Value of section plane,MPR,and 3D-CTVR techniques in the fine differential diagnosis of ossicular chain in the case of conductive hearing loss with intact tympanic membrane

Aim: To assess the quality of high-resolution CT section planes(HRCT), multi-planar reformation(MPR) and 3-dimensional volume rendered computer tomography(3D-CTVR) were here used in the fine differential diagnosis of ossicular chain in the case of conductive hearing loss with intact tympanic membrane.Methods: Here, 17 cases of otosclerosis and 22 cases of ossicular chain deformity were selected. All patients had normal external ear canals,intact tympanic membranes, conductive hearing loss, type A tympanograms, and negative Gelle's tests. The respective radiological reports of the status of the ossicles via 3 protocols were compared to surgical findings. The quantitative assessments of the representation of different segments of the ossicular chain were based on a 3-point scoring system.Results: MPR and CTVR imaging both showed the integrity of whole ossicular chain well. MPR and CTVR imaging were found to be superior to section planes with respect to showing the superstructure of the stapes and malformations(P > 0.05).Conclusion: CTVR and MPR imaging were found to be better able to show the whole ossicular chain in the conductive hearing loss with normal tympanic membranes. Furthermore, the use of these techniques can have profound contributive value in the differential diagnosis of otosclerosis and ossicular chain absence or malformation.

Combination therapy for scalp angiosarcoma using bevacizumab and chemotherapy: a case report and review of literature

Bevacizumab, an angiogenesis inhibitor, is a recombined humanized monoclonal antibody against vascular endothelial growth factor and a promising therapeutic option for angiosarcoma management. This is a ease report and review of the literature using bevacizumab and combination chemotherapy for angiosarcoma. The understanding of the effectiveness of combined therapy of bevacizumab and chemotherapy agents is still limited. The benefits of bevacizumab treatment for angiosarcoma will need to be weighed against the risks of venous thromboembolism in this population.

Scala tympani drill-out technique for oval window atresia with malformed facial nerve: A report of three cases

Objective: To report a scala tympani drill-out technique for managing malformed facial nerve covering the entire oval window(OW).Methods: Data from three cases with OW atresia, malformed stapes and abnormal facial nerve courses were reported, in which a scala tympani drill-out technique was employed with a TORP between the tympanic membrane and scala tympani fenestration for hearing reconstruction.Results: Air conduction hearing improved in two of the three cases following surgery. In the third case, there was no improvement in air conduction hearing following a canal wall up mastoidectomy and tympanoplasty. There were no vertigo, tinnitus or sensorineural hearing loss in the three cases.Conclusion: The scala tympani drill-out technique, which is basically fenestration at the initial part of the basal turn, provides a choice in hearing reconstruction when the OW is completely covered by abarrently coursed facial nerve.

Iontophoresis-assisted corneal crosslinking using 0.1% riboflavin for progressive keratoconus

AIM：To report the clinical results of iontophoresis-assisted epithelium-on corneal crosslinking（I-CXL） using 0.1% riboflavin in distilled water for progressive keratoconus. METHODS：In this prospective clinical study, we examined 94 eyes of 75 patients with progressive keratoconus who were treated with I-CXL using 0.1% riboflavin in distilled water. Best correct visual acuity（BCVA）, Scheimpflug tomography, corneal topography, anterior segment optical coherence tomography, intraocular pressure, and endothelial cell density were evaluated at baseline and 1, 3, 6, 12, and 24 mo after I-CXL.RESULTS：After 24 mo I-CXL, compared to the level at baseline, BCVA significantly improved 0.14±0.07（P=0.010）; mean keratometry signifi cantly decreased 0.72±1.97（P=0.021）; maximum keratometry significantly reduced 2.30±5.01（P=0.014）; central keratoconus index significantly reduced 0.04±0.08（P=0.007）. The demarcation line was visible in 83.1% of eyes at 1mo after treatment, with a depth of 298.95±51.97 μm, and gradually indistinguishable. One eye had repeat treatment. Intraocular pressure and endothelial cell density did not change significantly.CONCLUSION：I-CXL using 0.1% riboflavin halts keratoconus progression within 24 mo, resulting in a significant improvement in visual and topographic parameters. Moreover, the depth of the demarcation line is similar to that previously reported in standard epithelium-off CXL procedures.

Efficacy of iontophoresis-assisted epithelium-on corneal cross-linking for keratoconus

Corneal cross-linking（CXL） is a noninvasive therapeutic procedure for keratoconus that is aimed at improving corneal biomechanical properties by induction of covalent cross-links between stromal proteins. It is accomplished by ultraviolet A（UVA） radiation of the cornea, which is first saturated with photosensitizing riboflavin. It has been shown that standard epithelium-off CXL（S-CXL） is efficacious, and it has been recommended as the standard of care procedure for keratoconus. However, epithelial removal leads to pain, transient vision loss, and a higher risk of corneal infection. To avoid these disadvantages, transepithelial CXL was developed. Recently, iontophoresis has been adopted to increase riboflavin penetration through the epithelium. Several clinical observations have demonstrated the safety and efficacy of iontophoresisassisted epithelium-on CXL（I-CXL） for keratoconus. This review aimed to provide a comprehensive summary of the published studies regarding I-CXL and a comparison between I-CXL and S-CXL. All articles used in this review were mainly retrieved from the Pub Med database. Original articles and reviews were selected if they were related to the I-CXL technique or related to the comparison between I-CXL and S-CXL.

Radiofrequency Ablation of Hepatic Paragonimiasis: a Case Report

HEPATIC paragonimiasis is a rare disease with non-specific manifestation,which is often misdiagnosed in clinical practice.Long-time drug therapy treating this disease would be accompanied by the possible development of side effects.Given the fact that this disease has seldom been reported in the literature,we provide in this article a detailed report of one case with hepatic paragonimiases treated by radiofrequency ablation,which brought favorable outcome,aiming to shed some light on the understanding of this rare condition.

Hypertension in the elderly： insights from recent research

高血压在全世界是死亡和病态的一个领先的原因并且，高血压的流行与 aging.Hypertension 正在增加在老与钠敏感的增加的出现率被联系，孤立的收缩高血压，并且“上衣 effect'.Arterial 僵硬和 endothelial 机能障碍也与 age.These 因素增加的白色应该在选择这治疗的主要目的是阻止控制 tr 的 stroke.The fmdings 的 antihypertensive therapy.The

Fast rate （≥ 250 beats/min） right ventricular burst stimulation is useful for ventricular tachycardia induction in arrhythmogenic right ventricular cardiomyopathy

在 arrhythmogenic 的主要挑战的 BackgroundOne 恰好室的心肌症(ARVC ) 脱离是室的心悸亢进(vt ) non-inducibility。学习试图估计是否快评价(&#x02265；250 beats/min ) 恰好室的爆炸刺激为在与有经历了 electrophysiological 学习的临床的持续 vt 的 ARVC.MethodsNinety 一个连续 ARVC 病人一起的病人感应的 vt 是有用的被注册。刺激协议如下在正确的室的顶和流出道被实现：走 A，直到两倍额外刺激；步 B，有低率的增长刺激(&#x0003c；250 beats/min ) ；步 C，爆炸刺激与快评价(&#x02265；250 beats/min ) ；步 D，与 76 个病人全部的 isoproterenol.ResultsA 的静脉内的注入上面重复了所有步有的可诱导的 vt (83.5%) ，在哪个之中 49 被步 C 导致， 15 被步 B 导致， 8 和 4 由步 A 和 D 分别地。临床的 vt 在 60 个病人(65.9%) 被导致。仅仅二自发地停止的室的纤维性颤动被步 C 导致。Multivariate 分析证明在湾穴节奏下面的更狭窄的基线 QRS 持续时间独立地与 vt non-inducibility 被联系(或：1.1；95% CI：1.0-1.1；P = 0.019 ).ConclusionFast 率(&#x02265；250 beats/min ) 恰好室的爆炸刺激为在 ARVC 病人感应的 vt 提供一个有用补加的方法。

Clinical characteristics of Danshen Ligustrazine injection in the treatment of coronary heart disease with hypertension-A real world study

Objective:To explore the characteristics and rules of Danshen Ligustrazine Injection in the treatment of coronary heart disease with hypertension.Methods:From the information systems of 12 tertiary tier-one hospitals across the country,we extracted the medical data of the application of Danshen Ligustrazine Injection in the treatment of patients with coronary heart disease and hypertension.After normalization,the model was established by Apriori algorithm,and the association rules were analyzed by Clementine 12.0 software.Results:Most of the 1928 patients were between 75 and 90 years old(54.26%).There were more males than females,most with type 2 diabetes,cerebral infarction,etc.Each dose was more than 10 mL(52.78%).Aspirin enteric-coated tablets(67.63%),L-carnitine injection(58.77%),and atorvastatin calcium capsules(50.93%)were often used in combination with safflower yellow pigment(22.20%),Shexiang Baoxin Pill(16.55%),Suxiao Jiuxin Pill(15.09%);the most commonly used combination of western medicine was anticoagulant thrombolytic and antiplatelet drugs(85.84%),and the type of Chinese medicine was Huoxuehuayu(72.98%);The most common combination of two western medicines was L-carnitine injection+aspirin enteric-coated tablets,with a support of 41.9%;The most common combination of two Chinese and western medicines is western medicine·anti-anginal medicine+western medicine·anticoagulant thrombolytic and antiplatelet drugs with a support of 67.6%.Conclusion:Danshen Ligustrazine injection is mainly used in elderly patients with coronary heart disease and hypertension,with many comorbidities.The dosage standard needs to be optimized.The combination of drugs and guidelines should coordinate with each other,which provide clues for clinical diagnosis and treatment and optimization of medication.

Iontophoresis-assisted versus standard corneal crosslinking for progressive keratoconus

Background:To compare the safety and efficacy of iontophoresis-assisted epithelial-on corneal crosslinking(I-CXL)using 0.1%riboflavin-distilled water solution with standard epithelium-off corneal crosslinking(S-CXL)for progressive keratoconus.Methods:In a retrospective analysis,progressive keratoconus patients treated with I-CXL(17 eyes of 17 patients)or S-CXL(13 eyes of 13 patients)were included.All patients were followed up at least 12 months.All patients underwent detailed ophthalmologic examinations involving pre-and postoperative visual acuity,topographic parameters and pachymetry.Intra-and postoperative complications were recorded.Results:No statistically significant differences were observed between the two groups at baseline with respect to visual acuity,age and thinnest corneal thickness(TCT).The postoperative decreases of K1 and Kmean in the S-CXL group represented statistically significantly better results than in the I-CXL group(t=2.093 and 2.123,P=0.046 and 0.043,respectively).Alterations of other parameters showed no significant differences between the two groups.There were no failure cases in the two groups.Conclusions:I-CXL using 0.1%riboflavin-distilled water solution provided effective treatment for progressive keratoconus at 12-month follow-up.However,the decreases of K1 and Kmean caused by I-CXL were less than those by S-CXL.Although treatment time,postoperative patient pain and risk of infection in I-CXL are all less than those in S-CXL,I-CXL is unable to completely replace S-CXL for progressive keratoconus temporarily.

The Treatment of Tacrolimus(FK506) for Psoriasis: One Case Report and Literature Analysis

Psoriasis is a chronic recurrent inflammatory dermatosis,which is characterized by epidermal proliferation and erythema scales.Its etiology and pathogenesis are still unknown and treatment is difficult.The concentration of tacrolimus for the treatment of psoriasis has not been reported at home and abroad.In this report,we detected the tacrolimus plasma concentration and hope to provide a certain reference value for the clinical treatment of psoriasis.

中国北京地区部分医院患者疼痛现状调查(英文)

Objective:This study aimed to survey the characteristics and treatments of cancer pain in Beijing hospitals,China.Methods:At 20:00 on December 22,2009,there conducted a questionnaire survey in 2238 patients with malignant tumors of 26 hospitals in Beijing,and the survey results were statistically analyzed.Results:The 531 cases in 2238 patients had pained and 121 cases (22.79%) had outbreak pain with one week.At 20:00 on December 22,2009,199 cases (38%) in the above-mentioned 531 pain patients suffered the moderate to severe pain (pain scores ≥ 4).The number of pain (pain scores ≥ 4) patients in the consecutive three days from December 20 to December 22 were 150.Conclusion:In the 531 cancer pain patients of the surveyed hospitals,38% of the patients were not satisfied with the pain control.Doctors believed that the main reason for pain not controlled was the non-standard treatment,but patients considered to be afraid of addiction.

Close association between abnormal expressed enzymes of energy metabolism and diarrhea-predominant irritable bowel syndrome

Background:Irritable bowel syndrome (IBS) is one of the most common functional intestinal diseases, but its pathogenesis is still unknown.The present study aimed to screen the differentially expressed proteins in the mucosa of colon between IBS with diarrhea (IBS-D) patients and the healthy controls.Methods:Forty-two IBS-D patients meeting the Rome III diagnostic criteria and 40 control subjects from July 2007 to June 2009 in Chinese PLA General Hospital were enrolled in the present study.We examined the protein expression profiles in mucosa of colon corresponding to IBS-D patients (n=5) and controls (n=5) using 2-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS).Secondly, Western blot and immunohistochemical analysis were carried out to validate the screened proteins in 27 IBS-D patients and 27 controls.Thirdly, high-performance liquid chromatography (HPLC) was further carried out to determine ATP concentration in the mucosa of colon between 10 IBS-D patients and 8 controls.Comparisons between 2 groups were performed by Student's t-test or Mann-Whitney U-test.Results:Twelve differentially expressed proteins were screened out.The α-enolase (ENOA) in the sigmoid colon (0.917 ± 0.007 vs.1.310 ± 0.100, t=2.643, P=0.017) and caecum (0.765 ± 0.060 vs.1.212 ± 0.122, t=2.225, P=0.023), Isobutyryl-CoA dehydrogenase (ACAD8) in the sigmoid colon (1.127 ± 0.201 vs.1.497 ± 0.392, t=7.093, P=0.008) of the IBS-D group were significantly lower while acetyl-CoA acetyltransferase (CT) in the caecum (2.453 ± 0.422 vs.0.931 ± 0.652, t=8.363, P=0.015) and ATP synthase subunit d (ATP5H) in the sigmoid (0.843 ± 0.042 vs.0.631 ± 0.042, t=8.613,P=0.007) of the IBS-D group was significantly higher, compared with the controls.The ATP concentration in the mucosa of the sigmoid colon in IBS-D group was significantly lower than that of control group (0.470 [0.180, 1.360] vs.5.350 [2.230, 7.900], U=55, P<0.001).Conclusions:Many proteins related to energy metabolism presented differential expression patterns in the mucosa of colon of the IBS-D patients.The abnormalities in energy metabolism may be involved in the pathogenesis of IBS which deserves more studies to elucidate.

Controlling the Recurrence of Pelvic Endometriosis after A Conservative Operation:Comparison between Chinese Herbal Medicine and Western Medicine

Objective： To compare the clinical effect of Chinese medicine （CM） and Western medicine （WM） for controlling the recurrence of pelvic endometriosis after a conservative operation. Methods： The study was a multi-center, randomized, parallel controlled and prospective clinical trial. Patients were randomly divided into two groups： CM group （106 cases） and WM group （102 cases）. Drugs were given to patients during 1--5 days of the first menstruation after a conservative operation in both groups. Patients with stages I and I1 （revised American Fertility Society） were treated for 3 months, while the patients with stages Ill and IV were treated for 6 months. The patients in the CM group were treated using three types of Chinese herbal medicine based on syndrome differentiation. Patients in the WM group were treated using gonadotropin releasing hormone agonist （GnRH-a） or gestrinone. Patients treated with GnRH-a received add-back therapy of Tibolone Tablets once a day after 4 months of treatment. Any cases of dysmenorrheal chronic pelvic pain, menstruation and any adverse reactions of patients were recorded once a month during the preoperative and postoperative periods and once every 3 months during the follow-up period. During the preoperative, postoperative and the follow-up periods, patients underwent type B ultrasonography of the pelvis and measurements of serum CA125 levels, gynecologic examination, routine evaluations of blood, urine, hepatic function （glutamate pyruvate transaminase）, renal function （blood urea nitrogen） and electrocardiograms. Dudng the follow-up period they underwent type B pelvic ultrasonography, measurement of serum CA125 levels and further gynecologic examinations. The two treatments were compared for clinical recurrence rates, pregnancy rates and the incidence of adverse reactions. Results： The incidence and timing of recurrence of endometriosis were not significantly different between the two groups. The first pregnancy achieved by the patient in the CM .qroup was si.clnificantly earlier than that in the WM group （P〈0.05）. Moreover, the incidence of adverse reactions in the WM group was significantly higher than in the CM group （P〈O.01）. Conclusions： Treatment with Chinese herbal medicines prevented the recurrence of endometriosis after a conservative operation, improved the conception rate and showed fewer and lighter adverse reactions than did treatment with WM therapy. Treatment with Chinese herbal medicine meets the need of patients wishing to have a child following endometriosis and is an appropriate form of clinical treatment.

Chinese Medicine Improves Postoperative Quality of Life in Endometriosis Patients:A Randomized Controlled Trial

Objective： To investigate the effect of Chinese medicine （CM） and Western medicine （WM） on quality of life （QOL） after conservative surgery for endometriosis. Methods： A total of 320 patients with endometdosis were randomized into two groups by using random block design, CM group （160 cases, activating blood circulation and removing blood stasis treatment based on syndrome differentiation） and WM group （160 cases, gonadotropin-releasing hormone agonist or gestrinone treatment） after conservative surgery. Treatment was given for 3-6 months （according to the revised American Fertility Society scoring system stage）, and the Wodd Health Organization QOL-BREF （WHOQOL-BREF） was applied to patients before and after treatment to assess QOL. Results： There were 136 cases in the CM group and 141 cases in the WM group completing therapy. In the CM group, the use of the WHOQOL-BREF showed that the physical, psychological and environmental scores post- treatment were significantly higher than those at pre-treatment （P〈0.05）, and for 12 items （pain and discomfort, energy and fatigue, sleep and rest, mobility, activities of daily living, work capacity, negative feelings, health and social care： accessibility and quality, participation in and opportunities for recreation/leisure activities, appetite, QOL score, overall health status and QOL）, the difference in scores was significant （P〈0.05）. In the WM group, 4 items （pain and discomfort, opportunities for acquiring new information and skills, QOI_ score, overall health status and QOL） had significantly different scores post-treatment compared with those at pre-treatment （P〈0.05）. Before treatment, the QOL in the two groups of patients showed no significant difference （P〉0.05）. After treatment, the scores for physical health in the CM group were significantly higher than those of the WM group （P〈0.05） and the scores of 4 items （mobility, activities of daily living, sexual activity, QOL score） in the CM group were significantly higher than those in the WM group （P〈0.05）. Conclusions： CM and WM treatment could improve the QOL of patients with endometriosis after conservative surgery. CM treatment is more effective than WM.

Epithelial defect repair in the auricle and auditory meatus by grafting with cultured adipose-derived mesenchymal stem cell aggregate-extracellular matrix

Background: Several patients experience persistent otorrhea after a flawless surgical procedure because of insufficient epithelial healing. Several efforts, such as autologous tissue allograft and xenograft, have been made to halt otorrhea. However, a stable technology to induce temporal epithelial repair is yet to be established. Therefore, this study aims to investigate whether implantation of seeding adipose-derived mesenchymal stem cell (ADMSC) aggregates on extracellular matrix (ECM;herein, ADMSC aggregate-ECM) into damaged skin wound promotes skin regeneration. Methods: ADMSC aggregate-ECM was prepared using a previously described procedure that isolated ADMSCs from rabbits and applied to the auricle and auditory meatus wound beds of New Zealand white rabbits. Wound healing was assessed by general observation and hematoxylin and eosin (H&E) staining. Secretion of growth factor of the tissue was evaluated by western blotting. Two other groups, namely, ECM and control, were used. Comparisons of three groups were conducted by one-way analysis of variance analysis. Results: ADMSCs adhered tightly to the ECM and quickly formed cell sheets. At 2 weeks, general observation and H&E staining indicated that the wound healing rates in the ADMSC aggregate-ECM (69.02±6.36%) and ECM (59.32 + 4.10%) groups were higher than that in the control group (43.74± 12.15%;P=0.005, P<0.001, respectively) in ear auricle excisional wounds. At 7 weeks, The scar elevation index was evidently reduced in the ADMSC aggregate-ECM (2.08±0.87) and ECM (2.31 ±0.33) groups compared with the control group (4.06 ±0.45;P < 0.001, P < 0.001, respectively). In addition, the scar elevation index of the ADMSC aggregate-ECM group reached the lowest rate 4 weeks in advance. In auditory meatus excisional wounds, the ADMSC aggregate-ECM group had the largest range of normal skin-like structure at 4 weeks. The ADMSC aggregate-ECM and ECM groups secreted increased amounts of growth factors that contributed to skin regeneration at weeks 1 and 2, respectively. Conclusions: ADMSC aggregate-ECM and ECM are effective repair materials for wound healing, especially ADMSC aggregate- ECM. This approach will provide a meaningful experimental basis for mastoid epithelium repair in subsequent clinical trials.

MULTIPLE SUBPIAL TRANSECTION FOR TREATMENT OF INTRACTABLE EPILEPSY

On the basis of experimental study, we applied multiple subpial transection (MST) to treat 50 patients with intractable epilepsy in which epileptigenic lesion involved functional areas such as pericentral gyms, postcentral gyrus, Broca's area, Wernicke's area, visual cortex, etc. They were followed up for 6 to 40 months. Complete control of seizures was obtained in 32 patients, significant reduction of seizure (more than 50%) in 13, reduction (less than 50%) in 3, and no effect in 2. The total effective rate was 96%. No functional defect was found in all patients. The mechanism of the disease and surgical technique were discussed in detail. We consider that MST could replace some standard excisional therapy for local epilepsy.