Objective To compare the efficacy and safety of 7.2%hypertonic saline hydroxyethyl starch 200/0.5(HES) and 15% mannitol in the treatment of increased intracranial pressure( ICP) .Methods 112 neurosurgical patients at risk of increased ICP were randomized divided into 2 group to receive either HES or 15% mannitol at a defined infusion rate, which was stopped when ICP was<15 mmHg.Results Of the 112 patients, 58 patients received HES and 54 received mannitol 15%.In eight patients, ICP did not exceed 20 mmHg in treatment was not necessary.Both drugs decreased ICP below 15 mmHg (P<0.0001);HES within 6.0(1.2~15.0) min(all results are presented as median (minimum-maximum range) and mannitol within 8.7(4.2~19.9) min(P<0.0002).HES caused a greater decrease in ICP than mannitol (57% vs 48%; P<0.01).The cerebral perfusion pressure was increased from 60 (39~78) mmHg to 72 (54 ~85) mmHg by infusion with HES (P<0.0001) and from 61(47 ~71) mmHg to 70(50 ~79) mmHg with mannitol ( P <0.0001 ).The mean arterial pressure was increased by 3.7% during the infusion of HES but was not altered by mannitol.There were no clinically relevant effects on electrolyte concentrations and osmolarity in the blood.The mean effective dose to achieve an ICP below 15 mmHg was 1.4 (0.3~3.1) mL/kg for HES and 1.8(0.45~6.5) mL/kg for mannitol (P<0.05).Conclusion HES is more effective than mannitol 15% in the treatment of increased ICP.A dose of 1.4 mL/kg of HES can be recommended as effective and safe.The advantage of HES might be explained by local osmotic effects, because there are no clinically relevant differences in hemodynamic clinical chemistry parameters;efficacy.

Objective: To determine the predictive value of excision repair cross complement 1 (ERCC1) expression in non-small cell lung cancer (NSCLC) and the sensitivity of NSCLC to non-cisplatin based chemo-therapy and cisplatin based chemotherapy. Methods: The expression of ERCC1 was examined by immunohis-tochemical technique in 130 patients with advanced NSCLC seen in our hospital between February 1st 2006 and October 30th 2007. These 130 patients were divied into three groups. Patients in group A (n=68) had neg-ative ERCC1 expression and received cisplatin based chemotherapy. Patients in group B (n=31) had positive expression of ERCC1 and received non-cisplatin based chemotherapy. Patients in group C (n=31) had posi-tive expression of ERCC1 and received cisplatin based chemotherapy. Results: The expression rate of ER-CC1 was 62 of 130 (47.8%). The rate of ERCC1 in pulmonary adenocarcinoma was higher than that in squa-mous carcinoma. The response rates of chemotherapy in group A, B, and C group were 58.8 %, 51.6%, and 41.5%, respecitvely. There was no significant difference in the response rate between group A and group B (X~2=0.451, P=0.502). There was a significant difference in the response rate between group A and group C (X~2= 6.011, P=0.014). The response rate in group B was higher than that in group C (X~2=2.384, P=1.123). The average survival time in group A, group B, and group C were 12.0 months, 11.0 months, and 7.8 months, respecit-vely. There was no significant difference in patient survival between group A and group B (X~2=3.809, P=0.051). There was significant difference in patient survival between group A and group C (X~2=46.368, P=0.000). Con-clusion: ERCC1 may be an important indicator of the sensitivity of advanced NSCLC to cisplatin or non-cisplat-in based chemotherapy.

Objective To investigate the effect of dexmedetomidine on renal function in the patients undergoing cardiac valve replacement under cardiopulmonary bypass.Methods Fifty patients with rheumatic heart disease were randomly divided into the dexmedetomidine group (group D,n=25) and control group (group C,n=25).Arterial blood samples were collected before operation (T0),at postoperative 24 h (T1),48 h (T2),72 h (T3) and 96 h (T4) respectively.Serum Crea,blood urea nitrogen,cystatin C(Cys-C) and glomerular filtration rate(GFR) were detected by the Hitachi7600 automatic biochemical analyzer.Results Compared with T0,the levels of BUN and Cys-C at postoperative various time points were significant increased,while GFR was decreased,the differences were statistically significant (P<0.05).The levels of BUN and Cys-C started to gradually decrease and GFR started to increase from T2,the difference compared with that at T0 was statistically significant(P<0.05).But the levels of various indicators at T4 did not recovered to those before operation;compared with T0,serum Crea level had no statistical difference among postoperative various time points(P>0.05).Serum Crea level at T2-T4 in the group D was significantly lower than that at T0,the difference was statistically significant (P<0.05).There was no statistically significant difference in Crea,BUN,Cys-C and GFR between the two groups(P>0.05).Conclusion Dexmedetomidine can promote the recovery of postoperative renal function in the patients with cardiac valve replacement under cardiopulmonary bypass and has a certain protective effect on kidney.

Background:Conventional gastrointestinal endoscopy is incapable of determining the deriving layers,size and nature of submucosal lesions,however,mini probe ultrasonography(MPS)is effective for mural stratification and determining the deriving layers and nature of lesions within gastrointestinal wall,and is considered to be an optimal examination for suspected submucosal tumors before endoscopic or surgical operation. Aims:To assess the diagnostic value of MPS for gastrointestinal submucosal lesions and the significance of MPS-assisted endoscopic therapy. Methods:A total of 69 patients with presumed gastrointestinal submucosal protruded lesions were retrospectively enrolled. All of them underwent MPS and then endoscopic therapy,such as cyst incision,high frequency electric snare resection,endoscopic mucosal resection and endoscopic submucosal dissection were performed according to the deriving layers,size and nature determined by MPS. The ultimate diagnosis was confirmed by histopathological examination. Results:In the 69 cases of lesions,MPS showed that 15 were derived from muscularis mucosa,40 from submucosa,and 14 from muscularis propria;10 of them were considered as cyst,18 were stromal tumor,8 were leiomyoma,6 were ectopic pancreas,15 were neuroendocrine tumor,and 12 were lipoma. Compared with pathological diagnosis,an overall coincidence rate of 91. 3%(63 / 69)was achieved by MPS. Conclusions:The accuracy rate of MPS is high for determining the deriving layers and nature of gastrointestinal submucosal protruded lesions prior to the attempting of endoscopic removal. It might be helpful for selecting treatment modalities for this kind of lesions.

Objective To investigate the relationship between atherosclerosis and cardiovascular risk factors in the elderly,thus to provide new method for detection of atherosclerosis in the elderly.Methods From November 2010 to October 2011,348 elderly who addmitted to or had physical examination in our hospital were recruited in the study.All participants were interviewed through questionnaire,and medical history was recorded,Brachial-ankle pulse wave velocity (baPWV) was measured.Simultaneously,height,body weight,waist circumferrence,triglyceride ( TG ),total cholesterol ( TC ),high density lipoprotein-cholesterol ( HDL-C ),low density lipoprotein-cholesterol(LDL-C) were measured.The association between baPWV and cardiovascular and atherosclerosis was investigated.Results The incidence of higher baPWV was increasing as the number of risk factors of cardio vascular disease adding.Logistic regression analysis show that:Age ( OR =5.223,95％ CI 3.606 -7.564),LDL-C( OR =4.554,95％ CI 2.413 - 8.593 ),Smoking ( OR =6.007,95％ CI 3.775 - 9.560),Obesity( OR =3.019,95 ％ CI 2.363 - 3.857 ),Hypertension ( OR =6.938,95％ CI 3.591 - 13.404 ),High-salt diet( OR =2.555,95％ CI 2.108 -3.096)were independent risk factors of baPWV increase (P ＜0.05); Exercise and good sleep were the protective factors for baPWV increasing.BaPWV levels were significantly lower in the exercise group (exercise time ＞ 1 h/d)than in the few exercise group (exercise time ＜ 1h/d) (t =2.719,P =0.012 ),and lower in good sleep group participants than in insomnia participants (t =2.561,P =0.017 ) (P ＜ 0.05 ).BaPWV levels were significantly higherin the group with essential hypertension ( 1852.0 ± 46.7 cm/s),with Type 2 Diabetes Mellitus ( 1693.0 ± 38.2 cm/s),with coronary heart disease ( 1729.0 ± 40.4 cm/s) than in the healthy group ( 1356.0 ± 3 1.3 cm/s) ( P ＜ 0.05 ).There was no statistical difference between the essential hypertension group and the hypertension complicated with cerebral infarction group,as well as between the coronary heart disease group and the myocardial infarction group.Conclusion Age,LDL-C increasing,smoking,obesity,hypertension and high-salt diet were independent risk factors of baPWV increase;Exercise and good sleep were protective factors.BaPWV could be one of the methods for early detection of atherosclerosis.

Objective To investigate the characteristic,diagnosis,clinical staging, treatment and clinical prognosis of occult breast carcinoma (OBC). Method Forty-six cases of OBC were analyzed retrospectively with the clinical and follow-up information that were confirmed by postoperative pathologic diagnosis from November 1981 to November 2005. Results All patients showed axillary node enlargement as the first sign and were operated.The operation included axillary node excision in 2 patients,radical mastec-tomy or modified radical mastectomy in 44 patients. Forty-five cases got follow-up for 1-22 years,33 cases had existed 3 years,18 cases had existed 5 years,8 cases had existed 10 years. Conclusions For axillary mass which causes are uncertain ,the possibility of OBC should be considered .Meanwhile excision and pathological examination is necessary.The metastatic histological structure and immunohistochemical index of the axillary nodes usually provide important clue for the source of this tumor.Radical or modified mastectomy is the best method, and pest-operative chemotherapy and/or radiotherapy should be done. It has been showed that targeted therapy is very important to breast cancer with C-erbB-2 positive recently.To the cases that neck lymphatic metastasis is M4G3 positive by immunohistochemical examination and no primary focus clinically, the diagnosis of OBC should be considered. The cases without primary focus have better prognosis than those with primary focus.

Objective: To evaluate the consistency of transesophageal echocardiography (TEE) and pulmonary artery catheter (PAC) method in monitoring cardiac volume load and cardiac hemodynamic indexes.Methods: A total of 45 patients undergoing coronary artery bypass grafting in our hospital were selected.The right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV) and right ventricular ejection fraction (RVEF) were monitored during surgery by TEE and PAC respectively.Consistency of monitored data was compared between two methods.Results: Both TEE and PAC indicated that compared with baseline level, after loading, there were significant rise in RVEDV [TEE: (38±6)ml vs.(51±9ml), PAC: (153±17)ml vs.(188±19)ml], RVESV [TEE: (19±4)ml vs.(33±5)ml, PAC: (92±16)ml vs.(110±23)ml], P<0.01 all, but there was no significant change in RVEF, P>0.05.Before therapy, RVEDV, RVESV and RVEF monitored by PAC and TEE showed significant positive correlation, and all relevant coefficients were >0.8 (r=0.844, 0.862, 0.916, P<0.01 all);after therapy, correlation of RVEDV and RVESV significantly reduced to <0.6 (r=0.552, 0.579, P<0.05 both), but RVEF correlation remained >0.8 (r=0.892, P<0.01).Conclusion: In clinical monitor, the consistency of TEE and PAC is high,the former is non-traumatic,and is more convenient for clinical use.

Objective To investigate the interfractional and intrafractional prostate motion during hypofractionated precise radiotherapy for prostate cancer. Methods From 2013 to 2016, twenty?eight patients who received 5 Gy radiotherapy in 9 fractions for prostate cancer were enrolled as subjects. Every patient had three gold fiducials implanted into the prostate by transrectal ultrasound guidance two weeks before computed tomography ( CT) simulation. All patients underwent CT scans in the supine position with full bladders and rectal balloons filled with 60 ml air. The Pinnacle planning system was used to design the treatment plans. Twenty?three patients were treated with a Synergy accelerator. Those patients underwent cone?beam CT ( CBCT) scans prior to treatment. The set?up error was recorded by bone alignment between CBCT images and planning CT images. The prostate displacement was then recorded by gold fiducial alignment. The interfraction prostate displacement was defined by the difference between the above two parameters. The other 5 patients were treated with a Novalis accelerator. Based on gold fiducial alignment,the real?time tracking of gold fiducials was carried out by the ExacTrac system to evaluate the intrafractional prostate displacement. Results A total of 207 measurements of interfractional prostate displacement were made in the 23 patients before treatment. The mean interfractional prostate displacements in the left?right (LR),superior?inferior (SI),and anterior?posterior (AP) directions were (0.05±0?10),(0.20±0?22),and (0.19±0?18) cm,respectively. The displacements larger than 0?3 cm in the above three directions were observed in 1,52,and 49 measurements,respectively,while the displacements larger than 0?5 cm in the three directions were observed in 1,29,and 16 measurements,respectively. A total of 225 measurements of gold fiducial displacement were made in the 5 patients during treatment. The mean intrafractional prostate displacements in LR,SI,and AP directions were (0.61±0?50),(0.68±0?69),and (0.70±0?67) mm, respectively. The displacements larger than 3 mm in the three directions were observed in 0, 1, and 1 measurement, respectively. Conclusions In hypofractionated precise radiotherapy for prostate cancer, the interfractional prostate displacement is significantly larger than the intrafractional prostate displacement. The interfractional prostate displacement must be corrected before radiotherapy. In order to avoid off?target irradiation due to postural changes in patients,the tracking of the intrafractional prostate displacement is still necessary although the displacement is relatively small. The rectal balloon can help immobilize the prostate.

Objective To implement and evaluate evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia.Methods This study is a prospective before and after comparison study.Collected 200 acute stroke patients with dysphagia and divided them into test group (trained medical staffs) and control group(untrained medical staffs) equally according to the time order.Two groups of 100 patients were surveyed using a checklist before and after implementation of 10 guidelines about nutrition support.Before the implementation of guidelines,the staffs were enforced training,and summarized regularly.Compliances with guidelines by doctors and nurses were compared,and outcomes of patients were assessed.Results Compared with the control group,the correct implementation of the project significantly improved in the experimental group on nutritional risk screening (92.0％,64.0％; x2 =22.840),nutritional supplements selection (80.0％,48.0％; x2 =22.220),nutrition infusion methods (90％,18％ ; x2 =1.040) and nutrition infusion adjustment (abdominal distension/adjusted:21/10,6/4;x2 =9.634,constipation/adjusted:41/40,57/53 ; x2 =5.122,all P ＜ 0.05).The mortality rate,poor prognosis and length of stay in department of neurology intensive care unit and in hospital were not significant different between the experimental group and the control group.The incidence of hospital-acquired pneumonia was significantly lower in the experimental group (44.3％) than that in the control group (67.5％,x2 =7.281,P =0.007),but other patient outcomes were unaffected significantly.Conclusion Implementation of evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia is associated with improvements in clinical quality and selected patient outcomes.

Objective To investigate the mid-term efficacy and complications of bone cement or biotype hemiarthroplasty for the femoral neck fracture in the elderly patients.Methods From January 2011 to January 2014,sixty-seven elderly patients (67 hips) with femoral neck fracture were treated with hemiarthroplasty.All patients were treated with bipolar femoral head prosthesis,and the prosthesis included into bone cement and biologic type,according to the fixation of the femoral stem.The 3 year postoperative Harris score and surgeryrelated complications (joint dislocation,prosthesis loosening,acetabular subsidence,and mortality) were evaluated.Results All patients were followed up for 3 years.The excellent and good rate of Harris score was 87.1％ (27/31) in the bone cement group and 80.6％ (25/31) in the cementless group (X2 =0.47,P＞0.05).There was no significant difference in the complications between the two groups (P＞0.05).Conclusion The hemiarthroplasty is an effective and safe methodfor the treatment of femoral neck fracture in the elderly.The key to achieve excellent results is to choose the femoral prosthesis based on the preoperative planning and operation.