Objective To compare cardiovascular responses of intubations by Discopo and Macintosh laryngoscope in elderly patients with hypertension. Methods Sixty elderly hypertensive patients with ASAⅡ~Ⅲundergoing elective surgery were equally randomized into two groups. After induction of general anesthesia , orotracheal intubation was performed with Discopo or Macintosh. The Mean arterial pressure (MBP) and heart rate (HR), as while as Electrocardiogram (ECG) and Blood oxygen saturation (SpO2), were recorded before (baseline values) and at 1,3,5 minutes after intubation(post-induction values). The rate of one-time successive intubation,intubation time and complication were also recorded. Results Compared with the macintosh group, the rate of one-time successive intubation was higher and the intubation time was shorter in the Discopo group (P< 0.05, respectively),with no complications. Compared with T0,MBP and HR at T2 in the two groups and T3 in the Macintosh group increased significantly (P < 0.05). Compared with the Macintosh group,MBP and HR at T2,T3 of the Discopo group decreased significantly (P < 0.05). Conclusion Little effect of tracheal intubation with Discopo on cardiovascular response was observed in elderly hypertensive patients.

Objective To explore the clinical value of total laparoscopic hysterectomy(TLH).Methods Retrospective analysis was conducted on clinical data of 38 cases of TLH(Laparoscopic Group)and 40 cases of total abdominal hysterectomy(Open Group)from November 2005 to October 2006 in our hospital,to compare operative time,intraoperative blood loss,the incidence of postoperative pyrexia,recovery time of bowel movement,and hospital stay in both groups.Results The operative time in the Laparoscopic Group(85.8?13.8)min was significantly shorter than that in the Open Group(99.3?9.3)min(t=-5.923,P=0.000).The blood loss was significantly less in the Laparoscopic Group(105.8?32.4)ml than that in the Open Group(166.0?67.4)ml(t=-4.930,P=0.000).The incidence of postoperative pyrexia was distinctively lower in the Laparoscopic Group(3 cases)than that in the Open Group(15 cases)(?2=9.270,P=0.002).The time to first flatus was significantly shorter in the Laparoscopic Group(26.2?4.2)h than that in the Open Group(40.5?4.9)h(t=-13.601,P=0.000).The postoperative hospital stay in the Laparoscopic Group(6.8?0.9)d was distinctively shorter than that in the Open Group(10.6?0.8)d(t=-19.612,P=0.000).Follow-up examination for six months showed that two cases of poor healing of incision and two cases of vaginal residual granulation in the Open Group and one case of vaginal residual granulation in Laparoscopic Group,and no other complications were found.Conclusions TLH gets the advantage over total abdominal hysterectomy.If surgeons are familiar with the laparoscopic operative skills,TLH can be an ideal procedure for hysterectomy.

Objective To analyze the clinical features, diagnosis and treatment of the primary omental torsion (POT).Method The clinical data of 12 patients with POT admitted to our hospital from May 2010 to May 2015 were retrospectively reviewed.The clinical manifestations, laboratory investigation, medical image, treatment and outcomes of patients were analyzed.Results Twelve cases were all males with median age of 50.The POT was diagnosed during surgical exploration and confirmed pathologically after operation.Right abdominal pain was the main complaint in 11 cases, and pain migration to right lower quadrant in 1 case.In physical examination, the local peritonitis signs were elicited, including right quadrant tenderness and rebound tenderness at same location.All cases had mal temperature except one presenting low fever of 37.5 ℃.White blood cell counts was 12×109/L in one case, and(4-10)109/L in other 11 cases.Abdominal solid mass was found in one case by ultrasonic scan, measured 7 cm×5 cm with unclear surrounding boundary.Mesenteric fat opacity and dropsy were shown in 10 cases on CT plain scan, while thickness and effusion of hepatic flexure of colon was found in one case;however, none of them were suggested as POT by these two image study before operation.All patients were gnosed as localized peritonitis or appendicitis clinically before emergent surgical exploration.The necrotic omentum was resected and all patients recovered smoothly.There were no complications in all cases during one-year follow-up.The CT images were reviewed after operation, which indicated that the mesentery of dropsy and the thickened hepatic flexure of colon should be the imaging signs of omental torsion;and also 9 of 12 cases had whirlpools sign.Conclusion The preoperative diagnosis of POT is difficulty, the typical whirlpools sign of abdominal mass on CT imaging is of highly value in diagnosis.The surgical removal of omental infarction is effective and the prognosis is good.

Objective To investigate the clinical efficacy of the self-retaining laryngeal microsurgical operation in the treatment of Reinke ’ s edema of vocal cords . Methods There were 24 cases of Reinke ’ s edema who were treated with self-retaining laryngoscope mucosal stripping surgery of vocal cords from January 2004 to December 2009 ( traditional group ) , while another group of 32 cases of Reinke ’ s edema were treated with self-retaining laryngoscopic microsurgery lateral submucosal incision micro-flap operation of vocal cords from January 2010 to December 2015 ( laryngeal microsurgery group ) .The two groups were executed with electronic laryngoscopy and subjective voice evaluation GRBAS ( The Speech and Language Institute of Japanese in 1979, G: Grade, R:Roughness, B:Breathness, A:Asthenia, S:Strain) in pre-operation and post-operation (1 week, 3 weeks, 8 weeks).The wound healing time of vocal cords , hoarseness improved time and voice improvement were retrospectively compared between the two groups . Results The patients in laryngeal microsurgery group had earlier voice hoarse improvement and more rapid mucosal epithelial of vocal cords recovery time in post-operation as compared with the patients in the traditional group [voice improving time, (7.3 ±1.9) d vs. (11.3 ±2.7) d, t=-6.481, P=0.000;mucosal epithelial of vocal cords recovery time , (12.2 ±3.1) d vs.(20.1 ±3.4) d, t=-9.062, P=0.000].The results of pre-operative voice evaluation with GRBAS showed no significant differences between the two groups, but the results of post-operative evaluation of each session (1 week, 3 weeks, 8 weeks) showed that the main data were statistically different.The GRBAS score of laryngeal microsurgery group was lower than that of traditional group in post -operation, especially after 8 weeks (8 weeks after post-operation, G:1.0 ±0.8 vs.1.6 ±0.2, t=-3.584, P=0.000; R:1.0 ±0.9 vs. 1.5 ±0.4, t=-2.536, P=0.014;B:1.0 ±0.6 vs.1.4 ±0.5, t=-2.647, P=0.011).In laryngeal microsurgery group, 24 cases were cured , 5 cases were effective and 3 cases were invalid , contrasting in the traditional group with 11 cases of cured , 7 cases of effective and 6 cases of invalid respectively, with a significant difference (Z=-2.239, P=0.025).No significant difference in effective rate between the two groups [90.6%(29/32) vs.75.0%(18/24),χ2 =1.459, P=0.227]. Conclusion The clinical efficacy of self-retaining laryngoscope microsurgery in the treatment of Reinke ’ s edema of vocal cords is faster and better comparing traditional operation , with a more significant pronunciation quality improvement .

Objective We used the DNA methylation microarrays to investigate the differential methylation genes and loci sites in Kashin-Beck disease (KBD),to study the relationship between DNA methylation and KBD pathogenesis.Methods Totally 12 KBD adults and 12 healthy adults were selected and peripheral blood samples were collected and DNA was extracted.Illumina 450K bead-chip was applied to detect methylation status in KBD and healthy controls.Aberrant hyper-methylated sites were filtrated according to the P value after correction and methylation differences,together with GenomeStudio soft.Screened genes were validated using bisulfite sequencing polymerase chain reaction (BSP) technology.Results A total of 484 948 loci sites were analyzed and compared,93 differential methylated loci were found by comparing KBD and normal people,including 34 hypermethylated sites and 59 hypomethylated sites.There were 50 genes corresponding to the loci,43 genes not reported in literature.According to gene ontology analysis,the genes were involved in the immune response,antigen processing,phosphate and phosphoric acid metabolism and phosphorylation and the process of metal ions in combination.However,in the verification test using BSP method,there was no significant difference in methylation rate in human leukocyte antigen (HLA)-DRB1 between the case and the control group (48％ vs 70％,x2 =3.688,P ＞ 0.05).Conclusions The high and low differentially methylated sites in peripheral blood DNA of KBD patients are significantly different from those of the health control.HLA-DRB1 locus is not significantly different between the BSP verification test and methylation chip.

Objective QR-DVT 9000 NEWTOM CT, an oral maxillofacial dedicated CT, was applied in the diagnosis of maxillary sinus related diseases. Its value and technique are summarized. Method Patients with maxillary sinus related diseases were scanned and images were reconstructed with QR-DVT 9000 CT. The axial view of reconstructed image was analyzed in sagittal plane, coronal plane and 3-D. Results QR-DVT 9000 NEWTOM CT could display the position, shape and anatomic relationship of maxillary sinus with adjacent structures in sagittal image, coronal image and 3-D image. Conclusion QR-DVT 9000 NEWTOM CT, an oral maxillofacial dedicated CT, is considerably valuable in the diagnosis of maxillary sinus related diseases, and it can guide clinical surgery more effectively than routine X ray examination.

The blood pressure changes is very common in patients with acute ischaemic stroke.However,the optimal management of the blood pressure in acute ischaemic stroke remains unclear.There is a very important clinical significance on how to manage hypertension in acute ischaemic stroke.The review summarizes recent guidelines on blood pressure management after acute ischaemic stroke.The aim of the review is to expound the treated principle of hypertension in acute ischaemic stroke.

Objective To study the clinical effect of sevoflurane combined with remifentanil in laparoscopic cholecystectomy (LC).Methods50 cases of laparoscopic cholecystectomy in Tianjin Haihe Hospital from February 2015 to September 2016 were selected as the research object, and randomly divided into the control group and the experimental group, each group had a total of 25 cases.The patients in control group were treated with continuous intravenous infusion of propofol.The experimental group received sevoflurane.Patients in the experimental group and the control group were given remifentanil after surgery.Compared with the experimental group and control group of patients with the degree of recovery and related Linchuan indicators.ResultsAfter the corresponding anesthesia, the control group of patients with recovery time was (13.4±3.1) minutes, the score was (4.1±1.2) points, extubation time was (14.6±3.7) minutes.However, the extubation time and recovery time of the control group were significantly longer than those of the experimental group, and the recovery score was lower than that of the experimental group, with statistical difference (P<0.05).There was no obvious adverse reaction in the experimental group and the control group, and there was no significant difference in the changes of cardiovascular factors.ConclusionSevoflurane combined with remifentanil for laparoscopic cholecystectomy can improve the anesthetic effect to a great extent, stable operation and postoperative patients with cardiovascular function, recovery time is short, the clinical significance of only one step promotion and application.

Objective Construct the finite element model of vertebral pedicle screw fixation in thoracolumbar fractures can obtain the intuitive systematic mechanical effects under different motion conditions, it has a very important significance to the patients' rehabilitation, evaluation of system stability and prognosis.In this study, the biomechanical effects of different motion states of thoracic and lumbar spine fracture models were analyzed by the finite element analysis method.Methods We selected 1 orthopedic health volunteers from Nanjing General Hospital of Nanjing Military Region in June 2014, established the finite element model by the CT scan data of the healthy volunteer, used the geometric cutting method for fracture simulation and replacement, assembled posterior orthopedic internal fixation system of vertebral pedicle screw, simulated the different motion states and obtained the stress nephogram and displacement graph of the nail-stick system..Results For the six-nail and two-rod internal fixation system of posterior nail-stick system which set nails through injured vertebrae, we used the finite element operation method to simulate the biomechanical characteristics of different modes of motion in space, it combined by the movement of six directions(flexion, dorsiflexion, left side bend, right side bend, left twist, right twist).The maximum stress(94.99±1.72MPa) and the maximum displacement(0.1854±0.0052mm) and the of the dorsiflexion were significantly lower than that of flexion[(126.82±5.56)MPa、(0.2502±0.0050)mm]、left side bend[(152.18±9.13)Mpa、(0.3172±0.0048)mm]、right side bend[(159.58±13.54)Mpa、(0.3315±0.0051)mm](P<0.05).Conclusion The method of finite element analysis can obtain clear and intuitive biomechanical data, which provides effective evidence for the evaluation of surgical efficacy, the development of postoperative rehabilitation methods and the evaluation of the stability of thoracolumbar spinal system.

Objective:To analyze risk factors that were associated with loss of correction curvature after short-segment restoration and fixation in cases who had single-segment thoracolumbar fracture.Methods:87 Cases who had experienced single-segment thoracolumbar fracture and had underwent short-segment restoration and fixation in our department from Jan 2008 to Jan 2011,and had complete follow-up imaging were included.Cobb angles were measured on lateral thoracolumbar X-ray preoperatively,postoperatively and before removal of internal fixation.And these included the angle formed by vertebras that located above and below injured vertebrae (α angle),superior endplate of injured vertebrae and its superior vertebrae (β angle),inferior endplate of injured vertebrae and its inferior vertebrae (γ angle),inferior and superior endplate of injured vertebrae (δ angle).T-test was used to analyze these angles and their changes.And correlation analysis was used to analyze relationships between α angle change and other risk factors.Results:When compared with preoperative angles,the mean α angle,β angle,γ angle and δ angle were all significantly increased (p＜0.05) after the operation.The mean α angle and δ angle before the removal of internal fixation were both significantly smaller than those after the operation (p＜0.05),and the mean change ofα angle was-2.85 degrees.After the correlation analysis,we found significant correlations between the change ofα angle and postoperative correction curvature(-0.342,p=0.026),injured region in endplate(0.374,p=0.015),and change of the δ angle(0.231,p=0.041).Conclusion:There was significant loss in the correction curvature before the removal of internal fixation.And the loss was significantly associated with postoperative correction curvature,injured region in endplate,and change of the δ angle.