Objective To evaluate the effects of different positions on cerebral blood flow in patients undergoing laparoscopic surgery.Methods Thirty patients of both sexes,aged 23-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic surgery,were included.Patients' position was changed using a random number table after induction of anesthesia.Patients were placed in the supine position and tilted 15° head-up or 15° head-down,and the parameters of the middle cerebral artery were monitored using the transcranial Doppler ultrasound.After admission to the operating room (baseline),after induction of anesthesia and before pneumoperitoneum,in the supine position,at head-up tilt and at head-down tilt,the mean blood flow velocity,pulsatility index,resistance index,mean arterial blood pressure (MAP) and heart rate were recorded.Results Compared with the baseline in the supine position,the MAP and bilateral mean blood flow velocity were significantly decreased at head-up tilt,and the MAP and bilateral pulsatility and resistance indices were significantly increased at head-down tilt (P＜0.05).Conclusion During laparoscopic surgery,head-up tilt can lead to a decrease in cerebral blood flow,and head-down tilt exerts no effect on cerebral blood flow.

Objective Through the analysis of cases,to improve the cognition of clinicians on extracranial vas-cular embolism diseases(VED)in children.Methods The clinical information included incidence trend,thrombophi-lia,clinical features,treatment and prognosis of 29 children with VED,who were admitted from January 201 1 to Decem-ber 201 5 in Nanjing Children′s Hospital Affiliated to Nanjing Medical University,and retrospectively analyzed.Results The annual rate of VED increased from 0 to 1 .49 per 1 0 000 hospital admissions from January 201 1 to December 201 5.In 29 cases,there were 20 male and 9 female,with an average age of 6.03 years old (2 h -1 3.83 years old).In-fants accounted for >20%(6 /29 cases).The average age of the female,non infected group,rheumatic disease group and venous thrombosis group was higher than that of the male,the infection group,the non rheumatic disease group and the arterial embolization group,but there was no significant difference(all P >0.05).Thrombophilia were as follows:in-fection disease,heart disease,kidney disease syndrome,rheumatoid disease,tumor,and twins embolization syndrome. Risk factors included central venous line,immobility,dehydration,glucocorticoids use,etc.Heart disease was the leading cause of non thrombotic embolism,while other thrombophilic diseases resulted in thrombotic embolism.Pulmonary em-bolism was mainly seen in patients with severe pneumonia,especially mycoplasma pneumoniae pneumonia (MPP ).The older the age,the more typical clinical manifestations,and significantly elevated D dimer,fibrin/fibrinogen degradation products tips VED.Treatment depends on the degree of risk.Thirty -seven point five percent(3 /8 cases)of children with arterial embolism were less than 1 year old,and the mortality 25.00% (2 /8 cases)was significantly higher than that of venous thrombosis 1 7.65%(3 /1 7 cases)and 1 1 .76% (2 /1 7 cases).Conclusion Heart disease mainly cause arterial embolism and infection,while nephritic syndrome and rheumatic disease mainly cause venous embolism.Pulmona-ry embolism is mainly seen in children with severe pneumonia,especially MPP.The risk of arterial embolization is higher than that of venous embolism.

Objective To evaluate the mid-term tollow-up results of cervical artificial disc replacement (CADR) for cervical degenerative disc disease,and to explore whether it can reduce the occurrence of adjacent segment degeneration (ASD).Methods A prospective comparative study of 93 patients who underwent CADR or anterior cervical decompression and fusion (ACDF) for cervical degenerative disc disease were conducted.All patients were followed up for more than 6 years.The Japanese Orthopaedic Association (JOA) score,neck disability index (NDI),Odom's scale,X-rays and magnetic resonance imaging (MRI) were used to evaluate the clinical and radiologic results.Results Twenty eight patients who underwent CADR and 35 patients who underwent ACDF had complete follow-up data.At final follow-up,the JOA score and NDI improved significantly in both groups.Between the two groups,there was no significant difference in terms of JOA score,NDI and Odom's scale.The sagittal alignment was well maintained in both groups.The total cervical spine range of motion (ROM) had no significant change for the CADR group,whereas,it significantly decreased for the ACDF group.The ROM at the replacement level of CADR patients decreased from 9.5° ± 3.7° before operation to 7.0° ± 3.0° 3 months after operation,and it was maintained to 6.6° ± 4.1° at final follow-up without significant decrease.Lateral radiographs and T2-weighted MRI showed the incidence of ASD in CADR group was significantly lower than that in ACDF group.Conclusion The six-year follow-up results of CADR are basically satisfactory.Compared with ACDF,it could better preserve physiological motion and biomechanics of cervical spine,and reduce the incidence of ASD.

Objective To observe the effects of vitamin C (VC) and E (VE) on the uhrastrueture of liver, kidney and brain tissue of fluorosis rats. Methods One hundred and twenty Wistar rats were chosen as the experimental animals and were divided into 9 groups randomly. The control group were given distilled water and the fluoride exposed group were given distilled water containing sodium fluoride 150 mg/L. The throe VC-fluoride exposed groups were given VC orally in a dose of 50,100,150 mg·kg-1.d-1, respectively, and the three VE-fluoride exposed groups were given VE of 25,50,75 mg·kg-1·d-1, respectively. The VC-VE-fluoride exposed group were given VC of 100 mg·kg-1·d-1and VE of 50 mg·kg-1·d-1at the same time of high fluoride water intake. The rats were sacrificed after 9 months and the ultrastructure changes on liver, kidney and brain tissues of each group were observed under transmission electron microscope(TEM). Results The uhrastrueture of liver, kidney and brain showed pathologic changes in the rats that drank water containing high eoneentrations of sodium fluoride. ①Edema of hepatocytes, smeared mitochontria and nuclear matrix, lipid droplet in eytoplasm of hepatocytes, margination of nueleohs as well as obvious swelling of liver sinusoidal endothelial were observed in fluoride exposed group. ② There were marginafion of heterochromatin, expansion of cell space and endoplasmic reticulum in the kidney after the exposure to excess fluoride.③Signifieant changes were found on glial eells on the brain, including cell swelling, increase and marginafion of heterochromatin in the fluoride exposure group. There were no significant uhrastrueture changes in the VC or VE intervention group, while the VC-VE-fluoride exposure group was almost the same as the control group. Conclusions Fluoresis may cause damage on liver, kidney and brain in rats. VC and VE, alone or combined, have protective effects, and the combined supplementation was stronger than single supplementations.

Aim To investigate the effects of dioscin ( Dio) on rat myocardial contractility. Methods Left ventricular contractile function was measured using the Langendorff non-recirculating mode of isolated rat heart perfusion. Effects of low, middle and high concentra-tion of Dio were investigated by measuring left ventricu-lar systolic pressure ( LVSP ) and left ventricular end diastolic pressure ( LVEDP) . Also, peak rates of rise/fall of left ventricular pressure ( ± dp/dtmax ) of isolated rat heart were calculated. Effects of Dio on intracellu-lar free calcium concentration in rat H9 c2 cells were measured by using the confocal microscopy. Mitochon-drial membrane potential was detected with multifunc-tional microplate reader. Results With 0. 1, 1 μmol · L-1 Dio, LVSP were significantly enhanced from (11. 55 ± 0. 52), (10. 53 ± 0. 28) kPa to (13. 08 ± 0. 72), (12. 53 ±0. 64) kPa(P<0. 01); +dp/dtmax were dramatically increased from ( 0. 38 ± 0. 10 ) , (0. 40 ± 0. 07) kPa·ms-1 to (0. 42 ± 0. 11), (0. 43 ± 0. 02) kPa·ms-1(P<0. 05). With the 10μmol· L-1 Dio, LVSP and + dp/dtmax were both decreased from (12. 13 ± 0. 33) kPa and (0. 42 ± 0. 04) kPa· ms-1 to ( 9. 46 ± 0. 77 ) kPa and ( 0. 24 ± 0. 04 ) kPa ·ms-1 (P <0. 01). With 0. 1, 1, 10 μmol·L-1 Dio, the relative fluorescence intensity of intracellular free calcium concentrations was increased significantly from (16. 62 ± 0. 89) to (21. 48 ± 0. 80), (25. 68 ± 0. 69) and (19. 84 ± 0. 66)(P <0. 01)respectively. 0. 1, 1μmol·L-1 Dio showed no significant effects on the mitochondrial membrane potential of rat H9 c2 cells, while with effects of 10 μmol·L-1 Dio, the ra-tio of JC-1 monomer and J-aggregates was changed from (1. 14 ± 0. 03) to (1. 35 ± 0. 06)(P<0. 01), indica-ting a decrease in the mitochondrial membrane poten-tial. Conclusion Low and middle concentrations of Dio show a positive inotropic effect on isolated rat heart, as the LVSP and + dp/dtmax are enhanced, which may concern with the increase of the intracellu-lar concentration of Ca2+. It will not cause the calcium overload while the intracellular concentration of Ca2+ is increased by low and middle concentration of Dio in the myocytes except high concentration of Dio.

Objective: To explore the blood-saving effect of autologous platelet-rich plasma (PRP) back-transfusion in patients with Stanford type A aortic dissection surgery. Methods: A total of 59 consecutive patients who received Stanford type A aortic dissection surgery in our hospital from 2013-01 to 2015-10 were studied. The patients were at the age of (50±6) years with mean body weighting at (80±12) kg and were randomly divided into 2 groups: Traditional (T) group,n=31 and Autologous PRP back-transfusion (P) group,n=28. Blood levels of Hb, platelet counts, PT, APTT were measured at pre-induction of anesthesia (T1), before CPB (T2), prior ifnishing of CPB (T3) and at 1 h (T4), 24 h (T5), 48 h (T6) after the operation. The in-operative, 48 h post-operative volumes of allogeneic blood transfusion and the volume of chest tube drainage at 48h after operation were recorded; the complication occurrence at peri-operative period was recorded. Results: In P group, whole blood processing volume was (1269±197) ml, PRP volume was (753±78) ml, PRP separation time was (35±9) min and the separated platelets were about (22±3)% of total platelet counts. Compared with T group, P group had decreased Hb at T2 (131.0±15.0) g/L vs (101.0±10.0) g/L, decreased platelet counts at T3 (115.0±51.0)×109 /L vs (83.0±23.0)×109/L, while increased platelet counts at T4 (103.0±25.0)×109/L vs (151.0±27.0)×109/L, T5 (105.0±25.0)×109 /L vs (147.0±39.0)×109/L and T6 (101.0±26.0) ×109/L vs (149.0±35.0)×109/L, allP<0.05; P group presented reduced PT at T4 (17.6±2.1) s vs (14.1±1.1) s and T5 (17.6±2.7) s vs (13.5±0.8) s, allP<0.05. The in-operative transfusions of platelet, plasma, cold precipitation and post-operative transfusions of red blood cells, platelets, plasma, cold precipitation and the volume of chest tube drainage at 48h after operation were less in P group,P<0.05. Compared with T group, P group had the lower rates of acute post-operative lung injury (32.1% vs 19.4%), shorter mechanical ventilation time (69.1±5.9) h vs (43.1±1.5) h and ICU staying time (8.1±2.8) d vs (5.3±1.1) d, allP<0.05. Conclusion: Autologous PRP back-transfusion could reduce the post-operative bleeding and allogeneic blood transfusion for Stanford A aortic dissection surgery, it has obvious blood-saving effect.

Administration, Oral ; Adult ; Atrial Flutter ; drug therapy ; physiopathology ; Digoxin ; therapeutic use ; Echocardiography ; Female ; Fetal Diseases ; drug therapy ; physiopathology ; Humans ; Hydrops Fetalis ; drug therapy ; physiopathology ; Infant, Newborn ; Male ; Pregnancy

ObjectiveTo Compare the clinical results between microscope and loupes which used in microsurgical discectomy.MethodsA prospective randomized controlled trial of 93 patients who had undergone microsurgical discectomy from January 2007 to December 2010 was performed.Clinical results were assessed by comparing the following parameters between patients who had undergone the surgery by microscope and loupes:length of stay,hospitalization cost,operative time,estimated blood loss,Japanese Orthopaedic Association (JOA) score and JOA recovery rate,Odom's standard.ResultsForty-nine patients underwent surgery by microscope,and forty-four patients underwent surgery by loupes.Eighty patients received outpatient or telephone follow-up.The follow-up period was 6.17 to 52.90 months with an average of (29.64±13.05) months,and the follow-up rate was 86.02％.According preoperative data,the two groups didn't differ with respect to age,gender,level of radiculopathy,or preoperative JOA score and JOA recovery rate.No statistically significant differences were identified in postoperative JOA score and JOA recovery rate,length of stay,hospitalization cost,length of follow-up,or relapse rate.Statistically significant differences were identified in operative time,estimated blood loss,and follow-up JOA score and JOA recovery rate.Conclusion Microscope can provide relatively more clear and comfortable vision for the surgery.It can short the operative time,decrease blood loss,reduce the potential risk of nerve injury,and retain more normal tissue,which can ensure better clinical results.

Objective To evaluate the efficacy and application value of retroperitoneal laparoscopic nephroureterectomy for localized and poor differentiated renal pelvic carcinoma by comparing with open nephroureterectomy.Methods Thirty-three pelvic carcinoma patients underwent radical nephroureterectomy were retrospeetively analyzed.All tumors were confirmed to be localized,stage T1-T3 and grade 3.Retroperitoneal laparoscopic nephroureterectomy was performed in 12 patients,the ureteral orifice was resected in traditional way through a small incision in lower abdomen.Open radical nephroureterectomy was performed in 21 cases.Clinical outcomes of the patients were compared between the 2 surgery groups.Results Mean operative time was 232 vs 212 min(P=0.100)and blood loss volume was 162 vs 233 ml(P=0.001)in the laparoscopic and open nephroureterectomy groups.Mean postoperative hospitalization was 7.6 vs 9.8 d(P＜0.001)for the laparoscopic and open groups.During the followup for 7-67 months,all the 33 patients survived.There was no recurrence or metastasis in laparoscopic group.While there was 1 retroperitoneal recurrence,and 3 cases suffering from superficial bladder cancer in open surgery group.Conclnsion Retroperitoneal laparoscopic nephroureterectomy may be performed safely in local renal pelvic carcinoma patients with poor differentiated tumors,with less intraoperative blood loss and early recovery.