Objective To observe the ventilation effect of I-gel laryngeal mask in endoscopic thyroid surgery under general anesthesia. Methods A total of 60 cases of endoscopic thyroid surgery under general anesthesia, were randomly di?vided into 3 groups (n=20):the group that patients used endotracheal intubation (Group Q);the group that patients employed Supreme laryngeal mask (Group S);the group that patients wore I-gel laryngeal mask (Group I). Success rate of insertion, du?ration of insertion, endotracheal pressure of Group S and Group I worerecored, and fiberoptic bronchoscopy was performed in Group S and I to evaluate the position of laryngeal mask. Mean arterial pressure(MAP), heart rate(HR), pulse oxygen satura?tion (SpO2) at time points of before insertion (T0), 1 min after insertion (T1), 3 min after insertion (T2), before the establishment of CO2 operating space (T3), 30 min after the establishment of CO2 operating space (T4), 10 min after the resection of speci?mens (T5), 1 min before removal of laryngeal mask (T6) and 1 min after the removal of laryngeal mask (T7) were recorded and the end-tidal carbon dioxide pressure [ p(CO2) ]and peak airway pressure (Ppeak) form T1 to T5. were also recorded. Occur?rence of nausea and vomiting, sore throat and other adverse reactions after removal of laryngeal mask were also noted. Re?sults The successful rate of insertion was not significant different among all three groups. Compared with Group Q, inser?tion time was significantly shorter in Group I and S (P<0.05). Endotracheal pressure and fiberoptic bronchoscopy score are not statistically different between Group S and I. Compared with Group Q, MAP and HR in T1, T6 and T7 were significantly lower in Group S and I (P<0.05). SpO2,p(CO2) and Ppeak show no statistical difference between three groups. Compared with Group S and Q, the occurrence of sore throat, painful swallowing and bleeding which is indicated by the appearance of blood in laryngeal were all significantly lower in Group I (P<0.05). Conclusion Both I-gel laryngeal mask and Supreme laryngeal mask can be used safely and effectively in airway management of endoscopic thyroid surgery patients while I-gel laryngeal mask is less hurting and more comfortable than Supreme laryngeal mask.

Objective:To observe the effect of stereotactic aspiration combined with corresponding drug therapy in the treatment of cerebral hemorrhage induced by different drugs. Methods:Totally 66 patients with hemorrhage induced by antithrombotic drugs were randomly divided into the control group and the treatment group with 33 cases in each. The control group was given corresponding drug therapy according to the pathogenesis of cerebral hemorrhage, and the treatment group was treated by stereotactic hematoma aspiration additionally. Daily life ability, NIHSS and prognosis improvement were compared between the two groups before and after the treat-ment. Results:After the treatment, NIHSS of the treatment group was ( 10. 17 ± 2. 97 ) and Barthel index score was ( 59. 97 ± 12. 10), which were both better than those of the control group (P<0. 05). The prognosis of the treatment group was also better than that of the control group (P<0. 05). There was no severe adverse drug reaction in the two groups. Conclusion:For different drug in-duced cerebral hemorrhage, corresponding drug therapy should be carried out, and combining with stereotactic hematoma aspiration, the therapeutic regimen can effectively improve neurological deficits and activities of daily living of the patients, and then improve the prognosis of the patients with promising safety.

[Objective] To explore the clinical effects of three methods in the treatment of cesarean scar pregnancy.[Method]All the patients with cesarean scar pregnancy accepted treatment at 2 affiliated hospitals of Sun Yat-Sen University from May 2006 to September 2016 were retrospectively analyzed.According to their different therapies,186 of them were divided into three groups:surgery group (undergone transvaginal removal of ectopic pregnancy tissue and repair of uterine defect,73 cases),medical treatment group (treated with medical and combined with curettage,51 cases),UAE group (treated with UAE and combined with suction curettage,62 cases).The success rate,hospitalization time,hospitalization expenses and treatment side effects of the three groups were compared.[Result] The success rates of the three groups were 98.6％,54.9％,and 80.6％;The hospitalization days of the three groups were (7.3 ± 3.3) days,(16.2 ± 11.2) days,(12.6 ± 10.4) d.The hospitalization expenses of the three groups were (7 967 ±1 987) yuan,(5 499-± 1 965) yuan,(15 863 ± 5 941) yuan.The treatment side effects of the three groups were 15.1％,23.5％,and 37.1％.The success rate,hospitalization days,hospitalization expenses and treatment side effects of the three groups were statistically different (P ＜ 0.05).The surgery group has a highest success rate,shortest hospitalization time,lower hospitalization expenses,and less complication.[Conclusions] Transvaginal removal of ectopic pregnancy tissue and repair of uterine defect is a reliable treatment for CSP.

Objective To investigate the relationship between interleukin (IL)-28B gene polymorphisms (rs12979860 and rs8099917) and treatment response in patients with chronic hepatitis C in China.Methods Taqman probes single nucleotide polymorphism genotyping methods were used to detect the genotypes of rs12979860 (C/T) and rs8099917 (T/G) located at IL-28B gene in 105 included patients.The patients were treated with standard doses of pegylated interferon plus ribavirin and were followed up regularly for therapeutic response and adverse reaction.The relationship between IL-28B gene polymorphism and antiviral treatment response of patients were analyzed.Categorical data were analyzed using Pearson chi-square test or Fisher exact test.Results Totally 105 cases were included in our study and 2 cases lost to follow-up because of moving away.Eight-one cases (78.6%) of the remaining 103 patients were CC/TT genotype (CC/TT group) at rs12979860 and rs8099917, 19 cases (18.4%) were CT/TG (CT/TG group) and 3 cases (2.9%)were TT/TG (TT/TG group).No other genotypes were detected and linkage disequilibrium was discovered at the two polymorphism loci (r2=0.11).After 4 weeks of treatment, 35 cases (43.2%) in CC/TT group, 3 cases (15.8%) in CT/TG group and non in TT/TG group achieved rapid virological response (RVR).There were statistically significant differences among three groups (P=0.033).After 12 weeks of treatment, 45 cases (55.6%) in CC/TT group, 6 cases (31.6%) in CT/TG group and none in TT/TG group achieved early virological response (EVR).There were statistically significant differences among three groups (P=0.025).At the end of the treatment, 68 cases (83.9%) in CC/TT group, 10 cases (52.6%) in CT/TG group and only 1 case (33.3%) in TT/TG group achieved end-of-treatment response (ETR).There were significant statistical differences among the three groups (P=0.003).After 24 weeks of follow-up, 62 cases (76.5%) in CC/TT group, 9 cases (47.4%) in CT/TG group and 1 case (33.3%) in TT/TG group achieved sustained virological response (SVR).There were statistically significant differences among the three groups (P=0.014).One hundred and one cases in CC/TT group developed adverse events, among them 19 cases needed clinical treatment.There were 43 cases in CT/TG group developed adverse events and 9 cases needed treatment.Seven cases in TT/TG group developed adverse events and only 1 case needed treatment.There were no statistically significant difference among three groups (χ2=0.139,P>0.05).Conclusions The genotype of rs12979860 (C/T) and rs8099917 (T/G) at IL-28B gene could affect the treatment response in patients with chronic hepatitis C.RVR and SVR are higher in patients with genotype CC/TT, which might help to guide HCV treatment.

Objective To investigate the effect of the bedside lung ultrasound in emergency (BLUE)-plus lung ultrasound protocol on lung consolidation and atelectasis of critical patients.Methods All patients who need to receive mechanical ventilation for more than 48 hours in ICU from June 2010 to December 2011 in Peking Union Medical College Hospital were included in the study.BLUE-plus and BLUE lung ultrasound,bedside X-ray,lung CT examination were performed on all patients at the same time.The condition of lung consolidation and atelectasis discovered by BLUE-plus lung ultrasound protocol was recorded and compared with bedside X-ray or lung CT.The difference in assessment of lung consolidation and atelectasis between BLUE-plus lung ultrasound protocol and BLUE protocol was compared.Results A total of 78 patients were finally enrolled in the study.The lung CT found 70 cases (89.74％) had different degrees of lung consolidation and atelectasis.The sensitivity,specificity and diagnostic accuracy of lung consolidation and atelectasis by the bedside chest X-ray were 31.29％,75.00％ and 38.46％,respectively.BLUE-plus lung ultrasound protocol found 68 cases with lung consolidation and atelectasis,and its sensitivity,specificity,and diagnostic accuracy were 95.71％,87.50％ and 94.87％,respectively,which were significantly higher than those of lung CT.BLUE protocol found 48 cases of lung consolidation and atelectasis,and its sensitivity,specificity,and diagnostic accuracy were 65.71％,75.00％ and 66.67％,respectively.The position of lung consolidation and atelectasis which hadn't been found by BLUE protocol was mainly proved to be located in the basement of lung by lung CT.Conclusions The incidence of lung consolidation and atelectasis in critical patients who received mechanical ventilation is high.The BLUE-plus lung ultrasound protocol has a relatively higher sensitivity,specificity and diagnostic accuracy for consolidation and atelectasis,which can find majority of consolidation and atelectasis.As BLUE-plus lung ultrasound is a bedside noninvasive method allowing immediate assessment of most lung consolidation and atelectasis,it will be likely the alternative of the CT and play a key role in assessment of lung consolidation and atelectasis.

Objective To estimate the clinical effect of fuzhenghuayu capsule in treatment of early hepatocirrhosis by liver instantaneous elastic imaging. Methods Eighty patients with early hepatocirrhosis were divided into experiment group and control group according to the treatment method with 40 cases each. All the patients in 2 groups were given the same antiviral treatment with entecavir dispersible tablets, and the patients in experiment group combined with fuzhenghuayu capsule. All treatment lasted for 6 months. The liver stiffness measurement (LSM) was measured before treatment and 1, 3 and 6 months after treatment by liver instantaneous elasticity imaging. The serum hyaluronic acid was measured, and the Child-Pugh score was evaluated at the same time. Results The LSM, hyaluronic acid and Child-Pugh scores 6 months after treatment in experiment group were significantly lower than those in control group:(19.3 ± 0.9) kPa vs. (29.6 ± 1.3) kPa, (215.6 ± 59.3)μg/L vs. (344.4 ± 39.6)μg/L and (2.1 ± 1.3) scores vs. (3.9 ± 0.9) scores, and there were statistical differences (P<0.05). No obvious adverse reactions related to the use of fuzhenghuayu capsule were found during the course of treatment. Conclusions Liver instantaneous elasticity imaging can be used to evaluate and monitor early hepatocirrhosis. Fuzhenghuayu capsule on patients with early hepatocirrhosis has a certain degree of curative effect.

Objective To evaluate fluid responsiveness by stroke volume variation (SVV) in mechanically ventilated patients with refractory septic shock.Methods Forty-two refractory septic shock patients were enrolled in the study.According to the responsiveness of fluid loading, the patients were divided into responsive group and non-responsive group.The SVV values of two groups were retrospectively analyzed.The receiver operating characteristic curve was drafted to determine the cut-off value of SVV for predicting fluid responsiveness.Results Among the 42 refractory septic shock patients, 24 were found responsive to fluid loading, 18 were not;before the fluid loading, central venous pressure, heart rate, mean arterial pressure and global end-diastolic volume index in the both groups showed no significant differences whereas the SVV in the responsive group was much higher than that in the nonresponsive group (P =0.006).Using SVV ≥ 12% as the threshold to predict fluid responsiveness, the sensitivity was 77%,specificity was 85%.Conclusion SVV can accurately predict fluid responsiveness in refractory septic shock patients.

ObjectiveThe purpose of the study was to observe and analysis the actual dosage of patients with breast cancer using metal oxide semiconductor field effect transistor (MOSFET) detector.MethodsFirst, Phantom measurements were performed to investigate dose distribution in the area of the junction in a half-field matching method and the influence of factors related to the accelerator. In vivo dose measurements were performed for patients with breast cancer to investigate the skin dose and the junction of supraclavicular-axillary field and tangential field in 6 MV X-ray beams. ResultsPhantom measurements showed that the relative deviation in the junction were within + 3％, and the dose distributions in the junction area depended on the matching field direction (x or y). In vivo measurement of tangential region for patients showed that, the maximum dose deviation between measurement and calculation was -30. 39％,the minimum deviation was - 18. 85％, the average dose deviation was -24. 76％. The dose deviation of tangential fields for patients with breast-conserving surgery was larger than that patients with radical surgery (t =2. 40 ,P＜0. 05), while dose deviation of supraclavicular-axillary fields was not significantly different. The average values of 15 fraction in the junction area showed more stable than one individual measurement.ConclusionsIt is important to real-time, in vivo measurement of radiation dose during radiotherapy in patients with breast cancer, and change treatment plan in time, to ensure the accuracy of target dose.

Objective To evaluate the usefulness of serum galactemannan(GM) for the diagnosis of invasive pulmonary aspergillosis (IPA) in critically ill patients. Methods Study was conducted between February 2007 and July 2008. Included patients on admission ICU who suffer from suspected IPA. GM test and culture were collected 2 weekly. Chnical feature, mycological evidence and optical density index (ODI) were noted. Clinically invasive fungal infection(IFI) were defined proven, probable and possible. The patients were classified into neutropenia, non-neutropenia and treated with immunosuppressive agents, non-neutropenia and non-immunosuppressive agents. To compared of the sensitivity and specificity of GM in different patients. Results 94 patients were included, 4 patients were proven, 29 patients were probable, 34 patients were possible IFI, 27 patients were non-IPA. The positive rate of the GM was 31.9% (30/94). The sensitivity and specificity of GM in proven cases and probable cases are 66.7% and 92.6%. GM assay tended to become positive earlier than the culture 2-10(5.33±2.17)d. We found that differences in patient diagnosis and selection might account for the disparities seen for positive rate for the GM test. There was positive in three of the four patients with proven, the positive rate of GM was 65.5% for probable cases, for possible cases was 17.6%, for non-IPA cases was 7.4% (P=0.001). For patient with neutropenia , treated with immunosuppressive agents and without immunosuppressive agents, the positive rate of GM was 52.9%vs 41.7% vs 34. 6% (P=0.015) ;the sensitivity was 80.0% vs 70. 0% vs 53.8% (P=0.011), the ODI was 1.365 (0.582-6.736) vs 1. 123 (0. 623-6.868) vs 0.554 (0.522-0.823), P=0. 005, respectively. Conclusion These results show that GM test is useful for early diagnosis IPA in critically ill patients. Differences in patient selection and diagnosis might account for the disparities seen for positive rate and sensitivity for the GM test. It has been higher sensitivity and ODI in the patient treated by immunosuppressive agents.

Objective To study the value of copeptin and APACHE Ⅱ used for assessing acute paraquat poisoning (APP). Methods One hundred and twenty six APP patients were divided into survival group (n = 58) and death group (n = 68), with clinical death as the endpoint of observation. 3 mL blood was obtained from each subject at 2 h , 24 h and 7 d after admission for detecting the levels of copeptin , and APACHE Ⅱ scores were recorded at the same time. Results There was significant difference in dosages of paraquat taken in the death group and the survival group , but the differences were significant in the rescue time , the first time for hemoperfusion and the times for hemoperfusion. 2 h after admission , the death group and survival group had significant difference in elevated copeptin but no significant difference in scores by APACHE Ⅱ. 24 h after admission copeptin decreased to normal level in the survival group but maintained at a higher level in the death group, while the scores by APACHE Ⅱ had insignificant difference between two groups. 7 d after admission, copeptin kept at a higher level and the scores by APACHE Ⅱwere significantly increased in the death group , with significant differences compared to the survival group. The oral doses of pesticides the patients took were positively correlated with copeptin level and scores by APACHE Ⅱ. Conclusion Repeated detection of copeptin and APACHE Ⅱ score are of clinical importance for the assessment of prognosis of APP patients and reasonable distribution of medical resources.