Objective:To analyze the risk factors for complications of the retromandibular approach in patients with parotid gland posterior and lower pole tumors.Methods:A retrospective analysis was conducted on the clinical data of 140 patients with parotid posterior lower pole tumors admitted to the Xingtai Third Hospital from October 2019 to October 2021. They were divided into two groups based on whether complications occurred: the occurrence group and the non occurrence group. General data of the two groups of patients were collected, including age, gender, course of disease, previous surgical history, number of tumors, tumor length, resection range, facial nerve dissociation, tumor site resection frequency, and fascia preservation; Single factor and logistic multivariate analysis were conducted to determine the risk factors for complications of the posterior retromandibular approach in patients with parotid gland posterior and lower pole tumors.Results:A total of 140 patients with parotid gland posterior lower pole tumors underwent retromandibular approach treatment, with complications occurring in 38 cases (27.14%), including 7 cases of temporary facial paralysis, 10 cases of facial depression, 11 cases of Frey syndrome, 2 cases of fistula, and 8 cases of sensory abnormalities of the greater auricular nerve. Through logistic multivariate analysis, it was found that the number of tumors ≥ 2 ( OR=2.856), the resection range (total resection) ( OR=2.477), the number of surgeries ≥3 ( OR=5.637), facial nerve dissociation ( OR=3.526), and lack of fascia preservation ( OR=2.551) were all risk factors for postoperative complications in patients with parotid posterior pole tumors (all P<0.05). Conclusions:In clinical practice, relevant prevention and treatment measures should be formulated for these high-risk factors to reduce the incidence of postoperative complications.

Objective:To explore the role of navigation-assisted valgus stress method in avoiding excessive correction of lower limb mechanical axis after high tibial osteotomy (HTO).Methods:A retrospective study was carried out on osteoarthritis (OA) patients who were treated with HTO for medial compartment pain of knee from January 2020 to March 2022 in the Department of Joint Surgery, Shanghai Changhai Hospital, the First Affiliated Hospital of Naval Medical University. According to the different ways of confirming alignment during operation, they were divided into computer navigation assisted valgus stress HTO group (referred to as navigation group) and traditional rod fluoroscopy HTO group (referred to as traditional group). There were 28 patients in the navigation group, 10 males and 18 females, with age of 54.4±9.1 years (range, 41-73 years) and body mass index of 26.1±3.3 kg/m 2 (range, 19.8-35.2 kg/m 2); There were 30 patients in the traditional group, 13 males and 17 females, aged 56.9±8.5 years (range, 40-70 years), with a body mass index of 25.7±4.0 kg/m 2 (range, 19.2-32.9 kg/m 2). Measuring the mechanical femoral tibial angle (mFTA), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA), Lysholm score and Hospital for Special Surgery (HSS) score before operation and at the last follow-up of the two groups, and conduct statistical analysis. Results:Both groups were followed up. The follow-up time of navigation group and traditional group was 21.3±8.7 months and 22.5±7.6 months, respectively, with no significant difference ( t=0.53, P=0.596). There were significant differences between the two groups in the amount of mechanical axis correction (ΔmFTA) and the amount of bone correction (ΔMPTA) ( t=2.09, P=0.041; t=2.58, P=0.012), while there was no significant difference in ΔJLCA ( t=0.32, P=0.753). In the navigation group, there were 9 cases (32%) of undercorrection, 17 cases (61%) with acceptable alignment, and 2 cases (7%) with over correction, while in the traditional group, there were 5 cases (17%) with under correction, 13 cases (43%) with acceptable alignment, and 12 cases (40%) with over correction. There was significant difference in the distribution rate of alignment between the two groups ( P=0.012), and the rate of overcorrection in the navigation group was significantly lower than that in the control group (7% vs. 40%, P=0.005). The intra group correlation coefficient between the navigation correction mechanical axis and ΔmFTA was 0.787. There was no significant difference in Lysholm score and HSS score between the two groups before and after surgery (all P>0.05), and they were significantly improved after operation (all P<0.05). Conclusion:Navigation-assisted valgus stress method HTO is reliable, which can accurately achieve the target alignment, reduce the incidence of over correction, and obtain good clinical results.

BACKGROUND: Mandibular distraction osteogenesis (MDO) is a kind of endogenous tissue engineering technology that lengthens the jaw and opens airway so that a patient can breathe safely and comfortably on his or her own. Endothelial progenitor cells (EPCs) are crucial for MDO-related angiogenesis. Moreover, emerging evidence suggests that heat shock protein 20 (Hsp20) modulates angiogenesis under hypoxic conditions. However, the specific role of Hsp20 in EPCs, in the context of MDO, is not yet known. The aim of this study was to explore the expression of Hsp20 during MDO and the effects of Hsp20 on EPCs under hypoxia. METHODS: Mandibular distraction osteogenesis and mandibular bone defect (MBD) canine model were established. The expression of CD34, CD133, HIF-1α, and Hsp20 in callus was detected by immunofluorescence on day 14 after surgery. Canine bone marrow EPCs were cultured, with or without optimal cobalt chloride (CoCl2 ) concentration. Hypoxic effects, caused by CoCl2 , were evaluated by means of the cell cycle, cell apoptosis, transwell cell migration, and tube formation assays. The Hsp20/KDR/PI3K/Akt expression levels were evaluated via immunofluorescence, RT-qPCR, and western blot. Next, EPCs were incorporated with either Hsp20-overexpression or Hsp20-siRNA lentivirus. The resulting effects were evaluated as described above. RESULTS: CD34, CD133, HIF-1α, and Hsp20 were displayed more positive in the callus of MDO compared with MBD. In addition, hypoxic conditions, generated by 0.1 mM CoCl2 , in canine EPCs, accelerated cell proliferation, migration, tube formation, and Hsp20 expression. Hsp20 overexpression in EPCs significantly stimulated cell proliferation, migration, and tube formation, whereas Hsp20 inhibition produced the opposite effect. Additionally, the molecular mechanism was partly dependent on the KDR/PI3K/Akt pathway. CONCLUSION In summary, herein, we present a novel mechanism of Hsp20-mediated regulation of canine EPCs via Akt activation in a hypoxic microenvironment.

Since December 2019, Corona Virus Disease (COVID-19), a new emerging infection disease occurred in Wuhan, has spread in 27 countries and regions. The clusters of many cases were reported with the epidemic progresses. We collected currently available information for 377 COVID-19 clusters (1 719 cases), excluded the hospital clusters and Hubei cases, during the period from January 1, 2020 to February 20, 2020. There were 297 family clusters (79%), case median 4; 39 clusters of dining (10%), case median 5; 23 clusters of shopping malls or supermarkets (6%), case median 13; 12 clusters of work units (3%), case median 6, and 6 clusters of transportation. We selected 325 cases to estimate the incubation period and found its range is 1 to 20 days, median was 7 days, and mode was 4 days. The analysis of the epidemic situation in a department store in China indicates that there is a possibility of patients as the source of infection during the incubation period of the epidemic. From February 5, 2020 to February 21, 2020, 634 persons were infected in the Diamond Princess Liner. All persons are susceptible to SARS-CoV-2. The older, patients during the incubation period and the worse environment may be the cause of the cases rising. The progress of the two typical outbreaks clearly demonstrates the spread of the early cases in Wuhan. Whatever happens, screening and isolating close contacts remains essential except for clinical treatment during the epidemic. Especially for the healthy people in the epidemic area, isolation is the key.

Objective: To elucidate the clinical behavior, causes of misdiagnosis, surgical management, and outcomes of facial nerve schwannomas (FNS). Methods: A retrospective review in Chinese People′s Liberation Army General Hospital from January 1, 2002 to December 31, 2015 was carried out and evaluated 110 patients with FNS, including 50 males and 60 females, aged 16-67 years old. The appropriate surgical strategy was selected based on each patient′s clinical manifestations, facial nerve function, and imaging characteristics. After surgery, patients received follow-up visits to assess their facial nerve functions, with the effect of treatment compared to the reality before surgery. The Kruskal-Wallis H test was used to distinguish between the pre- and post-operation facial nerve functions in patients who had different facial nerve functions before the operations. Results: 110 cases of FNS mainly presented with facial paralysis, hearing loss, tinnitus, otalgia, dizziness, and facial spasm. 20 of the cases were misdiagnosed as Bell′s Palsy, 6 were mistaken for chronic otitis media/cholesteatoma with radical mastoidectomy, 3 were mistaken for Meniere′s disease, 1 was misdiagnosed as petrous bone cholesteatoma, and 4 were mistaken for acoustic neuroma. 81.8 % (90/110) of the patients had multiple segments of the facial nerve, including the vertical segment of the facial nerve, accounting for 65.5% (72/110), followed by the labyrinthine/geniculate segment, for 61.8% (68/110), and the horizontal segment, for 55.5% (61/110). The appropriate surgical approaches were chosed based on the sizes and scopes of the tumors evaluated by imaging: transmastoid approach in 73 cases, translabyrinthe approach in 14 cases, middle cranial fossa approach in 13 cases, retrosigmoid approach in 3 cases, transmastoid-middle cranial fossa approach in 3 cases, and transmastoid-neck approach in 4 cases, with all the patients undergoing a total/subtotal resection of the tumor. Eighty-seven patients had their facial nerves reconstructed. Among them, 6 received facial nerve end-to-end anastomosis, 55 received great auricular nerve graft, and 26 were subjected to facial nerve-hypoglossal nerve anastomosis. Because of long histories, facial muscle atrophies, or other reasons, the remaining patients were not received facial nerve reconstruction. The House-Brackmann(H-B) grading scale was used to evaluate the facial nerve function pre- and post-operation. Patients with better facial nerve functions and shorter history of facial paralysis before operation would get relatively better facial nerve function. The before and after operation comparisons revealed that the recovery of the facial nerve functions in patients with H-B Ⅰ-Ⅲ was better than the improvement in patients with H-B Ⅳ-Ⅴ. The difference was statistically significant (Kruskal-Wallis H test, H=8.508, P<0.05). Conclusions The diagnosis of patients with unknown facial paralysis, hearing loss, and tinnitus should take into account the possibility of FNS. CT and other imaging examinations of the temporal bone can avoid misdiagnosis and determine the tumor size and extent of lesions, as well as provide the basis for the choice of the surgical approach. After tumors have been completely resected, facial nerve reconstruction can be performed simultaneously, according to the defect of the nerve.

Objective To investigate the hydrophilic chemical constituents from Thesium Chinensis Turcz.Methods The water extract of Thesium Chinensis Turcz.was adsorbed onto AB-8 resin column and eluted with 50% ethanol to give the hydrophilic portion TT50.TT50 was further separated and purified by repeated column chromatography on silica gel,Sephadex LH-20.The structures of these purified compounds were identified by NMR spectral analysis and comparison with the reported data.Results Six compounds were isolated and identified as kaempferol(1),kaempferol-3-O-glucoside(2),kaepmferol-3,7-di-O-β-D-glucopyranoside(3),kaempferol-3-O-L-rhamnopyranosyl(1 → 2)-β-D-glucopyranoside(4),kaemperol-3-O-α-L-rham-nopyranosyl(1→2)-[6-O-acetyl]-β-D-glucopyranoside(5),rutinoside(6).Conclusion The main constituents of TT50 were kaempferol glycosides.Compounds 4 and 5 were isolated from this plant for the first time.

Objective To explore the feasibility of reducing radiation dose of CT colonography (CTC) while preserving image quality using the third-generation dual-source CT at 70 kV tube voltage with advanced modeled iterative reconstruction (ADMIRE). Methods This prospective study consecutively included 53 patients. All patients underwent CTC at 120 kV in supine position with filtered back projection reconstruction and at 70 kV in prone position with ADMIRE with the same scan range. Radiation dose and image quality were compared between these two protocols. Results CT dose index volume,dose-length product,and effective dose of 70 kV were (1.47±0.23)mGy,(68.85±13.82)mGy·cm,and (1.03±0.21)mSv,respectively,which were significantly lower than 120 kV mode [(2.96±0.61)mGy (t=25.356,P=0.000),(136.97±32.77)mGy·cm (t=22.246,P=0.000),and (2.05±0.49)mSv (t=22.293,P=0.000)]. Signal to noise ratio of 70 kV with ADMIRE was 3.60±0.58,which was obviously higher than that of 120 kV as 2.34±0.47 (t=-18.036,P=0.000). Noise of 70 kV with ADMIRE was (11.81±1.93)HU,which was obviously lower than that of 120 kV as (14.39±2.57)HU (t=7.856,P=0.000). The κ value of two radiologists' overall subjective image score was 0.843 (P=0.000). For 2D images,the noise score of 70 kV with ADMIRE was significantly lower (Z=325.000,P=0.000) and the overall image quality was significantly higher (Z=78.000,P=0.001) compared with 120 kV;however,the sharpness had no significant difference. All scores ranged from 4 to 5. For 3D virtual endoscopy,the overall image quality of 70 kV with ADMIRE and 120 kV was not significantly different (Z=4.000,P=0.059),and all scores ranged from 4 to 5. Conclusion CTC at 70 kV tube voltage combined with ADMIRE can remarkably reduce the radiation dose while maintaining imaging quality than 120 kV at third-generation dual-source CT.
Colon ; diagnostic imaging ; Colonography, Computed Tomographic ; methods ; Humans ; Prone Position ; Prospective Studies ; Radiation Dosage ; Radiographic Image Interpretation, Computer-Assisted ; Radionuclide Imaging ; Signal-To-Noise Ratio

Objective To detect the levels of CD31+/CD42b- and CD144+ endothelial microparticles (EMPs)in plasma,and analyze the relationship with carotid intima-media thickness (CIMT)and the risk factors of atherosclerosis.Methods Totally 122 outpatients and inpatients in our hospital were selected,and carotid artery ultrasound examination was performed.The results were divided into a thickening group (62 cases)and a control group (60 cases).Flow cytometry was used to detect the levels of CD31+/CD42b- and CD144+ EMPs in the blood to analyze the relationship between the level of endothelial cells and CIMT,and to investigate the relationship between the level of plasma EMPs and the risk factors of atherosclerosis.Results Compared with the control group,the levels of EMPs of CD31+/CD42b- and CD144+ were significantly higher.In the correlation analysis, plasma CD31+/CD42b- and CD144+EMPs levels were positively correlated with CIMT;in multi-factor Logistic regression analysis,CD31+/CD42b- EMPs levels were correlated positively with age,TC and Cys C;plasma CD144+ EMPs levels were correlated with UA and BMI.Conclusion The levels of CD31+/CD42b-,CD144+EMPs in plasma were correlated with CIMT,guiding early prevention of cardiovascular diseases.

Objective To investigate the clinical significance of soluble CD40 ligand (sCD40L ) and lipoprotein associated phospholipase A2 (Lp-PLA2 ) in the assessment of coronary artery severity and risk classification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods Of the 9 6 patients with coronary heart disease diagnosed by coronary angiography,2 8 patients had stable angina pectoris (SAP),38 patients unstable angina pectoris (UAP)and 30 patients acute non-ST-segment elevation myocardial infarction (NSTEMI).Another 30 patients with non-coronary heart disease (NC)served as controls.The sCD40L and Lp-PLA2 levels were determined by enzyme-linked immune sorbent assay (ELISA)method.The Gensini score was used to assess the severity of coronary artery and analyze the correlation with sCD40L and Lp-PLA2.The correlation of sCD40L and Lp-PLA2 with GRACE risk score was analyzed too.Results ① sCD40L was significantly higher in NSTEMI and UAP groups than in SAP and NC groups (P<0 .0 5 ),but there was no significant difference between NSTEMI and UAP groups (P>0 .0 5 )or SAP and NC groups (P>0 .0 5 ).Lp-PLA2 was significantly higher in NSTEMI group than in UAP,SAP and NC groups (P<0.05).Lp-PLA2 was significantly higher in UAP group than in SAP and NC groups (P<0.05).② We found that sCD40L had obvious correlation with Lp-PLA2 (r=0.284, P<0.01),Gensini score (r=0.213,P<0.05),and GRACE (r=0.224,P<0.05).Lp-PLA2 was significantly correlated with Gensini score (r=0.270,P<0.05),and GRACE (r=0.323,P<0.01).③ Multivariate logistic regression analysis showed that Lp-PLA2 was independently associated with NSTE-ACS (P<0.05).Conclusion The sCD40L and Lp-PLA2 which were significantly elevated in NSTE-ACS are correlated with the severity of coronary artery disease.The two indexes indicate the instability of atherosclerotic plaque;thus they can be used as predictors of risk assessment in coronary heart disease.