Objective To investigate the causes,diagnosis,treatment of the difficult postoperative decannulation resulting from tracheotomy between children and adults and the method of improving the rate of successful decannulation.Methods Clinical data of 56 cases with difficult decannulation after tracheotomy were analysed retrospectively,all the patients were admitted in our hospital between Jan 1990 and Oct 2006.All the patients were separated into two groups,children group including 24 cases of 14 months ～ 14 years old,adult group including 32 cases of age ranging 15 ～ 48 years old.The postoperative time after tracheotomy were 6 month ～ 1.5 year and 6 month ～ 2 year respectively.Results There were differences of the etiology,diagnostic choice and the clinical manifestation in the treatment of the diffficult decannulation after tracheotomy between children and adults.Children with difficult decannulation after tracheotomy occurred mainly in laryngitis and airway foreign body airway caused by obstruction retrieved after tracheotomy (14/24,58.33 ％),followed by the emergency tracheotomy,such as head and neck trauma (7/24,29.17％).Adults with difficult decannulation after tracheotomy mainly occurred in the throat caused by traumatic lesions of the larynx (including malformations,subglottic stenosis of larynx or vocal cord paralysis) (23/32,71.88％).The average block time in children with anti-inflammatory treatment was significantly lower than that in without anti-inflammatory therapy (6.2 d vs 10.1 d,t =4.26,P ＜ 0.01).However,there was no significant difference in the average block time in adults with anti-inflammatory and without anti-inflammatory treatment (t =1.63,P ＞ 0.05).In the course of treatment,rates of children consciously breathing difficulties (21/21,100％) was also significantly higher than the adult group (13/28,46.43％).Conclusion Children less than 3 years old should avoid tracheotomy.There is no definite relation between the successful treatment in the difficult decannulation and the age of the patients over 3 years old.The first failure treatment in children may be related with the local inflammation.When in treatment,doctors should observe the characteristics of respiratory difficulties,take attention to the influence of children psychological factors to the treatment.Children should be treated in the non-traumatic examination methods.

International cooperation and exchanges plays an important role in the disciplines development in hospital,and can indirectly improve the overall capacity and quality of healthcare..This paper draw on 10 years of international cooperation and exchange in the practice of discipline development,,analyzed working patterns and mechanisms to strengthen international scientific cooperation.

ObjectiveTo investigate the effects of different amounts of iodine intake on the cellular and humoral immune in Grave's disease (GD) patients.MethodsThe clinical GD cases were diagnosed by thyroid fine needle Cytology examination.Patients in GD group are divided into GD group Ⅰ and GD group Ⅱ based on the median of urine iodine.The blood levels of FT4,FT3,TSH,TPOAb,TGAb,TRAb and TNF-t were detected.The difference and association of these parameters between these groups were analyzed.ResultsThe TNF-αt level in GD Ⅰ group was higher than that of GD Ⅱ group( P ＞ 0.05 ) ;The average level of TRAb of GD Ⅰgroup ( [ 1.4 ±0.2 ] U/L) were higher than that of GD Ⅱ group ( [ 1.2 ± 0.1 ] U/L) ( P ＜ 0.05 ) ;The positive rates of TGAb and TPOAb of GD Ⅰ group were higher than that of GD Ⅱ group ( P ＜ 0.05 ).The percentages of patients with high level of TGAb and TPOAb in GD Ⅰ group ( 78.9％ 、84.2％ ) were higher than that in GD Ⅱ group (50.0％,62.5％ ) ( x2 =6.79,10.70,P ＜0.05 ) ; Analysis showed a linear positive correlation of TNF-αwith TRAb and TPOAb ( r is 0.489 and 0.563,P ＜ 0.01 ).ConclusionIodine is an important factor to the development of Graves disease.Excessive iodine intake will exaggerate the GD condition and patients with GD should be controlled for iodine intake.

Objective To explore the surgical strategy and effects for treating complex malignant tumors of the inferior vena cava (IVC) or/and the tumors extending into right atrium/ventricle.Methods Between Dec 2004 and Jul 2008, eight patients underwent surgical resections, among those seven patients with tumors of IVC or the tumors extending into right atrium/ventricle were operated on under deep hypothermia with cardiopulmonary bypass( CPB), and one patient with recurrence of leiomyosarcoma of the IVC successfully underwent en bloc resection and caval reconstruction. The prosthetic graft was used for IVC reconstruction in two patients and vascular patch in the other two patients. Preoperative chest roentgenography, computed tomography, ultrasonography, or magnetic resonance imaging was used to exclude the presence of metastatic disease, to assess local resectability of the tumour and the extent of involvement and obstruction of the IVC. Results One patient died of liver failure postoperatively. The postoperative course was uneventful in other 7 patients. On follow-up two patients died 2 and 5 months later due to functional disorder of the liver. Three patients have been followed up for 14 - 24 months and were

Objective To investigate the effects of trichostatin A(TSA)on the mice model of collagen induced arthritis(CIA).Methods Mice model of rheumatoid arthritis(RA)was induced in DBA/1 mice with type Ⅱ collagen.Paws were scored for histological severity of arthritis.The severity of inflammation of mouse joint was evaluated by histological examination.Real-time PGR was used to determine the cytokine mRNA expression.Cytokine production was measured by ELISA from serum,spleen cell culture or dendritic cell and T cell co-culture supematant.T cell proliferation was examined by MTT method.Results TSA can significantly suppress the severity of the arthritis in CIA.IFN-γ was elevated in CIA mice,but was inhibited significantly by TSA introduced either at the same time with immunization or at the onset of manifestation of arthritis.Collagen specific T cell proliferation was significantly suppressed by introduction of TSA.Increased level of IL-4 by T cells was observed in TSA treated group compared to that of control group.Conclusion IL-4 level was increased and played a critical role in the protective effects of TSA in CIA.TSA suppresses the progress of CIA by regulates the balance of Th1/Th2 differentiation.

Objective·To explore the effect of intracardiac shunts direction on preoperative cerebral tissue oxygenation in children with congenital heart disease. Methods·Sixty children aged from 4 to 24 months diagnosed with ventricular septal defect (VSD group), tetralogy of Fallot (TOF group) and indirect inguinal hernia (control group) undergoing elective surgeries were recruited, with 20 cases in each group. The NIRS cerebral oximeter was used to monitor TOI of patients. Two sensors were placed on the subject's forehead bilaterally for continuous monitoring of cerebral oximetry. Pulse oxygen saturation (SpO2), noninvasive blood pressure, heart rate were also measured and recorded. TOI and fractional tissue oxygen extraction (FTOE) were compared among the three groups and multiple linear regression analysis was used to evaluate the relationship between TOI and these parameters. Results·There was no significant difference in TOI between VSD group and control group (P>0.05). Both sides of TOI in TOF group were significantly lower than those in other two groups (P=0.000) and FTOE in TOF group were significantly higher than those in VSD group (P=0.005). Multiple linear regression analysis showed that only SpO2 was related to TOI in children with congenital heart disease (r=0.560, P=0.000). Conclusion·Different intracardiac shunts direction can affect cerebral tissue oxygenation through affecting systemic oxygen supply. Children with right-to-left shunt physiology have lower TOI and higher FTOE due to low systemic oxygenation.

AIM: To identify the differences of gene expression between human age-related cataract and clear lenses. METHODS: The RNA were extracted from human age related cataract and clear lens epithelial cells, labeled with cy3/cy5 as probes, then were hybridized to cDNA chip containing 8 064 genes. The differential expressions of the genes were screened. Furthermore, a primary classification of these genes function was given. The expression levels of the identified genes were further evaluated by real time polymerase chain reaction. RESULTS: 286 genes expression were observed to increase and 438 genes expression were observed to decrease in cataractous lens epithelial cells as compared with normal lens. According to functional analysis, the changed genes in cataract lens are associated with lens structural components, cytoskeleton, cell cycle, apoptosis and stress responses. CONCLUSION: These data suggest that there are differences in gene expression between cataract and clear human lens epithelial cells. The majority of genes changed in cataract exhibited decreased expression. Processes associated with the down-regulated genes may reflect the inability of the lens to maintain its homeostasis and transparency.

Objective To validate feasibility of comet assay as a tool for detecting DNA damage induced by various types of chemical mutagens.Study of DNA damage induced by4chemicals on human lymphocytes was carried out in vitro.Methods Human lymphocytes were exposed to4-nitroquinoline-1-oxide(4NQO,a UV-mimetic agent ),methyl methanesulfonate(MMS,an alkylating agent ),Bleomycin(BLM,a radiamimetic agent )and Mitomycin(MMC,a DNA crosslink agent )for3h,the DNA single strand breaks(SSB)induced by4chemicals were measured immediately(0h-incubation)and21h-incubation after3h-exposure to the chemicals with comet assay.Results It was found that the SSB induced by4NQO,MMS and BLM,which revealed a dose-response relationship(P

Objective To investigate the effects on IL-6 and PGE2 expression in wear-particles-induced osteoblast cells by blocking calcium phosphatase (Cn)/ activated T nuclear factor (NFAT) pathway. Methods Fetal Sprague-Dawley rats were used in this study. Osteoblast were prepared from the calvariae of rats . Osteoblast cells were incubated in four group according to different supplementation:(1) neither Ti particles nor 11R-VIVIT (Control group), (2) only Ti particles (Ti group), (3) both Ti particles and 11R-VIVIT (Ti/VIVIT group), and (4) only 11R-VIVIT (VIVIT group). Cells were incubated for 96 hours and the expression of NFATc1 protein was detected by western blot. The expression of IL-6 and PGE2 in liquid supernatant of osteoblast were detected at 6, 24 and 96 hours by ELISA. Results The expression of NFATc1 in the Ti group was higher than that in the Control group (P < 0.01), but in Ti/VIVIT group that was significantly lower than in the titanium particle group (P < 0.01). The IL-6 and PGE2 expression in the supernatant of the Ti group were significantly increased than those in the control group (P < 0.05). The IL-6 and PGE2 in the Ti/VIVIT group were significantly lower than that in the Ti group (P < 0.05). Conclusions 11R-VIVIT peptide specific blockade of Cn/NFAT signaling pathway significantly inhibited IL-6 and PGE2 of osteoblast cells induced by titanium particles.

Objective To study the immediate effect of applying a portable functional electrical stimulation device (PUEFESD) to the upper extremities of stroke patients.Methods Twenty stroke survivors were selected.Pairs of electrodes of the PUEFESD were applied on the dorsal and palm sides of the affected forearm and thenar to stimulate the extensors and flexors as well as the thenar muscles sequentially according to a programmed protocol.Functional evaluation was conducted before and immediately after the stimulation.All participants were assessed with regard to their motor function and performance in the activities of daily living using an upper extremity function test (UEFT),the upper extremity motor function portion of the Fugal-Meyer assessment (FMA),and rating with the modified Barthel index (MBI).A visual analogue scale (VAS) was used to evaluate pain in the affected upper extremity.Results The patients' average FMA score was 19.4 ± 7.1 before the stimulation and 30.4 ± 9.6 after.The corresponding UEFT scores were 3.6 ± 3.7 and 26.9 ± 5.9,and the average MBI scores were 53.8 ± 26.2 and 65.8 ± 17.7.All of these increases were statistically significant.The average VAS score,however,did not change significantly.Conclusions Functional electric stimulation can quickly improve upper extremity function and the ADL ability of stroke patients,but pain is not relieved significantly.