Objective To observe and compare the effects of four kinds of anesthetic methods on the revival time,the rate of re-dormant after revival,the total Ketamine's doses and the respiratory status after extubation,and to improve the safety of anesthesia.Method 80 cases of children with palatorrphy were randomly divided into 4 groups: group A(n=20) given Midazolam and Ketamine,group B(n=20) given Fentanyl and Ketamine,group C(n=20) given Isoflurane and Ketamine,and group D(n=20) given Sevoflurane and Ketamine.Results(1) The revival time in group D and group C shortened(D and C

Objective To evaluate the physiological and anatomic basis,indications,surgical skills, prevention of ureter injury and clinic outcomes of using high uterosacral ligament suspension(HUS)for correction of advanced uterine prolapse by the vaginal route.Methods Fifty women with advanced uterine prolapse underwent transvaginal HUS after vaginal hysterectomy with reconstruction of pubocervical and rectovaginal fascia to correct their uterine prolapse between June 2003 and September 2007.The average age of the women was 60.1 years.The mean follow-up period was 24 months(range 4-51 months).The degree of pelvic organ prolapse preoperatively and anatomic outcomes postoperatively were assessed with pelvic organ prolapse quantification system(POP-Q).Results The remnants of the uterosacral ligaments were clearly identified and palpated posterior and medial to the ischial spines by traction with a 24 cm long Allis clamp and used for successful vaginal vault suspension and reconstruction in all 50 consecutive advanced uterine prolapse patients.The ureter injury was avoided by complete knowledge of the ureter's course from the cervix/apex toward its insertion in the sacral region and how far outside of the uterosacral ligament,by uteri palpation and by suturing purposefully placed"deep"dorsally and posteriorly toward the sacrum,as well as by cystoscopy examination of the spillage of urine from both ureters.Mean POP-Q point C improved from 1.5 to-7.5 cm with a median follow-up of 24 months.If the successful HUS was defined as point C≤stage I prolapse,both the objective and subjective cure rates were as high as 100% with a maximum follow-up of 51 months.None of the 50 patients had repeat operation for recurrence of prolapse.There was no major intra-or postoperative complications,such as ureter and other pelvic organ injury.Conclusion HUS with fascial reconstruction seems to be a safe,minimal traumatic,tolerable and highly successful procedure for vaginal repair of advanced uterine prolapse.Because of the use of native tissue as suspension site HUS is more physiologic and cost effective.

Alkaptonuria ; diagnosis ; genetics ; therapy ; Homogentisate 1,2-Dioxygenase ; genetics ; Humans ; Infant ; Male

OBJECTIVETo assess the early therapeutic and cognitive effect of repetitive transcranial magnetic stimulation (rTMS) combined with antidepressant medication in treatment of first-episode patients with major depression.

METHODSSixty first-episode depressed inpatients aged 18-45 y, who met the DSM-IV clinical criteria for major depressive episode were randomly assigned to citalopram treatment (20 mg/d) in combination with a two-week period of either rTMS (study group)or sham procedure (control group) on left dorsal-lateral prefrontal cortex (10 Hz, 90% motor threshold). The Hamilton Depression Rating Scale (HAMD) was used to assess the severity of depression. The Wisconsin Card Sorting Test (WCST) and Continuous Performance Test (CPT) were used to assess cognitive function of depression.

RESULTThe response rate was significantly greater in the study group compared to the control group after treatment (57% compared with 29%,P<0.05). The HAMD scores significantly declined after treatment in two groups, and the study group showed lower scores compared to the control group after 2 weeks (P<0.01). Neuropsychological assessments showed that there was no significant difference between the two groups except for the significant improvement in the categories on WCST in study group compared to the baseline (P<0.05) and the control group (P<0.05)after 2 weeks treatment. No serious event occurred in the patients during the rTMS study.

CONCLUSION10 Hz rTMS enhances early effects of citalopram and improves cognitive function in first-episode major depressive patients.

Adolescent ; Adult ; Antidepressive Agents ; therapeutic use ; Citalopram ; therapeutic use ; Combined Modality Therapy ; Depressive Disorder, Major ; therapy ; Humans ; Middle Aged ; Transcranial Magnetic Stimulation ; Treatment Outcome ; Young Adult

Confocal laser scanning microscopy(CLSM) is a new technique for microscopic imaging, which can collect the transverse section image of the samples and produce three-dimensional reconstruction and present higher spatial resolution than the conventional light microscope. As a precision instrument for the microscopic image, it plays an important role in forensic pathology. The article reviews the recent research achievements from sudden cardiac death, bullet wound and nervous system damage, etc, and explores the potential applications of the forensic pathology research and forensic practice.
Calcium/metabolism* ; Craniocerebral Trauma/pathology* ; Death, Sudden, Cardiac/pathology* ; Forensic Pathology/methods* ; Humans ; Image Processing, Computer-Assisted ; Microscopy, Confocal ; Myocardium/ultrastructure* ; Sensitivity and Specificity ; Trauma, Nervous System/pathology* ; Wounds and Injuries/pathology* ; Wounds, Gunshot/pathology*

Objective:To analyze the microbiological characteristics of patients with severe burns caused by blast in different periods and explore the application value of metagenomics next-generation sequencing (mNGS) in detecting pathogenic microorganisms.Methods:The retrospective observational study was applied. From June 13 to September 13, 2020, twenty-three patients (21 males and 2 females) with severe burns caused by blast who met the inclusion criteria were admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine, with age of (64±5) years and total burn area of (86±14) % total body surface area. Abbreviated burn severity index (ABSI) score, revised Baux score, acute physiology and chronic health status evaluation (APACHE) Ⅱscore, and sequential organ failure assessment (SOFA) score were counted on admission. Within 7, 8-20 and 21-30 d after admission, the complications, infection source and distribution of pathogenic microorganisms in patients were recorded. The detection of pathogenic microorganisms was analyzed, and the difference in detection efficiency between microbial culture method and mNGS was compared. After admission, the infection of overall source distribution of pathogenic microorganisms in patients was analyzed, and the difference in detection efficiency between microbial culture method and mNGS was compared. Data were statistically analyzed with McNemar and Fisher exact probability test.Results:On admission, ABSI score, revised Baux score, APACHE Ⅱ score and SOFA score were (12.6±2.4), (91±22), (26±4), and (10.3±2.3) respectively. Within 7 d after admission, the main complications of patients were inhalation injury, septic shock, and hypoproteinemia. Patients were mainly infected with pathogenic microorganism on wound, blood stream, and lung. Within 8-20 d after admission, the incidence of septic shock was the highest. The incidence of inhalation injury was significantly lower than that of ≤7 d after admission ( P<0.01), the main source of infection were wound, lung, and blood stream, and the incidence of wound and blood stream infection were significantly lower than that of ≤7 d after admission ( P<0.01). Within 21-30 d after admission, the incidences of multiple organ failure and acute respiratory distress syndrome were low, the incidence of inhalation injury was significantly lower than that of ≤7 d after admission ( P<0.01), and the incidence of septic shock was significantly lower than that of ≤7 d after admission ( P<0.01) and 8-20 d after admission ( P<0.01). There were only low bloodstream infections, and the incidence of wound infection was significantly lower than that of ≤7 d after admission ( P<0.01) and 8-20 d after admission ( P<0.05), and the incidences of lung and blood stream infection were significantly lower than those of ≤7 d after admission ( P<0.01). Within ≤7 d after admission, gram-positive bacteria were mainly Staphylococcus aureus. Gram-negative bacteria were mainly Klebsiella pneumoniae and Stenotrophomonas maltophilia. The fungi contained only Candida. Within 8-20 d after admission, Staphylococcus aureus was mainly the gram-positive bacteria, and the detection rate of Enterococcus was significantly lower than that of ≤7 d after admission ( P<0.01). Pseudomonas aeruginosa and Acinetobacter baumannii were the main gram-negative bacteria, and their detection rates were significantly lower than those of ≤7 d after admission ( P<0.01).There was a new detection of Fusarium. Within 21-30 d after admission, Staphylococcus aureus was the mainly gram-positive bacteria, and the detection rates of Enterococcus and Bacillus were significantly lower than those of ≤7 d after admission ( P<0.01). Pseudomonas aeruginosa and Acinetobacter baumannii were still the main gram-negative bacteria, and increased with the extension of time after admission. The detection rate of Pseudomonas aeruginosa was significantly higher than that of ≤7 d after admission ( P<0.01) and 8-20 d after admission ( P<0.01), and the detection rate of Acinetobacter baumannii was significantly higher than that of ≤7 d after admission ( P<0.01). The detection rate of Klebsiella pneumoniae was significantly lower than those of ≤7 d after admission ( P<0.01) and 8-20 d after admission ( P<0.01). All Candida, Mould, Fusarium were detected. Within ≤7 d and 8-20 d, the consistency between mNGS and bacterial culture was high ( κ=0.659, 0.596). Within 21-30 d after admission, the consistency between mNGS and bacterial culture was moderate ( κ=0.407). In different time periods, the positive test rate of mNGS was basically constant, while that of microbial culture showed a decline with the extension time after admission. Five hundred and six strains of pathogenic microorganisms were isolated from wound, blood, sputum, and indwelling catheter, and Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae were the main pathogenic microorganisms. Pseudomonas aeruginosa and Acinetobacter baumannii were the most common in the wound samples, Klebsiella pneumoniae was more often seen in blood samples while Pseudomonas aeruginosa and Acinetobacter baumannii in sputum samples, and Acinetobacter baumannii in indwelling catheter samples were the most common. The detection rates of Pseudomonas aeruginosa in wound and sputum were significantly higher than those of blood ( P<0.05 or P<0.01) and indwelling catheter ( P<0.01), respectively. The consistency between the overall results of mNGS and microbial culture were moderate ( κ=0.556). The consistency between mNGS and microbial culture was high in samples of blood and indwelling catheter ( κ=0.631, 0.619), but those were moderate in sputum and wound ( κ=0.558, 0.528). Conclusions:The most common infections of patients with severe burn caused by blast injury were wound infection and blood stream infection. With the extension of time after admission, the main pathogenic bacterial strains of patients changed from Staphylococcus aureus, Klebsiella pneumoniae, and Stenotrophomonas maltophilia to Acinetobacter baumannii and Pseudomonas aeruginosa. mNGS showed a higher positive rate of detecting pathogenic microorganisms than conventional microbial culture.

BACKGROUNDEsophageal cancer is one of the most common malignancies in the world. In order to identify the proteins associated with esophageal squamous cell carcinomas (ESCC), we analyzed the protein profiles of ESCC cases with tumor and matched adjacent normal tissues.

METHODSTwo-dimensional electrophoresis (2-DE) was carried out to analyze the protein profiles. Dysregulated protein spots were identified by Matrix-Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) and verified by liquid chromatography/electrospray ionization ion trap-mass spectrometry/mass spectrometry (LC-ESI-IT MS). RT-PCR and immunohistochemistry on tissue microarray were performed to confirm the gene dysregulation in esophageal cancerous tissues. RNA interference (RNAi) was used to knock down the gene expression in ESCC cell lines. Apoptosis assay with annexin V-FITC/PI staining was conducted and cells were analyzed by flow cytometry.

RESULTS2-DE showed that two protein spots with approximate molecular weights and different pI were elevated in 12 out of 18 ESCCs as compared to the corresponding normal tissues. Both the two spots were identified as MnSOD by MALDI-TOF and were verified by LC-ESI-IT MS. MnSOD overexpression was detected in 14 tumors out of 24 cases by RT-PCR and 52 tumors out of 116 cases by immunohistochemistry comparing to normal epithelia. siRNA-mediated silencing of MnSOD in KYSE450 and KYSE150 cell lines revealed that MnSOD protected ESCC cells from apoptosis induced by ultraviolet (UV) and doxorubicin (DOX).

CONCLUSIONSThese findings suggest that there existed two isoforms of MnSOD protein in normal and tumor esophageal tissues. MnSOD was overexpressed in ESCC and its up-regulation in esophageal cancer cells was associated with apoptosis resistance.

Amino Acid Sequence ; Apoptosis ; drug effects ; radiation effects ; Carcinoma, Squamous Cell ; enzymology ; pathology ; Cell Line, Tumor ; Doxorubicin ; pharmacology ; Esophageal Neoplasms ; enzymology ; pathology ; Humans ; Molecular Sequence Data ; RNA Interference ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Superoxide Dismutase ; genetics ; physiology ; Ultraviolet Rays ; Up-Regulation

Objective::To study the effect of evodia on lipid metabolism and low-density lipoprotein-receptor(LDL-R) mRNA expression in hyperlipidemia mice. Method::Kunming mice (n=80) were randomly divided into normal control group (n=20) and model group (n=60). Serum lipids of the model group were measured after 3 weeks.After successful modeling, the mice can be randomly divided into 5 groups (with 10 in each group): model group (equivalent normal saline), positive control group (simvastatin, 5 mg·kg^-1·d^-1), drug group (evodia of 5.25, 10.5, 21 mg·kg^{- 1}·d^{- 1}). The mice were given drugs for 3 weeks.Htoxylin-eosin(HE) staining was used to observe the liver cell structure and the change of aortic arch atherosclerosis in the mice.The enzyme linked immunosorbent assay kit was used to test the contents of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and total serum adiponectin (ADPN) in serum of the mice.The expression of LDL-R mRNA in liver of each group was detected by reverse transcription-polymerase chain reaction (RT-PCR). Result::Liver HE staining showed hepatocyte swelling with steatosis in the model group, and alleviated liver steatosis in high-dose, medium-dose evodia and simvastatin groups.HE staining showed damages on the aortict arch wall in the model group, with obvious intima thickening and inflammatory cell infiltration.The intima was thickened obviously in the low-dose group, and the structure of aortic vessel wall was clear in the high-dose group.Compared with the normal group, TC, TG and HDL-C levels in serum of the model group were increased, while HDL-C level was decreased (P<0.01). Serum TC and TG levels of mice in the medium and high-dose groups decreased, whereas LDL-C and HDLl-C levels increased in low, medium and high-dose groups (P<0.05, P<0.01). Compared with the normal group, the adiponectin level in the model group was decreased, while the serum adiponectin levels in medium and high-dose groups were significantly increased (P<0.01). The LDL-R mRNA expression in the liver of mice in the model group was significantly reduced compared with the normal group (P<0.01). The LDL-R mRNA expression in medium and high-dose evodia groups was significantly increased compared with the model group (P<0.01). Conclusion::Evodia can improve the tendency of hepatic lesions and aortic atherosclerosis in hyperlipidemia mice, which may be related to the regulation of adiponectin level, the reduction of lipid content in mice and the up-regulation of LDL-R mRNA expression in mice liver.