Objective To investigate the effects of ABO blood group factors on postoperative cognitive function in elderly patients.Methods One hundred twenty patients, aged 65-75 yr, with body mass index of 17-26 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective thoracic surgery, were divided into 4 groups (n =30 each) according to the blood group: blood group A group (group A), blood group B group (group B), blood group O group (group O) and blood group AB group (group AB).Combined general-epidural anesthesia was used during surgery, patient-controlled epidural analgesia was performed after surgery, and visual analogue scale score was maintained ≤4.Before surgery (T0), and at 6, 24 and 72 h after surgery (T1-3), Mini-Mental State Examination (MMSE) was used to assess the cognitive function, and the occurrence of postoperative cognitive dysfunction (POCD) was recorded.Blood samples were drawn from the central vein at T0-3 for determination of neuron-specific enolase (NSE) and S-100β protein concentrations in serum.Results Compared with the values at T0, MMSE scores were significantly decreased, and serum NSE and S-100β concentrations were increased at T1-3 in A, B and AB groups, and at T1 and T2 in group O (P＜0.05).Compared with group A, MMSE scores were significantly increased, and serum NSE and S-100β concentrations were decreased at T1-3 in B, AB and O groups (P＜0.05).Compared with group O, MMSE scores were significantly decreased, and serum NSE and S-100β concentrations were increased at T1.3 in B and AB groups (P＜0.05).There was no significant difference in MMSE scores and serum NSE and S-100β concentrations at T1-3 between group B and group AB (P＞0.05).The incidence of POCD from the high to the low was group A, group AB, group B, and group O in turn (P＜0.05 or 0.01).Conclusion ABO blood group factors affect postoperative cognitive function in elderly patients, elderly patients of blood group A are found to be prone to develop POCD, and the incidence of POCD is relatively low for elderly patients of blood group O.

Objective To investigate the mRNA response of type1 and type2 cytokines in immunization failure children who were infected hepatitis B virus (HBV) via placenta from HBV carrier mothers. Methods All subjects were born to HBV carrier mothers and received hepatitis B immunoprophylaxis treatment according to routine schedule. Interleukin-4 (IL-4) and interferon-gamma (IFN-?) transcription of peripheral blood mononuclear cells upon lectins or two-doses of HBsAg from 29 children with persistent HBV infection since birth (Nonresponders), 9 with transient HBV infection at birth and at less than 6 month of age (Responders) were analyzed by semi-quantitative RT-PCR. 25 children with positive anti-HBs response and never positive HBsAg were used as controls. Results Nonresponders expressed a marked higher spontaneous IFN-? mRNA transcription than controls (95% confidence interval is 1665～3089 in nonresponders,763～1609 in controls, P=0.008). Upon two doses of HBsAg stimulation, all three groups expressed a higher IFN-? mRNA transcription than spontaneous transcription, but the increase in nonresponders is lower than controls (95% confidence interval by low dose of HBsAg is 899～1703 in controls, 170～854 in nonresponders,P=0.004). The responders expressed a significant increase of IL-4 mRNA transcription upon high-dose HBsAg stimulation but not in nonresponders (95% confidence interval of the increase in controls is 213～861, P=0.011). Positive correlations were found between ALT level and the IFN-? mRNA transcription upon lectins stimulation and between ALT level and IFN-? mRNA/IL-4 mRNA ratio upon high-dose HBsAg stimulation.Conclusions Low responses of type 1 and type 2 cytokines transcription upon specific stimulation exist in intrauteral infected hepatitis B immunization failure children, and the over response of type 1 cytokine upon nonspecific stimulation may contribute to the liver injury in nonresponders.

In order to investigate the occurrence of chronic hepatitis B virus(HBV) infection in HB vaccine inoculated infants born to HBsAg positive mothers and its affecting factors and also to study the effect of combined use of HB immunoglobulin (HBIG) and HB vaccine on the blocking of perinatal transmission of HBV, we divided 624 infants born to HBsAg positive mothers into two groups randomly. The first group of infants were simply vaccinated with HB vaccine 20μg at,0, 1, 6 months old. The second group of infants were inoculated with HBIG 100 IU at their birth and further vaccinated with HB vaccine 20μg at 1,2,7 months old. The HBsAg of the two groups of infants was tested at the age of 1,3,6,12,18,24 months old and every year by EIA. They were all followed up for 6.34±1.71 years averagely. The follow-up results showed that there were 89 childeren infected chronically by HBV, among them 82% appeared to be HBsAg positive, firstly seen before the age of 6 months mainly attributing to uterus infection. The HBV chronic infection rate of infants born to HBsAg, HBeAg positive mothers (HB vaccine immunized, 24.5%; HBIG+HB vaccine, 10.6%, P<0.005) was higher than that of infants born to HBsAg positive mothers (HB vaccine immunized, 10.7%; HBIG+HB vaccine 3.8%, P<0.025). Moreover, the chronicity rate of the infants whose HBsAg firstly appeared within 6　　months and were born to HBsAg, HBeAg positive mothers was higher than that of the infants born to HBsAg positive months (68%,40% respertively in HB vaccine inoculated group, P<0.025). Infants immunized combinely with HBIG and HB vaccine had their chronic HBV infection decreased from 17.6% to 5.0% at l year old as compared with that of HB vaccine inoculated infants. The total chronic HBV infection rate in children born to HBsAg, HBeAg positive mothers decreased from 24.5% to 10.6% (P<0.005) and that in children born to HBsAg positive mothers decreased from 10.7% to 3.8% (P<0.025). The HBV chronicity rate of HBsAg positive infants born to HBsAg, HBeAg positive mothers also decreased and that of infants born with HBsAg negative, but became positive after 1-6 months decreased from 40.9% to 0% (P=0.0315). The HBsAg seronegative conversion rate in l month old infants born to HBsAg positive mothers increased from 26.4% to 58.8% (P<0.025). All these data indicated that infants born to HBsAg positive mothers, though had been HB vaccine immunized, still had chronic infection, that was chiefly due to chronic uterus infection by HBV. The single use of HB vaccine can not completely block the uterus infection of HBV, but when combinatively used with HBIG, the blocking effect is more efficient, the chronicity of HBV infection also can be avoided.

Objective To observe the effect of segmented external dissection and internal ligation and leather bridge ligation plastic surgery in treatment of circumferential mixed hemorrhoids. Methods One hundred and twenty patients with circumferential mixed hemorrhoids were enrolled in this study, and they were divided into observation group and control group according to operation methods, with 60 cases in each group. The patients in two groups were treated with segmented Milligan-Morgan. The patients in observation group were treated with leather bridge ligation plastic surgery, and the patients in control group were treated with slit skin bridge plastic surgery. Postoperative complications and effect were observed. Results The pain scores on the first day and the third day after operation in two groups had no significant differences (P>0.05). On the seventh day after operation, the pain scores in observation group was significantly better than that in control group (P < 0.01). After operation, the number of edema and anal stenosis in two groups had no significant differences (P>0.05). The number of broken leather bridge in observation group was significantly shorter than that in control group (P<0.01). The healing time in the observation group was significantly shorter than that in control group:(24.0 ± 3.6) d vs. (29.6 ± 4.70) d, t =- 6.05, P<0.01. Conclusions Segmented external dissection and internal ligation and leather bridge ligation plastic surgery in treatment of circumferential mixed hemorrhoids is safe and easy to operate, and it has a significant clinical effect.

In resent years, the accounts about adults' sudden death without specific reason have been increased. The definition of cause of death was a hot potato to legal medical experts. With the deep - going of etiology to molecular level, clinical cardiac diseases' researches have confirmed that the arrhythmia has been resulted from a kind of " idiopathic disorder of cardiac action potential" that is related to cardiac sodium channel diseases by SCN5A mutation confirmed by using the techniques of molecular genetics. The paper reviewed the characteristic of SMDS ( Sudden Manhood Death Syndrome) in forensic science and some kinds of diseases' genotype and phenotype in clinical medicine, and hoped to acquire some revelation for further related research.

Objective To compare the influence of different feeding mode on the immunoprophylaxis efficacy of the babies born to hepatitis B (HB) carrier mothers. Methods The babies born to HB carrier mothers received HB vaccine alone routinely or HB immunoglobulin (HBIG) plus HB vaccine immunoprophylaxis were followed up. Among infants with HB vaccine alone, 21 were breastfed and 40 bottle-fed, among those with HBIG and HB vaccine, 33 were breastfed and 135 bottle-fed. Results Among babies receiving HB vaccine alone, the positive rates of anti-HBs at 1,3,6,12 month of age are 4.8%, 42.9%, 57.9%, 80.9% in breastfed group, and 12.2%, 26.3%, 60.5%, 73.2% in bottle-fed group. Among those with HBIG and HB vaccine, the positive rates of anti-HBs at 1, 4, 7, 12 month of age are 72.7%,75.8%,77.4%,90.9% in breastfed group, and 77.0%, 72.9%,76.2%,90.4% in bottle-fed group. With HB vaccine alone, 1 infant in breastfed group and 3 in bottle-fed group, and with HBIG and HB vaccine, 0 in breastfed group and 4 in bottle-fed group were chronically infected at 1-year of age. There are no significant differences of the incidence of anti-HBs and immunoprophylaxis failure between breastfed and bottle-fed babies. Conclusion Breastfeeding doesn't pose a negative influence on the response of anti-HBs and the failure rates of the HB immunoprophylaxis in the infants born to HB carrier mothers

Objective To observe the clinical effect and safety of using Sufentanil in children's enteroscopy under general anesthesia. Methods 80 ASA Ⅰ ~ Ⅱ children, aged 5~10 years, weighed 18~35 kg, who scheduled for enteroscopy, were randomly divided into two groups: group Sufentanil (group S, n = 40) and group Fentanyl (group F, n = 40). Group S were given Sufentanil 0.2 μg/kg and Propofol 2.50 mg/kg in intravenous injection, group F were given Fentanyl 2.0 μg/kg and Propofol 2.50 mg/kg in intravenous injection. Proseal laryngeal mask airway (PLMA) was inserted when eyelash reflex disappeared and the submaxilla was loosen, and Propofol 6.00 ~8.00 mg/(kg?h) and 2% ~ 3% Sevoflurane inhalation for anesthesia maintenance. Parameters of HR, MAP, SpO2 and RR were recorded at different times: before induction (T0), insertion of PLMA (T1), enteroscopy to the ileocecal valve (T2) and end of operation (T3). Also, time of induction and recovery, pain on injection, perioperative body movement, intraoperative regurgitation, glossocoma, nausea and vomiting, throat pain and agitation were also recorded. Results Compared with T0, HR and MAP at T1 and T2 were significantly higher in group F (P < 0.05), but in group S, there was no significant differences (P > 0.05). RR in both groups were significantly lower at T1 compared with T0 (P < 0.05), and no significant differences between the two groups (P > 0.05). HR, MAP and RR were significantly lower in group S than that in group F at T1 and T2 times (P < 0.05). Pain on injection, body movement and agitation were significantly lower in group S than that in group F (P < 0.05). Induction and recovery time in group S were significantly shorter than that in group F (P < 0.05). Conclusions The anesthetic effect of Sufentanil for combined intravenous and inhalation anesthesia in children's enteroscopy is safe and satisfactory. It could provide more smoothly intraoperative hemodynamics and higher quality of awakening.

Objective To investigate the scintigraphic features of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) and to explore the clinical significance of 99Tcm-EHIDA hepatobiliary scintigraphy.Methods Hepatobiliary scintigraphy with 99Tcm-EHIDA was performed in 28 genetic confirmed NICCD cases (16 males,12 females,1-8 months).Normal dynamics (i.e.,time-activity curve) of the tracer in heart,liver and kidneys was defined as normal hepatic uptake function.Decreased liver uptake of the tracer and/or prolonged heart and kidneys radioactivity retention was defined as impaired hepatic uptake function.Normal or delayed biliary excretion was defined as radioactivity appearing in the bowel within 60 min or after 60 min.Occluded biliary excretion was defined as absent bowel radioactivity within 24 h.The characteristics of hepatobiliary scintigraphy and their relationship with levels of serum total bilirubin (TB),direct bilirubin(DB),ALT,total bile acid (TBA) were retrospectively analyzed.Statistical analysis was performed using Kruskal-Wallis rank sum test.Results Of 28 NICCD patients,20 showed normal uptake while 8 had impaired hepatic uptake.Ten of twenty patients with normal uptake function showed normal biliary excretion and the others showed delayed biliary excretion.Four of eight cases who presented impaired hepatic uptake function were with delayed biliary and the rest displayed biliary excretion occlusion.Compared with the patients with normal hepatic uptake function,patients with impaired hepatic uptake had significantly higher levels of TB and DB (TB:183.6(128.7-280.9) mmol/L vs 105.5(80.0-141.7) mmol/L,Z=-2.25;DB:135.6 (95.7-212.6) mmol/L vs 73.1(53.9-97.9) mmol/L,Z=-2.73; both P＜0.05).Compared with the cases with normal biliary excretion function,patients with delayed biliary excretion had significantly higher levels of TB,DB and TBA (TB:137.5 (122.0-170.9) mmol/L vs 81.7(65.7-93.5) mmol/L,Z=-3.92;DB:96.5 (81.1-108.0) mrrol/L vs 54.1(45.3-72.6) mmol/L,Z=-3.74; TBA:245.6(183.9-299.2) mmol/L vs 136.0(73.5-163.2) mmol/L,Z=-2.57; all P＜0.05).The levels of TB (262.0(152.1-542.8) mmol/L) and DB (192.7(118.1-407.2) mmol/L; both Z=-2.82; both P＜0.05) were the highest in patients with occluded biliary excretion.Compared with the patients with delayed excretion,the occluded excretion subgroup had significantly higher levels of ALT (71.5 (48.5-144.8) U/L vs 20.0(16.5-27.7) U/L,Z=-2.66,P＜0.05).Conclusion 99Tcm-EHIDA hepatobiliary scintigraphy may evaluate hepatic uptake and excretion function of the NICCD infants.When the hepatic uptake is remarkably decreased,the occluded biliary excretion can be shown.

Objective To evaluate the efficacy of sniffing position in alleviating glossoptosis during the emergence from anesthesia in children. Methods Two hundred pediatric patients who developed glos?soptosis during the emergence from anesthesia, aged 2-8 yr, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, were randomly divided into 4 groups ( n=50 each) using a random number table:head extension position group ( group A ) , head tilted position group ( group B ) , oropharyngeal airway group ( group C) and sniffing position group ( group D) . Alleviation of glossoptosis, and occurrence of la?ryngospasm, agitation, vomiting and oral hemorrhage were recorded. Alleviation rate was calculated. Re?sults Compared with group A, the alleviation rate was significantly increased in C and D groups, the alle?viation rate was decreased in group B, and the incidence of laryngospasm, agitation and oral hemorrhage was increased in group C ( P<0?05 ) . Conclusion Sniffing position can effectively alleviate glossoptosis during the emergence from anesthesia in children with good safety.