Objective To compare the bronchial blocker and double-lumen tube for one-lung ventilation in the elderly patients undergoing minimally invasive direct coronary artery bypass (MIDCAB).Methods Thirty six patients of both sexes,aged 65-78 yr,with the left ventricular ejection fraction ≥ 45％,with body mass index ＜ 30 kg/m2,of ASA physical status Ⅱ or Ⅲ (NYHA Ⅰ-Ⅲ),scheduled for elective MIDCAB in the left thorax,were randomly divided into 2 groups (n =18 each):double-lumen endotracheal tube group (group D) and bronchial blocker group (group B).Anesthesia was induced with midazolam 0.05 mg/kg,etomidate 0.3 mg/kg,fentanyl 10μg/kg and cisatracurium 0.15-0.20 mg/kg.The patients were intubated with a left-sided double-lumen endotracheal tube 5 min later in group D.The patients were intubated with a single-lumen endotracheal tube 5 min later,and then Coopdech bronchial blocker was inserted into the primary bronchus in group B.The patients were mechanically ventilated.Before induction of anesthesia,at 2 min before intubation,immediately before and after intubation,and at 1 and 2 min after intubation,mean arterial pressure (MAP),heart rate (HR),and mean pulmonary arterial pressure (mPAP) were recorded and rate-pressure product (RPP) was calculated.The requirement for vasoactive drugs was recorded during induction of anesthesia.Lung collapse developed after the pleura was opened was also recorded.Surgical exposure was scored at the end of operation.Results Compared with group D,MAP,HR RPP and mPAP were significantly decreased after intubation,the requirement for nicardipine and esmolol was decreased,and no significant change was found in the requirement for atropine and metaraminol,rate of lung collapse and score of surgical exposure in group B.Conclusion Compared with doublelumen tube,bronchial blocker can provide sufficient exposure of the surgical filed,and intubation-induced fluctuation of hemodynamics is small in the elderly patients undergoing MIDCAB.

Objective To investigate the effect of skull acupuncture on cerebral infarct volume and plasma SOD activity and MDA and NO contents. Method Forty-eight male SPF-grade SD rats were randomized into sham operation, model and skull acupuncture groups. A rat model of middle cerebral artery occlusion (MCAO) was made by intraluminal thread occlusion. Rat nerve function was assessed by Zea Longa neurological function scoring. Rat cerebral infarct volume was measured by TTC staining. Plasma superoxide dismutase (SOD) activity and malondialdehyde (MDA) and nitric oxide (NO) contents were measured by colorimetry. Result Rat neurobehavioral score was significantly lower on day 1, 3 and 7 in the model group than in the sham operation group (P<0.01). TTC measurement showed that cerebral infarct volume was significantly smaller in the skull acupuncture group than in the model group (P<0.01). Plasma SOD activity was lower and MDA and NO contents were higher in the model group than in the sham operation group (all P<0.01). Plasma SOD activity increased and MDA and NO contents decreased after skull acupuncture treatment compared with the model group (all P<0.01). Conclusion Skull acupuncture has a protective effect against cerebral ischemia/reperfusion injury and can increase plasma SOD activity and decrease plasma MDA and NO contents in rats with cerebral ischemia/reperfusion injury.

BACKGROUND: Benign prostatic hyperplasia is a common disease of older males. Although the etiology remains unclear, the factors of life style and habits may have an effect on the disease.OBJECTIVE:To examine the association of cigarette smoking and body mass index with the risk of clinical benign prostatic hyperplasia.DESIGN: A hospital-based case-control study SETTINGS:Department of Epidemiology and Statistics, Public Health School,Tongji Medical College, Huazhong University of Science and Technology; Department of Preventive Medicine, Liaoning Medical College.PARTICIPANTS：Totally 343 males with benign prostatic hyperplasia of 50-82 years old (patient group),who were surgically treated between May 2004 and May 2006,were selected from the Department of Urinary Surgery of the First Affiliated Hospital and Third Affiliated Hospital of Liaoning Medical College (former Jinzhou Railway Central Hospital),Jinzhou Central Hospital and Jinzhou Second People's Hospital．Inclusive criteria：① males above 50 years old；intemational prostatic symptom score(IPSS)＞7；②Digital recta examination (DRE) after miction indicated prostate grade Ⅰ(transverse diameter＞3 cm); ③prostatic volume≥30 g;④maximum unnary flow rate＜15 mL／s；Meanwhile，361 inpatients with diseases irrelative to the risk factors of benign prostatic hyperplasia,prostatic cancer and prostatitis were selected trom the above hospitals as the control group,they were 50-82 years of age with an average of 65 years old．Informed contents were obtained from all the enrolled subjects．METHODS：All the patients and controls were interviewed using an anonymous questionnaire．All participants were asked to report whether they had smoked 20 packs of cigarettes or more in their lifetimes and,if yes,they were smokers,on the contrary they were non-smokers．Based on usual number of cigarettes reported in the questionnaire, men were categorized as 1-10，11-20，21-30 and ＞30 cigarettes per day．Based on duration of smoking,the participants were funher classified as never smoke，1-19,20-29 and ≥30 years．Body mass index(BMI)was assessed from measured body mass and body height，and che standards of BMI in adults in China was 18．5-23．9 for normal,24．0-27．9 for overweight and ≥28．0 for obesity)，then the participants were further classified as BMI＜18．4，18．5-23．9,24．0-27．9 and ≥28．0 subgroups respectively．Years of education(＜7,7-11,and≥12) and occupation(worker,peasant, Intellectual and others) were also investigated．The results of the investigation were input into computer to establish database，the odds ratios (OR) and the 95％ confidence interval(CI)in relation to the various measures were estimated using unconditional multiple logistic regression models, including number of cigarettes smoked per day，BMI,years smoked，years of education,occupation．MAIN OUTCOME MEASURES：Relationships of number of cigarettes smoked per day,years smoked．BMI,years of education and occupation with benign prostatic hyperplasia．RESULTS：Totally 343 cases in the patient group and 361 cases in the control group were involved in the analysis of results．①Patients smoked≥30 cigarettes per day had an elevated risk of benign prostatic hypertrophy as compared with the non-smokers(OR=1．32，95％ CI:0．92-2．58，P＜0．01)．②The risks of benign prostatic hypertrophy in overweight and obesity were significantly increased as compared with non-smokers(OR=1.68,95％ CI: 1．32-3．67；OR=2．35，95％CI:1．83-4．16)，③Manual worker (peasant) was negatively correlated with the risk of benign prostatic hyperplasia (χ2=6．62，P＜0．01)．CONCLUSION:Smoking 30 cigarettes per day was positively related to benign prostatic hyperplasia.For male who were both overweight(BMI 24.0-27.9)and obesity(BMI≥28.0)，smoking was significantly associated the increased risk of surgically treated benign prostatic hyperplasia.

[Objective]To evaluate the effects of sutureless technique in comparison to conventional techniques for repair of total anomalous pulmonary venous connection(TAPVC)with the method of propensity score analysis.[Methods]From October 2007 to December 2013,179 consecutive patients were enrolled in this study. Patients were operated with sutureless technique(n = 81)or Conventional technique(n=98),and followed up at an interval of 1 month,3 months,6 months and then once a year post-operation. During analysis,three type of propensity-score matching methods,including nearest neighbor caliper matching,Mahalanobis metric matching with propensity score ,optimal full matching were used to create balanced groups of patients receiving each treatment. Surgeons’performance difference was assessed with random frailty proportional hazards models with gamma. Composite endpoints was defined by postoperative death or late death or postoperative pulmonary venous obstruction(PVO),which was evaluated with Kaplan-Meier curve and multivariable Cox proportional hazard model,adjusted by Preoperative-PVO,age,gender,weight and TAPVC type.[Results]Nearest neighbor caliper matching method was the best choice during propensity score analysis. After matching ,sutureless group included 73 patients and Conventional group73 patients. In sutureless group,cardiopulmonary bypass(CPB)time(Z=2.18, P=0.030),cross-clamp time(Z=3.63,P<0.001),rate of composite endpoints(HR 95%CI=0.20(0.06~0.61),P=0.005),late death(HR 95%CI=0.03(0.01~0.55),P=0.017)were significantly better than that in Conventional group. In subgroup analysis ,for patients with pre-PVO,decreased composite endpoints was seen in sutureless group.[Conclusion]Comparison using thepropensity score analysis demonstrated that sutureless strategy for primary repair of TAPVC may associate with decreased mortality rate of post-PVO and CPB time and cross-clamp time.

Objective:To explore the environmental risk factors of different categories of congenital heart defects ( CHD) and provide evidence for further risk factors and prevention research of CHD pheno-types. Methods:Data of Guangdong CHD Register Study from 2004 to 2012 were used. In the study, 3 038 CHD cases and 3 038 paired controls from 34 hospitals distributed in 17 cities were registered and related information were collected using uniform, and structured questionnaires. All the CHD phenotypes were coded according to the International Classification of Diseases 10th Revision (ICD-10) and classified into 6 categories according to their pathological features. Univariate analyses were adopted to filter poten-tial risk factors for each category of CHD. Then multivariate conditional Logistic regression was used to calculate the odds ratios of the risk factors for each category of CHD. Results:The risk factors for left-to-right shunt CHD included low ( OR=2 . 63 , 95%CI:2 . 04 -3 . 39 ) or over birth weight ( OR =2 . 21 , 95%CI:1 . 47-3 . 32 ) , premature delivery ( OR=1 . 95 , 95%CI:1 . 53-2 . 49 ) , polyembryony ( OR=1. 99, 95%CI: 1. 22 -3. 26), maternal low education, mother as factory worker (OR =1. 62, 95%CI:1 . 32-1 . 98 ) , parity≥2 ( OR =1 . 38 , 95%CI: 1 . 13 -1 . 69 ) , maternal abnormal reproduction history ( OR=2 . 29 , 95%CI:1 . 75-3 . 01 ) , fever ( OR=2 . 38 , 95%CI:1 . 26-4 . 48 ) , virus infection ( OR=1 . 80 , 95%CI:1 . 29 -2 . 51 ) , medicine usage ( OR=1 . 73 , 95%CI:1 . 11 -2 . 69 ) , passive smoking ( OR=1 . 69 , 95%CI:1 . 26-2 . 29 ) , chemical agent contact ( OR=8 . 71 , 95%CI:2 . 33 -32 . 58 ) , living in newly decorated houses ( OR=2 . 56 , 95%CI:1 . 60-4 . 09 ) or room close to the main road ( OR=1 . 40 , 95%CI:1 . 14-1 . 72 ) in the first 3 months of pregnancy and father as factory worker ( OR=1 . 46 , 95%CI:1 . 23-1 . 73 ) . The risk factors for pulmonary outflow tract obstruction CHD in-cluded low ( OR =5 . 98 , 95% CI: 2 . 88 -12 . 44 ) or over birth weight ( OR = 6 . 56 , 95% CI:1. 19-36. 26), maternal low education, parity≥2 (OR=2. 08, 95%CI:1. 03-4. 22), virus infection in the first 3 months of pregnancy ( OR =4 . 30 , 95%CI: 1 . 27 -13 . 45 ) . The risk factors for left ventricular outflow tract obstruction CHD included father as factory worker ( OR=6 . 01 , 95%CI:1 . 05-34. 59). The risk factors for transposition of the great arteries included low birth weight (OR=12. 93, 95%CI:1. 14-146. 26), maternal low education, mother as factory worker (OR=3. 69, 95%CI:1. 53-8. 91). The risk factors for conditions with intra cardiac mixing of oxygenated and deoxygenated blood in-cluded parity=2 ( OR=3 . 45 , 95%CI:1 . 42-8 . 38 ) . The risk factors for other CHD included over birth weight (OR=4. 87, 95%CI:1. 19-19. 94), maternal abnormal reproduction history (OR=2. 96, 95%CI:1. 14 - 7. 68 ), virus infection ( OR = 4. 92, 95% CI: 1. 56 - 15. 47 ), medicine usage (OR=4. 90, 95%CI:1. 22-19. 77) or passive smoking (OR=10. 31, 95%CI:1. 25-85. 05) in the first 3 months of pregnancy. Conclusion:The environmental risk factors were discrepant among different categories of CHD. Further risk factors study of CHD phenotypes should be performed specially. To prevent CHD, attention should be paid to the risk factors which are related to multi or complex categories of CHD.

Objective To study the radioseusitization effect of gold nanoparticles modified by sodium glycididazole.Methods The sodium glycididazole was connected to gold nanoparticle,in dimension of about 18 nm,that had been modified with polyethylene glycol.The nanoparticle-swallowing efficiency of lung adenocarcinoma A549 cells was observed by a scanning electron microscope.Cells were divided into four groups:sodium glycididazole group,gold nanoparticles group,sodium glycididazole-gold nanoparticles group,and no drug control group.The radiosensitivity was detected by MTT and colony formation assays.Results Sodium glycididazole-gold nanoparticles could enter the cell cytoplasm and nucleus.The concentration of 0.003 mg/ml gold nanoparticles and sodium glycididazole-gold nanoparticles had no obvious cytotoxic effect.After irradiation of 2,4,6,8 Gy,the cell survival of the sodium glycididazole-gold nanoparticle group was significantly lower than that of the other three groups (F =4.8,14.5,5.7,7.6,P ＜0.05) and the D0 and Dq values of the sodium glycididazole-gold nanoparticle group were significantly lower than those of other three groups.Conclusion Sodium glycididazole-gold nanoparticles can enhance the radiosensitivity of lung adenocarcinoma cells.

Objective To develop an ideal substitution material for bladder defect ,which can reduce serious complications of urinary intestinal diversion ,we establish experimental rabbit model of reconstruction the new bladder by ileal seromuscular with transplantation of autologous peritoneum .This animal research provides the basical ground for the experimental model and further clinical application of replacement bladder .Methods Randomly ,seven experimental female rabbits were chosen ,and their body weight was 4 .0-5 .0 kg .By intravenous anesthesia ,the bladder substitute operation was carried out (to transplant the peritoneum to an ileum segment which mucosa had been removed .These flaps were used to mend and reconstruct the bladder by composite cys‐toplasty) .Animals were euthanized at 4 ,8 weeks for routine pathology and immunohistochemistry .Results Seven rabbits under‐went reconstruction ,but three were lost to complications .The length of ileum was 4 .0 cm ,and the area of substitute peritoneum was 4 .0 cm × 2 .5 cm .Voiding behaviour was normal ,and urine was clear in the remainder .At autopsy ,reconstructed bladders were healthy .Pathological examination showed that the technique was successful in creating seromuscular segments with no epithelial remnants .When applied surgically ,the seromuscular flaps with peritoneum survived at 4 weeks and the peritoneum was substituted by transitional epithelium at 8 weeks .Conclusion In this experimental rabbit model ,reconstruction bladder by autologous peritone‐um and seromuscular segment is an ideal approach for which can prevent regrowth by ileal epithelial cells and overcome the compli‐cations of conventional enterocystoplasty .Voiding behaviour is normal in the remainder .This animal study provides the basical ground for the large experimental model and further clinical application of the new enterocysplasty .

ObjectiveForskolin （FSK） analogs，isoforskolin （isoF），deacetylforskolin（deaF），and 1-acetylforskolin（1-aF），extracted from Coleus forskohlii native to Yunnan，were assayed for their adenylate cyclase stimulating activities in vitro and for effects of two analogs on ocular hypertension （OHT） in water-loaded rabbits．MethodsAdenylate cyclase stimulation was determined by protein-binding method of radioimmunoassay，and intraocular pressure was monitored by pneumatonometer．ResultsIt showed that isoforskolin and forskolin stimulated adenylate cyclase in vitro with almost equal activity，deacetylforskolin with milder activity，and 1-acetylforskolin with little activity in vitro．1％ deaF and 1-aF suppressed rabbit OHT induced by water-loading for at least 3h，with the maximal inhibitory rates of 6.0，10.9% respectively．ConclusionThis study suggests that two foskolin analogs （isoforskolin，deacetylforskolin） possess adenylate cyclase stimulation activities in vitro；deacetylforskolin and 1-acetylforskolin suppress OHT induced by water-loading in rabbits．

Objective To establish a rabbit model of radiation-induced skeletal muscle injury in order to study the ultrastructural pathological changes and underlying mechanism.Methods 28 New Zealand rabbits were randomly divided into 2 groups with 16 rabbits in experimental group and 12 rabbits in control group.The experimental rabbits were irradiated on hip with a single dose of 80 Gy of 9 MeV electrons from a linear accelerator.1 month and 6 months after irradiation the pathological changes were respectively observed under light microscope and electron microscope.Results One month after irradiation,the morphologic changes including degeneration,necrosis of muscle cells,and hemorrhage between the muscle cells were observed under light microscope and the swelling of myofibrillae,blurring of light and shade band,vacuolar degeneration of mitochondria and amorphous areas of necrosis were observed under electron microscope.Six months after irradiation,the morphologic changes of nucleolus chips,fibrous connective tissue,thickening of vascular wall and vascular congestion between the muscle cells and the amorphous areas of necrosis in the experimental group were much more serious than those of 1 month after irradiation.In addition,the myofilaments were lost in degeneration areas and the sarcomere became shorten.Observation with electron microscope showed that the mitochondrial size and its morphological changes were varied and the amounts of collagen between myofibrillaes were increased 6 months after irradiation.Conclusions A rabbit model of high-dose irradiated skeleton muscle injury was successfully established with a single dose of 80 Gy of 9 MeV electrons from a linear accelerator.The degeneration and necrosis of muscle cells may be promoted by mitochondrial and vascular injury,degeneration of vessel and nerve fiber.

Objective:To analyze the impact of previous exposure to macrolide, quinolones and nitroimidazole antibiotics on eradication rate of bismuth quadruple therapy (BQT) in newly diagnosed patients with Helicobacter pylori( H. pylori). Methods:A total of 469 patients with H. pylori initially treated at the Third Hospital of Peking University from September 2017 to August 2020 were retrospectively recruited. The therapeutic regimens were BQT containing clarithromycin/levofloxacin/metronidazole recommended by Chinese guidelines. Clinical data were collected, including general demographic data, exposure history of antibiotics, CYP2C16 metabolic pattern, endoscopic diagnosis, bacterial density, H.pylori resistance, eradication results, etc. Univariate analysis, Chi-square test, Fisher exact probability test, Kruskal-Wallis H test and Logistic regression model were used as statistical methods. Results:Among different eradication therapies, univariate and multivariate analyses suggested that previous exposure to macrolides ( OR=3.37,95 %CI 1.04-10.98, P<0.05) was relevant to the decreased eradication rate of BQT containing clarithromycin. This may be due to increased resistance to clarithromycin ( OR=6.12,95 %CI 3.99-9.40, P<0.01).The previous exposure to quinolones ( OR=3.65, 95 %CI 1.27-10.49, P<0.05) was relevant to the decreased eradication rate of BQT containing levofloxacin, which was probably explained by the increased resistance to levofloxacin ( OR=2.50, 95 %CI 1.69-3.71, P<0.01). But the previous history of nitroimidazole did not impact the efficacy of BQT containing metronidazole. Conclusions:In patients newly diagnosed with H.pylori infection, the previous exposure to macrolide or quinolones antibiotics is related to lower eradiation rates of H. pylori. Although the exposure to nitroimidazole also indicates drug resistance to metronidazole, the clinical efficacy of BQT with metronidazole 400 mg four times a day is not affected.