Objective To investigate the immune disorder in elderly patients with severe ischemic stroke and to explore whether a new type of diabetes-specific enteral nutrition formula can regulate the immune function of these patients.Methods In the randomized controlled prospective study,90 patients aged 60-80 years with acute ischemic stroke and NIHSS score more than 10 and dysphagia were randomized to two groups:receiving a new type(Group A) of,versus traditional(Group B) diabetes-specific enteral nutrition.30 Patients aged 60-80 years with acute ischemic stroke and NIHSS score ≥10 without dysphagia were enrolled as control(Group C).The immune function was observed,and the nutritional status and immunological function were compared between two different enteral nutrition groups at 7 days of treatment.Results After 7 day follow-up,the serum lipid stats significantly ameliorated in group A.An obvious suppression of immune state was observed in severe acute ischemic patients at onset of 7 days.At day 7 of treatment,the percentage of CD3+ T cells in group A was(69.25±9.93)％ after treatment vs.(63.36±7.79)％ at baseline(P＜0.001),and CD3 +CD4+T cells was(45.79±9.47)％ after treatment vs.(36.12±9.15)％ at baseline(P＜0.001),as well as CD4+/CD8+ cells were(2.27±1.40)％ after treatment vs.(1.70±0.82)％ at baseline(P=0.001).At 7 days of treatment,the percentage of CD3+ T cells was higher in group A (69.25 ±9.93) ％ than in group B(63.07± 9.47) ％ (P＜0.001),and the percentage of CD3 + CD4 cells was higher in group A(45.79 ± 9.47) ％ than in group B(41.32 ± 8.89) ％ (P=0.024).Conclusions Enteral nutrition preparations can provide sufficient energy support in the acute ischemic stroke.Immunosuppressive state exists in patients with acute phase of severe ischemic stroke.The new type of diabetic enteral nutrition formula can significantly improve immunosuppressive state in patients with acute severe stroke.

OBJECTIVE: To explore the therapeutic methods and effect of pingyangmycin injection in huge hemangioma at Hypopharynx and laryngeal under suspension laryngoscopy. METHOD: To ananysize the medical records of 12 Patients with giant hemangioma at hypopharynx and laryngeal. Patients were underwent polysomnography before operation. Inseted the suspension laryngoscopy to pars laryngea by mouth to exposing the hemangioma under general anaesthesia, then injected Pingyangmycin by a long-tube needling (one time per three weeks, accumulated dose less than 50 mg). RESULT: Among all patients, ten were cured and two showed obvious improvement. The data of PSG after operation indicates that the symptom of anoxia of post-operation were significantly ameliorated than that of pre-operation, no recurrence occurred during one year follow-up of the hemangioma. CONCLUSION The methods of pingyangmycin injection under suspension laryngoscopic surgery is significantly enhanced clinical effect and improved the life quality of patients with huge hemangioma, which with low risk, high security, can ameliorating anoxia, complete cure, and is a ideal therapeutic measure.
Adult ; Bleomycin ; administration & dosage ; analogs & derivatives ; Female ; Hemangioma ; therapy ; Humans ; Hypopharynx ; pathology ; Laryngoscopy ; Larynx ; pathology ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Objective:Total 621 cases of medical disputes occurred during 2000 to 2013 were analyzed retro-spectively, to investigate the dispute factors and analysis of improvement, to promote doctor-patient relationship. Methods:621cases of medical disputes from 2000 to 2013, on a case by case attributes are classified, analyzed two year interval comparison, find the dispute factors in evolution.Results:Through the analysis of 621 cases of disputes over property, complications of the disease cause dispute case first, economic reasons, the second medical defect.Conclusions:Analysis of the two year interval comparison shows:how to strengthen the hospital scientific management, innovative service mode, the medical system implemented is the important link of reducing medical disputes.

Objective To evaluate the gene therapeutic effects of guinea pigs model with immune -mediated inner ear disease(IMIED)after locally injection of bone -marrow mesenchymal stem cells(BMSCs) decorated by in-terleukin-4 gene .Methods Guinea pigs were immunized with keyhole limpet hemocyanin (KLH) and caused 55 animal models ,divided into five groups ,each group with 11 animals :groupA(BMSCs carrier) ,group B(BMSCs emp-ty -carrier control group) ,group C(recombinent lentivirus IL -4 gene) ,group D(lentivirus empty -carrier control group) ,group E(simulation operation control group) .Groups were all injected with the corresponding suspension (20 μl)[includs BMSCs ceas of (1 .5~2 .0) × 106 ,the concentration of (entivirus) is 0 .5 × 108 pfu] by the scala tympani window into the inner ear .The fluorography immunohistochemistry test and enzyme immunohistochemistry test for the situation of IL -4 gene express and productive protein distribution in inner ear .Auditory functions and the KLH level of guinea pigs blood were monitored respectively by auditory brainstem responses (ABRs) and ELISA test .Results The threshold of ABR wave Ⅲ decreased in group A ,group B and group C .The result were more significant in group A and group B than that in group C ,but results in group A was more prominent (P<0 .05) . The results of immunohistochemistry test showed that fluorescence positive BMSCs mainly scattered in scala tymani and scala vestibule .The microscope results showed that for the group A ,B and C ,there were only few foccule and red and white blood cells in scala tympani floc ,but for group D and group E ,with different levels of labyrinthine hy-drops and some mononuclear cells around the spiral ganglion and small blood vessels .Conclusion Restructuring lentiviral vector with IL -4 gene can be successfully transfected into BMSCs in vitro ,compared to inplangting into inner ear in scala tympani approach ,the cells can migrate and generate gene product of IL -4 ,to significantly im-prove the auditory functions and inflammatory reaction of inner ear disease ,and BMSCs can be used as a carrier to migrate to the damaged part with therapeutic gene .

OBJECTIVE: To assess the effect of one-stage repair of secondary nasolabial deformity and nasal septoplasty for cleft patients on nasal airway resistance (NAR). METHOD: Using active anterior rhinomanometry, NAR was measured in eighteen patients with cleft lip and palate who suffered form one-stage repair of secondary nasolabial deformity and septoplasty at per-and-post operation. RESULT: NAR was (0.664 +/- 0.200) kPa/(s x L) before operation, (0.304 +/- 0.180) kPa/(s x L) six months after operation, and (0.396 +/- 0.250) kPa/(s x L) twelve months after operation respectively. The differences are statistically significant (P < 0.01) between the NAR before and after operation. Subjective impression score of nasal patency was 7.5 +/- 1.5 before-operation, 2.1 +/- 2.0 after-operation for six months, 3.0 +/- 2.4 after-operation for twelve months. There are significant differences in the subjective impression score of nasal patency as well (P < 0.01). CONCLUSION Correction of septal deformities play a very important role in the operation for secondary nasolabial deformity, which can decrease NAR and improve the subjective impression of nasal patency.
Adolescent ; Airway Resistance ; Cleft Lip ; surgery ; Cleft Palate ; surgery ; Female ; Humans ; Male ; Nasal Septum ; abnormalities ; surgery ; Nasopharynx ; surgery ; Postoperative Period ; Rhinoplasty ; Young Adult

Objective To investigate the regulatory effects of IFN-γon the expression of pro-grammed death ligand 2 (PDL2) on human placenta mesenchymal stem cells (hPMSCs) and the hPMSCs-induced differentiation of peripheral blood CD 8+IL-10+T cell subsets .Methods hPMSCs were isolated from mature human placenta by enzyme digestion .The expression of PDL2 on hPMSCs and the regulatory effects of IFN-γon PDL2 expression were detected by RT-PCR and flow cytometry ( FCM ) , respectively . Peripheral blood mononuclear cells (PBMCs) were isolated from healthy subjects by density gradient centrif-ugation.T cells were purified with sheep red blood cells .FCM was used to detect the ratios of CD 8+IL-10+T cell subsets in PHA or CD3/CD28 beads activated T cells in the presence of hPMSCs treated with Anti-PDL2 McAb or IFN-γ.Results PDL2 molecules were highly expressed on hPMSCs that could be further enhanced by IFN-γ.The results of FCM demonstrated that hPMSCs could induce the differentiation of CD 8+IL-10+T cell subsets .The ratios of CD8+IL-10+T cell population in T cells activated by different stimulators including PHA and CD3/CD28 beads were significantly increased in the presence of hPMSCs as compared with those without hPMSCs (P<0.01).In addition, the antibody blocking experiments indicated that PDL 2 McAb down-regulated the percentages of CD 8+IL-10+T cell subsets in PHA or CD 3/CD28 beads stimulated T cells in the presence of hPMSCs as compared with those of unblocked groups .CD8+IL-10+T cell subsets were up-regulated in IFN-γtreated hPMSCs groups as compared with those of untreated groups .Conclusion hPMSCs could induce the differentiation of peripheral blood T cells into CD 8+IL-10+T cell subsets , which was enhanced by PDL 2 expressed on hPMSCs .IFN-γcould promote the differentiation of CD 8+IL-10+T cell subsets induced by hPMSCs through up-regulating the expression of PDL2 on hPMSCs.

Objective To evaluate the result of revascularization for lower limb artery ischemia in elder patients. Method During Jan 2006 to Nov 2008, 262 elder patients (60 years old and up), underwent artery revascularization for lower limb arterial ischemia. Mortality, morbidity, primary patency, secondary patency and limb salvage were analyzed. Result There were a total of 323 ischemia limbs in those 262 elder patients undergoing revascalarization, among those 102 limbs underwent artery bypass, 98 limbs underwent endoluminal angioplasty with or without stenting, 67 limbs underwent embolectomy or endarterectomy, 56 limbs underwent open surgery combined with endoluminal treatment due to multiple segment lesions. Operation success rate was 94.7%. Two patients died within 30 days. Perioperative morbidity developed in 15 cases. 245 patients (93.5%) were followed-up from 1 month to 35 months. Mortality was 6.1% (15 cases), primary patency was 80.5%, secondary patency was 92.7% and limb salvage rate was 95.2%. Risk factors analysis showed that history of cardiac disease and elder ages were associated with higher mortality. Diabetes mellitus, critical ischemia and multiple segment lesions were associated with poor long term patency and limb salvage. Conclusion Lower limb ischemia is severe disease related to elder patients' death and amputation. Careful patient selection, detailed pre-operation work-up, meticulous operative technique play crucial roles for a successful arterial reconstruction.

OBJECTIVE: To explore the feasibility of low-temperature radiofrequency ablation for the treatment of tongue base cyst. METHOD: Low-temperature radiofrequency ablation was used to treat 14 patients with the cyst of tongue base under general anesthesia with endotracheal intubation. Operation time, the volume of blood loss and postoperative complications were recorded and the follow-up was taken after surgery. RESULT: The tongue base cysts were totally resected in 14 patients, among which 12 patients only underwent one operation under general anesthesia and two patients received once again under local anesthesia. The procedure took approximately 5-10 min and the volume of blood loss during surgery varied from 1-5 ml. Endotracheal catheter was extubated as usual and incision of trachea was not done. The VAS score of foreign pharynx sensation decreased significantly from preoperative 83.1 +/- 11.2 to postoperative 10.3 +/- 3.6 (P < 0.01). There were no significant postoperative haemorrhage, pharyngalgia, dyspnea or other complications. Speech and the motor function of tongue base were not affected. Follow-up survey ranged from 7 months to 3 years and the cure rate was about 92.9% (13/14) as the recurrence occurred only in one out of 14 cases. CONCLUSION Low-temperature radiofrequency ablation is a promising management for the cyst of tongue base with less trauma, complications or recurrence.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Catheter Ablation ; methods ; Child ; Cold Temperature ; Female ; Humans ; Male ; Middle Aged ; Ranula ; surgery ; Treatment Outcome ; Young Adult

Objective To retrospectively evaluate interobserver variability between radiologists by using lexicon of the Thyroid Imaging Reporting and Data System ( TI-RADS ) to classify lesions on ultrasonography and retrospectively determine the positive predictive value ( PPV) of each TI-RADS level. Methods Five radiologists retrospectively reviewed 188 consecutive thyroid nodules with known pathologic diagnosis of 172 patients from June,2016 to November,2016. Each observer described each lesion with TI-RADS terminology and final TI-RADS level were assigned by adding the points from all categories. Cohen κ statistic was used to assessed the interobserver variability for each ultrasonographic ( US ) descriptors and final TI-RADS level. PPV for all TI-RADS levels were determined for all readers combined. Results For each US descriptor,composition,echogenicity,shape,margin,echogenic foci,their κ were 0.743 (0.713－0.772),0.418 (0.319－0.517),0.468 (0.389－0.547),0.397 (0.291－0.503) and 0.566 (0.514－0.617) respectively ( data in parentheses are 95% confidential intervals). The κ for TI-RADS level was 0.782 (0.749 －0.81). PPV for TI-RADS level 1 to 5 were 0(0/8),0(0/23),14.3% (4/28),29.7%(11/37) and 85.7% (78/91). Conclusions Interobserver agreement with the TI-RADS terminology is substantial for composition, moderate for echogenicity, shape and echogenic foci, fair for margin. Interobserver agreement is substantial for TI-RADS level. Consequently different understanding in US images has little influence in patient management,justifying the use of ACR-TIRADS in clinical practice.

Purpose/Significance Through the establishment of a quality control system for electronic medical record(EMR)con-tent,the standardization and normalization of medical record writing is realized,and the quality of hospital medical record is improved.Method/Process The intelligent medical data center is built based on hospital medical data,and the knowledge base and rule base with tumor specialty characteristics are formed by combining natural language processing(NLP)and machine learning technology.The new quality control mode of"pre-audit,comprehensive coverage,process supervision and closed-loop management"of EMR is realized.Result/Conclusion After the application of the medical record quality control system based on NLP,the quality control coverage rate in-creased from 1%to 100%,and the rate of class A medical records increased to more than 96%,with good real-time and accuracy,providing a solid information foundation for the high-quality development of hospital medical records.