Objective To observe the effects of general anesthesia and combined spinal epidural anesthesia in elderly patients with lower limb fracture surgery, and to evaluate the effect of postoperative cognitive function and pain score.Methods Retrospective analysis, screening of intraoperative anesthesia, postoperative change lost invalid cases, from November 2012 to October 2015 in our hospital accepted surgical treatment of 180 patients with lower limb fracture surgery were selected according to different patients with different anesthesia methods can be divided into treatment group and control group, 90 cases each group of patients.Patients in the treatment group were treated with combined spinal epidural anesthesia , while the control group received general anesthesia.The incidence of cognitive dysfunction and postoperative pain scores were compared between the two groups. Results the incidence of cognitive dysfunction after surgery in 90 cases of observation group was lower than that of the control group , and the difference was statistically significant (P<0.05).The evaluation of two groups of postoperative chronic pain for 3 days, 6 days, 10 days, 15 days, the incidence rate of VAS score and the character, whether the impact on the daily life and the rest, the patients in the treatment group pain scores were significantly lower than the control group, the difference was significant (P <0.05).Conclusion After lumbar epidural anesthesia in elderly lower limb fracture surgery effect on cognitive function in patients with small, and can reduce the pain of patients, in the actual work according to the actual situation of different specific problems in different specific analysis.

Objective To investigate the effect of necrostatin-1 (Nec-1) on the expression of liver monocyte chemotactic protein-1 (MCP-1) in septic rats and its mechanism. Methods Forty-eight male Sprague-Dawley (SD) rats were randomly divided into sham group, model group, and Nec-1 group by randomized digital number method, with 16 rats in each group. The model of sepsis was reproduced by cecal ligation and puncture (CLP). Rats in sham group received anesthesia, and flipping the cecum followed by closure of the abdomen without ligation of the cecum. Rats in Nec-1 group were given 1 mg/kg Nec-1 [25 mg Nec-1 solution dissolved in 2.5 mL of dimethyl sulfoxide (DMSO)] through caudal vein 30 minutes before operation, while the rats in model group were given 0.1 mL/kg of DMSO only. Blood from abdominal aorta and liver tissue in each group were collected at 0 hour and 8 hours after operation. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined with automatic biochemistry analyzer. The pathological changes in liver were observed under light microscope using hematoxylin-eosin (HE) staining. The serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were determined by enzyme linked immunosorbent assay (ELISA). The MCP-1 mRNA expression in the liver was determined by reverse transcription-polymerase chain reaction (RT-PCR). Results There was no significant differences in the levels of serum ALT, AST, TNF-α, IL-6 and expressions of liver MCP-1 mRNA at 0 hour among three groups, and the liver cellular structure was normal. At 8 hours, compared with sham group, the expressions of serum ALT, AST, TNF-α, IL-6 and liver MCP-1 mRNA were significantly increased in model group and Nec-1 group [ALT (U/L): 172.35±21.88, 129.67±18.20 vs. 60.04±11.74, AST (U/L): 511.03±34.92, 363.51±25.25 vs. 254.83±31.04, TNF-α(ng/L): 603.96±24.18, 483.87±26.60 vs. 265.74±15.14, IL-6 (ng/L): 975.62±65.37, 712.09±45.47 vs. 310.42±13.88, MCP-1 mRNA (2-ΔΔCt): 7.09±0.18, 5.51±0.45 vs. 0.99±0.06, all P < 0.05]. Levels of the above parameters in Nec-1 group at 8 hours were significantly decreased compared with those of model group (all P < 0.05). Under light microscopy, it was noted that the structure of hepatic lobules was destroyed, with exacerbation of immunocyte infiltration at 8 hours in model group. At 8 hours, it was found that Nec-1 alleviated the pathological damage in Nec-1 group. Conclusion Nec-1 can protect the liver of rats with sepsis, lower the expression of serum TNF-α and serum IL-6 and liver MCP-1 mRNA, and obviously reduce the damage of inflammation.

Objective To study community morbidity of gastroesophageal reflux cough (GERC),and then establish its procedure of diagnosis. Methods For the patients with chronic cough, on the basis of inquiring medical history and physical examination, chest radiograph, induced sputum, pulmonary ventilation function and airway hyperresponsiveness, blood eosinophilic, IgE,allergens skin test, nose, throat examination,sinus X-ray or pharyngoscope etc was managed. On the basis of the results,patients suspecting GERC was screened out, and then RDQ was performed, extra-esophageal symptoms related performance was inquired and scores were recorded. The patients with scores ≥ 12 were diagnosed as GERC; the patients with scores ＜ 12 were performed diagnosing treatment with proton pump inhibitor (PPI),and patients with positive results were diagnosed as GERC. The materials was analyzed statistically. Results The patients with chronic cough were 430 cases,and the community morbidity of GERC was 22.79%(98/430). RDQ ≥12 scores was 68.37%(67/98),and RDQ ＜ 12 scores was 31.63%(31/98).There was significant difference in extra-esophagus manifestation (P ＜0.01);26 cases with RDQ ＜12 scores were diagnosed as GERC (83.87%),and the rate of GERC in chronic cough was 21.63% (93/430). Conclusions RDQ is a favourable screening test in diagnosing GERC. PPI diagnosing treatment has high sensibility in GERC. It is necessary to establish community diagnosis procedure.

Objective To evaluate the clinical characteristics, diagnosis and treatment procedures for adrenal pheochromocytoma and adrenal ganglioneucoma.Methods Thirty-two cases of adrenal pheochromocytoma and 14 cases of adrenal ganglioneucoma surgical treated between 1999—2005 were analysed, The average of ganglioneucoma was 39 years old (16～63). tumor size ranged from 2.5 cm to 15 cm. The mean age of pheochromocytoma was 42 years old (19～74), tumor size ranged from 2cm to 16 cm. Tumor located in the adrenal area. All cases accepted surgical operation and were confirmed by pathology. Results Most cases of adrenal ganglioneucoma did not have any symptom but were founded incidentally. Differentials were obviously between ganglioneucoma and pheochromocytoma. Conclusion Both adrenal ganglioneucoma and pheochromocytoma are rare diseases.CT、urinary CA and 131I-MIBG are good methods for diagnosis.The final diagnosis depends on the pathology, surgical resection of tumor is a preferred choice.

Objective To study the stability of micro-implant orthodontic anchorage(MA)with different pitch in the case of immediate loading.Method Employing 3D finite element analysis method,the stress and dis-placement distribution on the bone interface of MIA with different pitch(0.3 mm、0.5 mm、0.7 mm and 1.0 mm,respectively),which was 1.47 N loaded vertically in the major axis direction,were analyzed.Result The pitch affected the stress distribution significantly,because the maximum stress increased with the pitch decreasing and the impact of pitch on stress distribution on neck and central locations of MIA were different;to decrease the pitch could reduce the max displacement of the jaw,but the impact of pitch on displacement distribution of MIA was not significant.Condusions In the case of immediate loading.MIA with pitch 0.5 mm-0.7 mm is suggested to be selected as orthodontic anchorage in the clinic.

Objective To assess the relationship between eosinophil count and intracranial aneurysm (IA).Methods For the retrospective study,we collected data of the count of eosinophils obtained from the peripheral blood samples and other clinical data of 79 patients with IA admitted to our hospital between January 2014 and December 2015 and 65 healthy people as control group.Risk factors for IA were analyzed by multivariate Logistics regression analysis.Results Clinical characteristics were comparable between the two groups (P＞0.05).Compared with those in the control group,eosinophil and platelet counts in IA group were significantly higher [(0.18±0.12)109/L vs.(0.12±0.09)109/L;(196.44±57.33)109/L vs.(178.80±47.23)109/L,respectively;all P＜0.05],while platelet distribution width (PDW) and mean platelet volume (MPV) were lower [(13.95 ± 3.332)fL vs.(15.30±3.5)fL;(11.02±1.73)fL vs.(11.66±1.31)fL,respectively;all P＜0.05].Logistic regression analysis indicated that eosinophil was the independent risk factor for IA.Corclusion Our study demonstrated that increased eosinophil count is the independent risk factor for IA.

Objective To investigate the safety and clinical significance in presurgical application of tyrosine kinase inhibitor (TKI) targeted therapy in high-risk renal-cell-carcinoma patients.Methods TKI targeted therapy was applied to 33 high-risk renal-cell-carcinoma patients from Jun.2010 to Dec.2013,7 cases with paraneoplastic symdromes and 1 with bilateral lesions received surgical treatments.There were 6 males and 2 females in this group with average age of 50 (42-56) years.They were high-risk patients because of renal tumor and vena caval tumor thrombus in 3 cases,renal tumor and vena caval tumor thrombus and hypercalcinemia in 1 case,renal tumors with metastasis to lung and lymph nodes in 2 cases,renal tumor with metastasis to lung and bones in 1 cases,and bilateral kidney cancer in 1 case.The clinical stages included 3 cases of T3aN1M1 and T3bN0M0 respectively,and 1 case of T3bN0M1 and T3aN0M0,respectively.The primary metastasis sites were lymph nodes and lung (3 cases respectively),and another 1 in bone.4 cases suffered from vena cava tumor thrombi with 3 staged Mayo Ⅲ and 1 Mayo Ⅳ.7 cases with paraneoplastic syndromes were contra-indicated for surgery due to poor ECOG performance score (with score 3 in 3 cases and 2 in 4 cases).4 cases received Sorafinib 400mg po bid and the other 4 Sunitinib 50 mg po qd,4 weeks on and 2 weeks off,with duration of 8-12 weeks.Medical therapy ceased 6 to 16 days (median 12 days) before operation.Results Patients with neoadjuvant therapy experienced good toleration.The 7 cases with poor ECOGs improved during medical therapy.The tumor sizes in the bilateral lesions shrunk remarkably.All 7 patients received surgery:3 radical nephrectomies,4 nephrectomies and resections of Vena Caval tumor thrombus,and 1 bilateral lesions underwent nephron sparing surgery.Operations were successful though with mild to moderate adhesion,and the blood loss ranged from 120 to 500 ml,with averaged of 280 ml.Pathologic results were clear-cell renal carcinomas.All incisions were well-healed.4 patients with metastasis continued TKI therapy.All patients were alive without recurrence during the follow-up of 4 to 42 mon.Conclusions Presurgical application of targeted therapy is safe and may increase the opportunity of surgery for some patients with poor general situation,also patients with bilateral lesions may benefit from it for its possibility of nephron sparing.

Objective To investigate the therapeutic effect of the meso-cavo-atrial shunt (MCAS) in the treatment of combined Budd-Chiari syndrome (BCS). Methods The clinical data of 17 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC) were admitted to the Qilu Hospital from February 2000 to May 2004. All patients were treated by MCAS with artificial blood vessels. The pre- and postoperative clinical symptoms, the IVC and portal venous (PV) pressures, the incidence of postoperative complications and the patency rate of the artificial vessels were analyzed. The survival of patients was analyzed using the Kaplan-Meier analysis, and the data were analyzed using the chi-square test and t test. Results No patient died during the perioperative period, and the symptoms of 15 patients disappeared or were relieved after operation, with a significant difference compared with those before operation (χ2 =9.78, P <0. 05 ). Three patients had complications after the operation. The postoperative PV and IVC pressures were decreased by 1.2 cm H2O (1 cm H2O =0.098 kPa) and 18.5 cm H2O, respectively. There were significant differences in the decrease of IVC and PV pressures ( t = 2.38, 3.06, P < 0.05 ). The 1-, 3-, 5-year survival rates were 16/17, 15/17 and 14/17, respectively, and the 5-year patency rate of the artificial vessels was 14/17.Conclusions MCAS can simultaneously relieve IVC and PV hypertension for patients with combined BCS. The postoperative complication rate was decreased, the 5-year survival rate and the patency rate of the artificial vessels were improved after the treatment, so MCAS is an optional surgical method for treating combined BCS.

Objective To investigate the morbidity,clinical manifestations,and imageology characteristics,and the influencing factors of severe cyclosporine A(CsA)-related neurotoxicity(SNCT)in the patients after allogenic hematopoietic stem cell transplantation(allo-HSCT).Methods Finding of SNCT was carried out in 164 allo-HSCT recipients from January 2003 to June 2006.Clinical characteristics were analysed,including precursory symptoms and clinical manifestations.Associations between the onset of SNCT with blood CsA levels,age,transplant types,human leucocyte antigen(HIJA)matching,conditioning regimens,antihuman thymocyte globulin(ATG)used in the prevention and treatment for graft-versus-host disease(GVHD)and intravenous corticosteroid used for acute GVHD were analyzed.Statistical analysis was performed with Binary Logistic Regression using SPSS/PC version 11.0.Results Thirteen patients(7.93%)were identified to have SNCT,including seizures(n=8,4.88%),paralysis(n=6,3.66%),coma(n:2,1.22%),cerebllar ataxia(n=3,1.83%)and chondrioid encephalomyopathy (n=1,0.61%).All the patients had precursory symptoms prior SNCT including headache(n=8),agitation(n=4)and hypertension(n=6).Magnetic resonance imaging(MRI)performed in twelve patients after SNCT showed that eleven patients had signal abnormalities in cerebral cortex and cerebral white matter.Six patients examined with computerized tomography(CT)had no abnormal findings.After extenuation or withdrawal of CsA.ten patients had complete recovery.two had partial recovery and one died of SNCT.Simple effect analysis of Binary Logistic Regression showed that the associations between the onset of SNCT with blood CsA levels.transplanta types.HLA matching.ATG used in the prevention and treatment for GVHD and intravenous corticosteroid used for acute GVHD were of statistical significance.The multiple effect analysis of Binary Logistic Regression showed that the associations of the onset of SNCT with blood CsA levels and ATG used had statistical significance and the odds ratio(OR)was 1.007(P=0.006) and 6.727(P=0.030),respectively.Conclusions 91.67%of the allo-HSCT recipients with SNCT have MRI abnormalities.High blood CsA levels and the use of ATG Call elevate the risk of the occurrence of SNCT.

Objective To evaluate the method, clinical efficacy and safety of one phase treat-ment of renal calculi associated with pyonephrosis by percutaneous nephrolithotripsy(PCNL) by pneu-matic combined with ultrasonic lithotriptor. Methods Sixty-six cases of renal calculi accompanied with pyonephrosis were treated with PCNL. The renal calyx was punctured under ultrasound gui-dance, then the tract was dilated from F8 to F16 by peel-away vascular access sheathes. After the in-sertion of the flexible sheath, metallic dilator was inserted and the flexible sheath was pulled out. The tract was dilated by metallic sheath to F21 and the operation sheath and nephroseope were placed into working tract. EMS III LithoClast Master was used. Ultrasonic powered lithotriptor probe with suc-tion was used to clear the liquor puris and calculus fragments with low-pressure or no-pressure. The combined pneumatic and ultrasonic powered lithotriptor was used to break and clear the calculi. Re-salts Of the 66 cases, there was no bacteremia or pyaemia intraoperatively and postoperatively. And there was no other severe complication occurred intraoperatively. One phase PCNL was successfully completed in 60 cases. Other 4 cases had residual calculi less than 1.5 em in diameter and received ESWL to break the calculi, 2 cases had bigger residual calculi and accepted second PCNL 1 week after the first intervention. In the follow-up period, the 3 month post-operative serum Cr was 56-203 μmol/L with an average decrease of 40 μmol/L, GFR was 5.0-56.2 ml/min with an average increase of 23.6 ml/min compared with the pre-operative data. At 6 months postoperative serum Cr was 56-158 μmol/L with average decrease of 31 μmol/L, GFR was 5.0-79.2 ml/min with an average in-crease of 30.2 ml/min. Conclusion Application of PCNL in the treatment of patients with renal cal-culi accompanied with pyonephrosis is safe, cost-effective and clinically efficient by pneumatic com-bined with ultrasonic lithotriptor.