Objective To analyze the effect of extracorporeal shock wave assisted drug therapy on clinical outcomes of patients with temporomandibular disorders(TMD).Methods A total of 86 TMD patients in our hospital from September 2018 to September 2019 were included and divided into group A(n=43)and group B(n=43)by random number table method.Group A(n=43)received oral glucosamine hydrochloride tablets on the basis of conventional treatment;group B(n=43)received extracorporeal shock wave therapy on the basis of group A.The pain degree,maximum mouth opening,temporomandibular joint function,temporomandibular joint bounce times,life quality and occurrence of adverse reactions were compared between the two groups.Results Compared with that before treatment,the visual analogue scale(VAS)scores,maximum mouth opening,temporomandibular joint dysfunction index(DI),palpation index(PI),Fricton craniomandibular index(CMI)level,joint bounce times and oral health impact scale(OHIP-14)score of two groups were significantly improved(P＜0.05),and all indexes in group B were significantly better than those in group A(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Extracorporeal shock wave assisted drug therapy can effectively reduce joint bounce in TMD patients,relieve patients'pain,improve patients'life quality and temporomandibular joint function,and has good safety.

Objective To analyze the clinical efficacy of microwave ablation in the colorectal cancer with simultaneously multiple liver metastases that was initially evaluated as potentially resectable.Methods The patients with potentially resectable colorectal cancer with simultaneous multiple liver metastases treated in the De-partment of General Surgery of the First Affiliated Hospital of Hebei North University,the Center of Minimally Invasive Therapy in Oncology of Traditional Chinese and Western Medicine in Dongzhimen Hospital of Beijing U-niversity of Chinese Medicine,and the Second Department of General Surgery in the Fourth Hospital of Hebei Medical University from October 1,2018 to October 1,2020 were selected in this study.The general data,pathological features,treatment methods,and clinical efficacy of the patients were collected.According to the treatment methods,the patients were assigned into a surgical resection group(conversion therapy + laparoscopic primary resection +hepatectomy)and a microwave ablation group(conversion therapy +laparoscopic primary re-section +microwave ablation).The surgical indicators(operation duration,time to first postoperative anal ex-haust,hospital stay,etc.)and postoperative complications(anastomotic stenosis,anastomotic hemorrhage,incision infection,etc.)were compared between the two groups.The survival period was followed up,including the overall survival period and disease-free survival period,and the survival curves were drawn to analyze the clinical efficacy of the two treatment regimens.Results A total of 198 patients with potentially resectable color-ectal cancer with simultaneous multiple liver metastases were included in this study.Sixty-six patients were cured by neoadjuvant chemotherapy(FOLFOX or FOLFIRI),including 30 patients in the surgical resection group and 36 patients in the microwave ablation group(with 57 tumors ablated).After the first ablation,54(94.74%)tumors achieved complete ablation,and all of them reached no evidence of disease status after re-ablation.The microwave ablation group had shorter operation duration,less intraoperative blood loss,shorter time to first post-operative anal exhaust,shorter time of taking a liquid diet,shorter hospital stay,and lower hospitalization cost than the surgical resection group(all P<0.001).In addition,the microwave ablation group had lower visual analogue scale score(P<0.001)than the surgical resection group.The incidences of complications such as inci-sion infection(P =0.740),anastomotic fistula(P =1.000),and anastomotic stenosis(P =1.000),the over-all survival period(P =0.191),and the disease-free survival period(P =0.934)showed no significant differ-ences between the two groups.Conclusions For patients with colorectal cancer with simultaneous multiple liver metastases initially assessed as potentially resectable,laparoscopic primary resection +surgical resection/microwave ablation after conversion therapy was safe,effective,and had similar survival outcomes.Microwave ablation outper-formed surgical resection in postoperative recovery,economy,and tolerability,being worthy of clinical promotion.

Objective: To assess the outcomes of partial cricotracheal resection (CTR) and extended cricotracheal resection (ECTR) for severe laryngotracheal stenosis. Methods: From November 2009 to September 2017, 18 patients underwent CTR and ECTR at the Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Air Force Medical University for severe laryngotracheal stenosis were reviewed retrospectively. There were 12-male and 6-female patients, with the age ranged from 4 to 56 years (median 25 years). The causes were postintubation in 11 cases, cervical trauma in 4, idiopathic in 3. The stenosis located in subglottic and tracheal (n=12), glottic and subglottic and tracheal (n=3), subglottic (n=2), and glottic and subglottic (n=1). Two patients had concurrent unilateral vocal cord palsy.One patient had undergone previous endoscopic balloon dilation and 8 patients had previous laryngotracheal reconstruction. The stenosis was graded according to modified Myer-Cotton classification as follows: Ⅲb (n=1), Ⅲc(n=1), Ⅳa (n=2), Ⅳb (n=12), Ⅳc (n=2). The surgical outcomes and complications were recorded. Results: Among 18 patients,11 of the 12 patients undergoing CTR were decannulated. Five of the 6 patients undergoing ECTR were decannulated. Resected airway length ranged from 1.5 to 4.0 cm (median 2.8 cm). Surgical complications included infection of incision wound in 2 cases, anastomotic granulation in 2, cervical subcutaneous emphysema in 1, aspiration in 1, and unilateral arytenoid prolapse in 1. No recurrent laryngeal nerve injury or tracheoesophageal fistula occurred. The median follow up was 11 months. Conclusions CTR is efficient for severe subglottic and upper tracheal stenosis while ECTR is efficient for subglottic stenosis extended to the glottis. Both procedures also provide a salvage therapy for patients with previous failed treatments.

Objective:To investigate the role of interleukin-13(IL-13), interleukin-13 receptor α2(IL-13Rα2) and 11 β -hydroxysteroid dehydrogenase 2(11βHSD2) signaling pathway in liver metastasis of colon cancer and its mechanism.Methods:A retrospective case-control study was conducted to analyze the clinical data of 80 patients with colorectal cancer who were operated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2015 to December 2018.All patients were followed up by clinic or telephone until August 30, 2019.According to the occurrence of liver metastasis, the patients were divided into metastasis group ( n=22) and non metastasis group ( n=58). Real-time fluorescence quantitative Polymerase Chain Reaction(PCR) and Western blotting were used to detect and compare the mRNA relative expression and protein expression of IL-13, IL-13Rα2, 11βHSD2, cyclooxygenase 2(COX 2) and protein kinase B in cancer tissues and cancer adjacent tissues. Glycyrrhetinic acid, an inhibitor of 11 β HSD2, was used to inhibit the activity of 11hsd2 in human colon cancer cell line HCT-8.The mRNA relative expression and protein expression of IL-13, IL-13Rα2, 11βHSD2, COX 2 and protein kinase B were detected by real-time fluorescence quantitative PCR and Western blotting before and 24 hours after glycyrrhetinic acid addition. Results:The mRNA relative expression of IL-13(0.79±0.11, 0.40±0.10), IL-13Rα2(0.72±0.13, 0.46±0.11), 11βHSD2(0.84±0.26, 0.60±0.08), COX 2(0.70±0.25, 0.37±0.04), protein kinase B (0.76±0.13, 0.42±0.06) in colon cancer tissues of metastatic and non metastatic groups were higher than those in cancer adjacent tissues(0.09±0.01, 0.10±0.06, 0.09±0.02, 0.09±0.03, 0.09±0.01, 0.09±0.02, 0.13±0.02, 0.12±0.07, 0.05±0.02, 0.05±0.03). The difference was statistically significant (t value was 28.36, 23.20, 22.07, 24.88, 16.47, 16.47, 47.86, 18.55, 24.55, 26.20, 44.40, all P<0.001). The protein expression of IL-13(0.48±0.11, 0.32±0.07), IL-13Rα2(0.52±0.11, 0.36±0.11), 11βHSD2(0.63±0.12, 0.48±0.11), COX2(0.45±0.15, 0.27±0.09), protein kinase B(0.50±0.12, 0.29±0.08) in colon cancer tissues of metastatic and non metastatic groups were higher than those in cancer adjacent tissues(0.12±0.02, 0.13±0.01, 0.10±0.02, 0.10±0.02, 0.14±0.06, 0.13±0.05, 0.10±0.03, 0.10±0.04, 0.10±0.03, 0.10±0.02). The difference was statistically significant ( t value were 15.63, 21.15, 17.71, 17.28, 11.01, 18.14, 10.55, 13.12, 15.76 and 18.90 respectively, all P<0.001). The relative expression of mRNA and protein in metastasis group was higher than that in non metastasis group ( t=15.15, 3.01, 8.97, 2.52, 6.34, 2.26, 9.82, 2.52, 16.02, 3.57, respectively, all P< 0.05). Compared with that those of before glycyrrhetinic acid addition, after 24 hours of glycyrrhetinic acid addition, the mRNA relative expression and protein expression of IL-13, IL-13Rα2 had no significant change (all P>0.05), while the mRNA relative expression and protein expression of COX 2 and protein kinase B(before adding: 0.725±0.159, 0.639±0.162, 0.741±0.178, 0.668±0.145, after adding: 0.108±0.085, 0.116±0.048, 0.122±0.063, 0.119±0.066) were decreased( t value were 18.744, 16.954, 17.956, 18.875 respectively , all P<0.01). Conclusion:The activation of IL-13/IL-13α2/11βHSD2 signaling pathway can promote liver metastasis of colon cancer.The mechanism may be that 11βHSD2 over expression promotes cancer cells invasion and migration-related COX2 expression and PI3K/protein kinase B pathway, and promotes liver metastasis of colon cancer.

Objective:To study the quality of life and postoperative complications in patients after laparoscopic cholecystectomy (LC).Methods:The data from 319 patients who were admitted to Nanjing First Hospital Affiliated to Nanjing Medical University and underwent LC from October 2013 to October 2017 were reviewed. These patients were assessed by a questionnaire which was based on the Gastrointestinal Quality of Life Index (GIQLI) before and after surgery.Results:The GIQLI scores on conscious symptoms, physiological function were significantly lower after surgery. The main postoperative complications were diarrhea (53.9%), decline in physical strength (30.1%), abdominal distension (25.4%), fatigue (26.9%) and abdominal pain (11.0%). Among patients with decline in physical strength, fatigue, and abdominal pain, 60.4%, 55.8%, and 51.4% of each of the groups, respectively, were associated with diarrhea. The incidences of severe diarrhea was 0.9%, severe fatigue was 0.3%, severe decline in physical strength 0% and severe abdominal pain 0%.Conclusions:The quality of life of patients declined after LC. The main postoperative complications were diarrhea, decline in physical strength, abdominal distension, fatigue and abdominal pain. However, the incidence of serious complications was small.

Objective To evaluate the effect of hypernatremia in donors on perioperative recovery of liver function in the recipients undergoing liver transplantation. Methods Clinical data of 73 liver transplant recipients were analyzed retrospectively. According to the serum levels of sodium in donors, all recipients were divided into hypernatremia group (donor serum sodium ≥150 mmol/L, n=19) and non-hypernatremia group (donor serum sodium < 150 mmol/L, n=54). Serum alanine aminotransferase(ALT), aspartate aminotransferase (AST), model for end-stage liver disease (MELD) score, albumin, total bilirubin (TB), serum creatinine, prothrombin time and hepatocyte growth factor (HGF) in the recipients were detected at 1, 3, 7, 14 and 21 d after liver transplantation. The time of postoperative use of liver-protecting drugs in the recipients, the length of intensive care unit (ICU) stay, the average length of hospital stay and the incidence rate of postoperative complications were statistically compared and analyzed. Results Compared with the non-hypernatremia group, the serum levels of TB, ALT, AST, HGF and MELD scores of the recipients in the hypernatremia group at the postoperative 1, 3 and 7 d were significantly higher (all P < 0.05), whereas the serum albumin level was significantly decreased (P < 0.05). The prothrombin time in the hypernatremia group was significantly longer than that in the non-hypernatremia group at 3 and 7 d after operation (both P < 0.05). In the hypernatremia group, the time of postoperative use of liver-protecting drugs and the length of ICU stay were 9 (7-13) d and 11 (8-13) d, significantly longer than 4 (3-9) d and 7 (3-9) d in the non-hypernatremia group (both P < 0.05). The average length of hospital stay, serum creatinine level and incidence rate of postoperative complications did not significantly differ between two groups (all P>0.05). All recipients were recovered and discharged. Conclusions The hypernatremia in donors exert no significant effect on the perioperative liver function of the recipients, whereas it can prolong the postoperative recovery time of liver function of the recipients.

Objective: To explore the application value of thyroid alar cartilage(TAC) in the laryngotracheal reconstruction of subglotticstenosis in the paediatric population. Methods: Twelve patients(7 males,5 females; range from 2.3 to 12.0 years) with subglotticstenosis who had undergone laryngotracheal reconstruction procedures at our hospital fromSeptember 2016 to July 2018 were analyzed retrospectively.The degree of stenosis was classified according to Myer-Cotton classification system:grade Ⅱ(n=4),grade Ⅲ(n=6) and grade Ⅳ(n=2). The stenosis planes were subglotticbut did not exceed the 3rd tracheal cartilage ring. Results: Of all 12 patients, 11 were decannulated and 1 failed. All patients with grade Ⅱ and Ⅲ patients were decannulated at one procedure. There were no severe complications such as tube dislogement,asphyxia and unhealed wound. Conclusions The TAC for widening laryngotracheal lumen is relatively simple and reliable for laryngotracheal reconstruction in the pediatric population with subglottic stenosis. This would′t cause any structural damage to the laryngeal cavity.

The length of tracheal defect or stenosis exceeded 5 cm could not be treated by simple resection and end-to-end anastomosis of the remaining trachea. Various ways of tracheal replacement had appeared sequentially, such as radial forearm free flap with cartilage grafts, tracheal tissue-engineering and tracheal allotransplantation. Among these methods, tracheal allotransplantation displayed a better long-term result. In this review, we are focused on recent advances in tracheal allotransplantation, particularly on revascularization and reepithelialization of graft, as well as on the application of immunosuppressive agents.

ObjectiveTo investigate the effect of Blumgart anastomosis (BA) on pancreatic fistula (PF) and other complications after pancreaticoduodenectomy. MethodsThe clinical data of 190 patients who underwent pancreaticoduodenectomy in our hospital from January 2005 to December 2011 were analyzed retrospectively. The patients were divided into three groups, with 55 patients in the BA group, 65 patients in the duct-to-mucosa anastomosis group, and 70 patients in the invaginated pancreaticojejunostomy group. The incidence rates of PF and other complications after different methods of anastomosis were compared. The chi-square test was applied for comparison of the incidence of complications between groups. ResultsNo deaths occurred during surgery. The incidence rate of postoperative complications was 48.4% (92/190), and that of PF was 20.5% (39/190), with 5.5% (3/55) in the BA group, 20% (13/65) in the duct-to-mucosa anastomosis group, and 32.9% (23/70) in the invaginated pancreaticojejunostomy group. In the pancreatic duct with a diameter of ＜3 mm, the incidence rate of PF showed a significant difference between the three groups (χ2=6.089, P＜0.05), while in the pancreatic duct with a diameter of ≥3 mm, there was no significant difference in PF between the three groups (χ2=5.436, P＜0.05). ConclusionBA is a safe, simple, and time-saving technique and can reduce the incidence of PF, which is worthy of clinical application.

non-myeloablative BuCy+fludarabine conditioning regimen,and another one was treated with TBI+VP-1 6 +CTX+CCNU conditioning regimen.Only one case received short-term MTX,cyclosporin A and ATG regimen for prevention of graft-versus-host disease (GVHD).The GVHD prevention regimens of the other patients were based on short-term MTX,cyclosporin A,ATG and mycophenolate mofetil regimen.The hematopoietic reconstitution, complications and prognosis were observed.Results One patient died of intracranial hemorrhage,and hematopoi-etic reconstitution was achieved in the other 20 patients.The median time for hematopoietic reconstitution shortened by one day in large-dose group compared with that in low-dose group.Adverse reactions included high fever, shivering,gastrointestinal tract adverse reaction,liver injury,oral mucositis and other rare side effects.GVHD occurred more frequently in patients with HLA mismatched transplantation.Nine patients with aGVHD and 9 patients with cGVHD recovered after effective treatment.Within 100 days after transplantation,18 patients had bacterial or fungal infection,mainly upper respiratory tract infection;7 patients had cytomegalovirus infection;2 had EB viremia,and one had urinary BK virus infection.Only one patient died of VOD.Hemorrhagic cystitis occurred in 5 patients and improved after treatment.The median survival time was 24 months (ranging from 136 days to 9 years).One-year and 3-year overall survival rates were 85.2% and 63.9%,the disease free survival rates were 81% and 23.8%,recurrence free survival rates were 71.4% and 14.3%,respectively.Conclusion URD-HSCT was an effective method to treat leukemia.Conditioning regimen of BuCy and modified BuCy2 were safe and effective,the adverse reactions were reversible and well tolerated.Hematopoietic reconstitution time shortened in large-dose MNC and CD34 + cell number groups compared with that in low-dose group.The occurrence rate of GVHD with HLA mismatched transplantation was more than that of HLA matched transplantation.Low-dose heparin,prostaglandin E1 and Danshen injection can effectively prevent VOD.