Analysis on the influencing factors of low back pain in the occupational workers of key industries in China / 中国职业医学

OBJECTIVE: To explore the influencing factors of low back pain and the relationship of the influence of bad working posture, weight load and frequency of load and the dose-response relationship among the occupational workers of key industries in China. METHODS: A total of 57 501 employees from 15 key industries in China were selected as research subjects using stratified cluster sampling method. The occurrence of low back pain in the past one year, as well as occupational factors such as job type, labor organization and work posture were investigated by using the Chinese version Musculoskeletal Disorders Questionnaire. RESULTS: The prevalence of low back pain in the occupational population of key industries in China was 16.4%(9 448/57 501). Multivariate Logistic regression analysis showed that the risk of low back pain in females was higher than that in males(P<0.01). Married, obese, occasional and frequent smokers, and a history of lower back disease were associated with increased risk of low back pain(all P<0.05). The risk of low back pain was associated with older age, higher education level, and lower frequency of physical exercise(all P<0.01). The risk of low back pain was higher with longer working time, greater back curvature, and the high frequency of long standing and sitting position work, uncomfortable working posture, repeated operation per minute, and lifting>5 kg weight(all P<0.01). CONCLUSION: The influencing factors of low back pain in the occupational population of key industries in China include bad working posture, high frequency load, weight load and other individual factors. There is a dose-response relationship with low back posture load and frequency of load.

Evidence for determining the safe surgical margin for pleomorphic adenoma of parotid gland / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the treatment outcomes, complications and histopathologic features between conventional parotidectomy and functional regional parotidectomy in the treatment for pleomorphic adenoma of parotid gland and to provide clinical, and pathological evidence for determining the safe surgical margin.</p><p><b>METHODS</b>Of 109 patients, 60 patients received conventional parotidectomy and 49 patients received functional regional parotidectomy. The rates of tumor recurrence and complications were compared between the groups of patients.</p><p><b>RESULTS</b>There was no significant difference in the incidence of tumor recurrence, the facial paralysis and sialosyrinx between two groups. The rates of Frey's syndrome, numbness of auricular region, and facial asymmetry were 30.0%, 61.7%, and 38.3% in the patients with conventional parotidectomy respectively, while the rates were 6.1%, 30.6%, and 8.2% in the patients with functional regional parotidectomy, with significant statistically difference, respectively (P < 0.05). Of 109 patients, 33 with incomplete capsule, 29 with capsule penetration, 25 with pseudopodia, and 13 with satellite nodules. There was no significant difference in the depth of tumor infiltration between two groups of patients. For the tumor smaller than 2 cm, the depth of infiltration in conventional group was from 0.061 to 1.122 mm, functional group was from 0.442 to 3.127 mm (Z = -1.093, P = 0.057); for the tumors between 2 - 4 cm, the depth in conventional group was from 0.081 to 7.908 mm, functional group was from 0.082 to 6.632 mm (Z = -0.214, P = 0.831); for the tumor larger than 4 cm, the depth of infiltration was from 0.340 to 8.476 mm.</p><p><b>CONCLUSIONS</b>Compared with conventional parotidectomy, functional regional parotidectomy has good outcomes and less complications. The surgical margins of pleomorphic adenomas of the parotid gland should be determined by the size of tumor. The 1 cm-surgical margins are safe for the tumors less than 4 cm, and the tumors more than 4 cm should be treated with superficial parotidectomy.</p>

Meta-analysis of surgical techniques for preventing Frey syndrome and a concave facial deformity after parotidectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the curative effects on surgical methods for the prevention of Frey syndrome and a concave facial deformity after parotidectomy.</p><p><b>METHODS</b>A literature search was performed using the Wianfang Database, Chinese Biomedical Literature Disk Database, Chinese Digital Hospital Library and Chinese Scientific Journals Database of VIP from January 1989 to December 2008. Twenty-six Chinese language controlled studies involving surgical techniques for prevention of Frey syndrome and the concave facial deformity after parotidectomy were identified. Review manager 4.2 software was applied for Meta analysis.</p><p><b>RESULTS</b>Meta-analysis for surgical techniques to prevent symptomatic Frey syndrome, a positive starch-iodine test, and contour deformity, favored intervention with a cumulative odds ratio (OR) of 0.14 [95% confidence interval (CI), 0.07-0.25]; OR, 0.21 (95% CI, 0.17-0.26); and OR, 0.09 (95% CI, 0.04-0.19), respectively. There was a significant difference in the incidence of these complications between surgical treatment groups and control groups (Z = 6.42, Z = 13.70, Z = 6.43, all P < 0.05). The application of a sternocleidomastoid muscle flap decreased the incidence of symptomatic Frey syndrome (Z = 2.33, P < 0.05), positive starch-iodine test (Z = 7.48, P < 0.05) and contour deformity (Z = 7.78, P < 0.05). The application of acellular dermal matrix decreased the incidence of symptomatic Frey syndrome (Z = 6.02, P < 0.05) and positive starch-iodine test (Z = 5.72, P < 0.05) but did not decrease the incidence of contour deformity (Z = 1.27, P > 0.05).</p><p><b>CONCLUSIONS</b>Meta-analysis of operative techniques to prevent symptomatic Frey syndrome, a positive starch-iodine test, and facial asymmetry suggests that such methods are likely to reduce the incidence of these complications and improve the quality of life after parotidectomy.</p>

Significance of a reversal expression of the angiopoietin-1 and 2 in oral squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the significance of Angiopoietin-1 (Ang-1), Angiopoietin-2 (Ang-2) expression in angiogenesis, vessel maturation, progress and prognosis of oral squamous cell carcinoma (OSCC).</p><p><b>METHODS</b>The expression of Ang-1, Ang-2, vascular endothelial growth factor (VEGF), CD34 and alpha-smooth muscle actin (alpha-SMA) were studied in 62 human OSCCs, 30 adjacent noncancerous oral tissues and 10 normal oral mucosa by conventional immunohistochemistry. Microvessel density (MVD) and vessel maturation index (VMI) were also assessed with double-labeling immunohistochemistry staining against CD34, a marker of pan-endothelial cells, and that against alpha-SMA, a marker of mural cells (pericytes/smooth muscle cells). The images were analyzed with BioMias system.</p><p><b>RESULTS</b>Ang-1/Ang-2 protein expression ratio were significantly lower in OSCC than that in adjacent noncancerous oral tissues and normal oral mucosa (t were -5.42 and -6.234, all P<0.01). There were significantly different Ang-1/Ang-2 protein expression ratio in different tumor' lymph node metastasis status and MVD groups and VMI groups, respectively (t were 3.421, -3.221, 3.824, all P<0.01). The patients with low Ang-1/Ang-2 protein expression ratio and high VEGF protein expression were found to have a significantly higher MVD when compared to others (t were 2.055, 2.345, 2.985, all P<0.05). Ang-1/Ang-2 protein expression ratio had a tendency to be a prognostic factor (chi2=3.383, P=0.066).</p><p><b>CONCLUSIONS</b>The reversion of Ang-1 and Ang-2 expression may plays an important role in the development and progression of OSCC. It is closely associated with the angiogenesis, vessel maturation and prognosis of OSCC.</p>

The characteristics and significance of microvessel in oral squamous cell carcinoma / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of distribution status of maturation and morphology of the microvessel in oral squamous cell carcinoma (OSCC) and analyze the correlations between the characteristics and clinicopathologic parameters.</p><p><b>METHODS</b>The microvessel in 62 cases of OSCC, 30 cases of adjacent normal tissue and 10 cases of normal oral mucosa were detected by double-labeling immunohistochemistry technique. Image analysis mucosa, the microvascular density (MVD) was higher while vessel maturation system was also used for the analysis</p><p><b>RESULTS</b>Compared with adjacent normal tissues and normal oral index (VMI), vascular form factor (VFF) and vascular perimeter (VP) were lower in OSCC with significant difference (P < 0.01). The MVD was higher (P < 0.01) and VMI was lower (P < 0.05) in peritumoral site than those in intratumoral site. The MVD were correlated significantly with lymph node metastasis (P < 0.01).</p><p><b>CONCLUSIONS</b>The microvessels in OSCC were significantly different from those in normal oral tissues. The differences may contribute to the application of antiangiogenic therapy, and the peritumoral area in OSCC may become a target site of the therapy. The MVD may be hopefully used as an indicator of tumor malignancy.</p>

Reconstruction of cervical pharyngeal fistula by combined both pectoralis major muscle flap and intermediate split thickness skin graft / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the method that use combined pectoralis major muscle flap and intermediate split thickness skin graft to reconstruct giant cervical pharyngeal fistula.</p><p><b>METHODS</b>Use pectoralis major muscle flap combined with intermediate split thickness skin graft to reconstruct giant cervical pharyngeal fistula caused by malignant tumor surgical treatment and radiotherapy.</p><p><b>RESULTS</b>In this group, 11 flaps survived after operation, while 2 of them got delayed union after proper treatment. The following -up showed good function and shape, all the flaps remain alive. The patients' swallowing function were recovered and got good contours.</p><p><b>CONCLUSIONS</b>Pectoralis major muscle flap has enough volume and vascular pedicle length. Intermediate split thickness skin is easy to survive and has stable colour. Through this combined reconstructive methods, we got good clinical results to treat giant cervical pharyngeal fistula.</p>

Clinical anatomy measurement of accessory nerve in neck dissection / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the relations between accessory nerve and its surrounding structures.</p><p><b>METHODS</b>One hundred and thirty six patients were divided into two groups: has or has no neck surgical history. Neck dissection were performed and the four distance were measured simultaneously. The distance of accessory nerve and the great auricular nerve going out the posterior edge of sternocleidomastoid muscle; the distance of the point accessory nerve going out the posterior edge of sternocleidomastoid muscle to clavicular midpoint; the distance of the point accessory nerve going out the posterior edge of sternocleidomastoid muscle to sternoclavicular articulation; the distance of the point accessory nerve enter trapezius muscle to clavicular midpoint.</p><p><b>RESULTS</b>In no neck dissection group, the point accessory nerve going out sternomastoid muscle were supra the point of great auricular nerve going out the sternomastoid muscle, the average length of two points is (0. 61 +/- 0. 35) cm , the significance has not observed between genders (P > 0.05), however, there has significant difference between two groups of has or has no neck surgical history (P < 0.05). 88.2% (112/127) accessory nerve going out supra the great auricular within 1.0 cm, 11.8% (15/127) within 1.0 approximately 2.0 cm. 67.7% (86/127) accessory nerve adopt branch from cervical plexus before entering trapezius. The distances of the point accessory nerve going out the posterior edge of sternocleidomastoid muscle to clavicular midpoint and to sternoclavicular articulation were significant relative not with before neck surgical history but gender. The distance of the point accessory nerve enter trapezius muscle to clavicular midpoint is (4.96 +/- 0.78) cm, it has no difference both before neck surgical history and gender (P > 0.05).</p><p><b>CONCLUSION</b>In no neck surgical history group,both of the distance that accessory nerve and the great auricular nerve going out the posterior edge of sternocleidomastoid muscle and the point accessory nerve enter trapezius muscle to clavicular midpoint were helpful for search accessory nerve in surgery. But in patients who have neck surgical history or great auricular have been injured, accessory nerve could be looked for associating with the distances of the point accessory nerve going out the posterior edge of sternocleidomastoid muscle to clavicular midpoint and to sternoclavicular articulation; the distance of the point accessory nerve enter trapezius muscle to clavicular midpoint.</p>