Acetaminophen ; therapeutic use ; Ductus Arteriosus, Patent ; drug therapy ; Humans ; Infant ; Infant, Newborn ; Infant, Premature

Objective To investigate the clinical effects and safety of urethral anastomoses and ureteroscopy urethral realignment in the treatment of urethral straddle injury and catheter placement failure. Methods Ninety patients with urethral straddle injury and catheter placement failure were chosen and divided into A group (45 patients, choosing urethral anastomoses) and B group (45 patients, choosing ureteroscopy urethral realignment). The operation time, intraoperative blood loss, hospital staying time and peri-operation complications in both groups were compared. Results The operation time, intraoperative blood loss, hospital staying time in B group were significantly lower than those in A group: (26.15 ± 10.41) min vs. (71.93 ± 14.50) min, (22.37 ± 7.41) ml vs. (50.70 ± 13.25) ml, (3.22 ± 0.97) d vs. (5.19 ± 1.43) d, P<0.05. After 6 months′follow-up, the clinical indicators in peri-operation period of B group were significantly better than those in A group (P<0.05). The complications incidence in B group was significantly lower than that in A group: 2.22%(1/45) vs. 13.33%(6/45), P <0.05. Conclusions The technology of ureteroscopy urethral realignment in the treatment of urethral straddle injury and catheter placement failure can efficiently shorten the operation time, reduce the degree of trauma and accelerate the rehabilitation process, and it is helpful to reduce the risk of complications in peri-operation period.

Objective To evaluate the efficacy of 125Ⅰ brachytherapy alone for the treatment of recurrent parotid gland carcinoma.Methods Recurrent parotid gland carcinoma patients (n =24) treated by 125Ⅰ brachytherapy alone between 2006 and 2013 at Peking University Hospital of Stomatology were enrolled in this retrospective study.All patients underwent surgery or radiotherapy.The local control rate,survival rate,and side effects were evaluated.Results The median follow-up time was 21 months (range,4-59 months).Among the 24 patients,6 had local failure and 10 died during the follow-up period.The 1-and 3-year overall survival rates,progression-free survival rates,local control rates were 74.8％ and 39.3％,74.8％ and 31.5％,82.0％ and 69.4％,respectively.No grade 3 or over radiation injury was found.Conclusions 125Ⅰ seed brachytherapy alone could provide an ahernative treatment method for inoperable recurrent parotid gland carcinoma patients.

Objective To evaluate the treatment of malignant submandibular gland tumors with surgery combined with 125I radioactive implantation.Methods Thirty-two patients with malignant submandibular gland tumors were treated with surgery combined with 125I seed implantation from December 2005 to December 2012.All of the 32 patients with primary disease were treated by excision of the submandibular gland and neoplasm.None of the patients received wide excision or neck dissection without the evidence of the neck metastases.The planning targets was based on computerized tomography (CT)images,tumors site,extent and pathologic type.The matched peripheral dose (mPD) was 90-110 Gy.Recurrence-free survival (RFS),overall survival (OS) rates and side effects were retrospectively reviewed.Results Totally 32 patients received 1394 radioactive seeds implantation,radioactive seeds and dose distributed were well in all patients.All patients were followed for 15-126 months (mean of 64 months),with 5 recurrence,5 distant metastases,and 4 patients who died of disease.The 3-and 5-year RFS were 93.1％ and 87.9％,and OS rates were 93.3％ and 84.5％,respectively.No severe complications were observed during follow-up.Conclusions The excision of the neoplasm and the submandibular gland,combined with 125I seed implantation brachytherapy was an effective modality for the treatment of malignant submandibular gland tumors.

Objective To summarize clinical features of local and regional failure of salivary gland carcinoma treating by 125I seed,and evaluate the clinical and histologic risk factors for its development.Methods Patients with salivary gland carcinoma treated by 125I seeds between Oct 2001 and Aug 2012 were analyzed retrospectively.The risk factors were analyzed statistically,including age,gender,tumor site,TNM stage,histological differentiation,radiotherapy,treatment,matched peripheral dose and primary or recurrent tumor.Results Ninety-four of 449 patients with salivary gland carcinoma treated by 125I seeds developed local and/or regional area recurrence.Of these,six patients failed in both local and regional area,77 patients failed in local area and eleven patients failed in regional area.The local and regional failure rate was 20.9％.The result of multivariate analysis showed that surgery,radiotherapy and matched peripheral dose were the protective factors(OR =0.458,0.297,0.982,P ＜ 0.05),while age and TNM stage were the risk factors(OR =1.250,1.483,P ＜ O.05).Conclusions The local and regional failure rate was 20.9％.Surgery,radiotherapy and matched peripheral dose were the protective factors;age and TNM stage were the risk factors.

Objective:To explore and evaluate the accuracy, conformity, and clinical application value of digital surgical techniques in guiding 125I seed implantation in the brachytherapy of deep head and neck tumors. Methods:Twelve patients with deep head and neck tumors who received brachytherapy of radioactive 125I seed implantation were selected for the study.The locations of the implantation needles and seeds were designed based on CT images before the operation.A digital positioning model was built according to the treatment plan to accurately import the planned locations of implantation needles into the surgical navigation system.Meanwhile, an individualized puncture guidance template was designed and printed according to the patients′ facial profiles as well as the locations and directions of the implantation needles.During the operation, the template was put in place under the guidance of the navigation system and meanwhile, the implantation needle puncture and radioactive seed implantation were conducted under the joint guidance of the visual needle path and real-time implantation needle locations in the navigation system and template guidance holes.The locations of the implantation needle and the seeds were validated by CT scan and the dose distribution in target areas was calculated.Adverse reactions such as hematoma, pain, infection, nonunion of puncture sites, and tumor cell implantation were observed during and after the operation. Results:All 12 patients successfully received implantation needle puncture and radioactive seed implantation under the guidance of the digital surgical techniques, achieving excellent effects of real-time visualization guidance.Meanwhile, the locations and number of the implantation needles and seeds were consistent with the treatment plan and were distributed evenly.Furthermore, according to postoperative verification, D90 ranged from 83.7 Gy to 131.0 Gy, with an average of 107.5 Gy; V100 was 89.6%-99.3%, with an average of 94.6%, and V150 ranged from 40.2% to 58.9%, averaging 47.8%.No serious adverse reactions were observed during and after the operation. Conclusions:With digital surgical techniques, the surgical navigation system and 3D-printed individualized puncture guidance template jointly guided the implantation needle puncture and 125I seed implantation, improving the accuracy and conformity of the brachytherapy.Therefore, they have clinical application value in head and neck brachytherapy, especially in deep areas with complex anatomical structures.

Objective To investigate radiation-induced carotid and cerebral vascular injury and its relationship with radiation-induced temporal lobe necrosis in nasopharyngeal carcinoma (NPC) patients.Methods Fifty-eight NPC patients with radiation-induced temporal lobe necrosis (TLN) were recruited in the study.Duplex ultrasonography was used to scan bilateral carotid arterials to evaluate the intima-media thickness (IMT) and occurrence of plaque formation.Flow velocities of bilateral middle cerebral arteries (MCAs),internal carotid arteries (ICAs) and basal artery (BA) were estimated through Transcranial Color Doppler (TCD).The result were compared with data from 33 patients who were free from radiation-induced temporal lobe necrosis after radiotherapy and 29 healthy individuals,to study the relationship between IMT,occurrence of plaque and ventricular diastolic dysfunction.Results Significant differences in IMT,occurrence of plaques of ICAs and flow velocities of both MCAs and ICAs were found between patients after and healthy individuals (t =18.624,8.221,P ＜0.05;x2 =17.886,P ＜0.05;t =14.367,10.112,P ＜0.05).IMT had positive correlation with post radiation interval (r =0.368,P =0.049).IMT or incidence of plaques may be related to dose of radiotherapy,course of treatment and T stage (x2 =-17.635,12.006,-3.125,P ＜ 0.05).Compared with result from patients without radiation-induced TLN,the mean IMT was significantly thicker in patients with TLN (t =10.208,P ＜ 0.05).Plaques were more common in patients with TLN than patients without TLN (x2 =13.118,P ＜0.05).In addition,flow velocities of MCAs and ICAs in patients with TLN were much faster (t =5.011,5.035,P ＜ 0.05).Among patients with unilateral TLN,flow velocity of MCAs was significantly different between ipsilateral and contralateral sides to the lesion (t =18.362,P ＜ 0.05).Conclusions Thickening of IMT,occurrence of plaque formation and hemodynamic abnormality are more common in patients after radiotherapy,especially in those with TLN,compared with healthy individuals.

Objective To discuss key points of prevention and treatment of perioperative pulmonary hypertensive crisis in patients with serious pulmonary arterial hypertension associated with ventricular septal defect. Methods Retrospectively analyzed the nursing experience of perioperative pulmonary hypertensive crisis on 31 patients with serious pulmonary arterial hypertension associated with ventricular septal defect from March to December during 2016.Among these patients,7 patients occurred pulmonary hypertensive crisis.The prevention contained avoiding oxygen lack,keeping pH alkaloid in the body, application of pulmonary vasodilator, deep sedation. Results A total of 30 cases survived the perioperative period, and were discharged from the hospital, one died. Conclusions The patients with serious pulmonary arterial hypertension had more risks during the perioperative period,the main cause of death was pulmonary hypertensive crisis during this time.So prevention of pulmonary hypertension crisis is the key point of postoperative nursing.

Objective To investigate the predicting value of Notch1 levels expressed in peripheral blood mononuclear cell (PBMC) for coronary artery calcification.Methods 300 consecutive patients with coronary artery disease (CAD) who hospitalizing in the department of cardiology in Guangzhou first people's hospital from January 2016 to June 2017 were enrolled.All Patients received 320-slice multi-detector row computed tomography scanning and coronary artery calcium sore(CCS)were measured.Patients were divided into three groups:control group (CCS =0),Low CCS group (CCS ＜97.6) and high CCS group (CCS ≥97.6) according to the mean value of CCS (CCS =97.6).Notch1 expressed in PBMC,serum interlekin-6 (IL-6) and high sensitivity C reactive protein (hs-CRP)of patients were examined and compared among three groups.Results The levels of Notch1 in PBMC and serum IL-6,hs-CRP of patients in high CCS group were significant higher than the other two groups [Notch1:7.02 ± 0.86 vs 6.32 ± 0.78 vs 5.49 ± 0.71;IL-6:(133.66 ± 10.18) μg/L vs (127.49 ± 10.79) μg/L vs (111.62 ± 9.87) μg/L;hs-CRP:(3.98 ± 1.02) mg/L vs (3.11 ±0.95)mg/L vs (2.56 ±0.76)mg/L] (P ＜0.05).The Spearman correlation analysis showed that the levels of Notch1 in PBMC were positive correlated with the levels of serum IL-6 and hs-CRP in enrolled patients with coronary calcification (P ＜ 0.05).Multivariate logistic regression analysis showed that the levels of Notch1 in PBMC and serum IL-6 were two strong independent risk factors for severity of coronary calcification in patients with CAD (P ＜ 0.05).Conclusions Notch1 expression in PBMC of patients with CAD was valuable to predicate the severity of coronary calcification.That the Notch1 signal path regulating the inflammation conditions in patients may be one of the most important mechanisms in the formation and progress of coronary calcification.

OBJECTIVE To compare the effects of post-aural injection of methylprednisolone and dexamethasone in flat-type sudden hearing loss.METHODS 142 patients with flat-type sudden hearing lossin our hospital were selected and divided into methylprednisolone group and dexamethasone group randomly.All patients in these two groups received local injection of glucocorticoidsoncein mastoid periosteum.Patients in methylprednisolone group were injected methylprednisolone solution;Patients in dexamethasone group were injected dexamethasone solution.The efficacy,hearing improvement of two groups were compared.RESULTS After the treatment,the recovery rate of methylprednisolone and dexamethasone group were 25.35％ and 16.90％,the total effective rate was 88.73％ and 63.38％,respectively;Each clinical index between two groups had statistically significant difference (P＜0.05);Moreover,the hearing improvement in methylprednisolone group was much better than dexamethasone group,withan averagedincrease of (26.5 ±4.3) dB in 125-250 Hz in methylprednisolone group while only (18.5 ± 6.2) dB in 125-250 Hz in dexamethasone group,which demonstrated statistical significantly difference(P＜0.05).CONCLUSION The clinical efficacy of local injection with methylprednisolone was better than dexamethasone,and demostrated mild adverse reactions,which could be widely applied in clinical therapy.