Objective To study the anesthetic effect and influence to circulatory and respiratory function of target controlled infusion(TCI)and intravenous injection of propofol anesthesia in elderly patients undergoing colonoscopy.Method 50 patients above 55 years of age undergoing colonoscopy were randomly allocated to 2 groups.The TCI group received target controlled infusion of propofol with a target concentration of 3?g/ml.The injection group received intravenous injection of 2mg/kg propofol with addition of 20-50mg propofol for each time at intervals during anesthesia when necessary.BP,HR,SpO2,and limb motion were detected during colonoscopy operation,and the time of eye-open and word-response after colonoscopy were also recorded.Results No significant difference was found in colonoscopy time and limb motion response between the two groups.Patients in TCI group consumed more propofol and opening of eyes was delayed compared to those patients in the injection group(P

Objective To investigate the application value of pancreatic duct guide wire and transpancreatic septotomy with precutting technique in difficult endoscopic retrograde cholangiopancreatography.Method258 patients who underwent difficult endoscopic retrograde cholangiopancreatography from April 2014 to April 2016 were selected as study subject, 128 patients among them received the technique of pancreatic duct guide wire, the other 130 patients received transpancreatic septotomy with precutting techniques. The success rate, intubation time and incidence of complications were compared between these two methods for cannulation.Result There was no signiifcant difference in preoperative clinical data between the two groups, the success rate did not differ signiifcantly between the two groups (93.75 % vs 93.85 %). Compared with transpancreatic septotomy with precutting techniques group, pancreatic duct guide wire group is less intubation time consuming (5.92 ± 0.69 vs 12.81 ± 3.67) min, the difference was statistically significant (t = -2.27,P < 0.05). 25 patients experienced complications, with 6 cases of acute pancreatitis, 2 cases of biliray tract infection in pancreatic duct guide wire group, and 8 cases of acute pancreatitis, 3 cases of hemorrhage,6 cases of biliray tract infection in transpancreatic septotomy with precutting techniques group. The pancreatic duct guide wire group had a signiifcantly lower incidence of complications (6.25 % vs 13.08 %). the difference was statistically signiifcant (χ2 = 3.27,P < 0.05). The incidence of acute pancreatitis did not differ signiifcantly between the two groups (4.69 % vs 6.15 %).ConclusionsPancreatic duct guide wire and transpancreatic septotomy with precutting techniques both can further improve the success rate of bile duct cannulation with ERCP. The incidence of acute pancreatitis did not differ significantly between two groups. But pancreatic duct guide wire group is less intubation time consuming, and had a significantly lower incidence of complications. Because of the convenience and safety of the pancreatic duct guide wire technique, and the insertion of the pancreatic duct does not increase the risk of postoperative acute pancreatitis. We think that this method is more worthy of Clinical promotion.

Objective To investigate the feasibility of using CT texture analysis to differentiate among lipid-poor adrenal adenoma,pheochromocytoma and adrenal metastases.Methods 66 lipid-poor adrenal adenoma,98 pheochromocytoma and 101 adrenal metastases lesions were analyzed retrospectively.All the patients had abdominal non-enhanced CT and adrenal enhanced CT scans.We used TexRAD software to analyze the textural features of CT images and compared the differences in each texture parameter among three adrenal lesions.Results On non-enhanced CT images,there were significant differences in Mean and Kurtosis at all the texture scales(SSF 0-6) among the three types of adrenal lesions (P<0.05),as well as SD at fine and coarse texture scale (SSF 2,6)(P<0.05).Entropy (SSF 0-3, 5-6) and MPP (SSF 0-2, 4-6) were significantly lower in lipid-poor adrenal adenoma and adrenal metastases than that in pheochromocytoma (P<0.05).There were significant differences in Skewness (SSF 0-3) among three types of lesions, which was lowest in pheochromocytoma and highest in adrenal metastases.On enhanced CT images, Mean, SD, Entrophy and MPP showed significantly differences among the three types of adrenal lesions at all the texture scales (SSF 0-6) (P<0.05), which were all highest in pheochromocytoma and lowest in adrenal metastases.Skewness (SSF 0) and Kurtosis (SSF 0, 2) were significantly lower in adrenal metastases than that in lipid-poor adrenal adenoma and pheochromocytoma (P<0.05).Conclusion There are significant differences in CT texture analysis parameters among lipid-poor adrenal adenoma,pheochromocytoma and adrenal metastases.CT texture analysis has potential clinical application values in differentiating these three adrenal lesions.

Objective To analyze the stroke subtypes and influencing factors in four largest economic regions of China.Methods We analyzed the investigation data of QUEST(Quality Evaluation of Stroke Care and Treatment)study conducted in 2006 which included 62 hospitals in a national scale.According to the concept of four economic regions designed by the Development Research Center of the State Council,we performed the univariate and multivariate analysis for the stroke subtypes and its related risk factors in the different economic regions.Results There were 3362(73.5％)ischemic stroke patients and 1214(26.5％)hemorrhagic stroke patients among the total 4576 first-ever stroke patients.Comparison of stroke subtypes in the four different economic regions was statistically significant(P ＜ 0.001),with a percentage of 80.8％ ischemic stroke patients in the northeastern region,78.9％ in the eastern region,68.3％ in the central region and 67.0％ in the western region.The comparisons of risk factors such as history of hypertension,diabetes,hyperlipidaemia,coronary artery event,atrial fibrillation,and overweight in the four different economic regions were also statistically significant(P ＜0.05).Conclusions The subtypes of first-ever stroke vary in the four largest economic regions with a highest proportion of ischemic stroke in the northeastern region and relatively high proportion of hemorrhagic stroke in the central and western economic regions.There are also discrepancies of stroke risk factors in the different economic regions.

Objective To investigate the clinical therapeutic effect of general spine system(GSS) short-seg-ment posterior fixation for the thoracolumbar spine fracture.Methods Totally 47 patients with thorocalumbar fracture were retrospectively analyzed from May 2006 to July 2009,which were operated by general spine system short-segment posterior fixation,preoperative and postoperative Cobb angle,front and rear margin height ratio of vertebral body and the recovery of neural function were measured respectively.Results All patients were followed up,in 47 patients with thoracolumbar burst fracture,kyphosis deformity were corrected satisfactorily in X-ray visibly,vertebral body height got good recovery.2 cases occurred loss of corrective angle less than 5% after operation,in Frankel function classification.B～D classes showed significant improvement( at least one grade),A grade improved to B in 1 case,no serious complications occurred.Conclusion GSS short-segment posterior fixation was a safe and effective treatment method for thoracolumbar fracture.It can restore height and physiological curve of injuried vertebral body,contribute to recovery on neural function.

Objective To evaluate whether therapeutic ultrasound, applied alone or with urokinase, may have a thrombolytic effect on blood clots in vitro, and the other factors influencing the urokinase-mediated thrombolysis. Methods Experiments were carried out in an in vitro blood clot model.The blood clots were divided into four groups as physiological solution group(NS), urokinase group(UK),physiological solution plus ultrasound group(NS + US), urokinase group plus ultrasound group(UK + US).After intervention of one hour in static 37 ℃ water bath, each group of blood clots was weighed. After that,the weight loss and thrombolysis rate of the blood clots in each group were calculated. To observe the impact of the age of the blood clots on urokinase-mediated thrombolysis rate, the thrombolysis rate of eight time points 3, 4, 5, 6, 7, 8, 9, 10 hours was tested. The time was determined from the blood drawn from the body to the initiation of thrombolysis test. Results In terms of thrombolysis rate, there was significant difference between UK group and UK + US group(LSD-t 12. 1, P ＜ 0.01), with a thrombolysis rate 29. 3% ±8. 2% and 37. 5% ±7. 9%, respectively. However, the difference of thrombolysis rate between NS group and NS + US group with a thrombolysis rate 13. 4% ±4. 4% and 14. 5% ± 5.4%, respectively,was not statistically significant with a P value of 0. 08(LSD-t 1.8). The age of the blood clots had a negative correlation to the thrombolysis rate to some extent. Conclusion Therapeutic ultrasound has a significant effect on thrombolysis in combination with urokinase rather than used alone. To a certain extent,the thrombolysis rate decreases with the age of blood clot.

Objective To explore the effect of Ginsenoside Rgl on glutathion (GSH) level and glutathion peroxidase (GPx) activity after oxygen-glucose deprivation/reperfusion in cultured hippocampal cells. Methods The model of oxygen-glucose deprivation and reperfusion were established with the hippocampal neurons of rats. They were randomly divided into control group, model group and Ginsenoside Rgl treatment groups (5 μmol/L, 20 μmol/L, 60 μmol/L). The GSH level and GPx activity were measured 6 h after reperfusion. The apoptosis and the metabolic rate of methyl thiazolyl tetrazolium (MTT) were detected 24 h after reperfusion. Results Compared with model group, the GSH level, GPx activity, and metabolic rate of MTT improved (P<0.001), and the apoptosis decreased in the Ginsenoside Rgl groups (P<0.001) except with the dosage of 5 μmol/L (P>0.05). Conclusion Ginsenoside Rgl can protect the brain from ischemia by increasing the GSH level and GPx activity.

BACKGROUND: Lower extremity deep venous thrombosis is commonly seen after hip arthroplasty. The time of thrombosis after arthroplasty in senile patients with osteoporotic femoral neck fractures is little reported.OBJECTIVE: To investigate the time of perioperative lower extremity deep venous thrombosis in senile patients with osteoporotic femoral neck fractures undergoing hip arthroplasty. METHODS: The data of 178 patients with femoral neck fractures undergoing hip arthroplasty were analyzed, and were then allocated to anticoagulant and non-anticoagulant groups according to the preoperative use of low-molecular-weight heparins or not. Doppler ultrasonography of both lower extremity arteries was conducted at 1, 3, 5 and 5-7 days after injury, and 2, 5, 7 and 14 days postoperatively to monitor the lower extremity deep venous thrombosis, and the number and incidence of thrombosis in the two groups were recorded at different time points. The time of thrombosis occurred frequently after injury and surgery was determined through drawing the frequency distribution table and line chart.RESULTS AND CONCLUSION: (1) The incidence of thrombosis showed significant difference between anticoagulant (n=6, 8%) and non-anticoagulant (n=22, 21%)) groups (P < 0.05). (2) Thrombosis frequently occurred at 3 days after injury and 1 day postoperatively. (3) These results suggest that the thrombosis in patients with femoral neck fractures frequently occurs at 1-3 days after injury and 1 day after replacement. Additionally, active prevention measures after injury can significantly reduce the incidence of lower extremity venous thrombosis.

Objective To investigate and analyze risk factors of re-fracture after operation of osteoporotic hip fracture.Methods Two hundred forty-seven patients receiving operation of osteoporotic hip fracture were retrospectively studied and followed up,and all patients were divided into re-fracture group (54 patients) and no-re-fracture group (193 patients).The related factors such as sex,age,body mass index (BMI),affected side,initial fracture site,operation type,perioperative blood loss,postoperative delirium,postoperative bedridden time,medical complications,Charlson comorbidity index,antiostoporosis therapy,hip function scores with Harris and functional independence measurement (FIM) scores were compared by single factor analysis and multivariate Logistic regression analysis.Results Single factor analysis and multivariate Logistic regression analysis both showed that the risk factors of re-fracture after operation of osteoporotic hip fracture included age,postoperative delirium,hypertension,diabetes mellitus,cerebrovascular disease,antiostoporosis therapy,hip function scores with Harris and FIM scores (P ＜ 0.05 or ＜ 0.01).Conclusions Risk factors of re-fracture after operation of osteoporotic hip fracture include passive factors of age,postoperative delirium and medical complications,and subjective factors of antiostoporosis therapy,hip function scores with Harris and FIM scores.Patients should receive medical treatment positively,enhance antiostoporosis therapy and rehabilitation training of hip function to prevent re-fracture.

Objective To investigate the effect of arthroscopic debridement and meniscectomy in treatment of moderate or severe meniscus injury combined with knee osteoarthritis in early or middle stage. Methods 156 cases diagnosed with moderate or severe meniscus injury combined with knee osteoarthritis in early or middle stage were collected from October 2011 to October 2014. Lysholm knee score and preoperative examinations such as anteroposterior, lateral, axial radiographs, the standing full leg length X-ray film and MRI scan of the knee were recommended to definitively understand the osteoarthritis staging and meniscus injury grading. All patients were treated with arthroscopic debridement and meniscectomy. After operation, physical rehabilitation exercises and regular clinical follow-up were carried out as planned. The Lysholm knee score data from preoperation and terminal follow-up was statistical analyzed. Results No patient experienced any perioperative and postoperative complications. Statistical analysis showed that the Lysholm knee score of postoperation was significantly higher than that of preoperation [(87.3 ± 7.9) vs (67.5 ± 4.9), P < 0.05). Conclusion Arthroscopic debridement and meniscectomy in treatment of moderate or severe meniscus injury combined with knee osteoarthritis in early or middle stage, gains beneficial effects for its minimal invasion and quick recovery.