Objective To investigate the effects of dexmedetomidine on tonsillectomy in children with sevoflurane combined with anesthesia recovery period of restless.Methods A total of 62 patients with tonsillectomy under general anesthesia from 2011 to 2015 in our hospital werecollected and randomly divided into the control group and the experiment group with 31 cases in each.Two groups of children were treated by 7％sevoflurane inhalation anesthesia induction,supplemented by a small amount of intravenous anesthetics propofol 2 mg/kg,sufentanil 2 μg/kg,CIS atracurium 150 μg/kg intravenous injection.Patients in the experiment group were treated by dexmedetomidine 0.2 μg/(kg·h)continuous intravenous infusion until the end of the operation,patients in the control group were treated by normal saline intravenous infusion.Compared the systolic blood pressure and heart rate of the 2 groups of before anesthesia induction,after anesthesia induction,after operation 5min,the end of the operation ; occurred rate of restless at after anesthesia extubation 5minutes,10minutes,15minutes,20minutes,25minutes.Results Compared with the control group,the systolic blood pressure and heart rate of the experiment group without statistical significance before anesthesia induction; after anesthesia induction,after operation,5min,at the end of operation,the systolic blood pressure and heart rate were lower(P<0.05); children recovery time,extubation time,recovery time of delivery from the anesthesia room were shorter(P<0.05); occurred rate of restless were lower after anesthesia extubation 5minutes,10minutes,15minutes,20minutes,25minutes(P<0.05).Conclusion Dexmedetomidine can prevent tonsillectomy after sevoflurane anesthesia result in the recovery period of restless.

Objective To evaluate the effect and safety of pseudomonas aeruginosa injection (PA-MSHA) combined with ulinastatin (UTI) injection in the treatment of patients with malignant pleural effusion and/or ascites.Methods 52 patients were randomly divided into PA-MSHA group and PA-MSHA combined with UTI group,each group including 26 patients.All patients were given ultrasonic testing before treatment.The single drug group was given PA-MSHA 10 ml intrapleural and/or intraperitoneal injection.The two-drug combination group was given PA-MSHA 10ml and UTI 300 000 U,twice per week.Evaluation of the efficacy and adverse reaction was performed after 4 times.Results The effective rate of single PA-MSHA group was 34.6 ％ (CR 1 case,PR 8 cases),while the effective rate of PA-MSHA combined with UTI group was 61.5 ％ (CR 2 cases,PR 14 cases).The effective rate of PA-MSHA combined with UTI group was statistically higher than that of single PA-MSHA group (P ＜ 0.05).8 cases got fever in single PA-MSHA group,3 cases in PA-MSHA combined with UTI group got fever,side effect had no statistical significance (P ＞ 0.05).Conclusion PA-MSHA combined with UTI has better effect in the treatment of patients with malignant pleural effusion and/or ascites compared with single PA-MSHA,and both treatments have low side effects.

Objective To determine the minimal local analgesic dose (MLAD) of hypobaric levobupivacaine in elderly patients undergoing spinal anesthesia during lower limb surgery. Methods A total of 25 patients underwent spinal anesthesia with hypobaric levobupivacaine during lower limb surgery. The initial dose of levobupivaeaine was 7.50 mg for the first patient. The dose for next patient was added by 0.25 mg if the level of sensory block was lower than that of T10, conversely the dose was subtracted by 0.25 mg. The MLAD of hypobaric levobupivacaine was calculated with up-and-down sequential experiment according to Dixon-Messay method. Results The MLAD of hypobaric levobupivacaine were 6.67 mg (95% confidence interval: 6.34-7.25). The anesthesia effects of all patients were good. The degree of motor blockade of the healthy leg was less than another leg.The intraoperative and postoperative complications rates associated with spinal anesthesia were low.Conclusions The MLAD of hypobaric levobupivacaine is 6.67 mg in elderly patients undergoing spinal anesthesia during unilateral lower limb surgery.

Objective To explore the management process and prevention and control during the high incidence of influenza in elderly patients in community hospitals. Methods To standardize the treatment and control of the elderly patients with high incidence of influenza by perfecting the rules and regulations, strengthening the discipline construction, the monitoring of the key crowd, the epidemiological investigation, the effective protection and isolation, and the drug treatment. Results Older patients under the flu could control the development and spread of the disease in a timely and effective way during the visit. No serious complications and cross-infections occurred, and the patient's quality of life and self-protection were improved. Conclusion The standardized management of disease diagnosis and treatment in a special period is of great significance for reducing the incidence of the disease and ensuring the physical and mental health of patients.

Objective To compare the blood transfusion effects in salvaged autotransfusion and allogeneic blood trans-fusion in the operation of the lower lumbar fractures under combined spinal-epidural anesthesia. Methods A total of 60 patients who accepted lumbar fractures operation under combined spinal-epidural anesthesia in our hospital from January 2012 to January 2014 were chosen as study objects. According to different blood transfusion ways, 60 patients were divided into the control group and the observation group, with 30 patients in each group. Patients in the control group accepted allogeneic blood transfusion, and patients in the observation group accepted salvaged autotransfusion. The blood transfusion effects and complications in the two groups were compared. Results The infection rate in the ob-servation group was 3.33%, and the infection rate in the control group was 20.00%. The infection rate in the observa-tion group was significantly lower than that in the observation group(P<0.05). In addition, the differences in the average amount of blood transfusion, blood recovery and hospitalization time were statistically significant (P<0.05). Conclu-sion Compared with allogeneic blood transfusion, salvaged autotransfusion has lower postoperative infection rate, shorter hospitalization time and blood recovery, and it is worth promoting salvaged autotransfusion for further applica-tion in lumbar fractures operation.

Objective To compare the dosimetric effects of micro-multileaf collimator (MLC)(2 mm leaf width) and conventional MLC (10 mm leaf width) on inverse intensity-modulated radiotherapy(IMRT) in intracranial stereotactic radiosurgery(SRS). Methods In view of the fact that the micro-MLC has a small open field,30 patients with intracranial tumor with a<10 cm diameter were enrolled in this study. Their inverse dynamic IMRT plans were established using conventional MLC (conventional group) and micro-MLC (micro group) with the same other conditions. The radiation doses to the target volume and the organs at risk (OAR) were compared between the two groups with t test. Results Compared with the conventional group, the micro group had a significantly better dose distribution in the target volume (P=0.019). However, there were no significant differences in D98,D95,D50,and D3between the two groups (P=0.774,0.650,0.170,0.080). The micro group had a 58.7% lower mean homogeneity index and a 20.1% higher mean conformity index than the conventional group (P=0.000). The micro group had significantly lower radiation doses to OAR than the conventional group (P=0.044). The mean Dmeanand Dmaxof the brain stem in the micro group were 10.0% and 8.2%,respectively,lower than those in the conventional group (P=0.768,0.753). The mean Dmeanand Dmax of the right eye and left eye in the micro group were 16.5%,19.3%,21.4%,and 13.4%,respectively,lower than those in the conventional group (P=0.572,0.775 and 0.734,0.630). The mean Dmaxof the left lens, right lens, left optic nerve, right optic nerve, and optic chiasm in the micro group were 50.4%, 24.1%, 38.5%, 27.8%, and 5.7%, respectively, lower than those in the conventional group (P=0.172,0.467, 0.521,0.740,0.899). The PRV100,PRV50,and PRV25of the normal tissue in the micro group were no more than those in the conventional group(P=0.839,0.832,0.972). Conclusions In inverse IMRT in intracranial SRS,micro-MLC is better than conventional MLC because it can improve CI of the target volume and reduce the radiation doses to OAR.

Objective: To compare the value of right ventricular (RV) free wall longitudinal strain (FWLS) by speckle tracking echocardiography (STE) and conventional parameters in evaluation of RV dysfunction in chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Sixty CTEPH patients were enrolled as group A and 45 pulmonary embolism (PE) patients with normal pulmonary pressure were enrolled as group B in this study. CTEPH patients were divided into 2 subgroups using the World Health Organization (WHO) function classification: patients with WHO Ⅰ-Ⅱ were designated as group A1 and those with WHO Ⅲ-Ⅳ were designated as group A2. Conventional RV functional parameters including tricuspid annular plane systolic excursion (TAPSE), tissue Doppler-derived tricuspid annular systolic velocity (S′), fractional area change (FAC), RV index of myocardial performance (RVIMP), and STE-derived RV FWLS were measured and compared. Clinical right heart failure (RHF) was defined as the presence of symptoms of heart failure and signs of systemic circulation congestion during hospitalization. Results: Compared to group B, group A patients had significant enlarged right heart dimension and impaired RV systolic function parameters (all P<0.001). The TAPSE, S′, FAC, and RV FWLS showed significant differences between CTEPH patients with mild (group A1) and severe symptoms (group A2) (all P<0.01), while RVIMP showed no significant difference (P=0.188). On receiver operating characteristic analysis, FWLS had the largest AUC to identify RHF (AUC=0.864, P<0.001), when the cutoff value was 15.05%, the sensitivity was 85.71%, and the specificity was 64.29%, respectively. On binary logistic regression analysis, only right atria area (OR=1.212, 95%CI=1.004-1.48, P=0.046) and RV FWLS (OR=0.662, 95%CI=0.470-0.933, P=0.018) were identified as independent predictor of RHF. Conclusions Compared with conventional parameters, RV FWLS showed advantages in identifying abnormal RV function in CTEPH patients.

Objective: To investigate the predictors of death after endovascular mechanical thrombectomy (EMT) in patients with acute vertebrobasilar occlusive stroke (VBOS). Methods: Patients with acute VBOS treated with EMT in Wuhan No. 1 Hospital were enrolled retrospectively. The demographic and clinical data were collected. According to whether the patients died at 90 d after procedure, they were divided into survival group and death group. The demographic and clinical data were compared between the two groups. Multivariate logistic regression analysis was used to determine the independent risk factors for death at 90 d after EMT. Results: A total of 47 patients were enrolled. The median age was 62 years, 34 were males (72.3%), the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16, 42 patients (89.4%) had recanalization (modified Thrombolysis in Cerebral Infarction[mTICI] 2b/3 grade), and 12 (25.5%) died within 90 d after procedure. Univariate analysis showed that the baseline NIHSS score (26 [21-28]vs. 12 [5-23]; Z=-3.165, P=0.002), percentage of neutrophil (81.61% ±11.82% vs. 72.20% ±12.09%; t=-2.137, P=0.033), neutrophil/lymphocyte ratio (10.54±7.17 vs. 4.98±3.57; t=-2.393, P=0.017), and incidence of sICH (25.0% vs. 2.9%; χ²=5.627, P=0.018) in the death group were significantly higher than those in the survival group, while the percentage of lymphocyte (12.00%±9.04% vs. 20.67%±10.39%; t=-2.429, P=0.015) was significantly lower than that of the survival group. Multivariate logistic regression analysis showed that high baseline NIHSS score (odds ratio [OR] 1.243, 95% confidence interval [CI] 1.046-1.318; P=0.038), high neutrophil/lymphocyte ratio (OR 1.278, 95% CI 1.002-1.630; P=0.049) and symptomatic intracranial hemorrhage (OR 5.088, 95% CI 1.065-38.718; P=0.046) were the independent predictors for death. Conclusion High baseline NIHSS score, high neutrophil/lymphocyte ratio and symptomatic intracranial hemorrhage are the independent predictors for death within 90 d after EMT in patients with acute VBOS.

Objective To study the gynecologic laparoscopic surgery sevoflurane inhalation anesthesia on hemodynamics. Methods All 87 cases of patients in our hospital from May 2012 to May 2014 in Department of Obstetrics and Gyne-cology with laparoscopic surgery, were randomly divided into the observation group and the control group, the obser-vation group treated with sevoflurane inhalation anesthesia for laparoscopic surgery (n=44), the control group using combined spinal and epidural anesthesia for laparoscopic surgery(n=43),hemodynamic changes during operation in two groups of patients were compared. Results The RR, SpO2, PETCO2 in the observation group were higher than those in the control group,the difference was statistically significant(P<0.05). T1 T0,the time of systolic blood pressure (SBP)and diastolic blood pressure (DBP)and heart rate did not change much after induction of anesthesia, and T2, T3 time point,the SBP,DBP,HR of control group were lower than those in the observation group, there was statistically sig-nificant difference between the two groups(P<0.05). Anesthesia was induced with T0,T1 time points,there was no sig-nificant difference in hormone levels in two groups of patients with NE,E,CORT,ATII in the blood(P>0.05);and T2 after induction of anesthesia, T3 time point, compared with the time point of T0, the difference was statistically signif icant(P<0.05). The observation group and the hormone levels were lower than the control group, the difference was statistically significant(P<0.05). Conclusion Laparoscopic surgery sevoflurane inhalation anesthesia, hemodynamics of patients with stable,safe and reliable means of anesthesia.

OBJECTIVETo evaluate the impact of macroscopic enlarged lymph node on the clinicopathological characteristics of stage II colorectal cancer, and to explore the potential mechanism.

METHODSClinicopathological data of 116 consecutive patients with stage II colorectal cancer, who underwent colorectal radical resection and were identified as stage II colorectal cancer without mesenteric metastasis by postoperative pathology, in our department between December 2001 and December 2002 were analyzed retrospectively. All the patients were examined by the surgeons with gross appearance to decide the enlarged lymph nodes as metastasis during operation. There were 43 patients with macroscopic enlarged lymph nodes and 73 without such lymph nodes. Survival rate was compared between the two groups. Impact of macroscopic enlarged lymph node on the prognosis of stage II colorectal cancer was analyzed. Structure of macroscopic enlarged lymph node was observed. CK expression in 107 macroscopic enlarged lymph nodes from 43 cases was examined by immunohistochemistry.

RESULTSThe 10-year disease-free survival (DFS) of the whole group was 83.5%. The 10-year DFS of patients with macroscopic enlarged lymph nodes was 75.9%, which was significantly lower than 89.3% (P=0.038) of patients without macroscopic enlarged lymph nodes. Univariate analysis showed that macroscopical enlarged lymph node (P=0.038), perioperative blood transfusion (P=0.004), number of retrieved lymph nodes (P=0.016), concomitant disease (P=0.003), and preoperative serum carcinoembryonic antigen (CEA) level (P=0.050) were related to the prognosis of all the 116 patients. Multivariate analysis showed that macroscopical enlarged lymph node (P=0.044), number of retrieved lymph nodes (P=0.021), and perioperative blood transfusion (P=0.032) were independent prognostic factors. Haematoxylin and eosin (HE) staining indicated that enlarged lymph nodes had hyperplasia reaction. Immunohistochemistry showed that among 107 enlarged lymph nodes, 1 had macrometastases, 1 micrometastasis, 4 isolated tumor cell (ITC), and the rest 101 had no positive CK expression.

CONCLUSIONMacroscopic enlarged lymph node indicates a poor prognosis in patients with stage II colorectal cancer.

Carcinoembryonic Antigen ; Colorectal Neoplasms ; Disease-Free Survival ; Humans ; Immunohistochemistry ; Lymph Nodes ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Micrometastasis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate