The patient has complained of fullness in her right ear since she took a flight 5 years ago. Pure tone audiometry indicated normal hearing threshold and acoustic immitance proved type A tympanogram in both ears. She visited different doctors over and over again, with every doctor diagnosed her with psychogenic ear fullness. The patient was treated with vasodilative and neurotrophic medicine, together with psychotherapy, but her ear fullness didn't relieve. Three months ago she visited our department. Tubomanometry (TMM) can't find R value under 50mBar and ETS-7 score was zero in her right ear. Eustachian tube dysfunction was diagnosed and the patient was then given nasal decongestants, intranasal corticosteroids and myrtol for treatment. A month later the patient's symptom relieved and TMM showed R value less than 1 under 30mBar and EST-7 score was 14 in the right ear.
Audiometry, Pure-Tone ; Ear Diseases ; diagnosis ; physiopathology ; therapy ; Eustachian Tube ; physiopathology ; Female ; Humans

Objective To evaluate the effect of sevoflurane on left ventricular function in patients undergoing elective coronary artery bypass grafting (CABG) .Methods Thirty-five ASA Ⅱ or Ⅲ patients of both sexes (30 males, 5 females) aged 53-75 yr weighing 46-100 kg undergoing CABG were enrolled in this study. Transesophageal echocardiography (TEE) probe was placed. The TEE variables including cardiac index (CI), left ventricular short axis shortening (FS), left ventricular ejection fraction (LVEF), low propagation velocity ( Vp), E wave velocity (E) , A wave velocity ( A) , systolic wave velocity ( S) , diastolic wave velocity ( D), AR wave velocity, E/A ratio and S/D ratio were recorded before inhalation of sevoflurane (T_1 ) , and 5 min (T_2) and 15 rain ( T_3) after inhalation of sevoflurane after splitting of sternum, and before inhalation of sevoflurane (T_4 ), 5 min (T_5) and 15 min (T_6) after inhalation of sevoflurane after the closure of sternum. The end-tidal concentration of sevoflurane corresponded to 1 MAC. Anesthesia was induced with midazolam 0.05 nig/kg, sufentanil 0.5μg/kg and rocuronium 0.9 mg/kg and maintained with infusion of propofol at 4-6 mg·kg~(-1) ·h~(-1), remifentanil at 0.2-0.4μgkg~(-1)·h~(-1) and atracurium at 0.5 mg·kg~(-1)·h~(-1). The patients were mechanically ventilated after tracheal intubation (V_T 8 ml/kg, RR 12 bpm, I:E 1:2, FiO_2 70%-80% ) .Results (1) MAP and CI were significantly decreased at 5 and 15 min after sevoflurane inhalation. LVEF and FS were also decreased. (2) There was no significant change in diastolic function indexes after sevoflurane inhalation including E and A wave velocity, systolic wave velocity, diastolic wave velocity, E/A ratio and S/D ratio. (3) Cardiac function improved after CABG. CI, LVEF and FS were significantly increased after CABG as compared with preoperative values. Conclusion In patients undergoing elective CABG, sevoflurane (the end-tidal concentration corresponding to 1 MAC) can depress left ventricular systolic function but does not affect left ventricular diastolic function.

Objective To investigate the effect of montelukast sodium chewable tablets on pulmonary function in children with allergic asthma . Methods 86 cases of children with allergic asthma were randomLy divided into 2 groups, 43 cases in the control group were treated with routine clinical treatment, 43 cases in the experiment group received more with montelukast sodium chewable tablets.Serum T lymphocyte subsets, IL-6, TNF-α, IL-4 concentration levels, as well as FVC, FEV1, PEF levels and clinical efficacy were compared of two groups pre-and post-treatment.Results Compared with pre-treatment, Serum CD4 +, CD4 +/CD8 +, FVC, FEV1 and PEF levels in 2 groups increased, serum CD8 +, IL-4, IL-6, TNF-a levels decreased, compared with the control group, serum CD4 +, CD4 +/CD8 +, FVC, FEV1, PEF level and the effective rate in the experiment group post-treatment were higher, serum CD8 +, IL-4, IL-6, TNF-αlevels and the ineffective rate were lower, the differences were statistically significant (P<0.05).Conclusion Montelukast sodium chewable tablets can effectively improve the imbalance of immune function in children with allergic asthma , improve lung function, and has good clinical efficacy.

Paroxysmal nocturnal haemoglobinuria ( PNH) is a clonal hematopoietic stem cell disease characterized by intravascular hemolytic anemia , pancytopenia and thrombosis .Although PNH is an non-malignant disease , its complications have very negative impacts on patient's quality of life .The most common serious complication is thrombosis formation .

Objective To study H.pylori infection and the changes of muco sal inflammation， atrophy and intestinal metaplasia in the different histolog ical types of gastric polyps. Methods Two hundred and seventy－ eight cases of gastric polyps(12.6％ ) from 2 203 gastric mucosal biopsy cases were histologic ally classified and examined for the presence of Helicobacter pylori,for degree and type of inflammation,mucosal atrophy and intestinal metaplasia. Results 53. 9％ gastric polyps were infected with H.pylori,in which faveolar polyp was the highest with an infective rate of 73.1％ .The changes of active inflammation,atr ophy and metaplaisa in gastric mucosa were frequently accompanied with H.pylori positive faveolar polyps almost as same as those in adenoma.The fundic gland pol yps were usually with low rate of H.pylori infection,and the changes of mucosal active inflammation,atrophy and metaplasia were seldom observed. Conclusions Fav eolar polyps,which are different from fundic gland polyp,may caused by H.pylori infection and are usually with the changes of mucosal active inflammation,atroph y and metaplasia.

Cerebellum connects with each part of the auditory pathway directly or indirectly, forming the anatomical basis for a cerebellar role in auditory process. Functional imaging studies and clinical observations provide more abundant support for this view. Tinnitus is one of the most common clinical manifestations when the auditory system is impaired and remains unsolved. Basic science researches in neurotransmitter chemistry and molecular biochemistry, together with functional imaging studies, indicate that cerebellum might contribute to the pathophysiology of tinnitus. In this review we summarize the current understanding of cerebellar role in auditory process and tinnitus.
Auditory Pathways ; Cerebellum ; physiopathology ; Humans ; Tinnitus ; physiopathology

ObjectiveTo determine ff the cardiac index (CI) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).MethodsForty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midasolam,sufentunil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.CI was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.ResultsBland-Altman comparison of FloTrac-Vigileo system and PAC:matching data of 258 measurements:CI (2.8 ± 0.6 ) L· min - 1 · m- 2,bias was 0.23 L* min- 1 · m - 2 and limit of agreement was ( - 0.57,1.02)L · min- 1 · m- 2,resulting in κ ＝ 0.546 and an overall percentage error of 28.6 ％.ConclusionCI values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.

Objective To investigate the drug resistance tendency of Klebsiella pneumoniae isolated from the clinical samples during 2012-2014 to provide reliable evidence for clinical treatment .Methods The Klebsiella pneumoniae strains isolated from the submitted specimens were collected and identified according to the national clinical test procedures ,and the drug sensitivity test was performed by using MIC method .The confirmation test of ESBLs was conducted by using K‐B method and the phenotype of carbap‐enemases producing was confirmed by using the improved Hodge test .Results Totally 410 strains of Klebsiella pneumoniae were i‐solated ,55 .87% of which were derived from sputum ,and the rest was derived from pus(9 .53% ) ,secretion(9 .47% ) and blood (8 .78% );Klebsiella pneumoniae was mainly originated from ICU ,respiration department and oncology department ,accounting for 16 .10% ,9 .02% and 7 .80% respectively ;the resistance rates of Klebsiella pneumoniae against imipenem was 0 .74% ,the resist‐ance rates of Klebsiella pneumoniae against ampicillin/sulbactam ,cafazolin ,cefepime ,cefotaxime ,cefatriaxone ,ceftazidine ,compound sulfamethoxazole were decreased year by year ,while which against amoxicillin/clavulanic acid showed the increasing trend as a whole .Conclusion Timely conducting the identification and drug susceptibility analysis on local Klebsiella pneumoniae and tracking its drug resistance trend can guide the rational and standardized use of antibacterial drugs ,reduces the pressure for selecting anti‐bacterial drugs in order to reduce the generation of drug resistant strains .

Objective To predict the effectiveness of gentamicin combined with trisodium citrate for locking solution in preventing catheter-related bloodstream infection.Methods This is a retrospective study,ten kinds of common pathogens in catheter-related bloodstream infections were selected from medical intensive care unit (n =9) and cardiac care unit (n =1) between July 2011 and July 2012,and the diffusion method was used to analyze the inhibitory effect of gentamicin combined with trisodium citrate against tested pathogens.Results When trisodium citrate was tested alone,a certain antimicrobial activity could be detected from 10％ trisodium citrate,only Staphylococcus aureus and Staphylococci haemolyticus were inhibited,and then Enterococcus faecium was inhibited by 30％ trisodium citrate.Compared with trisodium citrate,gentamicin showed stronger antimicrobial activity.Staphylococcus aureus,Staphylococci haemolyticus,Enterococcus faecium and Escherichia coli could be inhibited by 0.32 g/L gentamicin and the antimicrobial activity was enhanced by increasing concentrations.The maximum activity was in 5 g/L gentamicin with 7-17 mm diameters.However,the antimicrobial activity of gentamicin didn't increase when combined with trisodium citrate,especially in 4％ trisodium citrate,the Staphylococci haemolyticus was not inhibited by all of the combinations with any concentration of gentamicin.In 0.32 g/L gentamicin,only the combination with 50％ trisodium citrate could inhibit the four kinds of pathogens (Staphylococcus aureus,Staphylococci haemolyticus,Enterococcusfaecium and Escherichia coli) with 8-21 mm diameters,while in 1 g/L,2 g/L,and 5 g/L gentamicin,these pathogens could be inhibited by the combination with only 10％ trisodium citrate,and the diameters were 5-24 mm,12-27 mm,and 17-28 mm,respectively.Conclusion Based on the data,gentamicin combined with trisodium citrate lock solution may play an important role in preventing catheter-related bloodstream infections caused by Gram-positive bacteria and Escherichia coli.

Objective To determine if the cardiac index (Cl) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).Methods Forty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midazolam,sufentanil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.Cl was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.Results Bland-Altman comparison of FloTrac-Vigileo system and PAC:matching data of 258 measurements:Cl (2.8 ± 0.6) L·min-1 ·m-2,bias was 0.23 L·min-1 ·m-2 and limit of agreement was (-0.57,1.02) L·min-1 ·m-2,resulting in κ =0.546 and an overall percentage error of 28.6％.Conclusion Cl values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.