Objective:To discuss the influence of different ways of anesthesia for surgery of vocal cord under laryngomicrosurgery.Methods:Forty ASA Ⅰ～Ⅱ patients undergoing surgery of vocal cord were randomly divided into two groups:Group Ⅰ ( n =20) received topical anesthesia of larynopharynx with 2% lidocaine 2ml before general anesthesia.Group Ⅱ ( n =20) received general anesthesia with topical anesthesia. Anesthesia was induced with 2% propofol 1～2mg/kg and fentanyl 100?g followed by vocuronium 0.1 mg/kg.The small-diameter Fr 6.0 trachea tube was intubated nasally.The lungs were mechanically ventilated.Anesthesia depth was maintained with 2.0 MAC isoflurance and propofol infusion 1～2mg/kg or discontinuous fentanyl.Dexamethasone was given at end of the procedure.ECG,HR,BP,S PO 2,P ET CO 2,blood gas were monitored during intubation,extubation or the microlaryngoscopy.Results:Cardiovascular reactions in Group Ⅰ were significantly less than in Group Ⅱ during intubation,extubation or placed microlaryngoscopy,and no complications occured in two groups.Conclution:Compared with topical anesthesia general anesthesia is a better method for surgery of vocal cord under laryngomicrosurgery.It can significantly relieve of cardiovascular effect and complication.

Objective To investigate the effect of cigarette smoke exposure on the interleukin-17-producing CD4+T helper lymphocyte( Th17 ) in peripheral blood and lungs of cigarette smoke-induced emphysema mice. MethodsForty male BALB/c mice were randomly divided into 4 groups, including a control group C12, a control group C24, a smoke-exposure group S12 and a smoke-exposure group S24, 10 mice each group. Morphological changes were evaluated by mean linear intercepts (Lm) and destructive index (DI). The concentration of IL-17, IFN-γ and TNF-α in bronchoalveolar lavage fluid(BALF) and the concentration of IFN-γ and TNF-α in lung homogenates were measured by enzyme-linked immunosorbent assay (ELISA). The proportion of CD4+IL-17+ Th17 cells in peripheral blood and lungs of mice was determined by flow cytometry. The mRNA expressions of RORγt and IL-17 in peripheral blood and lungs were evaluated by real-time PCR. ResultsLm and DI were significantly higher in S12 and S24 groups [(39.19±3.51)μm vs (46.87±7.16) μm, 39.13±1.57 vs 45.16±3.13]than that in C12 and C24 groups [(32.60± 3.21 ) μm vs (32.38±3.73) μm, 28.23± 1.62 vs 28.86±2.07], all P＜0.05. IL-17, IFN-γand TNF-α in BALF of S12 and S24 groups [(119.72±10.72) ng/L vs (296.40±14.00) ng/L,(129.7±22.2) ng/L vs(251. 1±62.4) ng/L, (17.35±1.60) ng/L, (36.35±1.43) ng/L]were higher than those in C12 and C24 groups [(52.06±4.70) ng/L vs (51.89 ±6.82) ng/L, ( 85.8 ±26.8) ng/L vs ( 88.9 ± 11.5 ) ng/L,(6.41 ±0.90) ng/L vs (5.85±0.92) ng/L], IFN-γ and TNF-α in lungs of S12 and S24 groups [( 1124.3±174.4) ng/L vs (1342.7±206.1) ng/L, (77.2±13.7) ng/L vs (101.7±19.0) ng/L, (129.7±22.2)ng/L vs (251.1 ±62.4) ng/L]were higher than those in C12 and C24 groups[(946.2±81.9) ng/L vs (1027.2±188.3) ng/L, (62.1±16.1) ng/L vs(64.4±15. 1) ng/L], all P＜0.05. The percentage of Th17 cells in lungs of S12 and S24 groups [(3.27±1.12)％ vs (7.19±2.24)％, ( 1.96±0.61 )％ vs (3.82±1.26)％]was significantly increased as compared with that of C12 and C24 groups [(1.80± 0.75)％ vs (1.99±0.59)％], all P＜0.05. And the percentage of Th17 cells in peripheral blood of S12 and S24 groups [(1.96±0.61)％ vs ( 3.82± 1.26)％]was also significantly higher than those in C12 and C24 groups [(0.90±0.37)％ vs (0.97±0.32)％], all P＜0.05. In peripheral blood and lungs,the mRNA levels of RORγt and IL-17 in S12 and S24 groups were higher than in C12 and C24 groups, all P＜0.05.Moreover, the frequency of Th17 cells in peripheral blood and lungs had a positive correlation with Lm and DI( r=0.706-0.772 ,all P＜0.05 ). ConclusionAn up-regulation of proportions Th17 in peripheral blood and lungs of cigarette smoke-inducsed emphysema mice were detected. It may be involved in the amplified and persistent inflammation.

Objective: To treat low-grade limb malignant tumors with hemicortical excision and reconstruction of the defect with recycled pasteurized autogratf. Methods:From January 2005 to January 2011, 10 patients [age (27.0±6.5) years] suffering from low-grade limb malignant tumors were treated with hemicortical excision and reconstruction of the defect with recycled pasteurized autogratf:7 were histopathologically diagnosed as parosteal osteosarcoma, and 3 as peripheral chondrosarcoma. According to the Enneking staging system, 8 were in Stage IA and 2 were in IB. Results:All the patients were followed-up for (50±23) months. All the patients had bony union at the last follow-up. The length of tumor bone resection was (9.5±2.7) cm, operation time was (150±45) min, intraoperative blood loss was (1000±350) mL, and drainage volume was (450±200) mL. hTe only fracture in the host bone during the operation was treated by internal ifxation. Local recurrence occurred in 1 patient was treated by a wide operative margin and reconstruction with a prosthesis. There was no distal metastasis. A ccording to the Enneking system, 9 patients had excellent results and 1 had good results. Conclusion:Hemicortical excision for low-grade limb malignant tumors is safe and effective.

Objective:To evaluate the efficacy of femoral primary malignant bone tumors treated by limb salvage, with wide en bloc excision and reconstruction of the defect with recycled pasteurized autogratf.
Methods: From January 2008 to January 2011, 11 patients (7 males, 4 females), aged (11.0±2.5) years suffering from femoral primary malignant bone tumors were treated with en bloc excision and reconstruction of the defect with recycled pasteurized autograft. Ten patients were histopathologically diagnosed with high-grade osteosarcoma, and 1 with Ewing’s sarcoma.According to the Enneking staging system, all patients were in Stage IIb.
Results:All patients were followed-up for 24-65(42±20) months and all showed bony union at the last follow-up. hTe length of tumor bone resection was (17.5±3.2) cm, the operation time was (180±35) min, the intraoperative blood loss was (1200±250) mL, and drainage volume was (650±125) mL. Local skin necrosis occurred in 1 patient (9.1%), which was resolved by debridement. Nonunion occurred in 3 patients (27.3%), who were treated by secondary iliac crest cancellous bone gratfing.Pulmonary metastasis occurred in 1 patient (9.1%) who died 35 months post-operatively. According to the function assessment by the Enneking system, 5 patients had excellent results, 4 had good results, 1 fair and 1 poor results, with a satisfaction rate of 81.2%.
Conclusion:A pasteurized autograft can be an easily accessible and economical alternative for children’s malignant bone tumor of femurs.

Objective To explore advantages of simulation-based medical education for overseas students on training of anesthcsia emergency skills.Methods twenty eight oversea students accepting anesthesia practice course were divided into two groups,each group fourteen.The students of simulation group (group S) were lectured with simulation-based medical education method,while the students of control group (group C) were lectured with tradition education method.Results the practice examination record and satisfaction degree for teaching in group S were both higher than that in group C (P＜0.05).Conclusion The simulation-based medical education was better than tradition education method on training of anesthesia emergency skills for oversea students.The simulation-based medical education may raise the learning interest of oversea students obviously,and it is beneficial to students' mastery of practice skills.

Objective To evaluate the expression of Tc17 in a cigarette smoke-induced mice model of emphysema.To explore the probable mechanisms about how Tc17 cells to elevate in lungs of mice.Methods Forty male Balb/c mice were randomly divided into four groups,including control group ( 12 weeks,C12),control group (24 weeks,C24),smoke-exposure group (12 weeks,S12) and smoke-exposure group (24 weeks,S24 ),10 mice each group,Emphysema of mice was observed by HE pigmentation.Morphological changes were evaluated by mean linear intercepts (Lm) and destructive index (DI).The proportion of CD8+ IL-17 + Tc17,CD8+ IL-17 + CC chemokine receptor type 6 ( CCR6 ) + and 6CCR6 + Tc17 cells in lungs of mice was determined by flow cytometry.The mRNA expressions of retinoidrelated orphan nuclear receptor(RORγt) and IL-17 were evaluated by real-time PCR.The levels of IL-1 β,IL-6,IL-23,transforming growth factor β (TGFβ) and CC chemokine ligand 20 (CCL20) were tested by ELISA.Correlations among these indexes were analyzed.Results Lm and DI were significantly higher in S12 and S24 than in C12 and C24,S24 in particular (t value 4.378-15.188,all P ＜ 0.05).The percentages of Tc17 in S12 and S24[(9.28 ± 1.12)%,( 13.13 ±3.56)%]was significantly increased as compared with that in C12 and C24[(2.40 ±0.60 )%,(2.64 ±0.96 )%],S24 in particular.The mRNA levels of RORγt and IL-17 in S12 and S24 were higher than in C12 and C24,S12 and S24 in particular.There was significant difference (all P ＜0.05 ).The frequency of Tc17 cells had a positive correlation with Lm and DI ( r value were 0.734 and 0.884 respectively,P ＜ 0.01 ).The percentages of CD8+ IL-17 + CCR6 +T cells and CCR6 + Tc17 were significantly elevated in S12 and S24 compared to C12 and C24,S24 in particular (all P ＜ 0.05 ).There was positive correlation between Tc17 cell ratio and CCL20 levels( r =0.899,P ＜0.01 ).The levels of IL-1 β,IL-6,IL-23 and TGFβ in S12 and S24 were significantly increased as compared with that in C12 and C24.There was significant difference (all P ＜0.05).Meanwhile,the frequency of Tc17 cells had a positive correlation with IL-1β,IL-6,IL-23,and TGFβ.Conclusions An up-regulation of proportions Tc17 in lungs of cigarette smoke-induced emphysema mice were detected.The CCR6/CCL20 axis and the increased IL-1β,IL-6,IL-23 and TGFβ probably contributed to this up-regulation.

Objective To investigate the clinical efficacy of a new minimal incision suture technique in repair of acute close rupture of Achilles tendon.Methods From August 2008 through October 2014,134 patients with acute close rupture of Achilles tendon were treated with a self-designed minimally invasive suture technique at our institution.They were 130 men and 4 women,with an average age of 37.4 years (range,from 18 to 52 years).The left side was injured in 93 patients and the right side in 41.The interval from injury to surgery was 1 to 7 days (average,2.5 days).The tendon rupture was located at 4.5 to 6.3 cm proximal to its insertion in 133 patients,and at 1.2 cm in one.With the ankle held in full plantar flexion,a 1.0 to 1.5 cm transverse incision was made over the palpable defect.Forceps were then used to mobilize the tendon from beneath the paratenon.The safe puncture site was determined by course and distribution of the sural nerve indirectly located by magnetic resonance imaging (MRI).Ethicon MB66 nonabsorbable suture was passed diagonally through the tendon bulk under epidural puncture needle guidance.The proximal and distal ends of the suture were tied together and buried.The tendon ends were apposed through the transverse incision.Postoperative individual rehabilitation was established based on pathological differentiation for tendon tissue.Results All the patients were followed up for 8 to 48 months (average,19.6 months).All the wounds healed at the first stage.No complications happened related to incision.The nervus suralis was injured in 3 patients;tendon re-rupture occurred in 4 patients,3 of whom received re-operation and one of whom conservative treatment.Their American Orthopaedic Foot and Ankle Society (AOFAS) scores averaged 99.6,giving a good to excellent rate of 100％ (133excellentcasesandonegoodcase).According to the Arner-Lindholm evaluation criteria,ankle function was excellent in 99 cases,good in 34 ones and poor in one,giving a good to excellent rate of 99.3％.Conclusion The new minimal incision suture technique is worthy of promotion in repair of ruptured Achilles tendon,because it is simple and reliable,does not interfere with the blood circulation to the Achilles tendon,prevents such complications as sural nerve injury and recurrent rupture,and leads to little adhesion and quick functional recovery.

Objective To understand the general self-efficacy level of patients with tuberculosis(TB patients) and its influencing factors, provide evidence for improving the general self-efficacy of TB patients.Methods All TB inpatients in a comprehensive pulmonary hospital were conducted face-to-face survey through a general questionnaire and general self-efficacy scale, self-efficacy level of TB patients and its influencing factors were analyzed.Results Mean scale of general self-efficacy of 402 TB patients was (20.4±4.2), of which only 14 cases(3.5%)showed a high level self-efficacy.163(40.5%), 225(56.0%), and 14(3.5%)patients were with low(10~),medium(20~), and high(30~) self-efficacy scale.The general self-efficacy level of TB patients was influenced by the course of disease(P<0.001), residence(P=0.012), whether or not attended the lecture on tuberculosis education(P=0.034), whether or not conducted physical exercise(P=0.053,stepwise multiple linear regression analysis: P=0.017), working status(P=0.027), No.of hospitalization due to TB(P=0.002), family economic situation(P=0.027), and education level(P=0.020).Conclusion TB patients' self-efficacy level is low, and the general self-efficacy level and its influencing factors should be assessed by health care workers during the follow-up for patients, individualized nursing intervention for improving the TB patients' self-efficacy level should be developed.

Objective To investigate the effects of desflurane on postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery.Methods Patients who underwent gynecological laparoscopic surgery in the hospital from Dec.2016 to Nov.2017 were selected and divided into two groups,64 cases in the observation group and 68 cases in the control group.The observation group were treated by desflurane,and the control group were treated by desflurane combined with propofol.General information and intraoperative information of patients were collected.The time of eye opening,extubation,staying in postanesthesia care unit (PACU),postoperative stay were recorded.The incidence and severity of nausea and vomiting from 0 to 6 hours and 6 to 24 hours after surgery were also recorded.Results There was no significant difference in general information between the two groups such as anesthesia time,fluid input and total amount of opioids in operation (P＞ 0.05).The incidence and severity of PONV after surgery from 0 to 6 hours and 6 to 24 hours was similar (P＞ 0.05).The eye opening time,extubation time,staying time in PACU was meaningfully lower in observation group compared with control group(P＜0.05),but the duration of hospitalization after surgery was insignificant(P＞0.05).Conclusion Anesthesia with desflurane doesn't lead to more often or more severe nausea or vomiting,while it help patients wake up faster,which is worthy of clinical promotion.