Objective The aim of this study was to explore the effects of volume controlled ventilation (VCV),pressure controlled ventilation(PCV)and pressure controlled ventilation-volume guaranteed (PCV-VG)on respiration and circulation in elderly patients undergoing thoracic surgery. Methods Thirty-six elderly patients who underwent thoracic surgery were enrolled in our study. Patients were divided into VCV,PCV and PCV-VG groups according to randomized design. The hemodynamic and respiratory data and the arterial blood gases had been recorded in the pre-operation,20 min,40 min,60 min after OLV and 20 min after the resumption of two lung ventilation. Results Compared with VCV group,Ppeak value was significantly lower in PCV and PCV-VG groups(P < 0.05),and the difference was not found between the PCV and PCV-VG groups. PaO2 levels in PCV and PCV-VG groups were higher than that in VCV group after the point of OLV+40(P < 0.05). Comparison of PCV group,PaO2 in PCV-VG group was higher,but did not show a significantly improved during OLV(P > 0.05). Conclusion Compared with VCV,the use of PCV and PCV-VG have significant advantages in the operative oxygenation and airway pressure for elderly patients undergoing OLV.

Germination of the seeds of Bupleurum chinense and B. falcatum activated by exogenous hormones of dif ferent concentrations was studied. The hormones used were GA3, 6-BA and IAA. The optimum concentration of the 3 hormones that activated the seed germination of B. chinense was 50?g/ml,while that for B. falcatum was 200?g/ml, 100?g/ml and 25?g/ml respectively. Among the 3 hormones, 6-BA showed the greatest effect on the 2 species of Bupleurum L. 50?g/ml 6-BA raised the germination rate of the seeds of B. chinese from 57.5 % to 84. 5 % and 100?g/ml 6-BA raised the germination rate of the seeds of B.falcatum from 28. 5 % to 76.0%

Objective To explore the therapeutic efficacy of a self-made occluder used for bronchoscopic lung volume reduction(BLVR).Methods Two patients with severe chronic obstructive pulmonary disease(COPD)in stable phase were selected for the present study.One or two nitinol occluders were placed,guided by brochoscopy,into the target bronchi of the two patients.Examination of pulmonary functions,chest computed tomography,complications,blood gas analysis,and evaluation of life quality with St George's respiratory questionnaire(SGRQ)were carried out before and 7 months after the bronchoscopic lung volume reduction.Results No dislodging or shifting of all the inserted occluders occurred.Only slight proliferation of granulation tissue was found in mucous membrane around the occluder,and atelectasis was observed at the target sites of lung.Before and 7 months after BLVR,ventilatory capacity(VC)of case 1 rose from 3.08L to 3.57L,and that of case 2 was elevated from 2.19L to 2.58L.Forced vital capacity(FVC)of case 1 was elevated from 2.87L to 3.57L,and that of case 2 from 2.60L to 2.58L.SGRQ showed a remarkable improvement of patients' dyspnea with a decrease of scores from 62 to 26 in case 1 and from 48 to 23 in case 2.No evident changes were found on arterial oxygen blood partial pressure(PaO2)in both patients,and no severe complications such as obstructive pneumonia or pneumothorax occurred yet in either case 1 or case 2.Conclusion The present study has demonstrated that the self-made occluder is convenient for insertion with satisfactory stability and therapeutic efficacy.Application of such occluder is safe with few complications,and may serve the purpose of reducing lung volume and improving lung function.

BACKGROUND: In China, this laboratory is the first one to report such researches, confirming that strong αo-immunoreactive (IR) appears in the substantia gelatinosa (SG) of spinal cord and lateral spinal nucleus which is similar to the distribution of certain neuropeptides that participate in sensory regulation, which suggests that guanine nucleotide binding protein (G protein) may be related to primary afferent informational transfer. OBJECTIVE: To observe the change of αo-IR in gelatinous substance by the method of transection of unilateral spinal dorsal roots.DESIGN: A randomized controlled experiment on animals.SETTING: Staff Room of Neurobiology, Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: The experiment was conducted at the Staff Room of Neurobiology, Tongji Medical College, Huazhong University of Science and Technology from December 1995 to December 1996. Fifteen healthy adult SD rats were selected and divided into 3 groups: ①normal group with five rats (not dealt with any disposal), ②transected dorsal root group with 10 rats (right side) and ③control group (non-transected left sidedness as control).METHODS: Right lumbar 1-3 spinal neural dorsal roots were cut off under the anesthesia of 100 g/L chloral hydrate (300 mg/kg)through intraperitoneal injection in rats, living for 48-60 hours after operation. The subunit αo of guanine nucleotide-binding protein (rabbit polyclonal antiserum) was demonstrated in the αo-IR of rat spinal cord by immunohisto chemical methods. G protein was oriented, and its change was observed after transection ofneural dorsal roots MAIN OUTCOME MEASURES: ①The αo-IR of Ⅰ to Ⅲ of the dorsal horn and lateral spinal nucleus of the normal rats and control rats. ②The αo-IR of Ⅰ to Ⅲ of the dorsal horn and lateral spinal nucleus of rats in the transected dorsal root group. RESULTS: Data of a total of 15 rats were involved in the result analysis. ①In the normal group and control group, intense αo-IR was presented in rexed lamina ( Ⅰ to Ⅲ ) of the dorsal horn of rats, and the highest αo-IR in second lamina (SG). Lateral spinal nucleus of rat revealed higher density of αo-IR containing fiber networks. Following unilateral transection of dorsal roots in SG, αo-IR was markedly decreased. ②Quantitative analysis of absorbance (A) of αo-IR, it was (0.847±0.081) in the inside of the control group, (0.633±0.073)(t=5.71 ,P ＜ 0.001 ) in the inside of transected dorsal root group. It was (0.823±0.089) in the middle area of the control group,(0.660 4±0.074)(t=6.90,P ＜ 0.001 ) in the middle area of the transected dorsal root group. It was (0.915±0.090) in the lumbar region of the control group, and (0.656±0.077)(t=10.31 ,P ＜ 0.001 ) in the lumbar region of the transected dorsal root group. Average value of the control group was (0.852±0.084), and average value of the transected dorsal root group was (0.639±0.078)(t=10.23 ,P ＜ 0.001 ).CONCLUSION: Part of G protein of end-brush neurons related with the primary afferent noxious stimulation in SG derives from primary sensory neurons, which maybe join the adjustment of primary sensory transfer.

Objective To evaluate the ultrasound(US) features of diffuse sclerosing variant (DSV) of papillary carcinoma of the thyroid. Methods The US and histopathlogical of 20 DSV patients were retrospectively assessed. Results Among the 20 cases,thyroid single lobe of 12 cases,bilateral lobes of 8 cases and cervical lymph nodes metastases of 18 cases (90%) were involved in DSV of papillary carcinoma of the thyroid. At ultrasound, echo diffuse abnormal change of single lobe or bilateral lobes of thyroid and diffuse scattered microcalcifications were seen in the DSV of papillary carcinoma of the thyroid. The blood flow signals of the abnormal lobes were occupied by 75% of one grade and 25 % of two grades. Conclusions DSV of papillary carcinoma of the thyroid is usually manifested as echo diffuse abnormal change,diffuse scattered microcalcifications and cervical lymphocytic infiltration on ultrasound in relatively young patients.

Humans ; Jaw, Edentulous ; therapy ; Maxilla ; Prostheses and Implants

Objective:To investigate the preoperative risk factors affecting early extremity blood supply after repair of major arterial injury so as to provide clues for prevention of limb ischemia.Methods:The clinical data were retrospectively analyzed of the 139 patients (140 extremities) with major extremity arterial injury who had been admitted to Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, The First Hospital Affiliated to Sun Yat-sen University from January 2003 to December 2019. There were 112 males and 27 females, with a mean age of 30 (20, 44) years. The primary outcome was the early status of blood supply to the injured extremity (48 hours after surgery). Univariate analysis was conducted of such factors as gender, age, ischemia time, injury mechanism, injury site, fracture, soft tissue lesion, and duration of surgery. The significant factors ( P<0.1) were then analyzed by logistic regression, and P<0.05 was considered statistically significant. Results:Ischemia happened in 44 (31.4%, 44/140) extremities within 48 hours after surgery. There were significant differences in injury mechanism, ischemia time, fracture, and soft tissue lesion between patients with and without postoperative extremity ischemia ( P<0.05). Logistic regression analysis indicated that blunt injury ( OR=5.639, 95% CI: 1.068 to 29.761, P=0.042) and soft tissue lesion ( OR=12.568, 95% CI: 3.402 to 46.431, P<0.001) were significant preoperative risk factors affecting the early blood supply after repair of major extremity arterial injury. Conclusion:As blunt injury and soft tissue defect are preoperative risk factors for early extremity ischemia after repair of major extremity arterial injury, surgeons should pay more attention to them when assessing patients and making repair protocols.

Objective:To summarize the clinical manifestations and gene mutation features of patients with nucleotide excision repair (NER) disorders.Methods:A retrospective analysis was made on clinical data of patients with NER disorders who were admitted to the Chinese People′s Liberation Army General Hospital from October 2008 to February 2022 and diagnosed in the Outpatient Department of Beijing Children′s Hospital, Capital Medical University from October 2015 to February 2022.Literature on previously reported Chinese patients with NER disorders was reviewed.Results:(1)A total of 16 patients with NER disorders were enrolled, including 6 males and 10 females.The onset age was 7.5 (4.0, 12.0) months and the age at diagnosis was 42.0 (21.5, 77.0) months.There were 3 types of NER disorders: Cockayne syndrome (CS) in 13 cases, Xeroderma Pigmentosum (XP) in 2 cases and Cerebro-Oculo-Facio-Skeletal syndrome (COFS) in 1 case.Four disease-causing genes were detected: CSA gene in 11 cases, CSB gene in 3 cases, XPG gene in 1 case, and XPD gene in 1 case.The first symptoms of the 16 patients were photosensitivity and developmental delay, and neurological symptoms were observed in all the 3 NER disorder types.XP and CS patients had skin symptoms.CS patients presented typical facial features, visual and auditory impairment, microcephaly and changes in neuroimaging features.COFS patients showed intrauterine growth retardation.(2)Results of literature review: a total of 96 Chinese patients reported were retrieved, involving 6 disease types, including CS in 45 cases, XP in 44 cases, trichothiodystrophy in 4 cases, COFS in 1 case, XP-CS in 1 case, and ultraviolet sensitive syndrome in 1 case.Nine mutated genes were identified: CSA in 33 cases, XPA in 15 cases, CSB in 13 cases, XPV in 10 cases, XPC in 9 cases, XPG in 7 cases, XPD in 7 cases, XPF in 1 case, and MPLKIP in 1 case.The common symptoms were growth failure (62 cases), skin photosensitivity (61 cases), typical facial features (52 cases), mental retardation (49 cases) and microcephaly (48 cases). Among 36 cases had imaging data 33 cases(91.7%)had calcification of basal nucleus or globus pallidus.Three cases had intrauterine growth retardation and microcephaly during pregnancy. Conclusions:Patients with such prenatal manifestations as intrauterine growth retardation and microcephaly or with typical symptoms like skin photosensitivity, typical facial features, growth failure, mental retardation, hypertonia, and calcifications of basal ganglia should be suspected of NER disorders.Early genetic testing is recommended to confirm the diagnosis.

OBJECTIVE： To provide scientific evidence for establishing perfect rationality evaluation indicator system of antibiotics. METHODS： On the basis of literature research， Delphi method was used to conduct several rounds of consultations on 30 experts in related fields with E-mail and questionnaire field investigation. After several rounds of consultations， rationality evaluation index system for antibiotics was determined. The effective recovery rate of expert consultation questionnaire was used to express the positive coefficient of experts； the authoritative coefficient was used to express the authoritative degree of experts； the index importance assignment and the full score ratio were used to reflect the concentration degree of experts’ opinions； the coefficient of variation and the coefficient of coordination were used to express the coordination degree of experts’ opinions. RESULTS & CONCLUSIONS： After two rounds of consultations， response rates of the questionnaire in two rounds of surveys were 100％ and 96.67％， indicating experts were highly motivated. The authoritative coefficients were 0.91 and 0.88， indicating experts had a high degree of authority. Finally， an evaluation index system for rationality of antibiotics was established， which included four first-level indicators （indications， drug selection， medication process， management indicators） and 35 second-level indicators. Among them， the mean value of importance scoring of first-level indicators ranged from 4.28 to 5.00， the full score ratio from 0.93 to 1.00， the coefficient of variation from 0.00 to 0.15 and the coefficient of coordination was 0.446 （P＜0.001）. While， the mean value of importance scoring of second-level indicators ranged from 3.83 to 4.79； the full score ratio from 0.67 to 1.00； variation coefficient from 0.10 to 0.26 and the coefficient of coordination was 0.115 （P＜0.001）， which indicating the system was reliable.

Patients with severe tumors do not refer to the patients with end-stage tumors,but rather to the patients with a performance status(PS)score between 2 and 4 in certain stages due to various reasons,such as acute or chronic comorbidities,tumor itself,or treatment-related adverse events.To these patients,there is a high probability of achieving survival benefit and/or improvement in PS scores after synergistic management of available life-support technologies and anti-tumor therapies based on dynamic and precise testing.Elderly patients with tumors frequently present with one or more chronic illnesses and have poor toler-ance and compliance to treatment.Moreover,their treatment regimens often lack high-quality clinical evidence,making them more susceptible to developing severe tumors.The management of severe tumors in the elderly is based on three basic diagnosis and treatment technologies:dynamic and precise detection,powerful life support technologies,and skillful application of current anti-tumor treatments.In specific clinical practice,the following 7 flexible and individualized treatment strategies should be adopted for different tumor types:1.concurrent management of cancer and comorbidities,2.upgrading and downgrading of anti-tumor drugs based on PS score,3.dynamic accurate detection,4.skillful combinations for increasing efficacy and reducing toxicity,5.complete overview,paying equal attention to systemic therapy and local therapy,6.safety first in medication for the elderly,7.multi-discipli-nary participation,individualized and comprehensive treatment.This article introduced the concept of severe tumors in the elderly and the associated management strategies,to increase awareness and provide feasible guidance for clinical practice.