Analysis of Etiology,Diagnosis,and Treatment Strategy and Efficacy of Pulsatile Tinnitus Caused by Abnormal Vascular Anatomy

Objective To investigate the etiology,clinical characteristics,diagnosis,and treatment strategies and efficacy of pulsatile tinnitus(PT)caused by vascular anatomy abnormality.Methods The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed.Results All 45 patients had vascular anatomical abnormalities.The patients were divided into 10 categories according to the different locations of vascular abnormalities:sigmoid sinus diverticulum(SSD),sigmoid sinus wall dehiscence(SSWD),SSWD with high jugular bulb,pure dilated mastoid emissary vein,aberrant internal carotid artery(ICA)in the middle ear,transverse-sigmoid sinus(TSS)transition stenosis,TSS transition stenosis with SSD,persistent occipital sinus stenosis,petrous segment stenosis of ICA,and dural arteriovenous fistula.All patients complained of PT synchronous with heartbeat rhythm.Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions.Tinnitus disappeared in 41 patients,was significantly relieved in 3 patients,and was unchanged in 1 patient postoperatively.Except for one patient with transient headache postoperatively,no obvious complications occurred.Conclusion PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination.PT can be relieved or even completely alleviated after appropriate surgical treatments.

Liver diseases in COVID-19:Etiology,treatment and prognosis

In December 2019,a novel coronavirus named severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)was identified in Wuhan,China causing coronavirus disease-2019(COVID-19).Numerous studies have shown varying degrees of liver damage in patients infected with SARS-CoV-2.However,in previous case studies of COVID-19,the exact cause of liver injury has not been clearly elucidated,nor is there clear evidence of the interaction between liver injury and COVID-19.This study will analyze the causes of liver injury in COVID-19 and the influence of liver-related complications on the treatment and prognosis of COVID-19.

Etiology, Pathology, Management and Prognosis of Chronic Pancreatitis in Chinese Population: A Retrospective Study

The purpose of this study was to investigate the etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population. The clinical data of 142 patients with chronic pancreatitis were retrospectively studied. All patients were of Chinese nationality and hospitalized from January 2008 to December 2011. Their ages ranged from 14 to 76 years, with a mean of 43 years. Of 142 patients, there were 72 cases of obstructive chronic pancreatitis（50.70%）, 19 cases of alcoholic chronic pancreatitis（13.38%）, 14 cases of autoimmune pancreatitis（9.86%） and 37 cases of undetermined etiology（26.06%）. Pathologically, the average inflammatory mass diameter was 3.8±3.3 cm, biliary obstruction occurred in 36 cases, gall stones in 70 cases, calcification in 88 cases, ductal dilatation in 61 cases, side branch dilatation in 32 cases, ductal irregularity in 10 cases, lymphocytic inflammation in 23 cases, obliterative phlebitis in 14 cases, extra pancreatic lesion in 19 cases and fibrosis in 142 cases. Location of pancreatic lesion in the region of head（n=97）, neck（n=16）, body（n=12）, tail（n=15） and whole pancreas（n=2） influenced the choice of surgical procedures. Ninety-four patients（66.20%） received surgical treatment and 33.80% received other treatments. After operation, 80.85% of 94 patients experienced decreased pain, and 8.51% of 94 showed recovery of endocrine function but with a complication rate of 12.77%. All the operations were performed successfully. According to the pain scale of European Organization for Research and Treatment of Cancer（QLQ-C30） a decrease from 76±22 to 14±18 was observed. Etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population vary from others.

Kleptomania:Recent Advances in Symptoms,Etiology and Treatment

Kleptomania is a kind of uncontrollable impulse and behavior of stealing,and it is also a serious disease.At present,studies on pathological theft at home and abroad are not sufficient,and the understanding of the symptoms,etiology and treatment of this disease is very insufficient.This article focuses on the latest development of symptoms, etiology and treatment of kleptomania,providing a reference for people to further identify, treat and study the disease.

Review: The vital role of traditional Chinese medicine (TCM) in the prevention and treatment of COVID-19 and the etiology and pathogenic mechanism of COVID-19 based on TCM theory

"Yi"is defined in traditional Chinese medicine theory as the general pathological conditions of epidemics.Throughout thousands of years of history,TCM has been playing an essential role in preventing and treating epidemics in China.Showing significant efficacy against severe acute respiratory syndrome(SARS)in 2002 and 2003,a medical intervention involving TCM was applied at the beginning of the pandemic of the corona virus disease 2019(COVID-19),and has been found with good preventive and curative value in clinical practice.In this study,the etiology and pathogenic mechanism of COVID-19 was discussed on a TCM theory basis,and the clinically effective prevention and treatment methods/prescriptions were summarized.It is suggested that TCM has been playing a unique and vital role in preventing and treating COVID-19,and thus contributes greatly to public health.

Etiology and Treatment of Post-surgical Blepharoptosis

Purpose: To investigate the etiology and the treatment of acquired blepharoptosis inpatients,.especially secondary to surgery.Methods: The clinical records of 65 consecutive patients with acquired ptosis were reviewed from an eye center and a comprehensive hospital..Potential factors responsible for acquired ptosis were investigated..Surgical management principles and post-operative exposure keratitis are discussed.Results:.The top three causes of acquired ptosis were postsurgical ptosis(20 / 65, 30.8%), traumatic ptosis(17 / 65,26.2%) and senile aponeurotic ptosis(12 / 65, 18.5%). Twenty patients had post-surgical ptosis secondary to orbital surgery(8 / 20, 40.0%), enucleation and hydroxyapatite(HA) artificial eye implantation(4 / 20, 20%), eyelid surgery(3 / 20,15%), cataract or glaucoma surgery(2 / 20, 10%), conjunctive surgery(2 / 20, 10%).and superior oblique muscle surgery(1 / 20, 5%). The levator palpebrae superioris(LPS) muscle of ten eyes(10 / 20, 50%) was found during exploration and reattached to the tarsal plate, with shortening of the LPS. Nine eyes(9 / 20, 45%) underwent a frontalis suspension(FS) operation because the LPS muscle was missing. One(1 / 20, 5%)patient was not operated on due to a poor Bell's phenomenon.Two patients(2 / 65, 3.1%)—one patient with post-surgical ptosis and another with aponeurotic ptosis—developed exposure keratitis after ptosis correction.Conclusion: Post-surgical ptosis is one of the most common causes of acquired ptosis. It is important to explore LPS muscle during surgery. LPS reattachment is performed if the muscle is found; otherwise, a FS operation is chosen. Exposure keratitis after correction should be monitored.

Liver fibrosis and hepatic stellate cells: Etiology, pathological hallmarks and therapeutic targets

Liver fibrosis is a reversible wound-healing process aimed at maintaining organ integrity, and presents as the critical pre-stage of liver cirrhosis, which will eventually progress to hepatocellular carcinoma in the absence of liver transplantation. Fibrosis generally results from chronic hepatic injury caused by various factors, mainly viral infection, schistosomiasis, and alcoholism; however, the exact pathological mechanisms are still unknown. Although numerous drugs have been shown to have antifibrotic activity in vitro and in animal models, none of these drugs have been shown to be efficacious in the clinic. Importantly, hepatic stellate cells(HSCs) play a key role in the initiation, progression, and regression of liver fibrosis by secreting fibrogenic factors that encourage portal fibrocytes, fibroblasts, and bone marrow-derived myofibroblasts to produce collagen and thereby propagate fibrosis. These cells are subject to intricate cross-talk with adjacent cells, resulting in scarring and subsequent liver damage. Thus, an understanding of the molecular mechanisms of liver fibrosis and their relationships with HSCs is essential for the discovery of new therapeutic targets. This comprehensive review outlines the role of HSCs in liver fibrosis and details novel strategies to suppress HSC activity, thereby providing new insights into potential treatments for liver fibrosis.

Pulmonary vein stenosis:Etiology,diagnosis and management

Pulmonary vein stenosis(PVS) is rare condition characterized by a challenging diagnosis and unfavorable prognosis at advance stages. At present, injury from radiofrequency ablation for atrial fibrillation has become the main cause of the disease. PVS is characterized by a progressive lumen size reduction of one or more pulmonary veins that, when hemodynamically significant, may raise lobar capillary pressure leading to signs and symptoms such as shortness of breath, cough, and hemoptysis. Image techniques(transesophageal echocardiography, computed tomography, magnetic resonance and perfusion imaging) are essential to reach a final diagnosis and decide an appropriate therapy. In this regard, series from referral centers have shown that surgical and transcatheter interventions may improve prognosis. The purpose of this article is to review the etiology, assessment and management of PVS.

Epididymo-Orchitis in Pre-Pubertal Children. Epidemiology, Etiology, Management and Follow-Up Recommendations

Epididymo-Orchitis (EO) is a disease that may affect males in all ages. Neonates and elderly patients may suffer from bacterial infection due to congenital or aging processes affecting the urinary tract. In sexually active post pubertal and young males sexually transmitted organisms may cause EO. EO is also prevalent in pre pubertal healthy boys;however in this group the etiology, the needed imaging modalities and proper management are not clearly defined yet. This manuscript will systematically review the various etiologies causing EO in pre-pubertal boys, discus about the needed proper imaging, and image interpretation, will give treatment and follow-up recommendations.

Analysis of Etiology and Clinical Characteristics of 1170 Patients with Symptomatic Epilepsy in Jianghan Plain

Objective: The etiology, clinical manifestations and treatment of 1170 patients with symptomatic epilepsy were retrospectively analyzed and provided guidance for further treatment of symptomatic epilepsy. Method: A retrospective analysis of 1170 cases of symptomatic epilepsy admitted to the First Affiliated Hospital of Yangtze University from January 2013 to June 2018 was conducted to analyze the etiology, clinical manifestations and treatment of different age groups. Results: Symptomatic epilepsy is high in the elderly, and men are more than women. Among the 1170 patients with symptomatic epilepsy, there were 81 (6.9%) cases of brain injury, 721 (61.6%) cases of cerebrovascular disease, 223 (19.0%) cases of tumor, 59 (5.0%) cases of central nervous system infection, 33 (2.8%) cases of immune metabolic disease, 11 (0.9%) cases of drugs, 6 (0.5%) cases of cortical dysplasia, 6 (0.5%) cases of neurodegenerative disease, 4 (0.3%) cases of parasites, 4 (0.3%) cases of poisons, and 22 (1.9%) cases of other diseases. Among them, central nervous system infection and cerebrovascular disease ranked first among the patients aged 0 - 18 years, followed by immune metabolic diseases;cerebrovascular disease ranked first among the patients aged 19 - 39 years, followed by tumors and brain trauma;cerebrovascular disease ranked first among the patients aged 40 - 65 years, followed by tumors and brain trauma;cerebrovascular disease ranked first among the patients aged over 65 years, followed by tumors, among the types of seizures, 74 (6.3%) cases of tonic seizures, 68 (5.8%) cases of clonic seizures, 856 (73.2%) cases of tonic-clonic seizures, 27 (2.3%) cases of myoclonic seizures, 12 (1.0%) cases of absence seizures, 116 (9.9%) cases of complicated partial seizures, and 17 (1.5%) cases of partial seizures, in addition to the etiology, 795 (67.9%) cases of sodium valproate, 152 (13.0%) cases of carbamazepine, 56 (4.8%) cases of topiramate, 117 (10.0%) cases of levetiracetam, 23 (2.0%) cases of lamotrigine, and 27 (2.3%) cases of others were taken. Conclusion: In symptomatic epilepsy, different age groups have different causes. Among them, cerebrovascular disease, central nervous system infection, brain trauma, and brain tumor are the main causes. The most common type of seizures is the occurrence of tonic-clonic seizures. The most common drugs are sodium valproate and carbamazepine.

Fulminant myocarditis:a comprehensive review from etiology to treatments and outcomes

Fulminant myocarditis(FM)is characterized by a rapid progressive decline in cardiac function and a high mortality rate.Since the first report of FM patients in the 1980s,several clinical trials and research studies have been published increasing our knowledge regarding FM.Currently,the diagnosis of FM depends on various techniques including electrocardiography,echocardiography,endomyocardial biopsy,and cardiac magnetic resonance.The development of mechanical circulation support(MCS)devices and progress in our understanding of the pathophysiological mechanisms underlying FM,treatment regimens have evolved from simple symptomatic treatment to a life support-based comprehensive treatment approach.The core mechanism underlying the development of FM is the occurrence of an inflammatory cytokine storm.This review provides a comprehensive account of the current understanding of FM pathophysiology and knowledge regarding its etiology,pathophysiology,treatments,and outcomes.

Incidence and clinical treatment of hypertriglyceridemic acute pancreatitis:A few issues

Hypertriglyceridemia is a well-recognized etiology of acute pancreatitis,and the incidence of hypertriglyceridemic acute pancreatitis(HTG-AP)has increased in frequency worldwide in response to lifestyle changes.It is crucial to identify hypertriglyceridemia as the cause of pancreatitis and initiate appropriate treatment.Insulin treatment produces effective lowering of triglycerides,but in our opinion,non-diabetic patients with HTG-AP require separate consideration to avoid hypoglycemia.

Fulminant myocarditis:a comprehensive review from etiology to treatments and outcomes

Fulminant myocarditis(FM)is characterized by a rapid progressive decline in cardiac function and a high mortality rate.Since the first report of FM patients in the 1980s,several clinical trials and research studies have been published increasing our knowledge regarding FM.Currently,the diagnosis of FM depends on various techniques including electrocardiography,echocardiography,endomyocardial biopsy,and cardiac magnetic resonance.The development of mechanical circulation support(MCS)devices and progress in our understanding of the pathophysiological mechanisms underlying FM,treatment regimens have evolved from simple symptomatic treatment to a life support-based comprehensive treatment approach.The core mechanism underlying the development of FM is the occurrence of an inflammatory cytokine storm.This review provides a comprehensive account of the current understanding of FM pathophysiology and knowledge regarding its etiology,pathophysiology,treatments,and outcomes.

Function of macrophage-derived exosomes in chronic liver disease:From pathogenesis to treatment

Chronic liver disease(CLD)imposes a heavy burden on millions of people worldwide.Despite substantial research on the pathogenesis of CLD disorders,no optimal treatment is currently available for some diseases,such as liver cancer.Exosomes,which are extracellular vesicles,are composed of various cellular components.Exosomes have unique functions in maintaining cellular homeostasis and regulating cell communication,which are associated with the occurrence of disease.Furthermore,they have application potential in diagnosis and treatment by carrying diverse curative payloads.Hepatic macrophages,which are key innate immune cells,show extraordinary heterogeneity and polarization.Hence,macrophage-derived exosomes may play a pivotal role in the initiation and progression of various liver diseases.This review focuses on the effects of macrophage-derived exosomes on liver disease etiology and their therapeutic potential,which will provide new insights into alleviating the global pressure of CLD.

Management of hilar cholangiocarcinoma in the North of England: Pathology, treatment, and outcome

AIM: To assess the management and outcome of hilar cholangiocarcinoma (Klatskin tumor) in a single tertiary referral center.METHODS: The notes of all patients with a diagnosis of hilar cholangiocarcinoma referred to our unit for over an 8-year period were identified and retrospectively reviewed. Presentation, management and outcome were assessed.RESULTS: Seventy-five patients were identified. The median age was 64 years (range 34-84 years). Male to female ratio was 1:1. Eighty-nine percent of patients presented with jaundice. Most patients referred were under Bismuth classification 3a, 3b or 4. Seventy patients required biliary drainage, 65 patients required 152percutaneous drainage procedures, and 25 had other complications. Forty-one patients had 51 endoscopic drainage procedures performed (15 failed). Of these,36 subsequently required percutaneous drainage. The median number of drainage procedures for all patients was three, 18 patients underwent resection (24%), nine had major complications and three died post-operatively.The 5-year survival rate was 4.2% for all patients, 21%for resected patients and 0% for those who did not undergo resection (P = 0.0021). The median number of admissions after diagnosis in resected patients was two and three in non-resected patients (P＜0.05).Twelve patients had external-beam radiotherapy, seven brachytherapy, and eight chemotherapy. There was no significant benefit in terms of survival (P = 0.46) or hospital admissions.CONCLUSION: Resection increases survival but carries the risk of significant morbidity and mortality.Percutaneous biliary drainage is almost always necessary and endoscopic drainage should be avoided if possible.

Anesthetic Treatment in Operations of Small Pelvic Organs Pathology

The article presents data on the surgical treatment of 405 patients with pelvic organ surgical and gynecological diseases. When using regional anesthesia during operations in the lower abdominal cavity of patients with pelvic pathology, a smoother operation course and early postoperative period were observed compared with general anesthesia use. In this work, 405 patients with surgical and gynecological diseases of pelvic organs, operated in the surgical and gynecological departments were analyzed. When using regional anesthesia, it was observed that intraoperative blood loss in patients and consumption of narcotic analgesics in the postoperative period decreases.

Surgical treatment of mixed cervical spondylosis with spontaneous cerebrospinal fluid leakage: A case report

BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.Here,we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur.CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction,presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton.The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago.Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae,and computed tomography showed a“sickleshaped”disc prolapse with calcification in C4/5.We chose to perform an anterior cervical discectomy.When the prolapsed C4/5 disc was scraped,clear fluid leakage was observed,and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater,which was compressed continuously with cotton patties,with no significant cerebrospinal fluid leakage after 1 h.CONCLUSION Three months after surgery,the patient was asymptomatic and follow-up imaging demonstrated complete resolution.

肝硬化临床研究进展

多种慢性肝病均可导致肝纤维化和假小叶形成,导致肝硬化(liver cirrhosis,LC),成为沉重的疾病负担。全球约有1.23亿LC患者^([1,2]),我国有700万LC及数亿LC高危人群,包括约2.7亿非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)、6500万慢性HBV感染.

张德英从痰论治痤疮验案举隅

[目的]总结张德英教授从痰证角度治疗痤疮的特色及经验。[方法]通过跟随张教授门诊临证学习,整理张教授治疗痤疮的病案,选取三则典型验案,结合中医经典理论,分析、总结张教授对痰证理论的独到见解及临床经验。[结果]张教授从当今人们的体质状况及痤疮发病特点出发,指出痤疮的病因病机为痰热或痰火上犯头面胸等处,局部肉腐而发病。根据痰浊生于中焦脾胃,为土家实邪,在治疗上可以通过泻土降浊、繁木制土、化土生金的方法达到化痰的目的,再加以清热药物,从而清化上焦痰热之邪,使痤疮得以治愈。同时需注意到五行相互关系,痰浊太盛则易克伐肾水而致肾虚,在治疗上祛痰降浊为先,痰浊去除后再补益肾水方可有效,甚或有些患者不需补肾,而肾自慢慢恢复。[结论]张教授对痰证理论认识独特,指出痤疮病机多为痰火或痰热郁于肌表,肉腐而成。治疗当以清化痰热为主。痰为土家之邪,化痰之法除泻土之外,根据五行理论,还有繁木制土、生金消土之法,其临床疗效显著,值得临床推广应用。

Food intolerance and the few-foods(or oligoantigenic)diet in children with attention-deficit hyperactivity disorder

The hypothesis that some children with attention-deficit hyperactivity disorder(ADHD)may show sensitivity or allergic reactions to various food items has led to the development of the the few-foods(or oligoantigenic)diet.The rationale of the diet is to eliminate certain foods from the diet in order to exclude potential allergens contained either naturally in food or in artificial ingredients with allergenic properties.The oligoantigenic diet attempts to identify individual foods to which a person might be sensitive.First,ADHD symptoms are monitored while multiple foods are excluded from the diet.Subsequently,if symptoms remit,foods are re-introduced,while observing the individual for the return of symptoms.An advantage of the oligoantigenic diet is that it can be tailored to the individual.A growing body of evidence suggests that behavioral symptoms of subgroups of children with ADHD may benefit from the elimination of certain foods.The effect sizes of an oligoantigenic diet regarding improvement of ADHD symptoms have been found to be medium to large.Available evidence suggests that the investigation of the role of food hypersensitivities in ADHD is a promising avenue worthy of further exploration.Further large-scale,randomized controlled studies including assessment of long-term outcome are therefore warranted.