Objective To compare dexmedetomidine versus midazolam sedation for myocardial protection in the patients undergoing percutaneous coronary intervention (PCI).Methods Sixty patients with acute myocardial infarction who required for emergency PCI,were selected and randomly divided into 2 groups (n =30 each) using a random number table:dexmedetomidine group (group D) and midazolam group (group M).In group D,a loading dose of dexmedetomidine 1 μg/kg was infused intravenously for 10 min before surgery.In group M,midazolam 0.05 mg/kg was injected intravenously before surgery.Dexmedetomidine 0.2-1.4 μg· kg-1 · h-1 and midazolam 0.02-0.10 mg·kg-1 ·h-1 were given via a pump during surgery until the end of surgery in the two groups.The RASS score was maintained at-2-2 in two groups.Before administration and on 3rd day after surgery,cardiovascular color doppler ultrasound was performed to record left ventricular ejection fraction (LVEF),venous blood samples were collected for determination of the levels of serum myocardial enzyme and cardiac troponin I (cTnI),and the development of surgical complications,duration of ICU stay and length of hospital stay were recorded.Results Compared with group M,the activities of serum creatine kinase,creatine kinase isoenzyme-MB,aspartate amino transferase and lactic dehydrogenase and cTnI concentrations were significantly decreased,LVEF was increased,and duration of ICU stay and length of hospital stay were shortened in group D.There was no significant difference in the development of postoperative complications between the two groups.Conclusion Dexmedetomidine sedation provides better efficacy for myocardial protection and prognosis and is more suitable for sedation than midazolam in the patients undergoing PCI.

Objective To investigate the factors associated with postoperative recurrence of benign thyroid nodules and its retreatment. Method A retrospective analysis was made on the pathologies, operative indications, and the types of operations in 51 postoperative recurrent cases with benign thyroid nodules in a poriod of 18 years. Result The recurrences were associated with the pathology, number of nodules, the indications and types of primary surgery. Among the 51 cases there were 29 cases with nodular goiter and 22 cases with thyroid adenoma. 21 patients had had simple nodular resection, 16 patients had partial lobe resection, 9 patients had subtotal thyroidectomy and 5 patients had thyroid lobectomy. Among 38 cases receiving reoperation, 19 cases had lobectomy, 3 cases had lobectomy plus opposite subtotal thyroidectomy, 7 cases had subtotal thyroidectomy and 9 cases had bilateral subtotal thyroidectomies without serious postoperative complications. 32 cases were followed up after secondary operation with an average period of 7 years, among which 1 case with multinodular goiter had recurrence. Conclusion Strict restriction on thyroidectomy for patients with mutinodular goiter and giving up simple nodular enucleation could help reduce postoperative recurrence of benign thyroid nodules.

Purpose:To investigate the telomerase activity in human digestive tract cancer and its significance and evaluate usefulness of the TRAP ELISA method .Methods:Telomerase activity was examined in 112 tumor specimens, including the following cancers: esophageal(12), gastric(36), hepatic(15), pancreatic (11), colorectal(38) and paracancerous tissues(94) by TRAP ELISA method.Results:The telomerase activity in tumor tissues was significantly higher than in paracancerous and normal tissues ( P

Objective To evaluate the relationship between p38mitogen-activated protein kinase (p38MAPK) signaling pathway and calcium over-loading during oxygen-glucose deprivation and restoration (OGD/R) in cardiomyocytes of rats.Methods Cardiomyocytes obtained from Sprague-Dawley rats,aged 1-3 days,were cultured and divided into 3 groups (n =27 each) using a random number table method:control group (group C),group OGD/R and p38MAPK inhibitor SB203580 group (group SB).The cells were subjected to OGD for 6 h followed by restoration of O2-glucose supply for 2 h.Ceils were incubated for 1 h with 10 μmol/L SB203580 in group SB.At 2 h of restoration of O2-glucose supply,cell morphology was observed under an inverted microscope,cell viability was measured by the CCK-8 method,the release of lactate dehydrogenase (LDH) in the supernatant was determined by 2,4-dinitrobenzene chromogenic method,intracellular calcium concentration was determined by flow cytometry,and the expression of phosphorylated p38MAPK (p-p38MAPK) and p38MAPK was detected using Western blot.The LDH release rate and p-p38MAPK/p38MAPK ratio were calculated.Results Compared with group C,the LDH release rate,intracellular calcium concentration and p-p38MAPK/p38MAPK were significantly increased,and the cell viability was markedly decreased in group OGD/R and group SB (P＜0.05).Compared with OGD/R group,the LDH release rate,intracellular calcium concentration and p-p38MAPK/p38MAPK ratio were significantly decreased,the cell viability was increased (P＜0.05),the cell morphology was nearly normal,and the number of cells was increased in group SB.Conclusion p38MAPK signaling pathway can mediate calcium overload after being activated and is involved in the pathophysiological mechanism of OGD/R in cardiomyocytes of rats.

Objective To investigate the clinical effects of Dexmedetomidine on analgesia and postoperative cognitive function in elderly patients with lumbar spine surgery.Methods The patients were randomly divided into the control group (n=88) and the study group (n=100).The patients in the study group were treated with Dexmedetomidine at a loading dose of 1.0 μg/kg for 15 min,and 0.3 μg · kg-1 · h 1 was continuously pumped.The anesthetic mode and drugs in the control group were similar to those in study group,except that Dexmedetomidine in the study group was replaced with physiological saline in the control group.Intraoperatively used dose of analgesic drugs,and pain and cognitive function changes were compared between the two groups.Results The intraoperatively used doses of Remifentanil,Fentanyl and propofol were significantly lower in the study group than in the control group (P＜0.05).The VAS scores were markedly lower in the study group than in the control group (2.6±0.5 vs.4.5± 1.2,t=4.9398,P=0.0000).The MMSE scores were higher in the study group than in the control group (28.0 ± 1.3 vs.26.0 ± 2.5,t =-6.6484,P=0.0000).Conclusions Intraoperative use of Dexmedetomidine for treatment of the elderly patients with lumbar surgery will not only reduce the perioperatively used dose of analgesic and sedative drug,but also reduce postoperative pain and improve postoperative cognitive function.

Objective To evaluate the diagnosis and treatment of transcatheter small bowel radiography in intestinal obstruction.Methods From January 2016 to December 2016,150 cases of adhesive small intestine obstruction were divided into small bowel radiography group and control group.The long-term results were collected after 6-month follow-up.Results First aerofluxus time [(72 ± 5) h vs.(109 ±7) h],defecation [(89 ±8)h vs.(139 ± 17)h],extubation [(81 ± 18)h vs.(105 ± 17)h] and first oral intake [(84 ±6)h vs.(109 ±9)h] in catheter group were shorter compared with control group (all P ＜ 0.05).The accuracy of determining obstruction site were superior in catheter group than control group (92％ vs.63％,P ＜ 0.05).Conclusion Endoscopic transnasal ileus tube significantly relieves symptoms in the adhesive intestinal obstruction,the transcatheter small intestinal radiography helps determine the obstruction site.

Objective To evaluate the clinical application and effect of computerized digital sur -gical assisted design and manufacture for reconstruction of mandibular defect with vascularied iliac crest flap graft .Methods CT was used to scan the craniofacial and maxillofacial region of mandibular ameloblastoma patient ,and then the 3D model of the maxillofacial skeleton was reconstructed using the computerized digital surgical aid design to simulate the focal resection and the mandibular defect reconstruction with the iliac crest flap .Surgical guides were prepared by 3D printing to assist focal re-section and bone reshaping .Postoperatively ,clinical and CT examinations were performed to observe the restoration of the patient's facial appearance and occlusal relationship ,as well as wound healing and graft survival .Results Postoperative review results showed that the bone graft survived well ,and the anastomosed bone was formed .The wound in the surgery area healed .No recurrence of the tumor was found after clinical and CT examination .The maxillofacial appearance was well restored ,and the re-sidual occlusal relationship recovered well .Conclusions The use of computerized digital surgical aided design combined with 3D printing technology can effectively simplify the mandibular segmental defect repair and reconstruction and optimize the postoperative repair effect .

Objective To explore the role of computer-aided design and manufacturing technology (CAD/CAM technology) in the repair of mandibular defects using the fibular osteomyocutaneous free flap.Methods Eight patients with a portion of mandible defect due to various reasons were subjected to preoperative CT scan,obtaining CT data of the mandible and the fibular bone to be transplanted.The original and the reconstructed skull model,as well as the mandible and fibula osteotomy guide plates,was printed using CAD/CAM technology.The titanium plates were preformed using the reconstructed skull model,and the operation was performed with the help of guide plates and a preformed titanium plate.The patients were followed up for 6 to 24 months to evaluate the operation effect.Results Two in 8 cases had flap necrosis caused by immune rejection of the implant,and one case had flap necrosis due to poor postoperative blood glucose control.The other 5 patients healed at the primary site and the fibular myocutaneous flap survived well.There were no serious complications in the donor and recepient site.The patients' satisfaction was high.Conclusions The reconstruction of mandible with the aid of CAD/CAM technique has the advantages of accelerating the operation process,shortening the operation time,improving the accuracy of mandibular amputation and fibular shaping,promotlng postoperative function and morphology recovery.

In Korea and China, ilaprazole is a widely used proton pump inhibitor in the treatment of gastric ulcers. In this study, a specific and sensitive LC-MS/MS method has been developed and validated for the quantification of ilaprazole enantiomers in the rat plasma, using R-lansoprazole as the internal standard. The enantioseparation was achieved on a CHIRALPAK AS-RH column (4.6 mm × 150 mm, i.d. 5μm), with a mobile phase composed of 10 mM ammonium acetate aqueous solution and acetonitrile (60:40, V/V), at a flow-rate of 0.5 mL/min. The method was validated over the concentration range of 0.5-300 ng/mL for both, R- and S -ilaprazole. The lower limit of quantification was 0.5 ng/mL for both enantiomers. The relative standard deviation (RSD) of intra- and inter-day precision of R-ilaprazole and S-ilaprazole was less than 10.9％, and the relative error accuracy (RE) ranged from -0.5％-2.0％. Finally, the method was successfully evaluated in rats in a stereoselective pharmacokinetic study of the ilaprazole racemate.