Objective To investigate the effect of obstructive sleep apnea syndrome(OSAS)on nocturnal ambulatory blood pressure monitoring results in older adults without cardiovascular or cerebrovascular diseases,and to identify factors causing fluctuations in nocturnal blood pressure in older adults with OSAS.Methods A total of 169 older adult OSAS patients with no history of cardiovascular or cerebrovascular diseases were enrolled.According to their severity of OSAS,the participants were divided into 4 groups,including a normal OSAS group,a mild OSAS group,a moderate OSAS group,and a severe OSAS group.The baseline characteristics of the 4 groups were compared to identify differences.The relationship between polysomnography parameters and nocturnal ambulatory blood pressure monitoring results and the factors causing nocturnal blood pressure fluctuations in older adults with OSAS were further analyzed.Results The nocturnal blood pressure fluctuation(NBPF)index of the normal OSAS group,the mild OSAS group,the moderate OSAS group,and the severe OSAS group were 1.89±1.58,3.35±5.40,3.90±6.40,and 16.60±27.70,respectively,indicating that the NBPF index gradually increased with the increasing severity of OSAS(P＜0.05).According to findings from the partial correlation analysis,the NBPF index was positively correlated with apnea-hypopnea index(AHI),micro-awakening index(MAI),percentage of cumulative time with oxygen saturation under 90％in the total sleep time(TS90％),oxygen desaturation index(ODI),and the longest apnea time(LAT)(P＜0.05),and negatively correlated with the lowest oxygen saturation(LSpO2)and sleep quality index(SQI)(P＜0.05).The mean nocturnal systolic and diastolic blood pressures were positively correlated with AHI,ODI,and TS90％(P＜0.05).A multi-factor regression analysis showed that every time ODI increased by 1 unit,the NBPF index increased by 0.26 units(β=0.26;95％CI,0.03-0.50;P=0.030),and every time TS90％increased by 1 unit,the NBPF index increased by 26.78 units(β=26.78;95％CI,2.47-51.08;P=0.031).Conclusion In older adult OSAS patients without cardiovascular or cerebrovascular disease,fluctuations in blood pressure at night become more pronounced with increasing disease severity.ODI and TS90％are important factors that affect nocturnal blood pressure fluctuations.

Objective To investigate MRI features of cystic oligodendrocytoma.Methods MRI features of 10 patients with oligodendroglial tumors proved with operation and pathology were analyzed retrospectively.Results Among 10 patients,lesionslocated on the supratentorium in 8 patients,while on the cerebellar vermis in 2 patients.Solitary lesion was found in 9 cases,and multiple lesions were found in 1 case.Complete cystic lesions were observed in 4 cases,large cystic lesions with solid nodules were found in 3 cases,and multi-cystic lesions were found in 3 cases.Smooth cyst wall of lesions were found in 7 cases,locally depressed and rough wall were found in 3 cases.Calcifications were found in 3 cases.Mild peritumoral edema was found in 9 cases,moderate to severe edema was found in 1 case.The lesions significantly enhanced in 3 cases,ring enhanced in 3 cases,and locally enhanced in 1 case.Conclusion COD is difficult to diagnose,but has certain MRI characteristics.COD should be considered when supratentorial complete cystic lesion or large cystic lesion with septum and/or solid nodule was found with MRI.

Objective To evaluate the effect of the clinical nursing path integrated with the holistic nursing on advanced schistosomiasis patients with ascites. Methods A total of 226 advanced schistosomiasis patients with ascites were randomly di?vided into a control group and an experimental group (113 cases each group). The subjects in the experimental group were nursed by the clinical nursing path integrated with the holistic nursing,while those in the control group were nursed only by the holistic nursing. Then the clinical relevant indexes of the two groups were observed,and the quality of life of the patients before and after hospital discharge was assessed. Results The improvement rate,satisfaction degree,and awareness rate of health knowledge of the patients in the experiment group were 93.8%,100%and 97.4%,respectively,which were significantly higher than those of the control group(all P<0.05). The mortality rate and the complication rate of the patients in the experimental group were 0 and 2.7%,respectively,which were significantly lower than those of the control group(both P<0.05). In addi?tion,the average hospitalization days and the hospitalization cost of the experiment group were(12.2 ± 0.7)d and(4 725.0 ± 310.1)Yuan respectively,which were less than those of the control group(both P<0.01). When 6 months after the discharge from hospital,the quality of life of the patients in the experimental group in various fields was significantly better than that of the control group(all P<0.05). Conclusions The clinical nursing pathway integrated with holistic nursing can effectively improve the improvement rate and decrease the mortality of the advanced schistosomiasis patients with ascites;meanwhile,it can short?en the hospitalization time and save the hospitalization cost. Therefore,this nursing model is suitable for popularization and ap?plication in the treatment and nursing work of the advanced schistosomiasis assistance.

Objective To develop a Jingcen DY?1 type spraying tanker for Oncomelania hupensis snail control and evaluate its effect of field application as well as the cost. Methods The currently available tractor was used as a vector,and the mechan?ical and electrical equipments and containers were integrated with shafts,pipelines and electric lines to produce a spraying tank?er for snail control,with the functions of carrying people and molluscicides,generating electric power and getting water,mixing stocking solutions,adjusting molluscicide solutions evenly,and spraying drugs. The volume of the molluscicide solution,flow rate of water injection,and the flow rate,range and advance speed of the spray gun were tested,and the solution concentrations of molluscicide in the tanker and at the muzzle of the spray gun at different time were detected. Meanwhile,the molluscicidal ef?fect and cost of the spraying tanker were analyzed by the field test. Results The volume of the liquid storage pot of the Jingcen DY?1 type spraying tanker was 1 800 L,the flow rate of water injection was 400 L/min,the flow rate and the spray range of the standard spray gun were 110-200 L/min and 19.70-23.50 m,respectively,the efficiency of drug spraying of the spraying tanker was 6 000 m2/h,and the ratio of spray width(m)to march speed(m/min)was 1∶200. When 5 min post mother liquid recirculat?ing ,the average concentration of the molluscicide at the upper? ,middle? and lower?layers of the liquid storage pot was (1 030.39 ± 43.00)mg/L,with a variation coefficient of 4.17%. The average concentration of the molluscicide in the spraying process(spraying for 2,4,6,8,9 min)was(953.00 ± 68.87)mg/L,with a variation coefficient of 7.22%. The concentration of the residual drug in the liquid storage pot post spraying was 1 000.43 mg/L,which reached the effect concentration for snail con?trol. After spraying for 7 days in the field,the average density of living snails reduced by 88.20% as compared to that before spraying,and the adjusted mortality of snails was 87.65%. The unit cost of Jingcen DY?1 spraying tanker was 0.086 7 Yuan/m2, which reduced by 58.20% as compared to that of the conventional spraying tanker. Conclusions Jingcen DY?1 type spraying tanker for snail control which integrates various equipments together can effectively control the concentration and dose of the mol?luscicide,and the machine is labor?saving,efficient,economic and well adapted,and is worthy to be widely applied.

Objective To observe the Oncomelania hupensis snail control effects of molluscicides with different formula?tions in the ditch with unstable water level in field of marshland and lake areas,so as to provide the evidence for formulating the prevention strategies. Methods A drainage channel with O. hupensis snails in Jiangling County,Jingzhou City were selected as the study field,then it was divided into 6 segments,except 1 segment was treated as the blank control group for observing the natural mortality rate of the snails,the other 5 segments were treated as observation groups,where 4% niclosamide ethanol?amine salt powder,5%niclosamide ethanolamine salt granule,25%suspension concentrate of niclosamide ethanolamine salt, 26% suspension concentrate of metaldehyde and niclosamide ethanolamine salt,50% niclosamide ethanolamine salt wettable powder were applied respectively. Before and after the mollusciciding,the snail surveys were carried out through the systematic sampling method,and the short?and long?term effects of snail control were observed,and the mortality rates of the snails on the slope above the water level and those below the water level were compared. Results When 7 d and 15 d after mullusciciding, the mortality rates of snails on the slope above the water level in each observation group were 79.52%-97.87% and 90.43%-96.30%,respectively,when compared with those before mollusciciding,all the differences were statistically significant(all P<0.01). When 7 d after mullusciciding,the mortality rates of snails below the water level in each observation group were 17.11%-50.00%,which were all lower than those of the snails on the slope above the water level in the corresponding groups(all P<0.05);when 15 d after mullusciciding,the rates were 9.43%-95.24%,and those in 25%suspension concentrate of niclosamide ethanolamine salt,26%suspension concentrate of metaldehyde and niclosamide ethanolamine salt,50%niclosamide ethanol?amine salt wettable powder groups were all lower than those of the snails on the slope above the water level in the corresponding groups(all P<0.01). Compared with the densities of living snails before mollusciciding,those 6 months after mollusciciding in each observation group decreased by 70.21%-78.98%. Conclusions The molluscicides in the formulation of powders and granule are suitable for both the snail environment with or without water,while those in the formulation of suspension agents and wettable powders are suitable only for environments with water.

OBJECTIVETo investigate the application of microsurgical technique in the replantation of amputated ear.

METHODS7 cases of amputated ears were analyzed from June 2009 to April 2015 in our department. We used microsurgical technique to anastomose about five vessels and nerves. The blood supply of auricle was restored within three to six hours. All subjects underwent treatments including anti-freezing, anti-spasm and anti-infection treatment after the emergency surgery.

RESULTS7 amputated ears were all survived after replantation. The patients were followed up for one month to six months ( average for 28 months). The appearances of survived ears body were fully recovered without any significant atrophy or pigmentation. The sensory function of ears recovered to normal after 1 year.

CONCLUSIONSThe application of microsurgical technique in the replantation of amputated ear can expect the high success rate of ear replantation. However, skilled and high-quality anastomosis technique of small vascular are required.

Amputation, Traumatic ; surgery ; Anastomosis, Surgical ; methods ; Ear Deformities, Acquired ; surgery ; Ear, External ; blood supply ; innervation ; Graft Survival ; Humans ; Microsurgery ; methods ; Replantation ; methods

Objective To investigate the diagnosis of intracranial artery fenestration and its other vascular anomalies with CT angiography ( CTA ) . Methods The image data of 653 patients examined with head CTA and 39 patients diagnosed as intracranial artery fenestration in Zhongshan Hospital Affiliated to Sun Yat-sen University from January 2013 to January 2014 were analyzed retrospectively. The incidence, location,morphology of intracranial artery fenestration, and other vascular anomalies were analyzed. Results (1) In 653 patients,39 (5. 97%) with 41 artery fenestrations were detected. The detection rates of basilar artery fenestration was 3. 37% (n=22),vertebral artery fenestration was 0. 31% (n=2),anterior cerebral artery fenestration was 1. 22% (n =8),anterior communicating artery fenestration was 0. 61%(n=4),and middle cerebral artery fenestration was 0. 76% (n=5),respectively. The post-circulation fenestration was mainly convex lens type (66. 67%,n =17),the anterior-circulation fenestration was mainly fissure type (76. 47%,n=24),and there was significant difference (χ2=7. 411,P<0. 05). (2) In the 39 patients,22 complicated other vascular anomalies. Most of them were unilateral or bilateral fetal-type posterior cerebral arteries (n=10),and followed by aneurysms (n=5). The locations of 5 aneurysms were far from the fenestration,3 located in the communicating segment of internal carotid artery,1 in the top of basilar artery,and 1 in the M2 segment of bilateral middle cerebral arteries. Conclusion CTA can intuitively and clearly reveal the intracranial artery fenestration and other vascular anomalies. But there is no significant correlation between arterial fenestration and vascular anomalies.

Objective This study was carried out to investigate the effect of myocardial insulin resistance on expression of p38 mitogen-activated protein kinase (MAPK) in ischemic heart failure in rat.Methods Male sprague-dawley rats were subjected either to ligation of the left anterior descending artery (LAD) (n =24) or to sham operation (n =24).After two weeks,cardiac size and function were determined by echocardiography.Glucose and fatty acid (FAO) oxidation rates as well as insulin response were measured in the isolated working heart.The protein expression of p38MAPK was evaluated by Western blotting.Results The infarcted hearts were dilated and had a reduced ejection fraction (ejection fraction ＜0.50).The basal glucose oxidation was preserved,but the fatty acid oxidation was significantly reduced.Insulin effect on substrate oxidation was significantly impaired for both the decrease in fatty acid oxidation and the increase in glucose oxidation.The protein expression of p38MAPK in infracted hearts wasfisigni cantly reduced(P＜0.05).Condusion Myocardial infarction in rats caused partial insulin resistance at the level of substrate oxidation,which was associated with cardiac contractile dysfunction and the expression of p38MAPK.

OBJECTIVE: To investigate the effect of different malleus treatments on the postoperative efficacy in the tympanosclerosis patients receiving ossicular chain reconstruction. METHOD: Fifty-nine patients (62 ears) with tympanosclerosis were treated by ossicular chain reconstruction. All the patients were divided into three groups, including malleus removal group (A, 24 ears), retaining only the malleus handle group (B, 18 ears) and the intact malleus group (C, 20 ears). All the patients were followed up 3 months pre-operation, 3 months and 1 year post-operation by audiometric measurement (the average hearing threshold at 0.5, 1.0, 2.0 kHz HI). Tympanic membrane was examined by ear endoscope. RESULT: The pre-operation mean air bone gap (ABG) in these groups were 40.07 +/- 77.56 dB, 37.31 +/- 76.45 dB, and 36.75 +/- 76.72 dB, among which the difference had no statistical significance (P > 0.05). At 3 months after operation, the ABG in all cases was improved at 0.5, 1 and 2 kHz. The difference of ABG improvement among these three groups had no statistical significance (P > 0.05). One year after surgery, the ABG of the three groups were decreased by 17.92 +/- 9.28 dB, 16.76 +/- 5.19 dB and 10.58 +/- 7.38 dB respectively. The hearing improvement in group C is less than the other two groups (P = 0.03, P = 0.016). The difference of hearing improvement between group A and group B had no statistical significance(P > 0.05). Group A and group B each have one case of tympanic membrane perforation and artificial ossicle falling off. CONCLUSION The operating processes of malleus in ossicular chain reconstruction of patients with tympanosclerosis were introduced. In terms of short-term efficacy, the three groups showed no significant difference. However, the long-term efficacy of the patients in the group A and group B were better compared with the group C.
Adolescent ; Adult ; Female ; Humans ; Male ; Malleus ; surgery ; Middle Aged ; Myringosclerosis ; surgery ; Ossicular Replacement ; methods ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective To compare the image quality and patient radiation dose of coronary computed tomography angiography (CCTA) received by prospectively-gated step-and-shoot (SAS) technique with those obtained by retrospectively-gated spiral (RGS) technique on a 256-slice CT scanner. Methods A total of 200 patients were enrolled in this study. One hundred patients underwent CCTA with SAS mode were subdivided into two groups: ( 1 ) 50 patients with an average heart rate (HR) ≤70 bpm were scanned with a data acquisition time window centered at the 75％ of the R-R cycle ( group A) and (2) 50 patients with HR ＞ 70 bpm were scanned with the data acquisition time window centered at the 45％ of the R-R cycle, including a phase tolerance of ±％ (group B). Other 100 patients underwent CCTA with RGS mode and ECG-based tube current modulation were also subdivided into two groups: (3) 50 patients with HR ≤70 bpm were scanned with cardiac dose right set to phase of 75％ (group C) and (4) 50 patients with HR ＞ 70 bpm were scanned with cardiac ose Rdight set to phases of 45％ and 75％ (group D). All patients were grouped in randomized order. The image quality of CCTA were evaluated using a rank scale from 1 to 4 ( 1 : excellent ; 4 : non-assessable ) .Radiation dose of the four groups received was also estimated. The image quality between groups was compared by Mann-Whitney U test.The radiation dose between groups was compared by t test. For the 100 patients received by prospective ECG-gated CCTA, the receiver operating characteristic curve (ROC) was used to analyze the CCTA image quality and average heart rate to determine the uppercutoff of HR for obtaining diagnostic coronary images with SAS mode. A spearman correlation analysis was also performed to analyze the correlation of HR and image quality in patients underwent CCTA with SAS mode.Results Of 2338 coronary artery segments, excellent or good image quality( score of 1 or 2) was achieved in 96. 5％ (585 of 606) in group A, 77.7％ (445 of 573 ) in B,96. 1％ (548 of 570) in C, and 85. 7％ (505/589) in D, with no significant difference for A vs C(Z ＝- 1. 351 ,P ＞0. 05) and with significant differenceS for B vs D (Z＝ -2. 236,P ＜0. 05). Linear correlation analysis indicated a significant degradation of image quality with the increase of heart rate using SAS mode (Spearman correlation, r ＝ 0. 577, P ＜0. 01 ). ROC analysis established an upper HR threshold of 78 bpm for obtaining diagnostic image quality using SAS mode( AUC ＝ 0. 827, P ＜ 0. 05 ). The average radiation dose in group A [ ( 2. 6 ± 0. 5 ) mSv]reduced 75 ％ comparing with that in group C [ ( 10. 6 ± 2. 3 ) mSy], and the average radiation dose in group B [ ( 4.0 ± 0. 7 ) mSy]reduced 69％ comparing with that in group D [ ( 13.0 ± 1. 4) mSv]. ConclusionUsing SAS mode to perform low-dose CCTA with 256-slice helical CT could keep the image quality and reduce radiation dose significantly. Our preliminary experience suggests a good promise of this technique which could be applied to a wider group of patients such as with higher heart rates.