Objective:To explore the feasibility and clinical efficacy of stratified suture of lateral pharyngeal wall(SSLPW) combined with soft palate radiofrequency coblation in the treatment of the patients with severe obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:The clinical data of 21 severe OSAHS patients underwent lateral pharyngoplasty(LP) combined with soft palate radiofrequency coblation (LP group) and 39 severe OSAHS patients underwent SSLPW combined with soft palate radiofrequency coblation (SSLPW group) were selected.The apnea hypopnea index(AHI),lowest SaO2(LSaO2),Epworth sleepiness scale(ESS) scores,and related postoperative complications of the patients in two groups were analyzed before and after operation.The successful rates of operation of the patients in two were compared.Results:In LP group,1 patient was cured (5%),19 patients were improved markedly (90%),1 patient was effective (5%),and no patient was invalid;the successful rate was 95.2%(20/21).In SSLPW group,2 patients were cured (5.1%),33 patients were improved markedly (84.6%),4 patients were effective (10.3%),and no patients was invalid;the successful rate was 89.7%(35/39);there was no statistical difference in the successful rate of operation of the patients between two groups (P>0.05).There was statistically significant improvement of the subjective symptoms.All the patients returned to normal subjective swallowing functions without nasal pharyngeal reflux and dysphagia in one month follow-up after operation.Compared with before operation,the AHI and ESS scores of the patients in two groups after operation were decreased(P<0.05);the LSaO2 scores were increased(P<0.05).Conclusion:The AHI,LSaO2 and ESS scores are significantly improved in the OSAHS patients after treated with SSLPW combined with soft palate radiofrequency coblation.The method is a valid option for the severe OSAHS patients.

Objective To evaluate the effectiveness of web-based mental health services.Methods Web-based mental health services were established in our hospital to offer continuing medical education on mental health and psychological assessments.The access of clinicians to psychiatric knowledge and consultation from psychiatry department was evaluated.Results A total of 803 medical staff took the continuing medical education,and 643 passed the examination.Five hundred and twenty-eight online psychological assessments were completed.The qualification rate of psychiatric examination was 83.3％ vs.31.7％ in educated and non-educated clinicians (x2=32.77,P＜0.01).The common consultation from psychiatry department of the educated group involved anxiety,depression/mania and delirium,of which anxiety and medically unexplained symptoms were comparatively higher while delirium was lower than the non-educated group (x2 values were 4.80,4.59 and 5.16,respectively; all P＜0.05).More use of online psychological assessments was found in the educated group (33.8％ vs.7.6％) before asking for a consultation from psychiatry department (x2=30.04,P＜0.01).Conclusions Online mental health continuing education and psychological assessment could improve psychiatric knowledge and recognition of anxiety and depression in clinicians.

[ABSTRACT]OBJECTIVETo estimate different dimensions of maxillary sinus measured on cone-beam computerized tomography (cone-beam CT), and determine the differences in side and gender.METHODScone-beam CT image data from 200 normal adults was selected and analyzed by Invivo Dental software. The craniocaudal diameter, anteroposterior diameter, width and volume of maxillary sinus were measured as well as the thickness of the orbital floor. Statistical analysis was performed with SPSS 11.5.RESULTSThere were no statistically significant differences in the craniocaudal diameter, anteroposterior diameter, width and volume of maxillary sinus between sides (P>0.05, respectively). Significant differences were noted in the craniocaudal diameter and volume of bilateral maxillary sinus and the width of right maxillary sinus based on gender (P<0.05, respectively). There were no significant differences in the width of left maxillary sinus, the anteroposterior diameter of bilateral maxillary sinus and the osseous thickness of the orbital floor (P>0.05, respectively).CONCLUSIONOur findings indicate that cone-beam CT can be used to measure different dimensions of maxillary sinus and provide imaging anatomical data for clinical treatment.

Parkinson′s disease (PD) is a common neurodegenerative disorder, which has a highly effective pharmacological symptomatic treatment. Levodopa is the most effective drug available for the symptomatic treatment of PD and is the gold standard with which other therapies must be compared. There are significant individual differences in clinical features, disease course, and response to pharmacological treatment in PD patients, not only attributed to disease process and environmental factors, but also genetic factors. Pharmacogenomics, also known as personalized medicine, is the study of how genetic variations in a person′s genome affect their response to drug therapies, which contribute to apply the patient with the best treatment plan, including the timing of dosing, the dose administered, and the most appropriate drugs. Pharmacogenomics accounts for 60%-90% variability in drug pharmacokinetics and pharmacodynamics. Major determinants of the pharmacogenomic outcome include pathogenic, mechanistic, metabolic, transporter and pleiotropic genes. This article will summarize the impact of polymorphisms in genes encoding dopamine signaling pathway on drug response, and the impact of genetic polymorphisms on complications and prognosis associated with dopaminergic drug therapy.

A comparative observation about histological and histochemical study were made onthe preservating methods of local ischemic kidney of dogs.The methods of this exp-eriment were divided into five groups:A.Local hypothermia;B.Hypothermic perfu-sion solution 500ml,4℃,containing Procaine 450 mg and Heparin 100 mg,infusedinto renal artery;C.Hypothermic perfusion solution 500ml,4℃,containing 20% Ma-nniton 32ml,25% MgSO_4 0.36 ml,Heparin 100 ml,infused into renal artery;D.Localhypothermia and heparin 30 mg injected into the same vessel.E.Local room tem-perature.The specimens were taken from the kidneys of the experimental dogs atvarious period after treated with every method.The results were as follows;A,D and E group presented irreversible histological changes within 4 hoursaftertreatment.Four hours later,the reaction of SDH,ATPase,AlPase werenegative.It suggested that the kidney damage was serious,as well as expressed thatthe effect of these preservating methods for ischemic kidney are not satisfactory.In B group,the histological and histochemical alteration is very light and almostreversible,during 60 days after treatment.In C group,hypothermic perfusionsolution containing Mannitol,MgSO_4 etc either during experiment or follow observa-tion for 60 days,no histological and histochemical alterations were found.It indica-ted that this method is an ideal perservating technique for ischemic kidney.

Objective:To investigate the safety and feasibility of the occipital condyle screw and evaluate the safepath parameters for the occipital condyle screw.Methods:Data of 64 patients with upper cervical computed tomographic angiograms from September 2016 to September 2018 were retrospectively collected. Excluded occipito-cervical injury, tumor, and vertebral artery course variation. Mimics software was used to reconstruct the occiput, atlas and vertebral artery. Three candidate entry points were placed for each occipital condyle, the midpoint of posterior of occipital condyle as middle entry point, and the medial and lateral entry points were located 3 mm medial and lateral to the middle entry point. The vertebral artery-occipital bone distance (VOD) of each entry point were measured on sagittal plane, and the minimum feasible value was determined to be 4mm. After that 3.5 mm diameter virtual screw was inserted into each candidate entry point with VOD>4 mm, each screw with maximum and minimum cranial angulation was combined with appropriate medial angulation to get the maximum screw length. Then, the screw placement parameters were measured by 3-Matic, and the safe range of cranial angulation and the success rate of screw placement were calculated.Results:The VOD of medial and middle entry point were 8.07±2.13 mm and 7.70±2.19 mm respectively, and the feasibility rate of screw placement of those entry point were 97.7% and 96.1%, respectively. There were significant differences inVOD and feasibility rate of screw placement between medial and middle entry point. The VOD of lateral entry point was 5.63±1.66 mm, and the feasibility rate was only 78.9%, which was significantly lower than that of medial and middle entry point. The lateral entry point could obtain a larger medial angulation, which was supplemented by a longer screw length. The medial angulation and length of screw gradually decreased with the inward movement of the entry point. There were significant differences in medial angulation and screw length among groups. The safe range of cranial angulation of medial, middle and lateral entry points were 8.17°±2.55°, 12.58°±4.23° and 12.09°±3.83°, respectively, and the difference were statistically significant. Among the screw entry point that could accommodate screw fixation, the maximum screw placement success rate can be obtained by adding 5° cranial angulation to the lateral and middle entry point, which were 98.02% and 98.37%, respectively,while 100% success rate of screw placement could be obtained at the medial entry point at 3° cranial angulation.Conclusion:In the selection of the entry point in the horizontal direction, middle and medial entry points have higher success rate of screw placement and wider safe range of cranial angulation because of less affection of horizontal segment of the vertebral artery. However, the screw length of medial entry point is much shorter than middle and lateral entry point. As a result, the middle entry point may be an optimal entry point for the occipital condyle screw.

Inorganic arsenic (iAs) is a toxic metalloid found ubiquitously in the environment. In humans, exposure to iAs can result in toxicity and cause toxicological manifestations. Arsenic trioxide (As2O3) has been used in the treatment for acute promyelocytic leukemia. The kidney is the critical target organ of trivalent inorganic As (iAsIII) toxicity. We examine if oral administration of astaxanthin (AST) has protective effects on nephrotoxicity and oxidative stress induced by As2O3 exposure (via intraperitoneal injection) in rats. Markers of renal function, histopathological changes, Na+-K+ ATPase, sulfydryl, oxidative stress, and As accumulation in kidneys were evaluated as indicators of As2O3 exposure. AST showed a significant protective effect against As2O3-induced nephrotoxicity. These results suggest that the mechanisms of action, by which AST reduces nephrotoxicity, may include antioxidant protection against oxidative injury and reduction of As accumulation. These findings might be of therapeutic benefit in humans or animals suffering from exposure to iAsIII from natural sources or cancer therapy.
Adenosine Triphosphatases ; Administration, Oral ; Animals ; Arsenic ; Humans ; Kidney ; Leukemia, Promyelocytic, Acute ; Oxidative Stress ; Rats ; Rats, Wistar*

Objective:To observe the expression of vascular endothelial growth factor (VEGF) and aquaporin 4 (AQP4) in the inner limiting membrane (ILM) of diabetic retinopathy (DR) with macular edema, and analyze the correlation between VEGF and AQP4 expression.Methods:A cross-sectional study. From September 2019 to September 2020, 38 eyes of 38 patients with DR and idiopathic macular hole (iMH) who underwent vitrectomy (PPV) combined with ILM stripping at the Hangzhou campus of The Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou were included in the study. Among them, there were 25 males and 13 females who aged 37-76 years old, average age was 59±10 years old; All eye included 15 right eyes and 23 left eyes. iMH and DR included 9 eyes in 9 cases and 29 eyes in 29 cases, respectively, and they were divided into iMH group and DR group. The DR group was divided into DME group and no DME group according to whether it was accompanied by diabetic macular edema (DME), with 14 eyes and 15 eyes respectively. After the stripped ILM tissue was fixed, immunofluorescence analysis was performed to obtain a picture of the fluorescence mode of AQP4 and VEGF, and the fluorescence intensity value of VEGF and AQP4 was measured by Image J software. The differences of VEGF and AQP4 immunofluorescence values in the specimens between groups were compared by one-way analysis of variance. The correlation between the fluorescence intensity of AQP4 and the fluorescence intensity of VEGF was analyzed by Pearson correlation analysis.Results:The average fluorescence intensity valuesof VEGF and AQP4 in ILM specimens of DME group, no DME group and iMH group were 38.96±7.53, 28.25±3.12, 30.07±4.84 and 49.07±8.73, 37.96±6.45, 38.08±5.04, respectively. The average fluorescence intensity of VEGF and AQP4 in the ILM specimens of the DME group was significantly higher than that of the no DME group and iMH group, and the difference was statistically significant ( F=13.977, 9.454; P<0.05). The average fluorescence intensity values of VEGF and AQP4 on IML specimens in the DR group were 33.80±7.91, 43.76±9.44, respectively. The results of Pearson correlation analysis showed that the fluorescence intensity of VEGF and AQP4 in the ILM specimens of the DR group was significantly positively correlated ( r=0.597, P=0.003). Conclusions:The expressions of VEGF and AQP4 in ILM of eyes with DR and DME are significantly increased compared with those without DME. The expression of VEGF and AQP4 in ILM of eyes with DR is positively correlated.

Objective: To compare the clinical outcomes of posterior maxillary implant surgery when using the regular transalveolar approach or with the crestal approach-sinus (CAS-KIT), a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure. Methods: In this retrospective study 887 patients during Jan 2012 to July 2015 in Hangzhou Dental Hospital with underwent either regular transalveolar approach or CAS-KIT approach for maxillary augmentation; whereas 11 patients dropped out for the reason of serious membrane perforations. Totally, 876 patients with 1 204 plants, placed immediately after transalveolar maxillary augmentation, were included in this study. The data analysis was performed by radiological measures to assess the changes in height of maxillary sinus floor after the transalveolar augmentation at different time points. In addition, the complications after surgery, failure rates, osseointegration condition and the performance of rehabilitation were evaluated as well. Results: Five hundred and three patients were experienced with regular transalveolar approach, and 7 patients were drop out for the serious membrane perforations. Thus, 496 patients received 653 implants in this group; the average lifted range in maxillary sinus floor height changes was (4.08±3.45) mm. The complications were minor membrane perforations during procedure in 64 patients, postoperative maxillary sinus infection happening in 2 patients and 13 patients experienced rehabilitation failure. Three hundred and eighty-four patients had CAS-KIT approach with 4 patients dropped out. Three hundred and eighty patients get 551 implants with the mean lifted range of (8.36±4.07) mm in maxillary sinus floor height changes. Minor membrane perforations during procedure occurred in 31 people and 2 got postoperative maxillary sinus infection. The 4 year overall survival rate of 1 204 implants was 97.26%, with four implants fell off after 3 months of rehabilitation and one implant occurred after one year of rehabilitation. Conclusions The regular transalveolar sinus lift technique is easier and time saving, but the compromised lifting range in maxillary sinus floor height and the comparatively high occurrence of intraoperative membrane perforations should be concerned. Using CAS-KIT could be an alternative method to perform maxillary sinus augmentation with a reduced incidence of complications. There was no statistically difference in implant failure rates and incidence of postoperative maxillary sinus infection between two groups.

BACKGROUND:Muscle weakness is a common symptom after coronavirus disease 2019(COVID-19)infection and affects the ability to perform daily activities in humans during recovery.Low-frequency pulsed magnetic field stimulation at a strength of 1.5 mT and a frequency of 3 300 Hz can enhance the maximal voluntary contraction and strength endurance of human skeletal muscle by inducing and activating classical transient receptor potential channel 1(TRPC1),which produces a series of pathological support effects on muscle tissue.It has not been studied whether this means will improve muscle weakness in patients recovering from COVID-19. OBJECTIVE:To select the low-frequency pulsed magnetic field for magnetic stimulation of lower limb muscle groups in patients with COVID-19,in order to observe the effect of this stimulation on the improvement of muscle weakness of lower limb muscle groups in patients with COVID-19 during the recovery period. METHODS:Fourteen patients infected with COVID-19(Omicron strain)positive for Innovita COVID-19 Ab Test(Colloidal Gold)and accompanied by muscle weakness were recruited and randomly divided into two groups:a test group receiving magnetic field stimulation and a control group receiving sham treatment,respectively.The total duration of the trial was 3 weeks.The test group was given low-frequency pulsed magnetic stimulation of the lower limbs every 48 hours and the control group was given the same intervention procedure as the test group but with sham stimulation.Patients in both groups were not informed whether the magnetic stimulation apparatus was running or not.Nine sessions were performed in both groups and the changes in the maximum voluntary contraction,explosive leg force and strength endurance of the local muscle groups of the lower limbs were subsequently observed in both groups. RESULTS AND CONCLUSION:Among the eight local muscle groups collected,seven local muscle groups in the test group showed an increase in the maximum voluntary contraction value after 3 weeks of low-frequency pulsed magnetic field stimulation.In the control group,there were only three muscle groups with improvement in the maximum voluntary contraction.The rate of improvement in the anterior and posterior muscle groups of the left leg in the test group was significantly higher than that in the control group.The longitudinal jump height and peak angular velocity of the knee joint in both groups were improved compared with the pre-test measurement,and the elevation rate of jumping height in the test group was higher than that in the control group.Under the fatigue condition,the decline rates of peak angular velocity of the knee joint and jumping height in the test group decreased significantly,while those in the control group did not change significantly.The above data confirmed that the low-frequency pulsed magnetic field stimulation with the intensity of 1.5 mT and frequency of 3 300 Hz could improve the muscle strength of more local muscle groups in the lower limbs of patients with COVID-19 during the recovery period compared with the human self-healing process,and the whole-body coordination ability and functional status based on explosive leg force of the legs could be significantly improved.Therefore,low-frequency pulsed magnetic field stimulation can be used as an effective,non-exercise rehabilitation tool to improve muscle weakness in the lower limbs of patients with COVID-19.