ObjectiveTo compare the clinical efficacy and safety of anesthesia induction between inhalation of sevoflurane and intravenous injection of propofol for laryngeal mask airway (LMA) insertion in elderly patients.Methods40,ASA physical grade Ⅰ ～ Ⅱ patients scheduled to receive elective total knee arthroplasty were allocated to 2 groups at random. Patients in group one( G1 ) received intravenous induction of propofol infusion by a targetcontrolled infusion system which was set at the effect-site concentration of 4.0μg/ml,while patients in group two(G2)received inhalational induction with sevoflurane using vital capacity manoeuver at the target of end-expiratory concentration of 3.0％. We observed the whole procedure of anesthesia induction and LMA insertion, while recording the changes in hemodynamic state and occurrence of adverse events. ResultsMore than 85％ patients achieved LMA insertion at first attempt using either induction manoeuver. Although consciousness loss time in G1 was 39. ls longer than G2, there was no difference in anesthesia induction time for LMA insertion between these two groups. Contrary to a significant decrease in MAP following induction for patients in G1, there appeared hemodynamically stable in patients of G2,while apnea also significantly seldom occurred in G2 as compared to G1 (20％ vs 85％ ,P ＜0. 05).ConclusionAs compared to intrvenous induction with propofol, inhalation induction with sevoflurane provided a valuable alternative for LMA insertion in adults.

Objective To explore the value of the square for intracranial puncture orientation applying in the intracranial hematoma microinvasive craniopuncture scavenging technique. Methods Fifty-one patients with hypertensive cerebral hemorrhage were randomly enrolled into the orientation square group( n=27)and the CT orientation routine group (n=24). The puncture point was fixed by certain wayin each group. Both groups received the same intracranial hematoma microinvasive craniopuncture scavenging technique. The punctural precision,the time spended for puncture orientation and the curative effect in two group were observed and compared. Results The deflected rate(18.5%)of the orientation square group was lower than that routine group significantly(50.0%)(P

Objective To evaluate the value and safety of flexible bronchoscopy in etiological diagnosis and treatment of hemoptysis in children. Methods The flexible bronchoscopy findings and clinical data of 22 children with hemoptysis were ana-lyzed retrospectively. Results The causes of hemoptysis were as follows, bronchiolitis and pneumonia in 8 cases (2 cases with bronchiectasis), foreign body in bronchus in 3 cases , idiopathic pulmonary hemosiderosis in 3 cases, neoplasms in airway in 2 cases, suspi-ciion of bronchial pulmonary vessel dysplasia in 4 cases (requiring angiogram) and unknown causes in 2 cases. Two cases suffered hypoxemia. Active bleeding was found in 6 cases and topical hemostasis treatment was effective. The bronchial foreign body was removed from right lower lobe bronchus in 3 cases. One case with atelectasis caused by granulation was treat-ed with bronchoscopic cryotherapy 2 times, no granulation was found during the third bronchoscopy and chest CT showed the atelectasis was cured 2 weeks later. Conclusions Flexible bronchoscopy is one of the necessary and safe examinations in chil-dren with hemoptysis and is of important value in clinical diagnosis and treatment.

Objective To analyse the difference between stage Ⅰ pure bronchioloalveolar carcinoma (BAC) and stage Ⅰ adenocarcinoma of the lung among operative cases.Methods We use the Lobectomy Cases Registration and Statistics System database (2006-2011) to compare the epidemiology,clinical presentation,image characteristics,surgical outcomes,recurrence and overall survival between BAC and adenocarcinoma groups.All the patients received lobectomy procedure in the department of thoracic surgery of Peking University People' s Hospital.Results Excluding those cases with both BAC and adenocarcinoma aspects,337 patients were enrolled.Thirty-nine patients were stage Ⅰ pure BAC and 298 patients were stage Ⅰadenocarcinoma.BAC has its proper clinical spectrum,occurring more frequently in women (69.2％ vs.52.0％,P =0.042)and in younger patients (57.4 vs.61.8,P =0.014).BAC also seems to be less dependent on tobacco exposure (12.8％ vs.29.9％,P =0.026).The percentage of ground-glass opacity (GGO) in CT scan of BAC patients was much more than that registered in adenocarcinoma patients (35.9％ vs.9.7％,P ＜0.001).And the tumor size of BAC group was smaller than that of the adenocarcinoma group (1.4 cm vs.2.3 cm,P ＜0.001).The operation method,time,blood loss and complications were similar between the two groups.Kaplan-Meier survival curves showed that both 3-year disease-free survival (DFS) and overall survival (OS) were significantly higher in patients affected by BAC (100％ vs.76.1％,P =0.030 and 100％ vs.86.1％,P =0.041).Conclusion BAC presents specificity in its epidemical,clinical,radiological and evolutionary aspects.Stage Ⅰ pure BAC patients have better prognosis following video-assisted thoracoscopic lobectomy and system lymph node dissection than the similar stage adenocarcinoma patients.

Objective To evaluate the relationship of metabolic syndrome (MS) and MS components with thyroid nodule. Methods A total of 10 357 subjects ( age ＞ 18 years old) who received physical checkup at the Second Affiliated Hospital of Dalian Medical University between June 2009 and June 2010 were enrolled in this retrospective study. Anthropometric parameter, fasting plasma glucose (FPG),serum lipid profile, blood uric acid, alanine aminotransferase and thyroid ultrasonography were measured. Results The prevalence of thyroid nodule,MS,and thyroid nodule + MS was 46. 96% ,23. 6%,and 11.6%, respectively. The prevalence of thyroid nodule was significantly higher in MS patients than in non MS patients ( 75.9% vs 38. 0%, P ＜ 0. 05 ). Multifactor logistic analysis showed that MS, body mass index (BMI) and FBG (β vales were 0. 78,1.22,and 0. 62,respectively; odds ratios were 4. 167,3. 876,and 2. 359, respectively; all P ＜ 0. 05 ) were independently correlated with the development of thyroid nodule. Conclusions Significantly increased prevalence of thyroid nodule could be found in MS patients. BMI and FBG may be independent risk factors of thyroid nodule.

Objective To evaluate the clinic efficacy of sufentanil and remifentanil by target- controlled infusion (TCI) combined with propofol in patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Methods Sixty patients,ASA Ⅰ ～ Ⅱ,undergoing elective EBUS-TBNA were randomly divided into group S ( sufentanil group),group R (remifentanil group) and group SR (sufentanil + remifentanil group),each group were twenty patients.The anesthesia of all groups is propofol intravenous anesthesia with 2％ lidocaine topical anesthesia,to controll BIS between 50 and 60 during surgery.Heart rate(HR),mean arterial pressure(MAP) pulse oxygen saturation( SpO2 ) and respiratory rate (RR) were recorded and compared 5mins after entering room(T0),30mins after the beginning of surgery(T1 ) and after surgery(T3).Arterial blood gas and the times of cough during surgery were also recorded and compared in all groups.The use of propofol and lidocaine,the wake-up time,satisfaction with anesthesia and adverse reactions in 6 hrs after surgery were also obtained.Results ( 1 ) RR decreased distinctly in group R and PaCO2 increased distinctly in group S and group R compared with that of group SR (P ＜0.05) during surgery.(2)The times of cough and the wake-up time lessened distinctly in group R and group SR compared with that of group S ( P ＜0.05 ).(3) The use of propofol and lidocaine,satisfaction with anesthesia and adverse reactions in 6 hrs after surgery were similar in all groups ( P ＞ 0.05 ).Conclusion Sufentanil compounded remifentanil by TCI combined with propofol is a safe and feasible anesthesia option for EBUS-TBNA,which provides better efficacy,high satisfaction and less side effects compared with using alone of sufentanil and remifentanil respectively.

The clinical practice on real patients is more and more difficult in the present condition of the hospitals.Then,the modern medical simulating teaching is the main direction of the development in this field due to its characteristics,based on high- technology,simulating the real clinical circumstance,and being applicable in practice and avoiding the risk of clinical miscarriage. The significance and main development direction of modern medical simulated teaching will be discussed in this article.

Objective To investigate the possible origin and role of follistatin (FS) in pregnancy Methods The maternal serum FS levels in menstrual cycle, first trimester (8～12 weeks) and term (38～41 weeks) were determined by a specific two site enzyme linked immunosorbent assay (ELISA). Reverse transcription polymerase chain reaction (RT PCR) method was utilized to semi quantitatively determine FS mRNA levels in the ovaries and placentas Results Maternal serum FS level at term was significantly higher than that in the first trimester of pregnancy and that in normal women during the menstrual cycle(180?26)?g/L ,(4.4?2.1)?g/L, (1.5?2.2)?g/L , (respectively P

Non-steroidal anti-inflammatory drugs( NSAIDs)are widely used in clinical practice,and their gastrointestinal adverse effects have attracted more and more attentions. Although many investigations were focused on gastroduodenal mucosal injury induced by NSAIDs over times,small intestinal injury has become the new hot-spot because of its high morbidity rate in recent years. The mechanisms of NSAIDs-induced small intestinal injury have not been fully elucidated and no specific prevention and treatment modalities have been developed. In this article,the mechanisms of NSAIDs-induced small intestinal injury and the preventive and therapeutic effect of muscovite were reviewed.

Targeting the key questions in the scale development process of TCM syndrome, such as the definition of the concept, the construction of the theoretical framework, the quantitative classification of the items, the rational use of the statistical methods and so on, this article put forward that on the basis of carefully distinguishing the three concepts of syndrome diagnosis, syndrome evaluation and disease diagnosis, and based on TCM dialectical thinking and mathematical validation to build theoretical framework. A scientific and reasonable quantitative classification method was established based on the reliability and validity as indexes. Non-linear intelligent mathematical statistics and symptomatic index groups were used to analyze the ideas and methods of data mining, with a purpose to improve and perfect the methodology of the development of syndromes scale and to improve the establishment and application of the syndrome scale.