Objective To explore the feasibility and efficacy of windowing middle meatus maxillary sinus and the frontal recess of tears to treat complex maxillary sinus under the nasal endoscope.Methods Clinical data of 22 patients with complex maxillary sinus lesions were analyzed retrospectively,which were adopted by the approach surgical treatment of through windowing middle meatus maxillary sinus and the frontal recess of tears.In which varus papilloma in 11 cases,5 cases of fungal maxillary sinusitis,3 cases of hemorrhagic and necrotic polyps,recurrent nasal polyps in 3 patients.After operation,they were all taken CT or MRI examination.Nasal cavity and other sinus lesions were first removed,the maxillary sinus ostium were opened through the nasal passages.Then,the maxillary sinus lesions were removed by the frontal recess of tears operation.Results Through the treatment of postoperative nasal cavity irrigation,these cases were followed up for 6 to 18 months.All cases incisions were healed completely,sinus cavity epithelium and clinical symptoms disappeared gradually.No injuries of nasolacrimal duct and complications such as facial numbness.Conclusion The method of the nasal passages joint the frontal recess of tears to treat the complex maxillary sinus benign lesions is a worthy selection of surgical procedures.Its eye shot is open and convenient operation,it can remove maxillary sinus lesions thoroughly and has fewer complications.

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Objective To observe the efficacy and safety of peginterferon α-2a and entecavir treatment in chronic hepatitis B(CHB)patients with alanine aminotransferase(ALT)＜2×upper limit of normal(ULN)and hepatic inflammatory activity(G)≥2.Methods 0ne hundred CHB patients with ALT＜2×ULN and G≥2 were enrolled in the open-label and control study. Fifty patients were treated with peginterferon α-2a including 34 hepatitis B e antigen(HBeAg)positive cases and the other 50 patients were treated with entecavir including 33 HBeAg positive cases.The patients were evaluated at week 48 of treatment. The data were analyzed using variance test,t test,Wileoxon test and X~2 test. Results Baseline levels of hepatitis B virus(HBV)DNA,ALT, HBeAg, hepatitis B surface antigen(HBsAg)and hepatic histology were comparable in peginterferon a-2a group and entecavir group. At week 48 of treatment, HBV DNA negative rates in the 2 groups were 66.0% and 72.0%,respectively(X~2=0.421,P=0.517);HBV DNA levels decreased(3.08±1.43)lg copy/mL and(3.79±1.36)lg copy/mL, respectively(t=2.544,P=0.013).Five(10%)patients in peginterferon α-2a group achieved HBsAg loss, while only 1(2.0%)in entecavir group(X~2=2.837,P=0.204);three(6%)patients in peginterferon α-2a group achieved HBsAg seroconversion, while no one in entecavir group(X~2=3.093,P=0.242).Fourteen(41.2%)HBeAg positive patients in peginterferon α-2a group achieved HBeAg loss and seroconversion,while 5(15.2%)HBeAg positive patients in entecavir group achieved HBeAg loss and 4 of them(12.1%)obtained HBeAg seroconversion (X~2=5.583,P=0.018;X~2=7.159,P=0.007).Paired liver biopsies before and after treatment were done in 15 patients in peginterferon α-2a group and 14 in entecavir group. Eleven patients in peginterferon α-2a group and 9 in entecavir group achieved necroinflammatory improvement(Knodell score decline ≥2)at week 48 of treatment(X~2=0.277,P=0.599).Concusions CHB patients with ALT＜2×ULN and G≥2 treated with peginterferon α-2a could achieve virological response,serological response and histologic improvement with good safety. HBeAg seroconversion rate in patients treated with pegintert'eron α-2a is much higher than that in patients treated with entecavir.

Objective To compare the efficacy of peginterferon (Peg-IFN) α-2a in HBeAg positive chronic hepatitis B (CHB) patients with mildly elevated alanine aminotransferase (ALT) level [ALT＜2× upper limit of normal (ULN)] and active hepatic inflammation(G≥2).Methods Fiftyfive HBeAg positive CHB patients with mildly elevated ALT (＜2×ULN) and active hepatic inflammation (G≥2) were enrolled in this randomized,open-label,controlled study.These patients were treated with either Peg-IFN α-2a 180 μg once weekly (n=27) or entecavir 0.5 mg once daily (n=28) for 48 weeks.The data were analyzed using chi-square test and t test.Results After 24 weeks of treatment,8 cases (29.6%) achieved HBeAg loss and 6 cases (22.2%) achieved HBeAg seroconversion in Peg-IFN α-2a group while none in entecavir group (χ2=9.71,P＜0.01;χ2=6.98,P＜0.0 1).Besides,two patients (7.4%) in Peg-IFN α-2a group achieved HBsAg loss.Compared with baseline level,the mean HBeAg titer at week 24 decreased (1 179.8±582.6) PEIU/mL in Peg-IFN α-2a group and (441.5±258.8) PEIU/mL in entecavir group (t=2.66,P=0.01),respectively.At week 24,the serum HBV DNA reduction in entecavir group was more dramatic than that in Peg-IFN α-2a group [(4.520±0.694) lg copy/mL vs.(3.520±1.442) lg copy/mL,t=2.45,P=0.029].In PegIFN α-2a group,the rate of HBeAg loss in patients with G=3 was higher than that in patients with G=2 (χ2=4.23,P=0.041).Conclusions Twenty-four-week treatment with Peg-IFN α-2a is more effective in term of HBeAg loss,HBeAg seroconversion and HBeAg titer reduction than entecavir,while entecavir is more effective in term of serum HBV DNA reduction.Patients with higher baseline hepatic inflammatory activity scores are more possible to achieve HBeAg loss when treated with Peg-IFN α-2a.

Objective To study effect of nasal tolerance with rat-derived 97-116 peptide of AChR α-subunit(Rα97-116(V108A))on the manifestation of muscle weakness and the immunity function of experimental autoimmune myasthenia gravis(EAMG).Methods Twenty-two EAMG model Lewis rats immunized thrice with Rα97-116(V108A)were divided randomly into tolerance group and control group.They were respectively immunized with Rα97-116(V108A)and PBS buffer solution for 10 days via nasal mucous.Then the body weight and Lennon score of two group Lewis rats were measured.Their serum anti-AChR antibodies were tested by ELISA,the expression levels of CD28,CTLA4,B7-1 and B7-2 were determined by flow cytometry.Results Compared with control group at different time points.the body weight of tolerance group rats(tolerance group(228.1±5.8)g,control group(215.0±16.2)g,t=2.395,P＜0.05)increased,the mean clinical score of rats(tolerance group 1.55±0.44.control group 2.10±0.66,t=-2.20,P＜0.05)decreased and the amount of serum anti-AChR antibody(tolerance group 0.97±0.20,control group 1.27±0.26,t=-2.857,P＜0.05)decreased obviously.the amount of CD28,B7-1,B7-2,CTLA4(%)expressed on the surface of peripheral blood cells(tolerance group:27.35±7.05,4.73±0.58,2.71±0.35,1.72±0.44,control group:40.02±8.81,9.52±1.25,5.88±1.09,2.64±0.47)down-regulated markedly(t=3.479,10.861,8.755,4.403,all P＜0.01).Conclusion Nasal mucous tolerance with Rα97-116(V108A)could ameliorate muscular weakness of EAMG rats while activates T cell and inhibits B cellular immunity.

Objective To evaluate the correlation between occupational exposure and work intensity of health care workers(HCWs)in an infectious diseases hospital for 5 consecutive years,and provide reference for occupational precaution.Methods Occupational exposures cases reported between January 2010 and December 2014 were ana-lyzed retrospectively,occupation types,exposure routes,and exposure sources were analyzed.Results A total of 228 cases of occupational exposure were reported,nurses and doctors were the major exposure population(75.44%and 19.30% respectively);occupational exposure mainly occurred during the infusion process(52.19%);hepatitis B was the main exposure source (71 .05%),followed by human immunodeficiency virus (10.09%).The Pearson correlation coefficient between the occupational exposure rate of doctors and the ratio of doctors to patients was-0.849 (P <0.05),and for nurses,the correlation coefficient was -0.823 (P <0.05 ).Conclusion Nurses are high risk population of occupational exposures,occupational exposure is most likely to occur during transfusion process,occupational exposure of doctors and nurses has a strong correlation with the work intensity.

Objective To investigate the polypropylene mesh used transvaginal Mesh for improve clinical efficacy and benefit the quality of life of pelvic organ prolapse( POP) .Methods 80 patients with POP were randomly divided into A group and B group,40 cases in each group.A group received vaginal mesh suspension surgery for treatment,B group used traditional vaginal hysterectomy and vaginal wall repair for treatment.The operation situations of the two groups preoperation and postoperation, the quality of life after 6 months were compared.Results In A group,the operative time[(83.32 ±21.34)min],blood loss[(87.43 ±33.52)mL],retention catheter time[(3.23 ± 0.54)d],postoperative hospital stay[(5.32 ±0.69)d]were significantly less than those in group B[(1 084.34 ± 27.88)min,(98.65 ±12.43)mL,(2.9 ±0.87)d,7.97d](all P<0.01),and the physiological function,physical function,bodily pain,general health,vitality,social functioning and mental health and other seven dimensions of A group were significantly improved,compared with group B(P <0.01).Conclusion Trans -vaginal Mesh has obvious therapeutic effect and improves patients'living quality on POP.It is worthy of clinical application.

Objective To investigate the safety,feasibility and effectivity of laparoscopic left hemihepatectomy for left hepatolithiasis.Methods From Jan.2005 to Dec.2013,36 patients with left hepatolithiasis underwent laparoscopic left hemihepatectomy (group LH),in comparison with 39 other patients who underwent conventional open left hemihepatectomy (group OH).The blood supply to left liver was dissected and cut off first.The liver parenchyma was transected and the left hepatic vein was dissected and clamped.Intraoperative choledochoscopy was carried out through the stump of left bile duct,laparoscopic choledocholithotomy and T-tube drainage were carried out when stones were found in the common or right bile duct.Blood loss,rate of residual stone,complication rate between the two groups were compared.Results The success rate of operation was 100％.Compared with group OH,group LH had shorter postoperative hospitalization,less incision infection and fewer analgesia needed(t =3.75,x2 =4.11,x2 =22.12,P ＜0.05).There was no statistical difference for blood loss,rate of transfusion,and postoperative complications such as bile leakage,pleural effusion,ascites,residual stones (t =0.66,x2 =0.70,x2 =0.01,x2 =0.52,x2 =0.01,x2 =0.28,x2 =0.01,P ＞ 0.05).Conclusions Laparoscopic left hemihepatectomy is safe,feasible,and effective for hepatolithiasis of the left liver lobe.

Objective To explore the efficacy of modified uvula palatopharyngeal plasty in the treatment of obstructive sleep ap-nea syndrome(OSAHS) .Methods 145 cases of OSAHS patients were treated from June 2006 to June 2010 in our hospital ,of which 54 were treated by traditional UPPP surgery ,and the remaining 91 cases were treated by h-UPPP surgery .Compared its effi-cacy by the preoperative and postoperative polysomnography map (PSG) analysis .Results In 145 cases of patients with OSAHS , the PSG monitoring indicators of 1 year after surgery were compared with preoperative ,and there were significant difference in the apnea total time(AI) ,the breathing hypopnea index(AHI) ,the lowest oxygen saturation(SaO2 )(P<0 .05) .The subjective symp-toms in postoperative recovery process of modified UPPP ,such as dry throat ,open nasal ,nasopharyngeal reflux symptoms were sig-nificantly reduced than that of traditional UPPP surgery .Conclusion h-UPPP surgery have a good effect .

Objective To study the relationship between ultrasonographic appearance of the endometrium and the blood flow of uterine artery,ovarian stroma and VEGF in the spontaneous ovulating cycle.Methods A total of 30 women with normal ovulating function participated in this study.On the day of positive urinary LH,the subjects were divided into three groups(A,B and C) according to Gonen's criterions of endometrial echogenic patterns.The peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI) in uterine arteries and ovarian stromal vessels were measured with transvaginal color Doppler ultrasonography;follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E_(2)) and progesterone(P) were assessed by fluoroimmunoassay;and vascular endothelial growth factor(VEGF) was assessed by Enzyme-linked immunosorbent assay on the third day of the cycle,the pre-ovulating phase,and the 6～7 day after ovulation.Results ① During the pre-ovulatory phase uterine arteries and ovarian stromal blood flow PSV in group A was significantly higher than that in group C(P0.05).Conclusion Lower receptivity in the hyperechogenic endometrium may be related with corpus luteum defection and disorder of the uterine blood vessel activities.