Internal fixation is one of the most important treatments for fractures.The stability of screws in internal fixation can be influenced by bone mineral density,quality of pilot holes,improper structure and surface characteristics of screws chosen,insertion torque,insertion angle,and screws unfit for the bone holes.Internal fixation of fractures can fail due to the instability of screws.This paper,on the basis of a comprehensive review of the studies on all the above factors influencing the screw stability,proposes effective methods to enhance screw stability so as to improve surgical outcomes of fracture internal fixation.

Objective: To explore the key technique and outcome of transoral radiofrequency ablation microsurgery for early stage of glottic carcinoma with anterior commissure involvement (ACI). Methods: A retrospective analysis was conducted on 31 patients, who were diagnosed as early stage glottic carcinoma during January 2010 to March 2016 in ENT Department. According to whether the anterior commissure was involved or not, two groups were divided. There were eleven cases with ACI (stages T1a, T1b, and T2). Twenty cases without ACI (stages Tis, T1a, and T2). All the patients received transoral radiofrequency ablation microsurgery and followed up closely.Only one case received radiotheraphy after surgery. SPSS19.0 software was used to analyze data. Results: The follow-up time was 12-67 months, and the median follow-up time was 30 months. Nine among 11 cases with ACI obtained good oncologic outcomes, initial local recurrence was identified in 2/11 cases, including 2 cases of T2. Two cases ultimately required salvage total laryngectomy. Meanwhile, initial local recurrence was identified in 2/20 cases without ACI, including 1 case of T1a and 1 case of T2. One case underwent elective neck dissection, and another one received salvage total laryngectomy.Compared to the patients without ACI, it seemed that the cases with ACI always accomponied with a little higher initial local recurrence and lower overall laryngealpreservation, but the difference had no significance (P>0.05). Conclusions Transoral radiofrequency ablation microsurgery is an effective treatment for glottic carcinoma with ACI. Its advantages, such as more flexibility and deformability, make it more feasible to operate at the narrow space of anterior commissure assisted with laryngeal endoscopy.Good oncologic outcomes can be obtained by this technique with lower initial local recurrence as well as higher overall laryngeal preservation rate.

OBJECTIVE: Analyze the data of the patients with sensorineural hearing loss in China and study the classification and incidence of inner ear malformationsby the high-resolution computed tomography. METHOD: The investigation took a retrospective review of CT findings relating to the 2,747 cases of outpatients. The inner ear malformations diagnosed by CT were classified according to the methods proposed by Sennaroglu. RESULT: (1)843 cases of inner ear malformations were found in 2747 cases of patients with sensorineural hearing loss by CT examination. The incidence of inner ear malformation was 30.69%(843/2747). (2) The epidemiological information of 843 cases of inner ear malformation according to Sennaroglu's classification was as follows: cochlea was 52. 31%(441/843), simple vestibular aqueduct was 40.33%(340/843), simple vestibular/ semicircular canal/internal auditory canal were 7. 35%(62/843) of the group. (3) 441 cases of cochlea malformation were consisted of these types of malformation: Michel deformity was 1.13% (5/441), cochlear aplasia was 1. 81% (8/441), common cavity deformity was 3. 17% (14/441), incomplete partition type I was 8. 62% (38/441), cochlea hypoplasia was 9. 07% (40/441) and incomplete partition type II was 76. 19% (336/441) of the group. CONCLUSION The results suggested that 30. 69% cases of inner ear malformation can be found in patients with sensorineural hearing loss, which is more higher than reported by the high-resolution computed tomography. Sennaroglu's classification is instructively significant in investigating the status of inner ear malformations.
China ; Cochlea ; Ear, Inner ; abnormalities ; Hearing Loss, Sensorineural ; etiology ; Humans ; Outpatients ; Retrospective Studies ; Semicircular Canals ; Temporal Bone ; Tomography, X-Ray Computed ; Vestibular Aqueduct ; Vestibule, Labyrinth

Objective To evaluate clinical value of utilization of real‐time fluorescence isothermal RNA amplification assay (SAT)for detecting Mycobacterium tuberculosis(MTB) in pleural effusion samples of patients with tuberculous pleurisy .Methods 90 hydrothorax specimens of patients with tuberculous pleurisy and 52 hydrothorax specimens of patients with non‐tuberculous pleurisy were selected ,and MTB was detected by using Roche culturing method ,SAT and TB DNA fluorescence quantitative expan‐sion method respectively .The sensitivity ,specificity and clinical value of SAT for detecting MTB were analysed .Results Taking Roche culturing method as the standard ,the sensitivity ,specificity and Youden index of SAT for detecting MTB were 90 .9% , 72 .1% and 0 .630 respectively .In patients clinically diagnosed with tuberculous pleurisy ,the positive detection rate of hydrothorax specimens detected by using Roche culturing method and SAT were 24 .4% and 43 .3% respectively ,and had statistically significant differences(χ2 =7 .166 3 ,P=0 .001 4) .Conclusion SAT is a rapid ,sensitive and specific method for the detection of MTB in pleu‐ral effusion samples ,which could improve the detection rate of MTB and decrease incidence of missed diagnosis and misdiagnosis .

OBJECTIVE: Explore the relationship between the pathogenic mutations of SLC26A4 gene and inner ear malformation, and analyze the feasibility of genetic testing to help current diagnosis in part of children with sensorineural hearing loss. METHOD: 2094 cases of children were detected by SLC26A4 with the method of DNA sequence. CT phenotypes of those children were classified according to the method proposed by Sennaroglu. We analyzed the relationship between the pathogenic mutations of gene and the CT phenotypes. RESULT: (1) 685 cases of inner ear malformations were found in 2094 cases of children with sensorineural hearing loss by CT examination (371 cases of cochlea malformation were consisted of the follow types of malformation. Michel deformity was 6 cases, cochlea aplasia was 8 cases, common cavity deformity was 12 cases, incomplete partition type I was 27 cases, cochlea hypoplasia was 30 cases and Mondini malformation was 288 cases); Vestibular aqueduct was 265 cases; Vestibular/semicircular canal/internal auditory canal were 49 cases, normal was 1409 cases. (2) The DNA sequence results revealed that 465 cases carried pathogenic mutations (Bi-allelic mutations) of SLC26A4 gene, among which 135 cases were homozygous, 330 cases were compound heterozygous. (3) Pathogenic mutations of SLC26A4 gene detected 100% (465/465) in the group related to vestibular aqueduct malformation. CONCLUSION The results suggest that pathogenic mutation of SLC26A4 gene is closely related to the CT phenotype of vestibular aqueduct malformation. Detecting of pathogenic mutations for hearing loss is binging the possibility to identify children with inner malformations at an early stage. As a consequence, it will improve the current diagnosis and therapeutical option.
Alleles ; Child ; Cochlea ; Deafness ; Ear, Inner ; abnormalities ; Genetic Testing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Membrane Transport Proteins ; genetics ; Mutation ; Phenotype ; Semicircular Canals ; Sulfate Transporters ; Temporal Bone ; Vestibular Aqueduct ; Vestibule, Labyrinth

OBJECTIVE: To study the clinical value of polysomnography (PSG) and ApneaGraph (AG200) in the diagnosis evaluation of obstructive sleep apnea hypopnea syndrome (OSAHS). METHOD: From January to December in 2012, 67 OSAHS patients diagnosed by PSG were examined by AG200. The apnea hypopnea index (AHI), hypopnea index (HI), apnea index (AI), the lowest oxygen saturation (LSaO2) was were detected and the results were analyzed statistically. RESULT: Significant differences were observed in AI, AHI, LSaO2 between AG200 and PSG (P < 0.05, respectively). No statistically significant difference was found in HI. The differences in HI between AG200 and PSG were not significant (P > 0.05). AHI, HI and LSaO2 was were significantly correlated between AG200 and PSG (r = 0.870, 0.743, 0.374, 0.716, P < 0.01). CONCLUSION AG200 could not replace PSG but could identify the level of upper airway obstruction.
Female ; Humans ; Male ; Polysomnography ; methods ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology

OBJECTIVE: To investigate the correlation between allergic rhinitis and obstructive sleep apnea-hypopnea (OSAHS) syndrome in children. METHOD: (1) According to medical history, physical signs, skin-prick test, serum sIgE, endoscopic examination and polysomnography, the incidence of allergic rhinitis was confirmed in 574 cases of childhood obstructive sleeping apnea-hypopnea syndrome in our hospital between July in 2008 to June in 2010. (2) Effects of anti-allergic drugs were observed on 78 children with OSAHS and allergic rhinitis meanwhile. RESULT: (1) 258 cases of allergic rhinitis were confirmed in 574 cases of OSAHS, accounting for 44.9% of the OSAHS cases and 50.4% of all cases of allergic rhinitis during the same period. Most of them were perennial allergic rhinitis (223 cases, 86.4%), and 72.5% of them were aroused by fungal allergen. Compared with other allergen, statistically significant difference was found (P < 0.05). (2) After receiving anti-allergic drugs regularly for 3 weeks, 40 cases suffering from mild and moderate OSAHS and allergic rhinitis, 3 cases out of 38 cases suffering from serious OSAHS and allergic rhinitis showed satisfactory results, while other cases had little improvement. CONCLUSION Allergic rhinitis is closely related to childhood OSAHS, and perennial allergic rhinitis dominates. The most common allergen is fungal allergen, the second is house and flour dust mites. So for patients of mild and moderate OSAHS with allergic rhinitis, regular anti-allergic drugs can lighten OSAHS effectively and may make patients avoid surgery. Severe OSAHS cases can receive surgical intervention if prior anti allergic therapy fails. Anti allergic therapy should be adopted routinely after tonsillectomy and adenoidectomy in case of hypopnea due to hypertrophy of inferior turbinate or tubal torus in allergic rhinitis.
Child ; Child, Preschool ; Female ; Humans ; Lymphoid Tissue ; pathology ; Male ; Rhinitis, Allergic, Perennial ; complications ; pathology ; Sleep Apnea, Obstructive ; complications ; Turbinates ; pathology

OBJECTIVE: To investigate the changes of humoral and cellular immune responses in children with OSAHS after adenoidectomy with tonsil ablation or partial tonsillectomy by a plasma-mediated radiofrequency-based device. METHOD: Seventy children with OSAHS were enrolled in the study. According to the size of tonsils, they were divided into two groups: the adenoidectomy with tonsil ablation group and the adenoidectomy with partial tonsillectomy group. 4 ml of peripheral venous blood was drawn before and 1 month, 3 months after operation. Serum IgG, IgA, IgM levels and peripheral blood T lymphocyte subsets were measured. RESULT: In the adenoidectomy with tonsil ablation group, the level of CD3+ and CD4+ /CD8+ ration were slightly increased, while the levels of CD4+ and CD8+ were slightly reduced at 1 month after operation as compared to preoperative period. However, in the adenoidectomy with partial tonsillectomy group, the levels of CD8+ at 1 month after operation were slightly increased compared with that in preoperative examination, while the CD3+, CD4+ level and the CD4+/CD8+ ratio were slightly reduced during the same period. In addition, the levels of serum immunoglobulins showed no significant difference between the two groups, and returned to the preoperative levels at 3 months after operation in both groups (P > 0.05). CONCLUSION The results of the present study indicate that the humoral and cellular immunity is not affected in children with OSAHS who undergo adenoidectomy with tonsil ablation or partial tonsillectomy using plasma-mediated radiofrequency ablation. The patients' immune functions can return to normal levels at 3 months after the surgery.
Adenoidectomy ; Child ; Child, Preschool ; Cryosurgery ; methods ; Female ; Humans ; Immunity, Cellular ; Immunity, Humoral ; Immunoglobulin A ; blood ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Male ; Palatine Tonsil ; surgery ; Postoperative Period ; Sleep Apnea, Obstructive ; immunology ; surgery ; T-Lymphocyte Subsets ; immunology ; Tonsillectomy ; Treatment Outcome

OBJECTIVE: To explore the expression of mycoplasma monoclonal antibody PD4 in different laryngeal carcinoma tissues and their clinical significance. METHOD: Using immunohistochemistry methods to detect 256 cases of laryngeal tissues, including 105 cases of laryngeal carcinoma tissues, 31 cases of neck metastasis lymph node tissues, 18 cases of precarcinoma tissues, 53 cases of vocal cord polyps, 20 cases of normal tissues adjacent to laryngeal carcinoma and 29 cases of normal tissues around laryngeal carcinoma. RESULT: (1) The positive rate of PD4 was 44.76% in laryngeal carcinoma, which was much higher than that in other laryngeal tissues (P < 0.01 or P < 0.05). (2) The PD4 expression in laryngeal carcinoma was higher in the third and fourth stages than in the first and second stages, higher with cervical metastasis than those without cervical metastasis and higher in the third and second histological grade than in the first histological grade (P < 0.01 or P < 0.05). (3) To 3 and 5 years survival, PD4 positive cases had lower chance than PD4 negative cases (P < 0.01). CONCLUSION These results implicate that the occurrence, development and prognosis of laryngeal carcinoma may be closely related to mycoplasma infection.
Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal ; Apoptosis Regulatory Proteins ; metabolism ; Carcinoma, Squamous Cell ; mortality ; pathology ; Female ; Humans ; Laryngeal Neoplasms ; mortality ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Mycoplasma Infections ; Neoplasm Staging ; Prognosis ; RNA-Binding Proteins ; metabolism

Chronic and heavy alcohol consumption is one of the causes of heart diseases. However, the effects of ethanol on insulin sensitivity in myocardium has been unclear. To investigate the effects of ethanol on the expression of AMP-activated protein kinase (AMPK), myocyte enhancer factor 2 (MEF2) and glucose transporter 4 (GLUT4), all of which are involved in the regulation of insulin sensitivity, in the myocardium, we performed three parts of experiments in vivo and in vitro. I: Rats were injected with 5-amino-4-imidazolecarboxamide ribonucleotide (AICAR, 0.8 mg.kg(-1)) for 2 h. II: Rats received different dose (0.5, 2.5 or 5 g.kg(-1).d(-1)) of ethanol for 22-week. III: Primary neonatal rat cardiomyocytes were isolated and treated with or without 100 mM ethanol or 1 mM AICAR for 4 h. The cardiac protein and mRNA expression of AMPKalpha subunits, MEF2 and GLUT4 were observed by western-blotting and RT-PCR, respectively. Serum TNFalpha levels were assessed by ELISA. The results showed chronic ethanol exposure induced insulin resistance. Ethanol decreased the mRNA levels of AMPKalpha1 and alpha2, the protein levels of total- and phospho-AMPKalpha in cardiomyocytes. Similarly, ethanol showed inhibitory effects on both the mRNA and protein levels of MEF2A and 2D, and GLUT4 in a dose-response-like fashion. Correlation analysis implied an association between phospho-AMPKalpha and MEF2A or MEF2D, and between the levels of MEF2 protein and GLUT4 transcription. In addition, ethanol elevated serum TNFalpha level. Taken together, chronic ethanol exposure decreases the expression of AMPKalpha and MEF2, and is associated with GLUT4 decline in rat myocardium.
AMP-Activated Protein Kinases/genetics/*metabolism ; Aminoimidazole Carboxamide/analogs & derivatives/pharmacology ; Animals ; Enzyme Activation/drug effects ; Ethanol/*administration & dosage/*pharmacology ; Feeding Behavior/*drug effects ; Gene Expression Regulation/drug effects ; Glucose Transporter Type 4/genetics/*metabolism ; Insulin/pharmacology ; Insulin Resistance ; Male ; Myocardium/*enzymology ; Myogenic Regulatory Factors/antagonists & inhibitors/genetics/*metabolism ; Protein Isoforms/antagonists & inhibitors/genetics/metabolism ; RNA, Messenger/genetics/metabolism ; Rats ; Rats, Wistar ; Ribonucleotides/pharmacology ; Time Factors ; Tumor Necrosis Factor-alpha/blood