Objective To evaluate the role of bispectral index (BIS) in assessing the depth of sedation in hypogastric operation of children. Methods Forty children undergoing hypogastric operation were divided into two groups with 20 cases each by pre-school (age 3-5) (Ⅰ group) and school (age 6-12)(Ⅱ group). Sedation was solely maintained with TCI propofol. The infusion was adjusted till adequate scdation (OAA/S≤ 1 score) before sacral block. The course of propofol infusion and BIS of recovery period were closely observed. Sedation scores were assessed by special anesthetists. Results During recovery period, the mean values of BIS were gradually increased, when BIS > 76 predicted 94% sensitivity and 50% specificity in Ⅰ group, 100% sensitivity and 100% specificity in Ⅱ group. ROC area under the curve of the two groups were 0.917 ± 0.007, 0.955 ± 0.004. Conclusions BIS can predict fairly well the level of consciences during recovering periods. BIS monitoring is an effective and reliable method to guide children recovery.

Objective To incestigate the fetures of cranial CT and MRI in the patients with hypertensive encephalopathy. Methods The CT and MRI findings of ten cases of hypertensive encephalopathy with the charge of CT,MRI appearance of FLAIR (fluid attenvated inversion-recovery), DWI(difussion weighted imaging),ADC(apparent diffusion coefficient) were analyzed retrospectively. Results Of ten patients,3 cases had abnormal finding in the cranial CT;10 cases had abnormal finding in the cranial MRI,the lesions were demonstrated as slightly hypointensity on T1WI and slightly hyperintensity on T2WI and remarkably hyperintensity on FLAIR,and iso or slightly hyperintensity on DWI,and remarkably hyperintensity on ADC.The lilateral parietal occipital lobes and cerebellar hemisphere and Brain Stem were the more common sites. Conclusions The only characteristric finding of hypertensive encephalopathy in MRI and CT imaging studies is vasogenic edema,especially in the subcortical white matter of the parietal and occipital lobes bilaterally,and cereballar hemisphere et al;especially FLAIR,DWI and ADC of MRI can be helpful for diagnosis and diffenential diagnosis,prognosis and curative effect of hypertensive encephalopathy.

Objective To observe the acute skin and mucous membrane reactions in patients treated with concurrent radiochemotherapy for nasopharyngeal carcinoma,and to analyze the influencing factors.Methods A total of 85 nasopharyngeal carcinoma cases treated with concurrent radiochemotherapy were enrolled in the study.Fifteen clinical and laboratory indexes,including BMI,radiation dose,degree of acute oral mucous and skin reactions and blood routine test were observed weekly.Univariate and multivariate regression analysis were performed to assess the factors,and screen the independent factors.Results Multiple-factor analysis showed that the risk factors cloesly related with acute radioactive oral mucosa reactions were smoking history(OR =3.467,P ＜ 0.05),single-dose of gross tumor volume (GTV) ＞2.15 Gy(OR =3.393,P ＜ 0.05),while those with acute radiation skin reactions were diabetes history(OR =87.859,P ＜ 0.05) and hemoglobin values 1 week before radiotherapy ＞ 130 g/L (OR =21.404,P ＜ 0.05).Conclusions In the patients treated with concurrent radiochemotherapy for nasopharyngeal carcinoma,smoking history and single-dose of GTVnx is the independent risk factors of acute radiation oral mucosa reactions,while diabetes history and hemoglobin values I week before radiotherapy are the independent factors of acute skin reactions.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Ankle Injuries ; therapy ; Female ; Humans ; Male ; Sprains and Strains ; therapy ; Treatment Outcome ; Young Adult

Objective To investigate the value of clinical characteristics in diagnosis of vocal fold paralysis (VFP) and arytenoid dislocation .Methods Eighty - eight patients of VFP and 27 patients of arytenoid dislocation were studied , by comparing the causes , laryngeal morphologic characteristics and laryngeal electromyography (LEMG) .Results The causes of 88 VFP patients included surgery (45 cases) ,neck trauma(2 cases) ,idiopathic causes(16 cases) ,infection(16 cases) ,and tumor invasion - related(9 cases) .Of the 27 arytenoid dislocation pa‐tients ,24 had a history of endotracheal intubation and the others had a history of gastric tube insertion .The vocal folds were mostly fixed at the paramedian position ,followed by the abducent position and the median position .No significant differences were found in laryngeal morphologic characteristics between the two groups ,including vocal fold shape , glottis vertical symmetry , mucosal waves , supraglottic compensation , glottis closure and arytenoid movement .The LEMG of VFP patients appeared as denervation patterns ,reinnervation potentials ,or electrical si‐lence ;the recruitment patterns appeared as mix or simple patterns ;the evoked potentials were absent .Of the VFP patients ,54 cases(61 .36% % )were found synkinesis of involved posterior cricoarytenoid and two of them also in ‐volved thyroatenoid .The patients with synkinesis had lower percentage of vocal fold bowing and higher percentage of glottic vertical asymmetry compared to the ones without synkinesis .Of the VFP patients whose cause was surgery or neck trauma ,the median - position fixed vocal folds were mostly observed in the patients with duration of less than 1 month or with synkinesis .Of the 27 arytenoid dislocation patients ,20(74 .07% )showed normal LEMG pat‐terns and 7(25 .93% )showed apparent LEMG abnormality on the affected side .Conclusion The causes of vocal fold paralysis and arytenoid dislocation are different .Laryngeal morphologic characteristics have limitations in distinguis‐hing vocal fold paralysis from arytenoid dislocation .The shape and position of involved vocal folds of the VFP pa‐tients are correlated with duration ,nerve regeneration and synkinesis .

Objective To discuss MRI characteristics of dysplastic gangliocytoma of the cerebellum.Methods MRI manifesta-tions of 13 cases with dysplastic gangliocytoma of the cerebellum verified by operation and pathology were analyzed retrospectively. Results All of 13 cases were located in the cerebellar hemisphere and vermis.The lesions presented striated pattern of iso-intensity signal and hypo-intensity signal on T1-weighted images.The sign of tiger stripes was the feature in dysplastic gangliocytoma on T2-weighted and FLAIR images.All of the tumors showed slightly striated enhancement after intravenous administration of contrast agent.The mass effects of dysplastic gangliocytoma of the cerebellum along with the forth ventricle and brain stem oppressed were seen in all cases.NAA was mildly reduced on magnetic resonance spectroscopy (MRS)in 7 cases of dysplastic gangliocytoma of the cerebellum.Conclusion There are distinctive manifestations in MRI images for dysplastic gangliocytoma of the cerebellum,which has crucial diagnostic value before operation.

Objective To assess the tolerance of elderly patients with esophageal carcinoma to chemoradiotherapy through.Methods A retrospective analysis of 596 elderly patients with esophageal carcinoma receiving chemoradiotherapy was conducted.Patients were divided into radiachemotherapy group and radiotherapy group,and according to age,patients were divided into four age groups (aged 70-74,75-79,80 80 and 85years and over).The tolerance to treatment was assessed by Charlson index.Results 185 patients completed chemoradiotherapy,113 patients reduced the dose of chemotherapy (reduction group),81 patients unfinished chemoradiotherapy (unfinished CRT group),160 patients completed radical radiotherapy alone (unfinished RT group),and 57 patients incompleted radiotherapy.Further analysis found that the tolerance to treatment in reduction group had significant differences between patients aged ≥ 75 years and ＜ 75 years (x2 =6.815,P=0.009),and between WIC ≥ 1 and ＜ 1(x2 =10.636,P=0.001); the tolerance to treatment in unfinished CRT group had significantly differences between aged ≥ 80 years and ＜80 years (x2 =63.842,P=0.000),and between WIC =0,1 and ≥ 2 (x2 =21.153,P=0.000).Conclusions Further age re-grouping and WIC assessment is necessary before treating esophageal cancer patients.Reduction of therapy dosage is more beneficial for patients aged ≥ 75 years and WIC≥1,and greater caution is required in chemotherapy for patients aged ≥ 80 years and WIC＞1.

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Objective:To investigate the calcium-phosphate metabolic condition in maintenance hemodialysis patients with chronic kidney disease (CKD), and to observe the effect of large dose calcitriol on secondary hyperparathyroidism (SHPT).
Methods:We tested and compared the serum levels of calcium, phosphate, intact parathyroid hormone (iPTH), and alkaline phosphatase (AKP) in hemodialysis patients at different hemodialysis time (Group A with hemodialysis period≤3 years and Group B with hemodialysis period>3 years). We also detected those indexes before and after treating SHPT with large dose calcitriol. Twenty SHPT patients were divided into Group I (enlargement of parathyroid gland or nodule detected by color Doppler ultrasound) and Group II (normal parathyroid gland detected by color Doppler ultrasound).
Results:In the maintenance hemodialysis patients, the serum phosphate was (2.11±0.38) mmol/L and iPTH was (581.11±487.75) pg/mL. The serum level of iPTH in Group B was higher than that in Group A [(828.13±690.39) pg/mL vs (477.94±324.73) pg/mL, P<0.001]. In Group I, the serum level of iPTH [before vs after:(2471.7±898.3) pg/mL vs (2510.4±825.7) pg/mL] and AKP [before vs after:(524.2±18.8)U/L vs (511.3±19.3)U/L] did not change after the treatment of large dose calcitriol (P>0.05). In Group II, the serum level of iPTH [before vs after:(1358.5±302.8) pg/mL vs (369.3±43.4) pg/mL, P<0.001] and AKP [before vs after:(565.9±23.9)U/L vs (234.8±21.1)U/L, P<0.001] decreased signiifcantly after the treatment of large dose calcitriol.
Conclusion:Patients with longer time of hemodialysis have a higher level of iPTH. Large dose calcitriol can improve the clinical syndrome of SHPT, and decrease the level of iPTH and AKP in SHPT patients with normal parathyroid gland.

Objective To explore the clinical application of adaptive support ventilation (ASV) in elderly patients with acute respiratory failure.Methods A total of 46 mechanically ventilated patients aged over 65 years with acute respiratory failure admitted from January 2013 to June 2015 were enrolled.Comparison between the ASV mode and synchronized intermittent mandatory ventilation (SIMV) mode was carried out in respects of the impacts of both modes on respiratory mechanics, hemodynamics, oxygen availability and comfort rate.Results Difference between ASV and SIMV in respiratory rate was [(20.84 ±4.04) vs.(24.50 ±4.60) cycles/min, t =4.04, P ＜0.05], in inspiratory resistance was [(13.24 ±4.76) vs.(16.54±5.25) cmH2O/ (L·s), t=3.16, P＜0.05], in mean airway pressure was [(13.58±2.58) vs.(16.63 ±1.57) mmHg, t =6.84, P＜0.05], in peak airway pressure was [(25.96 ± 3.69) vs.(27.87 ± 2.45) mmHg, t =2.92, P ＜ 0.05], and tidal volume was [(378.41 ± 85.61) vs.(341.52 ± 86.84) mL, t =2.05, P ＜ 0.05], and comfort rate of patients was increased in ASV mode.There were no statistically significant differences in arterial oxygen partial pressure, carbon dioxide partial pressure, lactate, heart rate, mean arterial pressure and central venous pressure between the two modes (PP ＞ 0.05).Conclusions Compared with the synchronized intermittent mandatory ventilation mode, the adaptive support ventilation mode can improve the respiratory mechanics and can increase the comfort rate in the elderly patients with mechanical ventilation.