Objective To evaluate the effects of low tidal-volume ventilation on blood gases and respiratory mechanics during open heart surgery in children with acyanotic congenital heart disease. Methods Forty NYHA class Ⅰ-Ⅱ patients with atrial or ventricular septal defect aged 3-6 yrs weighing 12-18 kg undergoing open heart surgery were randomly divided into 2 groups according to the tidal volume of mechanical ventilation: group A low tidal volume(V_r=7ml?kg~(-1),n=20) and group B conventional tidal volume(V_T=9 ml?kg~(-1), n=20). The respiratory rate(RR) was 21-23 bpm, I: E ratio 1:2 and FiO_2 100% in both groups. The patients were premedicated with intramuscular morphine 0.1 mg?kg~(-1) and scopolamine 0.01 mg?kg~(-1). Anesthesia was induced with midazolam 0.1 mg?kg~(-1), fentanyl 10 ?g?kg~(-1) and vecuronium 0.1 mg?kg~(-1) and maintained with infusion of fentanyl 4 ?g?kg~(-1)?h~(-1) and vecuronium 80 ?g?kg?h~(-1) supplemented with isoflurane inhalation(

Objective: To study the influence of micrometastasis in lymph node on the prognosis of oral squamous cell carcinoma(OSCC).Methods: In 36 patients micrometastasis in pathologically negative lymph nodes were tested by immunohistochemical cytokeratin(CK) examination and the relationship between CK+ and survival time of the patients was analyzed. Results: The survival time(month) of CK+ and CK- patients was 36.76?6.91 and 47.47?11.35 respectively(P=0.002).Multivariate analysis of Logistic regression model showed that micrometastasis in lymph node (P=0.044)and histologic grade (P=0.040) were regarded as independently prognostic factors while clinical stage (P=0.236)did not. Conclusion: The detection of micrometastasis in the lymph nodes may serve as a supplement to the present staging system of OSCC. The prognosis of patients with micrometastasis is poorer than those without micrometastasis.

Objective To investigate the epidemiological characteristics of polyomavirus type BK infection in renal transplant recipients.Method We systematically screened for active BKV infection preoperation and at 0.5,1,3,6,9,12 and 15 months after transplantation in 116 renal transplant recipients.The screening tests included urine cytology (by the Papanicolaou method) and BKV DNA PCR (the kit for testing the BK virus) assay of both urine and plasma,and the results were recorded.Renal biopsy was performed if the graft function was deteriorated gradually or the loads of BKV replication were very high.Routine histopathological examination and immunohistochemistry were performed on renal tissues from partial patients who received the tests of renal biopsy.Result Throughout the follow-up of 15 months,urinary decoy cells (median 8/10 HPF,[1～ 48/10 HPF]),BKV viruria (median 2.63 × 105 copies/mL,[1.78 × 103 ～ 8.54 × 109 copies/mL]),BKV viremia (median 2.70 × 104 copies/mL,[1.95 × 103 ～6.31 × 106 copies/mL]),and BKVAN (4 patients) occurred in 53.46％,24.17％,20.72％ and 3.45％ of renal-transplant recipients,respectively.The positive rate of the decoy cell and BKV DNA in urine reached the peak at the third month to the ninth month after transplantation,and the peak time of the BK viremia was the fifth month post-transplantation throughout the follow-up period.The change in BKV DNA level remained constant in blood and urine throughout the follow-up period.Conclusion The peak time of BKV infection was apparently three to nine months after transplantation,suggesting the importance of monitoring urine cytology and BKV DNA loads in post-transplantation patients closely during this period in order to reduce BKVAN after transplantation.

OBJECTIVE:To explore the effect of dabigatran etexilate on coagulation indexes and safety of elderly patients with persistent atrial fibrillation. METHODS:52 elderly patients with persistent atrial fibrillation were randomly divided into obser-vation group and control group by random number table,26 cases in each group. Creatinine clearance rate in observation group was higher than 30 ml/min,110 mg Dabigatran etexilate capsule was orally given,bid;when 15-30 ml/min,55 mg capsule was orally given,bid. Control group orally received Warfarin sodium tablet with initial dose of 2.5 mg,qd,according to international normal-ized ratio (INR) after 3-5 days till maintained in 2.0-3.0. After 3 months,coagulation indexes [prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),INR,platelet count (PLT),fibrinogen (FIB)] before and after treat-ment,incidences of clinical events (cerebral embolism,cerebral hemorrhage,fatal bleeding,the remaining parts of embolism, death)and adverse reactions in 2 groups were compared. RESULTS:There was no significant difference in PT,APTT,TT,PLT and FIB between 2 groups before treatment(P>0.05);after treatment,PT and INR in 2 groups significantly increased,and obser-vation group was obviously better than control group,the difference was statistically significant(P<0.05). No cerebral hemorrhage or fatal hemorrhage occurred in the two groups. There was no significant difference in the incidence of cerebral embolism between 2 groups (P>0.05);the incidence of remaining parts of embolism,death in observation group significantly lower than control group,the difference was statistically significant(P<0.05). The incidence of adverse reactions in observation group was significant-ly lower than control group,the difference was statistically significant (P<0.05). CONCLUSIONS:Dabigatran etexilate shows good coagulation effect on elderly patients with persistent atrial fibrillation,which can effectively improve PT and INR levels and reduce the incidences of clinical events,with good safety.

Objective To evaluate the agreement between colposcopic diagnosis with 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy (IFCPC) and cervical pathology in cervical lesions. Methods A retrospective cohort study was performed, which included 376 patients who underwent colposcopy with 2011 international terminology of colposcopy at Obstetrics and Gynecology Hospital of Fudan University from September 2014 to November 2014. With conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated and correlations between variables were analyzed. Results With 2011 international terminology of colposcopy, agreement of colposcopic diagnosis and cervical pathology was 60.9%(229/376)perfectly matched, and the strength of agreement with weighted Kappa statistic was 0.401 (P<0.01), and agreement within one grade was 97.6%(367/376), which were improved compared with traditional methods. Colposcopic diagnosis were 19.9%(75/376) overestimated and 19.1%(72/376) underestimated. There were no significant difference between agreements in various grade lesions (χ2=1.996, P=0.573). Positive predictive value of high grade colposcopy or more was 84.4%, the negative predictive value of low grade colposcopy or less was 88.8%, whereas false positives were 3.5%and false negatives were 39.3%. A linear trend among three types of transformation zone and patient ages was found (χ2=45.910, P<0.01), whereas lesion sizes were not linearly correlated with lesion degrees (χ2=0.690, P=0.406). In grade 1, grade 2 and nonspecific findings, thin acetowhite epithelium, dense acetowhite epithelium and Lugol′s non-staining were most frequent, the Youden indexes of each were 0.170, 0.373 and 0.145, 0.069 respectively. Positive predictive value of some other findings (such as fine mosaic) and two new signs (inner border sign and ridge sign) were 100.0%. There were no significant difference between agreements in examiners with different levels of experience (χ2=1.197,P=0.550). Conclusions Compared to traditional methods (such as Reid index), 2011 international terminology of colposcopy could improve the agreement between colposcopic diagnosis and pathologic diagnosis, without significant differences by the severity of lesion and the level of examiners′experience. Common findings were classified reasonably, and some signs were highly reliable, which is important for guiding biopsy. However, the reproducibility of transformation zone types and the implication of lesion size need to be further discussed.

ObjectiveTo investigate the effect of hydrogen (H2 ) on acute lung injury (ALI) in septic mice.MethodsOne hundred and twelve male C57BL/6 mice,aged 5 weeks,weighing 20-25 g,were randomly divided into 4 groups ( n =28 each):sham operation group (group A),sham operation + H2 group (group B),sepsis group (group C) and sepsis + H2 group (group D).Sepsis was produced by cecum ligation and puncture (CLP).Groups B and D received 1 h inhalation of 2％ H2 at 1 and 6 h after CLP operation or sham operation.Twenty animals in each group were selected and observed for the 7 d survival rate.The left 8 animals in each group were sacrificed at 24 h after CLP operation.Venous blood samples and lung tissues were obtained to determine the levels of superoxide dismutase (SOD),catalase (CAT) and 8-iso-prostaglandin F2alpha (8-iso-PGF2α) in the serum and lungs,the concentration of protein in bronchoalveolar lavage fluid (BALF),and the activity of myeloperoxidase (MPO) in the lungs.The lung injury score (LIS) was assessed and W/D lung weight ratio was calculated.ResultsCompared with group A,the 7 d survival rate and activities of SOD and CAT in the serum and lungs were significantly decreased,and LIS,W/D ratio,the concentration of protein in BALF,MPO activity and 8-iso-PGF2α level in the serum and lungs were significantly increased in group C ( P ＜ 0.05 ).Compared with group C,the 7 d survival rate and activities of SOD and CAT in the serum and lungs were significantly increased,and LIS,W/D ratio,the concentration of protein in BALF,MPO activity and 8-iso-PGF2α level in the serum and lungs were significantly decreased in group C ( P ＜ 0.05).ConclusionH2 can alleviate ALI in septic mice via inhibiting oxidative stress response.

Objective To investigate the effects of hydrogen-rich saline on lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice.Methods Thirty-two male C57BL/6 mice,weighing 20-25 g,were randomly divided into 4 groups (n =8 each):control group (group C),hydrogen-rich saline group (group H2),ALI group and ALI + hydrogen-rich saline group (group ALI+ H2).ALI was induced by inhaled aerosolized LPS 25μg (dissolved in PBS) in groups ALI and ALI+ H2.Aerosolized PBS 50μl was inhaled in groups C and H2.0.6mmol/L hydrogen-rich saline 5 ml/kg was injected intraperitoneally at 1 and 12 h after aerosolized PBS or LPS was inhaled in groups H2 and ALI+ H2,respectively.At 24 h after PBS or LPS treatment,the animals were mechanically ventilation for 15 min,and arterial blood gas analysis was performed.The oxygenation index (PaO2/FiO2) was calculated.Bronchoalveolar lavage fluid (BALF) was collected for determination of total protein concentration and polymorphonuclear neutrophils (PMN) count.The concentrations of TNF-α,IL-1β,IL-6 and high mobility group box-1 (HMGB-1) protein in BALF were determined by ELISA.Then the animals were sacrificed and the lungs were obtained for determination of W/D lung weight ratio (W/D ratio),and myeloperoxidase (MPO) and caspase-3 activities.The pathological changes of the lung were scored.Apoptosis index (AI) was calculated.Results Compared with group C,no significant difference was found in PaO2/FiO2,the concentrations of protein,TNF-α,IL-1β,IL-6 and HMGB1,and PMN count in BALF,lung injury score,W/D ratio,MPO and caspase-3 activities and AI in group H2 (P ＞ 0.05),and PaO2/FiO2 was significantly decreased,the concentrations of total protein,TNF-α,IL-1β,IL-6 and HMGB1,and PMN count in BALF,lung injury score,W/D ratio,MPO and caspase-3 activities,and Al were increased in groups ALI and ALI + H2 (P ＜ 0.05).Compared with group ALI,PaO2/FiO2 was signifieantly increased,the concentrations of total protein,TNF-α,IL-1β,IL-6 and HMGB1,and PMN count in BALF,lung injury score,W/D ratio,MPO and caspase-3 activities,and AI were decreased in group ALI+ H2 (P ＜ 0.05).Conclusion Hydrogen-rich saline can alleviate LPS-induced ALI via inhibition of inflammatory response and apoptosis in mice.

Objective To investigate the clinical features of and GJB2 gene mutations in a Chinese Han patient with keratitis-ichthyosis-deafness syndrome (KID syndrome),in hope to offer evidence for the clinical and genetic diagnosis of KID syndrome.Methods Clinical data were collected from a patient with KID syndrome.DNA was extracted from peripheral blood of the patient and his two family members (mother and brother).PCR was performed to amplify the exon 2 and its flanking splicing sites of GJB2 gene followed by bidirectional direct DNA sequencing. Results The patient presented with the typical triad of vascularizing keratitis,ichthyosis and congenital deafness.A G148A mutation in the exon 2 of GJB2 gene,resulting in the substitution of aspartic acid by asparagine at position 50 of the junction protein connexin 26 (Cx26),was identified in the patient,but not in either of his family members.Conclusion The G148A mutation in GJB2 gene may be responsible for the clinical phenotype of KID syndrome in this Chinese patient.

Objective To investigate the clinical efficacy of BK viremia and BK virus-associated nephropathy (BKVAN) with rescuing therapy in renal-transplant recipients.Methods We systematically screened for active BKV infection at 0.5,1,3,6,9,12 and 15 months after transplantation in 116 renal transplant recipients.The screening tests included BKV DNA PCR (the kit for testing the BK virus) assay of both urine and plasma,and the results were recorded.Renal biopsy was performed if the graft function deteriorated gradually or the loads of BKV replication were very high.According to the existing literature material,preferential therapy was given to the patients with BK viremia and BKVAN after renal transplantation.Results Throughout the follow-up of 15 months,urine BKV viruria (median 2.63 × 105 copies/mL,1.78 × 103 8.54 × 109 copies/mL),blood BKV viremia (median 2.70 × 104 copies/mL,1.95 × 103-6.31 × 106 copies/mL),and BKVAN (4 patients) occurred in 24.17％,20.72％ and 3.45％ renal-transplant recipients,respectively.According to related literature and guide,in 24 cases of BKV viremia including 4 BKVAN patients,the dosages of immunosuppressants were reduced or FK506 was replaced with CsA,the disease conditions were effectively improved,and no acute rejection,allograft dysfunction or graft loss occurred.Conclusion Rescuing therapy of immunosuppression reduction or replacing FK506 with CsA was effective for BKV viremia and BKVAN recipients,and could not increase the risk of acute rejection and graft loss.

Objective To summary and analysis the clinical experiences on the three hole method of VATS surgery in treatment of primary spontaneous pneumothorax.Methods The clinical data of 276 cases of primary spontaneous pneumothorax undergoing VATS surgery from July 2005 to July 2011 were analyzed retrospectively.Results The operating times were 25 to 76 minutes,averaging (41.7 ± 2.1) minutes ; all with traces of bleeding; transiting assisted small incision operation in 5 cases;postoperative thoracic closed drainage extubation time of 4-13 days,average (6.7 ± 0.2) days,mild postoperative air leakage in 27 cases,moderate in 9 cases without severe leakage,leakage,postoperative pulmonary atelectasis in 7 cases,pulmonary infection in 2 cases,reexpansion pulmonary edema in 1 cases,postoperative follow-up for 6-17 months,averaging(10.2 ± 1.7) months,recurrence occurred in 7 cases,1 case of operation again.Conclusion Three hole method of VATS technique has short operating time,less trauma,fewer complications,faster recovery,shorter hospitalization time and other advantages,and the recurrence rate is low,which is the ideal mode of operation for the treatment of primary spontaneous pneumothorax.