Objective To investigate the causer of, and the way to deal with the measurement of protecting from vascular compromise in free flap transplantation. Methods To retrospectively study the clinical data collected from the 89th Hospital of PLA including 305 cases of vascular compromise in free flap transplantation held on June, 1983 to December, 2006. Accoding to the different tissue flaps and different sites to be repaired, 11 factors of vascular compromise of free flap transplantation were to be investigated including operation design, the recipe of free flap, the variation of vascellum, the skill of recipe, the operation opportunity, the match of vascellum, the debride of vascellum, the vascellum angiotasis, the vascular anastomosis, the management of vascular articulo and the infection. Results Among the 305 cases of free flap transplantation, arterial compromise existed in 270 cases, 10 cases developed arterial compromise during operation, 6 cases were due to the injury of nutrient vessel, the flap survived after the revascularization. 4 cases obtained part necrosis of 10 cases, and the rotation flap and skingrafting covered the raw surface. The rest 213 cases survived and 47 cased failed. Another 35 cases of vein compromise were obtained. Among them, 5 cases survived, part necrosis of 10 cases, and 20 cases failed. Conclusion Vascular compromise is the factor of necrosis in free flap transplantation. It is of cardinal importance to timely and correctly treat the vascular compromise in free flap transplantation whether happened intra-or postoperatively. This is the key to access high successful rate. Preventive measures are even more beneficial than proper management after its occurrence. The venous return disorder was the main factor of free flap transplantation failure.

Objective To investigate the effect to the blood supply of the gastrocnemius if ligating the medial or lateral artery, and provide theory base for the sural artery flap repairing the soft tissue defects of legs injuries.Methods The anatomical study involved 16 fresh adult cadaver lower legs ligating the medial or lateral gastrocnemius vessel, the arteries of which were perfused with the Meglumine Diatrizoatis Mucilage,and then carried out the cross-sectional analysis of the CTA, the bifurcation, location length, diameter and perforator of the sural artery were recorded by dissection.To observe the anastomosis with gastrocnemius vessel in artery pipeline foundry made by 1 specimen.Results The consistent with the result of the angiography was the gastrocnemius can completely get enough blood supply from some anastomotic arteriole when ligating one side of the sural vessel.Under normal circumstances, the blood supply of gastrocnemius muscle mainly supplied by sural artery.In the case of the sural vessel was cut off, the blood supply of gastrocnemius come from the anastomotic arteriole between medial and lateral artery and the soleus.The anastomotic arteriole from soleus has larger diameter, but less quantity, and was invariably deteced in the lower third of the gastrocnemius muscle constantly.A lot of anastomotic arteriole were found between the muscle heads, and it was also invariably deteced in the lower third of the gastrocnemius muscle, communicating with the surai neurovascular axis, the average external diameter was less than 0.5 mm.Conclusion The blood supply of the gastrocnemius are enough when ligating the medial or lateral artery.

ObjectiveTo investigate the effect of dexmedetomidine on tracheal extubation response in patients undergoing thyroid surgery after general anesthesia.Methods Forty-two patients who ASA classification Ⅰ - Ⅱ,were performed thyroid surgery under total intravenous anesthesia.They were divided into dexmedetomidine group and control group by random number table with 21 cases each.Both groups patients anesthesia induction and maintenance with the same methods,dexmedetomidine group patients at 15 min before anesthesia induction with venous infusion dexmedetomidine 0.6 μ g/kg(finished 10 min infusion),followed by 0.4 μ g/(kg · h) continuous infusion,control group patients with pump equivalent in 0.9％ sodium chloride injection in the same way.Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR),surgery time,recovery time,extubation time,orientation recovery time,modified Aldrete score ≥9 scores time,rate of recovery from restlessness,tolerance score and recovery from any adverse effects were recorded.ResultsThere were no significant differences between two groups in surgery time,recovery time,extubation time,orientation recovery time,modified Aldrete score ≥ 9 scores time (P ＞0.05).SBP,DBP,HR at immediately and after extubation with 1,3,5 min of dexmedetomidine group were lower than those of control group(P ＜ 0.05 or ＜ 0.01 ).Tolerance score excellent rate of dexmedetomidine group was higher than that of control group[95.2％ (20/21) vs.28.6％ (6/21)] (P ＜ 0.05),the rate of recovery from restlessness of dexmedetomidine group was lower than that of control group[0 vs.28.6％(6/21 ) ] (P ＜ 0.05).ConclusionBefore anesthesia induction in patients with venous infusion dexmedetomidine 0.6 p g/kg(finished 10 min infusion),followed by 0.4 p g/(kg·h) continuous infusion can effectively reduce the patients' cardiovascular response to extubation,strengthen the patients' tolerance to endotracheal tube,reduce the patients' agitation and recover consciousness comfortable.

Objective To systematically assess the clinical efficacy of estrogen combined with antidepressants in the treatment of perimenopause-related depression in our country by meta analysis.Methods The electronic databases of CBMdisc,CNKI,VIP,Wanfang,PubMed,Cochrane Library and Google Scholar were retrieved by computer.The subject terms were set for retrieving the literatures on the effect evaluation of estrogen combined with antidepressants in treating perimenopause-related depression in our country published at home and abroad from January 1980 to February 2016.The study data and results of included literatures were performed the meta analysis by using the RevMan 5.1 software.Results Fifteen articles conforming to the inclusion standard were included.The data merged results showed that compared with single estrogen use group,in the aspects of the effective rate(RR=1.46,95%CI=1.29-1.66,P<0.004),HAMD score(WMD=-4.61,95%CI=-5.63——3.59,P<0.01)and KMI score(WMD=-5.83,95%CI=-11.12——0.53,P<0.01),the estrogen combined with antidepressants group had statistically significant difference.Conclusion The treatment and alleviating effect of estrogen substitution therapy combined with antidepressants for treating perimenopause symptoms and depression is superior to that of single estrogen use substitution therapy.

Objective To evaluate clinical application of the gastrocnemius blood vessles as recevier ones to anastomose with free flaps. Methods From June 2005 to July 2011,twenty adult lower limbs were infused with red glue to observe the origin,streching,branches and communication with other blood vessles of the gastrocnemius blood vessles and to measure their outer diameters and pedicle length. Operations were also simulated on these specimens to make the above chacracters of the vessles clear further.CT images of 16 fresh adult lower limbs were got to observe the effects of obstruction of one side of the gastrocnemius blood vessels to the blood supply of the gastrocnemius muscles. Fifty-two free flaps were transplanted to legs with large defects of skin and soft tissues where the gastrocnemius blood vessles were anastomosed with the flaps to supply artery blood and receive vein blood. Results The main blood vessles of the gastrocnemius muscles were medial and lateral gastrocnemius blood vessles. They both origined from the popliteal arteries and communicated with other blood vessles. The pedicles of the medial gastrocnemius blood vessles were 8.0 -13.8 cm in length which averaged 11.1 cm and their outer diameters were (1.8 ± 0.3) mm when they entered the muscles. The pedicles of the medial gastrocnemius blood vessles were 5.4 - 12.3 cm in length which averaged 8.8 cm.The outer diameters of the two accompanying veins were (1.8 ± 0.3)mm when they entered the muscles.When one gastrocnemius blood vessle were obstructed,the gastrocnemius muscles could got enough blood supply by co mmunicating branches between the obstructed vessle and other blood vessles.All the 52 free flaps survived. Through one to two-years follow-up, the defects cured with no infection and the knees' motions were normal. Conclusions With a long pedicle and wide diameter,the medial or lateral gastrocnemius blood vessle can be a reliable alternative used in free flap transplautation for repairing large defects of skin and soft tissues of seriously injured legs with no other choice of blood vessles, which causes unobvious effects to the blood supply of the legs and can simplify the free flap transplantation.

BACKGROUND:Elderly patients with degenerative lumbar degeneration often appear insufficient holding power of pedicle screw in spine surgery, which is prone to occur de-pinning and leads to insecure fixation. How to increase the holding power of screws has become a hot research. OBJECTIVE:To observe the early clinical effect of pedicle screws with cement augmentation for treating lumbar degenerative diseases in elderly patients. METHODS:A total of 65 old patients with lumbar degenerative diseases received a treatment between August 2012 and April 2014, and were divided into two groups according to the treatment strategy:treatment group (n=24;internal fixation of pedicle screws with cement augmentation) and control group (n=41;routine internal fixation of pedicle screws). General conditions of patients in two groups were observed and compared. Visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) score system were used for evaluating the lumbar and back pain, and restoration of neurological function in lower limbs respectively. RESULTS AND CONCLUSION:Al of the patients successful y received the surgery and then were fol owed up from 3 to 20 months. The anterioposterior and lateral X-ray film revealed no loosening, loss, fracture of the screws, and no loss of intervetebral space height was found. There was no significant difference in the blood loss and hospital stay between two groups (P>0.05). JOA at postoperative 3 and 6 months, and VAS score at postoperative 3 months were significantly improved after the treatment of pedicle screws with cement augmentation, when compared to control group (P<0.05). VAS scores showed no difference at 6 months postoperatively in two groups (P>0.05). Pedicle screws with cement augmentation for treating lumbar degenerative diseases have the advantages of improving the screws holding strength, reconstructing the stability of lumbar vertebra and obtaining clinical efficacy on degenerative spine.

Objective: To observe the expression of long non-coding RNA myocardial infarction associated transcript (LncRNA-MIAT) in tumor necrosis factor-α (TNF-α) induced endothelial cells (ECs) inflammation in vitroand to study the impact of LncRNA-MIAT on inflammatory regulation. Methods: LncRNA-MIAT expression in ECs was induced by TNF-α at different time and concentration. Expressions of intercellular adhesion molecule-1 (ICAM-1) and LncRNA-MIAT in inflammatory ECs were examined by quantitative real time polymerase chain reaction (qRT-PCR) and Western blot analysis. Moreover, ECs was transfected by siRNAMIAT to observe the effect of LncRNA-MIAT knock-down on ICAM-1 expression. Results: LncRNA-MIAT expression showed the increasing trend by elevated time and concentration of TNF-stimulation. Compared with TNF-α stimulation at 0h, 6h and 12h, LncRNA-MIAT expressions were increased at 24h and 48h of TNF-αstimulation respectively, allP<0.05; compared with TNF-α concentration at 0ng/ml and 0.125ng/ml, LncRNA-MIAT expressions were elevated by TNF-α stimulation at 1.000ng/ml and 10.000ng/ml respectively, allP<0.05. With siRNAMIAT knock-down, TNF-α induced ICAM-1 protein expression was significantly reduced in ECs,P<0.05. Conclusion: LncRNA-MIAT might be involved in ECs inflammatory response and it may play a role to promote inflammation.

ObjectiveTo compare the efficacy of intravenous infusion of dexmedetomidine and midazolam for premedication in children.MethodsNinety-two ASA Ⅰ or Ⅱ children (46 cases aged 1-3 yr and 46 cases aged 4-6 yr) scheduled for elective general or urologic surgeries,were enrolled in this study.The children were randomly divided into 2 groups (n =46 each):midazolam group (group M) and dexmedetomidine group (group D).The children accompanied by their parents were admitted to the anesthesia preparation room at about 20 min before induction of anesthesia,and midazolam 0.1 mg/kg òr dexmedetomidine 1 μg/kg was infused intravenously over 10 min.Anesthesia was induced with proporol-rocuroniume-remifentanil,and maintained with sevoflurane-remifentanil-rocuroniume.Modified Yale Preoperative Anxiety Scale (mYPAS) score,sedation score,HR,mean arterial pressure (MAP),respiratory rate (RR) and SpO2 were recorded before premedication (T1),before separation from their parents (T2) and when entering the operating room (T3).The incidence of sleep (a sedation score of 4) was recorded at T2,3.The end-tidal concentration of sevoflurane,infusion rate of remifentanil,laryngeal air way removal time,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiring rescue analgesic,and adverse effects were also retorded.ResultsCompared to that at T1,the mYPAS score was significantly decreased at T2,3,and the sedation score was significantly increased at T2,3 in both groups ( P ＜ 0.05),HR at T2 and MAP at T2,3 were significantly decreased in group D,and HR at T3 was significantly increased in group M ( P ＜ 0.05 ).Compared to group M,the sedation scores and the incidence of sleep were significantly increased at T2,3,and the HR was significantly decreased at T2 in group D ( P ＜ 0.05).There was no significant difference in the mYPAS score,RR,MAP,SpO2,end-tidal concentration of sevoflurane,infusion rate of remifentanil,laryngeal air way removal time,emergence time,duration of stay at the recovery room,incidence of delirium during recovery period,the percentage of patients requiting rescue analgesic,and incidence of adverse effects between D and M groups ( P ＞ 0.05).ConclusionThe sedative efficacy of iv dexmedetomidine is superior to that of iv midazolam when infused for premedication in children,but it exerts much influence on hemodynamics,and the changes in hemodynamics should be noted.

China ; Humans ; Streptococcus pneumoniae

Background and objectiveA common consensus has been reached regarding ifrst- and second-line therapies for advanced non-small cell lung cancer (NSCLC). The newest guideline from National Comprehensive Cancer Network (NCCN) also provides recommendations for third-line therapy. This study focused on fourth-line and enhanced treatments for advanced NSCLC. Treatment results and impact factors were analyzed and discussed.MethodsA total of 140 patients with advanced NSCLC were selected and their data were analyzed. Response rate, survival rate, and prognostic factors were evaluated.Results Among the 140 patients, 12.9% (18 cases) showed partial response, 25.7% (36 cases) suffered from a stable disease, and 38.6% (54 cases) exhibited a disease control rate. Median overall survival (OS) and fourth-line therapy OS were 31 months and 10.1 months, respectively. The median progression free survival (PFS) of fourth-line therapy was 2.6 months. Univariate and multivariate analyses indicated different therapy regimens and suggested whether or not patients should undergo follow-up treatments. These parameters were independent prognostic factors of the OS of the fourth-line therapy; by contrast, no independent impact factor of PFS was found. Chemotherapy resulted in better median OS in fourth-line therapy than in targeted therapy (11.7 monthsvs 7.1 months,P=0.013). Considering the median OS of fourth-line therapy, we observed that single agent therapy did not signiifcantly differ from double agent therapy; likewise, we found that ifrst-time usage did not signiifcantly differ from multiple usage of epidermal growth factor receptor tyrosine kinase inhibitor.Conclusion Fourth-line therapy is recommended to increase the survival of advanced NSCLC patients. Nevertheless, the role of fourth-line therapy in advanced NSCLC should be further assessed in clinical trials.