Objective To investigate the effect of intraoperative hypothermia and warming on hemostasis using thromboelastography(TEG)during radical esophagus cancer operation performed under general anesthesia combined with thoracic epidural block.Methods Sixteen ASA Ⅰ or Ⅱ patients undergoing elective radical esophagus cancer operation were randomly allocated to one of two groups(n=8 each):control group and warming group.The patients were unpremedicated.The operating room temperature was set at 21℃.Epidural catheter was placed at T_(7,8) and advanced 4 cm into epidural space.Correct epidural placement was confirmed by a test dose of 4 ml 1% lidocaine.0.375% bupivacaine was used during operation.General anesthesia was induced with fentanyl,thiopental and succinylcholine and maintained with isoflurane inhalation and intermittent i.v.boluses of vecuronium after endobronchial intubation with double lumen catheter.The patients were mechanically ventilated (V_T=8-10 ml?kg~(-1),RR=10-12 bpm,I:E=1:2,FiO_2=100%).In warming group TC-2000 wanning system (Thermacave,USA)was used.The lower part of the body was warmed for 45 min before induction of anesthesia (temperature was set at 38℃).After induction warming was continued(temperature was set at 43℃).In control group no wanning was provided.The fluid infused during operation was all warmed to 37℃.Tympanic temperature measurement was started from 20 min before induction and recorded every 10 min afterwards.TEG was performed before induction of anesthesia(T_0) and at 150 min after induction(T_1).The blood samples were divided into 2 aliquots of which one was tested at 37℃ and the other at patient's actual core temperature.Results The two groups were comparable with respect to age,sex,body weight duration of operation and the amount of fluid infused during operation.At T_1 the tympanic temperature was 34.7?0.4℃ in control group and 36.5?0.3℃ in warming group.At T_1 in control group the reaction time(R)and clot formation time(K)were significantly prolonged and a angle was significantly reduced when TEG was measured at core temperature compared with those measured at 37℃ (P＜0.05).At T_1 when TEG was measured at core temperature R and K were significantly shorter and a angle was significantly wider in warming group than in control group (P＜0.05).There was no significant difference in MA between the two groups at T_1.Conclusion Mild hypothermia developed during operation can impair bemostasis.Maintenance of normal body temperature(core temperature)during operation is necessary.

0.05). Ac-cording to the classification criteria of ARIA in 2001, 26 children suffered from intermittent A(R22 mild cases,4 moderate-severe cases),while 22 suf-fered from persistent AR(10 mild cases,12 mod-erate-severe cases). Forty percent patients with AR also had bronchial asthma. Domestic decora-tion was an important factor in the induction of AR and 27.1% of the children with AR had inher-ent predisposition. CONCLUSION The prevalence rate of AR in children aged from 9 to 10 in Nanjing is 5.1 %. Strategy of prevention and treatment of AR should beworked out according to the epidemic feature of AR.

0.05); The concentrations of NO in nasal polyp tissues was higher than that of the nasal mucosa in control group(P

OBJECTIVE To explore the therapeutic effect of modified uvulopalatopharyngoplasty(UPPP) combined with temperature-controlled radiofrequency ablation(TCRFA) in the treatment of moderate and severe obstructive sleep apnea hypopnea syndrome(OSAHS) . METHODS A total of 83 patients with moderate or severe OSAHS were underwent modified UPPPcombined with TCRFA. All patients were followed-up more than 2 years. Polysomnography was examined at 6 months,1 year and 2 years after operation. RESULTS The curative rate,obvious effective rate and effective rate were 28.9 %,33.7 % and 20.5 % respectively with a total effective rate of 83.1 % at 2 years after operation. The PSG showed that,the AHI values decreased signifi cantly(P

Objective To assess the influences of low-protein diet on the renal function and nutritional status in patients with stage 3/4 chronic kidney diseases (CKD).Methods Totally 34 patients with stage 3/4 CKD were randomly divided into group A (protein intake:0.6 g·kg~(-1)·d~(-1);n=14) and B (protein intake:0.8 g·kg~(-1)·d~(-1);n=20).Anthropometric measurement and blood biochemical tests were performed,nutri-tional status was assessed,and 24-hour dietary recall survey was conducted before and after the treatment.Patients were followed up for 6 months.Results In group A,the creatinine level significantly decreased (P=0.010),while albumin level (P=0.042) and the intake of energy (P=0.018) and carbohydrate (P<0.001) signifi-cantly increased after the treatment In all the 34 patients,in group A and group B,the malnutrition rates were de-creased by 14.7%,7.2%,and 21.1% after nutritional intervention.Conclusion The low-protein diet (protein intake 0.6 g·kg~(-1)·d~(-1)),in which part of the staple food was replaced by wheat starch,can increase the in-takes of carbohydrate and energy and improve renal function and nutritional status in patients with stage 3/4 CKD.

BACKGROUND: Both Allergic rhinitis and bronchial asthma are allergic diseases of respiratory tract. They frequently coexist in the same patients.OBJECTIVE: To study the incidence of allergic rhinitis in patients with bronchial asthma in Nanjing, and to analyze the correlation of clinical characteristic between allergic rhinitis and bronchial asthma.DESIGN: The questionnaire survey.SETTING: Department of Otorhinolaryngology-Head and Neck Surgery and Department of Respiratory, Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS: A total of 134 patients with bronchial asthma including 73 males and 61 females were selected form Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA from February 2001 to April 2005. Their ages ranged from 3 to 72 years. Severity of asthma of all patients was classified based on Global Initiative for Asthma (GINA). The diagnostic criteria of allergic rhinitis were established referred to the guideline of Haikou Meeting (November, 1997). All patients provided the confirmed consent.METHODS: The questionnaire survey of 134 bronchial asthma patients from the city of Nanjing was conducted. Their age, classification, severity, treatment status, and the family history of all 134 patients were investigated in details. Differences of age, age at onset, and course of disease between rhinitis and asthma of all patients were examined by two independent t tests. The correlation between clinical characteristics of allergic rhinitis and bronchial asthma was analyzed by Spearman rank correlation.MAIN OUTCOME MEASURES : Incidence of allergic rhinitis in patients with bronchial asthma and the correlation of clinical characteristic between allergic rhinitis and bronchial asthma.RESULTS：Of all 134 bronchial asthma patients，82(61．2％,82/134)were accompanied with allergic rhinitis．There were 45 males and 37 females．Of 82 patients with allergic rhinitis accompanying with bronchial asthma，severity was classified into grade Ⅰ (mild pause,n=56)，grade Ⅱ (mild persistence，n=21)，grade Ⅲ (moderate persistence，n=4)，and grade Ⅳ (severe persistence，n=1)．In addition,allergic rhinitis was classified into periodicity (n=65) and persistence(n=17)．According to the classification and seventy system recommended in ARIA,63 patients had mild symptoms and 19 had moderate and severe symptoms．Severity of allergic rhinitis was positively related to that of bronchial asthma(r=0.689,P＜0．01)．CONCLUSION: The morbidity of allergic rhinitis combining with bronchial asthma is high in Nanjing, China. While, their classification and severity are highly coherent.

BACKGROUND:Chitosan is a kind of natural biomaterial and is characterized by great biocompatibility, progressive degeneration and absorption and excellent mechanical property; however, whether it may become an ideal cytoskeleton in the engineering of cartilage tissue or not should be researched further.OBJECTIVE: To observe the hydrophilicity and adsorptivity to human nasal septum chondrocytes and the effect of its function of a novel scaffold made by [poly (dl-lactide-co-glycolide)] (PLGA)/chitosan nonwoven cloth embedded with lecithin (LEC) and poly-L-lysine (PLYS).DESIGN: Blank control study.SETTING: Department of Otolaryngology-Head and Neck Surgery, Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out in the Department of Otolaryngology-Head and Neck Surgery, Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA from October 2005 to June 2006. Chitosan nonwoven cloth was provided by Hainan Xinlong Company. The mainly technical parameters were detailed as the follows: degree of deacetylation ≥ 90% and relative molecular weight 2-5 × 105. PLGA/chitosan nonwoven cloth scaffold was made in Department of Otolaryngology-Hean and Neck Surgery, Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA and High Polymer Institute of Sun Yat-sen University. The mainly technical parameters were detailed as the follows: mole ratio between monome lactide and glycolide 75:25, porosity 82%-86%, pore diamater 100-300 μm, shear strength 48 MPa, depth 1.5 mm and completely degenerated duration 14-18 weeks. Human nasal septum chondrocytes were the septal cartilage of nose which was derived from operated patients with deflection of nasal septum under sterile condition.METHODS: PLGA/chitosan nonwoven cloth was sheared into pieces with the size of 1.5 cm × 1.5 cm, dipped in 0.01 volume fraction of LEC anhydrous alcohol and 1 g/L PLYS for 6 hours, dealt with ultraviolet radiation after dehydration for 1hour, dipped in 0.75 volume fraction of ethanol for 24 hours, washed with Hanks solution, and incubated for 24 hours. After operations mentioned above, two kinds of novel scaffolds containing various components were obtained, and they were simple scaffold and scaffold embedded with LEC and PLYS. Cells derived from the third generation of human nasal septum chondrocytes were used to make suspension. In addition, cell suspension was grown on those two scaffolds to determine the degree of hydrophilicity through observing diffused degree of cell suspension. Whether cell suspension of human nasal septum chondrocytes was wafted on scaffolds or not were observed under phase contrast microscope so as to determine adsorptivity between cells and scaffolds; meanwhile, growth of cells and production of matrix were also observed.MAIN OUTCOME MEASURES: ① Hydrophilicity of those two kinds of scaffolds (diffused degree of cell suspension of human nasal septum chondrocytes on scaffold) and adsorptivity to cells (whether cell suspension of human nasal septum chondrocytes was wafted on scaffolds or not); ② growth of cells and production of matrix.RESULTS: ① When simple scaffold was put in cell suspension of human nasal septum chondrocytes, cell suspension showing like balls attached to the surface of scaffold, and then, scattered into space of scaffold gradually. During the period of culture, phase contrast microscope indicated that masses of cells attached to the surface of fiber of scaffold.When the petri dish was shaken, cell groups drifted irregularly. The adherent rate was (21±3.7)%. With the cultured time passing by, matrix was not produced. ② When scaffold embedded with LEC and PLYS was put in cell suspension of human nasal septum chondrocytes, cell suspension scattered into space of scaffold rapidly. The adherent rate was (89±5.6)%, which was higher than that of single scaffold group. This suggested that scaffold showed a strong hydrophilicity.Phase contrast microscope indicated that chondrocytes as the form of monome or community were distributed between scaffold and fiber averagely and attached to the surface of fiber of scaffold. When the petri dish was shaken, cell groups did not drift irregularly, and only a few of cells were scarred at the bottom of petri dish. This suggested that scaffold had a strong adsorptivity to cells. One week after culture, matrix showing like cobweb was produced among fibers of scaffold.With the cultured time passing by, matrix was produced abundantly.CONCLUSION: The novel scaffold of PLGA/chitosan nonwoven cloth embedded with LEC and PLYS is characterized by an excellent hydrophilicity and adsorptivity to human nasal septum chondrocytes; meanwhile, it also can secrete matrix.

Objective To investigate the removal effect of immunoadsorption (IA) on associated antibodies and the efficacy in late-onset myasthenia gravis (MG). Methods A total of 25 late-onset MG patients were randomly selected to enroll in this study. IA therapy was given to 10 patients (IA group), while immunoglobin (0.4 g·kg-1·d-1) was administrated to the other 15 patients for 5 days(Ig group). The titers of Titin antibody (Titin-ab), acetylcholine receptor antibody (AchR-ab) and presynaptic membrane antibody (PrsmR-ab) were detected before and after the treatment. Quantitive MG (QMG) score was assessed before and immediately after the entire course of treatment. The clinical efficacy, the duration of respiratory support and in-hospital were compared between two groups. The correlation between three antibodies and QMG score was also analyzed. Results Compared with that before treatment, the Titin-ab PIN values, the AchR-ab PIN values, and the PrsmR-ab P/N values of IA group were all decreased significantly after treatment (P<0.05, respectively). The P/N value of Titin-ab in IA group was decreased by 54.7%～3.5%, which was significantly higher than that in Ig group(19.9%±3.1%) (P<0.01). QMG score reduced by 42.4%± 4.2% and 23.8%±3.7% in IA group and Ig group respectively (P<0.01, respectively). Symptoms were effectively ameliorated by both treatments, but the effective power of IA group was higher than that of Ig group (70% vs 40%, P<0.05). Remission time of IA group was significantly shorter than that of Ig group [(5.38±0.42) d vs (8.4±1.54) d, P=0.008), so was the duration of in-hospital [(13.50±0.50) d vs (16.50±0.50) d, P<0.05). The number of respiratory support in IA group was less than that in Ig group (1/10 vs 6/15, P<0.05). By the Pearson correlation analysis, the decrease of Titin-ab showed a better longitudinal correlation with the decrease of QMG score than the other two antibodies (r=0.6315, P<0.01). Conclusion IA can rapidly and effectively clear the pathogenic antibodies of late-onset MG patients and its short-term clinical efficacy is better than immunoglobin.

Objective To investigate the clinical treatment strategy of concomitant diseases and perioperation complications in elderly patients with hip fracture aged ≥ 80 years and the clinical prognosis.Methods A retrospective analysis was conducted in 95 hip fracture patients aged 80 and over years(80～90 years old) undergoing operation.There were 42 cases with femoral neck fractures and 53 cases with intertrochanteric fracture.71 cases (74.7％) had preoperative concomitant medical diseases.Screw fixation was performed in 3 cases (3.2％),hemiarthroplasty in 75 cases (78.9％),total hip replacement in 4 cases (4.2％),proximal femoral nail antirotation (PFNA) in 9 cases (9.5 ％) and reconstruction interlocking nail fixation in 4 cases (4.2 ％).Results No mortality was found during hospitalization.Postoperative anemia was the most common (74.7％),followed by hypoproteinemia (68.4％),digestive disorders (30.5％),electrolyte disturbance (28.4％) and psychiatric symptoms (15.8 ％).At least one-year follow-up was made in 73 cases.39 cases (53.4 ％) acquired independent activities after surgery,48 (65.8％) patients recovered to the preoperative level of activity.The concomitant diseases before surgery (OR =0.23,P =0.011),preoperative ability of activity (OR=0.23,P=0.025),the American Society of Anesthesiology (ASA) classification (OR=0.19,P=0.025) were the related factors influencing the one-year mortality.Conclusions The treatment of concomitant diseases should be emphasized in treating fracture.The active prevention during preoperative,intraoperative,postoperative period could reduce or avoid fatal complications and acquire good functions.

OBJECTIVE To observe the effect of administration intranasal corticosteroids on small airway disfunction for allergic rhinitis (AR) patients. METHODS AR patients with small airway disfunction were administrated intranasal corticosteroids for twelve weeks. Before treatment, nasal VAS, RQLQ were recorded, pulmonary function test were given. After therapy, VAS, RQLQ were obtained again at the 4th, 8th and 12th week. Pulmonary function test were performed at the 4th and 12th week. RESULTS VAS, RQLQ were all improved after therapy (P <0.01). The indices of FEV1/FVC%, MMEF pred%, MEF75pred%, MEF50pred%, MEF25pred%were also improved significantly (P<0.05), especially for MMEFpred%, MEF75pred%, MEF50pred% (P<0.01). CONCLUSION Small airway lesions can be obviously improved by the intranasal corticosteroids applied for AR. It has positive significance for preventing AR from developing into asthma.