This study was performed for the output of nitrous oxide (N_2O) after N_2O cessation. The breathing bag with the volume of 3000 ml served as the simulator lung,and 5 patients, ASA grade Ⅰ,aged 18-48 years scheduled for elective surgery,acted as the clinical subiects. After the equilibration of end-expiratory N_2O concentration of 50% was developed,the N_2O administration was cut off,then was expelled with oxygen flow rate at 3L/min or 6L/min. The inspiration-expiration N_2O concentration difference of simulator or patient lung (SC_(I-E) N_2O or PC_(I-E) N_2O)was recorded with an infra-red gas analyser. The N_2O dilution induced by the anesthesia circuit volume and the functional residual capacity, was similar to that by simulator lung,so the clinical output of N_2O in one minute was calculated as followed: N_2O output=(PC_(I-E) N_2O-SC_(I-E) N_2O)?minute volume of ventilation. The results showed that in the first minute after N_2O termination,there was no N_2O output,but from the second to the tenth minute the N_2O output increased gradually and was kept at the high level,additionally,the levels of N_2O output at the oxygen flow rate of 6L/min were higher than those at 3L/min in the corresponding times, respectively. It is suggested that following the withdrawal of 1:1 N_2O-O_2 anesthesia ,the N_2O output is related to the oxygen flow rate,and there is not the occurance of diffusion hypoxia.

We described clinical process of two cases of intraocular lymphoma in aspects of early diagnosis by fine needle aspiration (FNA) and biopsy and treatment by intravitreal methotrexate (MTX). Two patients were suspected to have primary intraocular lymphoma (PIOL) with geographic yellow-white infiltrates and vitreous opacity. FNA confirmed malignant intraocular lymphoma in one patient and failed in the other patient due to complication of vitreous hemorrhage. Subsequent vitreous biopsy confirmed malignant intraocular lymphoma in the other patient. Both patients were treated by intravitreal methotrexate. In case 1 the tumor had complete remission and follow-up of 12 months had not found any signs of recurrence. In case 2 the patient died of brain metastasis 22 months after the ocular biopsy. Our findings demonstrate that although cytological examination of vitrectomy specimens remains the gold standard in diagnosis of PIOL, examination of FNA and biopsy increases the reliability of early diagnosing or excluding a PIOL. Individualized intravitreal methotrexate can be used to effectively treat PIOL. More effective integrated program treating primary central nervous system lymphoma/PIOL is worthy of looking forward to.

Objective To evaluate the levels of plasma coupling factor 6(CF6) and cytochrome C(Cyt-c) in neonatal sepsis,and to explore the clinical significance in neonatal sepsis.Methods A total of 88 neonates admitted to Hunan Children's Hospital from January 2015 to April 2015 were collected.Neonates were divided into non-sepsis group(n=42) and sepsis group(n=46).According to the severity of infection,the non-sepsis group was further divided into non-infection group(n=20) and common infection group(n=22);the sepsis group was further divided into general sepsis group (31 cases,no organ failure) and severe sepsis group (15 cases,combined with multiple organ failure).Femoral venous blood was collected in all patients before the use of antibiotics after admission.The levels of Cyt-c and CF6 in plasma were measured by ELISA,and the levels of C-reactive protein(CRP),procalcitonin (PCT) were measured.The changes of CF6 and Cyt-c between these groups were compared,and the sensitivity and specificity with the traditional sepsis index (CRP,PCT) were analyzed.The correlation between the levels of CF6,Cyt-c and neonatal critical illness score was analyzed.Results (1)In sepsis group,the levels of CF6 and Cyt-c[(109.7±8.9)pg/ml and (44.5±4.9)ng/ml] were significantly higher than those in the non-sepsis group[(46.3±6.0)pg/ml,(31.8±6.7)ng/ml,P<0.01,respectively].(2) In the non-infection group,common infection group,general sepsis group and severe sepsis group,the levels of CF6 were (32.1±8.9)pg/ml,(59.3±7.2)pg/ml,(79.3±5.9)pg/ml,and (172.6±6.1)pg/ml,respectively;the levels of Cyt-c were (29.3±8.6)ng/ml,(35.4±4.1) ng/ml,(43.1±5.9) ng/ml,and (44.5±5.9)ng/ml,respectively.The differences between these groups were significant(P<0.01).(3)The receiver operating characteristic curve showed that the sensitivity and specificity of CF6 were 0.761,0.732,and the Cyt-c were 0.739,0.714.(4)Cyt-C and CF6 were negatively correlated with the neonatal critical illness score(r=-0.599,P<0.001;r=-0.337,P<0.01).Conclusion The levels of CF6 and Cyt-c increase in neonatal sepsis.The damage of mitochondria may be one of the pathological mechanisms in neonatal sepsis.The levels of CF6 and Cyt-c were closely related to the severity of neonatal sepsis.

Objective To investigate the changes in cortisol, adrenocorticotropic hormones (ACTH) in term infants with critical illness and to evaluate their functional status.Methods One hundred and fifty term infants who were transferred to the hospital within 72 hours after birth were involved (gestational age ≥ 37 weeks).These term infants were evaluated by neonatal critical illness scores (NCIS) at the time of admission, and they were divided into a mild group and a severe group according to the NCIS scores.Serum cortisol and ACTH concentrations were measured at the time of admission on day 7 and day 14 after birth.Results (1) Within 72 hours after birth, the basic serum cortisol concentration of severe illness infants [(283.5 ± 196.0) μg/L] was significantly higher than that of the infants with mild illness[(175.0 ± 186.5) μg/L], and there was a significant difference (t =-3.830, P =0.000).The basic serum cortisol concentration of the term infants with severe illness was higher than that of the term infants with mild illness,but there was no significant difference[7 d:(94.1 ±41.3) μg/L vs (62.5 ±37.9) μg/L,14 d:(68.6 ±47.7)μg/L vs (50.9 ± 38.4) μg/L, all P ＞ 0.05].(2) Among the infants with critical illness, the basic serum cortisol concentration within 72 hours after birth was significantly higher than those of day 7 and day 14 after birth (t--5.994, 2.848;P =0.000,0.036).(3) Among the mild infants, the basic serum cortisol concentration within 72 hours after birth was significantly higher than those of day 7 and day 14 after birth (t =4.691,3.076;P =0.000,0.037).(4) The basic serum ACTH concentrations had no significant difference between the severe group and the mild group[≤72 h: (101.55±61.52) ng/Lvs (85.54±59.83) ng/L,7 d:(54.91±22.75) ng/Lvs (71.07±20.51) ng/L,14 d: (44.67 ± 28.30) ng/L vs (44.92 ± 24.68) ng/L, all P ＞ 0.05].(5) The serum cortisol and ACTH concentration within 72 hours after birth of the dead infants[(351.9 ± 179.7) μg/L, (215.5 ± 165.9) ng/L] were significantly higher than those of the survivors [(201.4 ± 161.4) μg/L, (83.5 ± 54.0) ng/L], and there were significant differences(t =-2.547,-3.833;P =0.012,0.000).(6) The basic serum cortisol concentration within 72 hours after birth had a negative correlation with NCIS(r =-0.293, P =0.043), pH (r =-0.336, P =0.000) and base excess (BE) (r =-0.261 ,P =0.002);but it had a positive correlation with ACTH concentration within 72 hours after birth (r =0.443 ,P =0.000).The serum basic ACTH within 72 hours after birth had a negative correlation with BE (r =-0.181 ,P =0.031) ,and had positive correlation with the basic serum cortisol concentration within 72 hours and day 7 (r =0.443,0.268;P =0.000,0.048).Conclusions The term infants have the ability to response to external stimuli by regulating cortisol secretion.The basic serum cortisol concentration of term infants is related to the critical illness.The worse the condition is,the higher the base serum cortisol concentration is.

Objective To evaluate the role of 11C-methionine positron emission tomographv(MET PET-CT)in differentiating tumor recurrence from radiation necrosis in brain slioma patients.Methods From June 2008 to September 2009,30 brain glioma patients with suspected tumor recurvence or radiation necrosis after radiotherapy were evaluated by MET PET-CT.The median time between initial radiotherapy and PET examination was 13.5 months.Tumor recurrence were confirmed by histological analysis while necrosis was based on histological analysis or the subsequent clinical follow-up.Results Eighteen out of 19 patients were histologically confirmed tumor recurrence among those tumor recurrence shown by MET PET-CT after surgery or stereotactic biopsy.11 patients were considered to have radiation necrosis because of stable neurological sympotoms and without massive enlargement of the lesion during the after follow-up.The sensitivity,specificity and accuracy of MET PET-CT for detecting tumor recurrence were 100%,91.7%and 96.7%respectively.Conclusion MET PET-CT is a powerful tool in differentiating brain tumor recurrence from radiation necrosis after radiotherapy.

Objective To explore the application of high frequency oscillation in the area of respiratory distress syndrome (RDS) of premature.Methods A total of 101 cases with RDS of premature was collected who needed the machine support in neonatal intensive care unite (NICU) during 2010.11.01-2011.10.30.Forty one cases (high frequency oscillation group) received the high frequency oscillation,while 60 cases received the common ventilation (Control Mechanical Ventilation group;control group).The results of blood gas analysis were recorded before ventilation,after ventilation for 2 hours,after ventilation for 12 hours,and after ventilation for 24 hours.The chest X-Ray and the complication were examined.Results The result of the blood-gas before ventilation,after ventilation for 2 hours,after ventilation for 12 hours,and after ventilation for 24 hours,FIO2,PO2,PCO2,and Pa(A-a) were statistically analyzed,and F-value was 16.202,14.764,16.135,8.434,P ＜ 0.01.For chest X-ray in high frequent oscillation group,there were 36 cases who had improved after ventilation 24 hours and all had improved after ventilation 72 hours;however,in common ventilation group,there were 30 cases who had improved after 24 hours and 50 cases had improved after 72 hours,x2 =15.372 and 7.584,P ＜ 0.01,there was statistical difference for two groups.However,there were not different in cerebral injury/healing damage and retinopathy of prematurity (ROP) for two groups.Conclusions High frequency oscillation is an effective way to treat RDS of premature.

Objective To explore the clinico-pathological features and outcomes of primary focal segmental glomerular sclerosis with IgM deposition.Methods One hundred and two patients with primary focal segmental glomemlar sclerosis (pFSGS) in Hangzhou hospital of traditional Chinese medicine between 1996 and 2012 were retrospectively studied.The patients were divided into IgM deposition group (n =66) with IgM deposition in glomeruli and none-IgM deposition group (n =36) without IgM deposition.Baseline and clinical characteristics of all FSGS patients were assessed and outcomes were reviewed.The survival rates of the patients were analyzed using the Kaplan-Meier method.Results (1) There were not difference in age,sex ratio,incidence of microscopic hematuria,hypertension,renal insufficiency,eGFR,Ccr and Scr between two groups.However,proteinuria,incidence of nephrotic syndrome,urine microalbumin,urine NAG,serum cholesterol,serum high-density lipoprotein,and serum IgM in IgM deposition group were significantly higher than those in none-IgM deposition group (P ＜ 0.05),serum albumin and serum IgA in IgM deposition group were significantly lower than those in none-IgM deposition group (P ＜ 0.05).(2) The IgM deposition group had a significantly higher incidence of glomerular deposition of IgA,IgG,C3,C1q and fibrinogen than none-IgM deposition group (P ＜ 0.05).The score of mesangial matrix proliferation in the IgM deposition group was lower than that in none-IgM deposition group (P ＜ 0.05).(3) fifty-four patients (35 patients in IgM deposition group and 19 patients in none-IgM deposition group) were followed-up for a median of 64.6 (22.8,103.8) months.Progression to renal failure was observed in 5 patients of IgM deposition group and none in none-IgM deposition group.Compared with the none-IgM deposition,the survival rates in the IgM deposition group were statistically lower (P ＜ 0.05).Conclusions PFSGS patients with IgM deposition were severer in proteinuria,higher incidence of IgA,IgG,C3,C1q and fibrinogen deposition in glomeruli and worse outcome than those without IgM deposition.

ObjectiveTo evaluate the effect of labor analgesia and the outcome of maternals and neonatals by applying the vitamin B6- folic acid mixture to combined with spinal-epidural analgesia(CSEA) in nulliparous women at latency.MethodsAll the 112 full-term nulliparous parturients were selected and divided into the treated group and controlled group.Nulliparous women in two groups received CSEA,with which the additional vitamin - folic acid mixture was used only in treatment group.The contrast between the analgesic effect in groups,and alalgesic effect-acting period,fentanyl Apgar score and newborn usage were compared between groups also.ResultsThe analgesic effect-acting period and fentanyl dosage in the treated group were significantly decreased.There was significant difference between the 2 ( P ＜ 0.05 ).ConclusionsIt could be effective applying vitamin B6- folic acid mixture at latency in nulliparous women based on CSEA,which could shorten the lumbar hemp effect-acting period and reduce fentanyl narcotic drugs dosage.

Objective To analysis the clinical outcome at discharge and its risk factors of extremely preterm infants.Method To retrospectively analysis the clinical outcome at discharge and it's risk factors of extremely preterm infants (less than 28 weeks gestation) admitted from September 2008 to August 2014 in our Hospital.Result A total of 179 cases were enrolled.Survival rate was 59.2％ (106/179).Unfavorable outcome rate was 74.3％ (133/179),among them 73 cases died.The top five causes of death were severe bronchopulmonary dysplasia (BPD) (28 cases),Ⅲ ～ Ⅳ o intraventricular hemorrhage (IVH) (19 cases),sepsis (16 cases) and necrotizing enterocolitis (NEC) (6 cases).Among the 60 survivals with unfavorable outcomes,35 cases had either severe neurologic or ophthalmological sequela,and 25 cases had severe pulmonary sequela.Univariate analysis showed that,comparing with improved group,unfavorable outcome group had higher rates of not receiving prenatal steroids,placental abruption,male,small for gestation age,resuscitation with chest compression,admission age older than 72 hour,severe respiratory distress syndrome (RDS),without pulmonary surfactant (PS) usage,mechanical ventilation beyond 2 weeks and sepsis (P ＜ 0.05).Logistic regression analysis showed that those without prenatal steroids (OR =9.402,P =0.002),small for gestational age (OR =8.271,P =0.018),resuscitation with chest compression (OR =6.325,P =0.023),admission age older than 72 hour (OR =4.174,P =0.028) were independent risk factors for unfavorable outcome of extremely premature at discharge.Conclusion Extremely preterm infants have a higher rate of unfavorable outcome at discharge.Avoid small for gestational age,transfer properly and in time both in utero and after birth,and conduct prenatal steroids could improve their clinical outcome at discharge.

Objective To investigate the effect of illness severity on preterm infant's hypothalamusputituary-adrenal (HPA) axis, we measured the serum concentration of cortisol,aldosterone and adrenocorticotropic hormone (ACTH). Methods Ninety preterm infants who were transferred to our hospital within 72 hours after birth were involved. These preterm infants were divided into two groups:gestational age (GA) ≥34 weeks' preterm infants and GA <34 weeks' preterm infants. We evaluated these preterm infants at the time of admission,day 7 and day 14 after birth with neonatal critical illness score (NCIS). Then they were divided into mild group and severe group by the lowest score. We measured their serum cortisol,aldosterone and ACTH at the time of admission,day 7 and day l4 after birth. Results (1) The serum cortisol concentration of preterm infants with severe illness was higher than that of preterm infants with mild illness. Among the GA ≥34 weeks' preterm infants,the serum cortisol concentration of preterm infants with severe illness was significandy higher than that of preterm infants with mild illness within 72 hours after birth (t = -2.263,P =0. 029). Among the GA <34 weeks' preterm infants,the serum cortisol concentration of preterm infants with severe illness was significantly higher than that of preterm infants with mild illness on day 14 after birth (t =-2. 913 ,P =0. 006). (2) Among the preterm infants with severe illness,the serum cortisol concentration of the GA≥34 weeks' was significantly higher than that of the GA < 34 weeks' within 72 hours after birth (t =-2. 641 ,P =0. 010) ;the serum cortisol concentration of the GA <34 weeks' was significantly higher than that of the GA≥34 weeks' on the day 14 after birth(t = -2. 189,P =0. 036) . (3) The serum cortisol concentration was significantly decreased in the GA≥34 weeks'preterm infants (F = 4. 679, P =0. 012). (4) The serum cortisol concentration of aldosterone and ACTH was not significantly different between preterm infants with severe illness and those with mild illness. Conclusion The preterm infant already has the ability to respond to stimuli by regulating cortisol secretion. The serum cortisol concentration increases as disease severity worsens.Serum aldosterone and ACTH concentration are not correlated with the severity of the disease.