Objective To investigate the effect of nasal intubation guided by fiberoptic bronchoscope (FOB) and intubation guided by laryngoscope on hemodynamics and arterial oxygen saturation (SaO2).Methods Sixty-one patients received tracheal intubation for mechanical ventilation were divided into observation group (31 cases) and control group (30 cases) by random digits table who received FOB guided nasotracheal intubation and laryngoscope intubation respectively, the systolic blood pressure (SBP),diastolic blood pressure (DBP), heart rate (HR) and SaO2 of all patients in two groups was measured and recorded 1 min before intubation, the intubation moment and 5 min after intubation. Results Patients in two groups were successfully intubated. The average time in observation group was (35.2 ± 12.5) s and in control group was (38.7 ± 13.6) s, and there was no significant difference between two groups (P ＞ 0.05);SBP, DBP and HR of two groups at the intubation moment increased significantly than that at 1 min before intubation, while SaO2 decreased significantly, and the rangeability of above indexes in observation group were significantly lower than those in control group, there were significant differences between two groups (P ＜ 0.05). Conclusion FOB guided nasotracheal intubation has little effect on hemodynamics and blood SaO2, it is a safe method of endotracheal intubation and worthy of clinical application.

Objective To investigate the relationship between plasma level of homocysteine (Hcy) and amyotrophic lateral sclerosis (ALS).Methods The differences of Hcy,Vitamin B12,and folate levels between 150 outpatients with ALS and 137 age and sex matched controls were compared in a cross-sectional study.Results Compared with the healthy controls,patients with ALS had a higher plasma Hcy level [ ( 18.47 ± 13.09) μmol/L vs ( 11.91 ± 5.37 ) μmol/L,P ＜ 0.001 ] and a lower folate level [ ( 8.39 ±4.45) ng/ml vs (10.38 ±5.01) ng/ml,P ＜0.001].In a logistic regression model using ALS as a dependent variable,plasma level of Hcy was significantly associated with ALS.A trend for higher Hcy levels in patients with shorter interval from symptom onset to diagnosis ( ODI ) was also found [ Hcy levels (20.73 ± 15.79 ) μmol/L with ODI ＜ 19 months vs ( 16.41 ± 9.73 ) μmol/L with ODI ≥ 19 months,P =0.035 ].Conclusions Plasma Hcy level is significantly increased in patients with ALS.The individuals with shorter time to diagnosis present higher Hcy level,suggesting that it may associate with the progression pace of ALS.

Objective To investigate the relationship between alterations in the corneal innervation observed by laser confocal microscopy and peripheral neuropathy severity in the patients with impaired glucose tolerance (IGT).Methods A total of 70 patients with IGT were consecutively enrolled into the study.Among them,30 patients were diagnosed as peripheral neuropathy (IGT-PN),40 patients without peripheral neuropathy (IGT-NPN).Fifty age-matched healthy subjects were also studied.Corneal subbasal nerves were investigated by laser confocal microscopy.Results Corneal nerve fiber length (17.1 ±4.9) vs (14.0±3.8) mm/mm2; t=13.484,P＜0.05),newe branch density ((53.1 ±18.8) vs (36.2±11.5) mm/mm2 ; t =9.369,P ＜ 0.01) and nerve fibre tortuosity ((2.07 ± 0.76) vs (0.88 ± 0.55) levels,t =12.957,P ＜0.05)were significantly increased in IGT-NPN group when compared with control group,but nerve fibre density had no difference.Nerve fiber length,nerve branch density and nerve fibre density were significantly decreased in IGT-PN group compared with control group and IGT-NPN group,while NFT was significantly increased in IGT-PN group.Conclusions Patients with impaired glucose metabolism show alterations in corneal innervations before diagnosed with diabetes mellitus or peripheral neuropathy.It indicates that corneal confocal microscopy can be used for early diagnosis of diabetic peripheral neuropathy.

Objective To establish the reference range of anti-mutated citrullinated vimentin antibody (anti-MCV ) among healthy individuals in Northeast area of Sichuan .Methods The Alegria enzyme-linked immunosorbent assay system and the matched anti-MCH reagent test kit were adopted to detect the serum anti-MCV concentration in 141 serum samples collected from healthy individuals .Results The intra-batch and inter-batch precisions and the functional sensitivity of the Alegria enzyme-linked immunosorbent assay system all met the laboratory requirements .The concentration of serum anti-MCV was 12 .10(6 .70-41 .30) U/mL in the healthy female group and 11 .10(6 .00-18 .30)U/mL in the healthy male group ,there was no statistical difference be-tween these two groups(Z= -0 .991 ,P=0 .322);the detection results of serum anti-MCV in the age groups of <50 years old and ≥50 years old had no statistical differences (Z= -0 .588 ,P= 0 .558) .The reference range of anti-MCV in the investigated healthy individuals was 0 .00-18 .14 U/mL .Conclusion The reference range of anti-MCV has no correlation with gender and age . Establishing the reference range of anti-MCV suitable for the healthy population in the local area has very important clinical applica-tion value .

Objective To explore the diagnostic value of corneal confocal microscopy in the early small fibre neuropathy (SFN).Methods A total of 45 patients with small fibre neuropathy and 50 age-matched healthy subjects undertook a neurological evaluation,neurological deficits score (NDS),sural nerve conduction velocity,contact heat evoked potential (CHEP) and corneal confocal microscopy (CCM) to quantify small nerve fibre pathology.Four parameters including nerve fiber length (NFL),nerve branch density (NBD),nerve fiber density (NFD) and nerve fibre tortuosity (NFT) were calculated from the observation of corneal confocal microscopy.Results Compared with the control group,significantly decreased NFD and NBD were found in the SFN group [(42.00 ±25.26)/mm2 vs (72.38 ± 14.09) /mm2 ;(31.93 ± 13.21)/mm2 vs (46.24 ± 11.48)/mm2 ; with all P ＜ 0.05],while NFT were significantly increased in the SFN group [(2.48 ±0.87) levels vs (0.88 ±0.56) levels,P ＜0.001].The neurological deficits score was correlated with NFT,NFD and NBD (r =0.782,-0.376,-0.504 ; with all P ＜ 0.001).Conclusion CCM is a new and sensitive noninvasive clinical technique that may be used to detect early small fibre nerve damage in patients with SFN.

[Objective]To study the operative methods and effects of limb salvage with rotating hinge prosthesis replacement for malignant tumors around the knee.[Method]Limb salvage surgery with rotating hinge prosthesis replacement were performed in 14 patients with malignant bone tumors around the knee.There were 9 cases in distal femoral,5 cases in proximal tibia.[Result]Forteen patients were followed up for 17~65 months(averaged,4 months).The satisfactory rates were 85.7%,the extension and flexion spheres of knee activity were respectively 0? and 90?~130?(averaged,110?).There was recurrence in one patient after operation,infection one;prosthetic loosening one.[Conclusion]Application of rotating hinge prosthesis knee replacement in limb salvage treatment of malignant tumor around the knee is an effect method.It is an effect method for the treatment of malignant tumor of the knee by using rotating hinge prosthesis.It can decrease the strength of the bone-prosthetic and the incidence of the occurrence of fatigue fracture and the loosening of prosthetic.

[Objective]To improve the diagnosis and treatment of acute fatal pulmonary thromboembolism(PTE)in orthopedic perioperation.[Method]Clinical manifestations,radiological features,laboratory examination data,treatment and prognosis of 12 patients diagnosed as acute fatal PTE in orthopedic perioperation from February,2002 to July,2005 were retrospectively analyzed.[Result]Nine patients received emergent thrombolytic and anticoagulant therapy,7 were alleviated and 2 died;3 patients with sudden cardiac arrest died after failed cardiopulmonary resuscitation.[Conclusion]Acute fatal PTE is a severe disease of orthopaedics.The realization and alert of the existence of acute fatal PTE must be increased.Early diagnosis and efficient treatment is the key to preventing from death.

[Objective]To evaluate the accuracy of computer-assisted cervical pedicle screw installation and discuss the reasons of screw malposition.[Method]Totally 144 cervical pedicle screws were installed by computer-assisted navigation in 25 patients with lower cervical spinal disease.All the patients were examined by X-rays and CT after operation.Screw position and direction were measured on the sagittal and transsection image of intraoperative navigation and post-operative CT.The result was analyzed statistically.[Result]Two screws perforated the upper pedicle wall,3 deviated from the lateral pedicle wal1.There was no statistical difference in screw position or direction between navigation and CT image.Navigational images were based on the principle of rigid tissue.[Conclusion]Computer-assisted navigation can improve the accuracy of cervical pedicle screw installation.Screw malposition is responsible for the excursion phenomenon.

[Objective]To explore the change and its significance of the expression of basic fibroblastic growth factor(bFGF) and bone morphogenetic protein-2(BMP-2) of the local femoral head in nontraumatic osteonecrosis(NONFH). [Methods]Thirty samples of femoral heads of NONFH were collected as the experimental group and 10 fresh samples of femoral heads of femoral neck fracture as control group.The specimens were collected at the time of total articular replacement arthroplasty.The bone tissues from necrosis area and healthy area were made into general sections after immobility and decalcification.Pathological changes were exexamined by optical microscopy and the expression of bFGF and BMP-2 in femoral head was determined with in-situ hybridization technique.[Results]The organization structure of experimental group was disorganized,cracked,and the bone trabecula was rarefactive and non-intact.There were a great number of empty lacune in bone trabecula.The intensity and area of positive expression of bFGF and BMP-2 in femoral head of the experimental group were obviously lower than that of control group.The result had statistical significance(P

Objective To analyze the clinicopathological features and enhance the knowledge of Askin tumor in children. Methods The clinicopathological features of 4 cases of children with Askin tumor were described. Results Clinically, the tumor was often seen in elder child patients with painful thoracopulmonary masses.Histopathologically, the nest-like or lobular structures composed of small round-to-oval cells were surrounded by sparse fibrovascular stroma. Among tumor cells there were no or few resticular fibers,however in the surrounding of tumor masses the fibers were found. PAS staining in the tumor in a part of cases was positive. The positive rates of CD99 and Syn detected by immunohistochemistry were high. Neurosecretory granules can be observed by electron microscopy. Two patients received both chemotherapy and radiotherapy three patients died of metastatic tumor of lung and brain and chemotherapy complication in 24,25 and 5 months, respectively. Conclusions Askin tumor is a highly malignant neurosecretory tumor in thoracopulmonary region, which often be misdiagnosed as neuroblastoma, lymphoma, embryonal rhabdomyo sarcoma, tuberculosis and lung abscess, and requires a synthetical treatment plan consisting of pre-and postoperative chemotherapy, radiotherapy and surgical resection. The treatment methods of Askin tumor needs to be further studied.