Objective To analyze the skin barrier function in patients with facial steroid dermatitis.Methods Ninety-five patients with facial steroid dermatitis were enrolled into this study along with 25 healthy volunteers as controls.Transepidermal water loss(TEWL)and skin hydration were measured in 8 facial regions.including lesional skin in forehead,nasal tip,submaxilla,both cheeks and angulus oris,and non-lesional skin in the left posteior ear.Results Compared with the healthy group,the patients with steroid dermatitis had a significant higher value of TEWL on lower mandible,both angulus oris and cheeks(t:4.90,2.60,2.57,2.54,3.77,respectively,P＜0.01),while a significant lower level of skin hydration was noted on both angulus otis,right cheek and forehead(t=3.27,3.81,2.02,2.78,respectively,P＜0.05).Among the 8 test sites in both patients and controls,TEWL value decreased in the following order:submaxilla and both angulus oris＞both cheeks and forehead＞non lesional skin on the posteroir ear,and the decrease in skin water content was highest in submaxilla and both angnlus oris,followed by cheeks and forehead,and finally by left posterior ear.Conclusions In patients with facial steroid dermatitis,skin barrier function is disturbed on submaxilla,both angnlus oris and cheeks,and TEWL value is found to be higher in perioral area,while cheeks have a lower level of skin hydration.

Objective To compare and analyze the clinical application of lumbar plexus combined with sciatic nerve block and spinal anesthesia for elderly patients with knee joint surgery.Methods A total of 77 elderly patients with ASAⅠ ~Ⅲ undergoing single knee re-placement surgery were randomly divided into combined group which recieved lumbar plexus combined with sciatic nerve block and spinal an-esthesia group.The baseline values,blood pressure and heart rate at multiple time points,the block area and duration,the volume of intraoper-ative fluid,and other indexes of adverse reaction were observed.Results The MAP,SBP and DBP in the spinal anesthesia group after the op-eration have changed significantly at the time of T1,T2 and T3.The operating of anesthesia in the combined group was shorter than that of spi-nal anesthesia group.The rate of adverse reactions in combined group was significantly lower than that inspinal anesthesia group.Conclusion The spinal anesthesia can be satisfied for operation requirements,but it will cause the unstable circulation and varied adverse reactions.Lum-bar plexus combined with sciatic nerve block is safe and effective with less adverse reactions,less disturbance of hemodynamics,which is much better for the old or the patients with coagulation abnormalities combined heart and lung disease.

Objective To evaluate the efficiency of dezocine combined with sufentanil on postoertive analgesia for spinal deformity sur-gery.Methods Divided the 90 patients who were admitted into our hospital from January 2013 to September 2015 into three groups by ran-dom single blind method,namely the dezocine group,the sufentanil group and the combined group,with 30 cases in each group.All the pa-tients underwnet propofol and sevoflurane static absorption compound anesthesia,and they were given continuous intravenous analgesia with different drugs after the surgery.Their visual analogue scale (VAS)score,sedation scale (SS)score,adverse reaction,total PCIA times,ef-fective PCIA times,respiratory rate and arterial blood gas were measured at 2,6,24,48 hours after operation.Results The VAS score of the combined group was lower than that of the dezocine group (P <0.05).The combined group was significantly superior to the dezocine group and the sufentanil group in SS score and adverse reactions.At 24 and 48 hours after surgery,SaO2 and PaO2 in the combined group were higher than those in sufentanil group (P <0.05).PaCO2 in the combined group was lower than that in the dezocine group and the sufentanil group(P <0.05).Conclusion Dezocine combined with sufentanil is a more efficiency way with less adverse reaction on postoperative anal-gesia for spinal deformity surgery,and it is an ideal way of analgesia.

Objective To explore the effects of sedationand hemodynamics on different ages patients with the same concentration of dexmedetomidine under general anesthesia.Methods A total of 264 patients (ASAⅠ-Ⅱ)with orthopaedic surgery under general anesthesia in our hospital from April 2013 to May 2015 were divided into 3 groups by age,the young group (group Y,n =76),middle age group (group M, n =107),and old age group (group O,n =81 ).Fifteen minutes before anesthesia,patients were infused dexmedetomidine with 1 μg/kg, maintain the concentration of 0.5 μg·kg-1 ·h-1 and stop at 30 minutes before surgery finished.The SBP、DBP、BIS、HR before anesthesia (T1),pump injection start(T2),tracheal intubation(T3),1 minute after intubation(T4),5 minutes after skin incision(T5),endotracheal ex-tubation(T6)were observed.The dosage of propofoland remifentanil in anesthesia,duration from stop infusion to endotracheal extubation, Ramsay score and adverse reactions 5 minutes after PACU also need to be recorded.Results The level of SBP and DBP were significantly increased at T2,T3 in all groups.Compared with group O,both group Y and group M increased significantly,the difference was statistically significant(P <0.05).The level of SBP and DBP were significantly decreased at T5 in all groups,the difference was statistically significant (P <0.05).There was no significant difference in 3 groups at T4-T6(P >0.05).Compared with T1,the level of HR and BIS were signifi-cantly decreased at T2-T5,the difference was statistically significant(P <0.05).The dosage of propofol and remifentanil in group Y and group Mwas more than that of group O.The extubation time was significantly shorter and the Ramsay score was significantly less than those of the group O,the difference was statistical significance(P <0.05).SAS scores among the three groups was not significant difference (P >0.05). There was no significant difference in the total adverse reaction between group Y and group M(P >0.05),but it was significantly lower than that of group O(P <0.05).Conclusion Dexmedetomidine has good sedative effect in all groups,but older group have more adverse reac-tions and wake up time is extended.The concentratiuon of dexmedetomidine should be adjusted according to the age of patients.

Objective To investigate influence of dexmedetomidine on postoperative cognitive function in elder patients after hip re-placement surgery under spinal anesthesia. Methods Forty elderly patients with ASAⅠ~Ⅲ,undergoing hip replacement with spinal anesth-sia,were randomly divided into dexmedetomidine group( group A) and normal saline group( group B) ,with 20 patients in each group. Dexme-detomidine was given with 1 μg/kg after anesthesia and followed with 0. 5 μg·kg-1 ·h-1 in group A. The equal volume of normal saline was infused in group B. Cognitive function was evaluated before anesthesia,3 and 7 days after surgery by mini-mental state examination( MMSE) . The intraoperative concentration of TNF-α,IL-6,MDA were detected at the time of before surgery(T0),end of surgery(T1),3 days after sur-gery(T2),7 days after suegery. Results There was no significant difference in MMSE score before anesthesia between the two groups (P>0. 05). The difference of MMSE score at postoperative 3 days between two groups was statistical significance (P<0. 05). The MMSE score recovered normal in both groups 7 days later. There was no significant difference of TNF-α,IL-6,MDA concentration at T0 between two groups(P>0. 05). Compared with T0,the concentration of TNF-α,IL-6,MDA at T1,T2 in group B increased,the difference was significant. And the concentration of IL-6 at T1 in group A decreased,compared with that at T0,the difference was significant(P<0. 05). The concentra-tion of TNF-α,IL-6 at T1,T2 and MDA at T2 in group A were lower than those in group B,the difference was significant. (P<0. 05). Con-clusion Dexmedetomidine can decreased the concentration of TNF-α,IL-6,MDA,and improve the postoperative cognitive dysfunction of eld-erly patients who finished the hip replacement surgery under spinal anesthesia.

BACKGROUNDLung cancer invading left atrium or base of pulmonary vein belongs to locally advanced lung cancer (T4). The prognosis of treatment without surgery is poor. The aim of this study is to explore the feasibility and the value of surgical method in the treatment of this disease.

METHODSFrom April, 1993 to April, 2005, lobectomy or pneumonectomy combined with extended resection of left atrium were carried out in 46 patients with locally advanced lung cancer. The operations included left low lobectomy in 20 cases, left pneumonectomy in 6 cases, right middle and low lobectomy in 12 cases, right low lobectomy in 3 cases and right pueumonectomy in 5 cases respectively. The base of the pulmonary vein was invaded by the tumor in 34 patients, while left atriums were invaded obviously in 12 patients. Two patients were operated using extracoporeal circulation because of main pulmonary artery and left atrium being invaded. The Kaplan-Meier method (Log rank test) and a COX model were used to analyse the survival and the prognosis.

RESULTSThere was no operative mortality in this series, 15 patients had operative complication, including arrhythmia in 13 cases, pneumonia in 8 cases and heart failure in 1 case. The median survival was 35 months. The 1-, 3-, 5-year survival rates were 84.2%, 43.7%, 30.5% respectively. The survival of patients with N0/1 was better than that of patients with N2 disease, the median survival of them were 38 months and 19 months respectively (P=0.002). Using a Cox model analysis, lymph node stage (N0/1 or N2) was independent prognostic factor, while preoperative chemotherapy, sex, age and the pathologic type were not independent prognostic factors.

CONCLUSIONSSurgical treatment for lung cancer invading the left atrium or the base of pulmonary vein is feasible, especially for N0 patients.

Objective To observe the effects of propofol on neural stem ceils in mouse developing hippocampal dentate gyrus (DG).Methods Healthy 7 d old mice from the same litters were randomly allocated into three groups:high dose propofol group,low dose propofol group and 10％ fat emulsion control group.All mice were treated with drugs on postnatal 7 d.The mice in high dose propofol group were intraperitoneally injected with 60 mg/kg propofol;the mice in low dose group were intraperitoneally injected 30 mg/kg propofol;while the mice in the control group with equivalent volume of 10％ fat emulsion.Some mice were sacrificed at 24 h after medication injection,and the others were sacrificed at postnatal 14 d.The morphology and expression levels of Ki67,Nestin,BLBP and NeuN in hippocampal DG were detected by immunohistochemical method.Results Healthy 7 d old mice from the same litters were randomly allocated into three groups:high dose propofol group,low dose propofol group and 10％ fat emulsion control group.All mice were treated with drugs on postnatal 7 d.The mice in high dose propofol group were intraperitoneally injected with 60 mg/kg propofol;the mice in low dose group were intraperitoneally injected 30 mg/kg propofol;while the mice in the control group with equivalent volume of 10％ fat emulsion.Some mice were sacrificed at 24 h after medication injection,and the others were sacrificed at postnatal 14 d.The morphology and expression levels of Ki67,Nestin,BLBP and NeuN in hippocampal DG were detected by immunohistochemical method.Conclusion High dose propofol inhibits the proliferation of neural stem cells in hippocampal DG,and impaired the prominence number of neural stem cells and causes neurons dysmaturity.

Objective To investigate the predictive value of tissue plasminogen activator(t-PA),chro-mogranin A(CgA),and lipoprotein related phospholipase A2(LP-PLA2)in serum for major adverse cardio-vascular event(MACE)after percutaneous coronary intervention(PCI).Methods A total of 120 patients with coronary heart disease who underwent PCI in the hospital from August 2020 to August 2022 were en-rolled in the study.According to whether MACE occurred within 1 year after PCI,the patients were divided into MACE group(33 cases)and non-MACE group(87 cases).The levels of serum t-PA,CgA,LP-PLA2 and clinical data were compared between the MACE group and the non-MACE group.Multivariate Logistic regres-sion was used to analyze the risk factors of MACE after PCI.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of t-PA,CgA and LP-PLA2 alone or in combination for MACE after PCI.Results The proportion of patients with smoking history,NT-proBNP,CgA,LP-PLA2,and the propor-tion of patients with hypertension in the MACE group were higher than those in the non-MACE group(P＜0.05),while left ventricular ejection fraction(LVEF)and t-PA were lower than those in the non-MACE group(P＜0.05).There were no significant differences in age,gender composition,serum creatinine,triglyc-erides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),drinking history,NYHA cardiac function classification,combined diabetes,application of aspirin,and application of clopidogrel between the two groups(P＞0.05).Multivariate Logistic regression analysis showed that smoking history,increased NT-proBNP,hypertension,decreased LVEF,decreased t-PA,increased CgA and increased LP-PLA2 were risk factors for MACE after PCI(P＜0.05).ROC curve analysis showed that the areas under the curves(AUCs)of serum t-PA,CgA and LP-PLA2 alone or in combination for predicting MACE after PCI were 0.785(95％CI:0.693-0.877),0.678(95％CI:0.564-0.791),0.730(95％CI:0.636-0.824),0.888(95％CI:0.830-0.946),respectively.The efficacy of combined prediction was bet-ter than those of single detections(P＜0.05).Conclusion The lower the serum t-PA level is and the higher the CgA and LP-PLA2 levels are,the greater the risk of MACE after PCI is.The combination of the three in-dicators has higher value in predicting MACE after PCI.