Objective To compare the cardiomyocyte apoptosis and early postoperative recovery in patients undergoing cardiac valve replacement under propofol-or midazolam-combined anesthesia.Methods Forty NYHA class Ⅱ or Ⅲ patients (aged 48-64 yr and weighing 45-78 kg) undergoing cardiac valve replacement with cardiopulmonary bypass (CPB) were randomly divided into midazolam group (Group M) and propofol group (Group P) (n=20each). The patients were premedicated with morphine 0.1 mg/kg i.v. and scopolamine 0.3 mg i.v. Anesthesia was induced with midazolam 0.2 mg/kg (in Group M) or propofol 2 mg/kg (in Group P) combined with fentanyl 10 μg/kg and vecuronium 0.1 mg/kg, and maintained with propofol 5 mg. kg-1·h-1 (in Group P) or midazolam 0.1 mg·kg-1·h-1(in Group M) and intermittent i.v. boluses of fentanyl and vecuronium after tracheal intubation. The patients were mechanically ventilated with PETCO2 maintained at 35-45 mm Hg. Myocardial tissues were obtained from the right atrium before and after CPB for determination of apoptosis in cardiomyocytes (by TUNEL). The apoptotic index was calculated. The expression of caspase-3 and caspase-9 was determined by immunohistochemical avidin-biotin-peroxidase complex (ABC) technique staining. The mean airway pressure (MAP) and heart rate (HR) were monitored. Aortic cross-clamping time, surgical and CPB times, spontaneous recovery of normal heart beat, emergence from anesthesia, extubation time and duration of ICU stay were recorded and compared between the two groups.Results The percentage of spontaneous recovery of normal heart beat after release of aortic cross clamp was significantly higher and the need for dobutamine support was significantly less in Group P than in Group M ( P ＜ 0.05). The emergence from anesthesia was significantly more rapid, the extubation time and the ICU stay were significantly shorter in Group P than in Group M (P＜0.05). There were no significant differences in apoptosis index and expression of caspase-3 and caspase-9 before CPB between the two groups. The apoptosis index and expression of caspase-3 and caspase-9 were significantly increased after CPB in Group M and significantly higher than those after CPB in Group P (P＜0.05).Conclusion Cardiomyocyte apoptosis in patients undergoing CPB can be inhibited and the postoperative recovery is more rapid under propofol-combined anesthesia.

Objective To analyze the effect of different methods of anesthesia maintenance on clinical efficacy and postoperative recovery in elderly patients with gynecological diseases undergoing laparoscopic surgery.Methods A total of 80 elderly patients with gynecological diseases scheduled for laparoscopic surgery were enrolled in this study in our hospital from January 2015 to December 2016.All the patients were randomly divided into two groups of anesthesia maintenance:an intravenous anesthesia alone (n=40) and a combined intravenous and inhaled anesthesia (n =40).The pre-and post-anesthesia changes in arterial blood gas,blood pressure,heart rate and cognitive function,and postoperative complications were analyzed and compared between the two groups.Results There were no significant differences between the two groups in the times of palinesthesia,extubation and talking (all P＞ 0.05).After anesthesia,the levels of arterial blood gas,the blood pressure and the heart rate were relatively stable in both groups,and their differences between the two groups were without statistically significant (all P ＞ 0.05).While,the postoperative cognitive function recovered more rapidly in patients receiving intravenous anesthesia alone for anesthesia maintenance than in those receiving a combined intravenous and inhaled anesthesia,especially at 6 h after extubation.The Mini-mental State Examination (MMSE) score was significantly higher in patients receiving intravenous anesthesia alone (28.8 ± 0.5) than in patients receiving a combined intravenous and inhaled anesthesia (25.1 ±0.6),with statistically significant difference (P＜ 0.05).In addition,there was no statistical difference between the two groups in the incidence of complications.Conclusions As anesthesia maintenance,both an intravenous anesthesia alone and a combined intravenous and inhaled anesthesia can ensure a successfully laparoscopic surgery for gynecological diseases in elderly patients.However,the impact on cognitive function after laparoscopic surgery is smaller in the maintenance of intravenous anesthesia alone than in a combined intravenous and inhaled anesthesia in elderly patients.Intravenous anesthesia alone can be used in elderly patients to receive laparoscopic surgery as routine anesthesia maintenance.

Objective To observe the serum inflammatory factors level in patients with obstructive sleep apnea syndrome (OSAS) and coronary heart disease (CHD).Methods Venous blood was collected at 6 AM from 53 natiems with both OSAS and CHD and 37 simple snorers following a full night polysomnography (PSG) test.Serum MMP-9、TIMP-1 test were conducted.Results MMP-9,TIMP-1 level in patients with OSAS and CHD was significantiv higher than that of the simple snorers (P<0.05).Conclusion serum MMP-9 and TIMP-1 level increase in patients with OSAS and CHD.It is suggested that elevated level of serum MMP-9 and TIMP-1 might play an important role in the development of CHD in patients with OSAS.

Objective To investigate the clinical effect of Guizhi Fuling Capsule Combined with activating blood circulation to remove stasis to treat uterine fibroids.Methods 84 patients with uterine fibroids from June 2015 to October 2016 in our hospital were randomly selected and divided into experimental group and control group, 42 cases in each group.The control group was treated with Guizhi Fuling Capsule,and the experimental group was treated with blood activating and Stasis Removing Therapy on this basis of treatment.The patients were followed up for three months, and the clinical treatment effects of the two groups were compared and analyzed.Results The total effective rate of the experimental group was 97.6%,which was significantly better than the control group(76.1%), the difference was statistically significant(P<0.05);through the change of single symptom in two groups, it was found that there was no significant difference between the experimental group and the control group;The improvement rate of anemia, vaginal bleeding, abdominal pain, dysmenorrhea, menorrhagia in the experimental group was significantly higher than the control group, the difference between the two groups was statistically significant(P<0.05);The average volume of uterine fibroids in the experimental group was significantly lower than that in the control group, the difference was statistically significant(P<0.05).Conclusion Guizhi Fuling Capsule Combined with promoting blood circulation and removing blood stasis therapy has obvious effect and less adverse reaction.It can be used and popularized in clinic.

Objective To investigate the causes, prevention and treatment of recurrent laryngeal nerve (RLN) injury during operation in patients with thyroid cancer. Methods Clinical data of 192 patients undergone thyroidectomy operation were reviewed. Results RLN was exposed during operation in 192 patients. There were 3 cases of RLN injury, then RLN anastomosis was happened immediately during operation. It was significantiy improved in pronunciation after operation. 2 ～ 3 d after surgery, transitory hoarseness was observed in 3 patients. Unilateral RLN resection performed in 1 case with cancer involving RLN. Conclusions There were some causes of RLN injury. Exposure of RLN selectively,delicate operation and thyroid gland surgery specialist were the key point for prevention of the injury of RLN. Once RLN injury occured ,repairing should be performed as soon as possible.

Langerhans cell histiocytosis is an uncommon disease, involvement of the thyroid by langerhans cell histiocytosis is rare. Two cases of Langerhans cell histiocytosis of the thyroid confirmed by pathology were reported in this paper. The main clinical feature was enlargement of the thyroids. One patient had hypothyroidism. Meanwhile, the lungs and pituitaries of the two patients were affected. Langerhans cell histiocytosis of the thyroid had no typical symptoms and specific laboratory examination, and might be clinically diagnosed as chronic lymphocytic thyroiditis, benign or malignant thyroid tumors. Thyroid fine needle aspiration cytology might be useful in confirming the diagnosis. The effective treatments include systemic chemotherapy, local radiation therapy and surgical excision. The chemotherapy is still the major technological approach. Most patients can relieve partially after receiving the systemic chemotherapy.

Objective To explore the related prognostic factors of the patients with thyroid microcarcinoma.Methods Clinical data,including clinical,pathologic,and therapeutic factor of 203 patients with thyroid microcarcinoma admitted were analyzed retrospectively.Results The cause specific survival and locoregional failure free survival rates at 10 years were 100.0% and 91.4% , respectively.Univariate analysis showed that multifocality, cervical lymph node metastasis and radioiodine treatment was associated with prognosis.Multivariate analysis revealed that cervical lymph node metastasis was the only independent prognostic factor for locoregional failure free survival.The risk of locoregional recurrence increased 2.5 folds when lymph nodes metastasis occurred at presentation.Conclusion The ratio of thyroid microcarcinoma to thyroid carcinoma increased yearly and the overall survival rate of thyroid microcarcinoma was excellent.Of all the prognostic factors,lymph node metastasis was the most important one related to survival.

Objective To study the application of retrograde puncture in intravenous transfusion for patients with galactophore cancer. Methods Self compare was adopted,30 cases with galactophore cancer which have put up four cycles intravenous chemotherapy in all 120 intravenous punctures were divided into observation group and control group. Observation group adopted retrograde puncture; control group were given traditional operation. Smooth transfu-sion and the rate of phlebitis and comfort in intravenous chemotherapy in two groups were compared. Results There are significandy different in two groups, observation group is higher in smooth transfusion and comfort (P < 0.05), low-er the rate of phlebitis (P < 0.01) than that of control group. Conclusion Retrograde puncture had good effect in in-travenoas chemotherapy of galactophore cancer,it may be generalized.

Objective To investigate the expressions of Sema4D and HER-2 in breast cancers and their relationship with microlymphtic vessel density (MLVD).Methods MLVD and expressions of Sema4D and HER-2 were detected in 110 cases of breast cancer tissues by immunohistochemistry.The relationship of Sema4D and HER-2 expressions with clinicopathologic parameters was analyzed.Results The positive expression rate of Sema4D and HER-2 was 71.82％ (79/110) and 33.64％ (37/110),respectively,with a statistically significant differences compared to those in the control group ( P ＜0.01 ).The positive expression rates of Sema4D and MLVD in cases with lymphatic metastasis were higher than that without lymphatic metastasis ( P ＜ 0.01 ).The expressions of Sema4D and HER-2 were closely correlated with the histological grade,TNM stage,lymph node metastasis,and expression of ER of breast cancers ( P ＜0.05),but were not related to tumor size and expression of PR (P ＞ 0.05 ).On univariate analysis,the disease-free survival rate of patients with Sema4D positive expression was better than those with its negative expression ( P ＜ 0.05).Sema4D expression was positively correlated with the HER-2 expression ( r =0.535,P ＜ 0.01 ).Conclusions Sema4D may play important roles in the carcinogenesis and development of a breast cancer.

Objective To study a case series of thoracolumbar flexion-distraction fractures combined with compression of anterior and central columns to analyze the causes of its occult symptoms and explore the injury mechanism,imaging diagnosis and operative reduction of the fractures.Methods A retrospective study was carried out on data of 39 patients with thoracolumbar flexion-distraction fractures admitted into our hospital from May 2003 to December 2006.Of all,there were 17 patients with compression of anterior and central columns.The diagnostic value of imaging examinations such as X-ray,CT and MRI was evaluated.All patients were treated with posterior operation,in which simple distraction of the anterior and central columns was followed by compression and reduction of the posterior column from the rear axial direction.The clinical efficacy and safety of operation were assessed.Results The patients with compression of anterior and central columns accounted for 43.6% of all thoracolumbar flexion-distraction fractures.Before operation,six patients were misdiagnosed as simple compression fracture.Various kinds of imaging examinations detected the bone injury and/or ligaments complex injury of the posterior column at different degrees.The positive results on X-ray,CT,spiral CT multi-planar reconstruction (MPR)and MRI were in 8,7,11 and 17 patients respectively.After simple posterior distraction in 17 patients,there occurred over distraction in eight patients who were cured with posterior recompression plus reduction.Conclusions The posterior column injury of thoracolumbar flexion-distraction fractures combined with compression of anterior and central columns is relatively occult and easy to be misdiagnosed as simple compression fracture,when MPR CT and MRI are helpful for diagnosis.The operation with twostep reduction of axial distraction followed by compression can attain satisfactory and safe results.