Objective To dynamically observe the changes of the plasma superoxide dismutase(SOD) activity and malondialde-hyde(MDA) content of rabbits with hemorrhagic shock in high latitude .Methods 28 rabbits were randomly divided into 4 groups :0 .9% NaCl group ,7 .5% NaCl group ,Voluven(6% HES 130/0 .4) group and control group .The plasma SOD activity and MDA content were measured before shock .At 30 minutes of shock and 30 minutes later of volumetric resuscitation .Then the changes of MAP were observed .Results There were no static difference among 4 groups in the levels of SOD and MDA before shock ;at 30 minutes of shock ,the SOD activity was reduced signicantly and the MDA content was increased in each group (P<0 .01) .Afer fluid infusion there were no obvious change in the plasma levels of SOD and MDA compared with those of shock in 0 .9% NaCl group and in 7 .5% NaCl group(P>0 .05) ,whereas in Voluven group ,compared with those in 0 .9% NaCl and 7 .5% NaCl group the SOD activity was elevated signicantly and the MDA content was decreased (P<0 .01) .Conclusion Voluven can be used in scan-venging oxygen free redicals by recovering the plasma SOD activity in rabbits with hemorrhagic shock in high latitude .

Objective To evaluate impacts of acute hypervolemic hemodilution (AHH) and intra-operative cell salvage (ICS) with 6％ volume fraction of hydroxyethyl starch (HES) on hemodynamics,blood saving efficiency and renal function of orthopedic surgery patients.Methods A total of 58 patients from orthopedic surgery were involved and randomly divided into AHH + ICS group (30 cases) and control group (28 cases).Changes of hemodynamic indices (HR,MAP and CVP) and renal function indices (BUN,BCr,UCr and ALB) in both groups were compared before operation (T0),immediately after operation (T1) and at postoperative 4 hours (T2),1 day (T3) and 2 days (T4).CCr was counted and intraoperative blood conservation was observed at each time point as well.Results HR,MAP and CVP of the two groups had no significant differences.Both groups showed some drop of HR (P ＜ 0.05),but an increase of MAP and CVP at T1-T4 (P ＜ 0.05),in contrast with levels at TO.BUN,BCr and ALB also showed insignificant differences between groups or within group at each time point.CCr in the control group showed no significant difference at each time point.On the contrary,CCr in the AHH + ICS group had a fall at T1-T4 and was declined to the lowest level at T2.CCr in the AHH + ICS group showed a recovery at T3-T4 and its level at T4 was still lower than that at TO,with no significant difference.CCr in the two groups showed insignificant difference at TO,but its level in the AHH + ICS group was lower than that in the control group at T1-T4,at T2 in particular (P ＜0.01).Moreover,CCr in the two groups was still significantly different at T4 (P ＜ 0.05).Renal function indices of the two groups were all within normal range at each time point.Intraoperative blood loss and unrine volume of the two groups had no significant differences,but intraoperative fluid requirement,allogenic blood transfusion volume and transfusion rate of AHH + ICS group were notably lower than those of control group (P ＜ 0.05 or P ＜0.01).Conclusions AHH plus ICS using HES are safe,effective and promising integrated blood conservation measures,which significantly reduces intraoperative allogenic blood transfusion volume and transfusion rate and has few impacts on fundamental vital signs and renal function.However,prolonged use of large dose of HES may do harm to renal function and therefore should be carefully considered in treatment of patients with severe renal dysfunction.

rse effect when compared with tibolone.

Objective To compare the clinical effect and safety of limited fluid resuscitation and aggressive/normotensive fluid resuscitation in treatment of earthquake-induced traumatic hemorrhagic shock patients so as to provide reference for clinical application.Methods A total of 62 patients with traumatic hemorrhagic shock in earthquake were employed and divided randomly into limited fluid resuscitation group(Group Ⅰ,30 patients)and aggressive/normotensive fluid resuscitation group(Group Ⅱ,32 patients).All the patients were resuscitated by using halanted solution and HAES-steril as resuscitanaid resuscitation.Then,surgical hemostasis was carried out and dynamic changes of mean blood pressure(MAP),heart rate and central venous pressure(CVP)observed.The base excess,lactic acid and creatinine were detected at four resuscitation points.Results Before full fluid resuscitation,MAP remained at 50-70 mm Hg and 70-90 mm Hg respectively in both groups.After early resuscitation.heart rate showed significant decrease,while CVP increased(P＜0.01)but still changed at normal range.Total transfusion volume in Group Ⅰ was less than that of GroupⅡ(P＜0.01).There was no statistical difference upon urine volume(P＞0.05).There was statistical difierence upon base excess value after resuscitation within group(P＜0.01)but no statistical difference between two groups(P＞0.05).After resuscitation,hetic acid level wag obviously reduced in both groups(P＜0.01),with more significant change in Group Ⅰ,with statistical difference compared with Group Ⅱ(P＜0.01).There showed a significant decrease of creatinine in both groups after resuscitation.with statistical difierence within group (P＜0.01)but without statistical difference between two groups(P＞0.05).Conclusions Compared with aggressive/normotensive fluid resuscitation,limited fluid resuscitation is a more safe and effective way for fluid resuscitation of traumatic hemorrhagic shock,for it can not only reduce transfusion volume and ameliorate hemodynamic indices,but also can increase oxygen supply,improve microcirculation and protect renal function.

OBJECTIVE: To investigate the clinical prognostic impact factors of adult sinonasal rhabdomyosarcoma (SNRMS). METHOD: The clinical features, treatment methods, and disease outcome were reviewed retrospectively for twenty-three adult SNRMS between 2006 January and 2014 December. The survival analysis was performed by Kaplan-Meier estimate and the comparison between groups by Log-rank test. Multivariate analysis was carried out by Cox proportional hazard model. RESULT: Patients' ages ranged from 18 to 59 years (median, 23.2 years). With a median follow-up of 20 moths (3-47 moths), 14 cases dead and 9 cases alive, the 1-year and 2-year overall survival (OS) rates were 77.1% and 35.0%, respectively. Within the 1-year and 2-year OS rates,early stage group had a higher overall survival rates than advanced diease group (100.0%, 66.7% and 83.3%, 10.5%, P < 0.05); combined therapy group had a higher overall survival rates than single treatment group (86.7%, 50.0% and 50.8%, 0, P < 0.05). In the non-metastasis group (21 cases), 1-year and 2-year distant metastasis rates were 38.1% and 70.5%, respectively. Multivariate analysis showed that radiotherapy, chemotherapy and tumor diameter less than 5 cm were good prognostic factors (P < 0.05), while the lymph node metastasis, meningeal involvement and orbital involvement were poor prognostic factors (P < 0 05). In the 14 cases of dead patients, 92 8% (13/14) died of distant metastasis. CONCLUSION Adult RMS had a high advanced rate with poor prognosis. Distant metastasis is the leading cause of death. Controlling distant metastasis is a key to improve the survival rate.
Adolescent ; Adult ; Humans ; Lymphatic Metastasis ; Middle Aged ; Multivariate Analysis ; Paranasal Sinus Neoplasms ; diagnosis ; mortality ; pathology ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Rhabdomyosarcoma ; diagnosis ; mortality ; pathology ; Survival Analysis ; Survival Rate ; Treatment Outcome ; Young Adult

Objective To evaluate the roles of cytomorphology and immunohistochemistry in distinguishing between basaloid squamous cell carcinoma ( BSC) and small cell carcinoma ( SCC) of lung. Methods The direct smears and/or liquid-based cytology preparation ( ThinPrep) of bronchial brushing/washing and fine-needle aspiration ( FNA ) specimens from 17 cases of biopsy-proven BSC of lung were retrospectively reviewed and compared with those from 17 cases of SCC.The cytomorphologic parameters analyzed included proportion of cohesive cell clusters, cell palisades/rosettes, adenoid cystic features, crushing artifact, nuclear maximum diameter, nuclear molding, scantiness of cytoplasm,“salt-and-pepper”nuclei, distinct nucleoli, spindly configuration, individual cell keratinization, necrosis, hyaline material, apoptosis and mitotic activity.Immunocytochemical/immunohistochemical study of 25 cases was performed. Ten FNA samples of basaloid squamous cell carcinoma were also analyzed for epidermal growth factor receptor mutations in exons 18, 19, 20 and 21 using amplification refractory mutation system.Results Most of the 17 BSC cases ( 15/17 ) showed a predominance of tightly cohesive tumor cell clusters.The proportion of isolated tumor cells was high in SCC ( more than 60% in 14 cases ) .The nuclear maximum diameter of BSC was slightly larger than that of SCC (9 to 11μm in BSC versus 7 to 9μm in SCC).“Salt-in-pepper” nuclei, nuclear molding and crushing artifact were detected in all SCC cases (15/17, 17/17 and 14/17, respectively).These features were only occasionally found in BSC group.Nucleoli were present in BSC and rarely ( 2/17 ) in SCC. Only 9 of 17 BSC cases showed individual cell keratinization. The differences in the above-mentioned cytomorphologic features were statistically significance (P<0.05).The results of immunohistochemistry performed on the cell block sections and immunocytochemistry performed on the ThinPrep slides were identical to that performed on the corresponding biopsy specimens.The tumor cells in BSC were consistently positive for CK5, p40 and p63.TTF1, chromogranin A, synaptophysin and CD56 were positive in most of SCC.One of SCC cases showed focal PAX5 expression.No EGFR mutations were detected in the 10 BSC cases studied.Conclusions Selected cytomorphologic features, including presence of cohesive cell clusters, larger nuclear size, distinct nucleoli, lack of crushing artifact, absence of nuclear molding and presence of individual cell keratinization, are helpful in diagnosing BSC on cytology specimens. Immunohistochemistry using a panel of TTF1, CK5, p40/p63 and chromogranin A/synaptophysin/CD56 provides further clues in differential diagnosis between BSC and SCC.EGFR mutation study is often negative in lung BSC.