The pathological changes of the lungs after a single exposure to an atmosphere containing 100?15 ppm of hydrogen sulfide(H2S)for 3 hours were observed with optical and electron microscopy in rats.It was found that bronchial epitheliem,alveolar epithelium,pulmonary vessels and pulmonary interstitium were extensively involved.Pulmonary edema,focal pulmonary hemorrhage,exfoliation of the damaged epithelium,and infiltration of neutrophils occurred mainly in the 3rd hour to the 3rd day after H2S intoxication.Chronic inflammatory response and proliferation of fibrous tissue occurred mainly from the 7th to the 15th day after intoxication.Ultrastruc-turally,there were marked changes of alveolar epithelium,phagocytes,vascular endothelium,fi-broblasts,and inflammatory cells.Initial pulmonary edema emerged in the pulmonary interstitium and gradually affected the alveoli.Fragments of alveolar surfactant could be seen in the 3rd hour to the 3rd day after intoxication.These findings indicate that H2S inhalation exerts extensive injurious effects on the lungs in the rats.

Objective To investigate optimum dose of anesthesia in pediatric axillary brachial plexus branch block under ultrasound-guided. Methods Forty-eight children from May 2012 to May 2013 in hand surgery of our hospital,whose age was from 6 to 12 years,were randomly divided into four groups, each group has 12 cases. The doses of Ropivacaine were different in different groups. Group A was 0. 25 mL/kg,group B was 0. 2 mL/kg,group C was 0. 15 mL/kg,group D was 0. 10 mL/kg. And Ketamine was added to the treatment ac-cording to the incidence of anesthesia intraoperative. Evaluating the effect of anesthesia according to the situation of nerve block,observing an-esthesia duration time,dosage of anesthesia and rates of complications. Results The blocking effect of group A,B and C in each nerve area was correspond after 30 min,and anesthesia efficiency was higher than group D,but additional rate was lower than group D,the differences were statistically significant (P<0. 05). The block time in group D was shorter than the other groups,and the dose of Ketamine was most, and the block onset,perfect time were longer than the other groups (P<0. 05). But the differences between group A,B,C were not signifi-cant. Two cases in group D converted to general anesthesia. Four groups did not occur complication related narcotic drug. Conclusion In pediatric brachial plexus block used Ropivacaine under ultrasound-guided would get complete branch block,the exact effect of anesthesia, smaller dosage of local anesthesia. When the dosage of Ropivacaine was 0. 15 mL/kg could achieve a better anesthesia effect.

OBJECTIVE:To systematically review the clinical efficacy and safety of macrolide antimicrobial drugs in the adju-vant treatment of lung infection of Pseudomonas aeruginosa (PA) and provide evidence-based reference for the clinical treatment. METHODS:Retrieved from PubMed,Ovid,CJFD,VIP,CBM and Wangfang database,randomized controlled trials(RCT)about sensitive antimicrobial drugs of PA combined with macrolide antimicrobial drugs (test group) vs. sensitive antimicrobial drugs of PA alone(control group)in the treatment of lung infection of PA were included and comprehensively evaluated using Jadad scale. The homogeneity results were analyzed by Rev Man 5.2 software. RESULTS:13 RCTs were included,involving 872 patients. Me-ta-analysis showed that the effective rate [OR=6.42,95%CI(4.23,9.74),P<0.001] and PA clearance rate[OR=6.10,95%CI(4.10, 9.09),P<0.001] in test group were significantly higher than control group;the time of body temperature returned to normal[MD=-1.14,95%CI(-1.35,-0.94),P<0.001],time of cough sputum disappearance [MD=-1.70,95%CI (-1.97,-1.44),P<0.001] and time of the blood returned to normal[MD=-1.24,95%CI(-2.04,-0.43),P<0.001] were significantly shorter than control group,there were significant difference between 2 groups. There was no significant difference in the incidence of adverse re-action [OR=1.30,95%CI(0.73,2.31),P=0.37]. CONCLUSIONS:Macrolide antimicrobial drugs have good efficacy and safety in the adjuvant treatment of PA infection. Duo to the limit of research methodology quality,it remains to be further verified by large-sample and high-quality RCT.

Objective To explore the relationship between the expressions of vascular endothelial growth factor(VEGF) and matrix metalloproteinase-9(MMP-9) in prostate cancer.Methods The expression of VEGF and MMP-9 in 148 samples of pathologically verified human prostate cancer(PCa) and 10 samples of benign prostatic hyperplasia(BPH) were detected by immunohistochemical staining.Results VEGF was overexpressed in 98 of 148 tumor tissues(66.2%) and MMP-9 was overexpressed in 58 of 148 tumor tissues(39.2%).Both of them were significantly higher than those in BPH(P0.05).But the expression of VEGF was correlated with that of MMP-9.Conclusion The expressions of VEGF and MMP-9 are closely associated with the development of prostate cancer.Therefore VEGF and MMP-9 may be clinically useful as predictor of patients'survival.

U1 trastuctrural changes of myocardium and lungs from 6 cases died of cranioce-rebral penerating gunshot wound 2 hours after injury is reportcd.In all cases theelectron microscopy of the myocardial and lung tissue samples showed the similar ultrastructural morphological changes of the cells and interstitial tissues.The mostpr-ominent ultrastructural changes of myocardium were disorderly arrangement of the Zband.focal dissociation of the myofibrills,mitochondrial swelling with decreasing ofmatrix density and disruption of cristae,and interstial edema.The changes of theung tissue were increasing of width of alveolar septa with decreasing of the electron density.Aggregation of neutrophils in the capillaries of alveolar septa and some alveolar space was observed.The significance and the pathogenesis of the mainpathological changes were discussed.It is suggested that the pulmonary interstitialedema was neurogenic.The pulmonary edema may be manifested as interstitial edemaor intra-lveolar edema depending upon the time elapsed after the gunshot injury.

Objective:To evaluate the usefulness of fast FLAIR pulse sequence in the MRI of intraspinal canal disease.Methods:Forty-four patients with suspected intraspinal canal disease were imaged with fast FLAIR pulse sequence after routine T1 and T2 weighted imaging in a 0.5 T superconducting MR scaner.The parameters of FLAIR were TR/TI/TE=6000/1500～2000/90～120 ms.Results:There were 26 intraspinal extramedullary tumors,4 intramedullary tumors,11 myelitis,3 localized ischemic necrosis or malacia of spinal cord.The images of FLAIR pulse sequence clearly detected all lesions of the 44 cases.They were superior to routine T2 weighted images in demonstrating the extent of the lesions and their T2 signal character,expecially in inflammatory disease of spinal cord.Conclusion:FLARI is a very useful pulse sequence in the MRI of intraspinal canal disease,it may be use as an important supplement of routine T2 weighted sequence.

OBJECTIVE: To evaluate the effect of partial inferior turbinectomy in treating inferior nasal meatus epistaxis. METHOD: Twenty one case of inferior nasal meatus epistaxis were subjected to submucoperiosteous partial inferior turbinectomy and nasal cavity plugging under nasal endoscopy Its effect were analyzed. RESULT: All patients cured and discharged after 3-7 days. After 2 months to 3 years of follow up, no recurrence were seen. CONCLUSION Submucoperiosteous partial inferior turbinectomy under nasal endoscopy is an effective and reliable method in treating inferior nasal meatus epistaxis.
Adult ; Endoscopy ; Epistaxis ; surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Turbinates ; surgery

Objective To retrospectively analyze the characteristics of postoperative complications of endoscopic submucosal dissection (ESD) in patients of different age groups with lesions at different locations . Methods From January 2011 to October 2017, at The First Affiliated Hospital of Zhejiang University , clinical data of 1688 patients who received ESD treatment (1799 ESD operations) were collected.The lesions were located in the esophagus (n =232), stomach (n =1225), duodenum (n =9), colon (n =152) and rectum (n =181).There were 500 patients (508 ESD operations) with underlying diseases, and 1188 patients without underlying diseases.Most patients with lesions at stomach, esophagus and colon rectum, and these patients were divided into four age groups <45 years (n =202), 4559 years (n =643), 6074 years (n =744), and ≥75 years (n =99).The postoperative complications rates of ESD in different lesions among four age groups were compared.Chi-square test was performed for statistical analysis .Results From 2011 to 2017, the complication rates after ESD were 20.0％ (8/40), 18.3％ (21/115), 15.9％ (35/220), 10.7％ (31/291), 11.3％ (40/355), 10.7％ (41 /384) and 10.7％ (42/394), respectively, and the difference was not statistically significant (χ2 =10.432, P =0.064).Further analysis revealed that the complication rates after ESD between 2011 and 2013 was significantly higher than that between 2014 and 2017 (17.1％, 64/375 vs.10.8％, 154 /1424);and the difference was statistically significant (χ2 =10.895, P <0.01).The complication rates of patients with lesions in the esophagus of <45 years group,4559 years group, 6074 years group and ≥75 years group were 4.5％ (1/22), 23.6％ (17 /72), 24.4％ (31 /127) and five cases (totally 11 cases).The complication rates of patients with lesions in the stomach of <45 years group,4559 years group, 6074 years group and ≥75 years group were 19.2％ (28 /146), 14.2％ (68 /479), 15.8％ (85 /539) and 16.4％ (10/61).The complication rates of lesions in the colon of <45 years group, 4559 years group, 6074 years group and ≥75 years group were one case ( totally 12 cases), 3.4％ (2 /58), 10.9％ (7/64) and five cases ( totally 18 cases), respectively.The complication rates of lesions in the rectum of <45 years group, 4559 years group, 6074 years group and ≥75 years group were 3.3％ (1 /30), 10.4％ (7 /67), 19.4％ (14/72) and two cases (totally 12 cases), respectively.There were significant differences in complication rates between different age groups with lesions in the esophagus (χ2 =10.894, P =0.012) and the colon (χ2 =13.540, P =0.004). In addition, the complication rates of patients with underlying diseases and without underlying diseases were 14.6％ (74 /508) and 12.5％ (149 /1188), respectively, and there was no statistically significant difference (χ2 =1.278, P =0.258).Conclusions The postoperative complications of ESD is closely associated with lesion location and age.For elderly patients, especially those with lesions in the esophagus and colon , paying more attention and strengthening the clinical practice can effectively reduce the incidence of complications .

BACKGROUNDIncreasing evidences have shown that vascular endothelial growth factor C (VEGF-C) is involved in the tumor lymphangiogenesis via combining with its ligand, vascular endothelial growth factor receptor-3 (VEGFR-3), which is the most important factor contributing to lymph node metastasis. Futhermore, lymph node metastasis is the most familiar metastatic pathway in non-small cell lung cancer (NSCLC). Based on this knowledge, the present study aims to explore the relationship between VEGF-C and lymphangiogenesis and lymph node metastasis in NSCLC with the use of podoplanin, a novel lymphatic vessel endothelium marker to detect lymphatic vessel.

METHODSThe expression of VEGF-C and podoplanin were detected in 66 paraffin sections of NSCLC and 8 inflammatory pseudotumor tissues by immunohistochemistry (SP). Assessments of podoplanin+ lymphatic vessel density (LVD) and positive rates of VEGF-C were performed and their relationship was analysed.

RESULTSThe positive rate of VEGF-C in the inflammatory pseudotumor group (12.5%) was significantly lower than that in the NSCLC group (75.8%) (P < 0.01), the positive rate of VEGF-C in the positive lymph node group was significantly higher than that in the negative lymph node metastasis group (86.5% vs 62.1%, P < 0.05) and there was no difference between the well differentiated group and the poor differentiated group (76.3% vs 75.0%, P > 0.05). LVD in the positive VEGF-C group was significantly higher than that in the negative VEGF-C group (21.3±6.0 vs 17.7±5.1, P < 0.05), LVD in the inflammatory pseudotumor group (10.9±4.9) was distinctly lower than that in the NSCLC group (20.4±5.9) (P < 0.01) and compared with the negative lymph node metastasis group (18.5± 5.5), LVD (21.9±5.9) in the positive lymph node metastasis group increased significantly (P < 0.05).

CONCLUSIONSLymphangiogenesis is a significant factor for tumor lymphatic metastasis, VEGF-C may mediate lymphatic metastasis of NSCLC by the way of inducing lymphangiogenesis.

Objective To analyze the curative effect of teprenone capsule combined with quadruple therapy in the treatment of chronic atrophic gastritis.Methods From June 2013 to June 2017,one hundred and fifty patients with chronic atrophic gastritis admitted to the First Hospital of Ninghai County were retrospectively selected.According to different treatment schemes,they were divided into control group and observation group,with 75 patients in each group.The control group was treated with routine quadruple therapy, and the observation group was treated with teprenone capsule combined with quadruple therapy.The effective rate of the two groups was compared.Results The total effective rate of the observation group was 97.33% ,which was higher than 85.33% of the control group,the difference between the two groups was statistically significant(χ2 =3.197,P<0.05).After treatment,the levels of interleukin-8 and tumor necrosis factor - alpha in the observation group were ( 7.04 ± 1.03 ) ng/L, ( 41.02 ± 1.72)ng/L,respectively,which in the control group were (10.81 ± 1.63)ng/L,(57.35 ± 2.95) ng/L,respectively, the differences between the two groups were statistically significant (t=6.028,7.281,all P <0.05).The gastric mucosa score and the gastrin concentration in the observation group were (1.13 ± 0.32)points,(8.97 ± 2.33)pmol/L, respectively,which in the control group were ( 1. 82 ± 0. 61 ) points, ( 5. 36 ± 1. 52 ) pmol/L, respectively, the differences between the two groups were statistically significant ( t =5. 661, 6. 024, all P <0. 05 ). Conclusion Teprenone capsule combined with quadruple therapy can improve the clinical efficacy and reduce the degree of inflammation in patients with chronic atrophic gastritis,which is worthy of clinical application.