Objective To investigate the effects of methylprednisolone on lung function and inflammation during one-lung ventilation in patients undergoing pulmonary lobectomy.Methods Sixty patients (46 males, 10 females, aged 18-60 years, ASA grade Ⅰ or Ⅱ) scheduled for pulmonary lobectomy were randomly divided into two groups (n=30 each) using a random number table: the control group (group C) and the methylprednisolone group (group M).Patients in group M were treated with methylprednisolone before induction of anesthesia within 30 min, whereas patients in group G received equal volume of normal saline at the same time.The heart rate (HR), mean arterial pressure (MAP), peak airway pressure (Ppeak), plateau airway pressure (Pplat), and dynamic lung compliance (Cdyn) were recorded at the momment before OLV (T1), 30 min after OLV (T2), 1 h after OLV (T3), 10 min after resuming two-lung ventilation (T4) and the end of the surgery (T5).The arterial blood gas analysis were performed at the above time points in order to determined the oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2), then the oxygenation index (OI), alveolar to arterial difference of oxygen tension (A-aDO2) and respiratory index (RI) of each patient was evaluated.The concentration of serum TNF-α, IL-6 and IL-10 were determined by ELISA at T0, T4, 6 h (T5) and 24 h (T6) after surgery using venous blood samples.The incidence of pulmonary complications at 72 h after operation were also recorded.Results Compared with T0, the MAP and Cdyn was decreased, whereas the Ppeak and Pplat was increased significantly in both group at T1, T2 (P＜0.05), the OI was decreased and the A-aDO2, RI was increased significantly at T1-T4 (P＜0.05), and the concentration of serum TNF-α, IL-6 and IL-10 at T4-T6 was increased significantly in both group (P＜0.05).Compared with group C, the Cdyn was increased, the Ppeak and Pplat were decreased significantly in group G at T1, T2 (P＜0.05), the concentration of serum TNF-α and IL-6 were decreased, and IL-10 was increased significantly in group G at T4-T6 (P＜0.05).The incidence of postoperative pulmonary complications had no statistically signifcant differences between the two groups.Conclusion Methylprednisolone can significantly improve the pneumodynamics and lung compliance, alleviates the inflammatory responses, but have no significant effect on intrapulmonary oxygenation and gas exchange during one-lung ventilationin patients undergoing pulmonary lobectomy.

Objective To investigate the protective effects of creatine phosphate pretreatment on circulato ry function in prone position in elder patients with general anesthesia.Methods Forty patients in ASA physical status Ⅰ or Ⅱ of male and female,aged 60 to 75 years undergoing percutaneous nephrolithotripsy in prone position,were randomly divided into two groups (n =20 each):the control group (gToup N) and the creatine phosphate group (group P).In the group P,creatine phosphate sodium (30 mg·kg-1 in 50 mL normal saline) was continuous infused at a speed of 100 mL· h-1,while only normal saline 50 mL in the group N at the same time.HR,MAP,CO,SV,CVP,Pulse Pressure Variation (PVV) and Systemic Circulation Resistance (SVR) were monitored and recorded at 1 min before prone position (T0) and 1 min (T1),3 min (T2),5 min (T3),10 min (T4) after prone position.The requirement for vasoactive agents were also recorded.Results Compared with T0,HR began to increase significantly at T1 in the group N(P ＜ 0.05),while MAP,CO and SV began to decrease at T1 to T3,and CVP,PVV and SVR began to increase significantly at the same time in the group N (P ＜ 0.05).Compared with the group N,MAP,CO and SV were decreased,PPV,CVP and SVR were increased significantly at T1 to T2 in the group P (P ＜ 0.05).The requirement for vasoactive agents in the group P was obviously lower than that in the group N (P ＜ 0.05).Conclusion Creatine phosphate pretreatment can stabilize the hemodynamic change effectively,and prevent the adverse cardiovascular events caused by prone position in elder patients with general anesthesia.

AIMTo explore the effects of sleep deprivation (SD) on myocardium and its antioxygen index.

METHODS35 Sprague Dawley rats were randomly divided into five groups: Cage control, Tank control, SD 2 d, SD 4 d and SD 6 d. The "flower pot" technique was used to establish rats sleep deprivation model followed by record of surface electrocardiogram, detection of myocardium morphology changes under microscope and transmission electron microscope and investigation of MDA content and SOD activity of myocardial mitochondria.

RESULTSAfter sleep deprivation, heart rate increased and ECG showed ischemia of myocardium; subcellular organelles such as chromosome, endoplasmic reticulum, mitochondria, intercalated disk impaired, myofibril lysis or necrosis, and lipid peroxidation reaction effects spread widely; edema, bleeding of the microvessels and invasion of the monocytes could be seen in the lumen. The MDA level increased and SOD activity increased followed by a decreased trend.

CONCLUSIONSleep deprivation can induce damage on myocardium, and the stress especially oxygen stress caused by SD may be the possible mechanism.

Animals ; Electrocardiography ; Female ; Male ; Myocardial Ischemia ; etiology ; pathology ; physiopathology ; Oxidative Stress ; physiology ; Rats ; Rats, Sprague-Dawley ; Sleep Deprivation ; complications ; Superoxide Dismutase ; metabolism

Objective To evaluate the value of DWI in assessing the biological characteristics of breast invasive ductal carcinoma (IDC).Methods Eighty-seven IDC lesions confirmed by postoperative pathology were involved in this retrospective study.The ADC values of IDC were compared among different lymph node status,grades,and molecular subtype.The correlations of ADC value and lymph node status,grades,and molecular subtype were evaluated.Results The ADC value of IDC with positive lymph node was lower than that with negative lymph node (P=0.035),and the ADC value of the high grade IDC was lower than those of medium grade IDC and low grade IDC (P=0.021,0.002).There was no significant difference of ADC value between different molecular subtypes.There was low negative correlation of ADC value with grades (r.s =-0.357,P 0.001) and week negative correlation of ADC value lymph node status and nolecular subtype (rs =-0.227,P=0.034;rs-0.093,P＜0.001).Conclusion DWI can provide useful information in evaluating the biological characteristics of IDC.

Objective To evaluate the effect of goal-directed fluid therapy on postoperative rehabili-tation in elderly patients undergoing surgery in the prone position.Methods Sixty patients of both sexes,aged 60-75 yr,of American Society of Anesthesiologists physieal status Ⅱ or Ⅲ,scheduled for elective lumbar surgery in the prone position under general anesthesia,were divided into 2 groups (n =30 each) using a random number table:conventional fluid therapy group (group C) and goal-directed fluid therapy group (group G).The CNAP system was used to monitor stroke volume variation and cardiac index continuously in group G.Mean arterial pressure was maintained at 60-110 mmHg,central venous pressure at 6-12 emH2O and urine volume more than 0.5 ml · kg-1 · h 1 using conventional fluid therapy in group C.In group G,goal-directed fluid therapy was performed under the guidance of stroke volume variation,and cardiac index was maintained at 2.5-4.0 L · min-1 · m 2.The requirement for crystalloid and colloid solution,total volume of fluid infu sed,blood loss,urine volume and requirement for vasoaetive agents were recorded during operation.After anesthesia induction,at 1 h after turning to the prone position and at the end of operation,blood samples were collected fromn the left radial artery for blood gas analysis,and the blood lactate concentration was recorded.The volume of drainage within 3 dlays after operation,perioperative blood transfusion,early postoperative cardiovascular and pulmonary complications,development of oliguria and anuria,emergence time and length of hospital stay were recorded.Results Compared with group C,the requirement for crystalloid solution,total volume of fluid infused,urine volume and requirement for vasoactive agents were significantly decreased during operation,the requirement for colloid solution was increased during operation,the blood lactate concentration was decreased at 1 h after turning to the prone position and at the end of operation,the length of hospital stay was shortened,and the incidence of postoperative cardiovascular and pulnonary eomplications was decreased in group G (P＜0.05).Conclusion Goal-directed fluid therapy can promote postoperative rehabilitation and shows a certain clinical value in elderly patients undergoing surgery in the prone position.

OBJECTIVETo explore whether there is a relationship between gross tumor volume (GTV) and pathologic lymph node metastasis or prognosis of esophageal carcinoma, and to provide a new prognosis reference for esophageal carcinoma (EC).

METHODSSix hundred and seven patients received radical resection of thoracic esophageal carcinoma from May 2002 to June 2006 in our hospital, and their pre-operative CT images were transmitted to the three-dimensional conformal radiotherapy planning system by the network in digital format. Esophageal GTV targets were outlined and their GTV volumes were calculated. To analyze whether there is a relationship between GTV volume and pathologic lymph node metastasis or prognosis.

RESULTSIn the 607 cases of esophageal carcinoma, the GTV volume was (22.5 ± 16.8) cm(3) in 374 stage N0 EC patients, significantly different from that of (30.4 ± 20.1) cm(3) in 233 stage N1 EC cases (P < 0.001). There is a significant difference between the GTV volumes of the groups with and without lymph node metastasis (P < 0.05). There was a significant difference of the GTV volumes of EC patients with one lymph node metastasis and those with ≥ 4 lymph node metastasis (P < 0.05). There was a positive correlation between GTV volume and the number of lymph node metastasis (r = 0.230, P < 0.001). The 1-, 3-, 5-year survival rates since the surgery date were 83.8%, 53.5%, and 36.4%, respectively. There was a significant difference between the survival rates of stage N0 (48.5%) and stage N1 patients (18.2%, P < 0.001), and there was a significant difference between the survival rats of patients with 0, 1 and ≥ 2 lymph node metastasis (P < 0.01). Cox regression model analysis showed that GTV volume, number of lymph node metastasis, pathological type, and lesion site were independent prognostic factors (all P < 0.05).

CONCLUSIONThe GTV volume of esophageal carcinoma is positively correlated with the number of pathologic lymph node metastasis, and it is an independent prognostic factor for this cancer.

Adenocarcinoma ; diagnostic imaging ; pathology ; surgery ; Adult ; Aged ; Carcinoma, Small Cell ; diagnostic imaging ; pathology ; surgery ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; surgery ; Esophageal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Proportional Hazards Models ; Radiotherapy, Conformal ; Survival Rate ; Tomography, X-Ray Computed ; Tumor Burden

Objective To evaluate the efficacy and safety of "outside-in" arthroscopic cam resection in the treatment of femoroacetabular impingement (FAI)syndrome.Methods Nine patients were treated with "outside-in" hip arthroscopy for cam or mixed type FAI syndrome between July 2015 and July 2016.All the 9 patients(11 hips)underwent osseous correction of the femoral neck and labral debridement.Before the surgery and 12 months after it,all patients were evaluated using the Harris Score and their complications were observed.Results The average postoperative Harris Score(92.5,range from 64 to 100)was significantly better compared with the preoperative one(56.4,range from 22 to 70,P＜ 0.001).One patient with blister on dorsal foot and another with fluid leakage were cured.No neurovascular injuries or cartilage injuries were found among all the patients.Conclusion "Outside-in" arthroscopic treatment of FAI with osseous correction and labral debridement is safe and effective.

BACKGROUNDPortasystemic shunts, especially total shunts, are effective tools for reducing portal pressure and controlling variceal bleeding but lead to high risk of encephalopathy and accelerating liver failure. The purpose of this study is to evaluate the clinical effects of small-diameter expanded polytetrafluoroethylene (ePTFE) H-graft portacaval shunts in the treatment of portal hypertension.

METHODSThirty-one patients with portal hypertension were treated with ePTFE small-diameter H-graft portacaval shunts from December 1995 to April 2002. Twenty-one had externally ringed grafts and 10 had non-ringed grafts; 20 had 10 mm diameter grafts and 11 had 8 mm grafts. The left gastric artery and coronary vein were ligated in 22 patients. Additionally, 6 patients underwent pericardial devascularization, and splenectomies were performed on 30 patients.

RESULTSAn average decrease of free portal pressure (FPP) from (32.13 +/- 4.86) cmH2O before shunting to (12.55 +/- 5.57) cmH2O after shunting was observed. Portal blood flow was reduced by 1/3 compared with the levels measured before shunting. Twenty-eight patients survived after the operation, and no upper gastrointestinal rebleeding occurred in the follow-up period (40.2 months on average). We lost contact with one patient. Color Doppler ultrasonography and/or portography revealed the shunts to be patent in 28 cases and occluded in 2 (6.4%) cases. Encephalopathy developed in 4 patients (12.9%).

CONCLUSIONSmall-diameter ePTFE H-graft portacaval shunts can effectively reduce portal pressure. Moreover, the majority of the hepatopetal flow from the portal vein can be adequately maintained. The reinforced shunts may achieve a higher rate of patency. Morbidity from encephalopathy was less frequent than in patients receiving total shunts. Small-diameter H-graft portacaval shunts are also effective in preventing recurrent variceal bleeding.

Adult ; Blood Vessel Prosthesis ; Female ; Humans ; Hypertension, Portal ; surgery ; Male ; Middle Aged ; Polytetrafluoroethylene ; Portacaval Shunt, Surgical ; methods ; Treatment Outcome

OBJECTIVEUsing the volume calculating function of treatment planning system of 3DCRT to work out the value of GTV standard classifications and to provide the reference for clinical staging of esophageal carcinoma.

METHODSSix hundred and seven patients underwent radical resection of thoracic esophageal carcinoma in our hospital, and their pre-operative CT images were transmitted in digital format to the three-dimensional conformal radiotherapy planning system by the network. Esophageal lesion GTV targets were outlined, and their volumes were automatically computed by the planning system. Compared the differences of the GTV volumes in different pathological T stages, and analyzed the relationship between GTV volumes and pathological T stages. According to the median volume of GTV at different pathological T stages, divided the values of GTV volume corresponding to different T stages and selected the suitable classification standard of GTV volume.

RESULTSThe esophageal carcinoma GTV length, maximum diameter and volume were related to pathological T staging and with a positive correlation (all P < 0.001). The Spearman correlation coefficient (r) was 0.376, 0.466 and 0.464, respectively, P < 0.001. Except that the length, maximum diameter and volume of GTV in pathological T3 and T4 had no significant difference, other indicators of the pathological T stages showed significant differences between the groups (P < 0.001). According to the median volume of GTV at different pathological T stages, the GTV volumes were divided into three grades: 13.0 cm(3). When compared them with pathological T1, T2, and T3-T4 stages, the coincidence rate was 73.8%. The consistency was good between the GTV volume grades and pathological T stages (Kappa = 0.40, P < 0.001). The overall 5-year survival rates of GTV grades 1, 2, 3 were 78.1%, 31.5% and 33.5%, respectively (P < 0.0001). If the GTVs were divided into four grades: 39.0 cm(3), the coincidence rate of GTV volume grades and pathology T staging was only 54.7%, and the consistency was poor, Kappa = 0.24, P < 0.001. The overall 5-year survival rate of GTV 1, 2, 3, 4 were 78.1%, 31.5%, 36.2% and 27.5%, respectively (P < 0.0001).

CONCLUSIONThe length, maximum diameter and volume of esophageal carcinoma GTV are related to pathological T staging with a positive correlation. The classification that esophageal carcinoma GTVs divided into three grades has a good coincidence with the pathological T staging.

Adult ; Aged ; Carcinoma, Small Cell ; diagnostic imaging ; surgery ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; surgery ; Esophageal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; methods ; Survival Rate ; Tomography, X-Ray Computed ; Tumor Burden

Objective To investigate the diagnostic values of radiomics model based on ADC map in differentiating benign from malignant lesions in suspicious breast findings with MRI breast imaging reporting and data system (BI-RADS) category 4. Methods Eighty eight patients (36 benign and 52 malignant)with diagnosis of MRI BI-RADS 4 in our hospital from December 2014 to December 2015 were retrospectively enrolled in this study.All the patients were proved by pathology and examined by sequence of T1WI,T2WI,DWI and dynamic contrast enhanced magnetic resonance imaging(DCE-MRI),and then were further sub-categorized into BI-RADS 4A, BI-RADS 4B, or BI-RADS 4C based on DCE-MRI sequence. Thus positive predictive value(PPV)of each sub-category were calculated and ROC were used to describe its efficiency in differential diagnosis.Radiomics features based on ADC map were generated automatically from Analysis-Kinetics(GE Healthcare).Sixty three of the 88 cases randomized-selected by computer were used to establish forecasting models and other 25 cases for validation. Kruskal-Wallis test and Spearman were introduced to reduce radiomics features that were highly correlated with others. Logistic linear regression(LLR)model was constructed based on the selected features by'glm'function in R software and then verified by 10-fold cross validation (repeat 10 times). ROC was curved to determine the diagnostic accuracy of the model.Results The PPV of BI-RADS 4A,4B,4C were 16.7%(2/12),59.6%(28/47),75.9% (22/29)respectively.Area under curve(AUC)of ROC was 0.650,sensitivity and specificity were 76.9% and 45.9% respectively. Three hundred and ninety six radiomics features were extracted automatically by software and 5 features (size zone variability, difference entropy, zone percentage, intensity variability and inverse difference moment)were left after redundancy reduction step.Cross-validation showed the accuracy of Logistic regression model was 80.0%(20/25),AUC was 0.790,sensitivity and specificity were 81.3% and 77.8% when cut-off was 0.45. Conclusion The radiomics model could provide important reference for differentiation between benign and malignant lesions in suspicious BI-RADS 4 findings.