Objective To investigate the role of ERCP in geriatric population (≥70 yr) with biliary obstruction.Methods 218 geriatric patients (≥70 yr) and 189 non-geriatric ones ( ＜70 yr) admitted during 2001.1～2007.12 who had undergone biliary drainage by ERCP were retrospectively studied.Results The mean ages in geriatric and non-geriatric group were 79±9 and 56±7 yr,respectively.The success rates of biliary drainage were 96.8% (211/218) and 97.4% (184/189) in geriatric and non-geriatric group,respectively.The procedure time of ERCP was (55±30)rain and (58±34)min in geriatric and non-geriatric group,respectively.The complication rates were 16.1% (35/218) and 13.8% (26/189),respectively.The mortality rates were 1.83% ( 4/218 ) and 1.06% ( 2/189 ),respectively.There were no statistically significant differences between the two groups.However,the re-intervention rates were 16.1% (35/218) in geriatric group,which was significantly higher than that of 5.8% (11/189) in non-geriatric group.Conclusions ERCP was a less invasive,safe and effective treatment option for geriatric patients with bile duct obstruction.

Objective To study the diagnosis and treatment of delayed radiation-induced brain injury. Methods 21 patients with delayed radiation-induced brain injury were diagnosed by CT, MRI and MRS, and were treated with dehydration, corticosteroid, neuroprective drugs and hyperbaric oxygen or surgery. Results The symptoms of 66.7% patients were obviously improved, 19.0% patients partly recovered and the symptoms of 14.3% patients were not obviously improved. Conclusion The early diagnosis and reasonable treatment could decrease delayed radiation-induced brain injury to minimal extent. The operative treatment should be performed in the patients who had operative indicators. And it was important to prevent the occurrence of delayed radiation-induced brain injury.

OBJECTIVE To investigate the correlation between nasal obstruction score, Lund-Mackay score,congestion index and tissue remodeling degree of nasal mucosa in patients with chronic rhinosinusitis(CRS) and to study the role of diagnosing remodeling.METHODS Forty-three patients with CRS who underwent endoscopic surgery were studied.Congestion index of nasal mucosa was obtained by acoustic rhinometry.Nasal obstruction score was obtained by visual analogue scale.CT score was obtained by Lund-Mackay.The mucosa specimen of uncinate process from nasal cavity of the patients was used to evaluate the fibrosis degree.Statistical analysis was performed using SPSS11.5.RESULTS Nasal obstruction and Lund-Mackay score had no correlation with fibrosis degree of mucosa(r=0.77,P=0.40),whereas congestion index of nasal mucosa had a negative correlation with fibrosis degree of mucosa(r=-0.348, P=0.022).CONCLUSION Nasal congestion index can reflect the degree of remodeling in submucosal tissue.Nasal congestion index with obstruction symptoms and CT scan can be used to guide the CRS treatment strategies.

OBJECTIVE: To determine the inflammatory cells in the mucosa at the medial aspect of the normal uncinate process compared with that on the protected lateral aspect of the normal uncinate process. METHOD: The mucosa of 20 uncinate process from the nasal cavity of 17 patients with no evidence of sinus disease undergoing functional endoscopic sinus surgery were recruited for the study. The material was stained with HE, Chromotrope 2R, Alcian blue-periodic acid-schiff, Toluidine blue. Specimens were observed using an Olympus microscope. RESULT: The number of mast cells and goblet cells were found to be higher on the lateral aspect of the normal uncinate process than on the medial aspect. The number of plasma cells was obviously different from that of lymphocytes. We did not found any eosinophils on either sides of uncinate process. CONCLUSION There are differences in the number of mast cells and goblet cells between the mucosa at the medial aspect of the normal uncinate process and the mucosa at the protected lateral aspect of the normal uncinate process.
Adolescent ; Adult ; Ethmoid Sinus ; pathology ; Female ; Goblet Cells ; cytology ; pathology ; Humans ; Male ; Mast Cells ; cytology ; pathology ; Middle Aged ; Nasal Mucosa ; pathology ; Paranasal Sinuses ; pathology ; Young Adult

Objective To analyze the cost-benefit ratio of primary trigeminal neuralgia patients with bad drug control and never accepted the surgical treatment through surgery [including microvascular decompression (MVD) ,percutaneous radiofrequency rhizotomy (RFR) ,stereotactic radiotherapy (SRS)] .Methods A total of 89 patients with primary trigeminal neuralgia who under-went surgical treatment for the first time from 2005 to 2013 were enrolled in this study ,including 27 patients with MVD ,23 patients with RFR and 39 patients with SRS .Evaluation criteria (effect factors) include facial pain (excellent :no pain and no drug treat-ment ;good :no pain but medication ;worse:less than 50% of patients with pain ;worse:more than 50% of patients with facial pain or need to undergo secondary surgery ) ,numbness ,cost and .Results The mean age of the patients treated with MVD was (50 .4 ± 14 .3)years old ,RFR was(73 .2 ± 13 .6) years old SRS was (72 .6 ± 11 .8) years old ,MVD group was younger than RFR and SRS group(P<0 .05);The average total cost of each surgical approach as follows :MVD was 50274 yuan ,RFR was 4539 yuan ,SRS was 38512 yuan (P<0 .05);The postoperative facial numbness proportion of MVD was 1 .1% ,RFR was 52 .2% and SRS was 28 .2% (P<0 .05);The ratio of patients who needed recurrent surgery in two years was MVD 26 .0% ,RFR 73 .9% and SRS 30 .7% (P<0 .05);The mean remission rate of MVD was 1 .6 years ,the RFR was 2 .1 years ,and the SRS was 1 .0 year(P<0 .05);The cost-benefit ratio of MVD was 31618 yuan ,RFR was 1982 yuan ,SRS was 39297 yuan(P<0 .05) .Conclusion The cost-ben-efit ratio of the three surgical from low to high were RFR ,MVD ,SRS ,which means the unit cost of RFR gain the highest ,followed by M VD and SRS .

Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.

Objective:To investigate specificity of neurovascular compression in patients with primary trigeminal neuralgia (PTN) by three-dimension reconstruction and computational fluid dynamics.Methods:Clinical characteristics and preoperative magnetic resonance imaging (MRI) data of 20 patients with both PTN and single artery compression (PTN group) and 10 patients without PTN but having neurovascular contact in MRI images (control group) in the Second Affiliated Hospital of Zhengzhou University from January 2018 to December 2019 were collected and analyzed. After three-dimension reconstruction of the MRI images, curvature of the arterial loop, angle between the plane of arterial loop and the trigeminal nerve and location of the compression were observed. Then bidirectional structure-fluid coupling based on the optimized stereolithography models of arterial loop and nerve were processed by ANSYS 19.2 software. In the location of the compression of contact, equivalent stress (ES) of arterial loop on the nerve, shearing stress (SS) of the blood flow and local deformation of the nerve were iteratively computed. All parameters were analyzed and compared between the PTN group and the control group, and the correlation analysis was proceeded between the anatomical parameters and hemodynamical parameters.Results:The curvature of arterial loop [0.21(0.12) mm -1vs 0.13(0.07) mm -1, U=34.00, P<0.05], the angle between vascular loop and nerve [69.70(30.67)° vs 43.40(37.21)°, U=38.00, P<0.05] in the PTN group were significantly greater than those in the control group, and the location of compression was significantly closer to the root of nerve in the PTN group [PTN group: (4.23±1.29) mm vs control group: (5.54±1.85) mm, t=-2.26, P<0.05]. The average SS [15 952.48(5 365.56) Pa vs 12 501.97(6 355.26) Pa, U=53.00, P<0.05], ES [24 965.65(7 693.22) Pa vs 14 992.99(9 824.08) Pa, U=32.00, P<0.05] in the PTN group were significantly greater than those in the control group. The curvature of arterial loop was positively correlated with the SS ( r=0.931, P<0.05) and ES ( r=0.962, P<0.05), and the latter two ( r=0.787, P<0.05; r=0.853, P<0.05) were positively correlated with the local neural deformation. Conclusions:In patients with PTN, offending artery compresses the root of nerve by greater arterial curvature and angle between the arterial loop and nerve. These anatomical differences will cause significantly greater SS, ES and local neural deformation.

Objective:To evaluate the clinical prognosis of patients with pseudomyxoma peritonei (PMP) after cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).Methods:The clinical data of 42 patients with PMP after CRS combined with HIPEC in the Affiliated Haikou Hospital of Xiangya Medical College of Central South University from January 2012 to December 2018 was retrospectively analyzed. All patients underwent open surgery CRS combined with HIPEC, the operation condition and prognosis of patients were analyzed.Results:In 42 patients with PMP, the disenminated peritoneal adenomucinosis (DPAM) accounted for 61.9% (26/42), the peritoneal mucinous carcinomatosis (PMCA) accounted for 28.6% (12/42), and the borderline accounted for 9.5% (4/42). The incidence rate of major operative complications (grade Ⅲ-Ⅳ) after CRS combined with HIPEC was 21.4% (9/42). The logistic regression analysis showed that the previous surgery score ( OR = 35.765, 95% CI 2.746-43.986, P = 0.001) and completeness of CRS score ( OR = 23.865, 95% CI 1.345-347.876, P = 0.028) were independent factors influencing major postoperative complications in PMP patients. The overall survival time of 42 patients with PMP was (64.8±4.1) months, and the disease-free survival time was (54.0±4.9) months; the 3-year and 5-year overall survival rates were 80.8% and 65.9%, and the 3-year and 5-year disease-free survival rates were 59.5% and 54.6%, respectively. The difference in overall survival time of patients with different pathological subtypes was statistically significant ( P = 0.022). Conclusion:CRS combined with HIPEC is safe and effective for treatment of patients with PMP, and most of the patients have a good prognosis.

Objective To study the effect of T-2 toxin on proliferation and cell cycle of rat chondrocytes,in order to provide a new idea in molecular mechanism of T-2 toxin-induced chondrocyte damage.Methods Primary chondrocytes of neonatal Wistar rats were isolated and stained by toluidine blue staining and type Ⅱ collagen immunofluorescence staining.The effects of different concentrations of T-2 toxin [0 (control),1,5,10,20,50,100 μg/L)] on proliferation of chondrocytes for 24 h were detected by cell counting kit-8 (CCK-8) method,and control,1 (low dose),5 (medium dose),and 10 μg/L (high dose) T-2 toxin were selected for subsequent experiment;cell cycle changes were detected by flow cytometry;Real-time PCR and Western blotting were used to detect the effects of T-2 toxin on mRNA and protein expressions of proliferating cell nuclear antigen (PCNA) and Cyclin D1 in chondrocytes.Results With increase of T-2 toxin concentration (control,1,5,10,20,50,100 μg/L),the cell survival rates [(100.00 ± 0.00)％,(93.12 ± 1.66)％,(77.12 ± 1.11)％,(59.44 ± 4.09)％,(46.64 ± 3.86)％,(38.15 ± 3.37)％,(33.79 ± 0.99)％] were decreased,and the differences were statistically significant (F =139.21,P ＜0.05).The percentages of quiescent phase/pre-DNA synthesis phase (G0/G1 phase) ceils in 1,5,10 μg/L T-2 toxin groups [(22.03 ± 0.42)％,(30.54 ± 2.61)％,(36.01 ± 1.51)％] were significantly higher than that in control group [(13.79 ± 1.65)％,P ＜ 0.05];the percentages of DNA synthesis phase (S phase) cells [(60.27 ± 3.53)％,(53.88 ±4.38)％,(49.55 ± 2.49)％] were significantly lower than that in control group [(76.72 ± 4.24)％,P ＜ 0.05].The differences of mRNA levels of PCNA and Cyclin D1 between groups were statistically significant (F =46.80,17.97,P ＜ 0.05),and 5,10 μg/L T-2 toxin groups (0.77 ± 0.13,0.79 ± 0.08,0.60 ± 0.07,0.56 ± 0.05) were lower than the control group (0.99 ± 0.02,1.01 ± 0.01,P ＜ 0.05).The expressions of PCNA protein in 5,10 μg/L T-2 toxin groups (0.69 ± 0.03,0.49 ± 0.03) were lower than that in control group (0.92 ± 0.05,P ＜ 0.05);the expressions of Cyclin D1 protein in 1,5,10 μg/L T-2 toxin groups (0.80 ± 0.06,0.60 ± 0.07,0.33 ± 0.13) were lower than that in control group (0.95 ± 0.07,P ＜ 0.05).Conclusion T-2 toxin can inhibit the proliferation of chondrocytes,which may be worked through influencing the expression of cell cycle protein,causing cell cycle arrest,thereby inhibiting DNA synthesis.

Objective: To investigate the effect of NACHT-LRR-PYD- containing proteins 3 (NLRP3) mediated pyroptosis in myocardial cells undergoing hypoxia/deoxygenation (H/R) injury. Methods: In order to observe whether H/R-treatment could cause pyroptosis, H9c2 cells were divided into 2 groups randomly using the lottery method: control group(without H/R-treatment) and H/R group (in which the H9c2 cells were underwent H/R-treatment). In order to clarify the role of pyroptosis in H/R-injury, H9c2 cells were divided into 4 groups randomly using the lottery method: control group(in which the H9c2 cells were cultivated with normal medium); YVAD group(in which the H9c2 cells were pretreated with z-Val-Ala-Asp(Ome)-fluoromethylketone (Z-YVAD-FMK) 20 μm for 4 hours, then replaced with normal medium); H/R group(H9c2 cells underwent H/R-treatment); YVAD+H/R group (in which the H9c2 cells were pretreated with 20 μm Z-YVAD-FMK for 4 hours before H/R-treatment). To determine whether H/R-induced cell pyroptosis is associated with NLRP3, H9c2 cells were divided into 4 groups randomly using the lottery method: control group (in which cells were transfected with a control nonspecific siRNA); si-NLRP3 group (in which cells were transfected with NLRP3-targeting siRNA); H/R group(in which cells were transfected with a control nonspecific siRNA before H/R-treatment); si-NLRP3+H/R group(in which the H9c2 cells were transfected with NLRP3-targeting siRNA before H/R-treatment). Pore formation on cell membrane was detected by propidium iodide (PI) staining. Cell viability was detected by CCK8 reagent. The protein expression of Caspase-1, interleukin-1β (IL-1β) and NLRP3 was detected by Western blot. Results: (1) The positive rate of PI staining ((26.46±5.15)% vs. (1.69±0.73)%,P<0.01), expression of NLRP3 (0.57±0.16 vs. 0.23±0.06,P<0.01), expression of Caspase-1 (1.07±0.13 vs. 0.37±0.08,P<0.01), and expression of IL-1β (0.38±0.08 vs. 0.16±0.05,P<0.01) were significantly higher in H/R group than in control group. (2)The cell vitality was significantly higher in YVAD+H/R group than in H/R group ((87.31±9.05)% vs. (73.30±7.19)%, P<0.05).The positive rate of PI staining was significantly decreased in YVAD+H/R group than in H/R group ((18.12±4.36)% vs. (26.45±4.60)%, P<0.05). The expression of Caspase-1 (0.72±0.12 vs. 1.07±0.15, P<0.05) and IL-1β(0.29±0.07 vs. 0.39±0.06, P<0.05) were significantly lower in YVAD+H/R group than in H/R group. (3) The cell vitality was significantly increased in si-NLRP3+H/R group than in H/R group ((85.46±7.71)% vs. (72.41±5.53)%, P<0.05). The positive rate of PI staining was significantly lower in si-NLRP3+H/R group than in H/R group ((18.22±4.20)% vs. (26.73±3.26)%, P<0.05). The expression of Caspase-1(0.87±0.07 vs. 1.15±0.15, P<0.05) and IL-1β(0.41±0.07 vs. 0.58±0.10, P<0.05) were significantly decreased in si-NLRP3+H/R group than in H/R group. Conclusion NLRP3 mediated pyroptosis is involved in H/R injury of myocardial cells.