Objective To compare the effects of Dexmedetomidine and Midazolam for sedation in elderly patient with upper cervical spine fracture in awake tracheal intubation.Methods A total of 68 patients with upper cervical spine fracture undergoing awake tracheal intubation who treated in our hospital from Jan.2010 to Jan.2015 were considered as the objects,who was randomly divided into group A and group B.34 cases in group A were treated with Dexmedetomidine for sedation,and the other 34 cases in group B were treated with Midazolam for sedation.The Heart rate (HR),mean arterial pressure (MAP) and BIS value on the before anesthesia (T1),immediately before intubation (T2),immediately after intubation (T3),PaCO2 in before and after intubation,and the adverse reactions were compared between the two groups.Results There was no difference in HR,MAP and BIS at time of T1 between the two groups (P＞0.05).The HR,MAP and BIS were lower in group A than in group B at time of T2 and T3 (P＜0.01).The PaCO2 had no difference between the two groups at before and after intubation (P＞ 0.05).The rate of adverse effects had no difference between the two groups (x2 =1.308,P =0.253).Conclusions Compared with Midazolam,Dexmedetomidine can stable HR,MAP and BIS effectively and has a good safety in the treatment of elderly upper cervical spine fracture in awake tracheal intubation,which is worthy of clinical application.

Objective To evaluate the effect of dexmedetomidine on the inflammatory responses in brain tissues in septic rats.Methods Seventy-two male Sprague-Dawley rats,aged 10 weeks,weighing 250-280 g,were randomly divided into 4 groups (n =18 each):control group (group C); sepsis group (group lipopolysaccharide (LPS)) ; distilled water group (group DW) and dexmedetomidine group (group D).Sepsis was induced by intraperitoneal injection of LPS 5 mg/kg (dissolved in normal saline 1 ml) in groups LPS,DW and DEX,while normal saline 1 ml was injected intraperitoneally in group C.Distilled water 20 μl was injected into the lateral cerebral ventricle in group DW,while dexmedetomidine 3 μg/kg (dissolved in distilled water 20μl) was injected into the lateral cerebral ventricle in group DEX.Six animals were sacrificed at 1,2 and 6 h after administration and hippocampi were removed for determination of TNF-α and IL-6 contents (by ELISA) and TLR4 mRNA expression in hippocampal tissues (by RT-PCR).Results Compared with group C,TNF-α and IL-6 contents in hippocampus tissues were significantly increased at each time point after administration in group LPS (P ＜ 0.05).Compared with group LPS,no significant change was found in TNF-α and IL-6 contents in hippocampal tissues (P ＞ 0.05),and TLR4 mRNA expression was significantly up-regulated at each time point after administration in group DW (P ＜ 0.05).Compared with group DW,TNF-α and IL-6 contents in hippocampal tissues were significantly decreased at each time point after administration,and TLR4 mRNA expression was significantly up-regulated at 2 and 6 h after administration in group DEX (P ＜ 0.05).Conclusion Dexmedetomidine can reduce inflammatory responses in brain tissues in septic rats via down-regulating TLR-4 mRNA expression.

ObjectiveTo explore clinical application of selecting flap by using of digital technique in treatment of hemifacial atrophy.MethodsSeven patients with hemifacial atrophy were selected,preoperative CT angiography was performed,deformity and flap three-dimensional reconstruction and design bone and soft tissues using Mimics 14.3 software, latissimus muscular flap or femur anterolateral flap were selected,according to tilt donor area and recipient area blood vessel diameter. Defect model were printed using rapid prototyping. ResultsHemifacial atrophy had a good postoperative shape,and the flaps survived in all the 7 cases.Follow-up 3 years,the flaps look well and the patients get expecting results. ConclusionsThe digital technique was a relatively useful tool that can assist surgeons with reconstruction of the flap,and accurate marking of the extent of the flap to be harvested.Therefore avoiding intraoperative injuries to the blood vessels to better survival of the flaps.

ObjectiveTo retrospectively investigate the clinical results of video-assisted thoracoscopic surgery for pulmonary pure ground-glass opacity.MethodsThe clinical data of 45 patients with pGGO underwent video-assisted thoracoscopic surgery were collected.The gender constitution,age,smoking status,surgical procedures,lesion size,histological types of tumor,lymph node metastasis and prognosis were retrospectively analyzed.ResultsThe numbers of females and non-smokers were significantly larger than those of males and smokers.All 45 patients underwent video-assisted thoracoscopic surgery.37 patients of solitary pGGO were all operated with cure intention.27 of the 37 patients received local resection ( wedge resection in 18 or segment resection in 9),and the other 10 patients underwent lobectomy.There are 8 patients of multiple nodes.Amongthese,6 were operated with cure intention,while 2 received VATS biopsy.Pathological examinations after operation revealed that there were 31 cases of bronchioloalveolar carcinoma and 14 cases of atypical adenomatous hyperplasia.And there was no lymph node metastasis.The diameters of bronchioloalveolar carcinoma lesions were significantly longer than those of atypical adenomatous hyperplasia lesions( P ＜ 0.05 ).Patients were followed up for 4 months to 6 years,and all survived without local recurrence and distant metastasis.ConclusionThe diameters of bronchioloalveolar carcinoma lesions are longer than those of atypical adenomatous hyperplasia lesions.Video-assisted thoracoscopic sublobectomy for pulmonary pure ground-glass opacity may achive excellent clinical results.Computed tomography-guided localization is a useful,safe procedure.

Objective To detect the gene expression changes between urethra plates from hypospadias patients and foreskins from non-hypospadias patients by microarray and to investigate the underlying mechanisms of hypospadias.Methods Twelve hypospadias patients,aged 6-12 months (mean,8 months),were enrolled as the test group,including 5 moderate and 7 severe hypospadias patients.Six age-matched patients underwent circumcision were enrolled as controls.Samples from hypospaidas patient's urethra plates during hypospadias repair and samples from the foreskins during circumcision were obtained and processed into Tri-Reagent immediately for RNA extraction.Oligonucleotide expression microarrays were used to detect genes expression changes in tissues from patients with and without hypospadias.This microarray analysis incorporated 22 000 genes.The intensity of all genes present was analyzed by one-way ANOVA (P＜0.01) and Tukey's test.Four estrogen responsive genes,CYR61,CTGF,ATF3 and GADD45β,were tested by RT-PCR in 8 controls,8 moderate hypospadias and 8 severe hypospadias as well.Results Ninty-four genes were detected differentially expressed in hypospadias patients compared with phimosis patients.There were 47 genes upregulated in moderate hypospadias compared with controls(P＜0.01),68 genes up-regulated in severe hypospadias compared with controls(P＜0.001),17 genes up-regulated in severe hypospadias compared with moderate hypospadias(P＞0.05).These genes were involved in different cell functions such as growth regulation and signal transduction.CYR61,CTGF,ATF3 and GADD45β,known to be estrogen responsive or to interact with estrogen receptor were found up-regulated in microarray and the up-regulations were confirmed by RT-PCR.Conclusions The up-regulated genes contribute to the development of hypospadias.Up-regulation of estrogen responsive genes may play important roles in the development of hypospadias.

BACKGROUND: Studies on the biomechanical properties in NUSS procedure have obtained some achievements, but the effect of scoliosis surgical correction of scoliosis on thoracic deformity remains unclear.OBJECTIVE: To explore the effect of simultaneous correction of pectus excavatum and scoliosis on thoracic deformity so as to provide reference for designing a rational orthopedic scheme.METHODS: The three-dimensional reconstruction model of the chest was established based on the CT data of the patients with pectus excavatum and scoliosis. The surgical correction of pectus excavatum and scoliosis was simulated by numerical simulation method.RESULTS AND CONCLUSION: (1) Results after correction showed that the bilateral spinous processes at T3-5 segments displaced to the left (X direction) about 1 mm, suggesting that the simultaneous correction is favorable for the correction of scoliosis. (2) Compared with the single NUSS procedure, the displacement at Y direction was increased by 13.358 mm in the simultaneous correction; meanwhile, there was significant difference in the shortest displacement between two methods.(3) In views of Von Mises stress distribution, the stress in the simultaneous correction was decreased by 24.6 MPa compared with the single Nuss procedure, indicating that the simultaneous correction can significantly reduce the Von Mises stress on the chest, which contributes to alleviate the postoperative pain. (4) Our results show that the simultaneous correction cannot only improve scoliosis, but also improve the symptoms of pectus excavatum.

Objective To seek the predictive value of pudendal nerve function that need preventive anti-incontinence surgery at the same time following pelvic prolapse surgery in severe pelvic organ prolapse (POP) patients. Methods Seventy women completed this study from January 2014 to June 2015 in Fuzhou General Hospital of Nanjing Military Command, dividing into four groups: POP with or without coexisting occult stress urinary incontinence (OSUI) in preoperation, women with persistent stress urinary incontinence (SUI) in postoperation, women without SUI in postoperation. The pudendal nerve function in preoperation was measured by using Solar Urodynamic Neuro Module, including pudendal nerve terminal motor latency (PNTML), and amplitude. Results There were statistical significance on bilateral PNTML between POP coexisting OSUI group and only severe POP group [(2.62±0.23) versus (2.40±0.26) ms in right of PNTML, (2.55 ± 0.21) versus (2.37 ± 0.30) ms in left of PNTML; all P<0.05], but no statistical significance on bilateral amplitude (P>0.05). Compared de novo SUI group with POP group in postoperation, de novo SUI group′s right of PNTML was significantly increased [(2.74 ± 0.16) versus (2.47 ± 0.26) ms; P<0.05]; and the right of PNTML was extending 2.5 standard deviation at least compared with the health′s [(2.10±0.20) ms]. Conclusions The PNTML of pudendal nerve of POP coexisting OSUI is severe than only severe POP, the velocity of nerve conduction is slowing, and PNTML extension has a predictive value for postoperative urinary incontinence. When the right of PNTML of preoperative POP increased by at least 2.5 standard deviations than health′s, the risk of SUI postoperative strongly increased, and a anti-incontinence surgery at the same time following pelvic prolapse surgery should be adviced.

OBJECTIVETo study the effect of Panax notoginseng saponins (PNS) on (synaptophysin, syp) and tau gene expression in the brain tissue in senescence accelerated mouse prone 8 (SAMP 8).

METHODSAMP8 were randomly divided into 4 groups: PNS 23.38, 93.50 mg x kg(-1) group, huperzin A 0.038 6 mg x kg(-1) x d(-1) group and blank control group; the drug groups were treated with the designed drugs respectively per day by intragastric administration for 4 consecutive weeks, and double distilled water was given to blank control group. After treatment, the mRNA content of tau and syp were assayed by reverse transcription (RT) and real-time polymerase chain reaction (real-time PCR).

RESULTCompared with blank control group, the syp mRNA contents were increased in PNS groups (P < 0.05 or P < 0.01), and the tau mRNA content were not significant difference in all groups.

CONCLUSIONThis study suggests that PNS can up-regulate syp gene expression at transcriptional level in the brain of SAMP 8.

Aging ; drug effects ; metabolism ; Animals ; Brain ; drug effects ; metabolism ; Gene Expression ; drug effects ; genetics ; Mice ; Panax notoginseng ; chemistry ; Protein Tyrosine Phosphatase, Non-Receptor Type 11 ; genetics ; metabolism ; Saponins ; pharmacology ; tau Proteins ; genetics ; metabolism

Objective As the population ages,clinicians are increasingly confronted with octogenarians with early-staged non-small cell lung cancer(NSCLC).We reviewed the outcomes of octogenarians who underwent lobectomy for clinical stagc Ⅰ NSCLC,to determine whether there was a benefit to the VATS approach in this group,and to analysis the risk factors of complication and survival.Methods We conducted a retrospective single-institution review of patients age 80 years or greater who underwent lobectomy for NSCLC from January 2006 to December 2016.Clinical outcomes including complication rate and survival rate were analyzed.Results 162 octogenarians underwent lobectomy:98 VATS and 64 through open thoracotomy.Compared with thoracotomy,VATS patients had fewer complications (14.3 ％ vs.28.1％,P =0.03),shorter length of tube duration [(3.5 ± 1.5) days vs.(4.9 ± 2.0) days,P =0.04],and shorter length of stay [(5.5 ± 2.1) days vs.(7.8 ± 3.5) days,P =0.04].For patients with pathologic stage Ⅰ disease,the 5-year overall survival was 64.5％,for stage Ⅱ was 38.1％,and for stage Ⅲ was 20.1％.The 5-year overall survival rates of pathological stage Ⅰ and stage Ⅱ,Ⅲ are of significant differences(P =0.001).In a multivariate logistic regression analysis,the approach of thoracotomy emerged as an independent predictor of complication (OR =1.94,95％ CI 1.214-5.135,P =0.03).In a multivariate COX regression analysis,pathological stage(OR =2.01,95％C1 1.453-5.865,P=0.03) and ASA(OR =1.81,95％CI 1.188-4.015,P =0.04) are independent predictors of over survival.Conclusion Octogenarians with NSCLC can undergo resection with low mortality and survival among stage Ⅰ patients,which is comparable with the general lung cancer population.The VATS approach reduces morbidity in this age demographic,resulting in shorter length of tube duration and shorter stay,while the approach of thoracotomy is an independent predictor of complication.Our study also demonstrated that pathological stage and ASA are independent predictors of overall survival rate.

A total of 100 HIN1 flu real-time-PCR positive throat swabs collected from fever patients in Zhejiang,Hubei and Guangdong between June and November 2009,were provided by local CDC laboratories.After MDCK cell culture,57 Influenza A Pandemic (H1N1) viruses were isolated and submitted for whole genome sequencing.A total of 39 HA sequences,52 NA sequences,36 PB2 sequences,31 PB1 sequences,40 PA sequences,48 NP sequences,51 MP sequences and 36 NS sequences were obtained,including 20 whole genome sequences.Sequence comparison revealed they shared a high degree of homology (96％～99％) with known epidemic strains (A/Califomia/04/2009(H1N1).Phylogenetic analysis showed that although the sequences were highly conserved,they clustered into a small number of groups with only a few distinct strains.Site analysis revealed three substitutions at loop 220 (221-228) of the HA receptor binding site in the 39 HA sequences:A/Hubei/86/2009 PKVRDQEG→PKVRDQEA,A/Zhejiang/08/2009 PKVRDQEG→PKVRDQER,A/Hubei/75/2009PKVRDQEG→PKVRDQGG,the A/Hubei/75/2009 was isolated from an acute case,while the other two were from patients with mild symptoms.Other key sites such as 119,274,292 and 294 amino acids of NA protein,627 of PB2 protein were conserved.Meanwhile,all the M2 protein sequences possessed the Ser32Asn mutation,suggesting that these viruses were resistant to adamantanes.Comparison of these sequences with other H1N1 viruses collected from the NCBI database provides insight into H1N1 transmission and circulation patterns.