Objective To evaluate the effects of 6% hydroxyethyl starch (HES)130/0.4 and 6% HES 200/0.5 on blood coagulation in patients undergoing major operation under general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing major operation under general anesthesia during which the blood loss was expected to be＞20%of blood volume were allocated randomly into 3 groups(n=20 each):Ⅰ control group(C);Ⅱ6% HES200/0.5 group (H) and Ⅲ HES130/0.4 group (V).In group H and V the patients Arterial blood samples were taken before(T1),immediately(T2)and 1 h after the end of fluid infusion(T3)for determination of hematocrit(Hct),platelet count(PLT)and prothrombin time(PT),platelet maximum aggregation test induced by 5 μmol/L ADP,and Sonoclot coagulation and platelet function analysis(gbACT,CR,PF,TP).Activated partial thromboplastin time(Am),coagulation factor Ⅷ (FⅧ)activity and von Willebrand factor(vWF)were measured only in group H and V.Results (1) PT and APTT were significantly prolonged after fluid infusion at T2 and T3 as compared with the baseline values at T1 in group H and V.(2)FⅧ activity and platelet maximum aggregation induced by ADP were significantly decreased at the end of fluid infusion at T2 as compared with the baseline at T1 but increased again at T3 in group H and V.(3)There was no significant change in Sonoclot coagulation parameters after fluid infusion as compared with the baseline except clot formation rate (CR)in group H and V.Conclusion Acute hypervolemic hemodilution with 6% HES130/0.4 or 200/0.5 has minimal effect on blood coagulation and there is no significant difference in blood coagulation changes induced by 6%HES130/0.4 and 200/0.5.

Interleukin-21 (IL-21) is a recently discovered cytokine with immunomodulatory activity. It is a new member of the IL-2 family and mainly secreted by the activated CD4~+ T cells. IL-21 can promote proliferation, differentiation and function of T cells, natural killer (NK) cells, and B cells after binding with its receptor, thereby effectively strengthen the innate immunity and acquired immunity. The antitumor activity of IL-21 has been demonstrated in several tumor models. Its phase Ⅱ trials is being carried out in metastatic melanoma and renal cell carcinoma. IL-21 has a broad application prospects in the treatment of malignant tumors. Here, we review the anti-tumor effects of IL-21 and the application foreground of combination of IL-21 with other drugs in future tumor immunotherapy.

Objective:To investigate the dynamic changes of thyroid function and risk factors of hypothyroidism and delayed thyroid stimulating hormone (TSH) elevation in late preterm infants.Methods:This study retrospectively recruited 782 late preterm infants admitted to Nanjing Medical University First Affiliated Hospital and performed thyroid function monitoring from January 2017 and December 2019. Thyroid function test was performed in all cases at 4-7 d after birth and repeated at 2-4 weeks of age for those with normal results or two weeks after the first test for those with abnormal. The test would be continued if the second test was abnormal and stopped until the thyroid function became normal or hypothyroidism was diagnosed, based on which, these infants were divided into hypothyroidism ( n=11) and non-hypothyroidism groups ( n=771), or delayed TSH elevation ( n=71) and normal thyroid function groups ( n=450). The characteristics of thyroid hormone changes and perinatal data were compared between different groups using two independent sample t-test and Chi-square test, and risk factors of hypothyroidism and delayed TSH elevation were analyzed using logistic regression tests. Results:(1) Dynamic changes of thyroid function: among these 782 late preterm infants, five infants were found with transient hypothyroxinemia at the first test, and became normal at the second test; 249 (31.8%) exhibited hyperthyrotropinemia, and four of them were diagnosed with hypothyroidism based on the second and the third results; 71(9.1%) with delayed TSH elevation all became normal later; 11(1.4%) were diagnosed with hypothyroidism and treated with thyroxine, among which, seven cases were diagnosed at the first test, three at the second test and one at the third test. (2) Risk factors for hypothyroidism: lower birth weight was noted for infants with hypothyroidism compared with those without [(2 140.9±455.1) vs (2 464.1±474.0) g, t=-2.247, P=0.025]. Multivariate logistic regression analysis found that for every one gram reduction in birth weight, the risk of hypothyroidism elevated by 0.002 times ( OR=1.002, 95% CI: 1.000-1.004, P=0.045). (3) Risk factors for delayed TSH elevation: the birth weight was lower [(2 395.4±420.9) vs (2 523.6±462.3) g, t=-2.200, P=0.028], and the proportion of small for gestational age and twin pregnancy were higher in the delayed TSH elevation group than those in the normal thyroid function group [15.5% (11/71) vs 7.1% (32/450), χ2=5.690, P=0.017; 29.6% (21/71) vs 18.7% (84/450), χ2=4.537, P=0.033]. Multivariate logistic regression analysis found that small for gestational age ( OR=4.366, 95% CI: 1.649-11.564, P=0.003) and twin pregnancy ( OR=1.943, 95% CI: 1.048-3.600, P=0.035) were independent risk factors for delayed TSH elevation. Conclusions:Late preterm infants have a high incidence of different kinds of thyroid dysfunction. Thyroid function monitoring is necessary for late preterm infants because those with lower birth weight are more susceptible to develop hypothyroidism, and those small for gestational age infants and twins are more susceptible to develop delayed TSH elevation.

OBJECTIVE: Based on contiguous axial computed tomography (CT) images of the frontal sinus, a three-dimensional (3D) visualization and reconstruction of fronto-ethmoidal cells was performed using Intage Realia (version 2011) software to generate a model to accurately understand the anatomical structure of fronto-ethmoidal cells. METHOD: Retrospective analyses of nose CT scan data of 50 patients without sinusitis were performed. Using Digital Imaging and Communications in Medicine (DICOM) images of sinus axial CT scans, the 3D visualization and reconstruction of the sinus was performed using the Achilles tendon and nasal passage modes in Intage Realia (version 2011) software on personal computers. Two segmentations were performed on the reconstructed sinus, and the structures of the agger nasi, frontal cells, and supraorbital cells and the relative locations of the frontal sinus drainage pathway and cells were observed. RESULT: The 3D visualization of the fronto-ethmoidal cells and frontal sinus drainage pathway was successful, allowing accurate observation of the anatomical characteristics of the fronto-ethmoidal cells. CONCLUSION The 3D visualization of fronto-ethmoidal cells can be reconstructed based on contiguous axial CT images of the sinus, allowing an accurate understanding of the anatomical structure of fronto-ethmoidal cells and is well prepared for frontal sinus surgeries.
Frontal Sinus ; anatomy & histology ; surgery ; Humans ; Image Processing, Computer-Assisted ; Nasal Cavity ; Nose ; Paranasal Sinuses ; Retrospective Studies ; Sinusitis ; Software ; Tomography, X-Ray Computed

Objective To assess the effect of quality control circle on blood pressure and metabolic syndrome in patients with newly diagnosed primary hypertension. Methods Review health examination in 132 cases of newly diagnosed patients with primary hypertension as the control group, routine health education was given. The 128 cases of patients with newly diagnosed primary hypertension as the intervention group and the prospective study was done.The quality control group of quality control circle was set up in order to improve treatment adherence for patients with newly diagnosed primary hypertension, and the nursing intervention was implied for the intervention group for 6 months. Blood pressure and metabolic syndrome were compared between the two groups. Results The compliance rate was improved from 56.3%(72/128) to 90.6%(116/128) after intervention in the intervention group. There was significant difference before and after intervention (χ2=62.57, P<0.01).The systolic blood pressure, diastolic blood pressure, triglyceride (TG), fasting blood glucose (FBG) and waist circumference were (151.6±11.3) mmHg (1 mmHg=0.133 kPa), (98.6±12.1) mmHg, (1.98±0.36) mmol/L, (6.37±1.25) mmol/L, (92.88±6.90) cm respectively before intervention in the intervention group and were (132.6±14.3) mmHg, (82.5 ± 12.5) mmHg, (1.53 ± 0.17) mmol/L, (5.34 ± 1.06) mmol/L, (83.29 ± 5.47) cm respectively after intervention. There was statistically significant difference before and after intervention in the intervention group(t=7.11-12.79, P<0.05). The systolic blood pressure, diastolic blood pressure, TG, FBG and waist circumference were (150.4 ± 10.6) mmHg, (99.4 ± 10.8) mmHg, (1.94 ± 0.39) mmol/L, (6.52 ± 0.29) mmol/L, (91.37±6.03) cm respectively before intervention in the control group and were (145.3±13.7) mmHg, (92.6± 10.9) mmHg, (1.86 ±0.31) mmol/L, (6.02±0.27) mmol/L, (93.86±6.52) cm respectively after intervention. There was significant difference in systolic blood pressure and diastolic blood pressure before and after intervention in the control group (t=3.38, 5.09, P<0.05). But the difference was not statistically significant in TG, FBG and waist circumference (t=1.85, 1.27, 1.93, P>0.05). The difference of systolic blood pressure,diastolic blood pressure,TG, FBG and waist circumference between two groups was statistically significant after the intervention (t=6.77-12.84,P<0.05). The intervention group was significantly better than the control group. Conclusions The quality control circle may improve treatment adherence and it is helpful to improve the metabolic syndrome and it has high clinical application value for the treatment of primary hypertension.

Objective To evaluate the efficacy of dexmedetomidine used to supplement lumbar plexus combined with sciatic nerve block for total hip arthroplasty in the elderly patients.Methods Fifty ASA Ⅱ or Ⅲ patients,aged 80-93 yr,with a body mass index of 17-25 kg/m2,scheduled for unilateral total hip arthroplasty,were randomly divided into 2 groups (n =25 each):normal saline group (group NS) and dexmedetomidine group (group D).Lumbar plexus combined with sciatic nerve block was performed guided by a nerve stimulator in both groups.After a loading dose of dexmedetomidine 0.5 μg/kg was infused over 10 min starting from 20 min after the block,dexmedetomidine was infused at 0.2 μg· kg-1 · h-1 until the end of surgery.While the equal volume of normal saline was given instead of dexmedetomidine in group C.Propofol 20 mg or ketamine 10 mg was infused intravenously when the efficacy of the block was inadequate.The mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation (SpO2),respiratory rate (RR),side effects during operation,requirement for propofol or ketamine and doctor' s satisfaction were recorded after admission to the operating room,immediately after iv administration,at 0,10 and 30 min after the beginning of surgery,and at the end of surgery (T0-5).Results Compared with the baseline value at T0,MAP and HR were significantly increased at T2-5 in group C (P ＜ 0.05),and no significant change was found in the hemodynamic parameters at each time point in group D (P ＞ 0.05).Compared with group C,the MAP,HR,incidences of respiratory depression and agitation and requirement for propofol or ketamine were significantly decreased,and the doctor's satisfaction was significantly increased (P ＜ 0.05).Conclusion Dexmedetomidine can increase the efficacy of lumbar plexus combined with sciatic nerve block when used for supplementation of total hip arthroplasty in the elderly patients,the hemodynamics is stable and side effects are fewer.

Objective The incidence of laryngeal cancer has characteristic of regional differences, but the etiology is not clear. The aim of this study was to analyze the correlation between RECK gene promoter methylation and prognosis of laryngeal squamous cell carci-noma patients through detecting the RECK gene methylation status of primary laryngeal squamous cell carcinoma and adjacent tissues . Methods Methylation specific PCR assay was used to detect the RECK gene promoter methylation status of 70 laryngeal squamous cell carci-noma specimens in our hospital from July 2006 to Dcember 2007, and the differences of methylation status with different pathological parame-ters were compared.The correlation between RECK gene promoter methylation and prognosis of 64 patients completed five-year follow-up was analyzed. Results The RECK gene methylation rate (86.67%) of patients with poor differentiation in tumor cells was much higher than that of the patients with a moderate and better tumor cell differentiation (43.64%) (P<0.05).In 29 pairs of laryngeal cancer-adjacent tis-sues specimens matches, the RECK gene methylation in laryngeal carcinoma (55.12%) was higher than normal tissues (27.59%) ( P=0.029).RECK gene methylation significantly shortened the tumor free survival and overall survival analyzed by Log-rank (P=0.024, P=0.017).Lymph node metastasis and clinical stage in classⅢ-Ⅳsignificantly shortened the tumor free survival and overall survival (P=0.029, P=0.024;P=0.033, P=0.032).Moderate and better tumor cell differentiation significantly shortened the tumor free survival (P=0.024, P=0.049).Lymph node metastasis, clinical stage, and RECK gene methylation were independent risk factors of overall survival. Conclusion RECK gene promoter methylation in human laryngeal squamous cell carcinoma is an early event and may occur in the adjacent normal tissues, predicting a poor prognosis in patients.

Objective To explore the variation of engine exhausts and its secondary pollutant in the daytime. Methods The concentration of engine exhausts(NOx) and its secondary pollutant(O3) were determined during 7:00-17:00, Apr 10th and 12th, 2005. The ratio of air pollutants to vehicle flow (KNOx, KO3) was analyzed to reflect the variation of air pollutants concentration in the daytime. Results The values of KNOx, and KO3 showed the same trend during 7:00-9:00 and 17:00-18:00, the opposite trend during 11:00-15:00. The peak value was observed at 12:00 for KNOx with the lowest level, at 13:00 for KO3 with the highest level. Conclusion Air pollution by secondary pollutant from engine exhausts is associated with sunlight.

Objective To evaluate the role of early growth response gene1 (Egr-1) in liver injury in taurocholate-induced acute pancreatitis rat model. Methods Twenty-four male rats were divided into 4 groups. Egr-1 immunohistochemistry staining and pancreatic pathologic scoring were assessed, and the serum levels of AST, LDH, TNF-? and IL-1 ? were measured. Egr-1 mRNA levels of primary hepatocyte culture stimulated with TNF-? and pretreated primary hepatocytes with PD98059 followed by TNF-? stimulation were also observed. Results Egr-1 expression of liver correlated with degree of liver injury in acute pancreatitis in rat, and high Egr-1 mRNA expression of primary hepatocyte was observed when hepatocyte injury occurred. After pretreated with PD98059, TNF-?-stimulated hepatocytes showed a lower level of Egr-1 mRNA compared with hepatocytes without pretreatment. Conclusions Egr-1 may play an important role in liver injury in acute pancreatitis, and this effect depended partly upon extracellular signal-regulated kinase 1/2 (ERK1/2) pathway.

Objective To study the health state and service of the elderly in the Tongbai community. Methods The educational degree, disease histories, daily living capability, health care demand and the controlled state of hypertension and diabetes were recorded by questionnaires and physical examination. Results Overweight or obesity (66.1%) was the common disease, hypertension (42.2%) next, then coronary disease (10.0%) and diabetes (9.1%). Nearly 43.3% hypertension patients never or seldom measured their blood pressure. The rate of ideal blood pressure was lower than 25%. 30.4% diabetes patients never or seldom measured their fasting glucose and 69.3% patients never or seldom measured their post-meal glucose. 46.1% of the elderly required one or more kinds of community health services, in which annual health examination was 32.6%, and the next was health guide (23.0%), 53.9% of the elderly had no requirement of community services except medical care. Conclusion The elderly in community had high prevalence and poor control of chronic diseases. They did not fully understand the community health services, which brought the challenges to the medical care, health prevention, health education and reasonable utility of hygiene resources in community health services.