Objective:To explore the evaluation value of abnormal muscle response (AMR) monitoring in efficacy of microvascular decompression in primary hemifacial spasm.Methods:A retrospective study was performed. Sixty-four patients with primary hemifacial spasm, admitted to our hospital from April 2019 to December 2020, were chosen. All patients underwent intraoperative AMR monitoring and were divided into AMR complete-disappeared group, AMR significant-changed group and AMR not significant-changed group according to the monitoring results. The relief of spasticity symptoms among the three groups was observed one week and one year after surgery. The specificity and sensitivity of AMR monitoring in evaluating the efficacy, the relations between intraoperative AMR changes and postoperative efficacy after microvascular decompression were analyzed.Results:The specificity and sensitivity of AMR monitoring in predicting spasmodic relief after microvascular decompression were 89.7% and 66.7%, respectively, at one week, and 86.7% and 50.0%, respectively, at one year. There were statistical differences in clinical remission rate one week after microvascular decompression among AMR complete-disappeared group ( n=46), AMR significant-changed group ( n=8) and AMR not significant-changed group ( n=10, P<0.05); there were no significant differences in clinical remission rate one year after microvascular decompression among the three groups ( P>0.05). There was no significant difference in clinical remission rate one week and one year after microvascular decompression between patients having AMR complete disappearance before Teflon and patients having AMR complete disappearance after Teflon ( P>0.05). Conclusion:AMR monitoring has high specificity but modest sensitivity in predicting spasmodic relief after microvascular decompression; intraoperative AMR disappearance is associated with short-term efficacy, but it is not a reliable indicator for long-term efficacy; the time of disappearance of intraoperative AMR has no guiding significance in judging the efficacy of patients with primary hemifacial spasm.

Objective:To explore the feasibility and effectiveness of the construction of urban unmanned aerial vehicle (UAV) blood distribution system, and to provide a novel way for the distribution of emergency blood.Methods:The study was completed in Hangzhou from April 2019 to January 2021, and the main participants were from the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province Blood Center and Hangzhou Fast Ant Network Technology Co., Ltd. Firstly, an unmanned aircraft delivery system was built for urban emergency blood and a special blood storage box for drones were developed. The drone was used to deliver blood products from Zhejiang Province Blood Center to Binjiang Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine, and the following indicators were obtained: (1) flight time of the drone blood delivery; (2) real-time temperature of blood products during transportation; (3) Baidu map software was used to measure the blood delivery time of road traffic, which was compared with the flight time of the drone.Results:The urban drone blood delivery system consists of intelligent logistics drones, cryogenic blood storage tanks, unmanned logistics hub stations, and cloud-based operation control platforms. The drone route distance from Zhejiang Provincial Blood Center to Binjiang Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine was 2.36±0.06 km, and the ground distance was 5.8 km, with 27 flights from April 12, 2019 to January 29, 2021, and the drone flight time was, shorter than the road travel time for a round trip [(6.37±0.35) min vs. (17.00±1.94) min]. At different time points of the day, UAV blood delivery could save 15.98-4.28 min, with an average saving of 10.62±1.87 min. Conclusions:Urban UAV blood delivery systems have the advantages of being fast, unaffected by ground traffic conditions, and can ensure the safety of blood products during transportation, and are worthy of further exploration.

Objective:To develop an age-appropriate and disease-specific social adaptation measurement tool for adolescents infected with HIV in the context of Chinese culture, and to test its reliability and validity.Methods:Through literature review and consultation with 8 experts, this study constructed the conceptual framework of social adaptation of adolescents infected with HIV and formulated the dimensions and items of the scale. The convenient sampling method was adopted, and questionnaires were distributed online and offline at Beijing Ditan Hospital, Xuzhou Center for Disease Control and Prevention and Yunnan Provincial Infectious Disease Hospital from October 2020 to February 2021 for questionnaire validity testing. A preliminary age-specific and disease-adaptable Social Adaptation Scale for HIV Infected Adolescents was prepared using methods such as project analysis and reliability and validity testing.Results:The scale consisted of 3 dimensions of cognition, emotion and will, 5 variables, and a total of 23 items. The Cronbach's α coefficient of the scale was 0.856, and the split reliability was 0.836. The item-level content validity index ( I- CVI) of the scale was 0.750-1.000, the scale-level content validity index ( S- CVI) was 0.940, and the scale score and subjective well-being scale score were positivelycorrelated ( P<0.05) . Factor analysis extracted 5 common factors, and the cumulative explanatory variable was 61.156%. Conclusions:The scale has good reliability, validity and feasibility, which can be used as an evaluation tool for social adjustment of HIV-infected adolescents in China.

ObjectiveTo investigate the clinical significance of highly sensitive nucleic acid detection in precise antiviral therapy for patients with liver cirrhosis and its association with aminotransferase level. MethodsA total of 377 patients with hepatitis B cirrhosis who were hospitalized or attended the outpatient service from May 2013 to April 2019 were enrolled and tested by both domestic HBV DNA detection and highly sensitive Cobas HBV DNA detection. All patients underwent biochemical examination, four blood coagulation tests, routine blood test, and upper abdominal computed tomography or ultrasound. Sensitivity of different HBV DNA detection reagents was compared in liver cirrhosis patients with a low viral load, and the correlation between alanine aminotransferase (ALT) level and viral load was analyzed. The paired t-test was used for comparison of continuous data before and after treatment. The receiver operating characteristic (ROC) curve was used to screen out the optimal predictive values of ALT at different cut-off values of HBV DNA. ResultsAmong the 377 patients with hepatitis B cirrhosis, 215 tested positive and 162 tested negative by domestic HBV DNA, and among these 162 patients, 104 (64.2%) tested positive by Cobas HBV DNA detection, with a mean level of 267.5±42.3 IU/ml. After 24 weeks of antiviral therapy, the 104 patients with hepatitis B cirrhosis had significant improvements in viral replication level, ALT, and Child-Pugh score for liver function; HBV DNA decreased from 267.5±32.2 IU/ml before treatment to 59.6±7.7 IU/ml after treatment (t=3.486, P=0.002), ALT decreased from 871±10.8 U/L before treatment to 36.5±7.6 U/L after treatment (t=3.235, P=0.020), and the Child-Pugh score decreased from 6.5±0.7 before treatment to 5.7±0.5 after treatment (t=2.928, P=0.041). The ROC curve analysis of ALT in predicting HBV DNA decision point showed that an ALT level of 29 IU/L was the most sensitive cut-off value for predicting HBV DNA ＜20 IU/ml, with an area under the ROC curve of 0.904, a sensitivity of 1.0, and a specificity of 0.237. ConclusionPrecise detection helps to guarantee the precise clinical treatment of patients with hepatitis B cirrhosis and improve their treatment outcome and prognosis. An ALT level of 29 IU/L is a sensitive indicator for predicting patients with negative Cobas HBV DNA, so as to achieve individualized precise screening and treatment.

Objective: To evaluate the clinical efficacy of modified lateral window for maxillary sinus floor augmentation (MSFA). Methods: Fifty-five patients who visited the Stomatology Hospital Affiliated to Zhejiang University School of Medicine between June 2012 and October 2014 were enrolled in the study. Patients underwent MSFA with Bio-Oss grafts based on modified access window. During the operation the vertical height of the bony window was reduced from 6-8 mm of conventional oval window to 4-5 mm of slot-shaped window. The sinus membrane was detached completely via the lateral access and large particle Bio-Oss graft was placed in the sub-mucosal space. The implant survival, graft height, graft volume and resorption rates were measured. Intra-op and post-op complications were recorded. Results: There were 86 implants inserted. The 2-4 year cumulative survival rates were 97.67% by implant-based analysis and 96.36% by patient-based analysis. The residual bone height was (4.7±2.6) mm and bone width was (8.4±2.7) mm. The bone height of implantation site immediately after operation was (16.1±2.5) mm and it was (16.2±2.2) mm at restoration. The bone heights at 1 and 2 years after operation were (14.9±2.5) mm and (13.6±2.6) mm, respectively. The graft height was (10.6±2.8) mm and the graft volume was (1569±745) mm³ immediately after operation. The resorption rate of graft height 6 months after operation was 3.79% and that of graft volume was 7.87%. The 1-year accumulative resorption rate of graft height was 6.63% and that of graft volume was 10.89%. The 2-year accumulative resorption rate of graft height was 7.58% and that of graft volume was 15.26%. Small membrane perforation during MSFA was observed in 5 cases and all were successfully repaired by a collagen Bio-Gide membrane. Conclusion: The modified lateral technique obtains high implant survival rate, excellent graft stability and low complication rate at 2-4 year clinical follow-up, indicating that it is a safe, predictable and minimally invasive surgical method for severe atrophic maxillary posterior dentition.
Dental Implantation, Endosseous ; Follow-Up Studies ; Humans ; Maxillary Sinus ; surgery ; Sinus Floor Augmentation ; methods ; Treatment Outcome

Objective Tocheck and evaluate on clinical practice teaching files for providing a foundation of improved clinical teaching levels with enhanced establishment of practice teaching files. Methods The practice teaching files of eighteen clinical departments in a military medical university were selected as the subject and were evenly divided into teaching plans and teaching records as well as teach-ing summary three parts and 15 items. Each item had 2 scores in which quantity had one score and quality has another one. Evaluation results were converted into 100 points system. Results Among practice teach-ing files of eighteen clinical departments, 4 scored more than 90, 8 scored between 80 to 89, 3 scored between 70 to 79, 3 scored between 60 to 69. Three advanced departments are obstetrics and gynecology, auxiliary department and emergency department. There were no significant differences in the scores of major surgery and internal medicine. Compared with that of other departments in the hospital, the specialty of hospital had low scores. It showed that most of the clinical practice of the file information was relatively sound with complete records and some departments had missing items or incomplete and non-standard doc-umentation records. Conclusion Qualitative study on practice teaching files can reflect clinical practice teaching quality. And it is meaningful for us to enhance teaching files construction and to improve clinical practice teaching levels.

OBJECTIVE: To investigate the expression of miR-33b in hepatocellular carcinoma (HCC) and to explore regulatory mechanism of miR-33b for cell proliferation of HCC.
 METHODS: HCC tissues and adjacent non-tumor tissues were collected for this study (n=32 for each). Real-time PCR and Western blot were conducted to examine the mRNA and protein expression, respectively. MTT assay was used to detect the cell proliferation. Luciferase reporter gene assay was performed to verify the target relationship between miR-33b and Sal-like 4 (SALL4).
 RESULTS: MiR-33b was significantly downregulated in HCC tissues compared with adjacent non-tumor tissues. Overexpression of miR-33b decreased the proliferation of HCC LH86 cells. SALL4 was identified as a target gene of miR-33b, and its protein expression was negatively regulated by miR-33b. Overexpression of SALL4 reversed the suppressive effect of miR-33b on LH86 cell proliferation. SALL4 was significantly upregulated in HCC tissues compared with adjacent non-tumor tissues.
 CONCLUSION The miR-33b suppresses HCC cell proliferation through down-regulation of SALL4.
Carcinoma, Hepatocellular ; chemistry ; genetics ; physiopathology ; Cell Proliferation ; genetics ; physiology ; Down-Regulation ; Gene Expression Regulation, Neoplastic ; genetics ; physiology ; Humans ; Liver Neoplasms ; MicroRNAs ; analysis ; genetics ; physiology ; RNA, Messenger ; Real-Time Polymerase Chain Reaction ; Transcription Factors ; genetics ; physiology ; Tumor Cells, Cultured ; Up-Regulation

Objective To analyze the clinical manifestations,diagnosis and treatment of cerebral amyloid angiopathy (CAA) associated intracerebral hemorrhage.Methods The clinical manifestations,treatment and prognosis of CAA associated intracerebral hemorrhage were analyzed in 4 patients who were identified as CAA-related hemorrhage (CAAH) by pathology.Results All of the 4 patients showed massive lobar intracranial hemorrhage,and underwent craniotomy evacuation of hematoma.One patient had postoperative hemorrhage,and 2 patients were treated with recombinant activated factor Ⅶ after operation.In the next 6 months,re-hemorrhage was found in 3 patients in whom one patient died due to massive hemorrhage.Conclusions CAAH has varied clinical manifestations with high risk of cerebral hemorrhage,and pathological diagnosis is necessary for a definite diagnosis.The very elderly patients with CAAH can benefit from the craniotomy evacuation of hematoma.Although surgery for massive hemorrhage has risks in very elderly patients,it is a better treatment to save their lives.

ObjectiveTo evaluate the relationship between estrogen receptor-α-29 (ERα-29) gene polymorphisms and the development of HBV-related hepatocellular carcinoma (HCC) in Gansu Province, China, and to investigate the pathogenesis of HCC at the gene level. MethodsGene polymorphisms of ERα-29 were analyzed in 106 HBV-related HCC patients and 98 healthy individuals as normal controls using the polymerase chain reaction-restriction fragment length polymorphism technique. Population allele frequencies were calculated using the gene counting method and then tested using the Hardy-Weinberg law of genetic equilibrium. Comparisons of genotype and allele frequencies between groups were performed using the χ2 test. ResultsThe frequencies of TT genotype and T allele of ERα-29 gene in HBV-related HCC patients were significantly higher than those in the normal controls, i.e., 31.1% and 53.8% vs. 11.2% and 32.1% (χ2 = 3.449, P＜0.05; χ2 = 3.840, P＜0.05). In contrast, the frequencies of CC genotype and C allele of ERα-29 gene in HBV-related HCC patients were significantly lower than those in the normal controls, i.e., 23.6% and 46.2% vs. 47.0% and 67.9% (χ2 = 3.488, P＜0.05; χ2 = 3.840, P＜0.05). Compared with those carrying C allele, carriers of T allele had an increased risk (2.46-fold) of HBV-related HCC (OR = 2.46, 95% CI: 1.64-3.69). Conclusion T allele of ERα-29 gene can increase the risk of HBV-related HCC.

Objectives To explore the brain white matter integrity among the patients with buprenorphine tables,scopolamine and promethazine solution(BSP) dependence after abstinence.Methods BSP-dependent patients( n=16)and age/eduction-matched healthy control subjects ( n=18) were assessed by diffusion tensor imaging (DTI) after 3 days,1 month and 2 months of abstinence.White matter (WM) integrity was measured with DTI as fractional anisotropy ( FA),an index of intravoxel orientational coherence of white matter fibers.Results Compared with health controls,FA values were significantly lower in frontal,parietal,temporal and corpus callosum in the BSP addicts after 3-day withdrawal (P＜0.001,uncorrected).Increased FA values in left superior frontal cortex,right medial frontal gyms and fight inferior parietal gyrus were found in BSP users after 2 months of abstinence (P ＜0.001,uncorrected).However,no significant difference was found between these BSP addicts after 1-month abstince.Compared with health controls,BSP dependent subjects still exhibited significantly lower FA in the corpus callosum,frontal,parietal and temporal WM after 2-month withdrawal (P ＜ 0.001,uncorrected ).Conclusion The abnormalities showed less recovery in BSP dependent individuals with abstinence in white matter that suggests that rehabilitation time should be further prolonged for BSP addicts and emphasis cognitive-behavioral therapy to assist BSP abusers rebuild social functions.