Objective To investigate the effect of dexmedetomidine on the serum concentrations of S-100 β protein and neurone specific enolase (NSE) in elderly patients undergoing surgery.Methods One hundred ASA Ⅱ or Ⅲ patients,aged 65 ～75 yr with a body mass index of ＜25 kg/m2,scheduled for elective hip joint replacement surgery under general anesthesia,were randomly divided into 2 groups (n =50):control group (group C) and dexmedetomidine group (group D).Dexmedetomidine 0.5 μg/kg was infused intravenously over 15 min before anesthesia induction in group D and was maintained 0.4 μg/(kg·h) until 30 min before operation end,while the same volume of normal saline was infused in group C.Anesthesia was induced by iv injection of sufentanil 0.4 μg/kg and propofol 1 ～ 2 mg/kg until loss of consciousness.Tracheal intubation was facilitated with 0.6 mg/kg rocuronium bromide and the patients were mechanically ventilated.Anesthesia was maintained with sevoflurane by target controlled inhalation (TCI) (end-tidal concentration set at 1％～3％) and sufentanil 0.2 μg/(kg·h) in both groups.BIS was maintained at 40～60 during operation.Venous blood samples were obtained for determination of serum concentrations of S-100β protein and NSE before anesthesia (baseline),operation end and at 12h after operation.Patients were sent to Intensive Care Unit when operation end.All the patients were assessed for the development of delirium by experience research staff using Confusion Assessment Method for Intensive Care Unit.The incidence of postoperative delirium within 24h after operation were recorded,and compared between the two groups.Results The serum concentrations of S-100β protein and NSE was significantly increased at T1～2 than at T0 in two groups.The total dose of each anesthetic (propofol,sevoflurane),the serum concentrations of S-1005 protein and NSE,and the incidence of postoperative delirium were significantly lower in group D than in group C (P＜0.05).Conclusions Dexmedetomidine can reduce the serum concentrations of S-100 β protein and NSE,and can also reduce the occurrence of postoperative delirium in elderly patients undergoing hip joint replacement surgery.Dexmedetomidine can provides cerebral protection in elderly patients undergoing surgery.

Objective To compare the efficacy of combined intravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask versus laryngeal mask airway (LMA).Methods Seventy-two children,scheduled for elective high ligation of indirect inguinal hernia,were randomly divided into 2 groups (n =36 each):nasopharyngeal airway-face mask group (group M) and LMA group (group L).Propofol 1.0 mg/kg and fentanyl 2.0μg/kg were injected intravenously.The spontaneous breathing was kept.After lass of consciousness,a face mask was placed for inhalation of pure oxygen at 2 L/min and 3 ％ sevoflurane.When BIS value reached 50-60,a size 2 LMA was inserted in group L and a nasopharyngeal airway was placed via the left nasal cavity and the face mask was held tightly and connected to the anesthesia machine in group M.Anesthesia was maintained with inhalation of 2％-4％ sevoflurane.Fentanyl 1 μg/kg was injected intravenously 5 min before skin incision.The concentration of sevoflurane was adjusted to maintain BIS value at 40-60 during surgery.Mean arterial pressure,heart rate,partial pressure of end-tidal carbon dioxide and pulse oxygen saturation were recorded before induction,at 3 min during induction,immediately after successful insertion of the airway,at skin incision,3 min after skin incision,and immediately after removal of the airway.The airway insertion time,success rate of insertion at first attempt,emergence time,and adverse reactions were recorded.Results Compared with group L,mean arterial pressure and heart rate were significantly decreased during airway insertion or removal,nasopharyngeal airway insertion time was shortened and the success rate of nasopharyngeal airway insertion at first attempt (100％) was increased,and the agitation score and incidence of obstruction of the upper respiratory tract were decreased in group M (P ＜ 0.05).Conclusion Combined inravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane is easy to establish the airway,can maintain spontaneous breathing,has little influence on circulatory function and reduce complications during recovery from anesthesia in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask,and the efficacy is better than that with LMA.

Purpose　The aim is to sulfonize Hunai polysaccharide fr om p leurotus tuber-rigium(Fr.)Sing. and to evaluate the antioxidative activities of the sulfated po lysaccharide (S-HNP).Methods　S-HNP was prepared by the reacti on of Hunai polysaccharide with chlorosulfonic acid-Pyridine. The antioxidative activities o f S-HNP were evaluated as follows: (1) the inhibition effects on Fe2+- Vc inducing the injury of rat liver mitochondria in vitro, (2) the protectiv e ef fect on CuSO4 -Phen-Vc-H2O2 inducing the damage of DNA, (3) the scaven ging effect on O*-2. Results　 S-HNP could protect mitochondria from lipid peroxidation induced by Fe2+-Vc, i ncluding the inhibitions of the increase of TBARS content, the swelling of mitoc hondria and the decrease of membrane fluidity, and protect DNA from the damage induced by CuSO4-Phen-Vc-H2O2， and scavenge O*-2 generated in the sel f-oxidation of pyrogallic acid. Conclusion　S-HNP exhibi ted marked antioxidative activities.

Objective To analyze the reasons of CT misdiagnosis of solid-pseudopapillary tumor of pancreas (SPTP), including wrong orientation, mislocation. Methods The literatures on SPTP were discussed. Results Lesions of SPTP could appear at any position of the pancreas. Conclusion The result is very significant for guiding treatment and judging prognosis.

Objective: To study the association between the AKAP12 promoter methylation and recurrence of hepatocellular carcinoma. Methods: A total of 142 primary liver cancer patients underwent surgery in department of Hepatobiliary surgery in Peking University Cancer Hospital from 2003 to 2009 were selected as subjects in the survey; with the inclusion criteria as hepatocellular carcinoma, no cancer cells were observed in the surgical margin(SM) samples. All patients had neither lymph nor distant metastasis at the time of surgery, and receiving complete follow-up data for at least 3 years. By the end of May 2014, a total of 75 patients had relapsed of whom 71 died and there were no lost. All samples were acquired from the frozen surgical tissues. Genomic DNA was extracted using phenol/chloroform method and performed bisulfite modification following with polymerase chain reaction (PCR). AKAP12 methylation in hepatoma and the corresponding SM samples from 142 patients was determined by denature high-performance liquid chromatography (DHPLC) and bisulfite clone sequencing. Kaplan-Meier and Cox proportion hazard regression model were used to identify the factors related to the survival time. Results: In 142 cases, 125 patients (88.0%) were male and 17 (12.0%) cases were female. The median age was 52.5 years, ranging from 34 years to 76 years. AKAP12 methylation-positive rate was significantly higher in hepatomas than SMs (54.9% vs. 10.2%, P<0.001). Patients with AKAP12 methylation-positive had less risk of the recurrence (HR=0.62, 95%CI: 0.39-0.99); with tumor diameter more than 5 cm (HR=1.53, 95%CI: 1.00-2.50),portal vein invasion(HR=4.53, 95% CI:2.69-7.64) increased the recurrence risk. Moreover, portal vein invasion had a higher risk of death (HR=2.98, 95% CI: 1.73-4.98). Conclusion There was significant association between AKAP12 DNA methylation and low risk of recurrence and long progression-free survival of hepatocellular carcinoma patients.

OBJECTIVE: To explore the method and effect of the midfacial degloving approach and modified hemifacial degloving approach associated with nasal endoscopic surgery in the treatment of the nasal diseases. METHOD: Thirty patients with nasal diseases were treated with nasal endoscopic surgery by midfacial degloving approach and modified hemifacial degloving approach. Four cases underwent midfacial degloving approach with standard method, three cases were underwent by hemifacial degloving approach and our modified hemifacial degloving approach associated with nasal endoscopic surgery were performed in twenty-three cases. We used Caldwell-Luc's approaches which located mainly in affected-side, and modified bilateral intercartilaginous incision, which at first peeled off integrality healthy-side cutis and mucosa of nasal septum as well as periosteum of basis nasi. With preserving the integrality of the healthy-side nasal cavity parenchyma, the pyriform aperture incisions extending to the healthy-side vestibule wasn't been cut. With the incisions of septal cartilage of nasal and disease- side cutis and mucosa of nasal septum as well as the pyriform aperture incisions extending to the affected-side vestibule, the lesion were cleared away completely by modified midfacial degloving approach associated with nasal endoscopic surgery. RESULT: All cases cuts achieved primary healing. One of four cases with midfacial degloving approach suffered from straightness of nasal vestibule. One of three cases with hemifacial degloving approach was led to perforation of nasal septum. In 23 cases operated hy modified hemifacial degloving approach, no straightness of nasal vestibule and no perforation of nasal septum was happened. CONCLUSION The midfacial degloving approach and modified hemifacial degloving associated with endoscopic surgery can achieve the advantages of a widely exposed field for operation, no facial scar, making tumour resection easier, and also no nasal- stuffed in healthy nasal cavity as well as no straightness of nasal vestibule after modified approach.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Endoscopy ; methods ; Face ; surgery ; Female ; Humans ; Infant ; Male ; Middle Aged ; Nasal Septum ; surgery ; Nose ; surgery ; Nose Diseases ; surgery ; Otorhinolaryngologic Surgical Procedures ; methods ; Young Adult

Objective To study the iodine nutritional status among the key population in Chenzhou City of Hunan Province,and to provide scientific basis for prevention and control of iodine deficiency disorders (IDD).Methods According to the "Hunan Iodized Salt Monitoring Pilot Scheme",total of 11 counties (cities,districts) were selected in Chenzhou City in 2015.One township was selected by east,west,south,north and center in each county (city,district).Four villages were drawn from each township,and 15 households were selected from each village to collect salt samples.Forty children aged 8 to 10 years old (half male half female) were selected from each primary school in each township.Urine samples were taken and the goiter was examined.Totally 20 pregnant women were selected from each township and urine samples were collected.The content of iodine in salt samples and urine samples were detected by the method of direct titration and As-Ce catalytic spectrophotometry,respectively.The status of goiter was detected using palpation.Results Totally 3 300 salt samples were detected in 2015,the median of salt iodine content was 25.2 mg/kg.The coverage and qualified iodized salt consumption rates were 99.61％ (3 287/3 300) and 95.30％ (3 145/3 300),respectively,which achieved the standard for the elimination of IDD.Totally 2 200 urine samples of children aged 8 to 10 years old were tested,the median of urinary iodine was 238.98 μg/L.There was variations of urinary iodine in children aged 8 to 10 years old in each county (H =32.25,P ＜ 0.01).Totally 2 200 children aged 8 to 10 years old were checked,and no goiter was found.Totally 1 100 urine samples of pregnant women were detected,the median of urinary iodine was 204.25 μg/L.There was variations of urinary iodine in pregnant women in each county (H =117.47,P ＜ 0.01).Conclusions Totally,the iodine nutritional status among the key population is appropriate in Chenzhou City.However,surveillance and health education should be continuously strengthened in the future.