Objective To evaluate the changes in plasma S-100β protein concentration in patients undergoing cardiac surgery performed with cardiopulmonary bypass (CPB).Methods ASA Ⅱ or Ⅲ patients aged 60-77 yr weighing 55-75 kg with national institutes of health stroke scale(NIHSS) ＜ 10 undergoing coronary artery bypass grafting with CPB were enrolled in this study.Cerebral function was evaluated and scored using NIHSS at 2 d after operation.The patients were divided into 3 groups according to NIHSS scores:group A uncomplicated (NIHSS score 0-9),group B mild brain injury (NIHSS score 10-19) and group C moderate and severe brain injury (NIHSS 20-45).Plasma S-100β protein concentration was measured before CPB,at 30 min of CPB,the end of CPB and 1 h,6 h,24 h after CPB.The duration of operation,CPB time,aortic cross-clamping time and length of ICU stay and hospital stay were recorded.Results Ten patients in groups A and B and 12 in group C completed the trial.Plasma S-100β protein concentration was significantly increased during and after CPB as compared with the baseline at T0 and peaked at T3 (groups A,B) and T4 (group C).The plasma S-100β protein concentration was highest in group C and lowest in group A.The duration of operation,CPB time,aortic cross-clamping time and length of ICU stay and hospital stay were longest in group C and shortest in group A.Conclusion Plasma S-100β protein concentration can be used as a marker of cerebral injury after cardiac surgery performed with CPB and the concentration measured at 6 h after CPB is more significant in evaluating the degree of cerebral injury and prognosis.

Objective To investigate the accuracy of myeline base protein (MBP) in evaluation of brain injury in patients undergoing cardiac surgery performed under CPB. Methods Thirty-two ASA Ⅱ- Ⅳ patients of both sexes (20 males, 12 females) aged 59-76 yr weighing 52-72 kg undergoing coronary artery bypass grafting (CABG) under CPB were studied. Patients with history of neurological disease were excluded. Preoperative National Institute of Health stroke scale (NIHSS) score ≤ 9. According to postoperative NIHSS score on 2nd postoperative day, the patients were divided into 3 groups: group A no neurological deficit ( NIHSS score 0-9 );group B mild neurological deficit (NIHSS score 10-19) and group C moderate or severe neurological deficit (NIHSS score 20-45). Blood samples were taken from internal jugular vein before CPB (T0), at 30 min of CPB (T1), at the discontinuation of CPB (T2), and at 1, 6, 24 h after discontinuation of CPB (T3-5) for determination of the plasma MBP concentration. The duration of operation, CPB time, aortic cross-clamping time were recorded.Results In group B the plasma MBP level peaked at 6 h after CPB (T4) and then decreased rapidly while in group C the plasma MBP level exceeded the normal upper limit at T2 and kept increasing till 24 h after CPB (T5 ).The plasma MBP level decreased at T1-3.5 in group A as compared with the normal upper limit. The plasma MBPlevel was significantly higher at T3-5 in group B and at T1-5 in group C than in group A and at T1-5 in group C than in group B. Linear regression analysis indicated that there was positive correlation between plasma MBP level and CPB time at T5. NIHSS scores were positively correlated with plasma MBP level at T1 , T2, and T5. Conclusion MBP can early reflect the severity of brain injury in patients undergoing cardiac surgery under CPB.

Objective To evaluate the laparoscopic Palomo procedure in the management of varicocele in adolescent by assessment of the postoperative testicular growth and the changes of the biggest vessel diameter of varix. Methods From July 1999 to March 2004, laparoscopic high mass - ligation of testicular vessels according to Palomo procedure was performed on 31 boys who all presented with left varicocele Before and after operation at 1 month,3 and 6 months, the biggest vessel diameter of varicocele was measured by ultrasonography, testicular blood supply was evaluated by color Doppler flow imaging(CDFI) ,and fastis was recorded in length, width and thickness by ultrasonographic measurement, which volume was calculated by the formula V =?/6 ? length ? width ? thickness. Also the ratio of left to right testicular volume was calculated, and the left testicle was thought atrophy if the ratio was below 75% The biggest vessel diameter of varix, testicular blood supply, and the postoperative testicular increasing volume were compared before and after operation. Results The biggest vessel diameter of varicocele significantly reduced 1 month after operation(P

Objective:To evaluate the efficacy and safety of talc poudrage pleurodesis via semi-rigid medical thoracoscopy in the treatment of malignant pleural effusions,as well as the factors that may influence the outcomes.Methods:A series of 27 patients with malignant pleural effusion underwent medical thoracoscopic talc poudrage pleurodesis between July 2005 and September 2007 in Peking University First Hospital.Results:There were 16 male and 11 female patients in the series,the average age being 65.2 years.All the patients had documented malignant pleural effusions,including 16 cases of adenocarcinoma,6 of malignant mesothelioma,2 of squamous cell carcinoma,1 of lymphoepithelioma-like carcinoma,1of small cell carcinoma and 1 of undifferentiated lung cancer.Thirty days after the procedures,complete successful pleurodesis was achieved in 22 cases,and partial successful in 4 cases.Pleurodesis was not successful in one case.Overall successful rate was 96.3%(26/27).The average duration of thoracic tubing was 6.85 days.Chest pain,fever and an increase in peripheral WBC after the procedure occurred in 19(70.4%,19/27),21(77.8%,21/27),and 12(44.4%,12/27)cases respectively.No respiratory failure occurred.Conclusion:Medical thoracoscopic talc poudrage pleurodesis is a safe and effective method for the treatment of malignant pleural effusion.

Objective To investigate pathogenic factors,clinical characteristics,pathological changes in 6 patients with localized or disseminated intestinal neuronal dysplasia(IND).Methods The clinical retrospective study was performed in 6 cases with localized and disseminated IND.Results In 6 patients,constipation and partial intestinal obstruction were the major symptoms.Preoperatively,dia-gnoses were revaluated as intestinal stenosis in 2 cases,long sigmoid in 2 cases and long-segment aganglionosis and total gastrointestinal IND in the rest 2 cases,respectively.Exploratory laparotomy was performed on all these patients.Pathological study suggested that 4 of them were localized IND,on whom enterectomy and intestinal anastomosis were performed successfully.However,2 cases of disseminated IND died postoperatively.Conclusions Disseminated IND may be caused by congenital factors,while localized IND by the acquired factors which including intestinal obstruction,local ischemia or inflammation.The surgical interventions are effective for localized IND,and intestine transplantation might be prospective treatment for disseminated IND.

Objective To observe the 2-year survival situation of high intensity focused ultrasound(HIFU) treatment in unr esectable advanced pancreatic carcinoma.Methods Thirty-eight patients with unresectable pancreatic cancer received HIFU treatment.After treatment,the changes of laboratory tumor markers examination results,pain score,life quality score and survival situation were recorded.Results Among 35 patients with pain symptom before HIFU treatment,pain was relieved after HIFU treatment in 28 cases,the remission rate was 80.0％.The CA19-9 and CEA levels after HIFU therapy were obviously reduced compared with before treatment.The imaging examination showed the coagulation necrosis in HIFU-treated area.It was found the tumor volume was obviously shrunk during follow-up period.The median survival period was extended to (12.9 ± 6.6) months.Conclusion The HIFU treatment can effectively improve the life quality in the patients with unresectable pancreatic cancer and extends their survival period.

Objective To study the mechanism of adaptive immunity against Rhizopus arrihizus (R. arrihizus) infections. Methods Bone marrow derived dendritic cells (BMDCs) were separated from C57BL/6 mice and Card9-/- mice and then were cultured in vitro. Resting spores and swollen spores of R. arrihizus were in vitro co-cultured with BMDCs with or without Syk inhibition. Secretion of cytokines ( IL-23, IL-1βand IL-12) was analyzed by ELISA after 24 hours of culture. Na?ve T cells derived from C57BL/6 mice were in vitro co-cultured with spore-stimulated BMDCs for four days. Levels of IL-17A and IFN-γ in supernatants of cell culture were analyzed by ELISA. Flow cytometry was performed to analyze T cell differ-entiation. Confocal microscopy was used to observe the images of stained β-glucan on the surface of resting and swollen spores. Swollen spores were co-cultured with Dectin-1, Dectin-2, TLR2 and mannose receptor ( MMR) , and the binding results were analyzed by flow cytometry. Results Swollen spores but resting spores could induce the maturation of BMDCs and promote the secretion of cytokines (IL-23, IL-1βand IL-12). Co-culturing T cells with swollen spore-stimulated BMDCs enhanced their differentiation to Th17 and Th1. In addition, swollen spores promoted the secretion of Th1-related cytokine ( IFN-γ) and Th17-related cytokine (IL-17A). Adding Syk inhibitor to Card9-/-BMDCs or wild type BMDCs significantly inhibited the secretion of cytokines and T cell differentiation, especially in the Card9-/- group. β-glucan was overserved on the surface of swollen spores, but not on resting spores. On the surface of swollen spores existed pathogen associated molecular patterns ( PAMPs) that could bind with Dectin-1 and TLR2. Conclusion Swollen spores of R. arrihizus could active BMDCs to secrete cytokines of IL-23, IL-1β and IL-12 and trigger T cell responses in vitro. The possible mechanism might be associated with β-glucan exposed on the surface of swollen spores that binds with Dectin-1. The responses between BMDCs and R. arrihizus are Syk-Card9-dependent.

Objective:To investigate the value of quantitative electroencephalography (qEEG) in the evaluation of thrombolytic efficacy in acute cerebral infarction.Methods:A prospective cohort study was conducted. Ninety-four patients with acute cerebral infarction who received intravenous thrombolysis admitted to the department of emergency of Qinhuangdao First Hospital from October 2019 to September 2020 were enrolled. The relative energy values of δ, θ, α and β waves in qEEG before and 2 hours, 24 hours and 7 days after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis were dynamically monitored, and the power ratio index [DTABR, DTABR = (δ+θ)/(α+β)] was calculated. The National Institutes of Health stroke scale (NIHSS) score was also recorded. The reduction of NIHSS score ≥ 3 or the disappearance of neurological symptoms were regarded as effective thrombolytic therapy. The changes of DTABR before and after thrombolysis in patients with effective and ineffective thrombolysis were analyzed, and the correlation between DTABR and NIHSS score was analyzed by Pearson method.Results:A total of 94 patients were enrolled, including 64 males and 30 females. The average age was (61.71±10.11) years from 36 to 89 years old. Thrombolysis was effective in 57 cases and ineffective in 37 cases. Compared with before thrombolysis, DTABR of the effective group was significantly decreased at 2 hours, 24 hours and 7 days after thrombolysis (left cerebral infarction: 1.87±1.45, 1.59±0.88, 1.58±0.90 vs. 3.82±2.60; right cerebral infarction: 1.55±0.57, 1.41±0.50, 1.35±0.44 vs. 3.20±1.63, all P < 0.05). DTABR did not change or increase significantly at 2 hours, 24 hours and 7 days after thrombolysis compared with before thrombolysis (left cerebral infarction: 3.56±2.57, 3.48±2.19, 3.54±2.50 vs. 3.11±1.62; right cerebral infarction: 5.29±3.93, 5.33±3.94, 5.19±4.52 vs. 4.73±2.43, all P > 0.05). Pearson correlation analysis showed a significant positive correlation between DTABR and NIHSS score in patients with acute cerebral infarction (r = 0.691, P < 0.01).Conclusion:The quantitative index of qEEG, DTABR, can accurately and quickly monitor the process of thrombolysis in acute cerebral infarction, and can effectively evaluate the effect of thrombolysis in patients.

Objective To evaluate the effect of 36-neuro-motorial examination on early diagnosis of children with cerebral palsy within 1 year-old.Methods36-neuro-motorial examination was analysed in 210 children with cerebral palsy from 2 to 12 months. Results4-29 items reflecting the abnormity of reflex, muscle tone, posture and motion were observeed in patients with cerebral palsy.If these abnormities were laid according as frequency among 2-6 months,reflex abnormities are knee tendon reflex, palmar grasp reflex,Babinski sign,asymmetrical tonic neck reflex,ankle clonus,sitting equilibrium reflex,stepping reflex,crossed extension reflex,tonic labyrinthine reflex,trunk incurvation reflex,Moro reflex; posture abnormities are head to back≥15°,from supine to the side position, axillar suspension reflex,posterior neck fovea≥1cm in the supine position,landau reflex,Vojta reflex,traction reflex,tonic torticollis,abnormal spontaneous posture;muscle tone abnormities are foot dorsiflexion angle,scarf sign,tonic palmar grasp,to up the foot heel≥30° in the stand position,thumb decussation to the palm,poples angle,adductor angle,heel-ear angle; others are head cycle≤-2s, squint, active movement attenuation or abnormity, auditory abnormity, visual abnormity, ophthalmodonesis, epilepsy.Conclusions 36-neuro-motorial examination is effective for early diagnosis of cerebral palsy within 1 year.

Thyroid emergency is a rare but potent ially life-threatening condition if not recognized early and managed properly. It is usually due to a severe exacerbation of a preexisting thyrotoxicosis, which later leads to decompensation in different organ systems. The treatment of thyroid emergency remains challenging even with the armamentarium of modern intensive care technologies, especially in patients with cardiac failure and major organ dysfunction.[1–3] Herein, the authors described a case of thyroid emergency with cardiac arrest (CA) supported by extracorporeal membrane oxygenation (ECMO).