Objective To investigate the effects of different degrees of acute normovolemic hemodilution (ANH) with 6% HES 20010.5 on serum S-100B protein concentration and cerebral oxygen metabolism at 37℃ in rabbits.Methods Thirty-two adult rabbits weighing 2.0-2.5 kg were randomly assigned into 4 groups (n = 8each) : Ⅰ control group underwent no ANH and Ⅱ , Ⅲ , Ⅳ ANH group underwent ANH with hematocrit (Hct)reduced to 24%, 18% and 12% respectively. The animals were anesthetized with iv 20% urethane 5 ml/kg,tracheostomized and mechanically ventilated (VT = 15 ml/kg, RR = 30 bpm). The body temperature was maintained at 37℃. Left carotid artery and jugular vein were cannulated for BP monitoring, blood gas analysis and blood sampling. Right jugular vein was cannulated for CVP monitoring. Left femoral artery and vein were cannulated for hemodilution. Blood withdrawn from femoral artery was simultaneously replaced by iv infusion of equal volume of HES (200/0.5) until the target Hct was achieved. Hemodynamics parameters, were recorded and blood gases were analyzed and serum S-100B protein concentration and cerebral O2 metabolic rate (CERO2) were determined before (baseline) and at 2, 4 and 8 h after ANH. Brain water content was measured by wet/dry brain weight ratio. Results There were no significant differences in serum S-100B protein concentration, CERO2 and pH value between group Ⅰ and group Ⅱ (Hct 24%). Serum S-100B protein concentration and CERO2 were significantly increased at 8 h after ANH as compared with the baseline before ANH in group Ⅰ (Her 18%). Serun S-100B protein concentration and CERO2 were significantly increased at 2, 4 and 8 h after ANH as compared with the baseline before ANH in group Ⅳ (Hct 12%). There was no significant difference in brain water content among the 4 groups. Conclusion ANH does not affect cerebral O2 metabolic when Hct is reduced to 24%. CERO2 can not be sustained and ischemic cerebral injury may occur when Hct is reduced to≤18%.

OBJECTIVETo observe the effect of Modified Yiqi Chutan Recipe (MYCR) on blood flow perfusion in treating mid-late stage non-small cell lung cancer (NSCLC) patients by using multislice CT perfusion (CTP) , and to assess the relationship between each CTP parameter and the prognosis as well.

METHODSTotally 87 mid-late stage NSCLC patients were randomly assigned to the treatment group (44 cases, Shenyi Capsule + MYCR +chemotherapy) and the control group (43 cases, chemotherapy alone) in the ratio of 1:1. And 21 days consisted of 1 therapeutic course, 4 courses in total. All of them underwent CTP of primary tumor and routine thoracic CT examination (plain CT and enhancement CT) 3 times (before therapy, after 2 and 4 cycles). CT findings were analyzed for tumor size and perfusion parameters [blood flow (BF), blood volume (BV), permeability surface (PS), mean transit time (MTT), and time to peak (TP) before and after treatment, and relationship between perfusion parameters and prognosis was also assessed.

RESULTSIn 87 cases, 7 dropped out and 80 cases were available, 40 in the treatment group and 40 in the control group. (1) The relief rate was 47.5% (19/40) and the total stable rate was 77.5% (31/40) in the treatment group, and they were 40.0% (16/40) and 65.0% (26/40) in the control group, with no statistical difference between the two groups (χ² = 0.672, 1.227; P > 0.05). (2) Compared with before treatment group in the same group, BF and PS decreased, and MTT increased in the two groups after 2 and 4 courses (P < 0.05); BE and PS decreased, and MTT increased in the control group after 2 courses (P < 0.05). Compared with the control group after 4 courses, BE decreased more significantly in the treatment group (P < 0.05). (3) After 4 courses, all patients were assigned to the remission group (35 cases) and the non-remission group (45 cases) according to the RECIST standard. Compared with before treatment in the same group, BF, BF, and PS all decreased, and MTT increased in the remission group after treatment (all P < 0.05); BF increased in the non-remission group after treatment (P < 0.05). (4) All patients were assigned to the BE increase group (34 cases) and the BE decrease group (46 cases) according to changed BE values after treatment. Results showed the mean survival rate was 246 days in the BF increase group (the 1-year accumulative survival rate being 13.0%) and 387 days in the BE decrease group (the 1-year accumulative survival rate being 53.1%). The life span was prolonged and the 1-year accumulative survival rate was elevated in the BE increase group, with statistical difference as compared with the BE decrease group (χ² = 19.057, P < 0.01).

CONCLUSIONSShenyi Capsule plus MYCR could reduce BE in mid-late stage NSCLC patients , improve vascular permeability, showing better synergistic effect with chemotherapy. CTP could not only reflect the change of tumor size, but also reflect vascular function of the tumor. Meanwhile, changes of CTP parameters were closely associated with prognosis. Patients with post-treatment decreased BE value had better prognosis and longer life span.

Capillary Permeability ; drug effects ; Carcinoma, Non-Small-Cell Lung ; diagnosis ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Phytotherapy ; Tomography, X-Ray Computed

[Objective]To evaluate the incidence of chromosomal abnormalities and associated abnormalities in prenatally diag?nosed clubfoot,and to determine the prognostic factors as well.[Methods]A total of 89 fetuses with clubfoot diagnosed during Janu?ary 2010 to October 2015 in prenatal ultrasound scan and confirmed postnatally or by autopsy,were selected,within which 16 (18.0%)cases were without other abnormalities and 73(82.0%)cases were with other abnormalities. The associated abnormalities were identified ,the correlation with chromosomal abnormalities were analyzed with Fisher analysis and the factors affecting the outcomes were determined with Logistic regression analysis.[Results]Among associated abnormalities ,the skeletal abnormalities besides the clubfoot were the most frequently associated anomalies (35 ,47.9%),and the central nervous abnormalities followed secondly(30,41.1%). A chromosomal abnormality,with trisomy 18 being the most frequently detected,was identified in 34%(17/49)of the clubfoot fetuses with other anomalies ,whereas none of chromosomal abnormality was identified in 11 fetuses without other anomalies,a significant different rate of aberrant chromosome noted(P < 0.001). The survival rate of clubfoot fetuses without other anomalies was higher than that of clubfoot fetuses with other anomalies(50.0%vs 1.3%,P=0.03). The conditions of with or without associated anomalies were the independent prognostic factors (P = 0.01),the clubfoot fetuses associated with other anomalies had poor outcomes[OR=11.9(95%CI:1.8,80.1)].[Conclusion]Skeletal abnormalities besides the clubfoot were the most frequently associated anomalies. The condition of with or without associated anomalies is the independent prognostic index for fetuses with clubfoot. Aneuploidy were more commonly in clubfoot fetuses with associated abnormalities than in those without other abnormalities. No indication for karyotyping suggests for the clubfoot fetuses without other abnormalities due to the low incidence of associate chromo?somal anomalies.

Objective To investigate the value of neutrophil CD64 combined with monocyte chemotactic protein 1 (MCP-1),interleukin-8 (IL-8) and interferon-inducible protein-10 (IP-10) in the clinical diagnosis of neonatal sepsis.Method Cases of neonatal sepsis from March 2015 to June 2016 in the department were chosen as sepsis group.35 neonates with non-infection diseases were selected as noninfection group and 40 healthy newborn infants were assigned as control group.The level of CD64 in blood were detected by flow cytometry,while the level of MCP-1,IL-8 and IP-10 of the serum in the three groups were detected by automatic biochemical analyzer.The differences between groups were compared by single factor ANOVA.The ROC curves of sepsis diagnosed by whole blood CD64,serum MCP-1,IL-8 and IP-10 were drew.Result The level of CD64,IL-8 and IP-10 of the neonatal blood in the sepsis group were significantly higher than that in the non-infection group (P ＜ 0.05) and control group (P ＜ 0.05).There were no significant difference between the sepsis group and non-infection group in MCP-1 (P ＞ 0.05),but significantly higher than that in the control group (P ＜ 0.05).The levels of serum MCP-1 and IP-10 in the non-infection group were significantly higher than those in the control group (P ＜ 0.05),but there was no significant difference between the non-infection group and control group in CD64 and IL-8 (P ＞0.05).The optimal thresholds of blood CD64,MCP-1,IL-8 and IP-10 in the diagnosis of sepsis were 35.0 MFI,58.6 ng/L,60.3 ng/L,0.46 μg/L.The sensitivity and specificity of the diagnosis of sepsis were 92.8％ and 90.6％ in CD64,70.0％ and 42.6％ in MCP-1,78.5％ and 68.0％ in IL-8,72.8％ and 54.6％ in IP-10,97.1％ and 94.6％ when combined.Conclusion The combination test of CD64,MCP-1,IL-8 and IP-10 can improve the sensitivity and specificity of the diagnosis of sepsis.

Objective To explore the effect of therapeutic-oriented communication on relieving preoperative anxiety of patients with thyroid tumor.Methods Totals of 83 patients with thyroid tumor who meet the inclusion criterion were divided into intervention group ( n =42 ) and control group ( n =41 ) by odd and even hospitalization number.Control group received conventional treatment and care while intervention group received the traditional care plus therapeutic-oriented communication.Self-Rating Anxiety Scale (SAS) were used to investigate the anxiety status before and after intervention among these patients.Results There was no difference in the average SAS scores between two groups before intervention( P ＞0.05 ),the average SAS score in intervention group was significantly lower than that of control group after intervention [ ( 39.62 ± 4.08 ) vs (46.41 ± 3.54 ) ;t =- 8.097,P ＜ 0.01 ].Conclusions Therapeutic-oriented communication play an active role in alleviating anxiety of patients with thyroid tumors,and can effectively improve the patient' s mental health.

Background: Extensive studies have confirmed the efficacy of taxanes in combination with anthracycline-basedchemotherapy on breast cancer. However, few studies have assessed the efficacy of weekly taxane–anthracyclineregimens on locally advanced breast cancer. This study was to compare the efficacy and safety of a weekly taxane–anthracycline regimen with those of tri-weekly anthracycline-based regimen in patients with locally advanced breastcancer.Methods: Patients with locally advanced breast cancer were randomized to receive 4–6 cycles of neoadjuvant chemotherapywith tri-weekly 5-fluorouracil–epirubicin–cyclophosphamide (FEC) regimen or weekly paclitaxel–epirubicin(PE) regimen. The primary endpoint was the pathologic complete response (pCR) rate. Other endpoints included theclinical tumor response, breast-conserving surgery rate, and adverse events.Results: Between March 2010 and September 2013, 293 patients were randomized to the FEC (n = 151) and PE(n = 142) arms. The overall clinical response rate was significantly higher in the PE arm than in the FEC arm (76.06% vs.59.95%, P = 0.001). Consistently, the post-chemotherapy pathologic T and N stages were significantly lower in the PEarm than in the FEC arm (P < 0.001). However, the pCR rate was similar in the two arms (10.61% vs. 12.31%, P = 0.665).Overall, 36 (27.27%) patients in the FEC arm and 6 (35.28%) in the PE arm were qualified for breast-conserving surgery.Most adverse events were comparable in both arms, with more severe neutropenia in the PE arm than in the FEC arm(11.97% vs. 5.96%, P = 0.031).Conclusions: In patients with locally advanced breast cancer, weekly PE was not superior to FEC in terms of pCR.However, weekly PE has a higher response rate and superior down-staging effects. On this account, the PE regimenmay be considered an alternative option for locally advanced breast cancer. Long-term follow-up data are needed toconfirm the efficacy of this regimen on locally advanced breast cancer.

Objective To investigate the prevalence of transfusion-transmitted virus (TTV) and human papillomavirus (HPV) co-infection in cervical smears of patients with cervical lesions in littoral of Zhejiang province and analysis of transmitted route.Methods Nested polymerase chain reaction (nPCR) was established.TTV DNA were tested by nPCR in cervical smears of 95 patients with cervical lesions and 55 healthy women,paired serum samples were available from 55 and 42 women,and their viral titer.The genotypes of 95 specimens of cervical cytology were detected with HybriMax.The phylogenetic group of TTV was determined by means of nPCR with N22 primers.Results The prevalence of TTV DNA in cervical smears of patients with cervical lesions and healthy women was 52.7% (29/55) and was comparable with that in paired serum sample (50%).Symptomatic women had significantly higher prevalence of TTV DNA in cervical smears (74.7%)than healthy controls (P=0.005).The TTV DNA prevalence in patient serum samples was 51%.The phyiogenetic groups of TTV serum isolates were concordant with those of TTV from cervical smears of the same subjects,and genotype was G1b.The TTV viral titer in cervical smears were 10 to 1000 times as high as in serum.The total infection rate of HPV was 98.9% in patients,and was 27.3% in healthy women.The frequently detected genotype was HPV16,18,33 of HSIL,and HPV6 of LSIL.The HPV positive study subjects had significantly higher TTV DNA prevalence than HPV negatives (P=0.02).Conclusion High prevalence of TTV in cervical smears suggests that sexual transmission is another mode of expansion of TTV infection among the population.The higher viral titer in cervical smears than in the respective serum samples might indicate active TTV replication in the female genital tract.Nevertheless,cooperation between TTV and HPV needs to be further investigated.

Objective To investigate the efficacy of microvascular decompression on elderly patients with constitutional hemifacial spasm (HFS) in short- and long-terms. Methods Eighty-six elderly patients with HFS and 430 non-elderly patients with HFS, admitted to our hospital from June 2000 to June 2005, were selected in our study; their clinical data were retrospectively analyzed and their shortand long-term efficacies were compared. Results The total effective rate was not significantly different between elderly patients (96.6%, 81/86) and non-elderly group (97.9%, 421/430, P>0.05). Early complications appeared in 12.8% of the elderly patients (11/86) and 9.1% of the non-elderly group (39/430); no obvious difference was noted between the 2 groups (P>0.05). The recurrence rate in elderly group was 2.3% (2/86) and non-elderly group was 1.1% (5/430); no obvious difference was noted between the 2 groups (P>0.05). Rate of long-term complications in elderly group was 12.8% (11/86), and that of non-elderly group was 9.1% (39/430); no obvious difference was noted between the 2 groups (P>0.05). Conclusion The short- and long-term efficacies of microvascular decompression on HFS were equivalent between elderly and non-elderly patients; although several negative factors might cause surgical difficulty and increased risk in the elderly patients, as long as appropriate measures and skills are taken, the efficacy and safety of the surgery can be ensured.

Objective To evaluate rehabilitation effect of Amatsu' s tracheoesophageal shunt operation after total laryngectomy with sphincter mechanism. Methods Voice rehabilitations were performed for 60 cases with Amatsu' s tracheoesophgea[shunt operation after total laryngectomy with sphincter mechanism, in which 20 cases were involved in post-operation radiation therapy. Results Fifty two (86.7%) cases developed speech with voice and swallow rehabilitation, but 1 case of them suffered water drip from his tracheoesophageal shunt when drinking. The other 8 (11.3%) cases developed swallow rehabilitation but failed in speech rehabilitation for pharyngeal fistula (4 cases,in which 1 had pre-operative radiation therapy), tracheoesophageal shunt obstruction (2 cases), dyspnea with unknowen reason (1 cases), no desire to speech(1 cases). Furthermore, all the 20 cases who were involved in post-operative radiative therapy restore their speech and swallow capability finally. Conclusions Amatsu's tracheoesophageal shunt operation with sphincter mechanism brought effective speech rehabilitation results for total laryngectomee even with pest-operation radiation therapy.

Objective To explore the effect of Rational Emotive Therapy on depression and anxiety of patients with breast cancer. Methods A total of 82 patients with breast cancer were divided into the observation group (42 cases) and the contrast group (40 cases). They were investigated before and after the psychotherapy with Self-rating Depression Scale (SDS) and self-rating Anxiety Scale (SAS). Results The scores between the two groups were similar before intervention (P > 0. 05). while, after the psychotherapy, there were significant differences in each item of SDS and SAS (P <0. 01). Conclusions Rational Emotive Therapy is proved to be effective to improve the psychological status and promote healthy behaviors among breast cancer patients.