Objective To evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of thoracic tuberculosis.Methods The study was retrospective,from September 2009 to September 2012,38 patients who underwent EBUS-TBNA were finally diagnosed of thoracic tuberculosis,with enlarged hilar or mediastinal Iymph nodes on chest enhanced computed tomography(≥ 1.0 cm).Patients in whom EBUS TBNA was nondiagnostic subsequently underwent surgical biopsy.All the patients had a minimum of 6 months clinical and radiologic follow-up.Results EBUS-TBNA was performed on a total of 88 lymph node stations in 38 patients.Of the enlarged lymph nodes,60(68.18％) were located in the mediastinal region and the remaining 28 (31.82 ％) around the hilum or interlobar area.Of the 38 patients,EBUS-TBNA achieved definitive diagnosis in 34 patients(89.47％).EBUS was well tolerated by all of the patients with no complications.Conclusion EBUS-TBNA is a safe procedure with a high yield for the diagnoses of thoracic tuberculosis.

Objective To evaluate the efficacy of combined various surgical procedures for the treatment of post-traumatic epilepsy.Methods According to the preoperative primary location of epileptogenic focus and the monitoring results of intraoperative electrocorticography and depth electrodes,21 seizure patients were treated with various surgical procedures: 7 cases with epileptogenic focus resection,8 cases with epileptogenic focus resection combined with multiple subpial transection(MST),4 cases with anterior temporal lobectomy combined with amygdalo-hippocampotomy,1 case with selective amygdalo-hippocampotomy under neuronavigation,and 1 case with anterior callosotomy combined with MST and bipolar coagulation on funtional cortexes. Results All the patients were followed up from 3 months to 10 years postoperatively,and the surgical outcomes were such as the followings: satisfactory outcome in 9 cases(42.9%),marked improvement in 7 cases(33.3%),improvement in 3 cases(14.3%),slight improvement in 1 case(4.8%) and no improvement in 1case(4.8%).There was no died cases caused by the surgical procedures.Eight patients had temporary dysfunction after operation,but all recovered in four weeks after surgery.Conclusion The combined various surgical procedures are effective and safe for the treatment of post-traumatic epilepsy.

A method was developed for the determination of N-acetyl-S-( N-methylcarbamoyl ) cysteine ( AMCC) in human urine by online solid-phase extraction ( SPE )-high performance liquid chromatography ( HPLC ) . The separation of AMCC from the urine matrix was performed on AmoniPac PA Solid phase Extraction ( SPE ) column with 5 mmol/L KH2 PO4 as the mobile phase by left pump. Then the time was controlled to switch the valve to make only the section of sample containing AMCC transferred into the analytic column-Acclaim PAⅡ C18 . The determination was performed using gradient elution of 0. 1% H3 PO4 (containing 5% acetonitrile) and acetonitrile by right pump. The results showed that AMCC present good linear correlation in the range of 1 . 0-100 mg/L with a correlation coefficient of above 0 . 999 , the quantitation limit of the method was 0. 2 mg/L (with the sample inject volume =10 μL), the recoveries of spiked samples were in the range of 82 . 9%-85 . 9%, and the relative standard deviation ( n=6 ) of retention time and peak area were 0. 2% and 4. 0% respectively. Compared with offline SPE-HPLC, the proposed method was convenient, environmentally friendly, efficient and stable, and feasible for the detection of AMCC in 7 human urine samples.

Objective To investigate the effects of electrocorticography(ECoG) monitoring in microsurgical treatment of intracranial cavernous hemangiomas(ICH).Methods Fifteen cases of ICH with secondary epilepsy were investigated from 2000 to 2005.They all had been performed ECoG monitoring during operation for determining the precise position and scope of focal epileptogenicity.Results Follow-up visit found 10 cases cured without drugs,4 cases total controlled with 1/4~1/3 quantity of premedicant,1 case had epileptic seizure by chance with drugs.Conclusion ECoG monitoring can provide the direction during the surgical procedure,and controls the postoperative epileptic seizure.

Objective To explore the time of application of hemoperfusion (HP) for the treatment of acute serious organophosphorus pesticide (ASOPP). Methods One hundred and four patients with ASOPP were randomly divided into two groups, 46 patients accepted traditional treatment(control group), 58 patients were treated with traditional treatment and HP (HP group). The patients in HP group were again divided into three groups according the different time of treatment (time of beginning HP after poisoning), the 4-8 hours group (HP-1 group, 27 patients), the 9-16 hours group (HP-2 group, 19 patients), the 17-32 hours group (HP-3 group, 12 pafients).Tbe coma period, the dosage of atropine, the time of regaining the vitality of cholinesterase, the time of hospitalization and the rate of fatality and curing among groups were observed. Results The coma period, the dosage of atropine, the time of regaining the vitality of cholinesterase, the time of hospitalization and the rate of fatality of the HP group were less than those of the control group (P<0.05). Compared with HP-1 group, the eoma period, the dosage of atropine, the time of regaining the vitality of eholinesterase and the time of hospitalization of the HP-2 group and the HP-3 group were higher (P<0.05), but the difference of the rate of fatality and curing between the HP-1 group and the other HP groups was not statistically significant (P>0.05). The difference of all of the above indicators between HP-2 group and HP-3 group was not statistically significant (P>0.05). Conclusion Application of hemoperfusion among 4-32 hours after poisoning for the treatment of ASOPP can improve the efficacy of therapy, and the efficacy of application of hemoperfusion among 4-8 hours is the best.

Objective:To investigate the effect of dexmedetomidine (DEX) on reducing urethral stimulation in patients undergoing laparoscopic gastrointestinal surgery.Methods:From January 2019 to February 2020, 90 patients undergoing elective laparoscopic gastrointestinal surgery under general anesthesia in the Third Affiliated Hospital of Sun Yat-sen University were selected. They were randomly divided into 3 groups: catheterization before induction (group A), catheterization during induction (group B), and catheterization after induction (group C). In group A, patients received general anesthesia after awake catheterization. In group B, intravenous injection of DEX 0.5 μg/kg was pumped for 10 minutes, followed by catheterization and induction. In group C, patients received general anesthesia and then catheterization. Visual analogue scale (VAS) score of urethral stimulation, morphine dosage and the incidence of agitation during resuscitation were recorded. The heart rate and mean arterial pressure of the three groups were compared at the time of entering the room, catheterization, tracheal intubation, entering postanesthesia care unit (PACU), about extubation and 30 minutes after extubation.Results:The fluctuation of blood pressure and heart rate in group B was significantly less than that in group A and group C at the time of extubation and 30 minutes after extubation ( P<0.05). VAS of urethral stimulation in group B [(2.9±0.9)point] was significantly lower than that in group A [(4.4±1.8)point] when catheter was indwelling ( P<0.05). After extubation, VAS in group B [(2.8±1.1)point] was significantly lower than that in group A [(3.2±1.2)point] and C [(5.2±1.8)point] ( P<0.05). The utilization rate of morphine within 24 hours after surgery in group B (10%) was significantly lower than that in the other two groups (40%, 57%), and the incidence of postoperative agitation in group A and B was lower than that in group C within PACU ( P<0.05). The satisfaction of patients in group B (86.7%) was higher than that in group A (70%) and C (46.7%). The satisfaction of PACU personnel in group A (76.7%) and B (80%) was significantly higher than that in group C (43.3%). Conclusions:Sedation with dexmedetomidine during urethral catheterization can reduce urethral stimulation during resuscitation and improve patients' and PACU staffs' satisfaction.

Objective: To establish a method for rapid determination of 47 volatile organic compounds in the air of workplace using portable gas chromatography-mass spectrometer(GC-MS). Methods: The mixed standard gas with different concentration levels was made by using the static gas distribution method with the high purity nitrogen as dilution gas. The samples were injected into the GC-MS by a hand-held probe. Retention time and characteristic ion were used for qualitative analysis,and the internal standard method was usd for quantitation. Results: The 47 poisonous substances were separated and determined well. The linear range of this method was 0.2-16.0 mg/m³,and the relative standard deviation of 45 volatile ovganic compounds was 3.8%-15.8%. The average recovery was 79.3%-119.0%. Conclusion The method is simple,accurate,sensitive,has good separation effect,short analysis period, can be used for qualitative and quantitative analysis of volatile organic compounds in the workplace, and also supports the rapid identification and detection of occupational hazards.

OBJECTIVEThe aim of the present study was to evaluate the modulating effect of glycyrrhizic acid C-18 epimers, 18alpha-glycyrrhizic acid (alpha-GL) and 18beta-glycyrrhizic acid (beta-GL) on both P-glycoprotein (P-gp) activity and expression in Caco-2 cell.

METHODThe effects of P-gp activity were analyzed by rhodamine (Rhd 123) accumulation test, and those of P-gp expression were analyzed by flow cytometry and real-time PCR.

RESULTAt middle and high concentrations (10, 60 micromol x L(-1)), alpha-GL inhibited the function of P-gp and with on dose dependent while beta-GL induced the function of P-gp at three test concentrations with no dose dependent too. At middle and high concentrations (10, 60 micromol x L(-1)), alpha-GL down-regulated the expression of MDR1 mRNA. At high concentrations (60 micromol x L(-1)), beta-GL up-regulated the expression of MDR1 mRNA; At high concentrations (60 micromol x L(-1)), beta-GL induced the expression of P-gp protein while alpha-GL has no effect on the expression of P-gp protein at three test concentrations.

CONCLUSIONThe effects of alpha-GL and beta-GL on the expression of MDR1 mRNA and CYP3A mRNA showed the same trend. The character that epimers of GL act on CYP3A and P-gp show similar stereo selectivity whether relate to PXR need further study.

ATP Binding Cassette Transporter, Sub-Family B ; genetics ; metabolism ; Caco-2 Cells ; Down-Regulation ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; Gene Expression ; drug effects ; Glycyrrhizic Acid ; chemistry ; pharmacology ; Humans

Objective:To explore the effect of previous intestinal resection on anastomotic fistula within 30 days after surgery in Crohn′s disease.Methods:The clinical data from 92 Crohn′s disease patients who underwent intestinal resection and anastomosis at the Department of General Surgery in Shanghai Ninth People′s Hospital, Shanghai Jiaotong University School of Medicine from Jan 2016 to Sep 2019. Patients were divided into no previous intestinal resection group ( n=45) and previous intestinal resection group ( n=47). The relationship between previous intestinal resection and postoperative anastomotic leak in Crohn′s disease patients with intestinal resection and anastomosis was analyzed. Results:A total of 11 cases (12% leak rate) underwent postoperative anastomotic leak. There were 2 leaks in patients with no previous history of intestinal resection, while 9 leaks in patients with previous bowel resection (χ 2 =4.722, P=0.03). The OR of the postoperative anastomotic leak in Crohn′s disease patients with previous intestinal resection compared with no previous intestinal resection group was 5.092 (95% CI: 1.035-25.048). Patients with 1 previous resection (24 cases) had a leak rate of 13%, whereas patients with >1 previous resection episodes (23 cases) had a leak rate of 26%. The number of previous resection episodes correlated with an increasing risk for clinical anastomotic leak (correlation coefficien r=0.995). Conclusions:Previous intestinal resection is an independent risk factor for ensuing postoperative anastomotic leak in Crohn′s disease patients with intestinal resection and anastomosis.