Objective To compare the effects of general anesthesia and epidural anesthesia on short -term cognitive function in elderly patients after orthopedic surgery.Methods According to the digital table,90 elderly orthopedic patients were divided into the control group and observation group,45 cases in each group.The control group was given general anesthesia,and the observation group was given epidural anesthesia.Before anesthesia and 6h,12h,12h,72h after anesthesia,cognitive function was detected according to MMSE,and before anesthesia and operation,30min after operation,postoperation heart rate (HR)and blood pressure (BP)were measured.Results Before anesthesia,before operation,30 min intraoperation and after operation,the HR between the two groups had no significant differences(t =0.094,0.113,0.188,0.348,all P >0.05),and BP between the two groups also had no significant differences (t =0.190,0.179,0.181,0.271,all P >0.05).Compared with the scores of MMSE in the control group at postoperative 24h,the scores of MMSE in the observation group was significantly higher (t =37.947, P <0.01).Compared with pre -induction of anesthesia,the scores of MMSE in the observation group at postoperative 6h and 12h were relatively lower(t =37.210,65.118,all P <0.01),but there was no significant difference at 24h and 72h(t =1.861,P >0.05).Compared with pre -induction,the scores of MMSE in the control group at postopera-tive 6h,12h and 24h were significantly lower(t =29.912,41.000,39.528,all P <0.01),while the score of MMSE in the control group at postoperative 72h had no significant difference compared with before anesthesia(t =1.861,P >0.05).Conclusion Compared with general anesthesia,epidural anesthesia has less impact on short -term cognitive function.and the anesthetic effect is better.

Objective To investigate the effect of diabetes on hyperlipidemic acute panereatitis. Methods The clinical data of 96 patients with hyperlipidemic acute pancreatitis from Jun 1996 to Jun 2006 were retrospectively reviewed. Results Of all 96 patients, 21.9% (21/96) suffered from severe acute pancreatitis ( SAP ), 78. 1% ( 75/96 ) suffered from mild acute pancreatitis ( MAP ), respectively. Twenty-four patients (25%) were diabetics. Triglyceride level, obesity rate, SAP cases and APACHE Ⅱ scores in patients with diabetes were significantly higher than those of no-diabetes patients( P < 0. 05 ). The glucose level, diabetes of history length, triglyceride level and fat were the independent factors for prognosis of acute pancreatitis with hyperlipidemia by the Cox model analysis. With the increasing of APACHE Ⅱ score, the blood glucose level of patients increased. Blood glucose level in a short period of time does not correlate with lipid levels. Conclusions The level of blood glucose is related with hyperlipidemic acute pancreatitis, the history of the diabetes to a certain extent influences the development of hyperlipidemic acute pancreatitis.

Objective To investigate the effects of Ulinastatin (UTI) on the expression of NF-κB and ET-1 in rats with acute necrotizing pancreatitis (ANP)-associated lung injury and morphology of lung tissue.Methods 60 Sprague-Dawley rats were randomly divided into 3 groups with 20 rats in each group,including sham operation (SO) group,ANP group and UTI group.ANP was induced by injection of 5% sodium taurocholate (1 ml/kg) into pancreatic duct;normal saline was injected for SO group with same amount.UTI was injected for UTI group with the amount of 10 000 U/L via tail vein after ANP induction.The rats were sacrificed 24 h later.The contents of serum amylase,TNF-α and wet/dry weight ratio of the lung were measured.The expression of NF-κB and ET-I protein were detected by immunohistochemical method.The level of apoptosis was detected by TUNEL Results The contents of serum amylase,TNF-α,and wet/dry weight ratio of the lungin in UTI group at 24 hours were (5 648±378)IU/L,( 89.19±3.54) ng/L and 4.55 ±0.07,respectively;which were significantly lower than the corresponding (6 799±437 )IU/L,(183.30±8.18) ng/L and 4.89±0.20 in ANP group (P＜0.05 ).There was no NF-κB and ET-1 expression,and no apoptosis was present in SO group.The positive rates of NF-κB and ET-1 in UTI group were (19±3 ) % and(8±1) %,respectively,the corresponding values in ANP group were (25±2) % and (13±1 ) %,respectively (P ＜ 0.05 ).The level of apoptotie index in UTI group was 13.75±1.25,which was higher than that (6.90±0,85) in ANP group ( P ＜ 0.05 ).Conclusions The high expression of NF-κB and ET-1 in lung tissue may cause lung injury.UTI could ameliorate the microcirculation and lung injury caused by inflammation.

Objective:To investigate the clinical value of virtual monoenergetic images (VMI) and electron density map (EDM) derived from the dual-layer spectral detector CT (DLCT) in the differential diagnosis of benign and malignant pulmonary ground glass nodules (GGN).Methods:From July 2019 to August 2020, a total of 65 patients with lung GGN (27 benign GGNs and 38 malignant GGNs) confirmed by pathology were retrospectively enrolled in Gulou Clinical Medical College of Nanjing Medical University. All the patients underwent DLCT plain scanning within two weeks before the surgery. The conventional 120 kVp polyenergetic image (PI), EDM and 40-80 keV VMI were reconstructed. The differences of CT and electron density (ED) values between benign and malignant lesions on different images were compared by Mann-Whitney U test. Independent t-test was used to compare the lesion size and χ 2 test was used to analyze the CT features (including lesion location, shape, edge, internal structure, adjacent structure, nodule type) between benign and malignant lesions. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of different energy spectrum quantitative parameters in the differential diagnosis of benign and malignant GGN. The statistically significant CT signs and energy spectrum quantitative parameters were analyzed by logistic regression analysis to find out the independent risk factors of malignant GGN, and then ROC curve analysis was performed for each independent risk factor alone or in combination. Results:There were significant differences in lesion shape, spiculation, lobulation, location and size between benign and malignant groups ( P<0.05). The CT value of pulmonary GGN in PI, 40-80 keV VMI and the ED value in EDM were statistically different between benign and malignant lesions ( P<0.05). The area under ROC curve (AUC) were 0.680, 0.682, 0.683, 0.686, 0.694, 0.676 and 0.722, respectively, among which the ED value had the highest AUC. Binary logistic regression analysis was carried out with GGN shape, spiculation, lobulation, location, size, ED value and CT value in PI, 40-80 keV VMI as independent variables, and malignant GGN as dependent variables. The results showed that ED value (OR=1.045, 95%CI 1.001-1.090, P=0.044), lesion size (OR=1.582, 95%CI 1.159-2.158, P=0.004), spiculation sign (OR=11.352, 95%CI 2.379-54.172, P=0.002) were independent risk factors for malignant GGN. ROC curve analysis showed the AUC of ED value, lesion size, spiculation sign and combination of the three for differential diagnosis of benign and malignant GGN were 0.722, 0.772, 0.698 and 0.885. The AUC for the combined parameters was the largest, with sensitivity of 92.1% and specificity of 74.1%. Conclusion:The diagnostic efficacy of EDM is higher than that of other VMI in the differential diagnosis of pulmonary GGN by DLCT images; The efficacy is further improved when EDM is combined with lesion size and spiculation sign for comprehensive diagnosis.

Objectives: To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer. Methods: The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ² test, survival analysis was carried by Kaplan-Meier and Log-rank test. Results: Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ²=288.60,P<0.01),N stage(χ²=68.10, P<0.01), vascular invasion(χ²=128.70, P<0.01)and neural invasion(χ²=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ²=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05). Conclusion With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.