BACKGROUND: Few studies have explored the impact of perchlorate, nitrate, and thiocyanate (PNT) on kidney function. This study aimed to evaluate the association of urinary levels of PNT with renal function as well as the prevalence of chronic kidney disease (CKD) among the general population in the United States. METHODS: This analysis included data from 13,373 adults (≥20 years) from the National Health and Nutrition Examination Survey 2005 to 2016. We used multivariable linear and logistic regression, to explore the associations of urinary PNT with kidney function. Restricted cubic splines were used to assess the potentially non-linear relationships between PNT exposure and outcomes. RESULTS: After traditional creatinine adjustment, perchlorate (P-traditional) was positively associated with estimated glomerular filtration rate (eGFR) (adjusted β: 2.75; 95% confidence interval [CI]: 2.25 to 3.26; P  < 0.001), and negatively associated with urinary albumin-to-creatinine ratio (ACR) (adjusted β: -0.05; 95% CI: -0.07 to -0.02; P  = 0.001) in adjusted models. After both traditional and covariate-adjusted creatinine adjustment, urinary nitrate and thiocyanate were positively associated with eGFR (all P values <0.05), and negatively associated with ACR (all P values <0.05); higher nitrate or thiocyanate was associated with a lower risk of CKD (all P values <0.001). Moreover, there were L-shaped non-linear associations between nitrate, thiocyanate, and outcomes. In the adjusted models, for quartiles of PNT, statistically significant dose-response associations were observed in most relationships. Most results were consistent in the stratified and sensitivity analyses. CONCLUSIONS Exposures to PNT might be associated with kidney function, indicating a potential beneficial effect of environmental PNT exposure (especially nitrate and thiocyanate) on the human kidney.
Adult ; Humans ; United States/epidemiology* ; Nitrates/adverse effects* ; Nutrition Surveys ; Thiocyanates/urine* ; Perchlorates/urine* ; Creatinine ; Environmental Exposure ; Renal Insufficiency, Chronic/epidemiology* ; Logistic Models

The clinical practice of otorhinolaryngology is highly specialized. This paper intends to discuss the teaching method of online clinical practice of otorhinolaryngology. For the first time, the teaching method of "flipped classroom" combined with "standardized patients" is adopted to carry out online clinical practice for the eight-year program of clinical medicine students, and the students are assessed and the questionnaire survey of online practice satisfaction is conducted. According to the results, online clinical practice is a kind of teaching method with maneuverability, flexibility and interaction, but it can’t completely replace clinical practice. In the future, we can further explore the teaching mode of "online and offline mixed" clinical practice.

Objective　To explore the correlation between cerebral microbleeds and cognitive dysfunction as well as the risk factors affecting the occurrence of cognitive dysfunction.Methods　A total of 113 patients with no abnormalities by transcranial magnetic resonance imaging scans admitted to our hospital from May 2018 to June 2019,clinical risk factors were recorded.MoCA was tested for cognitive function assessment.MoCA score≥26 was divided into normal cognitive function group,MoCA score<26 was divided into cognitive dysfunction,and both groups were scanned with susceptibility weighted imaging.Analyze the clinical risk factors that affect the MoCA score and the relationship between the number,incidence, anatomic location and MoCA score of cerebral cerebral microbleeds.Results　There was a statistical difference in the years of education between the two groups of patients (P<0.05).The number of cerebral microbleeds lesions and the positive of cerebral microbleeds lesions were negatively correlated with the MoCA score (P<0.05).There was a negative correlation between basal ganglia microbleeds and MOCA score (P<0.05).Conclusion　Few years of education may be an independent risk factor for cognitive dysfunction,and cerebral microbleeds are closely related to the occurrence of cognitive dysfunction.

OBJECTIVE: To observe the differences in the sleep quality and the effects on insomnia severity between 's three-promotion needling method and the oral administration of estazolam. METHODS: A total of 70 patients of subacute insomnia were randomized into a three-promotion needling group and a medication group, 35 cases in each one. In the three-promotion needling group, the mild promotion technique with the filiform needle, the warm promotion technique with the fire needle and the strong promotion technique with the three-edged needle were adopted in combination. The acupuncture with the filiform needle was used at Baihui (GV 20), Sishencong (EX-HN1), Shenting (GV 24), Shenmen (HT 7), etc, The treatment was given 3 times a week, once every 2 days. The pricking technique with fire needle was applied to Ganshu (BL 18), Xinshu (BL 15), Feishu (BL 13), Pishu (BL 20), Shenshu (BL 23) and Geshu (BL 17), once every 3 days, twice a week. The bleeding technique with the three-edged needle was used at the ear apex, once every 2 days, 3 times a week. In the medication group, the estazolam tablets were taken orally before sleep, 1mg once every 2 days. The treatment was given consecutively for 4 weeks in the two groups. Separately, before treatment, in 2-week treatment and in 4-week treatment as well as in 1-month follow-up after treatment, the Pittsburgh sleep quality index (PSQI) and the insomnia severity index (ISI) scores were recorded in the patients of the two groups. The clinical effects were evaluated in the two groups. RESULTS: In 2 weeks and 4 weeks of treatment, as well as in the follow-up, PSQI scores and ISI scores were all reduced obviously as compared with those before treatment in the two groups (all <0.05). In the three-promotion needling group, the PSQI score at each time point was reduced much more obviously as compared with the medication group (all <0.05). In the follow-up, the ISI score in the three-promotion needling group was lower than the medication group (<0.05). The total effective rates were 97.2% (34/35) and 91.4% (32/35) at the end of treatment and in the follow-up respectively in the three-promotion needling group, higher than 85.7% (30/35) and 71.4% (25/35) in the medication group (both <0.05). CONCLUSION 's three-promotion needling method much more effectively improves the sleep quality and reduces insomnia severity in the patients of subacute insomnia. This therapy presents the satisfactory short-term and long-term effects.
Acupuncture Points ; Acupuncture Therapy ; Estazolam ; Humans ; Sleep Initiation and Maintenance Disorders ; therapy ; Treatment Outcome

MicroRNA (miRNA) is a kind of small non-coding RNA that regulates gene expression at the posttranscriptional level through inhibition of translation or degradation of messenger RNA.MiRNA is involved in the regulation of many cellular biological processes,and its abnormal expression closely relates to development of tumors.MiR-483 plays an important role in the tumorgenesis or development,meanwhile,its role in digestive system tumors has aroused widespread attention.

Objective To analyze the features of health economics in the treatment of leukemia;To evaluate the improvement trend of levels of clinical diagnosis, treatment and management. Methods TCM medical information dtatabase and electronic medical system in Zhejing Province TCM Hospital from January 2010 to December 2015 were retrived. According to inclusion and exclusion criteria, leukemia patients’ materials that met the critiria were screened. The total hospitalization fees, cost of Western medicine, the cost of Chinese patent medicine, cost of TCM decoction pieces, and cost of blood transfusion were set as costs, while white blood cell count, hemoglobin concentration, and platelet count were set as effectiveness indicators for cost effectiveness analysis. Results In patients with low white blood cell count increased unit white blood cell count, patients with high white blood cell count declined unit white blood cell count, patients with low hemoglobin increased unit hemoglobin count and patients with low platelet count increased unit platelet count, the total hospitalization fees, cost of Western medicine, the cost of Chinese patent medicine, cost of TCM decoction pieces, and blood transfusionfor the above increases showed a decreasing trend. Conclusion Health economics advantages in three blood routine indicators after treatment of integrated traditional Chinese and western medicine for leukemia is increasing year by year.

Objective: To summarize the skill and experience of transnasal endoscopic operation for retrobulbar lesions. Methods: Seven patients aged from 25 to 67 years old diagnosed as retrobulbar lesions who underwent transnasal endoscopic operation in Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital between January 2013 and October 2016 were retrospectively analyzed. Two males and five females were included in this study. Five patients underwent transnasal endoscopic operation via media rectus-inferior rectus space, with the other 2 cases via media rectus-superior rectus space. Results: Total lesion removal was achieved in 6 of 7 patients, while 1 patient underwent subtotal removal of the lesion. The visual acuity and visual field improved in 3 cases. The pathological examination showed hemangioma(5 cases), bone cyst(1 case) and fibroma(1 case). All patients were followed up for 9 months to 4 years without complications such as eye movement disorder or blindness, except for 1 case with preoperatively proptosis occurred postoperatively transient diplopia. There was no recurrence in 6 patients with total lesion removal, and the patient underwent subtotal removal of fibroma did not undertake operation again. Conclusion Transnasal endoscopic operation for retrobulbar lesions is a minimally invasive, safe and effective operatiiv method, which could be taken via different surgical approaches according to the size and location of the lesion.

Objective:To compare the effect of endoscopic-assisted low temperature plasma (ELTP) and electric planer (EP) on the treatment of adenoid hypertrophy.Methods:We searched China National Knowledge Infrastructure (CNKI),Wanfang Database,Weipu Database,Chinese Biomedical Literature (CMB),PubMed,Embase,Cochrane Database,and collected the randomized controlled studies regarding the effect of ELTP and EP on the treatment of adenoid hypertrophy from January 2007 to June 2016.Methodologies were used to evaluate the included studies,and Meta-analysis was performed by Revman 5.2.Results:Thirteen studies including 1 448 patients fulfilled the study requirement.Seven hundred and twenty-two patients were treated with ELTP,and 726 patients were treated with EP.The Meta-analysis showed:compared with EP,ELTP could improve the cure rare (OR=3.19,95％ CI 1.42to 7.15,P=0.005),reduce the blood loss during surgery (MD=-20.35,95％ CI-20.84 to-19.87,P＜0.001),shorten the operation time (MD=-15.71,95％ CI-18.06 to-12.17,P＜0.001),and reduce the incidence of complications (OR=0.13,95％ CI 0.06 to 0.30,P＜0.001),while there was no difference between the 2 groups in the postoperative residual rate of adenoid,postoperative hemorrhage rate and the rate oftorus tubarius injury.Conclusion:Comparing with EP,ELTP shows more advantages in the adenoidectomy.

Objective To study the clinical characteristicsand prognosis in pediatric sudden sensorineural hearing loss and provide guidance for clinical practice.Methods We retrospectively analyzed the clinical data of 23 pediatric sudden sensorineural hearing loss patients (25 ears) treated in our department during the past 9 years (from January 2008 to October 2016).Comparatively we looked into those related factors (age,gender,ear side,treatment onset,initial hearing threshold,virus infection history,audiogram configuration,presence of tinnitus,vertigo,ear fullness and recovery) between pediatric patients and 202 adult patients (219 ears).Results Pediatric patients comprised 10.2 ％ of pediatric/adult cases of sudden sensorineural hearing loss.The average hearing threshold (87.7± 16.1 dB),rate of presence of vertigo (48.0％) and rate of virus infectionin in the pediatric group,were significantly higher than those of in the adult group (P＜0.05).Tinnitus occurred in 80％ of pediatric patients,and 96 ％ of the audiogram configurations showed total deafness curves and flat lines.After positive treatment,the overall recovery rate of the pediatric and the adult group were 52.0％ and 46.6％,and the rate of complete recovery was 4.0％ and 14.2％,respectively.The difference was not statistically significant (P＞0.05).Conclusion Pediatric sudden sensorineural hearing loss was generally identified as severe hearing loss with a high rate of presence of tinnitus and vertigo,and most audiogram configurations were total deafness in fiat lines.Virus infection probably is one of the primary etiologies for sudden sensorineural hearing loss in children.

OBJECTIVETo identify the risk factors of esophagojejunal anastomotic leakage (EJAL) and its impact on prognosis of gastric cancer patients after curative total gastrectomy.

METHODSClinical and follow-up data of 1254 gastric cancer patients who underwent radical total gastrectomy at the Department of Digestive Surgery, Xijing Hospital, from January 2012 to May 2015 were retrospectively collected. Risk factors of EJAL and prognostic factors of patients were analyzed respectively. In order to reduce the influences of other prognostic factors on survival, patients with and without EJAL were selected using Gmatch methods based on the results of prognostic factor analysis. Survival of those with or without EJAL was examined before and after match respectively.

RESULTSEJAL occurred in 31 of 1 254 patients(2.5%). The leakage was diagnosed at a median of 6 (range, 4-12) days after surgery. Multivariate analysis demonstrated that preoperative low serum albumin(<35 g/L)(P=0.018), pulmonary insufficiency(P=0.006), long duration of operation(≥240 min)(P=0.001) were independent risk factors of EJAL. All the patients were followed up for 3-40(median 18) months. Multivariate analysis showed that age(≥65, P=0.000), intraoperative blood transfusion (P=0.016), EJAL (P=0.000), tumor location (distal, P=0.020; total, P=0.001), depth of invasion (T4, P=0.005) and lymph node metastasis (N2, P=0.002, N3, P=0.000) were prognostic predictors. Twenty-six patients with EJAL were successfully matched to 104 patients without EJAL in a ratio of 1/4 ratio. Patients with EJAL had a significantly worse overall 3-year survival rate than those without (44.3% vs. 66.7%, P=0.002).

CONCLUSIONSEJAL after curative total gastrectomy leads to worse survival. Patients with preoperative low serum albumin, pulmonary insufficiency and long duration of operation should be taken care of during perioperative period to prevent the occurrence of EJAL.

Aged ; Anastomotic Leak ; Female ; Gastrectomy ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; surgery ; Survival Rate