简介：BackgroundInmanyEuropeanandAmericanhospitals,representedbytheHouseEarClinic(HEC),theoverlaytympanoplastyisusedwithrareexception,withsimultaneouscanalwallupordownmastoidectomybeingtakenifneeded.InChina,underlaytympanoplastyisusedacrossthecountry,buttheoverlaytech-niqueisusedrarely.Theaimofthecurrentstudywastoreporttheauthors’experiencewithoverlaytympa-noplastyin83Chinesepatientsandstudyitsvalue.MethodsEight-threepatients(86ears)underwentover-laytympanoplastyinaccordancetothestandardoftheHEC.Thepatientswerefollowedupandconditionsoftheexternalauditorycanal,tympanicmembraneandhearingwerereviewedandanalyzed.ResultsAllpatientsgainedstageIincisionhealing.Thesizeofexternalauditorycanalandtympanicmembranemor-phologyweresatisfactory.Hearingeitherremainedunchangedorimproved.Therewerenohearingdeterio-rationorseriouscomplications.ConclusionsOverlaytympanoplastycarriespositivevalueintreatingchron-icotitismediaandcholesteatomawiththemeritsofprocedurestandardization,adequateoperativeexposure,thoroughdiseaseeliminationandextensiveadaptation.

简介：Objective:TostudycentralfunctionalnetworkconnectionsandtheiralterationsintinnituspatientsusingfMRI.Methods:Regionalhomogeneity(ReHo)valuesonfMRIwereobtainedfrom18tinnituspatientsand20ageandgender-matchedcontrolsubjects.ReHovalueswerecomparedbetweentinnituspatientsandcontrolsubjectstoevaluatefunctionalnetworkconnectiondifferences.Results:TinnituspatientsshowedincreasedReHovaluesingyrusfrontalisinferioranddecreasedReHovaluesintheanteriorlobeofcerebellumincomparisonwiththecontrols.Analysisoffunctionalnetworkconnectionfromthegyrusfrontalisinteriorshowsstrongerconnectionstothemiddlebrain(FWE,P<0.001)andrightventralstriatum(FEW,P<0.05,smallvolumecorrection).Conclusions:ThefMRIresultsindicatethatbothauditoryandnon-auditorycentersplayimportantrolesintinnitus.Functionalconnectionsamongtheauditorycortex,thalamus,medialtemporalgyrus,parahippocampalgyrusandinsulamaybeanunderlyingcauseforthedevelopmentoftinnitus.

简介：这研究寻求了在病理学的ENE阴茎癌估计extranodal扩展(ENE)和几个另外的风险因素的度的预示的意义。我们分析了有希望地与证明ENE在31个化疗天真的病人的一个连续系列上收集了数据经历了治疗学的地区性的lymphadenectomy。手术后的外部放射疗法然后被执行。我们学习了一个新奇分级系统和相关病人与他们的结果措施分级的利用的ENE的程度。ENE作为1被分级-如果淋巴节点(行)的囊被破裂不到三分之一个它的圆周或2-如果囊被破坏，超过三分之一个它的圆周或全部行被破坏。我们用Kaplan-Meier方法估计了全面幸存(OS)。Multivariate分析根据比例的危险用在univariate分析作为统计上重要被识别的因素建模的考克斯的意见被执行。ENE的发生率在有阴茎的病理学的节点积极的癌的病人是51.8%。中部的OS和5年的幸存是18个月(95%信心间隔(CI)，14.4-21.6)并且23%分别地。univariate分析上的预示的变量是ENE等级2，≥；有ENE的3行，最大的行≥；35公里，≥；5积极的行和骨盆的行参与。在multivariate分析上，仅仅ENE等级2仍然保持与减少的OS联系了(危险比率(HR)：6.50)。在结论，有ENE的病人有等级2是的差的结果，和ENE在有病理学的ENE的病人的差的OS的一个独立预兆的因素阴茎癌。

简介：AIM:Toinvestigatethelifetimeriskofdevelopmentofesophagealadenocarcinomaand/orhigh-gradedysplasiainpatientsdiagnosedwithBarrett’sesophagus.METHODS:DatawereextractedfromtheUnitedKingdomNationalBarrett’sOesophagusRegistryondateofdiagnosis,patientageandgenderof7877patientsfromwhohadbeenregisteredfrom35UnitedKingdomcenters.LifeexpectancywasevaluatedfromUnitedKingdomNationalStatisticsdatabasedupongenderandageatyearatdiagnosis.Thesedatawerethenusedwithpublishedestimatesofannualadenocarcinomaandhigh-gradedysplasiaincidencesfrommetaanalysesandlargepopulation-basedstudiestoestimateoveralllifetimeriskofdevelopmentofthesestudyendpoints.RESULTS:ThemeanageatdiagnosisofBarrett’sesophaguswas61.6yearsinmalesand67.3yearsinfemales.Themeanlifeexpectancyatdiagnosiswas23.1yearsinmales,20.7yearsinfemalesand22.2yearsoverall.Usingdatafrompublishedmeta-analyses,thelifetimeriskofdevelopmentofadenocarcinomawasbetween1in8and1in14andthelifetimeriskofhigh-gradedysplasiaoradenocarcinomawas1in5to1in6.Usingdatafrom3largerecentpopulation-basedcohortstudiesthelifetimeriskofadenocarcinomawasbetween1in10and1in37andofthecombinedendpointofhigh-gradedysplasiaandadenocarcinomawasbetween1in8and1in20.AgeatBarrett’sesophagusdiagnosisisreducingandlifeexpectancyisincreasing,whichwillpartiallycounter-balancelowerannualcancerincidence.CONCLUSION:Thereisasignificantlifetimeriskofdevelopmentofhigh-gradedysplasiaandadenocarcinomainBarrett’sesophagus.

简介：AIM:Toanalyzethepotentialrelationshipbetweengastroesophagealrefluxdisease(GERD)andthedevelopmentofatrialfibrillation(AF).METHODS:Usingthekeywords'atrialfibrillationandgastroesophagealreflux','atrialfibrillationandesophagitis,peptic','atrialfibrillationandhernia,hiatal'thePubMed,EMBASE,CochraneLibrary,OVIDSP,WILEYdatabaseswerescreenedforrelevantpublicationsonGERDandAFinadultsbetweenJanuary1972-December2013.StudieswritteninlanguagesotherthanEnglishorFrench,studiesnotperformedinhumans,reviews,casereports,abstracts,conferencepresentations,letterstotheeditor,editorials,commentsandopinionswerenottakenintoconsideration.ArticlestreatingthesubjectofradiofrequencyablationofAFandtheconsecutivedevelopmentofGERDwerealsoexcluded.RESULTS:Twothousandonehundredsixty-onetitleswerefoundofwhich8articlesmettheinclusioncriteria.ThepresenceofAFinpatientswithGERDwasreportedtobebetween0.62%-14%,highercomparedtothosewithoutGERD.EpidemiologicaldataprovidedbytheseobservationalstudiesshowedthatpatientswithGERD,especiallythosewithmoresevereGERD-relatedsymptoms,hadanincreasedriskofdevelopingAFcomparedwiththosewithoutGERD,butacausalrelationshipbetweenGERDandAFcouldnotbeestablishedbasedonthesestudies.ThemechanismsofAFasaconsequenceofGERDremainlargelyunknown,withinflammationandvagalstimulationplayingapossibleroleinthedevelopmentofthesedisorders.TreatmentwithprotonpompinhibitorsmayimprovesymptomsrelatedtoAFandfacilitateconversiontosinusrhythm.CONCLUSION:AlthoughlinksbetweenAFandGERDexist,largerandomizedclinicalstudiesarerequiredforabetterunderstandingoftherelationshipbetweenthesetwoentities.

简介：Objective:Toinvestigatetheprevalenceoflong-termfatigue,anxiety,depressionandsocialsupport,andtherelationshipsamongthesesymptomsinpostoperativepatientswithbreastcancer.Methods:Atotalof180postoperativepatientswithbreastcancermeetingcriterionwererecruitedinthiscross-sectionalstudy.TheBriefFatigueInventory(BFI),HospitalAnxietyandDepressionScale(HADS)andTheSocialSupportSurvey-Chineseversionwereusedtoassessingthefatigue,anxietyanddepression,Socialsupportofparticipants.ThemagnitudeoftherelationshipamongthesymptomsoffatigueandothervariableswasmeasuredbySpearmanRhocorrelation.Results:Theprevalenceoflong-termfatiguewas52.7%,and18.3%occurredmoderate/severefatigue.Two-thirdsofpatientshadabasalsocialsupport,only12.8%ofpatientshadbetter-perceivedsocialsupport.ResultsofHADSshowedthat16.7%and21.1%oftheparticipantshaveanxietyordepressiondisorder.Moderate/severefatiguewasnegativelycorrelatedwithsocialsupport(r=–0.158,P=0.038)andpositivelycorrelatedwithage(r=0.132,P=0.042),chemotherapy(r=0.297,P=0.027),anxiety(r=0.324,P=0.018)anddepression(r=0.211,P=0.034).Conclusions:Long-termfatiguewashighlyprevalentamongoverhalfofpostoperativepatientswithbreastcancer,andmoderate/severefatiguewasassociatedwithsocialandpsychologicalfactorssuchassocialsupport,anxietyanddepression.Ourresultssuggestthatoverallnursingcaremaybeamoreeffectivemannerinimprovingfatigueandqualityoflife.

简介：ObjectiveToanalyzethecharacteristicsofauditorybrainstemresponse(ABR)inpresbycusispatientsel-derthan90years.MethodsFourteenpresbycusispatientselderthan90years(presbycusisgroup,91.1.4±1.3years,26ears)and9normal-hearingyoungadults(controlgroup,22.7±1.2years,18ears)participatedinthestudy.Alternativeclick-evokedABRswererecordedinbothgroups.Thepeaklatency(PL)ofpeakI,Ⅲ,andV,andtheinter-peaklatency(IPI)ofI-Ⅲ,Ⅲ-V,andI-Vwerecomparedbetweengroups.ResultsInelderpresbycusispatients,theoccurrencerateofpeakIandⅢwereboth76.9%,andthatofpeakVwas84.6%.Inpresbycusisgroup,thepeaklatenciesofI,Ⅲ,Vweresignificantlylongerthanthatofcontrolgroup(P<0.001).TherewasnosignificantdifferencebetweengroupsintheIPIofpeakI-IⅢ(P=0.298,peakⅢ-V(P=0.254)andpeakI-V(P=0.364).ConclusionsAuditorybrainstemresponsesinpresbycusispa-tientselderthan90yearsshowedworsewavedifferentiation.

简介：Gapinducedpie-pulseinhibition(Gap-PPI)ofacousticstartlereflexhasbeenusedasameasurementoftinnitusinanimalmodels.However,whetherthistestissensitivetodetecttinnitusinhumansisstillunclear.Basedonthetestingprocedureusedinanimalstudies,ahumansubjecttestingmethodwasformulatedandconductedtoinvestigateifasimilarresultcouldbefoundintinnituspatients.Audiologicandtinnitusassessmentsandacousticstartlereflexmeasurementswereperformedonseventinnitussubjectsandnineagematchedsubjectswithouttinnitus.TherewasnosignificantdifferencefoundbetweenthecontrolandtinnitusgroupontheGap-PPlacrossthefrequenciesevaluated.Theamplitudeofthestartleresponseinthetinnitusgroupwithnormalhearingthresholdswassignificantlyhigherthanthecontrolgroupandthosewithtinnitusandhearingloss.Thispreliminaryresultsuggeststhathyperexcitabilityinthecentralauditorysystemmaybeinvolvedintinnitus.Therewasnocorrelationbetweenhearingthresholdsandtheincreasedamplitudeofstartleresponse.

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简介：这研究的目的是为把用不同技术比较修改Nesbit过程的结果神经与血管的捆(NVB)到正确腹的先天的阴茎弯曲(CPC)。捆在21用中间、侧面的解剖技术被动员(组1)并且13(组2)病人分别地。在中间的技术，uck's扁带在阴茎的背面的方面被打开，深背面的静脉在弯曲的最突出的地点被移开，钻石形的tunicaalbuginea(TA)从阴茎的中线被切除。在侧面的技术，捆在5和7o’在尿道上面用uck's扁带的一个纵的侧面的切口被动员；经由一条双边的途径的钟位置。弯曲的本地化和度用联合intracavernous注射刺激测试或从patients’被评估；相片。弯曲的吝啬的耐心的年龄和度在组之间是类似的。吝啬的操作时间为组2是更长的(P=0.01)。在组1，九个病人(42.8%)要求了一钻石切除，(47.6%)10要求了二钻石切除，(9.5%)二要求了超过二切除；在组2，六个病人(46.2%)要求二钻石切除和七个病人(53.8%)要求了超过二钻石切除(P=0.019)。在阴茎弄短的差别，阴茎弄直和龟头的麻木不是统计上重要的。为修改Nesbit过程的捆的中间的解剖减少TA的钻石形的移动的数字并且因此弄短与它的侧面的对应物比较的操作时间。

简介：BackgroundAcutecoronarysyndrome(ACS)isaleadingcauseofmortalityandmorbidityworldwide,whichcomprisesunstableangina(UA)andacutemyocardialinfarction(AMI),andtheinvestigationofbiologicalmarkerstoassessthosemostatriskofrecurrentcardiovasculareventsisnecessary.MethodsSixty-sixhealthycontrolpeopleand67casesofUApatientswereenrolledinGuangdonggeneralhospital.Enzymelinkedimmunosorbentassay(ELISA)wasusedtodetectthelevelofplasmaACTG2.Thereceiveroperatingcharacteristiccurve(ROC)wasusedtoanalyzethepredictionvalueofACTG2forUA.AccordingtotheaveragelevelofplasmaACTG2inUApatients,UApatientsweredividedintothelowACTG2group(

简介：Lungcanceristhemostfrequentlydiagnosedcancerandaleadingcauseofcancermortalityworldwide,withadenocarcinomabeingthemostcommonhistologicalsubtype.Deeperunderstandingofthepathobiologyofnon-smallcelllungcancer(NSCLC)hasledtothedevelopmentofsmallmoleculesthattargetgeneticmutationsknowntoplaycriticalrolesinprogressiontometastaticdiseaseandtoinfluenceresponsetotargetedtherapies.Theprinciplegoalofprecisionmedicineistodefinethosepatientpopulationsmostlikelytorespondtotargetedtherapies.However,thecancergenomelandscapeiscomposedofrelativelyfew"mountains"[representingthemostcommonlymutatedgeneslikeKRAS,epidermalgrowthfactor(EGFR),andanaplasticlymphomakinase(ALK)]andavastnumberof"hills"(representinglowfrequencybutpotentiallyactionablemutations).Low-frequencylesionsthataffectadruggablegeneproductallowarelativelysmallpopulationofcancerpatientsfortargetedtherapytobeselected.

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简介：BackgroundHospital-acquiredpneumonia(HAP)isthemostcommonandmostseriousnosocomialinfectionforcardiacsurgerypatients,withhighincidenceandfatalityrate1.ItisimportantforcardiacsurgeonstocorrectlyidentifyHAP,assesstheseverity,andthenadjustanti-infectionmethod,whichcanreducethemortalityrate,shortenhospitalizationtime,andreducethewasteofmedicalresources.ThepurposeofthisresearchistoevaluatetheapplicationvalueoflungCTindiagnosisandtreatmentofHAPaftercardiacsurgery.MethodsAretrospectiveanalysiswasconductedforclinicaldataabout76cardiacsurgerypatientswhowerediagnosedwithHAPduringJanuarytoDecember2013.Theclinicaldatamainlyincludedsymptoms,physicalsigns,laboratoryexaminations(suchasroutinebloodtestsandserumprocalcitonin),andlungCTandX-raydata.OurfocusisonthecomparisonbetweenlungCTandX-raydata.ResultsThepositivediagnosticrate,falsenegativerate,andfalsepositiverateoflungCTwere71/76(93.4%),5/76(6.6%),and1/76(1.3%)respectively.ThecoincidencerateofX-rayandCTwas45/76(59.2%),andthefalsenegativerateofX-raywas23/76(30.3%).ConclusionLungCTisbetterthanX-rayindiagnosisofHAPaftercardiacsurgeryandassessmentofseverity,andhasgreatersignificanceforguidingtherationaluseofantibiotics.Therefore,lungCTisworthyofapplicationandpopularization.

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简介：BackgroundTheclinicalcharacteristicsofstrokepatientstreatedwithdoubleanti-platelettherapy(DAPT)afterpercutaneouscoronaryintervention(PCI)isnotclear.MethodsIntotal,2675patientsunderwentPCIandDAPTinGuangdongGeneralHospital,and68outofthemwerehospitalizedduetosuspectedstroke,ofwhom23werediagnosedashavingstroke.Dataofthe23strokepatientswerecollectedandtraditionalriskfactorsassociatedwithstrokewereanalyzedretrospectively.ResultsThemeanageofthesepatientswas75.6±8.7years,and20(87.0%)weremales.Notably,19patientswerecomplicatedwithhypertension,7withdiabetesmellitus,7withprevioushistoryofstroke,nonewithatrialfibrillation(AF)orpatentforamenovale(PFO).Specifically,22patientswerediagnosedwithischemicstroke,and1patientwithhemorrhagicstroke.ConclusionStrokeinpatientstreatedwithDAPTafterPCIwascorrelatedwithadvancedage,gender,hypertension,diabetesmellitus,strokehistory.Longtermelectrocardiography(ECG)maybeneededforthediagnosisofAF,whiletrans-esophagealechocardiography(TEE)maybeneededforPFO.

简介：Objective:Toexploretheeffectsofpostmastectomyradiotherapy(PMRT)onthelocoregionalfailure-freesurvival(LRFFS)andoverallsurvival(OS)ofbreastcancerpatientsunderdifferenttumorstagesandwithonetothreepositiveaxillarylymphnodes(ALNs).Methods:Weconductedaretrospectivereviewof527patientswithonetothreepositivelymphnodeswhounderwentmodifiedradicalorpartialmastectomyandaxillarydissectionfromJanuary2000toDecember2002.ThepatientsweredividedintotheT1-T2N1andT3-T4N1groups.TheeffectsofPMRTontheLRFFSandOSofthesetwopatientgroupswereanalyzedusingSPSS19.0,Pearson’sχ2-test,Kaplan-Meiermethod,andCoxproportionalhazardmodel.Results:ForT1-T2N1patients,nostatisticalsignificancewasobservedintheeffectsofPMRTonLRFFS[hazardratio(HR)=0.726;95%confidenceinterval(CI):0.233-2.265;P=0.582]andOS(HR=0.914;95%CI:0.478-1.745;P=0.784)ofthegeneralpatients.Extracapsularextension(ECE)andhighhistologicalgradeweretheriskfactorsforLRFFSandOSwithstatisticalsignificanceinmultivariateanalysis.StratificationanalysisshowedthatPMRTstatisticallyimprovedtheclinicaloutcomesinhigh-riskpatients[ECE(+),LRFFS:P=0.026,OS:P=0.007;histologicalgradeIII,LRFFS:P<0.001,OS:P=0.007]butnotinlow-riskpatients[ECE(–),LRFFS:P=0.987,OS:P=0.502;histologicalgradeI-II,LRFFS:P=0.816,OS:P=0.296].ForT3-T4N1patients,PMRTeffectivelyimprovedthelocalcontrol(HR=0.089;95%CI:0.210-0.378;P=0.001)ofthegeneralpatients,whereasnostatisticaleffectwasobservedonOS(HR=1.251;95%CI:0.597-2.622;P=0.552).Absenceofestrogenreceptorsandprogesteronereceptors(ER/PR)(–)wasanindependentriskfactor.FurtherstratificationanalysisindicatedastatisticaldifferenceinLRFFSandOSbetweenthehigh-riskpatientswithER/PR(–)receivingPMRTandnotreceivingPMRT[ER/PR(–),LRFFS:P=0.046,OS:P=0.039].However,PMRThadabeneficialeffectonthereductionoflocoregionalr

简介：Purpose:Anumberofdifferentclinicalcharacteristicshavebeenreportedtosinglycorrelatewiththerapeuticactivityofepidermalgrowthfactorreceptor(EGFR)tyrosinekinaseinhibitors(TKIs)inadvancednon-small-celllungcancer(NSCLC).Thisstudyaimedtoidentifypredictivefactorsassociatedwithprognosticbenefitsofgefitinib.Patientsandmethods:EGFRgenetypingin33advancedNSCLCpatientsreceivedgefitinib(250mg/day)wereanalyzedwithmutant-enrichedPCRassay.Gefitinibresponsewasevaluatedwithpotentialpredictivefactorsretrospectively.Results:Theoverallobjectiveresponserate(ORR)andmedianprogression-freesurvival(PFS)inthe33patientstreatedbygefitinibwere45.5%and3.0(2.0-4.0)months.TheORRandmedianPFSinEGFRgenemutationpatientsweresignificantlyhigher/longerthanthoseinEGFRgenewild-typepatients(P<0.01).Similarly,theORRandmedianPFSinnon-smokerpatientsweresignificantlyhigher/longerthanthoseinsmokerpatients(P<0.05,P<0.01,respectively).However,nodifferenceforORRandmedianPFSoccurredbetweenmaleandfemalepatients.LogisticmultivariateanalysisshowedthatonlyEGFRmutatedgenewassignificantlyassociatedwiththeORR(P<0.01).BothEGFRmutatedgeneandnon-smokerwerethemajorfactorsthatcontributedtoPFS(P<0.05).Conclusions:EGFRmutatedgeneandnon-smokerstatusarepotentialpredictorsforgefitinibresponseinNSCLCpatients.

简介：Objective:Toinvestigatetheinfluenceofdifferentrightventricular(RV)pacingsitesonQRSwidth,andtoprovideapotentialreferencesiteforpermanentrightventricularpacinginpatientsimplantedwithpermanentpacemakers.PacingatthesitewiththeshortestQRSdurationmayreducethedeleteriouseffectsofRVpacingonLVfunction,andthushavingbeneficialeffectsonpatient’soutcome.Methods:AllconsecutivepatientswhowereplannedtohavepermanentpacemakerimplantationforaClassIorIIaindicationatourdepartmentfromOctober2010toJuly2012werescreenedfortheparticipationinthisprospective,singlecenter,non-randomizedstudy.ThebaselinesurfaceECGwasanalyzedforQRSwidthandmorphology,respectively.DuringtheimplantationprocedurepatientsweretransientlypacedatdifferentRVlocations(rightventricularapex,rightventricularinflowtract[RVIT],midseptum,highseptumandrightventricularoutflowtract[RVOT])beforetheleadwasplacedatitsfinalposition.Duringpacingatthedifferentpositionsthesurface12-leadsECGwasrecorded.BasedonthesurfaceofECGQRSdurationandmorphologyofthedifferentrightventricularpacingsiteswereanalyzedandcomparedwithbaselineandtoeachother.Results:Atotalof216patients(39%female,meanage69±13years,higherdegreeAVblock30.5%)wasenrolledinthestudy.PacedQRSdurationwassignificantlydifferentbetweenallrightventricularpacingsitescomparedwiththebaselineECG(baseline:106ms±21ms;meanpaced:158ms±16ms;p<0.001).RVApacingshowedthewidestQRS(168ms±16ms).QRSdurationwithRVITpacingwas166ms±15ms,andthatwithRVOTpacingwas165ms±15ms,respectively.QRSdurationwasnotsignificantlydifferentbetweenthesethreepositions.Mid-septalpacingshowedthenarrowestQRS(139ms±19ms)comparedtoallotherpacingsites(p<0.001).Pacingatthehigh-septumshowedabroaderQRS(153ms±14ms)thanthatpacingatthemid-septum.Comparedtootherrightventricularpacingsites