To develop a novel polyamino acid-based nanohydrogel drug delivery system for dexamethasone to enhance its delivery efficiency to the inner ear.

A fluorescein-labeled polyglutamic acid-based polyamino acid dexamethasone nanohydrogel was synthesized, and its gelation time was measured. The hydrogel was surgically injected into the round window niche of guinea pigs to determine its degradation time in the middle ear cavity in vivo. The safety, pharmacokinetics, and distribution patterns of dexamethasone in the inner ear were evaluated.

The hydrogel exhibited a gelation time of 80 seconds in a 37℃ water bath. In vivo, the hydrogel was almost completely degraded within 7 days in the middle ear cavity of guinea pigs. Transient hearing loss was observed one day after administration, but hearing gradually returned to normal over time. No significant cytotoxicity, vestibular stimulation signs, or pathological abnormalities in spiral ganglion cells were observed. Histopathological examination revealed no significant inflammatory reactions. Pharmacokinetic analysis demonstrated sustained drug release and prolonged dexamethasone activity. Immunofluorescence staining confirmed the distribution of dexamethasone in both the cochlea and vestibular organs.

The polyamino acid nanohydrogel exhibits excellent injectability and biodegradability, representing a safe and effective drug delivery system for the inner ear.

Objective To compare the differences in gut microbiota between cirrhosis patients receiving transjugular intrahepatic portosystemic shunt(TIPS)and those not,and explore the relationship between TIPS surgery and gut microbiota in order to provide new ideas for improving the prognosis of cirrhosis patients after TIPS surgery based on gut microbiota.Methods Those who had received TIPS surgery previously were assigned into the operation group,and those without the surgery served as the control group.Their stool samples were collected for 16S rRNA sequencing,and the correlation between gut microbiota and clinical indicators was analyzed.Results There were no significant differences in gender,age,body mass index(BMI),etiology and other baseline data between the 2 groups(P＞0.05),but obvious differences were observed in clinical serological indicators between them,including INR,APTT,RBC and PT counts,and HGB,ALP,ALB,total bilirubin(TBIL),and URE levels(P＜0.05).No statistical difference in alpha diversity was observed between the operation group and the control group(P＞0.05),but beta diversity was obviously different(P＜0.01),among which Bacteroides was increased in the operation group(P＜0.01)and Bifidobacterium was increased in the control group(P＜0.05).The function prediction analysis of gut microbiota showed that the metabolism of D-glutamine and D-glutamate(P＜0.05)and biosynthesis with secondary bile acids(P＜0.05)were up-regulated in the operation group compared with the control group.Correlation analysis between clinical indicators and flora indicated that TBIL and direct bilirubin(DBIL)were significantly correlated with the metabolic pathways of Bacteroides and Secondary bile acids biosynthesis.Conclusion Characteristic changes in gut microbiota are found in cirrhosis patients with and without TIPS surgery.Bacteroides may be involved in the regulation of metabolism of bile acids and thus increase bilirubin level.

Objective:To investigate the application effect of problem-based learning (PBL) in the teaching of professional postgraduate students in hepatobiliary surgery.Methods:A total of 60 professional postgraduate students in the same grade who were accepted by Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, were selected as research subjects. The students were randomly divided into PBL teaching group and lecture-based learning (LBL) teaching group, and the training effect was compared between the two groups. SPSS 25.0 software was used for t test and chi-square test. Results:Compared with the LBL group, the PBL group had significantly higher scores of written examination [(90.3±4.5) vs. (85.2±7.1), P<0.05] and skill examination [(92.3±4.9) vs. (86.3±7.9), P<0.05] and significantly better comprehensive abilities such as scientific research ability, clinical ability, organizing ability, literature review, collaboration and cooperation, and language expression [(85.0±7.5) vs. (73.0±9.1), P<0.05], as well as a significantly higher overall evaluation score [(90.2±3.2) vs. (83.3±3.9), P<0.05]. The PBL group also had a higher degree of satisfaction than the LBL group (83.3% vs. 56.7%). Conclusion:Application of PBL in the teaching of professional postgraduate students can improve the quality of teaching.

In recent years, with the strict management of blood glucose in diabetes patients, the risk of hypoglycemia is increasing. The occurrence of hypoglycemia will affect the physical and mental health of patients and reduce their quality of life. Therefore, in order to understand the ability of diabetes patients to prevent hypoglycemia, this article reviews the concept of hypoglycemia prevention, the importance of hypoglycemia prevention, the risk factors of hypoglycemia, the evaluation tools of hypoglycemia prevention, the current situation of hypoglycemia prevention and the ability improvement strategies, aiming to help medical and nursing staff carry out targeted nursing interventions, minimize the risk of hypoglycemia in diabetes patients, and improve the quality of life of patients.

OBJECTIVETo analyze the clinical characteristics of unilateral conductive hearing loss with intact tympanic membrane, and summarize the key diagnostic points, differential diagnosis and observe the effects of surgical treatment.

METHODSWe reviewed data from 82 patients with unilateral conductive hearing loss with intact tympanic membranes who accepted the exploratory tympanotomy from April 2011 to September 2013. There were 41 males and 41 females, aged from 7 to 66( averaged 26.5±13.7)years, with a history of one month to 50 years. The history, clinical symptoms, audiological evaluation, high resolution temporal bone CT, the results of surgical exploration and hearing reconstruction were analyzed.

RESULTSThe exploratory tympanotomy revealed 43 cases of congenital middle ear malformations (52.4%), 22 cases of otosclerosis (26.8%), eight cases of congenital cholesteatoma (9.8%), six cases of trauma induced conductive hearing loss (7.3%), three cases of congenital ossicular malformations with congenital cholesteatoma (3.7%). Progressive hearing loss was common in patients with otosclerosis and congenital cholesteatoma, and patients with congenital middle ear malformations described their hearing loss since childhood. High resolution temporal bone CT of congenital middle ear malformation, trauma induced conductive hearing loss, congenital cholesteatoma diagnosis rate was 40.0%, 50.0%, and 83.3% respectively. The preoperative air-conductive threshold of patients with absence of the oval window were increased to (66.9±1.1)dBHL, the preoperative bone-conductive threshold achieved (28.3±10.4)dBHL at 2 000 Hz. While patients with stapes fixation and that with ossicular chain discontinuity were (27.2±9.7)dBHL and (17.8±8.8)dBHL(P=0.000)respectively. Through the tympanic exploration with endaural incision under the microscope, different hearing reconstruction were applied according to different lesions. After the operation, the hearing level of 52 patients with return visit were improved, the mean air-conductive threshold were decreased from (60.0±11.4)dBHL to (32.2±12.1)dBHL(P=0.000); and the mean ABG were decreased from (43.2±12.0)dB to (16.3±9.4)dB(P=0.000).

CONCLUSIONSCongenital middle ear malformations, otosclerosis, congenital cholesteatoma are the most common causes in unilateral conductive hearing loss with an intact tympanic membrane. The diagnosis rate can be improved by analyzing the clinical features. Through exploratory tympanotomy and hearing reconstruction, we can clarify the diagnosis and achieve a satisfying hearing recover.

Adolescent ; Adult ; Aged ; Audiometry ; Child ; Cholesteatoma ; congenital ; pathology ; Diagnosis, Differential ; Ear Ossicles ; pathology ; Ear, Middle ; abnormalities ; Female ; Hearing Loss, Conductive ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Middle Ear Ventilation ; Otosclerosis ; pathology ; Tympanic Membrane ; Young Adult

OBJECTIVE To compare the clinical efficacy between adenoidectomy combined with auripuncture (AT+A) and adenoidectomy combined with tympanostomy tubes (AT+T) in children wiht otitis media with effusion. METHODS 92 cases of children with otitis media with effusion were selected from September 2010 to September 2014 in our hospital which was divided into AT+T group and AT+A group, depending on therapy methods.There were 48 in AT+T group and 44 in AT+A group. Retrospective analysis were made on a series of clinical data ,including the therapeutic effect, hearing threshold before and after treatment, infection rate and recurrence rate. RESULTS The hearing threshold has been significantly reduced within one year of follow-up after treatment,however,there was no significant difference (P>0.05). Total efficiency rate was 97.9% in AT+T group and 95.4% in AT+A group, no significant difference was found (P>0.05). The average middle ear fluid duration, infection and recurrence rate of children in AT+T group and AT+A group was (7.3±0.8) days, 6.3%, 4.2% and (11.7±0.4) days, 15.9%, 11.4% respectively, there was significant differences (P<0.05). CONCLUSION Both AT+T and AT +A have a good therapeutic effect for children with otitis media with effusion, which can significantly improve the hearing. Compared to AT+A, AT+T have a higher recovery rate,significantly reduce the recurrence and infection rate,and may be more suitable for clinical treatment of children with otitis media with effusion.

Asthma ; diagnosis ; Diagnostic Errors ; Humans ; Neurilemmoma ; diagnosis

Objective To establish D-dimer normal reference range in pregnant and postpartum women in Zhejiang Han population.Methods Plasma samples were collected from 669 healthy pregnant women, 578 healthy postpartum women, 8 venous thrombosis or DIC patients and 80 healthy non-pregnant women in Women′s Hospital, School of Medicine, Zhejiang University from March 2009 to August 2010.According to different gestational week, postpartum days and delivery pattern, the healthy pregnant and postpartum women were stratified into 3 groups: (1) ≤13 weeks (n=120), 14-20 weeks (n=120), 21-27 weeks (n=145), 28-34 weeks (n=147), ≥35 weeks (n=137);(2) The first day after vaginal delivery (n=163), the second day after vaginal delivery (n=121);(3) The first day after cesarean sections (n=166), the second day after cesarean sections (n=128). These groups were further stratified based on age: ＜30 years old and ≥30 years old.All blood samples were drawn in citrate sodium anticoagulated blood.D-dimer concentration was determined by STA-R Evolution coagulation analyzer.Since D-dimer concentration showed non-normal distribution, the normal values (one-tailed) were established by using (P95) percentile method.The results of 8 patients were used to validate the established normal values.Results In the group of ＜30 years old, the D-dimer values[M(P25-P75)]in group of ≤13 weeks, 14-20 weeks, 21-27 weeks, 28-34 weeks, ≥35 weeks and healthy non-pregnant women were 0.25(0.17-0.37), 0.51(0.38-0.75), 0.75(0.57-1.10), 1.14(0.80-1.48), 1.60(1.14-1.89) and 0.20(0.10-0.28) mg/L, respectively, which showed statistical difference(H=239.24, P＜0.05).In the group of ≥30 years old, the D-dimer values of the above different groups were 0.28(0.14-0.38), 0.50(0.36-0.65), 0.83(0.59-1.41), 0.93(0.68-1.37), 1.47(1.22-1.84) and 0.17(0.12-0.25) mg/L, respectively, which also showed statistical difference(H=127.75, P＜0.05).In the group of ＜30 years old, the D-dimer values were 2.45(1.51-3.77), 1.30(0.97-1.96), 2.68(1.52-3.74) and 1.55(1.10-2.10) on the first and second day after vaginal delivery and cesarean section, respectively, which showed statistical difference (H=64.85,P＜0.05).In the group of ≥30 years old, the corresponding values were 2.20(1.33-3.54), 1.33(1.02-2.14), 2.27(1.66-3.17) and 1.62(1.26-2.69), respectively, which also showed statistical difference(H=18.64, P＜0.05).D-dimer normal values were established based on different gestational week, postpartum days and delivery pattern.The normal values of ≤13 weeks, 14-20 weeks, 21-27 weeks, 28-34 weeks and ≥35 weeks were ≤0.64 mg/L, ≤1.54 mg/L, ≤2.60 mg/L, ≤3.01 mg/L and ≤3.19 mg/L, respectively. The normal values of 1st day after vaginal delivery, 2nd day after vaginal delivery,1st day after cesarean sections and 2nd day after cesarean sections were ≤7.83 mg/L, ≤3.29 mg/L, ≤9.95 mg/L and ≤3.80 mg/L.All 8 patients showed positive results with the above normal values.Conclusion D-dimer normal values in pregnant and postpartum women in Zhejiang Han population are established, which can improve the application values of D-dimer in the pregnant and postpartum population.

Objective To investigate whether the gene polymorphisms of cytochrome P450(CYP) 2E1 are associated with the risk of anti-tuberculosis drug induced hepatotoxity (ADIH).Methods In this case control study, 339 patients who matched the diagnosis criteria of tuberculosis were included. The gcneral healthy status and liver biochemical parameters were checked in all these patients. Polymerase chain reaction-restriction fragment length polymorphism (PCR RFLP) technique was used to determine CYP 2Et polymorphisms. The statistic analysis were performed by using both univariate and multivariate Logistic regression analysis. Results The allele frequencies of CYP 2E1 7632T/A, 1019C/T and 1259G/C in 103 tuberculosis patients of ADIH group were 17.5%, 26.2%and 27.2 % respectively, while those in 236 tuberculosis patients of control group were 29.7 % ,39.4 %and 40.7%, respectively (x2 =5.539, P＜0.05; x2 =5.458, P＜0.05; x2 =5.628, P＜0.05). The results of univariate analysis demonstrated that the risk of concurrent ADIH was significantly higher in patients with wild genotypes of CYP 2E1-7632T/A, CYP 2E1-1259G/C, CYP 2E1-1019C/T than in patients with other genotypes. After adjusted for sex, occupation and alcohol consumption status, the results of multivariate Logistic regression analysis also showed that wild genotypes of CYP 2E1-7632T/A, CYP 2El-1259G/C, CYP 2E1-1019C/T were significantly associated with higher risk of ADIH. The results of interaction analysis indicated that the wild genotypes of CYP 2E1-7632T/A and CYP 2E1-1259G/C or CYP 2E1-1019C/T had synergetic effects on the development of ADIH.Conclusions The risk of concurrent ADIH is significantly higher in patients with wild genotypes of CYP 2E1-7632T/A, CYP 2E1-1259G/C, CYP 2E1-1019C/T compared to patients with othergenotypes. Wild genotypes of CYP 2E1-7632T/A and CYP 2E1-1259G/C or CYP 2El-1019C/T have synergetic effects on the development of ADIH.

Objective To investigate the effect of the treatment of humeral lateral condyle fracture in children through elbow arthroscopy. Method From July 2003 to May 2008, 128 children with humeral lateral condyle fracture were randomly divided into open reduction group and arthroscopy group, each group of 64 cases. Results All 128 children received 12-24 months of follow up, with average of (18.07 ± 5.63) months. In arthroscopy group, the blood loss averaged(34.6 ± 9.1) ml, incision length of(0.98 ± 0.20) cm, and after the first 3 days the VAS was(3.99 ± 1.33) scores. However, in open reduction group, the blood loss averaged (109.9 ± 18.9) ml, incision length of (5.38 ± 1.30) cm, and the VAS was (7.03 ± 2.80) scores. All those in arthroscopy group were much better than those in open reduction group,the differences were statistically significant (P<0.01 or < 0.05). According to Mayo score, the total fine rate was 85.9%(55/64) in open reduction group, and 98.4%(63/64) in arthroscopy group (P<0.05). About in the incidence of postoperative complications,there were 8 cases of delayed healing, S cases of inside inversion or outside eversion elbow varus deformity, 9 cases of pin tract infection in open reduction group. However there were 1 cage of delayed healing, 2 cases of inside inversion and outside eversion elbow varus deformity, 1 case of pin tract infection in arthroscopy group(P< 0.01). Conclusion Arthroscopy operation has the advantages of the small incision, reset reduction accurate, less complications ,and is an effective method of treating the lateral condyle fractures in children.