[ABSTRACT]OBJECTIVETo investigate the treatment choice and curative effect of stage III external auditory canal cholesteatoma (EACC) with different degrees of damage to the posterior wall of external auditory canal and mastoid.METHODS44 patients (45 ears) diagnosed with III type external auditory canal cholesteatoma and treated with different surgeries were collected: 27 ears with damages of mastoid which did not involve tympanic antrum (group A) underwent simple mastoid repair+external auditory canal plasty+conchoplasty (in necessity). 18 ears with damages of mastoid which involve the tympanic antrum (group B) underwent mastoidectomy+mastoid filling+external auditory canal plasty+conchoplasty. RESULTSAll patients were followed up for 1 to 2 years postoperatively. There was no recurrence of cholesteatoma, no external auditory canal collapse, stricture or atresia,and hearing improved to different degrees. The postoperative dry ear rate of group A and group B was 100% and 94.4% respectively. The mean duration of dry ear in group A and B was (12.1±2.3) and (28.1±3.5) days respectively. The cases with smooth external auditory canal and good self-purification in group Aand B accounted for 100% and 88.9%respectively.CONCLUSIONType III external auditory canal cholesteatoma can be treated with different surgical methods according to different damages of mastoid. The cases in which damages of mastoid did not involve tympanic antrum can be treated with simple mastoid repair+external auditory canal plasty+conchoplasty (in necessity). The cases in which damages of mastoid involved tympanic antrum can be treated with mastoidectomy+mastoid filling+external auditory canal plasty+conchoplasty.

Objective To investigate the clinical effect of myringoplasty with double flaps in treatment of large tympanic membrane perforaton.Methods Ninety-five patients (112 ears) with large tympanic membrane perforation were enrolled in this study,48 patients (54 ears) were performed myringoplasty with double flaps (double flaps method group) and 50 patients (58 ears) were performed myringoplasty with underlay method (underlay method group).The air conduction (AC) and air bone gap (ABG) were measured before operation and 6 months after operation.The clinical efficacy of two groups was compared.Results The successful rate in double flaps method group was 96.3％ (52/54) and 91.4％ (53/58) in underlay method group,there was no significant difference (P ＞0.05).The effective rate in double flaps method group was 92.6％ (50/54) and 77.6％ (45/58) in underlay method group,there was significant difference (P ＜ 0.01).Conclusions Myringoplasty with double flaps in treatment of large tympanic membrane perforation can effectively mould tympanic membrane and improve hearing.The operation is worthy of spreading.

OBJECTIVE: To explore the clinical manifestations and treatments of retro-esophageal space abscess. METHOD: The clinical data of 27 cases with retro-esophageal space abscess were analyzed retrospectively. Twenty-one cases (77. 78%) were secondary to acute injury of esophageal meatus caused by foreign bodies. 2 cases (7. 41%)were secondary to old foreign body infection in retro-esophageal space, 3 cases (11. 11%) after secondary to pharyngeal abscess, and 1 case (3. 70%) was unknown to etiology. All patients were confirmed by sectional medicalimageology. Six cases(Conservation group, C group) were treated conservatively and 6 cases (Oropharyngeal incision group, OI group) were performed with oropharyngeal incision drainage. 15 cases(Extra-neck incision group, ENI group)were performed with extra-neck incision and vacuum sealing drainage. RESULT: In C group, 6 cases were cured with conservative therapy and the average hospital stay was 15. 6 days. In OI group, 5 cases were healed with oropharyngeal drainage but aspiration pneumonia complicated with septic shock occurred in 2 cases, and 1 case dead from septic shock secondary to mediastinum and lung abscess. The average hospital stay was 18. 8 days. In ENI group, 15 patients were cured with extra-neck drainage without complication and the average hospital stay was 9. 5 days. CONCLUSION The main causes of retro-esophageal space abscess are foreign body injury of upper esophagus and remnant of retro-esophageal space. Sectional medicalimageology can be of important value of diagnosis and treatment for displaying the retro-esophageal space abscess and other deep cervical fascia space sufficiently. Incision and vacuum sealing drainage via extra-neck is an effective therapy while oropharyngeal drainage is less effective and is not advocated as a primary treatment because of aspiration pneumonia complication . Conservative cure is a choice for patients without dyspnoea and background diseases, and it is necessary to recognize and treat severe complications early.
Abscess ; etiology ; therapy ; Drainage ; Esophagus ; Foreign Bodies ; complications ; Humans ; Neck ; Pharyngeal Diseases ; Retrospective Studies

Mother-to-child transmission (MTCT) is a major route of transmission of syphilis,and may occur at any time during pregnancy.MTCT of syphilis can lead to many adverse pregnancy outcomes,seriously affects maternal and infant health,and has been a severe public health and social problem.The risk of MTCT of syphilis is associated with stage of syphilis in pregnancy,stage of pregnancy,receiving or not receiving treatment,and is especially high in patients with early syphilis.With the growth of incidence of syphilis,the prevention for MTCT of syphilis has been becoming more and more important.Screening for and early treatment of syphilis in pregnancy can effectively block MTCT of syphilis.To learn the epidemiology,route,risk,and associated factors of MTCT of syphilis will undoubtedly facilitate the development of strategies for syphilis prevention and control.

Objective To explore the methods for training the abitity of critical thinking of ICU nurses.Methods ICU nurses were trained in terms of knowledge training, case study, care rounds, self-reflection, case discussion, simulation training and seminars. The Chinese version of the critical thinking disposition inventory(CTDI-CV)was used before and one year after the training.Result The scores on CTDI-CV as well as the items after training were all significantly higher than that before training(P<0.05).Conclusion The knowledge and ability in critical thinking can be improved by knowledge and skills training.

Objective To investigate the diagnosis and prognosis evaluation value of neutrophil elastase (NE) in ventilator-associated pneumonia (VAP).Methods A retrospective analysis was conducted.The data of patients undergoing mechanical ventilation admitted to Department of Central Intensive Care Unit (ICU) of Boai Hospital of Zhongshan City Affiliated to Southern Medical University from September 2012 to October 2015 were enrolled.The patients were divided into two groups according to whether they suffered from VAP or not.The content of NE in serum and bronchoalveolar lavage fluid (BALF) at the time of mechanical ventilation start,VAP diagnosis (the worst value from 48 hours after mechanical ventilation start to weaning in non-VAP patients),and at the time before mechanical ventilation weaning,as well as inflammation parameters,clinical pulmonary infection score (CPIS),duration of mechanical ventilation and prognosis were recorded.Receiver operating characteristic curve (ROC) was used to analyze the predictive value of NE on VAP diagnosis and prognosis.Results Finally 38 patients were enrolled in the VAP group,and 40 in non-VAP group,and baseline data was similar between the two groups.There was no significant difference in the content of NE in serum and BALF between VAP group and non-VAP group [serum NE (μg/L):67.04 (63.00,75.75) vs.69.00 (63.75,75.00),BALF NE (μg/L):96.26 (85.26,176.01) vs.95.26 (86.76,107.11),both P ＞ 0.05].From continuous monitoring,no significant change in the content of NE in serum and BALF during mechanical ventilation was found in the non-VAP group,but the content of NE in serum and BALF at the time of VAP diagnosis in VAP group was significantly higher than that at mechanical ventilation start [μg/L:157.00 (153.04,165.75) vs.67.04 (63.00,75.75),178.04 (153.00,188.25) vs.96.26 (85.26,176.01),both P ＜ 0.05],and NE content in serum and BALF was significantly decreased at the time after VAP clinical recovery and before mechanical ventilation weaning [μg/L:75.67 (64.51,110.55) vs.157.00 (153.04,165.79),95.50 (66.56,183.02) vs.178.04 (153.00,188.25),both P ＜ 0.05].The NE in the start time of VAP in VAP group was divided into four groups according to quartile,it was found that with the increase of NE content in serum and BALF,the CPIS was increased,the duration of mechanical ventilation was prolonged,and the prognosis was poor (all P ＜ 0.01).Compared with non-VAP group,white blood cell count (WBC),neutrocyte proportion,C-reactive protein (CRP),and procalcitonin (PCT) in VAP group were significantly increased (all P ＜ 0.01).NE in BALF was significantly positively correlated with WBC,neutrocyte proportion,CRP and PCT (r value was 0.507,0.432,0.779,and 0.519,respectively,all P =0.000),among which the highest correlation was CRP.NE in BALF used for VAP diagnosis has good accuracy,with sensitivity of 87.4％,and specificity of 90.6％,and sensitivity and specificity of NE in serum for VAP diagnosis was 78.6％ and 79.2％ respectively.Conclusion NE can be used as one of the indicators for VAP diagnosis,and it is related to the prognosis of VAP.

ObjectiveTo investigate the clinical and pathological features of Hirschprung disease (HD), intestinal neuro-nal dysplasia (IND) and hypoganglionosis (IH) in children.MethodsThe clinical data and pathologic slices from 238 children with intestinal dysganglionosis were retrospectively analyzed. The age, sex, involved intestinal length of children and prognosis were compared.ResultsIn 238 patients, 138 (58.0%) were diagnosed by rectal mucosal biopsies. There were 122 HD patients whose median age at diagnosis was 9 months and the ratio of male to female was 4.3:1, without involvement of whole colon. There were 45 IND patients whose median age at diagnosis was 14 months and the ratio of male to female was 1.05:1, and the whole colon of 33.3% patients was involved. There were two male IH patients whose ages at diagnosis were 12 years and 18 years respectively, and their whole colon was involved. There were 59 patients with HD complicated by IND whose median age at diagnosis was 13 months and the ratio of male to female was 5.56:1 and the whole colon of 16.9% patients was involved. There were 10 male patients with HD complicated by IH whose median age at diagnosis was 11.5 months and the whole colon of 80.0% patients was involved. The ages at diagnosis, the sex ratio, the rates of whole colon involved, and the cure rates among 5 groups were signiifcantly different (allP<0.01).ConclusionsThe rectal mucosal biopsy was the main method in diagnosis of intestinal dysganglionsis in children. Patients with HD had higher incidence and mild condition and favorable prognosis. Patients with IH or patients with HD complicated by IH had lower incidence rates and severe condition and poor prognosis, followed by patients with IND or patients with HD complicated by IND.

Three cyclotides were isolated from the whole plant of Viola yedoensis in this study. The two, vary peptide E and cycloviolacin Y5, were previously reported, and a novel cycloviolacin VY1 was characterized according to the interpretation of MS/MS fragmentation of peptides which were produced from the reduced and alkylated parent peptide with the digestion of Endo Lys-C, trypsin and chymotrypsin, separately. The stability of remarkable resistance to proteolytic degradation by trypsin and chymotrypsin, and that of thermal denaturation was confirmed again. Besides, the IC50 value of cycloviolacin VYI against influenza A H1N1 virus was (2.27 +/- 0.20) microg x mL(-1). It is the first cyclotide reported with anti-influenza A H1N1 virus activity in vitro assay.

OBJECTIVE: To explore the clinical features, pathologic characteristics and treatments of the facial paralysis caused by temporal bone tumors. METHOD: Retrospective analyzed the 23 clinical data of peripheral facial paralysis caused by temporal bone tumors, including 11 cases of facial nerve tumor: facial nerve neurilemmoma in 8 cases, facial nerve neurofibroma in 3 cases; 12 cases of temporal bone malignant tumor: temporal bone squamous cell carcinoma in 9 cases, chondrosarcoma in 1 case, rhabdomyosarcoma in 2 cases. All the patients accepted the CT scan examination and MRI examination. Twenty-three cases were surgically treated: facial nerve tumor resection were performed in 11 cases, among those, through mastoid approach in 7 cases, combined mastoid with middle cranial fossa approach in 3 cases, combined mastoid with parotid approach in 2 cases. Eight cases underwent facial nerve graft following the surgical removal of tumors. Twelve cases were temporal bone malignant tumor resection: among those, extended mastoidotympanectomy in 5 cases, subtotal temporal bone resection in 6 cases, total temporal bone resection in 1 case, all were treated by radiotherapies after surgeries. RESULT: Whether the tumors go along the facial nerve in imaging is the major identification method to identify the facial nerve tumors or no-facial nerve tumors. During the 3-8 years follow-up, 10 patients who were totally removed the facial nerve tumor were no recurrence, 1 patient had tumors present. The recurrence rate of temporal bone malignancy was 41. 7% (5/12), 5 cases of Stell stage T2 and 5 cases of stage T3. The 5-year survival rate was 66.7% (8/12). CONCLUSION Most of facial nerve tumors that cause the facial palsy are benign, and no-facial nerve tumors are most common among the malignant tumors. CT and MRI films are valuable for the diagnosis. Operation is the major treatment, the manner of the operation bases on the type and the extent of the tumors. Facial nerve grafting can improve the facial neurological function after the tumor excision. Malignancy should be treated by combination of operation and radiotherapy, etc.
Adolescent ; Adult ; Aged ; Bone Neoplasms ; complications ; pathology ; Child ; Facial Paralysis ; diagnosis ; etiology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Temporal Bone ; Young Adult

OBJECTIVE To discuss the clinical features of primary lateral recess cysts of the sphenoid sinus,and to study the therapeutic effect of the endoscopic surgery.METHODS Nine patients with primary lateral recess cysts of the sphenoid sinus received endoscopic surgery from 2007 to 2015.Clinical data of the disease was analyzed retrospectively.Seven cases complained of cheek numbness as the chief complaint and 2 cases with progressive vision loss as the chief complaint.There were no obvious positive signs in head and facial regions.All cases were underwent marsupialization of the cysts via sphenoid sinus with nasal endoscope under general anesthesia.RESULTS All the cases had no intraoperative and postoperative complications,and the symptoms were disappeared after operation.No recurrence was found during follow-up of 6 to 24 months.The cavity of the cysts had permanent drainage to sphenoid sinus after operation in all the patients.CONCLUSION 1.Primary lateral recess cysts of the sphenoid sinus had unique symptoms and imaging characteristics.2.The marsupialization of the cysts via sphenoid sinus with nasal endoscope under general anesthesia was a safe,effective and minimally invasive method to management of the primary lateral recess cysts of the sphenoid sinus.