A male patient with hypopharyngeal cancer accepted operation under general anesthesia. Sixth day after surgery in patient with sudden chest pain and obvious difficulty in breathing. Blood oxygen saturation of 90%. The electrocardiogram showed: ST-T change,Tv6 flat;blood gas analysis: pH 7. 491, PCO2 34. 1 mmHg, PO2 54. 7 mmHg; D-Dimer 3. 87 mg/L; white blood cell 17. 50 × 10(9)/L. CTPA showed: right pulmonary artery embolism,pulmonary infection. Another male patient with the right tonsil cancer accepted operation under general anesthesia. Fourth day of patient suddenly appear bosom frowsty and obvious difficulty in breathing. Blood oxygen sat- uration of 88%. Blood gas analysis: pH: 7. 48, PCO2 : 33 mmHg, PO2 : 57 mmHg; D-Dimer: 2. 97 mg/L; white blood cell:11. 80 × 10(9)/L. CTPA showed: the main pulmonary artery and right pulmonary artery branch embolism, pulmonary inflammation. Both were diagnosised as acute pulmonary embolism and recovered well after giving anticoagulant therapy in time.
Anesthesia, General ; Electrocardiography ; Fibrin Fibrinogen Degradation Products ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Laryngeal Neoplasms ; surgery ; Male ; Oxygen ; Postoperative Complications ; Pulmonary Embolism

ObjectiveTo investigate the influence on efficacy and quality of life of amisulpride in schizophrenia with predominantly negative symptoms.MethodsSeventy cases of schizophrenia with predominantly negative symptoms were randomly assigned to amisulpride group and clozapine group for 12weeks.The clinical efficacy and side effects were evaluated with SANS,BPRS and TESS before and 1,2,4,8,12 weeks after treatment respectively. GQOLI-74 were used to evaluate the patients' quality of life before and after drug administration.ResultsFor the last assessment,the score of BPRS decrease to 30.68 ±4.62 in amisulpride group,was significantly lower than the beginning(P＜0.01 ) ; the score of BPRS decrease to 31.31 ±4.78 in clozapine group,was significantly lower than the beginning (P ＜ 0.01 ).Two groups showed similar effects,with no significance.12weeks after treatment,the scores of emotional dull,poverty of thought,volition abulia,interest-social lack,attention dysfunction in amisulpride group were 12.31 ± 4.43,9.66 ± 3.07,8.91 ± 2.56,10.29 ± 2.68,5.58 ± 1.43 ; and the scores of emotional dull,poverty of thought,volition abulia,interest-social lack,attention dysfunction in clozapine group were 14.62 ± 4.27,9.32 ± 2.81,8.22 ± 2.60,9.54 ± 2.67,6.62 ± 1.59,and the efficacy of amisulpride in emotional dull and attention dysfunction were better than those of clozapine.And the scores of material life,physical function,psychological function,social function in amisulpride group were not higher than those in clozapine group(P＞ 0.05).And the scores of four domains in GQOLI-74 had been improved significantly in two groups(P＜0.01).The domains of physical function,psychological function,and social function in amisulpride was superior to clozapine(P＜0.01).The side effects were more in clozapine group than those in amisulpride group.ConclusionAmisulpride is as effective as clozapine for the treatment of schizophrenia with predominantly negative symptoms,but it has more advantage than clozapine to improve emotional dull,attention dysfunction and quality of life in schizophrenia with predominantly negative symptoms.

Objectives To study the signiifcance of ifbrin related markers such as ifbrin monome (FM), D-dimer (D-D), fibrinogen and fibrin degradation products (FDP) in diagnosis of pre-disseminated intravascular coagulation (pre-DIC) state in children with severe pneumonia. Methods A total of 213 children with severe pneumonia in pediatric intensive care unit were divided into pre-DIC group and case control group according to the occurrence of pre-DIC. And 40 healthy children were included as normal control group. FM、D-D、FDP、prothrombin time (PT)、activated partial thromboplastin time (APTT)、ifbrinogen (FIB)、platelet count (PLT)、thrombomodulin (TM) levels were analyzed. Receiver operating characteristic curve was used to evaluate the above indexes. Results All the markers but FIB showed signiifcant difference among the three groups (P<0 . 05 ). The differences of FM、D-D、FDP、APTT in paired comparison among the three groups were also signiifcant (P<0.01), Pre-DIC group had the highest level and case control group was the second. Pre-DIC group had higher PT than that of the other two groups (P<0 . 05 ), but PT levels in normal control group and the control group are of no signiifcant difference (P>0 . 05 ). Compared with those in normal control group, TM and PLT levels were signiifcantly higher in the other two groups (P<0 . 01 ), but the differences of TM and PLT in pre-DIC group were not signiifcant in comparison to those in case control group (P>0 . 05 ). FM、D-D、FDP had larger area under curves (AUC) for pre-DIC than other indexes ( 0 . 84、0 . 76、0 . 64 , respectively). The AUC for the joint detection of the three indexes was 0 . 85 . Conclusions Fibrin related markers such as FM、D-D and FDP are valuable indexes in diagnosis of pre-DIC state in children with severe pneumonia, the joint detection of the three indexes would help to improve diagnostic accuracy.

Objective: To study the effect of bifidobacterium-supplemented enteral nutrition in early postoperative patients with gastric cancer. Methods: 60 patients with gastric cancer were divided into two groups: bifidobacterium-supplemented enteral nutrition(BSEN-group, 30 cases), popular enteral nutrition group(EN-group,30 cases). The patients were infused with Nutrison Fibre or bifidobacterium-supplemented Nutrison Fibre for 7 postoperative days. Results: Bifidobacterium-supplemented enteral nutrient was well tolerated. The incidence of infections was significantly lower (P = 0.01) in BSEN-group than in EN-group. Conclusion: Early postoperative enteral nutrition plus bifidobacterium can reduce the rate of postoperative infections in comparison with popular enteral nutrition.

Background:C-MET is expressed in a variety of tumor,and its expression may help to predict the prognosis of patients with gastric cancer. Aims:To explore the association of C-MET protein expression with survival in patients with stage Ⅲ gastric cancer. Methods:A total of 178 consecutive initially treated patients with stage Ⅲ gastric cancer from April 2010 to April 2014 at Beijing Pinggu Hospital were enrolled in this study. The expression of C-MET protein was determined by immunohistochemistry. Kaplan-Meier method was used to analyze the survival in patients with high C-MET protein expression and low C-MET protein expression,COX proportional hazards model was used to analyze the influence of various factors on prognosis. Results:C-MET protein was low expressed in 139 patients(78. 1%),and high expressed in 39 patients(21. 9%). Median survival(25. 1 months vs. 45. 0 months),1-year survival rate(69. 2% vs. 91. 4%),2-year survival rate(41. 0% vs. 84. 0%)were significantly decreased in high C-MET protein expression group than in low C-MET protein expression group(P all <0. 05). C-MET protein expression,N staging,and age were the influencing factor for prognosis of gastric cancer(P all <0. 05),however,gender and tumor differentiation were not related with prognosis(P>0. 05). Conclusions:C-MET protein expression rate is 21. 9% in patients with stageⅢgastric cancer,C-MET expression is significantly associated with survival;1-year survival rate is lower in patients with high C-MET protein expression.

Objective:To investigate the expression level and clinical value of serum miR-148a-3p and miR-551b-5p in patients with acute pancreatitis (AP).Methods:The clinical data of 152 patients with AP admitted to Danzhou people's Hospital from January 2017 to September 2020 were selected. According to the severity of their illness, they were divided into MAP group ( n=70), MSAP group ( n=40), and SAP group ( n=42). The SAP group was divided into survival group ( n=25) and death group ( n=17) according to the prognosis of the patients. Another 50 healthy people were selected as the control group. Fastening venous blood was collected on the day of onset, and the expression levels of serum miR-148a-3p and miR-551b-5p in each group were detected by real-time quantitative PCR. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated. The expression levels of serum miR-148a-3p and miR-551b-5p were analyzed to evaluate the prognosis of SAP. The correlation between serum miR-148a-3p and miR-551b-5p expression levels in SAP patients was analyzed by Pearson method. Results:The expression levels of serum miR-148a-3p (3.18±1.27 vs 0.96±0.28) and miR-551b-5p (1.94±0.85 vs 0.51±0.12) in AP group were significantly higher than those in control group ( P<0.001). The expression levels of serum miR-148a-3p (4.36±1.70 vs 2.84±1.10, 2.50±0.92) and miR-551b-5p (2.80±1.04 vs 1.68±0.53, 1.42±0.45) in SAP group were significantly higher than those in MSAP group and MAP group ( P<0.001). The expression levels of serum miR-148a-3p (5.30±1.95 vs 3.47±1.40) and miR-551b-5p (3.62±1.37 vs 2.08±0.91) in death group were significantly higher than those in survival group ( P<0.001). ROC curve analysis showed that the AUC of the combination of miR-148a-3p and miR-551b-5 in judging the prognosis of SAP was significantly higher than that of the single index of miR-148a-3p and miR-551b-5[0.943(95% CI0.886-0.997) vs 0.860(95% CI0.797-0.924), 0.822(95% CI0.795-0.880)], with a sensitivity of 98.3% and specificity of 84.6%. Correlation analysis showed that there were positive correlation between the expression level of serum miR-148a-3p and miR-551b-5p in SAP patients ( r=0.835, P<0.001). Conclusions:The expression levels of miR-148a-3p and miR-551b-5p in serum of AP patients were significantly increased, and the combined detection of miR-148a-3p and miR-551b-5p had a good value in judging the prognosis of SAP.

Objective To evaluate the feasibility and safety of mediastinum examination with flexible endoscope via suprasternal fossa.Methods A total of 20 healthy pigs were enrolled.Mediastinocosopy was performed via a tunnel to thoracix through a 1.5 cm incision on suprastemal fossa.Mediastinum was observed and complications were recorded.Results Mediastinocosopy was successfully achieved in all pigs.No severe bleeding or death occurred during the procedure.Five pigs got fever after the procedure with elevated white blood cell count.Four pigs had pneumothorax and three of them died in 1-6 days.Conclusion Mediastinocosopy with flexible endoscope through suprastemal fossa is feasible to diagnose mediastinal diseases,which can be important experimental evidence for the mini-invasive therapy of mediastimum diseases.

Objective To explore the diagnosis and treatment of altitude sickness combined with urinary retention. Methods 30 cases of altitude sickness combined with urinary retention were treated from April 16th to 26th,2010.They were all male,The average age of them was 24 years (range,19 -38).All were the first time entering the high altitude area (3600 -5000 m) from low altitude area (600 - 1800 m ).The urinary frequency of 25 patients reduced from 8 to 10 times/d to 2 to 4 times/d,the urine output reduced from the 1500- 2400 ml/d to 600- 800 ml/d; the other 5 patients had no urine in 12 -18 h,even had no sense to urinate.26 patients also combined with altitude pulmonary edema and 4 combined with altitude cerebral edema.30 patients had double renal columns enlarged,21 cases had urinary protein ( + ～ ++ ). Results 30 patients were exported urine 300 -600 ml within 10 min,leaded to urine 1800 -2300ml in 12 h,returned to normal voiding after catheter removal in 18 -24 h. After comprehensive treatment such as oxygen,dehydration,diuretic,sedative,antispasmodic and anti-infection,22 cases who with chest tightness,shortness of breath,dyspnea,hemoptysis foam sputum,headache,vomiting and other symptoms of jet-like improved apparently after hospital admission within 1 hour.Their heart rate downed from 90 - 145beats/min to 68 -92 beats/min,respiration from 28 -45 times/min to 18 - 28 times/min,oxygen saturation from 48％ - 84％ to 92％ - 100％ ; 8 cases who with shortness of breath,palpitation and headache improved not obviously.After the antihypertensive treatment,their blood pressure was still high (systolic blood pressure 150 - 180 mm Hg,diastolic blood pressure 90 -110 mm Hg),oxygen saturation between 78％ to 87％,so they were carried to rear area for further treatment.30 cases were all cured no death. Conclusions The high altitude urinary retention is reversible disease,which is often associated with high altitude pulmonary edema,altitude cerebral edema,acute subclinical renal dysfunction and gastrointestinal disorders.They are easily being induced by elements such as gastroenteritis,lung infection,tonsillitis,periodontitis,tiredness and so on; low atmospheric pressure,hypoxia and high altitude is the possible cause; the ratio of missed diagnosis is high; the treatment of oxygen and indwelling catheterization is better; The best method of prevention is to wear pressurized suits and adapt the environment in a ladder-step gradual way.

Objective:To investigate the correlations between CO-029 expression and cholangiocarcinoma invasion and metastasis, and the further explore the potential mechanism involved.Methods:The constructed lentiviral vector of vshRNA-CO-029 (LV/GFP/CO-029) was used to transfect and screen the stable transfected cholangiocarcinoma cell line HCCC-9810-vshRNA-CO-029 as the silence group, HCCC-9810 cells transfected with the mock plasmid were used as the mock group, and the untransfected cells were used as the control group. Cell scratch assay, Transwell assay and in vivo implantation assay were used to detect the migration, invasion and metastasis of the three groups of cells. Immunoprecipitation and tumor necrosis factor (TNF)-α stimulation assay were used to detect the effect of CO-029 on the expression of EMT-related genes.Results:The scratch healing rate of the silence group was (27.11±4.58)%, which was lower than that in mock group (92.84±6.24)%, the number of cells passing through Matrigel in silence group was (57.15±6.10), which was significantly lower than that in mock group (108.20±9.21) and control group (112.00±10.45), the differences were statistically significant ( all P<0.01). The volume of liver tumors in the silence group of orthotopic xenograft mouse model was (2.17±0.54) cm 3, while the volume of liver tumors in the transplanted simulation group was (0.74±0.15) cm 3, the differences were statistically significant ( P<0.05). The incidence of lung metastasis and the number of lung metastases in the simulated group was 100%(6/6) and (214.17±35.64), respectively, while that in the silence group was 16.7% (1/6) and (41.56±14.15), respectively, the differences were statistically significant (all P<0.05). Co-immunoprecipitation showed that CO-029 can form a complex with TNF-αR1. TNF-α induced the down-regulation of E-cadherin and up-regulation of vimentin and N-cadherin in the mock group, but no significant changes were observed in the silence group. Conclusion:CO-029 expression is positively correlated with tumor invasion and metastasis of cholangiocarcinoma, and could couple with TNF-α to induce EMT, which is a novel well-established potential prognostic and therapeutic target for cholangiocarcinoma metastasis and prognosis intervention.

Objective:To determine children ’ s health status and influential factors in Nujiang prefecture , Yun-nan.Methods:Rickets morbidity rate , growth retardation rate , and low-weight rate were selected as the key indica-tors to calculate the sample size by using four-stage-sampling procedure .The data was collected through questionnaire survey, in-depth interviews, and focus-group discussions .χ2 test and qualitative analysis were used to analyze the quantitative and qualitative data .Results:The infant mortality rate was 13.14 %in 2011, which was 1.1 and 1.15 times more than the national and provincial average .The mortality rate of children under five was 16.35%in 2011, which was 1.05 and 1.13 times more than the national and provincial average .It was also 2.19 times more than the average in developed countries .The prevalence of medium and severe malnutrition in children under five was 2 .32%, which was 1 .54 times more than the national average .The incidence of low birth weight was 1 .41%.The research shows that the rates of rickets , growth retardation , and low-weight were 36.13%, 25.81%and 20.98%,and nutritional diseases are more serious .Conclusion:There are serious health problems for children in Nujiang pre-fecture, especially nutritional diseases .Influential factors include health policy and system , economic development, customs, geography, health service capacity , and parental health knowledge Suggestion:The government should im-prove top-level design , strengthen policy support , and develop the local economy in order to solve the social and poli-cy environment factors .Institutions and human capacity should be strengthened , access and quality of services should be improved , health education should be popularized , and health awareness and behaviors should be improved .