There has been controversy over what method should be used to treat patients with asymptomatic carotid stenosis, especially the optimal medical therapy has been able to reduce the risk of stroke significantly in these patients and its efficacy is equal to or even exceed today's carotid endarterectomy or stenting. However, the treatment value of revascularization in patients with asymptomatic carotid stenosis does not completely disappear, and with the improved technologies and the prolonged follow-up time, their effects may be more apparent in reducing the risk of stroke. The optimal medical treatment can indeed significantly reduce the risk of stroke in patients with asymptomatic carotid stenosis, but it may not be able to solve all the problems. This article expounds the opinions of different authors in the treatment of asymptomatic carotid stenosis with revascularization according to the data available.

Aspirin resistance is a common question for the preventive practice of ischemic stroke.Currently,it has not yet reached a consensus on how to manage aspirin resistance.In addition,whether to perform the detection of routine platelet function for aspirin resistance,and then whether to guide antiplatelet therapy is reasonable also have widespread cortroversy.

OBJECTIVE: To review the current global status of social healthcare systems for mental disorders in children and adolescents, which provide systematic and continuous protection against mental disorders.DATA SOURCES: A computer-based search for relevant English articles in Medline database published between January 1980 and March 2005 was conducted with the key words of "mental disorder, children and adolescents, care". The Chinese full-text periodical database and Wanfang database were also searched for relevant Chinese articles published between January 1990 and March 2005 using equivalent Chinese key words of "mental disorder, children and adolescents, care".STUDY SELECTION: The articles that reviewed the current status of social healthcare system for mental disorders in children and adolescents were included for analysis, and those not categorized as reviews were excluded.DATA EXTRACTION: Totally 58 related articles were collected, among which 13 met the inclusion criteria and 45 were excluded.DATA SYNTHESIS: The current status of social healthcare systems for mental disorders in children and adolescents in Europe, North America,South America, Australia, Asia and Africa were described. The prevention and treatment for mental disorders in Europe and North America were well developed. The training, education and research of mental disease in children in South America were still developing, and the healthcare system in Australia needs further improvement. Lack of professional physicians is the major problem in Asia, whereas a complete protective system has not been well established in Africa and the families assume the role of primary defense against the disorder.CONCLUSION: The comprehensive healthcare services for mental disorders in children and adolescents has been lacking globally. Policy development, cultural understanding in the healthcare, recognition of the important role of nongovernmental organizations, epidemiological research, and professional training can be beneficial efforts to better protect the children and adolescents from mental disorders.

Objective To evaluate feasibility of high frequency jet ventilation (HFJV) during trachea and carinal reconstruction. Methods Ten patients with lung cancer ,scheduled for elective trachea and carinal reconstruction ,were intubated with double lumen tube following routine anesthesia induction. A HFJV tube (ID=3mm) was inserted 3cm into main bronchus. HFJV was applied ,with the respiratory rate of 120/min,I:E=1:2 and drive pressure of 0.15-1.20MPa, after cut off the main bronchus of the opposite side. Blood gas analysis was made before the operation, 15min following one-lung ventilation, 5, 10, 20 min following HFJV and 15min following one-lung ventilation,respectively.Results PaO 2 was significantly higher following HFJV than that one-lung ventilation (P

Objective To investigate the effect of melatonin on oxidative stress and inflammatory reaction in patients with moderate to severe chronic obstructive pulmonary disease and to explore its mechanisms. Methods 42 patients with moderate to severity chronic obstructive pulmonary disease in stable stage were random-ly divided into melatonin group and control group,and 21 patients in each group treated with melatonin(3 mg/d) or placebo for 3 months respectively. The plasma levels of 8- isoprotane,IL-8,TNF-α,h-CRP pulmonary func-tion,six minutes walking test and MRC dyspnea score before treatment,2 months and 3 months after the treatment were analyzed. Results After 2 months of treatment,compared to placebo groups,melatonin could significantly decrease the concentration of 8-isoprotane(10.40 ± 5.4 vs. 16.92 ± 4.33,P<0.05),and the concentration of IL-8 (6.88 ± 2.37 vs. 11.33 ± 3.39,P < 0.05). After 3 months of treatment,compared to placebo groups,melatonin could significantly decrease the concentration of 8-isoprotane(9.40 ± 4.0 vs. 17.92 ± 3.33,P < 0.01),and IL-8 (5.67 ± 3.22 vs. 9.31 ± 3.23,P < 0.05). Compared with before treatment,melatonin could significantly de-creased the concentration of 8-isoprotane(9.40 ± 4.0 vs. 20.40 ± 8.4,P<0.01 )and IL-8(5.67 ± 3.22 vs. 12.33 ± 3.88,P<0.05)after 3 months. Meanwhile,the concentration of the TNF-α(25.83 ± 9.18 vs. 35.83 ± 12.18,P<0.05)and hypersensitive C(1.76 ± 1.18 vs. 3.09 ± 1.79,P < 0.05)reactive protein in the melatonin group was greatly lower than the placebo group. After 3 months,compared to the placebo group,MRC dyspnea score of pa-tients in the group of melatonin was improved significantly(1.56 ± 1.38 vs. 2.09 ± 1.16,P<0.05 ),and lung func-tion and six minutes walk test showed no significant difference between patients in the two groups. Conclusions Exogenous melatonin administration can decrease the concentration of 8-isoprotane,IL-8,TNF-αand h-CRP in the blood of patients with moderate to severe COPD ,and improve the MRC dyspnea score. Melatonin has a significant effect on reducing oxidative stress and inhibiting inflammatory reaction in patients with moderate and severe stage stable COPD,which demonstrates its potential therapeutic value with broad clinical application prospects.

Objective To investigate the clinical applicative of short 5 Fr pancreatic duct (PD) stents in difficult biliary cannulation of ERCP. Methods 131 patients who underwent difficult biliary cannulation during routine ERCP were randomized to receive prophylactic short 5 Fr PD stents (stent group, 66 patients) and not (control group, 65 patients) from January 2012 to October 2015. The success rate of biliary cannulation for the first ERCP, scores of abdominal pain, the incidence of post-ERCP pancreatitis (PEP) and hyperamylasemia and severe post-ERCP pancreatitis were analyzed. Results The success rate of biliary cannulation for the first ERCP was significantly higher with the stent group than the control group. The scores of abdominal pain of the stent group was significantly lower than the control group. The postoperative serum amylase value at 3 h and 24 h were obviously lower in PD stents group than those in control group. The incidence of hyperamylasemia, post-ERCP pancreatitis, severe post-ERCP pancreatitis were also significantly lower with PD stents group than the control group. 3 cm long 5 Fr PD stents has high success rate of placement, high spontaneous migration rate, low complications, decreases the need for endoscopic removal. Conclusion In difficult biliary cannulation during ERCP, placement of short 5 Fr PD stent is safe and effective, enhance the success rate of biliary cannulation, relieve the abdominal pain, reduces the rate of post-ERCP pancreatitis efficiently.

Objective:To explore psychological characteristics and influential factors of impulsivity of 8～12 years-old children with attention deficit hyperactivity disorder.Methods:70 children with ADHD and 126 controls and their parents were evaluated with BIS,SCARED,DSRSC,CSD,TMD and WCST.Results:①Children with ADHD showed significantly more impulsivity,higher anxious mood and depressive mood,lower social desirability,and time management disposition(P

Objective To investigate the effects of different positions of the patients mechanically ventilated under general anesthesia on respiratory mechanics during one or both lung ventilation before thoracotomy.Methods Twelve ASA Ⅰ or Ⅱ patients of both sexes (8 males, 4 females) aged 33-63 years weighing 62-85 kg scheduled for general thoracic surgery were studied. The preoperative lung function of the patients was normal. The patients were premedicated with intramuscular pethidine, promethazine and atropine. Anesthesia was induced with fentanyl, droperidol, midazolam, propofol and vecuronium. Left-sided double-lumen tube was inserted and correct placement was confirmed using a fiberoptic bronchoscope inserted through the bronchial lumen. Anesthesia was maintained with propofol and vecuronium infusion. The magnitude of neuro-muscular blockade was monitored by stimulation of radial nerve with TOF pulses. T4/T1 was maintained at 0 during study. The patients were placed in supine, left and right lateral position. In each position both lungs, left and right lung were ventilated for 10 min respectively. The non-ventilated bronchial lumen was open to the air during one-lung ventilation. The ventilatory parameters were kept unchanged during the study (VT = 8-10 ml?kg-1 , RR = 12 bpm, I:E = 1:2). Pressure-volume loop (P-V loop), peak airway pressure (Ppeak), airway resistance (Raw), total compliance (CT) (lung and thorax) and PETCO2 were measured and recorded at the end of each 10 min ventilation using S/5 monitor ( Datex-Ohmeda Finland) . Results During both lung ventilation Ppeak was significantly increased and CT was significantly decreased in left and right lateral position as compared with supine position ( P

OBJECTIVE: To investigate the expression of CDK4 and p16 in laryngeal squamous cell carcinoma (LSCC) tissues. METHOD: The expressions of CDK4 and p16 in 30 cases of LSCC tissues and 20 cases of edge tissues were detected by immunohistochemical technology SP method, and discuss their correlation with clincial pathology and clinical stage of LSCC. RESULT: The positive rates of CDK4 and p16 were 63. 3 %,46. 7% in LSCC tissues, and the positive rates were 25%, 90% in edge tissues. The expression of CDK4 in LSCC tissues was significantly higher than that in edge tissues(P<0. 05), which was not associated with the clincial pathology and clinical stage(P> 0. 05); The expression of p16 in LSCC tissues was significantly lower than that in edge tissues(P<0. 05), it was associated with the clincial pathology (P<0. 05), but not associated with clinical stage(P>0. 05) ;there is a negative correlation between CDK4 and p16 (r= -0. 786, P<0. 05). CONCLUSION Low expression of p16 and high expression of CDK4 may play an important role in the development of LSCC and the low expression of p16 in LSCC tissue could be used as important reference markers of malignant degree of tumour.
Biomarkers, Tumor ; Carcinoma, Squamous Cell ; metabolism ; Cyclin-Dependent Kinase 4 ; biosynthesis ; Cyclin-Dependent Kinase Inhibitor p16 ; biosynthesis ; Head and Neck Neoplasms ; metabolism ; Laryngeal Neoplasms ; metabolism ; Prognosis ; Squamous Cell Carcinoma of Head and Neck

Objective To evaluate the effects of different storage periods at room temperature on domestic cisatracurium-induced neuromuscular (N-M) block.Methods One hundred and twenty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,scheduled for elective operations under general anesthesia,were randomly divided into 3 groups (n =40 each):cisatracurium stored for 60 days at 4-8 ℃ group (group LT),cisatracurium stored for 30 days at room temperature group (group RT30) and cisatracurium stored for 60 days at room temperature group (group RT60).Anesthesia was induced with iv injection of midazolam and target-controlled infusion of propofol (target plasma concentration 3 μg/ml) and remifentanil (target effect-site concentration 3-5 ng/ml).A bolus of cisatracurium 0.2 mg/kg was given intravenously over 5-10 s as soon as the patients lost consciousness.N-M block was monitored with TOF-Watch SX (Organon,Netherlands).Single stimulation was applied to the ulnar nerve at wrist.The maximal degree of N-M block,onset time,clinical duration,recovery index and 75 ％ recovery time were recorded.The patients were intubated and mechanically ventilated when N-M block reached the maximal degree.The intubation condition was evaluated.Hypotension,bradycardia and skin allergy were recoded.Results Compared with group LT,no significant change was found in the onset time,clinical duration,recovery index and 75％ recovery time in group RT30 (P ＞ 0.05),and the onset time was significantly prolonged,clinical duration and 75％ recovery time were shortened in group RT60 (P ＜ 0.05).The onset time was significantly longer and clinical duration was shorter in group RT60 than in group RT30 (P ＜ 0.05).The intubation condition was excellent or good in the three groups and there was no significant difference among the three groups.There was no significant difference in the incidence of hypotension and bradycardia among the three groups (P ＞ 0.05).No patients developed skin allergy.The maximal degree of N-M block was 100％ in groups LT,RT30 and RT60 except one case with 95％ in group RT60.Conclusion No significant change is found in the N-M block induced by domestic cistracurium when stored for 30 days at room temperature,however,the N-M block is significantly attenuated when stored for 60 days at room temperature.