Objective To evaluate the effects of low tidal-volume ventilation on blood gases and respiratory mechanics during open heart surgery in children with acyanotic congenital heart disease. Methods Forty NYHA class Ⅰ-Ⅱ patients with atrial or ventricular septal defect aged 3-6 yrs weighing 12-18 kg undergoing open heart surgery were randomly divided into 2 groups according to the tidal volume of mechanical ventilation: group A low tidal volume(V_r=7ml?kg~(-1),n=20) and group B conventional tidal volume(V_T=9 ml?kg~(-1), n=20). The respiratory rate(RR) was 21-23 bpm, I: E ratio 1:2 and FiO_2 100% in both groups. The patients were premedicated with intramuscular morphine 0.1 mg?kg~(-1) and scopolamine 0.01 mg?kg~(-1). Anesthesia was induced with midazolam 0.1 mg?kg~(-1), fentanyl 10 ?g?kg~(-1) and vecuronium 0.1 mg?kg~(-1) and maintained with infusion of fentanyl 4 ?g?kg~(-1)?h~(-1) and vecuronium 80 ?g?kg?h~(-1) supplemented with isoflurane inhalation(

Objective: To study the influence of micrometastasis in lymph node on the prognosis of oral squamous cell carcinoma(OSCC).Methods: In 36 patients micrometastasis in pathologically negative lymph nodes were tested by immunohistochemical cytokeratin(CK) examination and the relationship between CK+ and survival time of the patients was analyzed. Results: The survival time(month) of CK+ and CK- patients was 36.76?6.91 and 47.47?11.35 respectively(P=0.002).Multivariate analysis of Logistic regression model showed that micrometastasis in lymph node (P=0.044)and histologic grade (P=0.040) were regarded as independently prognostic factors while clinical stage (P=0.236)did not. Conclusion: The detection of micrometastasis in the lymph nodes may serve as a supplement to the present staging system of OSCC. The prognosis of patients with micrometastasis is poorer than those without micrometastasis.

Objective To evaluate the agreement between colposcopic diagnosis with 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy (IFCPC) and cervical pathology in cervical lesions. Methods A retrospective cohort study was performed, which included 376 patients who underwent colposcopy with 2011 international terminology of colposcopy at Obstetrics and Gynecology Hospital of Fudan University from September 2014 to November 2014. With conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated and correlations between variables were analyzed. Results With 2011 international terminology of colposcopy, agreement of colposcopic diagnosis and cervical pathology was 60.9%(229/376)perfectly matched, and the strength of agreement with weighted Kappa statistic was 0.401 (P<0.01), and agreement within one grade was 97.6%(367/376), which were improved compared with traditional methods. Colposcopic diagnosis were 19.9%(75/376) overestimated and 19.1%(72/376) underestimated. There were no significant difference between agreements in various grade lesions (χ2=1.996, P=0.573). Positive predictive value of high grade colposcopy or more was 84.4%, the negative predictive value of low grade colposcopy or less was 88.8%, whereas false positives were 3.5%and false negatives were 39.3%. A linear trend among three types of transformation zone and patient ages was found (χ2=45.910, P<0.01), whereas lesion sizes were not linearly correlated with lesion degrees (χ2=0.690, P=0.406). In grade 1, grade 2 and nonspecific findings, thin acetowhite epithelium, dense acetowhite epithelium and Lugol′s non-staining were most frequent, the Youden indexes of each were 0.170, 0.373 and 0.145, 0.069 respectively. Positive predictive value of some other findings (such as fine mosaic) and two new signs (inner border sign and ridge sign) were 100.0%. There were no significant difference between agreements in examiners with different levels of experience (χ2=1.197,P=0.550). Conclusions Compared to traditional methods (such as Reid index), 2011 international terminology of colposcopy could improve the agreement between colposcopic diagnosis and pathologic diagnosis, without significant differences by the severity of lesion and the level of examiners′experience. Common findings were classified reasonably, and some signs were highly reliable, which is important for guiding biopsy. However, the reproducibility of transformation zone types and the implication of lesion size need to be further discussed.

OBJECTIVE:To explore the effect of dabigatran etexilate on coagulation indexes and safety of elderly patients with persistent atrial fibrillation. METHODS:52 elderly patients with persistent atrial fibrillation were randomly divided into obser-vation group and control group by random number table,26 cases in each group. Creatinine clearance rate in observation group was higher than 30 ml/min,110 mg Dabigatran etexilate capsule was orally given,bid;when 15-30 ml/min,55 mg capsule was orally given,bid. Control group orally received Warfarin sodium tablet with initial dose of 2.5 mg,qd,according to international normal-ized ratio (INR) after 3-5 days till maintained in 2.0-3.0. After 3 months,coagulation indexes [prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),INR,platelet count (PLT),fibrinogen (FIB)] before and after treat-ment,incidences of clinical events (cerebral embolism,cerebral hemorrhage,fatal bleeding,the remaining parts of embolism, death)and adverse reactions in 2 groups were compared. RESULTS:There was no significant difference in PT,APTT,TT,PLT and FIB between 2 groups before treatment(P>0.05);after treatment,PT and INR in 2 groups significantly increased,and obser-vation group was obviously better than control group,the difference was statistically significant(P<0.05). No cerebral hemorrhage or fatal hemorrhage occurred in the two groups. There was no significant difference in the incidence of cerebral embolism between 2 groups (P>0.05);the incidence of remaining parts of embolism,death in observation group significantly lower than control group,the difference was statistically significant(P<0.05). The incidence of adverse reactions in observation group was significant-ly lower than control group,the difference was statistically significant (P<0.05). CONCLUSIONS:Dabigatran etexilate shows good coagulation effect on elderly patients with persistent atrial fibrillation,which can effectively improve PT and INR levels and reduce the incidences of clinical events,with good safety.

Objective To investigate the epidemiological characteristics of polyomavirus type BK infection in renal transplant recipients.Method We systematically screened for active BKV infection preoperation and at 0.5,1,3,6,9,12 and 15 months after transplantation in 116 renal transplant recipients.The screening tests included urine cytology (by the Papanicolaou method) and BKV DNA PCR (the kit for testing the BK virus) assay of both urine and plasma,and the results were recorded.Renal biopsy was performed if the graft function was deteriorated gradually or the loads of BKV replication were very high.Routine histopathological examination and immunohistochemistry were performed on renal tissues from partial patients who received the tests of renal biopsy.Result Throughout the follow-up of 15 months,urinary decoy cells (median 8/10 HPF,[1～ 48/10 HPF]),BKV viruria (median 2.63 × 105 copies/mL,[1.78 × 103 ～ 8.54 × 109 copies/mL]),BKV viremia (median 2.70 × 104 copies/mL,[1.95 × 103 ～6.31 × 106 copies/mL]),and BKVAN (4 patients) occurred in 53.46％,24.17％,20.72％ and 3.45％ of renal-transplant recipients,respectively.The positive rate of the decoy cell and BKV DNA in urine reached the peak at the third month to the ninth month after transplantation,and the peak time of the BK viremia was the fifth month post-transplantation throughout the follow-up period.The change in BKV DNA level remained constant in blood and urine throughout the follow-up period.Conclusion The peak time of BKV infection was apparently three to nine months after transplantation,suggesting the importance of monitoring urine cytology and BKV DNA loads in post-transplantation patients closely during this period in order to reduce BKVAN after transplantation.

Objective To investigate the objective factors that affect the image quality of infant cranial CT using different mAs. Materials and Methods Ninety infants were divided into three groups randomly. The maximum anteroposterior diameter (MAPD) of skull of each infant was measured. Three reference levels, cerebellar, basal ganglia and centrum semiovale levels were selected respectively. Only one level was studied in each group and scanned with 150, 100 and 80 mAs. The subjective quality grade and the objective noise of all images were recorded and analysed statistically. Result The average MAPD of ninety patients was (148.0 ± 17.4)mm. On the cerebellar level, the subjective quality grade was lower than the other two levels, which were 6.3% , 9.4% and 22.9% respectively when mAs were 150, 100 and 80 mAs. Both quality grade of image and objective noise were significantly correlated with MAPD.Conclusion The inherent high noise of cerebellar level and MAPD were the objective factors that affect the image quality of low-dose cranial CT of infant.

Objective To explore the effect of β-element on the oadiosensitivity of transplanted tumor, and its relationship with the expression of survivin. Methods The transplanted mice model was established through the cell suspension inoculation. The mice with transplanted tumor size of 0. 8-1.0 cm3 were randomly divided into 8 groups as blank control, 25, 45 and 100 mg/kg group, irradiation group,25 mg/kg + irradiation group, 45 mg/kg + irradiation group, 100 mg/kg + irradiation group. The tumor size was measured every other day until tumor size was double, and the growth curve was obtained. The average tumor growth inhibition rate of β-element and tumor size were attained at 2,4,6 and 8 d after β-element injection. The expression of survivin was detected with immunohistochemistry. Results The nude mice model was successfully established and the growth curves were obtained according to the tumor size.Between 2 and 8 d after β-elemene injection, the variation tendency of the average tumor growth inhibition rate was consistent with the size in β-elemene treatment groups. The antitumor effect of β-elemene was in a dose-dependent manner. The values of radiosensitivity enhancement factor were 0. 84,1.24,2.04 for 25,45 and 100 mg/kg group, respectively ,and the optimal dose was 45 mg/kg. β-element had little effect on the expression of survivin, and the expression of survivin significantly enhanced in irradiation group and decreased in β-element + irradiation groups. Conclusions β-elemene could enhance the tumor radiosensitivity through inhibitiong the expression of survivin.

OBJECTIVE To investigate the protective effect of collagen peptides from walleye pollock skin(CPWPS)in the hydrogen peroxide(H2O2)-induced oxidative stress damage model of the human keratinocyte cell line (HaCaT). METHODS HaCaT cells were pretreated with CPWPS 50,100 and 200 mg · L-1 for 12 h. Then H2O2 was added to the final concentration of 300μmol · L-1. After 12 h,the activity of catalase(CAT),glutathion peroxidase(GSH-Px),total superoxide dismutase(T-SOD)and total antioxidant capacity (T- AOC) were detected by enzymes and biochemical method. The expression of aquaporin3 (AQP3) in HaCaT cells was measured by Western blotting. RESULTS Compared with control group,CPWPS group did not exhibit significant cytotoxicity at a concentration up to 300 mg·L-1. The viability of cells treated with H2O2 300μmol·L-1 for 12 h decreased to 54.0%(P<0.01). The viability of cells pretreated with CPWPS 50,100 and 200 mg · L-1 for 12 h increased to 69.4%,79.4%and 89.1%(P<0.05,P<0.01),respectively. Compared with the model group,the activity of CAT,GSH-Px,T-SOD and T-AOC in HaCaT cells pretreated with CPWPS 50,100 and 200 mg·L-1 for 12 h increased. Compared with model group,the activity of CAT,GSH-Px,T-SOD and T-AOC of CPWPS 200 mg · L-1 pretreatment group increased by 56.90%,48.68%,48.24% and 71.43%(P<0.01),respectively. Western blotting revealed that the expression of AQP3 in H2O2 model group was in?creased relative to that in control group,while the expression of AQP3 in CPWPS pretreatment groups was decreased. The expression of AQP3 in CPWPS 200 mg · L-1 pretreatment group decreased to 67.1%(P<0.01) compared to the H2O2 model group. CONCLUSION CPWPS can protect HaCaT cells against H2O2- induced oxidative stress damage. The cytoprotective effects are associated with enhanced antioxidant capacity and decreased expression of AQP3.

Objective To summary and analysis the clinical experiences on the three hole method of VATS surgery in treatment of primary spontaneous pneumothorax.Methods The clinical data of 276 cases of primary spontaneous pneumothorax undergoing VATS surgery from July 2005 to July 2011 were analyzed retrospectively.Results The operating times were 25 to 76 minutes,averaging (41.7 ± 2.1) minutes ; all with traces of bleeding; transiting assisted small incision operation in 5 cases;postoperative thoracic closed drainage extubation time of 4-13 days,average (6.7 ± 0.2) days,mild postoperative air leakage in 27 cases,moderate in 9 cases without severe leakage,leakage,postoperative pulmonary atelectasis in 7 cases,pulmonary infection in 2 cases,reexpansion pulmonary edema in 1 cases,postoperative follow-up for 6-17 months,averaging(10.2 ± 1.7) months,recurrence occurred in 7 cases,1 case of operation again.Conclusion Three hole method of VATS technique has short operating time,less trauma,fewer complications,faster recovery,shorter hospitalization time and other advantages,and the recurrence rate is low,which is the ideal mode of operation for the treatment of primary spontaneous pneumothorax.

Objective To investigate the factors related with swallowing function after stroke. Methods Stroke patients with dysphagia were reviewed, 296 cases with pseudobulbar paralysis, and 82 cases with bulbar paralysis. Swallowing function was evaluated with videoflu-oroscopic swallowing study (VFSS). The variable of age, sex, Body Mass Index (BMI), scores of National Institutes of Health Stroke Scale (NIHSS), Simplified Fug-Meyer Assessment (FMA) and modified Barthel Index (MBI), intubation, aspiration, length of hospitalization (LOH), and initiation of rehabilitation intervention were analyzed with Logistic regression. Results Age, NIHSS score, intubation, aspira-tion, initiation of rehabilitation intervention were the risk factors for poor outcome of swallowing function in all the patients, while the score of MBI was the protective factor for the pseudobulbar paralysis ones. Conclusion The younger the patients, the less the NIHSS score, no in-tubation, no aspiration, and the earlier the rehabilitation intervened, the more independent the pseudobulbar paralysis patients, the better swallowing function recovered.