Objective To investigate the effects of permissive hypercapnia ventilation on cerebral oxygen metabolism and postoperative cognitive function in elderly patients.Methods One hundred and twenty ASA Ⅰ-Ⅲ patients,aged 65-80 yr,undergoing elective lower abdominal surgery under general anesthesia,were randomly divided into 2 groups (n=60 each): routine ventilation group (group R) and permissive hypercapnia ventilation group (group H).In group H,VT=6-8 ml/kg,RR=12-14 bpm,I: E=1: 2,and PaCO2 was maintained at 45-65 mm Hg and pH value ＞ 7.2,while in group R,VT=10-12 ml/kg,RR=14-16 bpm,I:E=1:2,and PaCO2 was maintained at 35-45 mm Hg.Blood samples were taken from the radial artery and jugular bulb for blood gas analyses at 0,5,15 and 30 min after tracheal intubation (T0.3).Cerebral A-V O2 content differences (Da-jvO2)and cerebral O2 extraction rate (CERO2) were calculated at the same time.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 1 day before operation,and 24 h,48 h,1 week and 2 weeks after operation.Results Compared with group R,PEr CO2 andPaCO2 were significantly increased,and pH value,Da-jvO2 and CERO2 were significantly decreased at T1.3,MMSE score was significantly increased after operation,and the incidence of post-operative cognitive dysfunction was significantly decreased after operation (P ＜ 0.05 or0.01).Compared with the baseline value at T0,Da-jvO2 and CERO2 were significantly decreased at T1-3 in both groups,PETCO2 and PaCO2 were significantly increased,and pH value,Da-jvO2 and CERO2 were significantly decreased at T1-3 in group H,and MMSE score was significantly decreased at 24 h,48 h,1 week and 2 weeks after operation in both groups (P ＜ 0.01).Conclusion Permissive hypercapnia ventilation can improve the cerebral oxygen metabolism during operation,and reduce post-operative cognitive dysfunction in the elderly patients.

Objective To investigate the expression of TROP2 and MMP-9 protein expression in cholangiocarcinomas and their relationship between the pathological behavior and prognosis.Methods A total of 54 patients who were diagnosed with cholangiocarcinoma in the People's Hospital of Binzhou,were retrospectively reviewed.Immunohistochemical staining and Log rank test were used to detect the expression of TROP2 and MMP-9 protein in 54 cases of cholangiocarcinomas and 18 cases of normal bile duct tissues achieved by partial hepatectomy of hepatolithiasis.Results The positive expression rate of TROP2 in cholangiocarcinoma tissues (55.6％) was higher than that of normal bile duct tissues (5.6％).The positive expression rate of MMP-9 in cholangiocarcinoma tissues (51.9％) was higher than that of normal bile duct tissues (11.1％).The differences of the expression of TROP2 and MMP-9 in cholangiocarcinoma of TNM stage,lymph node metastasis and neural invasion were significant(all P ＜ 0.05).There was significant positive correlation between TROP-2 and MMP-9 expression by using spearman correlation analysis (r =0.555,P ＜ 0.001).Survival analysis showed that TROP2 expression was an independent prognostic factor in cholangiocarcinoma.Conclusions TROP2 plays a important role in the development and metastasis of cholangiocarcinoma.Thus,TROP2 may be a prognostic indicator for cholangiocarcinoma.