Objective To summarize the experiences usinG the Airtraq optical larynGoscope( AL)in the manaGement of unanticipated difficult endotracheal intubation. Methods Twenty surGical patients with General anesthesia usinG tracheal intubation were induced with propofol-remifentanyl and injected with atracuriun (0. 5 mG/kG). And then,larynGoscope with Macintosh directly throuGh oral tracheal intubation,and located the tracheal intubation by end tidal carbon dioxide detection method. AttemptinG oral tracheal intubation with Macintosh larynGoscope were failed for twice time,the AL was used to accomplish tracheal intubation. Results In all the patients,tracheal intubations with AL as a rescue intubation device Got clear GradeⅠCormack-Lehane Glottis exposure,with once-time successful intubation attemptinG in l8 patients. But in other 2 patients,tracheal intubations were accomplished by combined use of a fibreoptic bronchoscope which GuidinG tracheal tube into the Glottis throuGh AL after tracheal tube slidinG backward into the esophaGus repeatedly. DurinG the intubation attempts,interval mask ventilation were Given maintaininG SaO2≥90% in all patients. Conclusion AL offers an new effective technique as a rescue airway device in deal with unanticipated difficult tracheal intubation.

Objective To detect the genes differentially expressed in sepsis-injured lungs and discover new genetic targets for management of sepsis-induced acute lung injury (ALI) and evaluate the role of cDNA microarray in the study of molecular pathogenesis of sepsis. Methods In a murine model of polymicrobial sepsis induced by cecal ligation and puncture (CLP), the gene expression patterns of the lungs of the animals in sepsis group and control group (Sham-operation ) were screened at 6 h and 12 h after CLP by using a commercially available cDNA microarray chips containing 2 201 cDNA clones. The cDNA of differentially expressed unique genes were sorted and analyzed. Results Of the 2 201 cDNA clones on the chip, 80 known unique genes had significant differential expression at 6 and/or 12 h after CLP as compared with those of mice in control group. 40 of the 80 genes were up-regulated and 40 down-regulated and they were related with a range of genetic functions, such as cell defence or immune/inflammatory reaction, acute-phase reaction or heat-shock reaction, redox regulation, cytoskeleton, cell apoptosis, cell signaling and cell metabolism etc. By functional analysis of these differentially expressed genes, some unique genes or expression patterns were interpreted in the context of septic ALI process and warrant further investigation. Conclusion cDNA microarray technique provides a powerful new tool for detecting differentially expressed genes and analyzing gene expression patterns in sepsis-injured tissues. Further study using this technique may yield great insight into the molecular pathologic mechanism of sepsis and discern new targets for therapeutic interventions.

Objective To investigate the dynamic changes and clinical significanes of TNF?α,IL?1,IL?10 and HMGB?1 in patients with tuberculosis. Methods Fifty?nine patients with active tuberculosis were enrolled in this study. The patients received the standard chemotherapy and the curative effect of the patient was evaluat ed according to the outcome classification in our country. The peripheral blood serum from the patients during the treatment and 12 healthy volunteers were collected. The concentrations of serum TNF?α,IL?1,IL?10 and HMGB?1 were detected by ELISA tests. Results Significant decreases of the concentrations of serum TNF?α,IL?1 and HMGB?1 were shown in patients from the initial treatment,to retreatment and extra?pulmonary tuberculosis (P<0.01),and the serum IL?10 was increased significantly (P<0.01) along with the chemotherapy and improvement of the disease. At the beginning of the treatment ,the levels of 4 kinds of inflammatory factors had no significant differences between the completed and uncompleted treatment patients (P>0.05). At the end of the treatment , the levels of serum TNF?α,IL?1 and HMGB?1 of the uncompleted treatment group were significantly higher than the normal levels (P<0.01) ,but the level of IL?10 was significantly lower than the normal level (P<0.01). Conclusion The dynamic testing of the inflammatory cytokines contributes to evaluation and judgement of the curative effect and the condition of patients with the active tuberculosis.

[Objective]To investigate the outcomes of cementless metasul metal-on-metal total hip arthroplasty.[Method]Metasul metal-on-metal total hip arthroplasty of 30 hips in 25 patients was performed from August 2003 to December 2005.There were 11 males and 14 females with an average age of 47 years(28-72 years).Harris hip scores were determined before surgery and at the last follow-up examination.Standardized radiographs were obtained to evaluate component conditions.Blood samples were taken to determine serum chromium levels with use of atomic absorption spectrometry.[Result]Twenty-three patients(28 hips)were followed up with a mean period of 3.6 years(2.5-4.8 years).The mean Harris hip score improved from 49.5(17-78)points preoperatively to 93.4(55-99)points at the time of final follow-up.Twenty-two hips(85%)had an excellent result.Radiolucent lines were found in 3 hips.Focal femoral osteolysis was seen only in one patient.Sciatic nerve was injured in one case,which showed rehabilitation after 2.5 years.One hip had periprothetic infection because of diabetes 4 years after operation.There was no measurable wear by X-rays.No dislocation or fracture was found.The median serum chromium concentration was 0.082 ?g/mL(0.020～0.140 ?g/mL).No patient was diagnosed with renal insufficiency or hematologic malignancy during the study period.[Conclusion]The outcomes of Metasul metal-on-metal total hip arthroplasty are satisfactory.However,additional follow-up is necessary to determine any possible long-term deleterious effects.

[Objective]To discuss the cementless revision for postoperative infection after hip arthroplasty.[Methods]From November 1997 to December 2006,7 patients(7 hips) with infection after hip arthroplasty were treated,including 3 males and 4 females,with a mean age of 58 years(36～73 years).In the 7 hips,4 hips underwent a revision of total hip arthroplasty,2 hips only received new acetabular components and 1 hip underwent stem revision.One-stage revision was performed in 4 cases,two-stage revision was performed in 3 cases.Consecutive radiographs were compared to evaluate component conditions.Harris hip scores were determined before surgery and at the final follow-up examination.The erythrocyte sedimentation rate and C-reactive protein were detected.[Results]All patients were followed up with a mean period of 3.6 years(1.5～10.6 years).The mean Harris hip score improved from 35(18-63) points preoperatively to 89(60～99) points at the time of final follow-up.No re-infection was found.Femoral component exsertion was found in 1 patient but without any symptom.Pain of hip joint disappeared in 5 cases,and 2 patients had mild pain when walking long distance.At the time of final follow-up,5 patients still had slight limp.Heterotopic ossification developed in 1 hip.The mean polyethylene liner wear was 0.08 mm per year at final follow-up.Deep vein phlebothrombosis and nerve injury were not found.[Conclusion]It is possible to have satisfactory clinical outcome by one-stage or two-stage revision using cementless prothesis for postoperative infection after total hip arthroplasty.Whether the original prothesis can be saved when fixed tightly with femur or acetabular bone needs more experiences to confirm.

[Objective]To evaluate the clinical and radiographic results of revision hip arthroplasty with cementless prothesis.[Method]Revision hip arthroplasty of 41 hips in 36 patients was performed from November 1997 to August 2007 using cementless prothesis.In the 41 hips,29 hips underwent a revision total hip arthroplasty,8 hips underwent new acetabular components,and 4 hips underwent stem revision.Consecutive radiographs were compared to evaluate component conditions.The value of AAOS and Paprosky classification was used.Harris hip scores(HHSs)were determined before surgery and at the most recent follow-up examination.The Kaplan-Meier survivorship analysis was used to estimate the probability of survival of the prothesis.[Result]Twenty-two patients(26 hips)were available for complete clinical and radiographic analysis.The mean follow-up period was 4.6 years(range,1-11 years).The mean preoperative Harris hip score of 38(range,11-76)points improved to 88(range,60-99)points at the time of final follow-up.The pain and function socre improved from 16.9 and 17.3 points to 40.4 and 39.9 points,respectively.All patients had moderate to severe limp before revision.At the time of final follow-up,8 patients still had slight limp and 4 patients had moderate limp.Twenty-one hips(75%)had an excellent result.A 1mm width radiolucent line was found in 1 femoral component without any symptom.Osteolysis and migration were seen in 4 hips(3 in acetabular and 1 in femoral component),which needed re-revision(12.5% failure).Heterotopic ossification developed in 8 hips(31%).The mean polyethylene liner wear was 0.27 mm(range,0.02-0.87 mm)in all and 0.08 mm(range,0-0.25 mm)per year.The wear rate was only correlated with changes of abduction angle of the acetabulum.The coincidence of bone defect classification in AAOS is better than Paprosky.Kaplan-Meier survivorship at 4.6 years was 89% with repeat revision for any reason as the end point and 81% with repeat revision or radiographic loosening as the end point.[Conclusion]Cementless prothesis appears to be a good alternative to other revision systems in revision total hip arthroplasty.Careful intraoperative evaluation of bone deficiency are needed to choose an appropriate prothesis in order to obtain a good outcome.

[Objective]To evaluate the midterm clinical and radiographic results of revision hip arthroplasty by acetabular reinforcement ring (ARR) with impaction bone grafting. [Methods]Revision hip arthroplasty by ARR with impaction bone grafting of 8 hips was performed from May 2001 to December 2006. There were 5 males and 3 females with an average age of 53 years (range, 36~70 years).The mean BMI was 20 (range, 15~28). The mean interval between the primary arthroplasty and revision was 5 to 20 years (mean 6.7 years). The causes for revision were infective loosing in 2 and aseptic loosening in 6. In the 8 hips, 6 hips underwent a revision total hip arthroplasty, 2 hips received replacement of the acetabular component. Consecutive radiographs were compared to evaluate component conditions and the influence of bone deficiency to fix the prothesis was analyzed. Harris hip scores (HHSs) were determined before surgery and at the most recent follow-up examination. The Kaplan-Meier survivorship analysis was used to estimate the probability of survival of the prothesis.[Results]Seven hips were available for complete clinical and radiographic analysis. One patient died for myocardial infarction. The mean follow-up period was 4.5 years (range, 1.5~7.1 years).The mean preoperative Harris hip score of 30(range, 20~64) points improved to 88 (range, 74~94) points at the time of final follow-up, the pain and function socre improved from 13.8 and 11.5 to 40.3 and 39.9 respectively. All patients had severe limp before revision. At the time of final follow-up, 5 patients still had slight limp and 1 patients had moderate limp.Five hips had an excellent result. Infective osteolysis and migration were seen in 2 hips, which need re-revision. Heterotopic ossification developed in 2 hips . Kaplan-Meier survivorship at 4.5 years was 63% with repeat revision or radiographic loosening.[Conclusion]ARR with impaction bone grafting is an effective approach to treat massive acetabular bone defect in revision hip arthroplasty, the midterm result is acceptable, but any possible reason for infection must be monitored.

Objective:To evaluate the possible role of cytokines in pathophysiology and treatment of nasal polyps.Method:The expressions of Th1-typed cytokines IFN-γ、IL-2 、IL-12 and Th2-typed cytokines IL-4、IL-5、IL-8、IL-10、IL-13 were investigated with enzyme-linked immune sorbent assay(ELISA) in 25 patients with nasal polyps.Result:There was a significant upregulation of Th2-typed cytokines IL-4、IL-5、IL-8、IL-10、IL-13 in nasal polyps compared with normal nasal mucosa, especially　IL-4 and IL-5 (3.9 times and 8.8 times higher than normal mucous respectively) while the expression of Th1-typed cytokines IFN-γ、IL-2、IL-12 drcreased after treated with local glucocorticoid. The levels of Th2-typed cytokines decreased significantly and Th1-typed cytokines had no obvious change.Conclusion:The upregulation of Th2-typed cytokines such as IL-4、IL-5、IL-8、IL-10、IL-12 may play an important role in the pathophysiology of nasal polyps and Th2-typed cytokines can be viewed as a target of treatment to nasal polyps.

Objective To inject PPTA into the cochlea of guinea pigs through scala tympani fenestration ,to study the protective effect of PPTA injection on the cochlear damage induced by gentamicin and mechanism of oxy-gen free radical .Methods Randomly divided were the guinea pigs with normal hearing into three groups :the con-trol group ,GM group and PPTA group .We injected the artificial perilymph 10μl /d into cochlea through scala tym-pani fenestration on control group for 3 days ,injected GM 160 mg · kg -1 · d-1 on GM group for 3 days ,injected the PPTA 10 μl /d into the cochlea through scala tympani fenestration and injected GM 160 mg · kg -1 · d-1 at the same time on PPTA group for 3 days .We tested ABR and analyzed the hearing changes .We tested the OFR level reacted by SOD and GSH of the cochlea tissue .SEM and TEM were performed to observe the change of cell mor-phology .Results For ABR ,the control group was 12 .75 ± 3 .796 ,GM group 28 .230 ± 4 .953 ,PPTA group23 .47 ±9 .211 dB SPL(P<0 .05) .For SOD ,the normal group was 50 .241 ± 9 .080 ,GM group 28 .230 ± 4 .953 ,PPTA group 43 .089 ± 4 .587 U/mgprot(P<0 .05) .For GSH ,the normal group was 3 .03 ± 0 .33 ,GM group 1 .51 ± 0 .13 ,PP-TA group 2 .50 ± 0 .16 Ggsh/L(P<0 .05) .The changes of hair cells of PPTA group were obviously less severe than that of GM group .For TEM ,the changes of spiral ganglion and stria vascularis of PPTA group were obviously less severe than that of GM group .Conclusion Injecting PPTA through scala tympani fenestration can protect cochlea by generating the excess of OFR when confronting against GM .

Objective To study the effect of 5-lipoxygenase(5-LOX) inhibitor nordihyroguaiaretic acid (NDGA) combined the selective cyclooxygenase-2 (COX-2) inhibitor Celecoxib on the apoptosis of human colon carcinoma cell line HT-29. Methods Different concentration of NDGA and Celecoxib combinations were used to process cancer cell, and thiazolyl blue tetrazlium bromide (MTT) and phase contrast microscope and Annexin V/PI fluorescence staining and reverse transcription polymerase chain reaction (RT-PCR) were used to study the proliferation inhibited effect and apoptosis induced effect caused by combination of NDGA combined Celecoxib. Results MTT results showed that the viability of NDGA group, Celecoxib group and the group of NDGA combined Celecoxib (0.432±0.024,0.425±0.013,0.303±0.014 vs 0.693±0.018,t＝18.79,25.75,37.64,P＜0.01) was obviously lower than control group. The group of NDGA combined Celecoxib was significantly lower than NDGA group or Celecoxib group (t＝10.21, 14.14,P＜0.01). Under inverted phase contrast microscope, cell morphology significantly changed, and the group of NDGA combined Celecoxib changed most obviously. Apoptosis was observed by laser scanning confocal microscope (LSM) after NDGA and Celecoxib were used to process the HT-29. RT-PCR showed that up-regulation of Caspase-3 after treatment, and the combination of two drugs increased the most. Conclusions NDGA combined Celecoxib inhibited proliferation and induced apoptosis in human colon carcinoma cell line HT-29, and combined therapy had better effect than that of any drug used separate-ly. The mechanism may be associated with up-regulation of Caspase-3.