Objective To investigate the risk factors for sensorineural hearing loss (SNHL) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT).Methods From January 2012 to January 2013,29 patients with histopathologically confirmed NPC who received radiotherapy alone or concurrent chemoradiotherapy were included in this study.All patients underwent hearing tests,including pure tone audiometry and acoustic immittance measurement,before and after the IMRT.The cochlear doses for each ear were also collected for analysis.A prospective analysis was performed to investigate the relationship between cochlear dose and SNHL in patients with NPC,and the effects of other factors,including time after radiotherapy,chemotherapy,T stage,and age,were also analyzed.Results Of the 58 ears studied,6(10％) had low-frequency SNHL,and 17 (29％) had highfrequency SNHL.There were significant differences in mean cochlear doses between the patients who developed SNHL after radiotherapy and those who did not (left ears:46.1 Gy vs.35.5 Gy,P =0.006;right ears:45.0 Gy vs.35.8 Gy,P =0.009).When the mean cochlear dose was less than 44 Gy,only 15％ (6/38) of ears had high-frequency SNHL.The invasion of skull base bone was also a significant risk factor for SNHL(P =0.047),but age,chemotherapy,and time after IMRT were not significant risk factors.Conclusions The mean cochlear dose and invasion of skull base bone are significant risk factors for SNHL in patients with NPC after radiotherapy.It is recommended that the mean cochlear dose should be limited to 44 Gy to minimize the incidence of SNHL after IMRT.

Objective To investigate the clinical effect of minimally invasive reconstruction of coracoclavicular ligament with adjustable locking TightRope on treating Rockwood type Ⅲ acromioclavicular joint dislocation.Methods A retrospective case control study was conducted to analyze the clinical data of 62 patients with Rockwood type Ⅲ acromioclavicular dislocation admitted to the Traditional Chinese Medicine Hospital of Wuxi from January 2015 to January 2018.There were 34 males and 28 females,aged 18-71 years,with an average age of 43.7 years.Among the patients,32 were treated with minimally invasive reconstruction of coracoclavicular ligament with adjustable locking TightRope (TightRope group),and 30 with conventional double Endobutton technique (Endobutton group).The operation incision size,operation time,intraoperative blood loss,Constant-Murley score of shoulder joint function and postoperative complications were compared between the two groups.Results All patients were followed up for 6-14 months,with an average of 10.4 months.Compared with Endobutton group,TightRope group had smaller incision size [(1.6 ± 0.9) cm vs.(7.7 ± 2.6) cm],shorter operation time [(45.7 ± 21.1) minutes vs.(58.3 ± 16.7) minutes],and less bleeding during operation [(12.2 ±7.3) ml vs.(76.6 ± 12.2) ml],and the differences were statistically significant (P ＜ 0.05).The Constant-Murley scores of the two groups were significantly improved after operation (P ＜0.05),and there was no significant difference between the two groups in the Constant-Murley score 6 months after operation (P ＞ 0.05).In the Endobutton group,two patients had partial reduction loss of acromioclavicular joint caused by loosening of internal fixation,which was not dealt with because of no symptom,and one patient had coracoid fracture 1 month after operation which was treated with clavicular hook plate fixation.There was no related complication in the TightRope group.Conclusion For Rockwood type Ⅲ acromioclavicular joint dislocation,minimally invasive reconstruction of coracoclavicular ligament with adjustable locking TightRope shows the advantages of small incision,short operation time,and less bleeding,which is worthy of clinical application.

Objective To evaluate the feasibility of quantitative evaluation of fallopian tubes patency by the rising slope of pressure curve produced by bolus injection using a liquid diagnostic apparatus in the four-dimen-sional hysterosalpingo-contrast sonography. Methods A total of 205 patients with infertility were collected for four-dimensional hysterosalpingo-contrast sonography. In the examination,the contrast medium concentration,the liquid volume of the liquid diagnostic apparatus and the speed of the liquid were stationary calculated. The rising slope of the curve was calculated according to the real-time pressure curve produced by the contrast agent injection process. According to the hysterosalpingo-contrast sonography examination's results ,patients were divided into one side patency group,one side partial obstruction group and one side obstruction group. The correlation between the slope and the patency of the fallopian tube was analyzed by binary logistic regression. Results Binary logistic regression showed that the slope and fallopian tube patency had good correlation(all P < 0.05)between one side patency group and one side obstruction group,and also between one side partial obstruction group and one side obstruction group;but had no correlation between one side patency group and one side partial obstruction group(regression coefficient P>0.05,regression constant P=0.000). Conclusion The slope of pressure curve produced by four-dimensional hysterosalpingo-contrast sonography can be used to assess the patency of fallopian tubes quantitatively. It is a new auxiliary index for evaluating the patency of fallopian tubes.

Objective To observe the effect of transversus abdominis plane block(TAPB)combined with patients controlled intravenous analgesia(PCIA)on the analgesia of patients after splenectomy.Methods A retrospective study method was conducted.A total of 63 patients who underwent splenectomy+pericardial vascular dissection in the department of general surgery of Nanchang No.9 Hospital from January to December 2021 were selected as the study objects.The patients were divided into TAPB combined with PCIA group(33 cases)and alone PICA group(30 cases)according to different postoperative analgesia techniques,and the postoperative analgesia effect was compared between the two groups.Results There was no significant difference between the two groups in sex,age,height,body mass,Child-Pugh grade and American Society of Anesthesiologists(ASA)grade.The operation time,intraoperative blood loss and intraoperative blood transfusion volume in TAPB combined with PCIA group were increased compared with alone PICA group[operation time(minutes):85.0(32.5)vs.82.5(40.0),intraoperative blood loss(mL):500(300)vs.425(500),intraoperative blood transfusion(mL):400(300)vs.300(525)],the incidence of postoperative abdominal infection and incisional infection tended to decrease compared with alone PICA group[abdominal infection:18.2％(6/33)vs.20.0％(6/30),incisional infection:21.2％(7/330)vs.23.3％(7/30)],but there was no significant difference between the two groups(both P>0.05).The visual analogue score(VAS)decreased gradually over time in both groups,and VAS in TAPB combined with PCIA group was significantly lower than that in PICA group at 6,12,24,48 and 72 hours after operation[4.0(1.0)vs.6.0(3.0),3.0(2.0)vs.4.0(2.0),2.0(1.5)vs 3.5(1.5),1.0(1.0)vs.2.0(1.5),1.0(1.0)vs.2.0(2.0),all P<0.05],the total number of PCIA compressions in TAPB combined with PCIA group was significantly lower than that of alone PICA group(times:2.64±1.19 vs.3.67±1.67,P<0.05).Conclusion The analgesic effect of TAPB combined with PCIA after splenectomy and devascularization is better than that of PCIA alone.

Background Currently,there has been a gradual increase in the incidence of mental diseases,becoming a problem that has attracted great concern of the general public.Zhuhai is a core city of the Guangdong-Hong Kong-Macao Greater Bay Area,and the local government have attached great importance to the mental health of residents.The systematic study on the mental health has focused largely on pregnant women and medical workers,yet few are on the adult residents.Objective To investigate the prevalence and its influencing factors of anxiety and depression among adult residents in Zhuhai,so as to provide references for formulating targeted psychological intervention strategies.Methods From September 1 to December 1,2021,a cohort of 5 600 permanent residents aged 18 years and above in Zhuhai were selected through multistage sampling.All participants were subjected to complete Patients' Health Questionnaire Depression Scale-9 item(PHQ-9),Generalized Anxiety Disorder Scale-7 item(GAD-7)and National Mental Health Literacy Questionnaire based on Wenjuanxing software.Then Logistic regression was employed to identify the factors associated with anxiety and depression among the residents.Results Among the 5 600 residents,depressive symptoms were detected in 842(15.04％)residents and anxiety symptoms in 579(10.34％)residents.Logistic regression analysis yielded that female gender(OR=1.488),living in Doumen district(OR=1.942),junior college/undergraduate level(OR=3.602),postgraduate and above(OR=5.904),irregular meal pattern(OR=3.320),comorbid chronic diseases(OR=3.244),disqualification of self-assessment(OR=3.414)and disqualification of mental health skill(OR=2.131)were risk factors for depression symptoms,whereas age≥25 years old(of all age groups OR<1),monthly per capita income>20 000 yuan(OR=0.438)and exercising≥3 times a week(OR=0.431)were protective factors for depression symptoms.Age of 25～34 years old(OR=2.051),living in Jinwan district(OR=1.729)or Doumen district(OR=1.901),junior college/undergraduate level(OR=2.955),postgraduate and above(OR=6.662),irregular meal pattern(OR=2.741),comorbid chronic diseases(OR=3.535),disqualification of self-assessment(OR=3.325)and disqualification of mental health skill(OR=1.838)were risk factors for anxiety symptoms,while monthly per capita income of 6 001～9 000 yuan(OR=0.665)and exercising≥3 times a week(OR=0.572)were protective factors for anxiety symptoms.Conclusion The mental health status of adult residents in Zhuhai is affected by various factors,including gender,age,region of residence,education level,meal pattern,exercise frequency and chronic diseases.

Objective: To investigate the effects of milrinone on levels of inflammatory factors and liver and renal function after CPB in rheumatic heart disease patients for valve replacement. Methods: From January 2014 to January 2016, 80 patients received valve replacement in the Central Hospital of Chongqing Three Gorges were randomly divided into observation group and control group by block randomization grouping method, with 40 patients in each group.The patients in the observation group were pumped intravenously with milrinone 0.5μg·kg^-1·min^-1 for 72h after surgery, while the patients in the control group were not pumped.The serum levels of IL-6, IL-8, IL-10, TNF-α were detected by ELISA before operation and on 0d, 1d, 3d, 5d after operation, respectively.The levels of ALT, AST, Scr were also detected at the same time.Moreover, the time for operation, extracorporeal circulation, interruption, mechanical ventilation, ICU and hospital were also compared between the two groups. Results: The levels of TNF-α, IL-6, IL-8 and IL-10 increased immediately after operation in both groups[control group: (14.97±5.14)pg/mL, (52.45±10.37)pg/mL, (34.10±8.38)pg/mL, (32.27±8.45)pg/mL; observation group: (16.05±5.71)pg/mL, (54.39±8.56)pg/mL, (33.80±7.69)pg/mL, (31.48±5.94)pg/mL, t=-0.628, -0.644, 0.116, 0.342], and the peak values of TNF-α, IL-6 and IL-8 reached on the first day after operation in both two groups[control group: (52.07±10.18)pg/mL, (96.04±26.45)pg/mL, (91.14±18.28)pg/mL, (48.10±9.78)pg/mL; observation group: (50.37±12.98)pg/mL, (93.66±24.10)pg/mL, (83.16±16.28)pg/mL, (46.68±9.25)pg/mL, t=0.559, 0.295, 1.458, 0.473], and the peak value of IL-10 reached on the 3rd day after operation(t=-3.577), the differences were statistically significant on the 3rd day after operation[control group: (36.03±9.39)pg/mL, (59.56±14.38)pg/mL, (53.91±13.16)pg/mL, (85.55±16.49)pg/mL; observation group: (36.70±4.33)pg/mL, (36.20±3.85)pg/mL, (42.91±7.30)pg/mL, (101.33±10.81)pg/mL, t=-0.289, 7.017, 3.267, -3.577]. The levels of ALT, AST and Scr increased immediately after operation in both groups[control group: (38.51±5.12)U/L, (40.23±5.03)U/L, (62.27±5.02)μmol/L; observation group: (39.20±4.67)U/L, (39.6±4.94)U/L, (73.61±4.04)μmol/L, t=0.114, 0.243, 0.630], there were tatistically significant difference between the two groups on the 5th day after operation[control group: (61.45±5.27)U/L, (54.20±7.0)U/L, (86.45±9.01)μmol/L; observation group: (36.20±3.85)U/L, (34.85±7.12)U/L, (83.7±11.07)μmol/L, t=11.231, 9.224, 5.647], and on the fifth day, the levels of ALT, AST and Scr in the observation group dropped to normal, while only the level of Scr in the control group dropped to normal.There were no statistically significant differences in the time of operation, extracorporeal circulation, interruption, mechanical ventilation between two groups (t=0.267, 0.151, 0.187, 0.773, all P>0.05). However, there were statistically significant differences in the time of ICU and hospital [control group: (54.90±16.84)h, (14.35±3.01)d, observation group: (44.05±7.06)h, (10±1.86)d, t=8.149, 13.042, all P<0.05]. Conclusion Milrinone can obviously improve the inflammatory reaction in surgical trauma tissues caused by IL-6, IL-8, IL-10, TNF-α, and can protect liver, renal tissue from injury, moreover, it can decrease the incidence of postoperative complications and the length of hospital stay.