Objective:To investigate the pathophysiological mechanism,clinical menifestation and radiographic diagnosis of cholesterol granuloma following chronic supperative otitis media.Method:Six cases of CG following chronic suppurative otitis media, confirmed by surgery and pathology,were reviewed and analyzed.Result:CG frequently accompanied with other middle ear diseases，and was shown as a high signal intensity on both T1-and T2-weighted images in magnetic resonance imaging(MRI).Conclusion:It was postulated that the obstruction of pneumatized temporal bone air cells,caused by other middle ear diseases such as cholesteatoma and tympanosclerosis,might be the pathophsiological mechanism of CG.The evaluations of computed tomography(CT) and clinical manifestation were limited to distinguish CG from cholesteatoma or other neoplasm,while the MRI can be of great value to characteristic diagnosis.

Objective:To investigate the clinical characteristics,treatment and prognosis of primary pe-noscrotal extra-mammary Paget’s disease (PSPD).Methods:The clinical and pathological data of 22 cases of primary PSPD were retrospectively reviewed.Survival rate of the overall patients,the invasive patients,and the patients with positive surgical margin or negative surgical margin were analyzed with Ka-plan-Meier survival curve method.Results:Among all the patients with primary PSPD,the median age of onset was 64.5 (39 -84)years,the median time of disease duration was 40 (2 -300)months,and the median long diameter of lesion was 4.75 (1 -10)cm.In the study,12 patients (54.5%)were in pathological stage A1,6 patients (27.3%)were in pathological stage A2,and 4 patients (18.2%) were in pathological stage B.Scrotum and penile of most patients (n =12,54.5%)were involved,5 patients (22.7%)were scrotum only,and 5 patients (22.7%)were penile only.Erythema (n =18, 81.8%),itchiness (n =16,72.7%),ulcerate (n =12,54.5%),exudation (n =11,50.0%),and pain (n =4,18.2%)were the major manifestations.All the patients with primary PSPD were treated with wide surgical excision.The rate of invasive patients was 77.3% (n =17).Of them,6 patients had positive surgical margin.The surgical margins of non-invasive patients were all negative.Twelve patients exhibited local recurrence or/and metastases,and the status of surgical margins (P =0.015)and the depth of invasion (P =0.010)were important risk factors.Inguinal lymph nodes were generally in-volved.The difference of the delay of diagnosis between metastasis and non-metastasis was significant (P =0.040).The 5-year survival rates of the overall and invasive patients were 33.7% and 27.9%, respectively.The patients with positive surgical margin had poor prognosis.Conclusion:Primary PSPD, with the characteristics of long duration,high invasive tendency and high incidence of local recurrence or metastases,generally occurs in the elderly.Surgery should be performed at first.The delay of diagnosis, positive surgical margins and the involvement of inguinal lymph node are important risk factors.Biopsy, frozen section and inguinal lymph node biopsy (ILNB)can standardize diagnosis and treatment.

AIM: To explore the characteristic of relaxation of porcine cornea after LASIKMETHODS: Usual LASIK was performed on fresh porcine corneas with stable intraoculer pressure (IOP) maintained through optic nerve irrigation. The ablation depth on stroma is 30%, 50% and 70% respectively. Then the dumbbell-shaped corneal strip specimens were cut and stored in 20% Human Albumin solution for use (4℃).Sip up the Albumin solution on specimens, and fixed them on homemade jig. Stress relaxation tests were erformed on Tytron250 Dynamics Experiment System. the loading speed was 385mm/min,extending ratewas 1.5, and relaxation time was 1 000s. The data werecollected electronically and automatically.RESULTS: In LASIK procedure, though a single flap-cutting can cause a little reduction of corneal stress relaxation (P＜0.05,P=0.49), the cornea may still remain its property of visco-elasticity. When ablation depth was 30% or more, corneal stress relaxation decreased to almost one half (P＜0.01).The change of corneal stress relaxation degree in vertical meridian specimen was lower than that in horizontal specimen, especially when ablation depth was 70%, and it's statistically significant (P＜0.001). In LASIK operation, the more depth the ablation, the more reduce the stress relaxation degree, and it's easy to cause deformation and creep deformation.CONCLUSION: The changes of the stress relaxation in verticai and longitudinal meridian specimens are similar, and slightly obvious in longitudinal specimen, especially in 70%ablation group.

BACKGROUNDTo study the effect of DTB against HIV-1, for developing anti-HIV drugs.

METHODSDifferent concentration of DTB was added to cell culture system after viral inoculation, MTT staining method for viable cells (MTT assay) and p24 (ELISA) were used as markers to monitor the viral replication.

RESULTSThe inhibition rates of DTB at concentrations 160, 80, and 40mg/ml were 93.0%, 56.2% and 18.1%, respectively.

CONCLUSIONSDTB could effectively inhibit HIV-1 in vitro.

Anti-HIV Agents ; pharmacology ; Bilirubin ; analogs & derivatives ; pharmacology ; Dose-Response Relationship, Drug ; HIV-1 ; drug effects ; Humans ; In Vitro Techniques

Objective:To understand the situation and distribution of fluoride in rural centralized water supply in Inner Mongolia Autonomous Region (Inner Mongolia for short), and provide a reference for adjustment of prevention and control measures.Methods:From 2014 to 2018, 836, 947, 1 033, 1 068, 1 099 rural centralized water supply monitoring sites were designated in 77 banners (counties, districts) separately in Inner Mongolia, and factory water and tip water samples were collected during plentiful phase and exhausted phase every year, respectively, and fluoride content was tested. Descriptive analysis was done according to time, water period (plentiful phase and exhausted phase), water sample type (factory water and tip water), water treatment method (conventional treatment, sedimentation and filtration, only disinfection and untreated), area distribution [eastern region (Hulunbuir, Xing'an League, Tongliao and Chifeng), central region (Hohhot, Baotou, Ulanqab and Xilinhot) and western region (Ordos, Bayannur and Alashan)], and the results were analyzed visually by ArcMAP 10.2.Results:From 2014 to 2018, 3 251, 3 671, 4 058, 4 087 and 4 395 water samples were collected, the medians fluoride were 0.69, 0.70, 0.69, 0.64 and 0.66 mg/L, and the annual compliance rates of fluoride were 80.31% (2 611/3 251), 81.83% (3 004/3 671), 83.14% (3 374/4 058), 85.91% (3 511/4 087) and 84.57% (3 717/4 395). The difference of compliance rate of fluoride in rural centralized water supply in different years was statistically significant (χ 2=51.748, P < 0.01), and the compliance rate of fluoride showed an increasing trend with the years (χ 2=41.140, P < 0.01). The compliance rates of fluoride in plentiful phase and exhausted phase were 83.36% (8 128/9 750) and 83.29% (8 089/9 712), respectively, and the difference was not significant statistically (χ 2=0.020, P > 0.05). As for water sample type, the compliance rates of fluoride in factory water and tip water were 83.55% (6 583/7 879) and 83.17% (9 628/11 576), and the difference was not significant statistically (χ 2=0.485, P > 0.05). The difference of compliance rate of fluoride in different water treatment methods was statistically significant (χ 2=192.014, P < 0.01). The compliance rates of fluoride in water with conventional treatment and only disinfection were higher [95.51% (404/423) and 94.44% (986/1 044)]; and the untreated water had the lowest compliance rate of fluoride [81.75% (13 073/15 991)]. There was a statistically significant difference in compliance rates of fluoride in the eastern, central and western regions (χ 2=629.256, P < 0.01), with the eastern region had the highest compliance rate of 89.17% (7 337/8 228); the central region had the lowest compliance rate of 74.67% (5 391/7 220). The visualization results showed that the compliance rate of fluoride was obviously low in the central region north of Yin Mountains and west of Greater Higgnan Mountains. Conclusions:From 2014 to 2018, the compliance rates of fluoride in rural centralized water supply increase year by year, and some achievements have been made in fluorine reduction and water improvement project in Inner Mongolia. However, there are still some rural areas with low level of water fluoride compliance rates which mainly distribute in the central region of Inner Mongolia in the north of Yin Mountains and west of Greater Higgnan Mountains. The current focus of prevention and control should be shifted from "general control" to "precise fluorine control". In the future, it is necessary to implement treatment projects in key areas of fluorine pollution from the aspects of policy implementation and technological innovation to ensure the drinking water safety of local rural residents.

Biomechanical factors play a crucial role in the steady-state maintenance of articular cartilage. The primary cilium (PC) is a kind of organelle which can sense mechanical and chemical signals at the same time. It is also distributed on the surface of chondrocyte membrane. It is involved in multiple signal transduction pathways as well as in the process of chondrocyte phenotype maintenance and material metabolism. Abnormalities in PC are also associated with a variety of human bone and joint diseases. This paper mainly discusses the mechanism of PC in mechanical microenvironment of chondrocytes and the interaction with other signaling pathways, and explores its relationship with bone and joint diseases, so as to provide some scientific basis for clinical and basic research in orthopedics.

ObjectiveTo explore the possible peripheral analgesic mechanism of electroacupuncture （EA） at promimal and distal acupoints in treatment of myofascial pain syndrome （MPS）. MethodsTwenty-four SD rats were randomly divided into blank group， model group， proximal group， and distal group， with six rats in each group. MPS model was prepared by “strike combined with centrifugal exercise” in all groups except for the blank group. After modeling， the rats in the proximal group received EA at the local myofascial trigger points （MTrPs）， namely the Ashi points， with dilatational waves of frequency of 2/100 HZ and voltage of 2-4 V， current intensity depending on a slight trembling of the left lower limbs， once a day， 15min each time，for 14 days. The rats in the distal group received EA at “Yanglingquan” （GB 34） and “Yinlingquan” （SP 9）， with the same operations as the proximal group. The rats in the blank group and the model group were only grasped and hedged， without other interventions. After intervention， the paw withdrawl mechanical threshold （PWMT） was measured， and variability between the left and right hind paws was calculated. Musculoskeletal ultrasound imaging and electromyography monitoring were performed on the left lower extremity vastus medialis. The morphological changes of vastus medialis muscle of the left lower extremity were observed by HE staining. The positive expression of substance P （SP）， calcitonin gene-related peptide （CGRP）， CD68 and CD206 in muscle tissue was detected by immunohistochemistry. Abdominal aortic serum interleukin-1β （IL-1β）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， interleukin-10 （IL-10）， and interleukin-8 （interleukin-8） were detected by ELISA. ResultsCompared to those in the blank group， the fibers of the vastus medial muscle of the rats in the model group were broken and distorted with thickness in variation， and the myofascia was broken， with fibrillation potential， enlarged muscle cells， inward moved nucleus， and widened muscle space； the variability of PWMT between the left and right hind paws significantly increased， as well as the levels of SP， CGRP， CD68， and CD206 in the vastus medialis muscle （P＜0.01）， and the serum IL-8 and TNF-αlevels were significantly elevated （P＜0.05 or P＜0.01）. Compared to those in the model group， the muscle fibers in the proximal and distal group were complete in shape and arranged in an orderly manner， with continued non-broken myofascia， regular shape of muscle cells， and significantly reduced level of IL-8 （P＜0.01）； the amplitude and frequency of spontaneous discharge in the proximal group significantly decreased， as well as the variability of PWMT between the left and right hind paws， and the levels of SP， CGRP， and CD68 in the vastus medialis muscle， while the CD206 level increased significantly （P＜0.05 or P＜0.01 ）； there was complex discharges in the distal group， with significantly decreased level of CD68 in the vastus medialis muscle and increased level of CD206 （P＜0.01）. Compared to the proximal group， the level of IL-8 in the distal group was significantly higher （P＜0.05）. ConclusionsEA at proximal acupoints can significantly improve the pain threshold and local muscle tissue morpho-logy in rats， and its mechanism may be related to reducing the levels of pain-causing substances and related inflammatory factors and promoting the polarization of macrophages. The analgesic effect of EA at distal acupoints is not obvious， and the mechanism is still unclear.

OBJECTIVETo investigate the efficacy of brachytherapy for patients with localized prostate cancer and the influence factors.

METHODSThere were 61 patients with localized prostate cancer were treated with brachytherapy between April 2001 and March 2011 in Department of Urology, Peking University First Hospital, including 11 patients who received combined external beam radiotherapy. The mean age was 75.2 years (range 57-84 years). Clinical stage was T1c in 12 patients, T2a in 18 patients, T2b in 17 patients, and T2c in 14 patients. Long-term follow-up was carried on all patients for prostate specific antigen (PSA) and adverse effects. Kaplan-Meier survival curves, Log-rank test and univariate Cox proportional hazard regression analysis was used to examine the factors associated with the treatment efficacy.

RESULTSThe median follow-up was 49 months (range 9-126 months). The mean PSA before treatment and the mean nadir PSA after operation were (17.80 ± 14.44) µg/L and (1.16 ± 1.15) µg/L, respectively. The PSA of 58 patients (95.1%) reached a nadir < 4.0 µg/L, which was even < 1.0 µg/L in 37 patients (60.7%). The mean time to reach the nadir PSA was 11.6 months after operation. The short-term adverse events after operation included fever in 4 patients, hematuria in 7 patients, and hematochezia in 4 patients. The most common long-term adverse event was urinary irritation (31.1%); other long-term adverse events were rare, including hematochezia, hematuria, urinary incontinence, urinary retention, mild diarrhea and radiation enteritis. The estimated mean biochemical recurrence-free survival after brachytherapy was 41.0 months (95% CI: 31.05-50.94 months). The mean nadir PSA after operation were 1.32 µg/L in the 11 patients who received combined external beam radiotherapy, and their estimated mean biochemical recurrence-free survival was 38 months. Patients with nadir PSA < 1.0 µg/L had a significant longer biochemical recurrence-free survival than those with nadir PSA between 1.0 µg/L and 4.0 µg/L (42.9 vs. 32.0 months, χ² = 4.445, P = 0.035).

CONCLUSIONSBrachytherapy is an effective treatment strategy for localized prostate cancer, with relatively low rate of severe adverse events. After brachytherapy, a nadir PSA < 1.0 µg/L might indicate a better prognosis.

Aged ; Aged, 80 and over ; Brachytherapy ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prognosis ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; radiotherapy ; Treatment Outcome

Objective    To summarize the experience of robot-assisted lung basal segmentectomy, and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S9 and/or S10 segmentectomy. Methods    The clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed. There were 32 males and 46 females with a median age of 50 (33-72) years. The patients who underwent S9 and/or S10 segmentectomy were divided into a single-direction group (pulmonary ligament approach, n=19) and a bi-direction group (intersegmental tunneling, n=19) according to different approaches, and the perioperative outcomes between the two groups were compared. Results    All patients successfully completed the operation, without conversion to thoracotomy and lobectomy, serious complications, or perioperative death. The median operation time was 100 (40-185) min, the blood loss was 50 (10-210) mL, and the median number of dissected lymph nodes was 3 (1-14). There were 4 (5.1%) patients with postoperative air leakage, and 4 (5.1%) patients with hydropneumothorax. No patient showed localized atelectasis or lung congestion at 6 months after the operation. Further analysis showed that there was no significant difference in the operation time, blood loss, thoracic drainage time, complications or postoperative hospital stay between the single-direction and bi-direction groups (P>0.05). However, the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group [6 (1-13) vs. 5 (1-9), P=0.040]. Conclusion    The robotic lung basal segmentectomy for pulmonary nodules is safe and effective. The  perioperative results of robotic S9 and/or S10 complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.

Buruli ulcer (BU), caused by