Craniocerebral Trauma ; Earthquakes ; Head ; Humans

Objective To investigate the effect of ropiyacaine combined with intra-spinal epidural anesthesia by using the same volume but different injection speed on anaesthetic level.Methods 80 cases of patients of ASA～Ⅱdegree suitable to use intra-spinal epidural combined anesthesia for gynecologic operation were selected and ran- domly divided into three groups,0.75 % ropivacaine 2mg(15mg)administered,group A the speed of injection was 10 seconds,group B injection speed was 20 seconds,group C injection speed was 30 seconds,the anaesthetic level reached T_(10).The time of highest level in spinal anesthesia,30 minutes after spinal anesthesia MAP,and number of cases need to add epidural drug were all recorded.Results The best effect of anesthesia was found in group B,the block level of anesthesia was satisfactory,blood dynamic was stable,and there was no need to add epidural drug.Conclusion The speed of 0.75 % ropivacaine 2ml spinal epidural combined with anesthesia was suitable at the speed of 20 seconds.

Amifostine ; pharmacology ; Animals ; Benzene ; toxicity ; Blood ; drug effects ; Blood Cell Count ; Male ; Mice ; Random Allocation

Aminopyridines ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Benzamides ; therapeutic use ; Clinical Trials as Topic ; Depsipeptides ; therapeutic use ; Histone Deacetylase Inhibitors ; therapeutic use ; Histone Deacetylases ; metabolism ; Humans ; Hydroxamic Acids ; therapeutic use ; Indoles ; therapeutic use ; Neoplasms ; drug therapy ; enzymology ; Sulfonamides ; therapeutic use

OBJECTIVETo explore the risk factors and prevention strategies of post-operative complications in elderly patients with colorectal cancer.

METHODSData of 107 elderly patients (≥75 years) undergoing surgery for colorectal cancer were collected from January 2006 to December 2009 in the Department of Gastrointestinal Surgery, Peking University People's Hospital. POSSUM and E-POSSUM scoring systems were used to predict post-operative complications. ROC curve and observe/expect(O/E) were used to assess the validity of scoring systems. Logistic regression was used to evaluate the independent risk factors associated with post-operative complications of elderly patients with colorectal cancer.

RESULTSThe predictive complication rates of E-POSSUM and POSSUM in elderly patients with colorectal cancer were 13.9%-86.6%(average, 32.7%) and 19.1%-99.1% (average, 55.5%). The predictive validity of E-POSSUM was better than POSSUM(AUC of ROC: 0.862 vs. 0.576, O/E: 0.771 vs. 0.454), the former was closer to the actual complication rate(25.2%, 27/107). Concurrent diabetes mellitus(P=0.019) and rectal lesion(P=0.005) were independent risk factors associated with surgery-related post-operative complications. Anastomotic leakage was the most common surgery-related post-operative complications. Chronic obstructive pulmonary disease(P=0.026), ASA score(P=0.025), intestinal obstruction(P=0.037) and perforation(P=0.001) were independent risk factors associated with non-surgery-related post-operative complications. Pulmonary infection was the most common non-surgery-related post-operative complication.

CONCLUSIONSThe application of E-POSSUM scoring system can provide more accurate prediction of post-operative complications in elderly patients undergoing surgery for colorectal cancer. Positive interventions should be taken for high-risk patients to prevent post-operative complications.

Aged ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Male ; Postoperative Complications ; etiology ; prevention & control ; Risk Factors

Objective To investigate the clinical value of coronary computed tomography angiography(CCTA)based CT derived fractional flow reserve(CT-FFR)and ΔCT-FFR in improving the diagnostic efficiency for coronary abnormal hemodynamics in patients with severe calcification.Methods We retrospectively analyzed the clinical data of coronary artery disease(CAD)patients who underwent CCTA,CT-FFR,invasive coronary angiography(ICA)and FFR during hospitalization from January 2018 to June 2019 in Chinese PLA General Hospital.Severe calcification was defined as coronary artery calcium score(CACS)≥100 on single vessel level.A total of 107 CAD patients with 149 coronary arteries were included in the present study.The enrolled coronary arteries were assigned to CACS≥100 group(n=56)and CACS<100 group(n=93).CT-FFR was performed on the deep FFR platform based on machine learning(ML)algorithms and ΔCT-FFR was defined as CT-FFR difference between proximal and distal to the coronary lesion.The correlation and consistency between CT-FFR and FFR values were analyzed by Pearson and Bland-Altman methods.We attempted to analyze the incremental value of ΔCT-FFR for coronary functional evaluation,especial for coronary arteries with severe calcification,regarding FFR≤0.8 as the diagnostic gold standard.Comparison of receiver operating characteristic curves(ROC)between different diagnostic methods was presented by Delong test.Results Pearson and Bland-Altman analyses showed appreciable correlation(CACS≥100 group,r=0.71,P<0.01;CACS<100 group,r=0.73,P<0.01)and consistency(CACS≥100 group,Mean=-0.01,P=0.25;CACS<100 group,Mean=0,P=0.96)between CT-FFR and FFR values in both groups.FFR(0.80±0.08 vs.0.84±0.09,P=0.004)and CT-FFR(0.81±0.06 vs.0.85±0.06,P<0.001)levels were significant lower in CACS≥100 group than those in CACS<100 group,while ΔCT-FFR(0.14±0.06 vs.0.09±0.06,P<0.001)levels were significant higher in CACS≥100 group.Moreover,the diagnostic efficiency of CT-FFR in CACS≥100 group was inferior to that in CACS<100 group[AUC=0.792(95%CI 0.663-0.889)vs.AUC=0.929(95%CI 0.856-0.972),P=0.04],while it achieved significant improvement after ΔCT-FFR adjustment[AUC=0.876(95%CI 0.760-0.949)vs.AUC=0.792(95%CI 0.663-0.889),P=0.02]and was similar to that in CACS<100 group(P=0.37).Conclusion For coronary arteries with severe calcification,CT-FFR demonstrated significant incremental value in improving the diagnostic efficiency of coronary abnormal hemodynamics after ΔCT-FFR adjustment.

Objective To evaluate the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomographic angiography (CTA) (FFRCT) for functional myocardial ischemia.Methods Thirty-nine patients undergone coronary CTA and FFR examination from Aug.2012 to Jul.2015 in PLA General Hospital were retrospectively included in present study.Measurements of invasive FFR value was used as reference standard,and FFRCT based on coronary CTA image was performed in either per-patient or per-vessel level to assess the accuracy,specificity,sensitivity,the positive predictive value and negative predictive value for functional myocardial ischemia.Results In per-patient level,the accuracy of FFRCT was 82.05％,sensitivity was 83.33％,specificity was 80.95％,positive predictive value was 78.95％ and negative predictive value was 85.00％.In per-vessel level,the accuracy of FFRCT was 76.79％,sensitivity was 69.57％,specificity was 81.82％,positive predictive value was 72.73％ and negative predictive value was 79.41％.The area under ROC was 0.826 in per-patient level,and 0.786 in per-vessel level.For per-vessel,FFRCT was positively correlated with FFR value significantly (r=0.644;95％CI:0.458-0.775).Conclusion With FFR as reference standard,domestic noninvasive FFRCT can be used for the diagnosis of functional myocardial ischemia with high diagnostic performance and clinical application prospect.

OBJECTIVETo investigate the effect of the protocol recommended by NCCN-2007 on the diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC) in China.

METHODSNCCN protocol consists of identifying HNPCC characteristics according to the revised Bethesda Guidelines,genetic counseling with immunohistochemistry and finally genetic testing. Four hundred and nineteen patients diagnosed as colorectal cancer from January 2002 to February 2006 were selected. The hMLH1 and hMSH2 immunostaining were implemented for 90 patients who fulfilled the revised Bethesda Guidelines, in whom 8 patients fulfilling the Amsterdam II (Criteria were classified as group A and the other 82 patients as group B. The frozen tissues were collected from patients who showed loss of hMLH1 or hMSH2 protein expression, then RNA was extracted, and RT-PCR and cDNA sequencing were adopted to detect the germline mutations of hMLH1 and hMSH2.

RESULTSTumor tissues from 18 patients showed loss of hMLH1 or hMSH2 protein expression (5 patients in group A and 13 in group B). Finally, 21 patients(8 in group A and 13 in group B showed loss expression of MMR protein) were diagnosed as HNPCC, including 2 cases of hMLH1 and 1 case of hMSH2 mutations. These 3 cases with cDNA mutations did not fulfill the Amsterdam II( Criteria, and were finally diagnosed as HNPCC.

CONCLUSIONThe protocol recommended by NCCN-2007 offers a useful approach to identify HNPCC patients,and reduces the possibility of missed diagnosis of HNPCC.

Adult ; Aged ; Aged, 80 and over ; Base Pair Mismatch ; China ; Colorectal Neoplasms, Hereditary Nonpolyposis ; diagnosis ; genetics ; Female ; Gene Deletion ; Genetic Testing ; methods ; Guidelines as Topic ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo study anatomic and computed tomographic measurements of Chinese mandibular genial tubercles and to evaluate the correlations between them.

METHODSThe axial images were taken by spiral CT in 40 adult human skulls with 1 mm thick section from infraorbital margin to menton. Sagittal plane reconstruction was produced through mandibular central line. Then the height and width of superior genial tubercles, the distance between menton and inferior margin of genial tubercles, the distance between mandibular incisor apex and superior margin of superior genial tubercles, the thickness of mandible were measured respectively. Thereafter anatomic measurements were taken by the same methods as computed tomographic images. The measured value were showed as means +/- standard deviation, then paired-t test and correlation analysis was made by SPSS 10.0.

RESULTSThe genioglossus almost origins from superior genial tubercles, geniohyoideus from inferior genial tubercles. The height of superior genial tubercles which were measured by anatomy and spiral CT were (5.82 +/- 0.71) mm and (6.17 +/- 0.71) mm respectively. The width of superior genial tubercles were (6.98 +/- 1.35) mm and (7.01 +/- 1.13) mm. The distance between menton and inferior margin of superior genial tubercles were (11.08 +/- 2.05) mm and (10.41 +/- 1.55) mm. The distance between mandibular incisor apex and superior margin of superior genial tubercles for male were (15.57 +/- 1.82) mm and (14.34 +/- 2.06)mm, and for female were (9.36 +/- 2.79) mm (8.78 +/- 2.53) mm. The thickness of mandibles at genial tubercles were (11.95 +/- 1.59) mm and (12.19 +/- 1.64) mm. The distance from menton to superior margin of superior genial tubercles were (16.1 +/- 2.30) mm and (15.73 +/- 2.12) mm. The correlations between anatomic measurements and spiral CT measurements of the above mentioned parameters were significant except for height of superior genial tubercles (r = 0.59 - 0.92).

CONCLUSIONThe anatomic and spiral CT measurements of genial tubercles appear to have significant correlations. Preoperative spiral CT measurements of genial tubercles could be help for the design of osteotomy in genioglossus advancement.

Adult ; Chin ; anatomy & histology ; diagnostic imaging ; Female ; Humans ; Male ; Tomography, Spiral Computed

OBJECTIVETo evaluate magnetic resonance venography (MRV) in diagnosing obstructive interface morphology of Budd-Chiari syndrome(BCS).

METHODSMRV examination was performed on 44 cases of BCS, and the images of obstructive interface morphology of the inferior vena cava were reviewed by two radiologists.

RESULTSIn all 44 cases, there were 37 cases with complete obstruction and 7 with incomplete obstruction. MRV showed 4 cases with membrane with hole of incomplete obstruction. The morphologies MRV demonstrated that the proximal part of the 37 cases with complete obstruction were mainly divided into the cone type (36 cases) and the planum type (1 case). Besides, the type of distal end of obstruction were the cone type (30 cases), the planum type (4 cases) and the irregular type (3 cases). The overall sensitivity, specificity, positive and negative predictive values for the diagnosis of MRV were respectively 100%%, 57.1%, 92.5% and 100% as compared to the DSA.

CONCLUSIONThe examination of MRV is capable of revealing the obstructive interface morphology of the inferior vena cava, especially for the distal end of obstruction. MRV can provide guidelines in interventional treatment of Budd-Chiari syndrome.

Adult ; Aged ; Angiography, Digital Subtraction ; Budd-Chiari Syndrome ; diagnostic imaging ; pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Vena Cava, Inferior ; diagnostic imaging ; pathology ; Young Adult