were implanted in latissimus dorsi muscle. Meanwhile, segmental mandibular defects were created, and the customized meshes loaded with DFDBA, CHA, or recombinant human bone morphogenetic protein-2-incooperated DFDBA and CHA were implanted in situ. At 13 weeks, prefabricated bone flaps with recombinant human bone morphogenetic protein-2-incorporated DFDBA or CHA were transferred to repair segmental mandibular defects. Clinical and histological analyses were used to evaluate the ossification and vascularization of the prefabricated implants in ectopic and orthotopic sites.
RESULTS AND CONCLUSION:Segmental mandibular defects were successful y restored with prefabricated bone flaps and recombinant human bone morphogenetic protein-2-incorporated CHA in situ, but other segmental mandibular defects remained with recombinant human bone morphogenetic protein-2-incorporated DFDBA, DFDBA and CHA in situ. Moreover, mandibles reconstructed with prefabricated bone flaps revealed more regenerated and homogeneous bone formation than other reconstructions. These findings suggest that the animal model of mandibular reconstruction with prefabricated, customized bone in rhesus monkey is applicable.

Objective To preliminarily observe the clinical efficacy of hippocampal-sparing prophylactic cranial irradiation (HS-PCI) using helical tomotherapy (HT) in patients with limited-stage small-cell lung cancer (LS-SCLC) after chemoradiotherapy,and compare HT with intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in dose distribution.Methods From April to June,2014,six patients with LS-SCLC who had achieved a complete remission after chemoradiotherapy were assigned to HS-PCI using HT within a month after brain metastasis was ruled out using brain magnetic resonance imaging (MRI).After fusing CT images and MRI images,the hippocampus was contoured in the fusion images and hippocampal avoidance regions were created using a volumetric expansion of 3 mm around the hippocampus.A dose of 25 Gy in 10 fractions to 95％ of planning target volume (PTV) was prescribed in HT,IMRT,and VMAT.The clinical efficacy,adverse reactions,neurocognitive function,and brain metastasis were evaluated for HT.The dose distribution in PTV and hippocampus were compared between HT,IMRT,and VMAT.Results There were one patient with abdominal wall and abdominal lymph node metastases,one patient with local recurrence,and no patient with brain metastasis during the observation period.The numbers of patients with grade 1 and grade 2 headache,dizziness,and hair loss reactions were 3 and 1,3 and 1,and 4 and 2,respectively.There were no significant differences in the average score of the Mini-Mental State Examination before treatment and at 3 and 6 months after treatment (29.7,29.2,and 29.3 ; P =0.083,0.317,and 0.157).The mean dose to the hippocampus was 16.85 Gy for IMRT and 17.59 Gy for VMAT.For HT,the mean doses to the hippocampus and avoidance regions were reduced to 5.26 Gy and 6.21 Gy,respectively.The prescribed dose for HT was reduced by 79％ and 71％ compared with IMRT and VMAT,respectively.The average coverage rate of the prescribed dose was 94.48％ for HT.Conclusions HT achieves promising dose distribution and target coverage in sparing of the hippocampus.Moreover,HT dose not increase the incidence of adverse reactions.The change in neurocognitive function needs to be further studied with longterm observation and large-scale sampling.

Purpose:We observed and compared the therapeutic effects of CO_2 and dehy- drated ethanol as sclerosing agent,in percutaneous interventional methods for treatment of hepatic and renal cysts,Materials and methods:Twenty-two simple cysts,14 in livers,8 in kidneys,af- ter percutaneous puncture and aspiration,we instilled CO_2 or dehydrated ethanol into the cysts once, twice or thrice with followed-up for 2 to 29 months,Results:All the 22 cysts in 22 patients were better after treatment especially of them,including 8 of 12 cases(66.7%)treated with dehydrated ethanol only once.The maximum diameters of 8 renal cysts(8/8,100%)after one treatment re- duced to less than 2cm in the follow-up,comparing with only 5 of 14 hepatic cysts(5/14,35. 7%).Conclusion:1)Pereutaneous interventional method by guidance of ultrasound is safe and ef- fective in simple hepatic or renal cyst treatment.2)CO_2 is similar to dehydrated ethanol as a scleros- ing agent.3)The therapeutic effect of simple renal cyst is better than that of hepetic cyst.

OBJECTIVE: To improve the diagnosis and treatment of the acute attack of sphenoid and ethmoid fungal ball sinusitis based on the analysis of clinical features. METHOD: Eighteen patients with sphenoid and ethmoid fungal ball sinusitis were reviewed, and the main symptoms included headache and fever during acute attack. Endoscopy, nasal CT and MRI can provide useful information for diagnosis. Endoscopic sinus surgery was performed on thirteen patients after drug therapy, while the other 5 patients chose conservative therapy. RESULT: The pathological examination confirmed the fungal lesions and the 13 patients had a good recovery. The result of CT and MRI scanning had a good accordance with the intra-operative findings. One patient receiving conservative treatment had acute attack again 2.5 months later, and antibiotics and topical nasal drugs improved the symptoms. CONCLUSION Clinical presentation and radiological imaging contribute to the differential diagnosis of the acute attack of sphenoid and ethmoid fungal ball sinusitis, then the targeted therapy can be taken.
Adult ; Aged ; Diagnosis, Differential ; Ethmoid Sinus ; Ethmoid Sinusitis ; diagnosis ; microbiology ; therapy ; Female ; Fungi ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mycoses ; diagnosis ; therapy ; Retrospective Studies ; Sphenoid Sinus ; Sphenoid Sinusitis ; diagnosis ; microbiology ; therapy ; Tomography, X-Ray Computed ; Treatment Outcome

Objective To evaluate effects of chronic arsenic exposure and arsenic exposure time on oxidative DNA lesions in humans. Methods A cross-sectional study was conducted in 108 subjects exposed to high concentrations of arsenic in drinking water and 75 control subjects. A cohort study was conducted in 64 subjects exposed to high levels of arsenic in drinking water for 7 or 9 years. Urinary 8-oxo-7,8-dihydredeoxygnanine(8-OHdG) levels were analyzed by the enzyme-linked immunosorbent assay kit(ELISA). Urinary arsenic concentration was detected with hydride generation atomic absorption spectroscopy. Results In the cross-sectional study, the median of urinary arsenic concentration was 484.17 mg/kg Cr for the arsenic-exposed group, and 13.80 mg/kg Cr for the control group, and the difference between the two groups was statistically significant (t=32.57, P<0.01). The median of urinary 8-OHdG levels was 16.60 and 21.88 mg/kg Cr for arsenic-exposed children and adults respectively, much higher than control children(10.50 mg/kg Cr) and adults (9.11 mg/kg Cr), and the difference was statistically significant (t=5.049, 6913, all P<0.01). Urinary 8-OHdG levels were signifieandy lower for children than adults in the exposed group(t=-1.997, P<0.05). In the cohort study, the median of urinary arsenic concentration was 461.3 mg/kg Cr for the 7-year-exposed subjects and 422.90 mg/kg Cr for the 9-year-expesed subjects, and no significant difference was observed(t=-0.250, P 0.05). The median of urinary 8- OHdG levels for 9-year-exposed children and adults were 23.46 and 24.30 mg/kg Cr respectively, significantly increased compared with those of 7-year-exposed(14.29 and 18.38 mg/kg Cr), and the difference had statical signhqcanees (t= -2.949,-3.055, all P<0.01). Conclusions Chronic arsenic exposure can lead to oxidative DNA lesions in humans. The arsenic-induced DNA lesions may aggravate with the exposure time in a certain period.

OBJECTIVETo investigate the effects of TNF-alpha, TNF-beta and the acceptor expression about mechanical renal trauma with extraneous ADM.

METHODSThere were 104 healthy adult plain grade Wistar rat, randomly divided into four groups:8 in the group of control, 32 in the group of trauma, 32 in the group injected ADM before trauma, 32 in the group injected ADM post trauma. The experimental model of rat kidney with mechanical trauma was prepared by striking the area of rat skin reflecting by kidney with free dropping ferrous hammer in the last three groups. ADM (0.1 nmol/kg) administrated by intraperitoneal injection at 10 minutes before trauma or post trauma respectively in injected groups. All rats were executed by drawing-out all the blood in their hearts. Renal tissue was investigated to study positive expression of TNF-alpha, TNF-beta, TNFR after SABC stained.

RESULTSTNF-alpha expression:the TNF-alpha expression of trauma group was more positive than it of control group in the wound early time. The expression of group injected post trauma was less than it of trauma group at 1 h (P < 0.01). The expression of group injected before trauma was less than it of trauma group at 6 h (P < 0.05) TNF-beta expression: the TNF-beta expression of trauma group was less than it of control group at 1 h and 6 h (P < 0.05). The TNF-beta expression of group injected post trauma was more positive than it of trauma group at the same time of 1 h and 6 h (P < 0.01). TNFR expression: the TNFR expression of trauma group was less than it of control group at 6 h (P < 0.01). The TNFR expression of group injected before trauma was more positive than it of trauma group in the at the same time of 1 h and 6 h (P < 0.01).

CONCLUSIONSThe TNFR can regulate the TNF-alpha and the TNF-beta in dynamic balancing. The regulation of TNFR is main to TNF-alpha. What the TNF-beta participated in renal trauma mainly is the anti-damage process. ADM can reduce the expression of TNF-alpha. ADM increases the expression of TNF-beta and TNFR.

Adrenomedullin ; pharmacology ; Animals ; Disease Models, Animal ; Female ; Kidney ; injuries ; metabolism ; Lymphotoxin-alpha ; metabolism ; Male ; Rats ; Rats, Wistar ; Receptors, Tumor Necrosis Factor ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism