Objective To investigate the accurancy of somatosensory evoked potential (SSEP) and motor evoked potential (MEP) in estimation of the occurrence of intraoperative cerebral ischemia in patients undergoing carotid endarterectomy (CEA).Methods Ninety patients (71 males, 19 females, aged 18-80 years, ASA physical status grade Ⅱ or Ⅲ) undergoing CEA using general anesthesia were studied.Bilateral SSEP and MEP were monitored during CEA and the intraoperative changes of SSEP and MEP amplitude and latency were analyzed before, during and after ICA cross-clamping until CEA ended.Neurological dysfunction was investigated within 5 days after operation and the gold standard of cerebral ischemia was defined as the occurrence of neurological dysfunction.Results Fourteen cases (15.6%) were diagnosed as post-operative neurological dysfunction.The sensitivity, specificity of SSEP in detecting the occurrence of intraoperative brain ischemia were 79%, 92%, respectively.The sensitivity, specificity of MEP was 86%, 89% respectively.The sensitivity, specificity, of SSEP+MEP was 79%, 99% respectively.Conclusion During the carotid endarter ectomy,SSEP predicts the occurrence of cerebral ischemia with a high specificity.MEP has a high sensitivity.The combination monitoring of SSEP+MEP can improve the specificity, make up for the shortcomings of single monitoring.

To evaluate the efficacy and safety of limbal relaxing incision ( LRl) for correcting corneal astigmatism during implantable collamer lens ( lCL) surgery.METHODS:A total of 185 eyes of 105 patients with high myopia and corneal keratometric astigmatism were included in the study. lCL surgery with concomitant relaxing incision was performed in 105 eyes of 60 patients in LRls group ( Group A) . Eighty eyes of 45 patients only underwent lCL surgery were in control group ( Group B) . All patients undergone ophthalmic examination that included uncorrected visual acuity ( UCVA ) , best -corrected visual acuity ( BCVA ) , Pentacam analysis system to observe the changes of corneal astigmatism before and 1wk, 1 and 3mo after surgery.RESULTS: Respectively comparing UCVA between two groups in 1 and 3mo postoperatively, the P values were considered statistically significant ( P < 0. 05 ). But, respectively comparing BCVA between two groups in 1wk, 1 and 3mo postoperatively, the P values were considered no statistically significant ( P > 0. 05 ). Preoperative corneal astigmatism was 1. 52 ± 0. 55D in group A and 1. 48 ± 0. 57D in group B, there was no statistically significant difference (P>0. 05). One week postoperatively, the astigmatism was 0. 55 ± 0. 41D in group A and 1. 20 ± 0. 48D in group B. One month postoperatively, the astigmatism was 0. 60 ± 0. 38D in group A and 0. 93 ± 0. 47D. Three months postoperatively, the astigmatism was 0. 51 ± 0. 32D in group A and 0. 96 ± 0. 40D in group B. The difference between the two groups were statistically significant ( P<0. 05 ). The difference value of corned astigmatism before surgery and 1wk, 1 and 3mo after surgery had statistical significance ( P<0. 05). ln LRls group, at preoperative and postoperative time points, the average corneal astigmatism changes were also considered statistically significant difference (P<0. 05). CONCLUSlON: LRls performed during lCL surgery appeared to be an effective and safer procedure to reduce pre-existing corneal astigmatism and improve UCVA as well as the visual quality.

Adult ; Breast Neoplasms ; radiotherapy ; surgery ; Cone-Beam Computed Tomography ; instrumentation ; methods ; Female ; Humans ; Mastectomy, Segmental ; Middle Aged ; Particle Accelerators ; Postoperative Period ; Radiotherapy Planning, Computer-Assisted ; instrumentation ; methods ; Respiration

Objective To study the expression of PTEN and Caspase-3 proteins in esophageal squamous cell carcinoma(ESCC) and to analyze the relationships between the expressions of the proteins and clinicopathologic factors as well as prognosis.Methods 64 cases of ESCCs,16 cases of pericarcinoma tissues and 16 cases of dysplasia epithelium were immunohistochemically stained.All 64 patients who underwent surgical treatment up to January 2005 were regularly followed up through letters and check-ups.Results The positive expression rate in pericarcinoma tissues,dysplasia and ESCC were significantly down-regulated((P

OBJECTIVE To summarize the use of intraoperative neuromonitoring system for monitoring and protection of recurrent laryngeal nerve during thyroid surgery. METHODS There were 21 cases in this study, included 5 cases with thyroid cancer, 9 cases with thyroid benign tumor and 7cases with hyperthyroidism. Intraoperative neuromonitoring system includes the host monitor, stimulus detection pin of recurrent laryngeal nerve, special EMG endotracheal intubation tube which contacts vocal cord, grounding conductive circuit electrode, and anti-jamming probe. Operation method: a "three-step method" was adopted. First we revealed the cervical vagus nerve trunk and tested our instruments, and then dissected and protected the recurrent laryngeal nerve, followed by removal of thyroid tissue. RESULTS In all 21 patients, operative side recurrent laryngeal nerve were exposed from lower thyroid blood vessels to the larynx. All patients were phonated as well as before operation, and without drinking cough. CONCLUSION The intraoperative neuromonitoring system can avoid damage of the recurrent laryngeal nerves when we exposed the recurrent laryngeal nerve before resection of the thyroid tissue and tumor.

Objective To study the value of clinical application of leukocyte classification alarm system (Q‐Flag ) for Sysmex XT‐1800i blood cell analyzer .Methods 394 blood samples with alarm system (Q‐Flag) and 190 ones without abnormal alarm infor‐mation detected by the Sysmex XT‐1800i blood cell analyzer were performed to observe the quantity and morphology of blood cells by manual differentiation ,and the results were compared between them .Results The alarm system of Sysmex XT‐1800i blood cell analyzer in detecting cell morphologic abnormalities was 100 .0% for sensitivity ,62 .3% for specificity ,70 .8% for positive predic‐tive value and 100 .0% for negative predictive value .Based on thegold standardof manual differentiation ,no abnormal cells were observed in those blood samples without Q‐Flag alarm information and the coincidence rate was 100% .The coincidence rate of leu‐kocyte classification was from 0 .0% to 75 .0% for blood cell analyzer when the alarm system (Q‐Flag) was between 100U and 200U ,and that was from 66 .7% to 95 .6% when the alarm system (Q‐Flag) was between 200U and 300U .Conclusion The alarm system sensitivity of leukocyte classification alarm system (Q‐Flag) is high for Sysmex XT‐1800i blood cell analyzer ,and it is nec‐essary to manually differentiate the samples with abnormal Q‐Flag in order to provide accurate and reliable clinical diagnostic infor‐mation .

Objective To explore the mechanism of endotoxemic injury in kidneys and protective effect of dexamethasone on renal cells.Methods Fifty-four eighteen-day Wistar rats were divided into control,endotoxemic(LPS)and dexamethasone groups randomly,18 rats in every group.Rats in control group were injected intraperitoneally with the same volume(0.1 mL)of 9 g/L sodium chloride as other two groups.All rats in LPS group were injected with a single bolus of LPS(4 mg/kg).The rats in dexamethasone group received LPS(4 mg/kg)and dexamethasone(5 mg/kg).Then they were sacrificed at 6,24 and 72 hours after injection.The ultrastructure was observed by electron microscope.Results In LPS group,glomerular basement membrane became thick and foot processes had coalescent partly,mitochondrial cristae became dissolved in proximal tubular endothelial cells and microvillus of distal tubular diminished at 6,24 hours after LPS injection.The morphological changes of apoptosis were found in the proximal tubular at 72 hours after LPS injection.These changes were in dexamethasone group.Conclusion Apoptosis participates in LPS injury of kidneys and dexamethasone have protective effect on injuried renal cells.

Objective To investigate the feasibility of congenital cytomegalovirus (CMV)infection screening by saliva polymerase chain reaction.Methods From November 1,2010 to February 29,2012,6733 newborns born in Changzhou Maternal and Child Health Care Hospital were enrolled.Saliva samples (0.2 ml) were collected within 3 days after birth,CMV-DNA was detected by real time-polymerase chain reaction and hearing screening was done with EroScan transient-evoked otoacoustic emissions at the same time.The positive rate of congenital CMV infection screening was calculated and clinical manifestations were analyzed.Chi square test was applied to statistical analysis.Results Totally 6733 newborns were screened and 107 of them were found to be positive with CMV DNA,the positive rate was 1.59％ (107/6733),among which 88 were asymptomatic (82.2％) and 19 were symptomatic (17.8 ％).The major clinical manifestations of the neonates with positive CMVDNA were pathological jaundice (13 cases),hepatomegaly (5 cases),granulocytopenia,thrombocytopenic purpura,anemia and small for gestational age (two cases each).Fourteen newborns had only one major clinical manifestation,three newborns had two major clinical manifestations and two newborns had three major clinical manifestations.There was no statistical difference between newborns with positive and negative CMV DNA on hearing screening [hearing loss in one ear:8.4％ (9/107) vs 5.8％ (382/6626); hearing loss in two ears:3.7 ％ (4/107) vs 2.4 ％ (159/6626),x2 =2.776,P=0.241].Conclusion It is feasible to screen congenital CMV infection with saliva sample.

Objective To explore the change of activin A(ACT A) in umbilical artery blood of newborns with fetal distress and its clinical significance.Methods Forty healthy pregnant women(control group)and 35 pregnant women with fetal distress (experimental group)were collected.The levels of ACT A of umbilical artery blood in both groups were determined by a solid quantitative biotin-avidin system enzyme-linked immunosorbent assay(BAS-ELISA),umbilical artery blood gas were also measured.Results The level of ACT A of umbilical artery blood in fetal distress group was (1 235.89?178.78)ng/L,and that in control group was (627.28?75.24)ng/L,and the level of ACT A of umbilical artery blood in fetal distress group was significantly higher than that in control group(P