Objective It was estimated that about 70% patients suffered from mild brain function disturbances after cardiac surgery with CPB Methods for early detection of brain injury after CPB in current use like EEG, transcranial Doppler, CT, MRI are expensive and not sensitive It was repored that combined assays of S 100 protein and NSE were conducive to early detection of brain ischemic injury and prediction of the prognosis The purpose of this study was to assess the changes in cerebral blood S 100 protein and NSE levels during and after open heart surgery with mild hypothermic CPB Methods 15 consecutive ASA Ⅱ Ⅲ patients undergoing elective open heart surgery under CPB were studied Aortic cross clamping time was 30 60 min and CPB time was less than 120 min Patients with hypertension and neurologic or endocrine diseases were excluded Anesthesia was induced with midazolam 0 15mg/kg, fentanyl 5?g/kg and vecuronium 0 1mg/kg Fentanyl 30 50 ?g/kg was continuously infused after tracheal intubation and during CPB Vecuronium was given intermittently to maintain muscle relaxation Midazolam was infused at 0 2mg?kg -1 h -1 during CPB Temperature was reduced to 32℃ 35℃ during CPB Aterial blood pH and PCO 2 were maintained within normal range and Hct between 25% 30% during CPB Internal jugular vein was caunulated and the catheter was advanced retrogradely until jugular bulb Jugular venous blood samples were taken for determination of S 100 protein and NSE content before CPB (A),when mild hypothermia (32℃ 35℃ ) was steadily maintained (B), rewarming to 36℃ (C), 30 min (D),4 6h (E) and 24h (F) after termination of CPB Results (1) After institution of CPB, S 100 protein level increased significantly (P

ABSTRACT:To explore the feasibility of DNA barcoding in the identification of sandflies ,the mitochondrial cytochrome c oxidase subunit I (COI) genes of 9 dominant species in China from three genera in the Phlebotominae were studied .The in‐traspecies and interspecies genetic distances were calculated using the Kimura‐2‐parameter model ,and the phylogenetic trees were reconstructed by neighbor‐joining (NJ) method .Results showed that all of sandflies species were successfully distinguish‐ed by the phylogenetic trees .The average intraspecific genetic distance (0 .8% ) was much less than the average interspecific ge‐netic distance (11 .2% ) .The study based on COI sequences indicates that the sandflies from China could be well distinguished with the commonly used COI barcodes ,which are potentially well utilized in sandflies species identification .

Objective To explore the feasibility and therapeutic effect of total laparoscopic hepatectomy(LH) for treating hepa‐tolithiasis .Methods 75 consecutive patients with hepatolithiasis operatively treated in our hospital from November 2003 to Novem‐ber 2012 were retrospectively analyzed .Among them ,35 cases underwent laparoscopic hepatectomy(LH group) and 40 cases under‐went open hepatectomies(OH group) .The operative modes in the two groups included the left liver lateral lobe resection ,left hemi‐hepatecomy ,common bile duct incision exploration ,choledochoscopy exploration for calculi extraction ,T tube drainage and cholecys‐tectomy .The clinical indicators including the operation time ,intraoperative blood loss ,analgesic drug use situation ,ambulation time , diet recovery time ,postoperative complication rate ,postoperative hospital stay time ,stone clearance rate and recurrence rate were analyzed and compared between the two groups .Results The operation time of the LH group was longer than that of the OH group[(205 .0 ± 40 .9) min vs .(155 .0 ± 26 .6) min ,P< 0 .01] and the postoperative hospital stay time of the LH group was shorter than that of the OH group[(12 .3 ± 2 .6) d vs .(15 .6 ± 4 .3)d ,P< 0 .01] .The intraoperative blood loss of the LH group was slightly more than that of the OH group[(330 .0 ± 259 .7) mL vs .(151 .5 ± 137 .0) mL ,P< 0 .01] .However ,the blood loss of last 10 cases in the LH group was similar to that of the OH group[(81 .0 ± 19 .70)mL vs .(78 .0 ± 22 .0)mL ,P> 0 .05) .The use rate of analge‐sic drugs in the LH group was lower than that of the OH group (0 vs .62 .5% ) .The ambulation time and the diet recovery time in the LH group were shorter than those in the OH group[(1 .5 ± 0 .5)d vs .(3 .6 ± 0 .7)d ,P< 0 .01 ;(2 .4 ± 0 .5)d vs .(4 .0 ± 0 .7) d , P< 0 .01] .No differences between the two groups were found in the occurrence rate of postoperative complications (2 .9% vs . 16 .0% ) ,stone clearance rate(instant clearance rate 91 .4% vs .90% ;final clearance rate 97 .1% vs .100% ) and the opeartion ex‐cellent rate(97 .1% vs .100% ) .No case of perioperative death occurred in the two groups(P > 0 .05) .Conclusion LH combined with choledochoscopy for treating hepatolithiasis is feasible and safe in the patients conforming to the selected standard with an e‐qual therapeutic effect to that of open hepatectomy .LH has the advanteages of minimally invasive surgery such as small incision , less pain ,fast recovery ,less complications ,etc .

Objective To evaluate the feasibility and efficacy of laparoscopic treatment of hepatic hemangioma. Methods The clinical data of 27 patients who received laparoscopic treatment of hepatic hemangioma from November 2003 to October 2009 were retrospectively analyzed. The hepatic inflow to the liver or to a hemiliver was temporarily blocked using a Pringle manoeuvre with a self-invented laparoscopic blocker at the porta hepatis or at the pedicle to the relevant hemiliver. The Electriccautery and ultracision were used for liver transaction. Results Laparoscopic treatment of hepatic hemangioma was successfully performed in 25 patients. Conversion to laparotomy was required in two (8%) patients for uncontrollable bleeding. There were no major postoperative complications and no mortality. The mean tumor diameter was (6.34±2. 17) cm. The operating time was ( 105.21 ±72.76)min. The time of hepatic inflow block was (10. 17±12. 21)min. The blood loss was (115. 5±212.14)ml. The volume of blood transfusion was (0. 87 ± 1.45)U. The volume of postoperative drainage was (112.60±201.03)ml. The time taken to return to normal activity was (2. 0±0. 8) days.The length of postoperative hospital stay was (5.5±2.4) days. The length of total hospital stay was (12. 5 ±5.3) days. The total cost was RMB10041.6±8678. 7. Conclusion In selected patients, laparoscopic treatment of hepatic hemangioma was safe and feasible.

Objective To compare the clinical efficiency of endoscopic thyroidectomy by breast approach with conventional open thyroidectomy in patients with benign thyroid tumor. Methods Ninety-one patients of thyroid adenoma or adenomatous goiter underwent endoscopic thyroidectomy (group endoscopy) , Ninety-nine patients underwent conventional open thyroidectomy (group open). Operative time, blood loss, the volum of drainage, time of hospital stay and postoperative stay, postoperative complications and analgesic requirements, time taken to return to normal activity and total fee were compared. Results There were no significant differences in operative time, time of stay and postoperation stay between the two groups. Blood loss was significantly less in group endoscopy (27. 7?17. 4) ml than in group open [ (96. 8?84. 8) ml, P

Objective To investigate the associations between expression of Tensin1 protein and clinicpathological characteristics and prognoses of gastric cancer (GC) patients.Methods The retrospective casecontrol study was conducted.The clinicopathological data of 163 GC patients who were admitted to the Affiliated Hospital of Jiangsu University between July 31,2011 and December 31,2013 were collected.The GC tissues and adjacent normal tissues were taken to paraffin imbedding,and then were detected by immunohistochemistry.Observation indicator:(1) expressions of Tensinl protein in GC tissues and adjacent normal tissues;(2) association between expression of Tensinl protein in GC tissues and clinicopathological characteristics;(3) followup and survival situations;(4) prognostic factors analysis.Follow-up using telephone interview was performed to detect survival up to January 1,2017.Measurement data with skewed distribution were described as M (range).Count data were analyzed using the chi-square test or pairing chi-square test.The survival curve and rate were respectively drawn and calculated using the Kaplan-Meier method,and Log-rank test was used for survival analysis.The univariate analysis and multivariate analysis were done using the COX roportional hazard model.Results (1) Expressions of Tensinl protein in GC tissues and adjacent normal tissues:immunohistochemistry showed that Tensinl protein in GC tissues and adjacent normal tissues mainly expressed in cytoplasm.Of 163 patients,154 (66 with high expression and 88 with low expression) and 9 had respectively positive and negative expressions of Tensinl protein in GC tissues;79 (37 with high expression and 42 with low expression) and 84 had respectively positive and negative expressions of Tensinl protein in adjacent normal tissues,with statistically significant differences in positive expression ratio and expression levels (x2=64.65,12.93,P＜0.05).(2) Association between expression of Tensinl protein in GC tissues and clinicopathological characteristics:high expression rate of Tensinl protein in GC tissues were respectively 31.34％ (21/67) in GC patients with tumor metastases and 46.88％ (45/96) in GC patients without tumor metastasis,with a statistically significant difference (x2 =3.95,P＜0.05).(3) Follow-up and survival situations:all the 163 patients were followed up for 3.3-64.7 months,with a median time of 28.7 months.The 3-year cumulative disease-free survival rate and cumulative overall survival rate in GC tissues were 63.12％,74.22％ in 66 patients with high expression of Tensinl protein and 47.30％,55.74％ in 97 patients with low and negative expressions of Tensin1 protein,showing statistically significant differences in above indicators (x2 =4.58,4.11,P＜0.05).Survival analysis of subgroups showed that 3-year cumulative disease-free survival rate in GC tissues of patients with maximum tumor dimension ≥ 5 cm,nerve and / or vascular invasions and stage Ⅲ of TNM staging were 45.98％,62.79％,52.75％ in patients with high expression of Tensin1 protein and 18.11％,31.10％,32.80％ in patients with low and negative expressions of Tensin1 protein,with a statistically significant difference (x2 =5.85,7.89,4.96,P＜0.05).The 3-year cumulative overall survival rate was respectively 66.00％,75.75％,67.93％ in patients with high expression of Tensin1 protein and 30.74％,40.15％,44.67％ in patients with low and negative expressions of Tensinl protein,with statistically significant differences (x2 =7.59,9.62,4.32,P ＜ 0.05).(4) Prognostic factors analysis:results of univariate analysis showed that maximum tumor dimension,histological grade,nerve and / or vascular invasions,postoperative TNM staging,postoperative adjuvant chemotherapy and expression of Tensin1 protein were related factors affecting prognoses of GC patients [hazard ratio (HR) =3.66,2.45,2.17,3.36,0.41,0.54,95％ confidence interval (CI):2.09-6.41,1.43-4.19,1.17-4.04,1.52-7.41,0.23-0.72,0.31-0.96,P＜0.05].Results of multivariate analysis showed that maximum tumor dimension ≥ 5 cm and grade Ⅲ of histological grade were independent risk factors affecting prognoses of GC patients (HR=3.21,2.17,95％CI:1.63-6.32,1.18-3.99,P＜0.05),and postoperative adjuvant chemotherapy and high expression of Tensin1 protein were independent protective factors affecting prognoses of GC patients (HR=0.50,0.44,95％CI:0.28-0.90,0.24-0.82,P＜0.05).Conclusion High expression of Tensin1 protein may inhibit GC metastasis,and it is also an independent protective factor affecting prognoses of GC patients.

Objective To explore the mechanism underlying the anti-hemorrhoid effects of Qingji Liangxue mixture(QLM).Methods Models of acute hemorrhoid in rats were established using a croton oil preparation(COP)and glacial acetic acid.A total of 80 SD female rats were randomly divided into two major groups:the COP group and the glacial acetic acid group,each consisting of 40 rats.In the COP group,rats were further randomly assigned to the following subgroups:control group 1(group CA),model group 1(group CB),low-dose QLM group 1-1(group CC),high-dose QLM group 1-2(group CD),and diosmin group 1(group CE),with eight rats in each subgroup.In the glacial acetic acid group,rats were randomly divided into the following subgroups:control group 2(group GA),model group 2(group GB),low-dose QLM group 2-1(group GC),high-dose QLM group 2-2(group GD),and diosmin group 2(group GE),with eight rats in each subgroup.Except for the control groups,all other subgroups were treated with COP or glacial acetic acid then treated with various drugs for 7 days.HE staining was used to observe anorectal histomorphology induced by COP and glacial acetic acid.ELIS As were used to measure serum levels of IL-6 and TNF-α induced by COP.Additionally,the area of perianal ulcers induced by glacial acetic acid was recorded.Twenty-four C57 mice were randomly divided into a control group(group A),low-dose QLM group(group B),high-dose QLM group(group C),and adrenal chromazone tablet group(group D).Results QLM significantly improved the pathological injury of animal models with similar hemorrhoids,reduced the score of pathological changes induced by COP(P＜0.05),reduced the serum levels of IL-6 and TNF-α(P＜0.05),reduced the area of perianal ulcers induced by glacial acetic acid(P＜0.05),and shortened the time of coagulation and bleeding(P＜0.05).Conclusions QLM has a good anti-hemorrhoid activity,which may be achieved by anti-inflammatory effects,hemostasis,and reducing tissue damage.

Objective:To provide consistent data basis for the application of reference intervals for children blood cell analysis in different testing systems.Methods:According to the requirements of American Institute for Clinical and Laboratory Standardization (CLSI) EP9-A3 document, 45 samples were collected and Sysmex XN20-A1 were used as reference system. Beckman DxH800, Siemens ADVIA 2120i, and Mindray BC5310 were comparison systems. Complete blood count and leukocyte classification were performed by four systems. The outliers of the detection results were tested by the generalized extreme student deviate (ESD) method. An optimal regression model was selected by scatter diagram, deviation diagram and frequency distribution diagram, which was used to fit the regression equation and calculate the deviation at the medical decision level and reference interval. The acceptable range for blood count deviation was cited from the Analytical Quality Specifications for Routine Tests in Clinical Hematology. The acceptable range for leukocyte classification was based on the EQA program of Royal College of Pathologists of Australasia (RCPA).Results:After the outliers were deleted, the scatter plot showed a linear relationship between the reference system and the three comparison systems. The deviation plot showed that the differences were variable. Deming regression or Passing-Bablok regression was selected according to the data distribution. The determination coefficient R2 of reference system and three comparison systems ranged from 0.95 to 0.99 in blood count and leukocyte classification. At the upper and lower limits of the reference interval, the deviations between XN-20A1 and ADVIA 2120 system were all acceptable, except for MONO# at 0.12×10 9/L. The deviations of all parameters at medical decision level were within acceptable ranges. The lower limit of PLT is partially unacceptable at the level of medical decision related to treatment and prognosis. Conclusions:The results of complete blood count and leukocyte classification in reference system and the comparison system had good consistency within the children′s reference interval. Our study provided a scientific basis for the feasibility of adopting a unified reference interval for different detection systems.

Objective:To investigate the distribution of fungal species and their sensitivity to antifungal drugs in children with invasive fungal infections.Methods:All the fungal strains primarily isolated from the sterile parts of children in Beijing Children′s Hospital, Capital Medical University from January 2010 to December 2016 were analyzed.The sensitivity of strains to 5-Fluorocytosine, Fluconazole, Amphotericin B, Itraconazole and Voriconazole was tested using ATB-FUNGUS 3 yeast drug sensitivity test strip in accordance with the standards of Clinical and Laboratory Standards Institute M27-A2.Statistical analysis of data was performed using WHONET 5.6 software.Results:Among 236 fungi isolated from aseptic samples, 64.0% (151 strains) were from blood, 22.9%(54 strains) from cerebrospinal fluid, 3.8%(9 strains) from bone marrow, 3.8%(9 strains) from ascites, 3.4%(8 strains) from pleural effusion and 2.1%(5 strains) from tissues.The top 3 dominant species detected in the 236 strains of fungi were Candida spp.(175 strains, 74.2%), Cryptococcus neoformans (31 strains, 13.1%), and Saccharomyces spp.(9 strains, 3.8%). Among the Candida spp., the main isolates were Candida albicans (107 strains, 61.1%), Candida parapsilosis (33 isolates, 18.9%), and Candida tropicalis (13 isolates, 7.4%). Rare fungi of Penicillium marneffei, Exophiala spp.and Rhizopys spp.were also detected. Candida spp.was 100% sensitive to Amphotericin B. Cryptococcus neoformans was 100% sensitive to Fluconazole, Voliconazole and Amphotericin B. Conclusions:The most common strain isolated from pediatric patients with invasive fungal infections is Candida spp., especially Candida albicans. Cryptococcus neoformans causes central nervous system and systemic disseminated infections that can′t be ignored.Amphotericin B has higher antibacterial activity against Candida spp.and Cryptococcus neoformans.Separation of species of invasive fungal infections and monitoring of drug resistance in children should be strengthened to effectively control invasive fungal infections and facilitate rational use of antifungal drugs.

OBJECTIVETo investigate clinicopathological features and prognostic factors of appendiceal neuroendocrine neoplasms(a-NEN).

METHODSClinical data of 20 patients diagnosed with a-NEN at Zhongshan Hospital of Fudan University between January 2000 and December 2016 were retrospectively analyzed. Pathological diagnosis was based on the WHO classification criteria of digestive system tumors (2010 edition). Based on the mitotic count and Ki-67 index, a-NENs were divided into grade 1 neuroendocrine tumor (NET G1), grade 2(G2) NET G2) and grade 3 (neuroendocrine carcinoma, NEC). Some special types of a-NEN (e.g. goblet cell carcinoid) and mixed adenoneuroendocrine neoplasms were classified as mixed adenoneuroendocrine carcinoma (MANEC). Follow-up was conducted by telephone or return visits. Univariate analysis was carried out using the Kaplan-Meier method, and the log-rank test was used to draw survival curves.

RESULTSOf 20 patients, 14 were male and 6 were female with median age of 54 years. Seventeen cases presented acute right lower quadrant abdominal pain, 1 chronic right lower quadrant abdominal pain, 1 persistent abdominal discomfort with outburst whole abdominal pain and 1 was found during body check without symptoms. Twenty cases comprised 8 G1 patients, 4 G2 patients, 3 G3 patients, and 5 MANEC patients. When diagnosed, there was 1 patient with liver metastasis, 1 patient with abdominal and pelvic metastases, and 2 patients with postoperative pathological findings of lymph node metastasis. Six patients underwent appendectomy, 12 underwent right hemicolectomy, 1 underwent right hemicolectomy plus small intestine resection, and 1 underwent partial hepatectomy plus right hemicolectomy. The follow-up time was 7-187 months(average, 36 months). The total 1- and 3-year survival rates were 94.7% and 60.2%, respectively. Univariate analysis showed that age >50 years (χ=7.036, P=0.008), pathology grade as MANEC (χ=5.297, P=0.021), and metastasis (χ=6.558, P=0.010) indicated lower 5-year survival rate.

CONCLUSIONSMost a-NEN patients have no typical symptoms, and the main complaint at consultation is acute right lower quadrant abdominal pain. Prognosis is poor for patients with age >50 years, MANEC pathology grade and metastasis.

Appendiceal Neoplasms ; complications ; diagnosis ; surgery ; Carcinoma, Neuroendocrine ; complications ; diagnosis ; therapy ; Female ; Gastrointestinal Neoplasms ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors ; complications ; diagnosis ; surgery ; Prognosis ; Retrospective Studies