Objective To evaluate the effects of fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP) on the gradient between arterial and end-tidal carbon dioxide (D(a-ET)CO2).Methods Sixty ASA Ⅰ or Ⅱ patients (body mass index ＜ 30 kg/m2),aged 25-50 yr,weighing 45-75 kg,scheduled for elective gynecological laparoscopic surgery,were randomized into A,B and C groups (n =20 each).The patients were mechanically ventilated with pure oxygen in group A,and with air and O2 (FiO2 =50％) in groups B (PEEP =0) and C (PEEP =5 cm H2O).PETCO2 was monitored during mechanically ventilation.Blood samples were obtained from the radial artery immediately after tracheal intubation (T1) and at 1 h of pneumoperitoneum (T2) for blood gas analysis.D(a-ET) CO2 and Qs/Qt were calculated.Results D(a-ET) CO2 and Qs/Qt were significantly lower at T2 in groups B and C than in group A (P ＜ 0.05).Compared with group B,D(a-ET)CO2 was significantly decreased at T2 (P ＜ 0.05),and no significant change was found in Qs/Qt in group C (P ＞ 0.05).Conclusion Decreased FiO2 and PEEP of 5 cm H2O can decrease D(a-ET)CO2 and increase the accuracy of PErCO2 for reflection of PaCO2,which is due to reduced intrapulmonary shunt.

OBJECTIVE:To observe the clinical effect and safety of Xuebijing injection in the treatment of moderate and se-vere infection of stage Ⅲ-Ⅳ pressure ulcer. METHODS:A total of 130 cases of moderate and severe infection of stage Ⅲ-Ⅳ pres-sure ulcer admitted to our hospital from Jul. 2011 and Jun. 2016 were randomly divided into observation group and control group, with 65 cases in each group. Control group was treated with 0.5%Iodophor disinfectant to disinfect the sore surface,given wet ster-ile gauze soaked with 0.5% Iodophor disinfectant to compress sore surface for 30 min,and then given Aikangfu absorptive silver ion antibacterial healing dressing to fill wound,changed dressing after 2/3 was soaked. Observation group was additionally given Xuebijing injection 50 mL added into normal saline 100 mL intravenously for 30-40 min,2-3 times a day,for consecutive 7 days,on the basis of control group. Treatment course of both groups lasted for 4 weeks. The clinical efficacy,the score of pres-sure ulcer scale for healing(PUSH),debridement time,the time of local symptom and SIRS disappearance as well as the occur-rence of ADR were compared between 2 groups. RESULTS:The total response rate of observation group(93.85%)was signifi-cantly higher than that of control group (80.00%),and debridement time,the time of local symptom and SIRS disappearance were all significantly shorter than control group,with statistical significance(P<0.05). Before treatment,there was no statisti-cal significance in PUSH score between 2 groups (P>0.05). After 1-4 weeks of treatment,PUSH score of 2 groups was de-creased significantly compared to before treatment,and the score of observation group was significantly lower than that of con-trol group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:For moderate and severe infection of stage Ⅲ-Ⅳ pressure ulcer,Xuebijing injection effectively reduces inflammatory exudation,improves the ab-sorption of necrotic tissue,relieves local symptom and systematic inflammatory reaction,promotes the healing of pressure ulcers and has good clinical effect and safety.

Objective To evaluate the value of spiral CT and 3D reconstruction in diagnosis and treatment of tibial plateau fractures.Methods 25 cases with tibial plateau fractures were examined with plain radiograhs,spiral CT and 3D reconstruction during July,1998 to December,2000.The tibial plateau fractures were classified according to Schatzker′s classification on the X-rays and 3D reconstruction images.On the superior view the tibial plateau fractures were divided into anterior lateral,posterior lateral,anterior medial and posterior medial fractures.Results 3D reconstruction images of 25 plateau fractures were the same as what arthroendoscopy were.25 fractures(including 23 arthroscopic management fractures)were operated under 3D reconstruction guide.No one case was infected.The treatment was valid.Conclusion Spiral CT and 3D reconstruction can offer more accurate classification and complement to new spatial classification of fractures.Also can provide better planning and management for the tibial plateau fractures.

Objective To study the clinical manifestation, pathological character, treatment strategies and prognostic factors of phyllodes tumor of breast .Methods We retrospectively reviewed 41 patients with breast phyllodes tumor.Results The average age was 35. Among all the patients, there were 20 benign cases, 5 borderline cases, 16 malignant cases. 19 patients received extensive local excision, 7 patients received local excision, 9 patients received simple mastectomy of breast and 6 patients were treated with modified radical operation. There were 4 patients undergoing radiotherapy after the operation. Follow-up was obtained for 35 cases, with an average of 26 months (5~101 months), one of the patients died of metastasis 3 years after the operation, two patients suffered from local recurrence.Conclusions Appropriate operation is the most important prognostic factor of breast phyllodes tumor.

Objecive To explore the significance of RECK expression in breast cancer .Methods Im-munohistochemical staining was used to analyze RECK expression levels in patients with breast cancer .We com-pared these data with the clinicopathological features of these patients .Rseults Breast cancer patients with nega-tive RECK expression had significantly lower DFS and 5-year survival rates than patients with positive RECK expression.In addition,for node-negative breast cancer ,negative RECK expression indicated markedly unfavor -able survival rate than positive arm .Multivariate analysis further confirmed that RECK expression was an inde -pendent prognostic factor for patients with breast cancer .Conclusion The loss of RECK expression indicates un-favorable survival rate for patients with breast cancer .RECK expression is a new ,important risk factor for recur-rence in breast cancer .

OBJECTIVE: To observe the short-term and long-term curative effect of the xenogenic acellular dermal matrix membrane (or joint muscle flap transfer) application used in the 82 cases postoperative tissue shortage repair that after the head neck carcinoma resection. METHOD: To held the 82 cases head neck carcinoma postoperative mucosa shortage repaired after resection by the xenogenic acellular dermal matrix membrane (or joint muscle flap transfer), 65 cases mucosa shortage wound be directly covered by the repair membrane and the other 17 cases mucosa shortage wound be repaired by the tranfered muscle tissue flap with the repair membrane covered; 53 cases underwent additional postoperative radiotherapy between 2-4 weeks and follow-up in 1, 3, 6, 12, 18, 24, 30, 36, 48, 60 months and observed the operation site repair process through the electronic laryngoscope, observed the patients respiration, swallow, phonation function. RESULT: Seventy-seven cases patients operation incision reached I phase healing standard, another 5 cases patients operation incision reached II phase healing standard because of the wound infection and fully-recovered through the local wound drainage,dressing process. All the patients tracheal cannula,the stomach tube be extubated successfully and without the local cicatricial constriction occurred. Seventy-eight cases follow up period reached 1 year including 53 cases who underwent postoperative radiotherapy, 49 cases follow up period reached 3 years including 32 cases who underwent postoperative radiotherapy, 14 cases follow up period reached 5 years including 12 cases who underwent postoperative radiotherapy. The patients with static local lesions discovered no reaction such as exclusion, allergy. CONCLUSION The application of xenogenic acellular dermal matrix membrane (or joint muscle flap transfer used in in the postoperative tissue shortage repair that after the head neck carcinoma resection have several advantage such as comparatively easily implementation, operation safety edge enough,well preserved organ function, comparatively low incidence about the laryngeal stenosis, the short-term and long-term repair effect are all exact.
Acellular Dermis ; Carcinoma, Squamous Cell ; radiotherapy ; surgery ; Female ; Head and Neck Neoplasms ; radiotherapy ; surgery ; Humans ; Male ; Mucous Membrane ; surgery ; Postoperative Period ; Squamous Cell Carcinoma of Head and Neck ; Surgical Flaps ; transplantation ; Wound Healing

Objective:To explore the value of machine learning models based on MRI predict the brain age of smokers and healthy controls, and further to explore the relationship between smoking and brain aging.Methods:This was a retrospective study. Dataset 1 consisted of 95 male smokers [20-50 (34±7) years old] and 49 healthy controls [20-50 (33±7) years old] recruited from August 2014 to October 2017 in First Affiliated Hospital of Zhengzhou University. Dataset 2 contained 114 healthy male volunteers [20-50 (34±11) years old] from the Southwestern University Adult Imaging Database from 2010 to 2015. All subjects underwent high-resolution 3D T 1WI scan. Gaussian process regression (GPR) model and support vector machine model were constructed to predict brain age based on structural MR images of healthy controls in dataset 1 and dataset 2. After the performance of the model was verified by the cross-validation method, the mean absolute error (MAE) between the predicted brain age and the actual age and the correlation ( r-value) between the actual age and the predicted brain age were calculated, and the best model was finally selected. The best models were applied to smokers and healthy controls to predict brain age. Finally, a general linear model was used to compare the differences in brain-predicted age difference (PAD) between smokers and healthy controls with age, taking years of education and total intracranial volume as covariates. Result:The performance of GPR model (MAE=5.334, r=0.747) in predicting brain age was better than support vector machine model (MAE=6.040, r=0.679). The GPR model predicted that PAD value of smokers in dataset 1 (2.19±6.64) was higher than that of healthy controls in dataset 1 (-0.80±8.94), and the difference was statistically significant ( F=8.52, P=0.004). Conclusion:GPR model based MRI has better performance in predicting brain age in smokers and healthy controls, and smokers show increased PAD values, further indicating that smoking accelerates brain aging.

Objective:To study the potential effects of intensity modulated radiation therapy (IMRT) on clinical efficacy,oral mucosa reaction and immunological foundation;and to explore the effect of immunological changes on clinical efficacy and oral mucosa reaction in patients with nasopharyngeal carcinoma.Methods:A total of 200 patients with nasopharyngeal carcinoma,who came from First Department of Nasopharyngeal Radiotherapy,the First People's Hospital of Foshan from October 2008 to November 2011,were selected.The patients were treated with nasopharyngeal radiotherapy,and divided into an observation group and a control group (n=100 in each group).The control group underwent common conventional two-dimensional radiotherapy treatment,while the observation group underwent IMRT.The 5-year survival rates and recurrence rates were recorded at follow-up.After the radiotherapy,the oral mucosa in the patients were evaluated by the classification standard of acute radioactive mucositis by American Radiotherapy Oncology Group (RTOG),and the number of T lymphocyte subsets before and after treatment was detected.Results:There were significant difference in non-regional-recurrence survival rate,disease-free survival rate,local recurrence rate between the above 2 groups (all P＜0.05),but no significant difference in the distant metastasis-free survival rate (P＞0.05).The acute oral mucosa reactions of grade 1,2,3,4 in the control group were 8.00％,20.00％,12.00％,7.00％,respectively,and those were 7.00％,22.00％,15.00％,1.00％ respectively.There was no significant difference in the acute response of oral mucosa in grade 1,2 and 3 in the 2 groups (all P＞0.05),but there was significant difference in the grade 4 (P＜0.05).There were significantly difference in CD8+,CD4+/CD8+ and CD4+ T lymphocyte subsets before and after treatment in the above 2 groups (all P＜0.01);there were also significantly difference after treatment between the observation group and the control group (all P＜0.01).Conclusion:In the process of treatment in patients with nasopharyngeal carcinoma,the use of IMRT on the basis of chemotherapy is more effective than the conventional two-dimensional radiotherapy,which can reduce the proportion of grade 4 (severe) acute oral mucosa reaction.It may be related to the protective effect of IMRT on immune function in the patients.

Objective:To investigate the risk factors for periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) and construct a nomogram model for prediction of such risks.Methods:In this retrospective study, we enrolled 69 patients with PJI after primary TKA (the infection group, n=69) who had been admitted to Department of Orthopedics, Nanjing Jinling Hospital, The First School of Clinical Medicine, Southern Medical University from January 2010 to December 2019. The non-infection group included the patients of the same kind but without postoperative infection during the same period who were matched according to time of admission, age, and gender in a ratio of 1∶3 ( n=207). The data on body mass index, anesthesia method, operation time, preoperative C-reactive protein, preoperative albumin, and comorbid medical conditions were collected from both groups to screen the risk factors for postoperative development of PJI using univariate and multivariate conditional logistic regression analyses. After a nomogram of the risk factors was plotted using R software, the consistency index (C-index) was calculated. The receiver operating characteristic curve, calibration curve, and clinical decision curve were drawn. Results:Multivariate conditional logistic regression analysis showed that preoperative albumin <35 g/L ( OR=7.166, 95% CI: 3.427 to 14.983, P<0.001), operation time >90 min ( OR=3.163, 95% CI: 1.476 to 6.779, P=0.003), diabetes mellitus ( OR=3.966, 95% CI: 1.833 to 8.578, P<0.001), rheumatic diseases ( OR=3.531, 95% CI: 1.362 to 9.156, P=0.009), and chronic lung diseases ( OR=4.734, 95% CI: 1.790 to 12.521, P=0.002) were risk factors for development of PJI after primary TKA. The nomogram constructed with R software visualized the model. The C-index of the nomogram was 0.809 (95% CI: 0.751 to 0.867), indicating a good predictive capability of the model. The calibration curves of the model showed that the nomogram was in good agreement with the actual observations. The decision curves showed that the threshold probabilities of the model ranged from 0.08 to 0.75, providing a good net clinical benefit. Conclusions:Preoperative low albumin, prolonged operation time, diabetes, rheumatic diseases, and chronic lung diseases may be the risk factors for PJI after primary TKA. The nomogram prediction model based on these factors can provide a reference for clinicians to prevent PJI.

To evaluate the expression of cAMP-dependent protein kinase type I-alpha regulatory subunit (PRKAR1α) in non-small cell lung cancer (NSCLC) and its correlation with clinicopathological features.
 Methods: PRKAR1α expressions in 79 NSCLC patients and matched adjacent non-carcinoma tissues were analyzed by using qRT-PCR and immunohistochemistry.
 Results: The negative rates of PRKAR1α protein in NSCLC, lung squamous cell carcinoma (SCL) and lung adenocarcinoma (ACL) were 58.2%, 77.8%, 32.4%, respectively. Compared to the matched adjacent non-carcinoma tissues, there were significant differences in levels of PRKAR1α mRNA and protein in ACL (P<0.05), but not in SCL and overall NSCLC (P>0.05). The expression of PRKAR1α protein was positively correlated with histological type, TNM stage, and lymph node metastasis (P<0.05). Tumor size and histogenesis differentiation were not related to the decreased PRKAR1α (P>0.05).
 Conclusion: Low expression of PRKAR1α in ACL might be involved in the pathogenesis, which might serve as a novel diagnostic candidate.
Adenocarcinoma ; chemistry ; classification ; genetics ; Adenocarcinoma of Lung ; Biomarkers, Tumor ; Carcinoma, Non-Small-Cell Lung ; chemistry ; genetics ; Carcinoma, Squamous Cell ; chemistry ; genetics ; Cyclic AMP-Dependent Protein Kinase RIalpha Subunit ; physiology ; Female ; Gene Expression Profiling ; Humans ; Immunohistochemistry ; Lung Neoplasms ; chemistry ; classification ; genetics ; Lymphatic Metastasis ; genetics ; Male ; Neoplasm Staging ; RNA, Messenger