Left atrial myxoma is one of the rare causes of cerebral infarction.As the left atrial myxoma complicated artery embolization is more common in cerebral vessels,the first clinical manifestation of about 1/3 patients with left atrial myxoma was cerebral infarction.This article reports a 24-year young female without common vascular risk factors,including hypertension,diabetes,and hyperlipidemia.Multiple cerebral infarctions are the first symptom in patients with left atrial myxoma,and they are analyzed in combination with literature.

Retinopathy of prematurity (ROP) is a proliferative vascular retinal disease. Cryotherapy, laser photocoagulation, intravitreal injection of anti-vascular endothelial growth factor, scleral buckling surgery and vitrectomy are the main treatments. Treated with cryotherapy or laser photocoagulation or intravitreal injection of anti-vascular endothelial growth factor, patients with a history of ROP have thicker foveas, and the morphology of the fovea and the development of the retinal vessels in the macular area are affected, resulting in abnormal vision development. However, the specific mechanisms by which different treatments of ROP affecting the development of the macula are not yet clear. It still need further study with large samples to verify and explore, whether changes in the levels of intraocular vascular endothelial growth factor changing the process of normal macular development and how the abnormal development of the macula affects visual function.

Objective To compare the influence of liberal fluid therapy, goal-directed fluid therapy and restrictive fluid therapy on inflammatory factors and postoperative recovery in patients undergoing laparoscopic colectomy, and find an optimal fluid therapy strategy for intestinal surgery. Methods Ninety colon carcinoma patients who had underwent laparoscopic colectomy at Shengjing Hospital Affiliated to China Medical University from April 2018 to February 2019 were selected. The patients were divided into control group (liberal fluid therapy), observation Ⅰgroup (goal-directed fluid group) and observationⅡgroup (restrictive fluid group) according to random digits table method with 30 cases each. The intraoperative liquid intake and output volume, surgery duration, albumin variation, first exhaust time, postoperative hospital stay and complications were recorded; the plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) before surgery and at the time of leaving post-anesthesia care unit (PACU) were measured. Results The intraoperative crystal solution volume, total fluid volume and urine output in control group were significantly higher than those in observationⅠgroup and observationⅡgroup: (3 113.3 ± 535.9) ml vs. (2 443.3 ± 559.7) and (2 065.0 ± 411.3) ml, (3 703.3 ± 656.4) ml vs. (3 120.0 ± 546.9) and (2 546.7 ± 455.2) ml, (1 078.3 ± 475.4) ml vs. (423.3 ± 222.7) and (299.2 ± 203.1) ml, those in observation Ⅰ group were significantly higher than those in observation Ⅱgroup, and there were statistical differences (P＜0.05). There was no statistical difference in blood loss volume among 3 groups (P＞0.05). There were no statistical differences in IL-6, TNF-α and CRP before surgery among 3 groups (P＞0.05). When leaving PACU, the IL-6 and TNF-α in observationⅡgroup were significantly higher than those in control group and observationⅠgroup: (26.2 ± 5.4) ng/L vs. (22.2 ± 4.9) and (21.4 ± 4.5) ng/L, (38.5 ± 2.6) ng/L vs. (32.5 ± 1.9) and (33.2 ± 1.9) ng/L, and there were statistical differences (P＜0.05); there was no statistical difference in CRP among 3 groups (P＞0.05). There were no statistical differences in surgery duration, albumin variation and incidence of complications among 3 groups (P＞0.05). The first exhaust time in observationⅡgroup was significantly longer than that in observationⅠgroup: (75.5 ± 35.7) h vs. (51.1 ± 23.8) h, the postoperative hospital stay in observationⅡgroup was significantly longer than that in control group and observationⅠgroup: (15.1 ± 2.8) d vs. (12.1±2.7) and (12.5 ± 3.5) d, and there were statistical differences (P＜0.05). Conclusions Compared with the restrictive fluid therapy, liberal and goal-directed fluid therapy are able to reduce inflammatory response and the length of postoperative hospital stay in patients undergoing laparoscopic colectomy. While goal-directed fluid therapy has shorter first exhaust time compared with liberal fluid therapy, it prompts early recovery after surgery.

Objective:To evaluate the effect of Banxia Baizhu Tianma Decoction combined with modified Buyang Huanwu Decoction and routine western medicine on ischemic stroke.Methods:Prospective cohort study. According to random number table method, 120 patients with ischemic stroke who met inclusion criteria in the hospital were divided into control group and treatment group, 60 in each group. The control group was given routine western medicine, while the treatment group was additionally given Banxia Baizhu Tianma Decoction and modified Buyang Huanwu Decoction. All were treated for 4 weeks. The severity of neurological deficits was evaluated by National Institute of Health Stroke Scale (NIHSS). The activities of daily living were evaluated by Barthel index. The high blood shear viscosity (HWBV), low blood shear viscosity (LWBV), plasma fibrinogen (FIB) and plasma viscosity (PV) were detected by full-automatic blood rheometer. The levels of MDA, SOD and NO were detected by ELISA. The clinical responsive rate was assessed.Results:The differences in total response rate between treatment group and control group were statistically significant [93.3% (56/60) vs. 75.0% (45/60), χ2=7.56, P=0.006]. After treatment, NIHSS score in treatment group was significantly lower than that in control group ( t=2.38, P=0.019), while Barthel index was significantly higher than that in control group ( t=13.28, P<0.01). After treatment, HWBV [(5.02±0.13) mPa?s vs. (6.18±0.28) mPa?s, t=29.11], LWBV [(1.18±0.21) mPa?s vs. (1.73±0.32) mPa?s, t=11.13], FIB [(2.26±0.28) g/L vs. (3.13±0.39) g/L, t=14.04] and PV [(8.87±1.44) mPa?s vs. (10.34±1.31) mPa?s, t=5.85] in treatment group were significantly lower than those in control group ( P<0.01), and the MDA [(4.14±1.23) mmol/L vs. (5.23±1.35) mmol/L, t=204.30] in treatment group was significantly lower than that in control group ( P<0.01), and levels of SOD [(113.34±0.28) mg/L vs. (96.59±0.57) mg/L, t=4.62] and NO [(26.01±3.26) μmol/L vs. (20.84±3.74) μmol/L, t=8.07] in treatment group were significantly higher than those in control group ( P<0.01). Conclusion:The Banxia Baizhu Tianma Decoction combined with modified Buyang Huanwu Decoction and routine western medicine can repair nerve function, improve hemorheology, oxidative stress indexes, clinical curative effect and activities of daily living in patients with ischemic stroke.

OBJECTIVETo establish an animal model of sulfur mustard (SM)-induced acute lung injury in rats through different routes and compare the morphological changes in lung tissue and cells.

METHODSOne hundred and thirty-six male rats were selected and randomly divided into 5 groups, namely peritoneal cavity SM group (n=32), trachea SM group (n=32), peritoneal cavity propylene glycol group (n=32), trachea propylene glycol group (n=32), and normal control group (n=8). The rats in peritoneal cavity SM group were injected intraperitoneally with diluted SM (0.1 ml, 8 mg/kg), and the rats in trachea SM group were injected intratracheally with diluted SM (0.1 ml, 2 mg/kg). Once the rats were sacrificed at 6, 24, 48, and 72 h after SM treatment, morphological changes in lung tissue and cells were observed by light and electron microscopy.

RESULTSIn the peritoneal cavity SM group, the epithelial cells of bronchioles maintained intact with increased exudate and bleeding in alveolar cavity and large areas of pulmonary consolidation under the light microscope. In the tracheal SM group, focal ulcer formed in the epithelial cells of bronchioles with increased exudate and bleeding in alveolar cavity, partial pulmonary consolidation, and compensatory emphysema in peripheral alveolar space under the light microscope. The alveolar interval areas were widened obviously in both groups in a time-dependent manner. Under the electron microscope, we observed local loss of cellular membrane in type I alveolar epithelium, broken or lost microvilli in cells of typeⅡalveolar epithelium and fuzzy mitochondrial crista as well as the appearance of ribosome detached from rough endoplasmic reticulum in both two groups. Compared with those in the trachea SM group and the control group, the ratio of the alveolar septum average area to the visual field area in the peritoneal cavity SM group at 6, 24, 48, and 72 h was significantly higher (P<0.05).

CONCLUSIONThe lung tissue injury through the intraperitoneal route is more severe than that through the tracheal route, while focal ulceration of bronchioles epithelial cells appears in the case of tracheal route. The degree of injury increases over time in both groups, and the cellular damage is approximately the same in both groups.

Acute Lung Injury ; chemically induced ; pathology ; Animals ; Disease Models, Animal ; Lung ; pathology ; Male ; Mustard Gas ; toxicity ; Peritoneum ; Pulmonary Alveoli ; pathology ; ultrastructure ; Rats ; Trachea

Objective To investigate the relationship between different smoking status with thyroid gland and its other related influence factors among the middle age and elderly population in iodine excessive area.Methods A total of 10 140 permanent residents aged 40-80 years old in Guiyang City during 2011 were randomly sampled for conducting the questionnaire survey,physical examination,biochemical detection and B-type ultrasonic examination of thyroid.The regression analysis was used to compare the relationship between different smoking status with thyroid volume,thyroid stimulating hormone(TSH),thyroid goiter and thyroid nodules as well as other related factors.Results After exclusion,a total of 6 122 research subjects were included in the study;the analysis results showed that once smoking group,current smoking and male were negatively correlated with TSH (P＜0.05);current smoking,male and body mass index were positively correlated with thyroid volume(P＜0.01);smoking had no relation with the prevalence rate of goiter and thyroid nodules(P＞0.05),and the age and female were the risk factors for thyroid nodules (P＜ 0.05).Conclusion Smoking can affect the TSH level,current smokers have a larger thyroid volume,and smoking has no relation with the prevalence rate of goiter and thyroid nodules.

Objective To investigate the clinical features and prognosis risk factors of the elderly and youth patients with acute severe poisoning.Methods Adult patients with acute severe poisoning in the emergency intensive care unit (EICU) of Nanjing Drum Tower Hospital from January 2008 to December 2017 were enrolled. The patients were divided into the elderly group (age ≥ 60 years) and the youth group (16 years≤age < 60 years), the clinical data of the two groups were analyzed. The patients were divided into survival group and death group according to the prognosis of 28-day, binary multivariate Logistic regression was used to analyze the risk factors of mortality of the elderly and youth patients; receiver operating characteristic curve (ROC) was used to assess the predictive value of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) in mortality of youth patients.Results A total of 343 patients with acute severe poisoning were included, 89 in the elderly group and 254 in the youth group. ① Clinical features: compared with the youth group, the elderly group had higher proportion of basic diseases included hypertension, type 2 diabetes and coronary heart disease, higher the initial APACHEⅡ scores at admission, higher the proportion of invasive mechanical ventilation and respiratory failure, and longer the length of EICU stay and the length of hospital stay. The main poisoning causes of elderly and youth patients were suicide (58.43％, 83.86％) and accidents (38.20％, 13.39％). The most common poisoning types of elderly patients were sedative hypnotics (23.60％) and organophosphorus pesticides (22.47％); the youth patients were mainly paraquat (42.52％) and organophosphorus pesticide (17.32％). There were 28 patients died (31.46％) in the elderly group and the cause of death were respiratory failure (53.57％), circulatory failure (32.14％) and multiple organ dysfunction syndrome (MODS, 14.29％). There were 67 patients died (26.38％) in the youth group and the cause of death were respiratory failure (59.70％), MODS (20.90％) and circulatory failure (19.40％). ② Risk factors of deaths: the APACHEⅡ score, incidence of acute kidney injury (AKI) and MODS in the elderly death group were significantly higher than those in the elderly survival group. Logistic regression analysis showed that AKI was the independent risk factor for death in elderly patients [odds ratio (OR) = 8.449, 95％ confidence interval (95％CI) =2.347-30.410,P = 0.001]. The proportion of female, APACHE Ⅱ score, and the incidence of AKI, respiratory failure and MODS in the youth death group were significantly higher than those in the youth survival group. Logistic regression analysis showed that APACHE Ⅱ score (OR = 1.175, 95％CI = 1.081-1.277,P = 0.001), AKI (OR = 34.470, 95％CI =11.681-101.722,P = 0.001) and MODS (OR = 3.834, 95％CI = 1.264-11.636,P = 0.018) were the independent factors for death in the youth patients. ③ Predictive value: the initial APACHEⅡscore was useful for predicting prognosis of youth patients with acute severe poisoning. The APACHE Ⅱ score to predict the death of the area under the ROC curve (AUC) was 0.744 (95％CI = 0.681-0.806,P = 0.001); the cut-off was 5, the sensitivity was 92.54％, the specificity was 51.34％, the positive predictive value was 65.53％, the negative predictive value was 87.31％, the positive likelihood ratio was 1.902, and the negative likelihood ratio was 0.145.Conclusions Patients with acute severe poisoning have their own clinical characteristics. To reduce the morbidity and improve the prognosis, we should strengthen the pre-hospital management and optimize the clinical treatment process.

Objective To investigate the clinical efficacy and side effects of nalbuphine for treatment of post combined spinal epidural anesthesia shivering undergoing cesarean section.Methods Ninety puerpera underwent elective caesarean section under combined spinal-epidural anesthesia,who developed shivering Wrench grade 3 or 4,aged 20-35 years,ASA physical status Ⅰ or Ⅱ,were randomly and double-blindly divided into three groups with 30 puerpera each to receive either saline (group C) or nalbuphine (group N,0.07 mg/kg) or tramadol (group T,1 mg/kg) as a slow intravenous bolus for treatment of shivering.Onset of shivering,time interval from treatment to cessation of shivering,success rate,recurrence rate after successon treatment outcome of shivering,OAA/S sedation scores,nausea and vomiting,bradycardia and hypotension were recorded.Results There was no significant difference of the time interval from treatment to cessation of shivering between the three groups.Compared with group C,there was statistically significant shorter time interval from treatment to cessation of shiveringin group N [(3.6±1.3) min vs (14.3±7.3) min] and group T [(4.2± 2.2) min vs (14.3±7.3) min],higher success ratein group N (93.3％ vs 16.7％) and group T (90％ vs 16.7％) and lower recurrance ratein group N (7.1％ vs 80.0％) and group T (11.1％ vs 80.0％)(P＜ 0.05).Higher sedation scores in group N were observed (P＜0.05).The incidence of nausea and vomiting was 60.0％ in group T,which was significantly higher than those in group C (20.0％) and group N (13.3％) (P＜0.05).There was no significant difference in the incidence of bradycardia and hypotension in three groups.Conclusion Nalbuphine can control the shivering of post combined spinal epidural anesthesia undergoing cesarean section safely and effectively,which seems suitable for parturients cesarean delivery due to the lower incidence of nause and vomiting and a certain sedation effect.

Persistent fetal vasculature syndrome (PFVS) is a rare congenital vitreous dysplasia, which is classified as anterior, posterior and combined types according to the location of the vascular abnormalities. The clinical manifestations of PFVS are diverse, and early surgical intervention is very important. The main objective of surgical treatment is to remove the anterior and posterior traction between fibrovascular membranes and retina as well as lens, and to reconstruct clear visual axis. Surgical treatments include pupilloplasty, lensectomy with or without intraocular lens implantation and vitrectomy via limbal or scleral approach. For new technologies, the applications of ophthalmic viscosurgical device and femtosecond lasers have desirable results . In addition to focusing on improving the success rate of surgery, it is also necessary to systematically and comprehensively assess the overall preoperative condition and postoperative visual function of the patients. PFVS eyes have limited improvement in postoperative vision, which is related to the extent of lesion involvement and the occurrence of complications. Eyes with macular dysplasia and tractional retinal detachment, as well as elongated ciliary process, have a poor prognosis of vision after surgery. How to improve postoperative vision in the eye affecting the posterior segment of the eye with PFVS from the microscopic anatomical relationship between the fibrous vascular pedicle and the retina is worth further study. On the other hand, reducing surgical trauma and optimizing surgical procedures in order to improve postoperative visual acuity and reduce postoperative complications are also the key research directions of future PFVS treatments.

Purpose To investigate the clinicopathological characteristics,diagnosis,and differential diagnosis of invasive mucinous adenocarcinoma(IMA)and mixed invasive mucinous and non-mucinous adenocarcinoma(mIMA).Methods The clinical data were collected in 36 patients with primary IMA and 17 patients with mIMA,and the expression of TTF-1,CK7,CK20,SATB2,CDX2,EGFR,HNF4a,etc.was detected by immunohistochemical EnVision two-step method.The Sanger se-quencing and the FISH were used for KRAS mutation and NRG1 gene rearrangement detection.The clinicopathological character-istics were analyzed with review of relevant literature.Results There were 9 cases(25.0％)and 3(8.3％)cases of papillary and micropapillary structures in IMA,while 13 cases(76.5％)(P＜0.001)and 9 cases(52.9％)(P=0.001)were present in mIMA.There were 5 cases(13.9％)of high nuclear grade of IMA and 10 cases(58.8％)of high nuclear grade of mIMA(P=0.002).TTF-1 had a positive rate of 37.5％in IMA,but 60.0％and 80.0％in the mucinous adenocarcinoma and non-mucinous adenocarcinoma components of mIMA(P=0.021),respectively.The positive rates of CK7,CK20,and CDX2 in IMA were 90.6％,21.9％,and 9.4％,and the positive rates in mucinous adenocarcinoma and non-mucinous adenocarcinoma components of mIMA were 100％,20％,20％and 100％,6.7％,6.7％,respectively and no SATB2 expression was found in all cases.There was no significant difference in the expres-sion of total EGFR and two EGFR mutation-specific antibodies(L858R,DEL19)between IMA and mIMA.There were 3 cases of mucinous adenocarcinoma with L858R positive in mIMA,and 2 of them were negative for non-mueinous adenocarcinoma.In another case,the non-mueinous adenocarcinoma component of mIMA expressed DEL19,but the mucinous adenocarcinoma component was not expressed.The positive rate of HNF4a in IMA was 72.0％(18/25),and those of HNF4a in mucinous adenocarcinoma and non-mucinous adenocarcinoma in mIMA were 41.7％(5/12)and 33.3％(4/12),respectively(P=0.048).KRAS gene sequencing was carried out in 19 cases of IMA,among which 9 cases(47.4％)had mutations,G12D and G12V were most commonly detected,and 4 cases of mIMA were sequenced,but none of them showed KRAS mutations.FISH detection showed that 2 cases(7.1％)IMAs had NRG1 translocation rearrangement.Conclusion Pulmonary mIMA is more aggressive than IMA.For example,mIMA has significantly more papillary structure,micropapillary structure,and high nu-clear grade cases than IMA.The differences in immunohisto-chemical expression and KRAS mutation between the two are sta-tistically significant.