Surgical operation is the main treatment of oral and maxillofacial tumors.Dysphagia is a common postoperative complication.Swal-lowing disorder can not only lead to mis-aspiration,malnutrition,aspiration pneumonia and other serious consequences,but also may cause psychological problems and social communication barriers,affecting the quality of life of the patients.At present,there is no systematic evalua-tion and rehabilitation management plan for the problem of swallowing disorder after oral and maxillofacial tumor surgery in China.Combining the characteristics of postoperative swallowing disorder in patients with oral and maxillofacial tumors,summarizing the clinical experience of ex-perts in the field of tumor and rehabilitation,reviewing and summarizing relevant literature at home and abroad,and through joint discussion and modification,a group of national experts reached this consensus including the core contents of the screening of swallowing disorders,the phased assessment of prognosis and complications,and the implementation plan of comprehensive management such as nutrition management,respiratory management,swallowing function recovery,psychology and nursing during rehabilitation treatment,in order to improve the evalua-tion and rehabilitation of swallowing disorder after oral and maxillofacial tumor surgery in clinic.

Neck dissection(ND)is one of the main treatment methods for oral and maxillofacial malignancies.Although ND type is in con-stant improvement,but intraoperative peal-pull-push injury of the accessory nerve,muscle,muscle membrane,fascia and ligament induced shoulder syndrome(SS)is still a common postoperative complication,combined with the influence of radiochemotherapy,not only can cause pain,stiffness,numbness,limited dysfunction of shoulder neck and arm,but also may have serious impact on patient's life quality and phys-ical and mental health.At present,there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors.Based on the previous clinical practice and the current available evidence,refer to the relevant lit-erature at home and abroad,the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss,modify and reach a consenusus on the etiology,assessment diagnosis,differential diagnosis,rehabilitation strategy and prevention of SS,in order to provide clinical reference.

Objective To explore the construction method,evaluation system,and related indicators of the Qi Yin deficiency syndrome model of type 2 diabetes(T2DM)in Guizhou miniature pigs.Methods Twenty-six 6-month-old Guizhou miniature pigs were divided into 2 groups:pigs fed a basic diet for 10 months(normal group,n=6),and pigs fed a high-sugar,high-fat diet for 10 months followed by Qingpi Fuzi decoction for 3 months(Qi Yin deficiency in T2DM model group,n=20).Qi Yin deficiency in the T2DM model was created in Guizhou miniature pigs.Traditional Chinese medicine syndrome types were evaluated using five scales,including urination,defecation,movement and mental state,response to the surrounding environment,and color of the skin,hair,and nasal disc.Serum CD4+and CD8+and their ratios,cAMP and cGMP and their ratios,as well as tongue RGB color values were used to evaluate Qi Yin deficiency syndrome.Fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),glucose tolerance test(OGTT),homeostasis model assessment of insulin resistance(HOMA-IR),triglycerides(TG),total cholesterol(TC),high-density lipoprotein-cholesterol(HDL-C),low-density lipoprotein-cholesterol(LDL-C),prothrombin time(PT),activated partial thromboplastin time(APTT),and other indicators were used to evaluate T2DM.Results Physically,the model group pigs were overweight and showed fatigue,with a tendency to lie down,lethargy,overeating and drinking,and dull fur.The defecation,movement and mental state,response to the surrounding environment,and color of the skin,fur,and nasal disc scores were relatively low(P＜0.05).The tongue appeared red with no or little coating.Pigs in the model group showed significantly lower of FBG,HbA1c,HOMA-IR,TC,LDL-C,cAMP,and cGMP,compared with the normal group.The RGB values of the tongue images were significantly reduced.The PT,APTT,CD4+,and CD4+/CD8+values were also significantly reduced,and TG,HDL-C,and cGMP were all elevated(all P＞0.05).Pathological staining showed destruction of pancreatic tissue.Conclusions The method of using a high-sugar and high-fat diet combined with traditional Chinese medicine for breaking Qi and damaging Yin can be used to establish a small pig model of T2DM with Qi Yin deficiency.The established model shows the main symptoms of fatigue,thirst,shortness of breath and lethargy,redness and dryness of the tongue,lack of coating on the tongue,and a weak pulse in traditional Chinese medicine syndromes,as well as concurrent symptoms including yellow and transparent urine,dry stools,slow response,curling up,dull fur,and a gray and dull nasal disc,as well as clinical manifestations of abnormal glucose and lipid metabolism and insulin resistance.

Objective To explore the construction method,evaluation system,and related indicators of the Qi Yin deficiency syndrome model of type 2 diabetes(T2DM)in Guizhou miniature pigs.Methods Twenty-six 6-month-old Guizhou miniature pigs were divided into 2 groups:pigs fed a basic diet for 10 months(normal group,n=6),and pigs fed a high-sugar,high-fat diet for 10 months followed by Qingpi Fuzi decoction for 3 months(Qi Yin deficiency in T2DM model group,n=20).Qi Yin deficiency in the T2DM model was created in Guizhou miniature pigs.Traditional Chinese medicine syndrome types were evaluated using five scales,including urination,defecation,movement and mental state,response to the surrounding environment,and color of the skin,hair,and nasal disc.Serum CD4+and CD8+and their ratios,cAMP and cGMP and their ratios,as well as tongue RGB color values were used to evaluate Qi Yin deficiency syndrome.Fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),glucose tolerance test(OGTT),homeostasis model assessment of insulin resistance(HOMA-IR),triglycerides(TG),total cholesterol(TC),high-density lipoprotein-cholesterol(HDL-C),low-density lipoprotein-cholesterol(LDL-C),prothrombin time(PT),activated partial thromboplastin time(APTT),and other indicators were used to evaluate T2DM.Results Physically,the model group pigs were overweight and showed fatigue,with a tendency to lie down,lethargy,overeating and drinking,and dull fur.The defecation,movement and mental state,response to the surrounding environment,and color of the skin,fur,and nasal disc scores were relatively low(P＜0.05).The tongue appeared red with no or little coating.Pigs in the model group showed significantly lower of FBG,HbA1c,HOMA-IR,TC,LDL-C,cAMP,and cGMP,compared with the normal group.The RGB values of the tongue images were significantly reduced.The PT,APTT,CD4+,and CD4+/CD8+values were also significantly reduced,and TG,HDL-C,and cGMP were all elevated(all P＞0.05).Pathological staining showed destruction of pancreatic tissue.Conclusions The method of using a high-sugar and high-fat diet combined with traditional Chinese medicine for breaking Qi and damaging Yin can be used to establish a small pig model of T2DM with Qi Yin deficiency.The established model shows the main symptoms of fatigue,thirst,shortness of breath and lethargy,redness and dryness of the tongue,lack of coating on the tongue,and a weak pulse in traditional Chinese medicine syndromes,as well as concurrent symptoms including yellow and transparent urine,dry stools,slow response,curling up,dull fur,and a gray and dull nasal disc,as well as clinical manifestations of abnormal glucose and lipid metabolism and insulin resistance.

Objective:To investigate the pathological characteristics and the clinical significance of novel coronavirus (2019-nCoV)-infected pneumonia (termed by WHO as coronavirus disease 2019, COVID-19).Methods:Minimally invasive autopsies from lung, heart, kidney, spleen, bone marrow, liver, pancreas, stomach, intestine, thyroid and skin were performed on three patients died of novel coronavirus pneumonia in Chongqing, China. Hematoxylin and eosin staining (HE), transmission electron microcopy, and histochemical staining were performed to investigate the pathological changes of indicated organs or tissues. Immunohistochemical staining was conducted to evaluate the infiltration of immune cells as well as the expression of 2019-nCoV proteins. Real time PCR was carried out to detect the RNA of 2019-nCoV.Results:Various damages were observed in the alveolar structure, with minor serous exudation and fibrin exudation. Hyaline membrane formation was observed in some alveoli. The infiltrated immune cells in alveoli were majorly macrophages and monocytes. Moderate multinucleated giant cells, minimal lymphocytes, eosinophils and neutrophils were also observed. Most of infiltrated lymphocytes were CD4-positive T cells. Significant proliferation of type Ⅱ alveolar epithelia and focal desquamation of alveolar epithelia were also indicated. The blood vessels of alveolar septum were congested, edematous and widened, with modest infiltration of monocytes and lymphocytes. Hyaline thrombi were found in a minority of microvessels. Focal hemorrhage in lung tissue, organization of exudates in some alveolar cavities, and pulmonary interstitial fibrosis were observed. Part of the bronchial epithelia were exfoliated. Coronavirus particles in bronchial mucosal epithelia and type Ⅱ alveolar epithelia were observed under electron microscope. Immunohistochemical staining showed that part of the alveolar epithelia and macrophages were positive for 2019-nCoV antigen. Real time PCR analyses identified positive signals for 2019-nCoV nucleic acid. Decreased numbers of lymphocyte, cell degeneration and necrosis were observed in spleen. Furthermore, degeneration and necrosis of parenchymal cells, formation of hyaline thrombus in small vessels, and pathological changes of chronic diseases were observed in other organs and tissues, while no evidence of coronavirus infection was observed in these organs.Conclusions:The lungs from novel coronavirus pneumonia patients manifest significant pathological lesions, including the alveolar exudative inflammation and interstitial inflammation, alveolar epithelium proliferation and hyaline membrane formation. While the 2019-nCoV is mainly distributed in lung, the infection also involves in the damages of heart, vessels, liver, kidney and other organs. Further studies are warranted to investigate the mechanism underlying pathological changes of this disease.

Objective To compare the effects of different anesthetics on the recovery of neurologi-cal function after intracranial aneurysm embolization. Methods One hundred patients of both sexes with aneurysmal subarachnoid hemorrhage, aged more than 18 yr, with body mass index of 18. 5-24. 0 kg∕m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ and WFNS grade Ⅰ-Ⅳ, with the thick-ness of subarachnoid hemorrhage more than 4 cm, were divided into 2 groups (n= 50 each) using a random number table: propofol group (group P) and sevoflurane group (group S). After anesthesia induction, group P received intravenous infusion of propofol 100-300 μg·kg-1 ·min-1 , while the end-tidal sevoflu-rane concentration was maintained at 1. 4％-3. 5％ in group S. Immediately before induction (T0 ), imme-diately after the end of induction (T1 ), immediately after successful embolization of aneurysm (T2 ) and at 1, 2, 3 and 5 days after surgery (T3-6 ), central venous blood samples were collected for determination of plasma neuron-specific enolase and S100β protein concentrations by enzyme-linked immunosorbent assay. The development of postoperative cerebral vasospasm and delayed ischemic neurological deficit was recorded. The patients were followed up, and the Glasgow outcome score and occurrence of newly developed cerebral infarction were recorded within 6 months after surgery. Results There was no significant difference in the concentrations of plasma neuron-specific enolase and S100β protein at each time point, incidence of postop-erative cerebral vasospasm and delayed ischemic neurological deficit, or Glasgow outcome score and inci-dence of newly developed cerebral infarction within 6 months after surgery between two groups (P>0. 05). Conclusion Propofol and sevoflurane exert no effect on the recovery of neurological function after intracra-nial aneurysm embolization.

Objective To study the clinical value of vaccum sealing drainage in plasma cell mastitis.Methods 59 patients with plasma cell mastitis admitted in our hospital were treated with vaccum sealing drainage (the experimental group) from Jan.2011 to Apr.2014.59 plasma cell mastitis patients were treated with traditional vaseline gauze drainage (the control group).Clinical data like hospitalization length,healing time,healing grade,scar size,dressing change frequency,one year recurrence rate and breast deformity were retrospectively analyzed.Results Patients treated with vaccum sealing drainage had shorter hospitalization length and healing time,lower one year recurrence rate and less breast deformity compared to patients treated with traditional Vaseline gauze drainage (P＜0.01),while there was no significant difference in terms of healing grade (P＞0.05).Conclusions Vaccum sealing drainage can significantly shorten the hospitalization time and incision healing time,reduce dressing change frequency and one year recurrence rate in patients with plasma cell mastitis.Because of the smaller scar caused by vaccum sealing drainage,the breast deformity is also less.It is of clinical value for plasma cell mastitis.

Objective To explore the risk factors of bile leakage in patients with laparoscopic common bile duct exploration and primary suture for the purpose of providing clues for reducing occurrence of bile leakage.Methods The clinic data of 193 choledocholithiasis patients with laparoscopic common bile duct exploration and primary suture from October 2012 to March 2017 were retrospective analysed.All patients were divided into bile leakage group (23 patients) and non-bile leakage group (170 patients).Risk factors influencing the incidence of bile leakage were determined by analyzing 21 relevant factors with one-way analysis of variance and Logistic multivariate regression analysis.Count data and ordinal data was expressed as frequency or a percentage.Chi-square test was used to compare with groups of count data,rank-sum test was for comparison between groups of ordinal data,and Logistic regression was for multivariate analysis.Results Among all the patients,the incidence of bile leakage was 11.92％ (23/193).The results of univariate analysis revealed that cholangitis,jaundice,bile characteristics,muddy stone,number of stones,incarcerated stone,open and close peristalsis of duodenal papilla were correlated with bile leakage (x2/Z =2.537,2.122,81.834,50.709,13.242,26.958,90.207,P ＜0.05).The result of multivariate analysis revealed that bile characteristics,muddy stone,incarcerated stone,open and close peristalsis of duodenal papilla was correlated with bile leakage (Wals =14.002,8.899,6.577,5.582,P ＜0.05).Conclusion Bile characteristics,muddy stone,incarcerated stone,open and close peristalsis of duodenal papilla were main risk factors of bile leakage in patients with laparoscopic common bile duct exploration and primary suture.

The three‐dimensional digital substraction angiography (3D‐DSA) significantly elevated detection rate of intracranial small vessel aneurysms in recent years .It has become the novel gold standard diagnosing antracranial small vessel aneurysms .The present article made a review on 3D‐DSA value for diagnosis ,treatment and prognostic assessment of intracranial small vessel aneurysms .

Objective To retrospectively evaluate the safety ,technical success rate and long‐term efficacy of the hepatic mul‐tiple cavernous hemangioma with super selective arterial cheoembolization .Methods 6 cases multiple hepatic cavernous hemangio‐ma by clinical diagnosed between 2004-2011 years in our hospital ,Through arterial super selective and completely filling cheoem‐bolization by Pingyang mycin lipiodol emulsion(PYM‐Lip) ,To assess the long‐term efficacy .by multi slice spiral CT enhanced scan‐ning and carry on relevant statistics processing in postoperative 6 ,12 ,36months .Results 26 lesions were embolismed in 6 cases multiple hepatic cavernous hemangioma ,Among the number of successful embolization were 15 of 1 cases ,2 of 4 cases ,3 of 1 cases , respectively .26 lesions was decreased with different degrees ,which the diameter of lesions were reduced with embolismed by CT enhanced scanning in postoperative 6 ,12 ,36months and diameter reduced> 50% ,diameter reduced≤50% ,lesions disappear was 38% (10/26) ,54% (14/26) ,8% (2/26) ,62% (16/26) ,23% (6/26) ,15% (4/26) ,69% (18/26) ,12% (3/26) ,19% (5/26) .Technical operation success rate 100% ,not serious complications occurred .There are statistically significant differences in the size of lesions before and after operation(P<0 .01) .Conclusion The technique success rate was high ,minimally invasive ,the complications was less ,the curative efficacy was obvious by transcatheter arterial super selective cheoembolizaton with hepatic multiple cavernous he ‐mangioma .