Objective To evaluate the effects of dexmedetomidine on the cerebral oxygen metabolism in elderly patients undergoing general anesthesia.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 60-87 yr,scheduled for elective abdominal surgery under general anesthesia,were randomly divided into 2 groups (n =25 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv injection of midazolam,fentanyl,atracurium and propofol.The patients were tracheally intubated and mechanically ventilated.In group D,dexmedetomidine 1.0μg/kg was infused intravenously over 20 min before induction of anesthesia,while the equal volume of normal saline was given in group C.Before induction of anesthesia,at 0 and 10 min after tracheal intubation and at the end of operation (T0-3),blood samples were taken from the radial artery and jugular bulb for blood gas analysis.Arteriovenous blood O2 content difference (DajvO2) and cerebral O2 extraction rate (CERO2) were calculated at the same time.The development of emergence agitation and postoperative delirium within 48 h after surgery were recorded.Resets Compared with the baseline values at T0,the Da-jvO2 and CERO2 were significantly decreased at T1-3 in the two groups (P ＜ 0.05).Compared with group C,the Da-jvO2 and CERO2 were significandy decreased at T2-3,and the incidence of emergence agitation and postoperative delirium within 48 h after surgery was decreased in group D (P ＜ 0.05).Conclusion Dexmedetomidine can improve the cerebral oxygen metabolism and reduce the development of postoperative delirium in elderly patients undergoing general anesthesia.

Objective:To investigate the correlation between intratumor microvessel density (IMVD) and lymph node micrometastases. Method: IMVD and lymph node micrometastases were stained with CD105 and CK19 antibody by immunohistochemical method of SABC respectively. Result:IMVD marked with CD105 antibody corre-lated with T stage and lymph node micrometastases(P<0.01). Conclusion: The result show that IMVD marked with CD105 antibody highly correlated with lymph node micrometastases. It could be a index to evaluate the prog-nosis of patients with pN_0 supraglottic laryngeal squamous cell carcinoma.

Objective To evaluate clinical outcome in postoperative patients with advanced gastric cancer treated with concurrent chemotherapy and dendritic cells (DCs) vaccine as well as alteration of immune function. Methods Sixty-four postoperative patients with advance gastric cancer were divided into control group and DC vaccine group, In control group, 38 patients were treated with LCH regimen consisted of 5-fluorouracil 0.75 g/d_(1-5) and oxaliplatin 0.2 g/d_1. In DC vaccine group,blood sample was obtained from 26 patients who were followed by LCH regimen treatment next day.One week after the chemotherapy, patients were immunized with DC vaccine for 2 times at interval of one week. The second cycle was performed after 28 days. The percentages of T lymphocytes and natural killer (NK) cells and cytokine levels before and after treatment were compared between two groups. The therapeutic effects (including no remote metastasis and enlarged lymph nodes in cavity and/or tumor reduced in volume) were also evaluated. Results The concentrations of T lymphocytes (CD3~+ and CD4~+ ), NK cells, interleukin (IL)-2, IL-12 and interferon-γ in DC vaccine group were significantly increased after vaccination compared with those before vaccination (P＜0.05), and even higher than those in control group (P＜0.05). The effective rate was higher in DC vaccine group (80. 76%) than that in control group (68.42%) with significant difference (P＜0. 05). The side effects of chemotherapy such as the decreased peripheral white blood ceils and immune cells were less serious in DC vaccine group compared with control group (P＜ 0.05), while the uncomfortable incidence of gastrointestinal tract and peripheral neuritis showed no significant difference between two groups (P＞0.05). Conclusions Application of concurrent chemotherapy and DC vaccine in patients with advanced gastric cancer after surgical treatment may achieve a short-term efficacy, meanwhile it can reduce the side effects induced by chemotherapy.

Objective To evaluate dendritic cell vaccine immunotherapy in postoperative colorectal cancer patients. Methods 40 colorectal cancer patients were divided into two groups. Group A was not treated with the dendritic cell vaccine after chemotherapy, Group B was treated with four courses of autologous dendritic cell vaccine. The level of cytokines was tested before and after the therapy in both groups. DTH were tested after the last course of treatment. Results The levels of cytokines significantly increased in group B after vaccination compared with that in group B before vaccination and that in group A.8 patients were DTH positive in 15 patients that were tested after the vaccination. The PTS (progression-free survival) was 22 months in group B compared with 17 months in group A. The recurrence of the disease was not observed in patients with DTH positive. Conclusion DC vaccine in postoperative colorectal cancer patients improves the immune status and elicits tumor-specific response.

Objective To describe a new technique with mini-open reconstruction of lateral ligaments of ankle with partial tendon of its peroneus brevis and evaluate its effect in treatment of chronic lateral ankle instability. Methods A total of 11 cases of chronic lateral ankle instability;at mean age of 27.6 years(16-42 years),were treated with mini-open reconstruction of the lateral ligaments of the ankle with partial tendon of its peroneus brevis.The mean delay between the initial episode of ankle sprain and the surgery was 10.3 months(4-32 months).Postoperatively,all cases were examined with MRI,stress X-rays and comparative stability of bilateral ankle inspection at clinical follow-up.The function of the ankle were evaluated bv American Orthopaedic Foot & Ankle Society (AOFAS)score and ankle-hind foot scale. Results The average duration of follow-up was 17.5 months(12-37 months).The mean AOFAS ankle-hindfoot score was 88.3 points(72-96 points)at the time of the latest follow-up,including excellent result in 6 cases(55%),good in 4(36%)and fair in 1(9%).MRI results showed that the ruptured lateral collateral ligaments of the ankle were repaired and remodeled very well in all patients.There was no recurrence of the ankle instability or other complications. Conclusion Mini-open reconstruction of the lateral ligaments of ankle with partial tendon of its peroneus brevis is safe and effective for treatment of chronic lateral ankle instability.

Objective To investigate the prognostic value of red cell distribution width (RDW) and relationship between RDW and severity of critical illness patients and prognostic role of RDW.Methods This was a prospective observational and diagnostic test study.From February 2011 to May 2013,196 medical patients in ICU were enrolled to study.Blood samples were taken within 24 hrs after admission to ICU for blood routine test and other chemical routine test,including RDW.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score were also calculated.The patients were divided into survival group (n =126) and death group (n =70) based on their hospital outcomes.Differences in RDW levels and APACHE Ⅱ score between survival and death groups were compared with One-way ANOVA.The correlation between RDW and APACHE Ⅱ score were analyzed by Spearman correlation test.Receiver operator curve (ROC) test was used to determine the predictive value of RDW and APACHE Ⅱ for hospital death.Results Both RDW level and APACHE Ⅱ score were significantly higher in death group than those in survival group,whichwere (13.35 ±2.21) vs.(11.34 ±1.32) and (20.43 ±6.41) vs.(13.94 ±6.77) respectively (both P ＜ 0.01).RDW significantly correlated with APACHE Ⅱ score (r =0.309,P ＜0.01).To predict hospital death area under curve (AUC) of ROC curve by RDW and APACHE Ⅱ score were 0.792 (0.725,0.860) and 0.754 (0.686,0.822) respectively.The best cut-off value was determined by Yoden Index were 12.35 for RDW and 17.5 for APACHE Ⅱ score.The Accuracy of prediction was 76.5％ and 70.4％ respectively.In addition,all the 12 paticnts whose RDW level ＞ 15.4 were dead.Conclusion RDW level at admission to ICU correlate well with the severity of critical illness.RDW level has an additional predictive value for the prognosis of critical ill patients.

Objective To determine the effect of primary realignment of posterior urethral injury associated with pelvic fracture on length and delayed operative treatment of ensuing urethral stricture.Methods A retrospective review was made on the clinical data of 64 patients with posterior urethral injury after pelvic fracture treated from January 2008 to January 2012.Of those patients,43 underwent primary endoscopic realignment (early realignment group) and 30 received primary suprapubic cystostomy (cystostomy group).All were evaluated postoperatively for the late stricture rate,stricture length,types of delayed repair,and operation frequency.Results Rate of stricture was 53％ (18/34) in early realignment group and 100％ (30/30) in cystostomy group,but all were corrected by delayed urethroplasty.Mean length of the stricture was (1.8±0.6) cm in early realignment group and (2.9±0.7)cm in cystostomy group(t=6.7,P＜0.05).Of the urethrostenosis patients in early realignment group,83％ (15/18) were successfully corrected with a simple endoscopic cold incision and 17％ (3/18) with open surgery.In contrast,only 60％ (18/30) in cystostomy group were successfully corrected by endoscopic cold incision.Patients in cystostomy group underwent (2.8 ± 0.5) procedures for cure compared with (1.6 ± 0.6) procedures in early realignment group (t =9.2,P＜0.05).Conclusion Primary endoscopic realignment for posterior urethral injury pelvic fracture offers the decrease in stricture incidence,stricture length,operation difficulty and operation frequency.

Vitamin D is mainly produced in the liver, and chronic liver injury caused by various reasons will affect the metabolism of vitamin D, lead to vitamin D deficiency, and accelerate disease progression. Recent studies have confirmed that in patients with liver cirrhosis, the degree of vitamin D deficiency is closely associated with the severity and complications of liver cirrhosis. This article introduces the role of vitamin D and vitamin D receptor in the evaluation and treatment of liver cirrhosis and points out that vitamin D helps to evaluate the severity of liver cirrhosis and may become a new point and an important drug for the treatment of liver cirrhosis.

Objective To investigate the clinical outcome of arthroscopic percutaneous cannulated screw fixation with subtalar fusion in the treatment of post-traumatic subtalar arthritis. Methods The study involved 12 patients (five males and seven females) with severe post-traumatic subtalar arthritis admitted to our hospital from April 2006 to December 2009. The patients were at age range of 28-68 years ( mean 45.6 years). All patients had the history of conservative treatment but failed in pain alleviation.Then, the percutaneous cannulated screw fixation plus subtalar fusion was selected. The ande and hind foot of all patients were evaluated preoperatively and postoperatively by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Imaging assessment was carried out by X-ray examination.Results The patients were followed up for mean 21.2 months (range 6-48 months), which showed thatthe mean AOFAS ankle-hindfoot scale was increased from (54.67 ± 5.28 ) points (range 43-61 points)preoperatively to (89.17 ±3.56) points (range 78-95 points) at final follow-up, with excellence rate of 93%. Eleven patients got good fusion with the mean time of 12.4 weeks (range 9-15 weeks). Only one patient had nonunion, with the pain in the lateral malleolus. The subtalar joint of the patient got union after plaster immobilization for three months, which was proved by X-ray examination. Conclusions The arthroscopic percutaneous cannulated screw fixation and subtalar fusion can acquire good clinical outcomes and hence is a recommended procedure for post-traumatic subtalar arthritis.

OBJECTIVE: To investigate the correlation between intratumor microvessel density(IMVD) and lymph node micrometastases. METHOD: IMVD and lymph node micrometastases were stained with CD105 and CK19 antibody by immunohistochemical method of SABC respectively. RESULT: IMVD marked with CD105 antibody correlated with T stage and lymph node micrometastases (P < 0.01). CONCLUSION The result show that IMVD marked with CD105 antibody highly correlated with lymph node micrometastases. It could be a index to evaluate the prognosis of patients with pN0 supraglottic laryngeal squamous cell carcinoma.
Adult ; Aged ; Carcinoma, Squamous Cell ; blood supply ; pathology ; Female ; Humans ; Laryngeal Neoplasms ; blood supply ; pathology ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Microvessels ; Middle Aged ; Neoplasm Staging