Adipocytes ; pathology ; Angiomyoma ; pathology ; Humans ; Nasal Cavity ; Nose Neoplasms ; pathology

ObjectiveTo investigate the clinical effects of posterior atlantoaxial fusion fixation in treatment of old atlantoaxial injury secondary to atlantoaxial dislocation.MethodsA retrospective analysis was carried out on 16 patients ( 14 males and 2 females) with old atlantoaxial injuries secondary to atlantoaxial dislocations managed with posterior atlantoaxial fusion fixation from March 2008 to March 2012.The time from injury to operation lasted for 3-36 months ( average 10.5 months).Posterior atlantoaxial transpedicular fixation was performed in 13 patients including 10 patients with old odontoid fractures and three with old traumatic transverse ligament disruptions of the atlas combined with atlantoaxial dislocations.Also,posterior atlantal arch transpediclar fixation combined with axial pedicle screw fixation was performed in three patients who had old odontoid fractures combined with atlantoaxial dislocations.All patients had simultaneous autogenous bone grafting between atlas and axis during reduction and fixation.The preoperative and postoperative Japanese Orthopaedic Association (JOA) scores were compared.Follow-up X-ray films and CT was performed to evaluate the atlantoaxial reduction and fusion.ResultsAll the patients were followed up for 9-18 months ( mean 13 months).None of the patients had spinal cord or vertebral artery injuries.Follow-up CT showed that two patients had partial penetration of one side axial pedicle screws into transverse foramen without nerve and blood vessel injuries.Clinical symptoms obtained different degree of improvement.The postoperative JOA scores ranged from 13 to 16 points ( mean 14.8 points) and the improvement rate of JOA was 71％-92％ ( mean 82％ ).The X-ray films and CT showed sound bone fusion,with good location of screws but with no signs of atlantoaxial instability or loss of reduction,or loosening or breakage of the screws.ConclusionPosterior atlantoaxial fusion fixation can effectively reconstruct atlantoaxial stability,improves neurologic function of spinal cord and has reliable curative effects.

BACKGROUNDAtrial fibrillation (AF) is one of the most common arrhythmia after coronary artery bypass grafting (CABG), which not only increases the suffering of the patients, but also prolongs hospital stay and enhances cost of care, especially for patients older than 70 years. This study was designed to evaluate the efficacy and safety of low-dose amiodarone in the prevention of AF after CABG, especially for the elderly.

METHODSTwo hundred and ten senile patients undergoing off-pump CABG were included in this prospective, randomized, double-blind and placebo controlled study. Patients were given 10 mg/kg of amiodarone (low-dose amiodarone group, n = 100) or placebo (control group, n = 110) daily for 7 days before surgery and followed by 200 mg of amiodarone or placebo daily for 10 days postoperatively.

RESULTSPostoperative AF occurred in 16 patients (16%) receiving amiodarone and in 36 (37.7%) patients receiving placebo (P = 0.006). AF occurred at (58.13 +/- 16.63) hours after CABG in the low-dose amiodarone group and at (45.03 +/- 17.40) hours in the control group (P = 0.018). The maximum ventricular rate during AF was significantly slower in the low-dose amiodarone group ((121.42 +/- 28.91) beats/min) than in the control group ((134.11 +/- 30.57) beats/min, P = 0.036). The duration of AF was (10.92 +/- 9.56) hours for the low-dose amiodarone group compared with (14.81 +/- 10.37) hours for the control group (P = 0.002). The postoperative left ventricular ejection fraction (LVEF) was significantly improved in the low-dose amiodarone group (from (59.9 +/- 10.3)% to (63.4 +/- 11.4)%, P = 0.001), and significantly higher compared with the control group ((58.5 +/- 10.7)%, P = 0.002). Both groups had a similar incidence of complication other than rhythm disturbances (12.0% vs 16.4%, P = 0.368). The low-dose amiodarone group patients had shorter hospital stays ((11.8 +/- 3.2) days vs (13.8 +/- 4.7) days, P = 0.001) and lower cost of care (RMB (79 115 +/- 16 673) Yuan vs RMB (84 997 +/- 21 587) Yuan, P = 0.031) than that of control group patients. The in-hospital mortality was not significantly different between the two groups (1.0% vs 0.9%, P = 0.946).

CONCLUSIONSPerioperative low-dose oral amiodarone appeared to be cost-effective in the prevention and delay of new-onset postoperative AF in aged patients. It significantly reduced ventricular rate and duration of AF after CABG, decreased hospital cost and stay, as well as promoted the amelioration of left ventricular systolic function. Furthermore, low-dose amiodarone was safe to use and well tolerated with low toxic and side effects, and did not increase the risk of complications and mortality. It is proved to be a first-line therapy and as routine prophylaxis for AF after CABG, especially for elderly patients complicated with left ventricular dysfunction.

Aged ; Amiodarone ; administration & dosage ; Anti-Arrhythmia Agents ; administration & dosage ; Atrial Fibrillation ; etiology ; prevention & control ; Coronary Artery Bypass ; adverse effects ; Double-Blind Method ; Drug Administration Schedule ; Female ; Humans ; Male ; Treatment Outcome

Objective To investigate the risk assessment,guiding role,and clinical value of Vaso CT image features for recanalization of vertebrobasilar junction occlusion. Methods From January 2016 to May 2017,14 patients with vertebrobasilar junction occlusion admitted to the Department of Neurology, Chinese PLA General Hospital were analyzed retrospectively. Preoperative cerebral angiography confirmed vertebrobasilar junction occlusion. Vaso CT was used to measure the length of the occluded vessels and vascular direction at both ends. According to these results, the operative risks were evaluated and the recanalization of vertebrobasilar junction occlusion were guided. Results The length of vertebrobasilar junction occlusion was 2. 56-19. 09 mm (mean 4. 5 ± 2. 1 mm) in 14 patients,and 13 of them were treated with the recanalization of vertebrobasilar artery occlusion,the blood vessels of 12 cases were successfully recanalized and stent placement was performed after the recanalization,among them,8 Solitaire stents and 4 Wingspan stents were implanted;One patient did not perform recanalization because of longer length of occlusion (19. 09 mm). All patients operated did not have any perioperative complications, and the neurological symptoms were significantly improved after procedure. Conclusion Vaso CT can accurately determine the surgical risk of the recanalization of vertebrobasilar junction occlusion,and can guide the surgical pathways,reduce the incidence of perioperative complications,and improve the success rate of the operation.

Objective To investigate the influencing factors of the formation of intracranial collateral circulation in patients with anterior circulation chronic occlusion. Methods From January 2015 to December 2017,181 consecutive patients with unilateral internal carotid artery or middle cerebral artery chronic occlusion diagnosed by DSA and admitted to the Department of Neurology,Chinese People′s Liberation Army General Hospital were enrolled retrospectively. According to the American society for interventional and therapeutic neuroradiology/society of interventional radiology ( ASITN/SIR ) collateral circulation grading system, 68 patients were divided into poor collateral circulation group (grade 0-2) and 113 were divided into good collateral circulation group (grade 3-4). After admission,the patients completed the relevant examinations, including blood routine,blood uric acid,blood lipids,and DSA examination. The age,gender,basic diseases (hypertension,diabetes,hyperlipidemia, coronary heart disease, history of previous ischemic stroke) and history of smoking/alcohol of the patients were recorded. The formation of collateral circulation was used as the dependent variable. The factor of P<0. 05 in the univariate analysis was included in the multivariate logistic regression analysis. Results (1) The patients of the poor collateral circulation group were older than those of the good collateral circulation group (61 ± 9 years vs. 56 ± 12 years),and the proportion of hyperlipidemia was higher than that of the good collateral circulation group (26. 5%[18/68] vs. 13. 3%[15/113]). The differences were statistically significant between the groups (all P<0. 05). There were no significant differences in the proportions of gender,hypertension,diabetes,coronary heart disease,ischemic stroke,tobacco and alcohol history between the two groups ( all P>0. 05) . (2) Compared with the good collateral circulation group,the level of high density lipoprotein ( HDL) in the poor collateral circulation group was lower. The differences were statistically significant between the groups (1. 0 ± 0. 2 mmol/L vs. 1. 1 ±0. 3 mmol/L,P<0. 05). There were no significant differences in blood uric acid,triglyceride,cholesterol, low-density lipoprotein,and platelet count levels between the two groups (all P>0. 05). (3) After variable selection,age (from young to old) and HDL (from low to high) as independent variables and the formation of collateral circulation as dependent variables, they were included in multivariate logistic regression analysis. The results showed that increasing age increases the risk of poor collateral circulation (OR,1. 053, 95%CI 1.021-1.085,P <0.05);the elevated HDL level was a protective factor of the formation of collateral circulation (OR,0. 265,95% CI 0. 085-0. 825,P<0. 05). Conclusion With the increase of age,the risk of intracranial poor collateral circulation increases,and the increased HDL level is beneficial to the formation of collateral circulation.

Objective To improve the patients' satisfaction to the nursing work through implementing the humanistic concern in nursing work. Methods We held some activities to provide the humanistic concern in nursing work, developed the educations to improve the professional quality of the nurses, constructed the criterion of civilized srvice, and strengthened the construction of nursing culture in the service demonstration ward. Meanwhile, we intensified the service ideas to create the harmonious patient-nurse relationships, the harmonious working settings, the harmonious treatment surroundings and the harmonious humanistic environment. Results The whole quality of the nurses was improved. especially the consciousness of active service. The relationship between nurses and patients was more harmonious, and the nursing quality and the degree of patients' satisfaction were elevated. Conclusions to implement the humanistic concern in nursing work is not only the base of building the harmonious relationships between patients and nurses. but also the guarantee of elevating the nursing quality and the degree of patients' satisfaction.

Objective To improve the knowledge of Kaposi sarcoma and the relationship between Kaposi sarcoma and human immunodeficiency virus (HIV) infection,and to improve the ability to diagnose and treat Kaposi sarcoma and acquired immune deficiency syndrome (AIDS).Methods Symptoms,signs and results of 121 patients encountered in the department of otorhinolaryngology head and neck surgery in Tanzania,who was diagnosed as Kaposi sarcoma actually with HIV infection and AIDS,were retrospectively analyzed in this study.Results There were 46 males and 75 females with age ranged from 5 to 65 years,medium 30 year.The mucous membranes and skin lesions was the most commonly seen clinical manifestation in 121 cases,these lesions appeared as raised blotches or lumps that might be purple,brown,or red,early stages typical lesions began as flat or slightly raised colored spots.Among the cases reported here,25 patients(20.66％)showed progressive nose blockage and nose bleeding and the purple-red new-grows were found in the nose of these patients.Fifteen patients (12.40％) had fiat or slightly raised colored spots in their mucous membrane of mouth (palate or tongue),and in other 7 patients,purple small lumps were found in the gums of the patients.There were same lesions in their pharynx in 9 cases.In 10 patients (8.26％),Kaposi sarcoma was found in tonsil looked like tonsillitis with enlarged tonsils by two to three degree.Twelve patients(9.92％) had masses in the neck with no pain.Thirty-five patients(28.92％)had lesions of purple black nodules,including 10 patients who had the same lesions with ulcer formation in the nodules.All patients had been followed-up for at least two-years.Eighty-five patients passed away in one year,survival rate of one year was 21.48％ (26/121),only 12 patients survived from the disease over two years,two years' survival rate was 9.92％ (12/121).Conclusions Kaposi sarcoma is the characteristic disease for AIDS,mainly found on the membranes and skin.These lesions appears as raised blotches or lumps that may be purple,brown,or red,early stages typical lesions begin as fiat or slightly raised colored spots.Patients who had kaposi sarcoma often died in a short-time without treatment.

Objective To investigate the effect of osteoblast-derived exosome(Exo)mediating microRNA(miR)-494 on bone metabolism and bone remodeling balance in osteoporosis(OP)rats and its mechanism.Methods Exosomes was isolated and identified from MC3T3-E1 osteoblast cell line and transferred to Exo by electrical transfer.Forty SD rats were randomly divided into control,model,miR-494 mimic(miR-494),and miR-494 inhibitor group,10 rats in each group.The ovaries were removed to construct the OP model except the control group.After modeling,the miR-494 group and miR-494 inhibitor group received tail vein injections of exosomes containing the corresponding miRNA,at a dose of 3×109 particles.Four weeks later,bone parameters were detected in each group of rats by Micro-CT,serum bone markers were measured by ELISA,pathological changes in bone tissue were observed by HE staining,osteoclast numbers were detected by tartrate-resistant acid phosphatase(TRACP)staining,and the expression levels of bone remodeling-related proteins and toll-like receptor 4(TLR4)pathway-related proteins were determined by Western blotting.Results Typical cup-shaped or round exosomes were successfully isolated with a diameter of about 100 nm from MC3T3-E1 cells,which contained CD63,CD9,tumor susceptibility gene 101(TSG101),heat shock protein 70(HSP70)proteins and can be taken up by MC3T3-E1 cells.Compared with the model group,the bone parameters of the rats in the miR-494 mimic group decreased,serum bone markers bone Gla protein(BGP),TRACP,C-terminal telopeptide of type Ⅰ collagen(CTX-Ⅰ)increased,osteoprotegerin(OPG),procollagen type Ⅰ N-terminal propeptide(PⅠNP)decreased,bone trabeculae structure was disordered,osteoclasts increased,bone morphogenetic protein 2(BMP-2),Runt related transcription factor 2(RUNX2)in bone tissue downregulated,receptor activator of nuclear factor kappa-B ligand(RANKL)upregulated,TLR4,nuclear factor kappa-B p65(NF-κB p65)and myeloid differentiation primary response 88(MyD88)upregulated(all P＜0.05).In contrast,the situation of the miR-494 inhibitor group was opposite,bone parameters and OPG,PⅠNP increased,BGP,TRACP,CTX-Ⅰdecreased,bone structure returned to normal,osteoclasts decreased,BMP-2,RUNX2 in bone tissue upregulated,RANKL downregulated,TLR4,NF-κB p65 and MyD88 downregulated(all P＜0.05).Conclusion The transfer of miRNA-494 by Exo aggravates abnormal bone metabolism in OP rats and inhibits bone remodeling balance,suggesting that the mechanism of action may be related to the regulation of TLR4 pathway.

BACKGROUNDPatients with persistent or permanent atrial fibrillation (AF) often need direct current cardioversion after radiofrequency ablation. The aim of this study was to investigate the effectiveness and safety of ibutilide for cardioversion of persistent or permanent atrial fibrillation after radiofrequency ablation and the factors related to conversion.

METHODSPatients with persistent or permanent atrial fibrillation were treated with combined ablation strategy including circumferential pulmonary vein isolation, linear ablation and CAFÉ potential ablation. If AF was not terminated after ablation, ibutilide was used for cardioversion (1 mg, intravenous injection in 10 minutes). These patients were divided into a conversion group and a non-conversion group according to whether AF was converted to sinus rhythm within 30 minutes after administration. ECG monitoring was performed during the injection of ibutilide. Atrial waves recorded by coronary sinus electrodes were measured for calculating average wavelength of AF waves in six seconds. The QT interval was measured immediately after conversion and 2 hours after injection of ibutilide.

RESULTSForty patients whose AF was not converted to sinus rhythm after radiofrequency ablation were given an intravenous injection of ibutilide. Of the 40 patients, 29 cases were converted to sinus rhythm, with a conversion rate of 72.5%. The average conversion time was (13.2 ± 5.5) minutes. Compared with the conversion group, patients in the non-conversion group had a longer history of AF (9.4 ± 5.3) years vs. (4.3 ± 2.8) years, P < 0.05), and a markedly enlarged left atrium (47.3 ± 2.9) mm vs. (42.1 ± 4.5) mm, P < 0.05). There were no significant differences in gender, age, body mass index and left ventricular function between the two groups. Ibutilide significantly prolonged the average wavelength of the AF wave (171.8 ± 29.5) ms vs. (242.0 ± 40.0) ms, P < 0.001). Two hours after ibutilide treatment, the QT interval was significantly shortened (421.0 ± 24.7) ms vs. (441.0 ± 37.4) ms, P < 0.05). No cases of serious arrhythmias or other adverse reactions were found.

CONCLUSIONSA single dose of ibutilide for conversion of persistent or permanent AF after radiofrequency ablation is safe and effective.

Adult ; Anti-Arrhythmia Agents ; therapeutic use ; Atrial Fibrillation ; drug therapy ; therapy ; Electric Countershock ; methods ; Female ; Humans ; Male ; Middle Aged ; Sulfonamides ; therapeutic use ; Treatment Outcome