Objective The aim of this study was to investigate the effects of different anesthetic drugs and techniques on serum SIL-2R, IL-6 and TNF-? in cancer patients undergoing elective thoracic surgery, trying to find a reasonable anesthesia for patients with compromised immune function. Methods Eighteen ASA Ⅰ-Ⅱ cancer patients(male 12, female 6) undergoing elective thoracic surgery were studied. The age ranged from 46-47 years. 6 patients suffered from lung cancer and 12 from cancer of esophagus or cardia. The patients received no radio-or chemotherapy before surgery. They were premedicated with intramuscular pethidine 50mg and atropine 0.5mg. Esophogus and cardia cancer patients were randomly divided into two groups: group Ⅱ and Ⅱ . Group Ⅲconsisted of only lung cancer patients. Group I received general anesthesia combined with continuous epidural block and postoperative epidural analgesia. An epidural catheter was inserted at T7-8 or T8.9 before general anesthesia. Anesthesia was induced with 2% thiopental sodium 5mg kg-1 and vecuronimn 0.06-0 .08mg kg-1 and maintained with 1%-2% isoflurane inhalation with epidural 2% lidocaine 6-7m1o h-1 . After operation epidural analgesia was produced with 0.125% bupivacaine 5-6ml h-1 for 72 h. In group Ⅱ the induction of general anesthesia was the same as in group Ⅰ , but anesthesia was maintained with ketamine infusion 1-2mg kg-1h-1 and epidural 2% lidocaine 6-7ml h-1. Postoperative analgesia was produced with epidural 0.1% bupivacaine + 0.0003% fentanyl 5-6m1o h-1 for 72 h. In group Ⅲ the induction and maintenance of anesthesia were the same as in group Ⅱ but postoperative analgesia was produced with epidural 0.1 % ketamine 4-5ml h-1. Blood samples were taken from peripheral vein before anesthesia, before and 2 h after skin incision and on the 1st, 3rd and 5th day after operation for determination of serum SIL-2R, IL-6 and TNF-? by ELISA(Genozyme Co) Results The serum SIL-2R, IL-6 and TNF-? levels were comparable before anesthesia and operation among the three groups. Serum SIL-2R decreased significantly at 2 h after skin incision(P

Purpose:To analyse the dosimetric parameters measured by the silicon diode, and to describe the features of the dose distributions for small fields.Materials and Methods:P-type silicon diode with small volune and high sensitivity was chosen to measure the PDD,OAR and Sc,p at isocenter for circular fields of 5mm ～50mm in diameter used for stereotactic irradiation .The dosimetric data measured are evaluated by comparising with ones by other methods, such as ionization chamber and films,and ones in literature.Results:The values PDD of 10 and 30 fields at depth from 5cm～20cm are almost the same as those in reference 7 within ?0.6; The effective linear attenuation coefficient extrapolated to zero fiels size is 0.0510cm -1 for 6MV-X rays. The Sc,p value measured by diode and chamber(NE2571) are agread each other within variations of ?0.4% for large field size, but a great difference appears when the field size is 2 times smaller than the diameter of chamber. The Sc,p values by diode for field size of 12.5mm～27.5mm are agreed well with the results by Monte Carlo calculations. The OARs measured by diode are ageed well within 1mm with ones by films developed by ourself. The penumbras(90%～10%) measured by diode are coincidence with the results published.Conclusion:Due to the high dose gradients at the beam edge and the absence of lateral electron equilibrium for the smaller fields, the detector size and positioning are the most impostant factors influenced the measured results. Our practice shows that the silicon diode with diameter of 2mm or smaller is the best choice for the dosimetric date collection for beams used in X-ray stereotactic irradiation.

Objective To detect human papillomavirus (HPV) infection and HRAS,PIK3CA mutations in early laungeal squamous cell carcinoma (LSCC),and prognostic analysis regarding the clinicopathological teatures,including HPV status,was conducted.Methods A total of 186 patients with T2N0-1M0 LSCC were included in this study.HPV infection,p16INK4A expression,and PIK3CA,HRAS hot spot mutations were detected.Results 9.8 ％ (16/163) cases of high-risk HPV infection and 3.8 ％ (7/186) cases of p16INK4A overexpression were found in the cohort.Three cases of PIK3CA mutation and no HRAS mutation were found.HPV-positive cases had a significantly longer overall survival (OS) (P =0.019).N1 stage had a significantly reduced RFS (P =0.021).In multivariate analysis,HPV status was the only significantly prognostic factor for OS (RR =0.30,95 ％ CI 0.09-0.96,P =0.043).Conclusions p16 cannot be used as a surrogate biomarker of HPV status in early LSCC patients.HRAS or PIK3CA mutation is not a common event in early LSCC,and no mutation is found in HPV-positive cases.HPV status is an independent prognostic factor for survival.

Objective:To develop an automatic and continuous distraction osteogenesis technique by using totally embedded distractor of nickel titanium (Ni-Ti) shape-memory alloy for the reconstruction of mandibular ramus. Methods:16 adult New Zealand rabbits were used in the experiment. Mandibular ramus and condyle on one side was removed to create a 1.5 cm segmental defect. A transport disc was created by "L" shape osteotomy at the end of the remnant ramus and Ni-Ti distractor was fixed and totally embedded in tissues. The rabbits were sacrificed 2 months after operation and the mandibles were harvested.The bone reconstruction were studied with radiographic and histological examination. Results: 2 months after operation all the animals were alive and mandible function kept well.The Ni-Ti distractors were self-activated and performed distraction osteogenesis automatically. The mandibular ramus achieved preliminary reconstruction. Histological examination showed bone regeneration in the distraction area. Conclusions: Ni-Ti distractor can fulfill automatic and continuous distraction osteogenesis.

Objective To explore the role of improved cranioplasty plus ventriculoperitoneal shunt in early treatment of hydrocephalus secondary to decompressive craniectomy for patients with severe craniocerebral injury. Methods A retrospective study was performed on 45 patients complicated by hydrocephalus after decompressive craniectomy for severe craniocerebral injury treated with early stage improved cranioplasty plus ventriculoperitoneal shunt from January 2006 to December 2010.Then,the clinical data,complications and outcomes were summarized. Results All operations were carried out 38-80 days after injury.The postoperative complications were distal obstruction of ventriculoperitoneal shunt in two patients and intracranial infection in one.The clinical symptoms were obviously improved in 36 patients (80％) and the cerebral ventricle was diminished in 34 (76％) one month postoperatively.The Glasgow Outcome Scale (GOS) at discharge was good in eight patients,moderate disability in 19,severe disability in 13 and prolonged coma in five,where better recovery (good recovery and moderate disability) in 27 patients (60％) showed significant improvement compared with preoperation ( x2 =23.47,P ＜0.01 ). Conclusion Early cranioplasty plus ventriculoperitoneal shunt is an effective and safe method for treatment of the complicated hydrocephalus after decompressive craniectomy for severe craniocerebral injury.

BACKGROUND:TiNi shape memory alloy(TiNi-SMA)distractor can be buried completely,there is no time delay and it is different from other distractors previously used.Therefore,it is necessary to reevaluate the osteogenetic time and quality.OBJECTIVE:To investigate the quality of the alveolar ridge augmented by TiNi-SMA distractor by bone mineral density (BMD)and biodynamics tests of new-formed bone.DESIGN:Randomized controlled observation.SETTING:Department of Stomatology of General Hospital of Chinese PLA.MATERIALS:Twelve healthy adult male mongrel canines(ranged from 21 to 26 kg)were provided and bred by Medical Experimental Animal Center of General Hospital of Chinese PLA.All the animals were accorded with the requirements of the quarantine and animal ethnics.Self-made distractors were used in the study.XR-36 Dual Energy X-Ray Absorptiometry (Norland,USA)and 858 Mini Bionix Ⅱ Biomaterial Testing Machine(MTS,USA)were used in the study.METHODS:The experiments were performed at the Medical Experimental Animal Center of General Hospital of Chinese PLA from July 2000 to May 2004.The animals were grouped into group Ⅰ(3 months group)and group Ⅱ(6 months group)randomlv with 6 animals in each group.The left mandible was used as experimental side and the right was used as COntrol side.The canines were kilied after anaesthesia at 3 or 6 months later in both groups.After the mandible samples were cut,the BMD of three points in the distraction gap,above the distraction gap and below the distraction gap were measured by dual energy X-ray.Compressive biomechanics test was performed in the middle of the distraction area of the experimental side and the corresponding area of the control side to detect compressive stress and the modulus of elasticity.MAIN OUTCOME MEASURES:①BMD of the distraction area of the experimental side and the control side in the group Ⅰand group Ⅱ.②Compressive strength and modulus of elasticity of the mandibles of the experimental side and the control side.RESULTS:All of the 12 experimental canines were included in the final analysis,no drop-out.BMD determination:BMD was lower in above the distraction gap of the mandibles of the experimental side than in the control side in the group Ⅰ (t=-2.898,P＜0.05).There was no significant difference in BMD between both sides in the group Ⅱ(P＞0.05).Compressive biomechanics test:Compressive stress and the modulus of elasticity of the mandibles on the experimental side were lower than on the control side in the group Ⅰ(t=-3.274,-3.534,P＜0.05).All indexes increased by some degree in the group Ⅱ compared to the group Ⅰ (P＞0.05).CONCLUSION:The new bone is strong enough for later repair such as implantation after distraction osteogenesis using TiNi-SMA distractor.

Objective To investigate the clinical outcome of modified large decompressive craniectomy in treatment of severe traumatic brain injury combined with acute subdural hematoma. Methods A retrospective analysis was carried out to compare the clinical outcome of large decompressive craniectomy (treatment group) for 81 patients with severe traumatic brain injury combined with acute subdural hematoma from July 2007 to June 2010 and that of standard large trauma decompressive craniectomy (control group) for 65 patients with same injuries from July 2004 to June 2007. Results According to the Glasgow outcome scale at the end of month 6 after injury, there were 21 patients (GCS 5 points) with good recovery, 19 (GCS4 points) with moderate deficit, 24 (GCS 3 points) with severe deficit, five (GCS 2 points) under persistent vegetative status and 12 (GCS 1 points) deaths in the treatment group,with good prognosis rate (good recovery and moderate deficit) of 49% (P ＜ 0.05) and poor prognosis rate of 51%. However, only 21 patients got favorable outcome, including 12 patients (GCS 5 points)with good recovery and nine (GCS 4 points) with moderate deficit; 44 patients got unfavorable outcome (68%), including 22 patients (GCS 3 points) with severe deficit, three (GCS 2 points) under persistent vegetative status and 19 (GCS 1 points) deaths in the control group (P ＜0.05). Furthermore, the incidences of delayed intracranial hematomas and subdural collection of fluid in the treatment group were significantly lower than those in the control group (P ＜ 0.05). Conclusion Modified large decompressive craniectomy can significantly improve the outcome and reduce complications of patients with severe traumatic brain injury combined with acute subdural hematoma.

Glucose ; administration & dosage ; Humans ; Irritants ; administration & dosage ; Joint Dislocations ; therapy ; Mandibular Condyle ; Recurrence ; Temporomandibular Joint ; injuries ; Temporomandibular Joint Disorders ; therapy

Objective To investigate the effect of platelet-rich plasma (PRP) on starting of wnt3 gene and klotho gene of adipose-derived stem cells (ADSCs) of rabbit.Methods Epididymal adipose tissue stem cells were obtained from New Zealand white rabbits,and the cells identified by morphology and inducing differentiation,and the cells were cultured to the fourth generation,PRP and PPP (platelet-poor plasma) were prepared by traditional centrifugal method from abdominal aortic of rabbit; ADSCs were cultured in culture medium containing PRP (experimental group),PPP (control group) and all medium (blank group) for each 5％ for 24h,48h and 72h.Cells of each group were dissociated and total RNA extracted.Effects of the starting of wnt3 gene and klotho gene were detected by RT-PCR.Results Primary ADSCs of rabbit grew in the way of long spindle swirly.The results of oil red O and alizarin red staining of the ADSCs were positive.Expression of wnt3 gene and klotho gene in the experimental group significantly increased from the results of RT-PCR (P＜0.05).Conclusions PRP can promote proliferation of the ADSCs of rabbit and increase the expression of wnt3 gene and klotho gene significantly.