Objective To investigate the correlation between serum bone metabolism biomarkers and bone mineral density (BMD) in chronic kidney disease (CKD) patients with different stages. Methods Seventy-eight CKD patients were enrolled in this study and were assigned to different groups according to their ereatinine clearance (Cer). Patients with Cer ≥ 15 ml/min were divided into 4 groups based on clinical CKD 1-4 stage standard, and those with Ccr<15 ml/min were divided into two groups of hemodialysis (HD) and non-HD. Their levels of serum calcium, phosphorus, alkalinity phosphatase (ALP), urea, Ser, osteocalein (gla-protein, OC), calcitonin (CT), intact parathyroid hormone (iPTH), osteoprotegerin (OPG) and BMD were detected respectively. Results (1) The serum levels of OPG, iPTH and phosphorus increased significantly in stage 3, 4, 5, respectively (P<0.01), and serum OPG level was elevated to (5.1±1.34) ng/L after HD, which was significantly higher than (3.35±0.76) ng/L before HD (P<0.05). The levels of serum OC, CT, calcium, ALP were not significantly different among patients with different CKD stages, while the level of OC was elevated in HD patients (P<0.05). The femoral WARDS triangle BMD of CKD stage 4 patients decreased to 0.77±0.09, which was less than the value of CKD stage 1 patients (P<0.01), with litde influence from hemodialysis treatment. (2) The level of serum OPG was positively correlated with the levels of serum phosphorus, iPTH, OC (r = 0.51, 0.39, 0.36,all P<0.01), and it was negatively correlated with the level of Ccr (r =-0.70, P<0.01). The femoral WARDS triangle BMD was negatively correlated with the levels of iPTH, OC, phosphorus and OPG (r =-0.59,-0.51,-0.45,-0.48, all P<0.05). Conclusions Most of serum bone metabolism biomarkers change according to the declined level of Cer. Compared with serum phosphorus, the levels of iPTH, BGP and femoral WARDS triangle BMD, serum OPG may be early diagnosticmarkers of renal osteodystrophy in CKD patients.

OBJECTIVE: To summarize the experience of improving survival rate of microsurgical free flap transfers for head and neck reconstruction. METHOD: One hundred and seventy-nine consecutive microsurgical free flap transfers performed in patients with head and neck region defects after surgical procedure due to carcinoma were reviewed. The microsurgical free flap survival rate and postoperative complication were evaluated. RESULT: The overall success rate of flap was 98.9%. The overall complication rate was 7.8%. The flap crisis rate was postoperative flap crisis incidence rate was 4.4%. The success rate of immediate surgical exploration within 6 hours successfully rescued the flap in were 6 six cases, and the other else two cases cut died flap and repaired the region defect in the head and neck with pectoralis major myocutaneous flap. CONCLUSION Key factors in improving the succeess rate are to guarantee vascular anastomosis patency, to achieve a good haemostasis, and to promptly closely observe discover blood vessel flap crisis after operation in the first 6 hours and immediate surgical exploration.
Anastomosis, Surgical ; Carcinoma ; surgery ; Female ; Free Tissue Flaps ; transplantation ; Head and Neck Neoplasms ; surgery ; Humans ; Image Processing, Computer-Assisted ; Male ; Postoperative Complications ; Survival Rate ; Thigh

OBJECTIVE: To review the clinical manifestations and management of nasal sinus mucoceles invaded the skull base and orbit. METHOD: Medical records for 30 patients of paranasal sinus mucoceles invaded the skull base and orbit were reviewed retrospectively. CT and MRI were important tools for diagnosing nasal sinus mucocele. The patients received endoscopic surgery to remove mucocele, some of them were operated auxiliary incision. Steroid therapies were given after the operations and routine examination with endoscopy were carried out during follow-up. RESULT: All cases were successfully performed surgery without complications after the surgeries, or the majority of symptoms. However, vision recovery was observed only in some patients. Recovery of vision depended on the timing of surgery and severity of initial visual loss. Delay treatment can seriously compromise the recovery of vision impairment. Moreover, the patients without light perception before surgery had poor visual recovery even when optic nerve decompressions were performed. CONCLUSION Endoscopic surgery has effect on nasal sinus mucocele with visual loss. Because visual recovery depends on prompt diagnosis and surgical intervention,a good understanding of the disease and prompt imaging studies are important.
Adult ; Aged ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mucocele ; pathology ; surgery ; Orbit ; pathology ; surgery ; Paranasal Sinus Diseases ; pathology ; surgery ; Retrospective Studies ; Skull Base ; pathology ; surgery ; Young Adult

Objective To investigate the association of radial arterial calcification damage with bone mineral density (BMD) and bone metabolism biomarkers in uremia patients.Methods Sixty-seven incident hemodialysis patients were recruited into uremic group.Serum creatinine,calcium,phosphorus,lumbar spine and femoral neck BMD were measured.Parathyroid hormone (iPTH),25OHD,1,25(OH)2D,fibroblast growth factor (FGF) 23,bone specific alkaline phosphates (BAP) and osteocalcin (BGP),type Ⅰ collagen pyridine crosslinked C-telopcptidc (ICTP) were detected.Radial artery calcification was analyzed by von Kossa staining and transmission electron microscopy.Arterial type Ⅰ collagen (Col Ⅰ) expression was examined.Twenty-three healthy cases received serum and BMD examination only as control.Results Uremic patients presented higher serum phosphate,iPTH,FGF23,lower serum calcium,25OHD,1,25 (OH)2D (all P ＜ 0.05),and lower lumbar spine and femoral neck BMD (all P ＜ 0.01) compared to controls.Significant calcium deposit was observed in radial arteries in 24 uremic cases (35.8％),including 10 cases of diabetes.Immunohistochemistric assay confirmed that Col Ⅰ expression increased around calcification site and electron microscope revealed that more calcium and phosphorus plaque attached among collagen fibers.No correlation was showed between iPTH and radial artery calcification (r =-0.08,P =0.306),but after stratified by iPTH levels,correlation of iPTH and calcification was found in low iPTH (＜ 150 ng/L) group and high iPTH group (＞ 300 ng/L) (r =-0.41,0.31,P=0.044,0.023).Diabetes,lumbar spine and femoral neck BMD,ICTP,FGF23 were correlated with arterial calcification (r =0.62,-0.25,-0.43,0.34,0.86,P =0.000,0.001,0.012,0.018,0.000).Multiple regression analysis showed femoral neck BMD,ICTP,FGF23 levels were independently associated with radial arterial calcification (β =-0.221,0.181,0.260,P =0.021,0.024,0.036).Conclusion In uremic patients,reduced BMD,abnormal bone turnover rate,especially accelerated bone reabsorption,and increased serum FGF23 level are independently associated with radial artery calcification.

A method was developed for the determination of eight steroid hormones ( estrone, α/β-estradiol, estriol, testosterone, epitestosterone, progesterone and testosterone propionate ) in butter samples by gel permeation chromatography ( GPC) purification-followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The samples were first extracted by ethylacetate/cyclohexane (1:1, V/V) and the extract was later degreased by GPC column. Then, the GPC concentrate was separated using a C18 column ( 100 mm í2. 0 mm i. d. , 3. 0 μm) with gradient elution of acetonitrile/water. Finally, the steroid hormone components were qualitatively and quantitatively determined by mass spectrometer with electrospray ionization in multi reaction monitoring mode. Using matrix matched external standard method, good linearity in response could be obtained in the concentration range of 1 . 0-20 . 0 μg/kg with correlation co-efficiency larger than 0 . 999 . The detection limits of the method were 0. 04-0. 30 μg/kg and the quantification limit was 1. 0 μg/kg. At the spike levels of 1. 0, 2. 0 and 4. 0μg/kg, the recoveries of hormones were within the range of 64. 1%-110%, and the relative standard deviation ( RSD) was less than 11%. The results show that the method is accurate and reliable, and meets the requirements for determination of 8 steroid hormones in butter samples.

According to the trend of the development of the quality education, it is necessary to re-form the traditional homework assignments in medical microbiology for improving the innovation ability of students. This program attempts to reform the homework on clinical medicine undergraduates. First, the teacher must master diversified knowledge, and then the student design and finish the homework combine with personal characteristic from the training requirements of experimental confirmation, theoretical cognition and social survey. The questionnaire shows the personalized homework can help students to master the pro-fessional knowledge, stimulate study interest and improve the comprehensive quality.

Objective: To review the clinical data of patients who underwent maxillary and mandibular reconstruction with vascularized fibula osteomycutaneous flap, using virtual surgery planning. Methods: From January 2012 to December 2016, 23 patients with mandibular defect and 2 patients with maxillary defect were treated in our department. In virtual surgery planning, the optimal osteotomy line and angle were designed. Segmental maxillectomy and mandibulectomy, as well as mandibular reconstruction were performed using guided templates to practice the virtual planning.Actual reconstruction results were compared with those of virtual surgery. Results: Among the 25 patients, 2 patients were repaired with the ipsilateral fibula myocutaneous flap, 22 patients were lateral fibula myocutaneous flap. One case of maxillary type Ⅱd defect was repaired with left fibular muscle flap. All patients were followed up for 12 to 48 months. Satisfied bony unions and occlusion were observed in 25 patients.All patients reported excellent or good facial appearance. One of them received dental implants at 1 year postoperatively. Conclusions An ideal contour of maxilla and mandible can be obtained using vascularized fibula osteomycutaneous flap in virtual surgery.

OBJECTIVETo analyze the causes of the vascular crisis and necrosis of free flaps used for reconstruction of defects following head and neck cancer resection and the managements of these issues.

METHODSA total of 850 cases with head and neck tumors who underwent free flap reconstruction from October 2010 to April 2014 were studied retrospectively. The risks for vascular crisis and necrosis were analyzed with one-factor analysis and multivariate analysis.

RESULTSThe total success rate of 95.1% (808/850) for the free flap reconstruction was obtained. Twelve flaps due to poor blood supply indicated during operation were replaced by other free flaps. Among 73 flaps with vascular crisis, 31 flaps were salvaged by surgical exploration and subcutaneous injection of low molecular heparin calcium. Obesity, smoking, preoperative radiotherapy and surgeon's experience, rather than age, hypertension and diabetes, were the risk factors of skin flap necrosis. Two-vein anastomosis had a higher success rate than one-vein anastomosis.

CONCLUSIONSThe necrosis rate of free flaps can be reduced by the choice of suitable flaps, subtly preparation of flaps, carefully vascular anastomosis, and prompt perioperative managements. The two-vein anastomosis is recommended. Diabetes, hypertension and elderly patients are not the contraindications for free flap reconstruction.

Aged ; Free Tissue Flaps ; Head ; Head and Neck Neoplasms ; surgery ; Heparin ; Humans ; Necrosis ; etiology ; Postoperative Complications ; etiology ; Reconstructive Surgical Procedures ; Retrospective Studies ; Risk Factors ; Surgical Flaps