Objective To observe the clinical effect of brachial plexus anesthesia shoulder manipulation solution combined with individualized treatment in treatment of periarthritis of shoulder.Methods 80 patients with periarthritis of shoulder were randomly divided into control group and observation group,40 cases in each group.The control group was given brachial plexus anesthesia shoulder manipulation solution,and the observation group was given brachial plexus anesthesia shoulder manipulation solution combined with individualized treatment.Joint function score and cure rate were compared before and after treatment in the two groups.Results The joint function score [(93.68 ±3.74)] and cure rate (62.50%) of the observation group were significantly higher than those in the control group[(79.35 ±3.21),35.00%] after 2 months treatment (t =1.57,3.86,χ2 =6.05,all P <0.05). Conclusion Brachial plexus anesthesia shoulder manipulation solution with individualized treatment has obvious effect in treatment of periarthritis of shoulder,and can effectively restore joint function in patients.

objective To investigate the relationship between serum iron,ferritin(SF),transferrin(TRF)and coronary artery stenosis asd well to find the possible cause of coronary heart disease,Methods All the 315 pailents underwent coronary angiography.Serum iron,SF and TBF were measured.All patients were divlded into three groups according to the Gensini score.The distribution of serum iron,SF,TRF in the three groups underwent analysis of variance and the relationship between serum iron,SF,TRF and the Gensini score were further investigated by means of multiple linear regression analysis.Results The analysis of one-way variance showed that serum iron,SF and TRF/SF Were associated with the Gensini score(coefficient correlation=6.162,7.191 and 4.380,P<0.05).Muhiple linear regression analysis adjusted for many risk factors for coronary heart disease showed that SF had independent association with the Gensini score.(r=0.240.P<0.01).Conclusion Ferritin is independ-ently associated with coronary artery stenosis.

Objective To investigate the clinical value of a newly designed surgical therapy for familial polyposis coli by severing the superior mesenteric artery&vein in order to make a complete lysis of the mesentery and an ileum pouch and the anal anastomosis within the entire muscular sheath of the rectum.Methods Six patients with familial polyposis coli(5 males and 1 female,aged 24-36 years)were admitted and underwent the procedure which was consisted of:(1)An incision was made in the left middle and lower parts of the rectus abdominis;(2)The greater omentum was retained and the large intestine was removed;(3)At the juncture of the sigmoid colon and the rectum,the muscular sheath was dissociated 0.5cm,the mucous membrane of the rectum was stripped in a revolving manner,the nourishing artery and vein in the membrane were exposed,and clamped and cut in sequence up to the anocutaneoue line;(4)The rectal mucous membrane was completely removed;(5)Under the right colonic artery,the superior mesenteric artery and vein were severed;(6)An N-,J-or W-shaped pouch was made in the ileum accordingly:(7)An anastomosis of the ileum pouch and the anal canal was made within the entire muscular sheath of the rectum,and a drainage was placed;(8)The mesostenium was fixed on the fight posterior abdomen,the small intestines were spread out to the right side,and the mesostenium was covered on the coarse surface of the colon bed:(9)A tube was placed in the left lower abdomen for a vacuum aspiration for 2 days after operation,combined with the suction drainage,to eliminate the pelvic effusions;and(10)The abdomen was closed.Results Patients were able to discriminate stools and flatus 3-7 days after operation.and the formed stools occurred 7-10 days after operation.Five patients were followed-up for 3-17 years,with averagely one defecation a day,with no night defecation and seepage.Urination was normal;In another one patient who underwent the procedure 4 months ago the defecation was twice a day,with no night defecation.All the 6 patients had normal autonomic nerve function and sexual function as well as normal defecation and urination,with no recurrence of polyposis coli or infection.The small bowel functions well with no ischemia related symptoms.Conclusion Cutting the superior mesenteric artery and vein and then making anastomosis of the ileum pouch and the anal canal within the muscular sheath of the rectum is a new surgical approach to familial polyposis coli.It is safe and significantly improves the patients' life quality.

abnormality from cardiomyopathy and endocardial fibroelastosis. Some pediatric patients have overlapped characteristics of both infant and adult type.

Purpose To investigate the mutations of ID3,TCF3 and MYC genes in Chinese Burkitt lymphoma and discuss their significance.Methods Total DNA was extracted from tumor tissues of 32 patients with Burkitt lymphoma,then the DNA was amplified by polymerase chain reaction (PCR),and the products of PCR were sequenced directly with Sanger sequencing methods.Results The mutation rates of ID3 and TCF3 genes were 35.5％ (11/31) and 18.8％ (6/32) respectively.The mutation rate of MYC was 50％.The mutation rates of MYC exon 1,MYC exon 2 and MYC exon 3 were 3.3％ (1/30),50％ (15/30) and 7.7％ (2/26) respectively.Conclusion Recurrent mutations of the ID3,TCF3 and MYC genes in Chinese Burkitt lymphoma were identified by Sanger sequencing.For TCF3 gene,a novel mutation c.2202G ＞ C p.L569V was found in three cases.In two cases,a novel mutation of c.1070A ＞G p.G182D was found in MYC gene.

Nine pediatric patients (4 females,5 males) with huge hemangioma of head and neck complicated with Kasabach-Merritt phenomenon,aged 15-135 days,undergoing elective radical resection for huge hemangioma of head and neck,were selected from June 2012 to June 2016 in our hospital.Two pediatric patients were sensitive to preoperative hormone treatment,the platelet count almost increased to the normal value,7 pediatric patients were not sensitive to preoperative hormone treatment,and the increase in platelet count was not obvious.When the platelet count ＜ 40× 109/L,platelet was infused at 12 h before operation until the platelet count ＞ 100× 109/L.Two pediatric patients with larger haemangioma in maxillofacial region kept spontaneous breathing,and anesthesia was induced by inhaling high-concentration of sevoflurane.Anesthesia was induced with intravenous midazolam,sufentanil and cisatracurium in the other seven pediatric patients.Pediatric patients were mechanically ventilated in pressure-controlled mode after endotracheal intubation with airway pressure of 9-12 cmH2O.All pediatric patients inhaled sevoflurane,and anesthesia was maintained by infusing remifentanil.Heart rate and systolic blood pressure were maintained within the normal range during operation.Fluid and blood products were infused according to the blood loss,urine volume,physiological requirement and central venous pressure,etc.Pediatric patients were transferred to pediatric intensive care unit (PICU) at the end of operation,and the endotracheal tube was removed after the patients were completely awake.One pediatric patient developed pulmonary infection after operation,was discharged from PICU on day 7 after operation,then cured and discharged from hospital after healing on day 20 after operation.The other eight pediatric patients were discharged from PICU on day 2 after operation,then cured and discharged from hospital on days 5-10 after operation.After a followup period of 1 yr,the pediatric patients recovered well,the platelet count was normal,and the tumor recurrence was not found.

Objective To investigate the protective effect of permissive hypercapnia in infants undergoing one-lung ventilation(OLV). Methods A total of 64 infants were randomly divided into Group N(normocapnia group,n=32)and Group H(hypercapnia group,n=32).Arterial blood gas samples were collected at four differ-ent time points:10 minutes after intubation(T1),30 and 60 minutes after artificial pneumothorax(T2,T3),and 30 minutes after being sent to post anesthesia care unit(T4)while vital signs(HR,MAP,SpO2and temperature) and ventilation parameters(Ppeak,Vt,PEEP,RR,MVV,and FiO2)were recorded simultaneously;OI was calcu-lated by corresponding equation. Bronchoalveolar lavage fluid(BALF)was collected before and after surgery for the measurement of RAGE. Results Compared with those at T1,MAP and PaO2were significantly lower but Ppeak was obviously higher in group N,while HR,Ppeakas well as PaCO2were increased(P<0.05)and Vt,MVV,pH, PaO2as well as lactic acid were decreased in group H(P < 0.05)at T2and T3. Compared with those in group N, MAP,HR as well as PaCO2were higher while Ppeak,Vt,MVV,pH,and lactic acid were lower in group H at T2 and T3(P<0.05).There was a significant increase of RAGE in both groups after surgery and it was much higher in group N when compared with that in group H after surgery(P<0.05). Conclusion PHC not only has advantages in improving tissue oxygenation,but also has the potential of lung protection for infants undergoing OLV.

Objective To investigate the effect of anesthesia factor on lung injury in patients un?dergoing thoracoscopic radical lung cancer surgery and to evaluate efficacy of combination of thoracic para?vertebral block(TPVB)with dexmedetomidine mixed with ropivacaine and general anesthesia. Methods One hundred patients of both sexes, aged 18-64 yr, with body mass index of 18-25 kg∕m2, of American Society of Anesthesiologists physical statusⅡorⅢ, scheduled for elective thoracoscopic radical lung cancer surgery, were divided into 5 groups(n=20 each)using a random number table: general anesthesia group (group G), TPVB with ropivacaine combined with general anesthesia group(group R), intravenously in?fused dexmedetomidine combined with general anesthesia group(group Div), intravenously infused dexme?detomidine plus TPVB with ropivacaine combined with general anesthesia group(group Div+R), and TPVB with dexmedetomidine mixed with ropivacaine combined with general anesthesia group(group Dtp+R). In group R, TPVB was performed under ultrasound guidance, two?point method was selected accord?ing to the position of intercostal space at surgical incision, and 0.5% ropivacaine 10 ml was injected into each puncture site. Dexmedetomidine 0.5 μg∕kg was intravenously infused over 10 min in group Div. Dexmedetomidine was intravenously infused for TPVB in group Div+R. TPVB solution contained dexmedeto?midine 0.5 μg∕kg and ropivacaine in group Dtp+R. Anesthesia was then induced and maintained by IV in?fusion of propofol and remifentanil. The intraoperative consumption of propofol and remifentanil and develop?ment of adverse reactions such as hypoxemia, hypotension and bradycardia were recorded. Normal lung tis?sues around the tumor margin were obtained immediately after tumor resection for determination of the ex?pression of hypoxia?inducible factor 1 alpha(HIF?1α), BCL2∕adenovirus E1B 19kDa interacting protein 3 (BNIP3)and microtubule?associated protein 1 light chain 3Ⅱ(LC3Ⅱ)(by Western blot), contents of tumor necrosis factor?alpha(TNF?α)and interleukin?6(IL?6)in lung tissues(by enzyme?linked immu?nosorbent assay)and cell apoptosis(by TUNEL)and for examination of the pathological changes(with a light microscope)which were scored. Apoptosis index was calculated. Results The amount of propofol consumed was significantly lower in Div+R and Dtp+R groups than in the other three groups, and the a?mount of remifentanil consumed was significantly higher in G and Div groups than in the other three groups (P<0.05). The incidence of hypertension and tachycardia was significantly lower in R and Div groups than in group G(P<0.05). The incidence of hypotension was significantly lower in R, Div and Dtp+R groups than in group Div+R(P<0.05). The incidence of bradycardia was significantly higher in Div and Div+R groups than in group R(P<0.05). Compared with G and R groups, apoptosis index, contents of TNF?α and IL?6 and lung injury scores were significantly decreased, and the expression of HIF?1α, BNIP3 and LC3Ⅱ was up?regulated in Div, Div+R and Dtp+R groups(P<0.05). Compared with group Div, the TNF?α content and lung injury scores were significantly decreased, and the expression of HIF?1α and LC3Ⅱwas up?regulated in Div+R and Dtp+R groups, and the IL?6 content was significantly decreased in group Dtp+R(P<0.05). Conclusion Combination of TPVB with dexmedetomidine mixed with ropivacaine and general anesthesia produces better efficacy in reducing lung injury in patients undergoing thoracoscopic radi?cal lung cancer surgery.

Objective To evaluate the modifying efficacy of thoracic paravertebral block ( TPVB) combined with general anesthesia in the patients undergoing single-port video-assisted thoracoscopic radical operation for lung cancer. Methods Sixty-six American Society of Anesthesiologists physical status Ⅰ orⅡ patients of both sexes, aged 18-64 yr, with body mass index of 20-24 kg∕m2 , undergoing elective sin-gle-port video-assisted thoracoscopic radical resection of lung cancer, were divided into TPVB plus general anesthesia group ( group TPVB+GA, n=33) and general anesthesia group ( group GA, n=33) using a random number table method. Ultrasound-guided TPVB was performed at T4 and T7 before induction of gen-eral anesthesia, and 0. 5％ ropivacaine 10 ml was injected into the two sites. General anesthesia was in-duced with midazolam, etomidate, sufentanil and rocuronium. Anesthesia was maintained by inhaling sevoflurane and infusing remifentanil. Patient-controlled intravenous analgesia ( PCIA ) with fentanyl 2μg∕kg, flurbiprofen 100 mg and 10 mg in 100 ml of normal saline. Sufentanil 0. 1μg∕kg was intravenously injected when VAS score≥4 during postanesthesia care unit ( PACU) . Propofol 0. 5-1. 0 mg∕kg was intra-venously injected when Sedation-Agitation Scale scores>5 during PACU. Nicardipine 0. 2 mg was injected intravenously when mean arterial pressureheart was increased by 30％ of baseline value during PACU. Es-molol 20 mg was given inravenously when heart rate was>100 bpm during PACU. The end-tidal concentra-tion of sevoflurane was recorded at 5 min after incision and at 5, 20, 30 and 60 min after inserting thoraco-scopic cannula. Venous blood samples were collected before operation, at 5 min after inserting thoracoscop-ic cannula, at closing chest and at 6 and 24 h after operation for determination of plasma norepinephrine concentrations by enzyme-linked immunosorbent assay. The consumption of remifentanil during opertion, requirement for sufentanil, propofol, nicardipine and esmolol during PACU, duration of PACU stay and development of postoperative nausea and vomiting were recorded. Results Compared with group GA, the intraoperative end-tidal concentration of sevoflurane and consumption of remifentanil were significantly re-duced, the concentration of norepinephrine was decreased at each time point during and after surgery, and the requirement for sufentanil, propofol, nicardipine and esmolol was decreased during PACU, and dura-tion of PACU stay was shortened during stay in PACU in group TPVB+GA ( P<0. 05) . Postoperative nause-a and vomiting was not found in the two groups. Conclusion TPVB combined with general anesthesia is helpful in carrying out anesthetic model of low-consumption opioids and in improving the quality of recovery from anesthesia and is more helpful in inhibiting intraoperative and postoperative stress responses and post-operative pain responses than general anesthesia alone when used for the single-port video-assisted thoraco-scopic radical operation for lung cancer.

Objective To explore the correlation between different body mass indexes and incidence of digestive carcinoma.Methods The retrospective cohort study was conducted.The data of 95 177 participants (75 909 males and 19 268 females) aged (51± 12)years with the range of 18-98 years who participated health examination at the Kailuan General Hospital,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan' gezhuang Hospital,Kailuan Jinggezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital from July 2006 to December 2015 were collected.According to definition of body mass indexes from Chinese guideline for prevention and control of adult overweight and obesity,all the 95 177 participants were allocated into the 3 groups,including 37 660 with BMI＜24 kg/m2 in the normal BMI group,39 793 with with 24 kg/m2 ≤BMI＜ 28 kg/m2 in the overweight group and 17 724 with BMI≥28 kg/m2 in the obesity group.All participants received the same-order health examinations by the fixed team of doctors in 2006,2008,2010,2012 and 2014 at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) comparisons of clinical characteristics among the 3 groups;(2) incidence of digestive carcinoma in the participants;(3) risk factors analysis affecting new-onset digestive carcinoma;(4) comparisons of the fitting degree of BMI on new-onset digestive carcinoma model;(5) stratified analysis of risk factors affecting new-onset digestive carcinoma at different locations.Measurement data with normal distribution were represented as Mean±SD,and comparisons among groups were analyzed using the one-way ANOVA.Measurement data with skewed distribution were described as M (range),and comparisons among groups were analyzed using the Kruskal-Wallis test.Count data were described as case number and percentage,and comparisons among groups were analyzed using the chi-square test.The cumulative incidence was calculated by the Kaplan-Meier method,and comparisons of incidences among groups were done by the Log-rank test.The incidences of digestive carcinomain patients with different BMI were calculated by person-year incidence (incidence density).The hazard ratio (HR) and 95％ confidence interval (CI) of different BMI (continuous variable and classification variable) on new-onset digestive carcinoma were estimated by the COX proportional hazards regression models.Restrictive cubic spline regression was used to calculate the dose-response relation between the continuous variable and the risks of digestive carcinoma.The fitting degree of BMI on new-onset digestive carcinoma model was calculated by the likelihood ratio test and akaike information criterion (AIC).Results (1) Comparisons of clinical characteristics among the 3 groups:age,sex (male),systolic pressure,diastolic pressure,waistline,total cholesterol (TC),triglyceride (TG),fasting plasma glucose (FPG),C reactive protein,cases with smoking,drinking,physical exercise,positive HBsAg,high salt intake,malignant tumor in immediate family were (51± 13)yeas,28 607,(125±20) mmHg (1 mmHg=0.133 kPa),(80± 11) mmHg,(81±9) cm,(4.9± 1.1) mmol/L,1.05 mmol/L(range,0.75-1.49 mmol/L),(5.3±1.6) mmol/L,0.58 mmol/L (range,0.20-1.60 mmol/L),11 962,6 845,5 676,711,.3 640,1 298 in the normal BMI group and (52±12)years,32 928,(133±21) mmHg,(85±11) mmHg,(89±8)cm,(5.0±1.2) mmol/L,1.39 mmol/L (range,0.99-2.08 mmol/L),(5.6± 1.7)mmol/L,0.84 mmol/L (range,0.33-2.07 mmol/L),12 364,7 413,6 322,839,4 401,1 463 in the overweight group and (51 ± 12) years,14 374,(139 ± 21) mmHg,(88 ± 12) mmHg,(96 ± 9) cm,(5.1 ± 1.2) mmol/L,1.67 mmol/L (range,1.18-2.51 mmol/L),(5.7± 1.8) mmol/L,1.22 mmol/L (range,0.53-2.82 mmol/L),5 092,2 818,2 847,355,2 235,704 in the obesity group,showing statistically significant differences among groups (F=90.60,x2 =576.34,F=2 768.38,3 570.80,22 319.30,256.99,x2 =9 108.21,F=507.11,x2 =3 219.47,52.78,64.38,13.36,0.76,130.39,9.74,P＜0.05).(2) Incidence of digestive carcinoma in the participants:all the 95 177 participants were followed up for 845 085 person-year,1 215 were diagnosed as new-onset digestive carcinoma,with a total person-year incidence of 1.44 thousand person / year.Of 1 215 patients,413 had colorectal-anal cancer,306 had liver cancer,234 had gastric cancer,113 had esophageal cancer,91 had the pancreatic cancer,36 had gallbladder carcinoma or cholangiocarcinoma,25 had intestinal cancer.Three patients had intestinal cancer complicated with colorectal-anal cancer.The person-year incidence of digestive carcinoma was 1.46 thousand person / year,1.37 thousand person / year and 1.53 thousand person / year in the normal BMI group,overweight group and obesity group,respectively.The cumulative incidences of digestive carcinoma in the normal BMI,overweight,obesity group were respectively 11.8‰,10.1‰ and 12.1‰,showing a statistically significant difference among 3 groups (x2=6.13,P＜0.05).There was no statistically significant difference between the normal BMI group and obesity group (x2 =1.07,P＞0.05),and statistically significant differences between the overweight group and normal BMI group and obesity group,respectively (x2=3.90,4.10,P ＜ 0.05).(3) Risk factors analysis affecting new-onset digestive carcinoma.Results of COX proportional hazards regression models showed that continuous BMI was not related factor affecting new-onset digestive carcinoma after adjustment of age,gender,systolic pressure,TC,TG,FPG,smoking,drinking,physical exercise,positive HBsAg,high salt intake,malignant tumor in immediate family (HR=0.99,95％CI:0.98-1.01,P＞0.05).After adding BMI as classification variable in the COX model,risk of new-onset digestive carcinoma in the overweight group was reduced compared with normal BMI group (HR =0.88,0.88,95％CI:0.78-1.01,0.77-0.98,P＜0.05) and risk of new-onset digestive carcinoma in the obesity group was not affected (HR=1.03,1.04,95％CI:0.88-1.20,0.89-1.22,P＞0.05).Results of restrictive cubic spline regression showed a "U" shaped relationship between BMI and incidence risk of digestive carcinoma and the lowest incidence of digestive carcinoma in patients with BMI as 25-27 kg/m2.(4) Comparisons of the fitting degree of BMI on new-onset digestive carcinoma model:multivariate model was constructed after adding risk factors of age,gender,systolic pressure,TC,TG,FPG,smoking,drinking,physical exercise,positive HBsAg,high salt intake,malignant tumor in immediate family,and-2Log L and AIC were 27 175.05 and 27 203.05 for the multivariate model.Then BMI variable was added into the multivariate model,and the-2Log L and AIC of the multivariate model+BMI model were 27 169.53 and 27 201.53,respectively,with a statistically significant difference compared with normal BMI group (x2 =5.52,P＜0.05).(5) Stratified analysis of risk factors affecting new-onset digestive carcinoma at different locations.Results of COX proportional hazards regression models showed risks of new-onset digestive carcinoma in the overweight and obesity groups were reduced compared with normal BMI group (HR=0.57,0.42,95％CI:0.38-0.84,0.23-0.79,P＜0.05) in the esophageal cancer model.Risks of new-onset digestive carcinoma in the overweight group were reduced compared with normal BMI group (HR=0.72,95％CI:0.55-0.93,P＜0.05) and risk of new-onset digestive carcinoma in the obesity group was not affected (HR=1.10,95％CI:0.82-1.47,P＞0.05) in the liver cancer model.Conclusions Participants in the overweight group have the lowest incidence of digestive carcinoma,especially in the esophageal cancer and liver cancer model.Incidence of digestive carcinoma is the lowest with BMI as 25-27 kg/m2.