Objective To compare the different characteristics of adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation-pressure support ventilation (SIMV-PSV) mode in weaning patients after general anesthesia.Methods One hundred and twenty-eight patients received general anesthesia,ending in odd and even numbers by hospital number divided into ASV group (single number,62 cases) and SIMV-PSV group (double number,66 cases).The propofol dosage,duration of mechanical ventilation,duration of intubation,ventilator alarms,ventilator settings manipulations and each stage of the blood gas analysis,hemodynamic,respiratory mechanics were recorded.Results One hundred and twenty-eight patients completed the extubation.The propofol dosage,duration of mechanical ventilation,duration of intubation in ASV group were significantly shorter than those in SIMV-PSV group [(1.13 ± 0.33)mg/kg vs.(1.28 ±0.49) mg/kg,(169.8±36.5) min vs.(201.9 ±37.3) min,(197.2 ±38.9) min vs.(239.5 ± 42.3) min,P ＜ 0.05].There was no statistically significant difference in various stages of heart rate,mean arterial pressure,central venous pressure,pH,arterial carbon dioxide partial pressure,oxygenation index between two groups (P ＞0.05).In the first and second stages,tidal volume in ASV group was significantly higher than that in SIMV-PSV group [(543.6 ± 72.3) ml vs.(489.5 ± 68.7) ml,(513.9 ± 65.7)ml vs.(462.8 ± 61.7) ml,P＜ 0.05],respiratory rate in ASV group was significantly lower than that in SIMV-PSV group [(13.2 ± 3.6) times/min vs.(17.2 ±4.1) times/min,(15.1 ± 3.1) times/min vs.(16.8 ± 3.7)times/min,P ＜ 0.05].In the first stage,the mean airway pressure and peak airway pressure in ASV group were significantly lower than those in SIMV-PSV group [(8.2 ± 1.7) cm H2O (1 cm H2O =0.098 kPa) vs.(12.3 ± 3.1) cm H2O,(16.2 ± 2.9) cm H2O vs.(21.2 ± 4.3) cm H2O,P ＜ 0.05].The pulmonary dynamic compliance in ASV group was better than that in SIMV-PSV group [(64.8 ± 12.3) ml/cm H2O vs.(52.6 ±13.5) ml/cm H2O,P ＜ 0.05].The ventilator alarms,ventilator settings manipulations in ASV group were significantly shorter than those in SIMV-PSV group [(2.3 ± 1.6) times vs.(5.1 ± 1.9) times,(0.8 ± 0.5) times vs.(1.6 ± 0.8) times,P ＜ 0.05].Conclusion ASV weaning mode is safe and effective,which could accelerate the extubation and simplify the manipulation.

Aim To study the chemical constituents of Dryopteris sublaeta Ching et Hsu. Methods Fresh plant of Dryopteris sublaeta Ching et Hsu was extracted twice with boiling water, concentrated to small volume under reduced pressure at 50 ℃. The concentrated material was partitioned with ether, ethyl acetate, and n-butanol. The fraction of ethyl acetate extract was chromatographed over macroporous adsorption resin (Diaion HP-20) eluted with a mixture of H2O and MeOH in increasing MeOH content.Their fractions from resin were repeatedly chromatographed over Toyopearl HW-40, Sephadex LH-20 and silica gel column chromatography. The compounds were identified on the basis of their physiochemical and spectral data. Results Four compounds were obtained and identified as 3,5-dihydroxy-stilbene-3-O-neohesperidoside ( 1 ), 3,5-dihydroxy-stilbene-3-O-β-D-glucoside ( 2 ), polydotin peceid (3) and 3,5,4'-trihydroxy-bibenzyl-3-O-β-D-glucoside (4). Conclusion Compound 1 is a new compound, the others were isolated from Dryopteris for the first time.

Aim To study the chemical constituents of Dryopteris sublaeta Ching et Hsu. Methods Fresh plant of Dryopteris sublaeta Ching et Hsu was extracted twice with boiling water, the extract was concentrated to small volume under reduced pressure at 50 ℃. The concentrated material was partitioned with ether, ethyl acetate, and n-butanol. The fraction of ether extract was chromatographed over silica gel column. The compounds were identified on the basis of their physiochemical and spectral data. Results Four compounds were obtained and identified as 2 (S)-5,7, 3'-trihydroxy-6,8-dimethy1-5'-methoxyflavanone ( 1 ), matteucinol ( 2 ), desmethoxymatteucinol ( 3 ) and 5,7,2'-trihydroxy-6,8-dimethy1-flavanone (4). Conclusion Compound 1 is a new one, the others were isolated from Dryopteris for the first time.

The aim of this study was to look for the chemical constituents from the rhizomes of Dryopteris sublaeta. The fresh plant was extracted twice with boiling water, the extract was concentrated to small volume under reduced pressure at 50 ℃. The concentrated material was partitioned with ether, ethyl acetate and n-butanol. The fraction of ethyl acetate was repeatedly chromatographied over silica gel and Sephadex LH-20 columns. Structures of pure compounds were established on the basis of their physiochemical and spectral data. Nine compounds were obtained and identified as sublaetentin A (1), sublaetentin B (2), sublaetentin C (3), sublaetentin D (4), matteuorienate A (5), matteuorienate C (6), arbutin (7), 3-methoxy-4-hydroxyphenyl-1-O-β-D-glucopyranoside (8) and 3,4-dimethoxyphenyl-1-O-β-D-glucopyranoside (9). Compounds 1-4 are new compounds, the others were isolated from this plant for the first time.

Objective To explore the clinico-biological characteristics, treatment and prognosis of salivary duct carcinoma. Methods This study included 12 cases of salivary duct carcinoma treated in our hospital. Clinical data were retrospectively analyzed for patients admitted between April 1995 and October 2006. The clinical characteristics, histological features, imaging, therapy methods and prognosis were analyzed. Results Of 12 salivary duct carcinoma, there were 10 males, 2 females. The age of onset ranged from 53 to 73 year old and the average was 56 year old. Physical examination revealed a firm and unboundary mass accompanied by nerve infiltrating symptom. The histological appearance was characterized by solid cell nests with ductal structures and central comedonecrosis. Extensive resection and radical neck dissection was performed in 11 patients, postoperation radiation done in 10 patients and chemotherapy in 3 patients. One year survival rate was 83. 33% , that of 3 years was 41. 67% , and of 5 years was 25. 00% , the median survival time was 36 months. Conclusion Salivary duct carcinoma is a rare malignant salivary tumor and most patients are men. Regional extensive resection and postoperative radiation or chemotherapy are the mainstay of therapy. Lymph node metastases in level Ⅰ ,Ⅱ , Ⅲ are a common finding in patients with SDC and the prognosis is poor.

Objective To explore risk factors of cardiac surgery in neonates with low body weight.Methods Retrospective analysis was made in neonates weighing less than 3 kg at surgery(n =192;group 1) and 3 to 6 kg(n =517;group 2),who had undergone open cardiac repairs from January 2006 to December 2015 at our institution.Patients were grouped according to the primary procedure performed and analyzed according to their weight at the time of surgical intervention.Patients were also analyzed according to preoperative risk scores.Univariate versus multivariate risk analysis was performed.Results Hospital early mortality in group 1 was 25.0％ (n =48) versus 14.5 ％ (n =75) in group 2 (P =0.001).Compared with group 2,neonates in group 1 had a significantly higher mortality for simple arterial switch procedure.Lower body weight remained strongly associated with mortality risk after stratifying the population by preoperative risk scores category levels 2.Within group 1,age,weight at surgery,preoperative risk score and type of procedure were not associated with significant differences in early mortality.Cardio-pulmonary bypass time,aortic cross-clamp time and the presence of a surgical complication were independent risk factors for early mortality in group 1.Conclusion Among neonates weighing less than 3.0kg who underwent open cardiac surgery,perioperative hemodynamic status,reflected by bypass time,cross-clamp time,and surgical complications,strongly influenced early mortality.In contrast,low body weight itself was not associated with early mortality.

Objective:To investigate the BRAF(V600E)gene mutation of pediatric papillary thyroid carcinoma (PTC) and refine their clinicopathological correlates. Methods:Tumor tissue samples of pediatric PTCs (≤18 years old) were collected from tumor tissue bank of Tianjin Medical University Cancer Institute and Hospital from January 2012 to December 2016.The medical records of 22 patients with pediatric PTC were reviewed retrospectively.The frequencies of BRAF(V600E) mutation were evaluated and the correlation between BRAF(V600E) mutation and clinical characteristics were analyzed. Results:BRAF(V600E) mutations were present in 45.5% of cases (10 cases). BRAF(V600E) mutation in pediatric PTC was obviously lower than that in adults PTC(77.7%) ( χ2=11.250, P=0.001). BRAF(V600E) mutation in>12-year-old group (66.7%) was remarkably higher than that in ≤12-year-old group (20.0%) ( P<0.05). BRAF(V600E) mutation in female (69.2%) was greatly higher than that in male (11.1%) ( P<0.05). There was no significant correlation with BRAF(V600E) mutation and multiple tumor, tumor size, highly invasive subtype, extrathyroidal extension, lymph node metastasis and radiological history of infants (all P>0.05). The median follow-up time was 45 months.No patients died and BRAF(V600E) mutation was not associated with the increase of recurrence rate ( P>0.05). Conclusions:BRAF(V600E)gene mutation in pediatric PTC is lower than that in adults. BRAF(V600E) mutation does not portend a more aggressive clinical biological behavior in pediatric PTC.

Objective:To evaluate the role of Tg in diagnosis of lateral cervical lymph node recurrence in papillary thyoid cancer(PTC)after radioactive iodine(RAI) therapy.Methods:From Jan 2012 to Aug 2018, 22 PTC patients who received RAI therapy after operation were reoperated for lateral cervical lymph node recurrence. The clinical data was retrospectively analyzed.Results:The median recurrence time was 30.5 (5-86) months. All 22 patients received RAI therapy after the first operation, and the median dose of RAI was 250mCi(100-700 mCi) and the episode of RAI therapy ranged from 1 to 4. All 22 PTC patients underwent neck reoperation, among which 20 cases were identified to have lymph node metastasis. The median number of lymph nodes dissected was 31 (8-83) and median number of metastatic lymph nodes was 4 (1-19) . The diagnostic accuracy of ultrasonography in detecting lymph node metastasis was 90.9%. Before reoperation, the median Tg was 1.305 (0.10-99.51) μg/L, with the cutoff value of Tg being 0.2 μg/L, and its sensitivity and specificity were 80.0% and 100%, respectively. The median stimulated Tg was 5.89 (0.14-255.80) μg/L in the 10 patients, with the cutoff value of stimulated Tg of 2 μg/L, and its sensitivity and specificity were 88.9% and 100%, respectively.Conclusions:The serum Tg level is helpful for monitoring the recurence of PTC, but recurrence cannot be completely ruled out for those with low Tg.

AIM: To investigate homeodomain-interacting protein kinase 2(HIPK2) gene expression level and its clinical significance in acute leukemia(AL) patients.METHODS: HIPK2 mRNA was determined by semi-quantitative reverse transcriptase polymerase chain reaction(semi-quantitive RT-PCR) in patients with acute leukemia and healthy donors.The relative transcription level was compared between the study group and the control group.RESULTS: ① The relative expression level of HIPK2 mRNA in AL patients was 0.364?0.286,significantly lower than that in control(1.160?0.272,P0.05).CONCLUSION: AL has significantly lower HIPK2 mRNA expression as compared to normal control,which may be associated with leukemogenesis and/or disease progression of AL.

Background Intrathoracic impedance monitoring has emerged as a promising new technique for the detection of impending heart failure (HF). Although false positive episodes have been reported in case reports and clinical trials, the efficacy and false positive rate in real-world practice remain unclear. Objective The aim of this study is to investigate the utility and reliability of the OptiVol alert feature in clinical practice. Methods We continuously recruited patients who underwent implantable cardioverter-defibrillator (ICD) or cardiac re-synchronization therapy with defibrillator (CRT-D) implantation with feature of intrathoracic impedance monitoring system in our center from Sep. 2010 to Oct. 2012. Regular in-office follow-up were required of all patients and the following information was collected at each visit: medical history, device interrogation, N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement and an echocardiogram. Worsening HF was defined as hospitalization or the presentation of signs or symptoms of HF. Results Forty three patients (male:76.7%, mean age:57 ± 15 years, left ventricular ejection fraction (LVEF):33%± 14%) were included in this observational study. Fifty four alert events and 14 adjudicated worsening HF were detected within 288 ±163 days follow-up. Eleven (20.4%) alert episodes were associated with acute cardiac decompensation in 9 patients with a positive predictive value of 78.6%. Forty three audible alerts showed no connection to worsening HF. The unexplained alerts rate was 79.6%and 1.27 per person-year. Thirty seven alarm alerts were detected in patients with EF<45%, among which 9 accompanied with HF, 17 alerts detected in patients with LVEF≥45%and 2 associated with HF. There was no sig-nificant difference between the two groups (9/37 vs. 2/17;P=0.47). Conclusions Patients with normal or nearly normal left ventricular systolic function also exhibited considerable alert events. The OptiVol fluid index predicted worsening cardiac events with a high unex-plained detection rate, and any alert must therefore be analyzed with great caution. Efforts to improve the specificity of this monitoring sys-tem represent a significant aspect of future studies.