Objective To explore the feasibility of the ultrasonic atomization surface anesthesia with lido-caine for awake fiberoptic endotracheal intubation in patientsˊautonomous position -display before general anesthesia and to evaluate its advantages.Methods 68 adult patients who needed prone position for elective surgery under general anesthesia were selected and randomly divided into two groups,the control group and the treatment group,each group in 34 cases.In control group patients were received surface anesthesia of cricothyroid membrane puncture.In treatment group,nebulized 2% lidocaine with ultrasonic nebulizer was used for topical anesthesia.Patients lied in the prone position according to their own comfort with the guide of the medical staff in the waking state after an awake fiberoptic endotracheal intubation.The statistics of mean arterial pressure (MAP)and heart rate (HR)were recorded respectively in the basal state(T0),in the time instantly after intubations(T1 ),in the 3 minute after intubations(T2 ) and in the time instantly after the body turning(T3 ).Choking cough response were recorded during endotracheal intubation.Patients were asked the efficacy of surface anesthesia and the tolerance for awake intubation after operation.Results Patients in both two groups completed the whole process smoothly.MAP and HR had no signifi-cant differences between the two groups in the same time point (all P >0.05).There were no statistical significance between the two groups in choking cough response,the time of surface anesthesia and intubation,neither (all P >0.05).Conclusion The surface anesthesia with lidocaine by continuous ultrasonic atomizing inhalation is a good and simple method deserving generalization with plenty merits and is practicable for patients to display position autonomously. This method have the advantages of small operation,it will and can replace cricothyroid membrane puncture.

Objective The international multidisciplinary lung adenocarcinoma classification was published by IASLC/ ATS/ERS in 2011.This study aimed to explore the clinicopathologic characteristics of lung adenocarcinoma based on IASLC/ATS/ERS classification and validate its clinical diagnostic and therapeutic value.Methods 2 056 cases of surgical resection from Shanghai Chest Hospital were classified according to the new classification and clinical information were retrospectively reviewed.The clinicopathologic characteristics based on new classification were analyzed statistically.Results Our data indicated that women were in high risk of lung adenocarcinoma; The average age of onset was 59-year-old; the female patients were younger than the male patients (58.7 years vs 60.2 years,P ＜ 0.01) ; Average tumor diameter was 2.6 centimeter; right lung was more popular than left and superior lobe than the inferior one.Acinar predominant subtype and papillary predominant subtype were frequently observed.Micropapillary predominant subtype and solid predominant subtype were identified to be more aggressive than other histopathologic subtypes.Most patients were classified as stage Ⅰ(71.7％),which were predominantly stage Ⅰa (53.1％).Conclusion The new classification is superior to reflect the clinicopathologic characteristics of lung adenocarcinoma and satisfy clinical needs,especially contributing to change and update the surgical strategy of early stage lung adenocarcinoma.

Objective To explore the method and the clinical effects of surgical treatment for severe hedge brain injury at frontotemporal bottom. Methods 96 patients with severe hedge brain injury at frontotemporal bottom were scored by GOS before surgery. Then unilateral or bilateral craniotomy was carried out,via a large flap incision in the site of frontotemporal and parietal hair,and the blood clots within the surgical fieldand the inactivation brain tissue having been fell off were removed, and the contusion lesions of brain bottom were exposed, and the inactivation brain tissue was cleared. If the brain injury was serious ,the removal of frontal pole and temporal pole should be proper. Discretion to The removing or replacing the bone flap should be based on consideration of the circumstances. Six nonths or one year after injury,96 patients were scored by GOS again. Results There were 17 cases of grade Ⅰ(17.71%) ,11 cases of gradeⅡ (11.46%),13 cases of gradeⅢ (13.54%),21 cases of grade Ⅳ(21.86%),34 cases of grade Ⅴ (35.42%) in 96 patients. Conclusion Early surgical treatment of severe hedge brain injury at frontotemporal bottom could improve the cure rate and reduce the rate of disability.

Objective To evaluate the role of autophagy in hippocampal neurons in cognitive dysfunction caused by sevoflurane anesthesia in juvenile rats.Methods One hundred four male SpragueDawley rats, aged 7 days, weighing 10-16 g, were randomly assigned into 3 groups using a random number table: control group (group C, n =8), sevoflurane anesthesia group (group S, n =48), and sevoflurane anesthesia + rapamycin group (group SR, n =48).Group C inhaled 60％ oxygen for 6 h.S and SR groups inhaled 3.6％ sevoflurane anesthesia for 6 h, and in addition, rapamycin 2 mg/kg was injected intraperitoneally at 1 h before of sevoflurane inhalation in group SR.The equal volume of phosphate buffer solution was given in C and S groups.At 1 h before sevoflurane anesthesia (T0) , immediately after the end of anesthesia (T1) , and at 12, 24 and 48 h after the end of anesthesia (T2-4) , 8 rats were randomly selected from S and SR groups to determine the expression of autophagy-related proteins microtubule-associated protein 1 light chain 3 (LC3) Ⅰ , LC3 Ⅱ and Beclin-1 in hippocampal neurons (by Western blot).The ratio of LC3 Ⅱ/LC3 Ⅰ was calculated.Morris water maze test was performed at 5 weeks after the end of anesthesia to assess the cognitive function.The escape latency, frequency of crossing the original platform, and duration of swimming spent at the target quadrant were recorded.Results Compared with the values at T0, the expression of LC3 Ⅱ and Beclin-1 was significantly down-regulated at T1-3 , and the ratio of LC3 Ⅱ/LC3 [was decreased in group S, and the expression of LC3 Ⅱ and Beclin-1 was significantly up-regulated at T1-4, and the ratio of LC3 Ⅱ/LC3 Ⅰ was increased in group SR (P＜0.05).Compared with group C, the escape latency was significantly prolonged, the frequency of crossing the original platform was reduced, and the duration of swimming spent at the target quadrant was shortened at 3-5 days in group S (P＜0.05) , and no significant change was found in the parameters mentioned above in group SR (P＞ 0.05).Compared with group S, the escape latency was significantly shortened, the frequency of crossing the original platform was increased, and the duration of swimming spent at the target quadrant was prolonged at 3-5 days, the expression of LC3 Ⅱ and Beclin-1 was up-regulated at T1-4 , and the ratio of LC3 Ⅱ/LC3Ⅰ was increased in group SR (P＜0.05).Conclusion Weakened autophagy in hippocampal neurons is involved in cognitive dysfunction caused by sevoflurane anesthesia in the juvenile rats.

Objective To explore the characteristics and treatment of pain after inflammatory spinal demyelination. Methods 271 patientssuffered from inflammatory spinal demyelination with pain were analyzed retrospectively. Results Acute radicular pain and Lhermitte'ssign were common in the acute pain syndromes. Individual therapy showed a benefit of decreased pain. Conclusion Pain is a commonclinical symptom of inflammatory spinal demyelination. Individualized therapeutic decisions could relieve symptom and improve outcome.

Background Chondrocytes' phenotype and biosynthesis of matrix are dependent on having an intact cytoskeletal structure.Microfilaments,microtubules,and intermediate filaments are three important components of the cytoskeletal structure of chondrocytes.The aims of this study were to determine and compare the effects of the disruption of these three cytoskeletal elements on the apoptosis and matrix synthesis by rabbit knee chondrocytes in vitro.Methods Chondrocytes were isolated from full-thickness knee cartilage of two-month-old rabbits using enzymatic methods (n=24).The isolated cells were stabilized for three days and then exposed to low,medium,and high doses of chemical agents that disrupt the three principal cytoskeletal elements of interest:colchicine for microtubules,acrylamide for intermediate filaments,and cytochalasin D for actin microfilaments.A group of control cells were treated with carrier.Early apoptosis was assessed using the Annexin-FITC binding assay by flow cytometry on days 1 and 2 after exposure to the disrupting chemical agents.The components and distribution of the cytoskeleton within the cells were analyzed by laser scanning confocal microscopy (LSCM) with immunofluorescence staining on day 3.The mRNA levels of aggrecan (AGG) and type Ⅱ collagen (Col-2) and their levels in culture medium were analyzed using real-time PCR and enzymelinked immunosorbent serologic assay (ELISA) on days 3,6,and 9.Results In the initial drug-dose-response study,there was no significant difference in the vitality of cells treated with 0.1 μmol/L colchicine,2.5 mmol/L acrylamide,and 10 μg/L cytochalasin D for two days when compared with the control group of cells.The concentrations of colchicine and acrylamide treatment selected above significantly decreased the number of viable cells over the nine-day culture and disrupted significantly more cell nuclei.Real-time PCR and ELISA results showed that the mRNA levels and medium concentrations of AGG and Col-2 were significantly decreased for cultures treated with colchicine and acrylamide when compared with untreated cells at three,six,and nine days,and this inhibition was correlated with higher matrix metalloprotease-13 expression in these cells.Cellular proliferation,monolayer morphology,and matrix metabolism were unaffected in cytochalasin D-treated cells when compared with control cells over the nine-day culture period.Conclusions The disruption of the microtubulin and intermediate filaments induced chondrocyte apoptosis,increased matrix metalloprotease expression,and decreased AGG and Col-2 expression in rabbit knee chondrocyte cultures.Our findings suggest that microtubulin and intermediate filaments play a critical role in the synthesis of cartilage matrix by rabbit knee chondrocytes.

OBJECTIVETo observe the effect of purgation and detoxification therapy on gastrointestinal dysfunction of critically ill patients undergoing abdominal surgery.

METHODSTotally 56 inpatients with severe gastrointestinal dysfunction after abdominal surgery at ICU of Guangdong Provincial Hospital of Traditional Chinese Medicine were assigned to the treatment group and the control group, 28 in each group. All patients received routine Western medical treatment. Patients in the treatment group additionally took Modified Huanglian Jiedu Decoction (MHJD) and received electroacupuncture (EA) for 7 days. The first exhaust time, defecation time, scores for gastrointestinal dysfunction, mechanical ventilation time, ICU hospitalization time, and 28-day fatality rate were observed. Furthermore, serum levels of diamine oxidase (DAO) and D-lactic acid were detected at day 1, 3, and 7 after treatment.

RESULTSThe first exhaust time and the first defecation time in the treatment group were ahead of schedule, when compared with those of the control group (P <0. 05). Scores for gastrointestinal dysfunction, mechanical ventilation time, serum levels of DAO obviously decreased in the treatment group (P <0. 05). There was no statistical difference in serum levels of D-lactic acid, ICU stay time, the incidence of pulmonary infection, and 28-day mortality between the two groups (P >0. 05). Results of Logistic analysis showed that scores for gastrointestinal dysfunction were related with the incidence of pulmonary infection (P <0. 05).

CONCLUSIONMHJD combined EA could promote the recovery of gastrointestinal function in critically ill patients after abdominal surgery via improving intestinal barrier function, which was benefit for shortening mechanical ventilation time.

Critical Illness ; Defecation ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Electroacupuncture ; Gastrointestinal Diseases ; drug therapy ; Humans ; Lactic Acid ; Medicine, Chinese Traditional

Objective To explore the treatment of acquired benign tracheoesophageal fistula.Methods Clinical data of 13 cases of acquired benign tracheoesophageal fistula were retrospectively studied and the related literature was reviewed.The physical conditions,locations of fistula and risk factors of the patients were assessed before surgery.A specific surgical protocol was determined for each individual patient using either radical surgery or palliative surgery to repair the fistula.Ten patients underwent radical surgery,including suture closure of the esophageal or tracheal defects only in 7 patients and segmental tracheal reseetion in 3 patients.The remaining 3 patients underwent palliative operation.Results No major complication was observed except pulmonary infectin in 2 patients.No patient died during the perioperative period.All but one patient who treated with mediastinal and neck radiation therapy 4 years ago were able to resume oral food three months after operation.All patients were followed up for 8 months to 73 months[mean (39.6 ± 19.7) months]and no fistulas were occurred in the patients who received a radical surgery.The tracheoesophageal fistula orifices became smaller or closed fairly well in the patients who underwent a palliative surgery.Conclusion Surgery is the treatment of choice for acquired benign tracheoesophageal fistula.Airway and esophagal stent placement is not recommended.Adequate drainage of gastric juice is a crucial step in the management of the condition.

RAPD molecular marker was widely applied to the studies of edible fungi due to it’s simplicity , rapidity and economy. The principle of RAPD molecular marker and its applications to edible fungi were summarized. The applications of RAPD to edible fungi were introduced in species and parental strain identification,genetic diversity, gene clone, gene isolation and the construction of gene linkage map. RAPD molecular marker provids a powerful tool for the studies of edible fungi.

Objective To impmve the method of "modified comet assay" in predicting the radiosensitivitv of solid tumor. Methods A single cell suspension from biopsy sample was lmdlated on ice with a dose of 5 Gy.The microscope slide was spread with agarose,lysed for 50 minutes,rinsed 3 times rinse solution,and given electrophoresis for 20 minutes. After being stained with PI,cell images were collected through the microscope and analyzed with Lucia G software(Version 4.6).In order to check system/ background errors,every sample was made into control slide and irradiation slide.The end-points were cell DNA contents and tail moment. Results The factors influencing the results included:(1)Sample was iaulty tor the biopsv taken from mucosa and no tumor cells were contained. (2)The slides with a high backgmund ( induced by necrosis) disturbed the measurement of comet assay. (3) Setting lymphocytes as control to check svstem errors was very important. (4)To separately collect images of the normal tissue cells and tumor cells from the biopsy sample improved the conformity between the clinical obscrvation and the lab result. Conclusions To increase the correlation between comet assay and clinical response,it is very helpful to set double control for checking system/background errors and to collect images of the normal tissue cells and tumor cells through the microscope,respectively.