Breast Neoplasms ; metabolism ; pathology ; Female ; Humans ; Insulin-Like Growth Factor Binding Protein 5 ; biosynthesis ; genetics ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; RNA, Messenger ; biosynthesis ; genetics ; Tumor Cells, Cultured

Objective To explore continuous renal replacement therapy(CRRT) machine for plasma exchange in critical disease in children.Methods Retrospective study of 8 patients(8 month to 14 years,mean 5.7 years) and 32 plasma exchange treatments,after(adowble) lumen catheter inserted into the subclayian venous,using the Baxter BM25 machine with commercially available plasma filters.Results Five patients(3 ABO-incompatibility in bone marrow transplantation,1 thrombotic thrombocytopaenic purpura TTP,1 sepsis) gained full recovery.One systemic lupus erythematosus(SLE) and 1 sepsis experienced moderate improvement while 1 case of acute disseminated encephalomyelitis failed PE treatment.The average total exchange volume was 80-100 mL/kg,achieved at a blood flow rate of 5-10 mL/(kg?min) and a turnover rate of 60-120 mL/(kg?h) over a 3-hours duration.Thirty-one PE treatments were finished smoothly,one of which experienced the serious complication involving plasma filter.Conclusion Plasma exchange therapy is a safe and effective procedure for severe autoimmune abnormalities and pathogen removal in children.

Objective:To evaluate effects of different medication forms of dexmedetomidine on perioperative cognitive function in elderly patients undergoing radical operation of gastric carcinoma, and Ramsay sedation score.Methods:A total of 150 patients aged 65 years and 75 years scheduled for elective radical operation of gastric carcinoma from December 2018 to December 2019 in Shanxi Provincial Cancer Hospital were enrolled, and they were divided into 3 groups according to random number table method: different medication forms of dexmedetomidine groups (group A, group B) and the control group (group C), 50 cases in each group. The patients in group A and group B continued to pump dexmedetomidine at a rate of 0.5 μg·kg -1·h -1 and 0.3 μg·kg -1·h -1 respectively for 15 min before induction of anesthesia. And the patients in group C were given intravenous pumping of an equal volume of 0.9% NaCl for 15 min. Subsequently, patients in group A and group B received continuous intravenous infusion of 0.3 μg·kg -1·h -1 for 30 min before the end of operation, the patients in group C received 0.9% NaCl infusion of equal volume until the end of operation. The cognitive function of the patients was measured by using the Monterey cognitive assessment scale (MoCA) the day before surgery and on day 1,3 and 7 after surgery, and the incidence of perioperative neurocognitive disorder (PND) was counted. Ramsay sedation score at 30 min, 24 h and 48 h after surgery was compared among the three groups. Results:There were 3 patients in group A and 3 patients in group C were excluded because they were transferred to ICU due to serious postoperative complications. There were significant differences in MoCA score among the three groups on day 1, 3, 7 after operation (all P < 0.01); MOCA score of group A, B and C on day 7 after operation was (26.9±0.7) scores, (26.6±1.0) scores, (26.3±1.2) scores, respectively, and the difference between group A and group C was statistically significant ( P < 0.01). The incidence of PND among the three groups on day 1, 3, 7 after surgery had statistically significant differences (all P < 0.05), and the incidence of PND in group A was lower than that in group B and C (all P < 0.05). Ramsay sedation score among the three groups at 30 min and 24 h, 48 h after operation showed statistically significant differences (all P < 0.01), and that in group C was lower than that in group A and group B, and the differences were statistically significant (all P < 0.01). Ramsay sedation score at 24 h after operation in group A was high than that in group B and group C (all P < 0.01). Conclusions:Dexmedetomidine assisted with anesthesia can reduce the incidence of PND in elderly patients undergoing radical operation of gastric carcinoma and enhance the sedative effect. What's more, the most obvious effect is the infusion of 0.5 μg·kg -1·h -1 before anesthesia induction.

Objective To explore the influence on isthmic spondylolisthesis (IS) from lumbar vertebras facet joint orientation (FJO) variation. Methods The lumbar vertebras of 60 patients scanned by 16-slices spiral CT were collected, 30 cases with IS was defined as isthmic group;30 cases with normal lumbar vertebras was defined as control group, the FJO at L3-4, L4-5 and L5-S1 were measured in two groups. The difference between two groups were compared at three levels, the difference between both sides of the facet joint orientation also was compared;the measured data and the data of 60 patients from foreign literature were compared at three levels. Results The FJO in isthmic group were (47.9±6.3)° ,(37.5±7.3)° , (37.9±7.7)° at the right of L3-4, L4-5, L5-S1 levels respectively,the FJO in control group were (53.1 ± 7.3)° , (40.5±6.3)° , (38.5±7.3)° respectively, the FJO in isthmic group were (48.1±6.0)° , (37.9 ± 7.4)° , (37.6 ± 7.6)° at the left of L3-4, L4-5, L5-S1 levels respectively, the FJO in control group were (52.3 ± 7.6)° , (41.6 ± 6.0)° , (38.2 ± 7.2)° respectively. The significant difference was found at L3-4 and L4-5 levels (P < 0.05), the orientation was similar at L5-S1 level (P > 0.05). The difference between the both sides FJO of lumbar vertebras was not found at L3-4,L4-5 and L5-S1 levels (P >0.05). The same as the measured data and the corresponding data from foreign literature(P > 0.05 ). Conclusions It seems possible that the coronal FJO may be the phenotypic representation of the familial etiology of IS. It is helpful for the measurement of lumbar vertebras FJO to find IS early,it is important to reduce and release the IS.

Objective To investigate in knowledge rate of 120 first aid and satisfaction rate with emergency services among Nanchong citizens. Methods 360 patients who received prehospital first aid from three hospitals and their accompanies were selected from January to June 2010. The investigation content included knowledge rate of 120 first aid and satisfaction rate with emergency services. Results Results showed that about half of those surveyed still did not know the emergency phone"120" and its function, lacked self-help and self-protection knowledge, some respondents felt quite helpless upon daily life of electric shock, gas poisoning, coma and traumatic accidents. The attitude of the majority of emergency personnel was good or better, but still very stiff or irresponsible attitude existed in those few. This undermined the "120" and the image of credibility and emergency personnel. Conclusions There is an urgent need for universal coverage of on-site first aid knowledge and enhance awareness of first aid. Full-time staff in emergency department must pay close attention to the knowledge of first aid training, mastering the technique of bleeding control and bandaging, fixing, handling and CPR, as well as the use of instruments and equipment equipped in vehicles. Only in this way can we continuously improve the treatment of critically ill patients and increase survival rate.

OBJECTIVETo investigate the clinical experiment of cortical screw in the treatment of tibiofibular syndesmosis separation together with ankle fractures.

METHODSFrom March 2008 to May 2012,42 patients with tibiofibular syndesmosis separation were treated with cortical screw, including 20 cases in the left and 24 cases in the right. All the patients had closed injury. According to Lauge-Hansen classification, there were 18 cases of supination-external rotation, in which 4 patients with injuries belong to type II, 8 patients with injuries belong to type III, 6 patients with injuries belong to type IV; 14 cases of pronation-external rotation, in which 6 patients with injuries belong to type III, 8 patients with injuries belong to type IV; and 12 cases of pronation-abduction, in which 4 patients with injuries belong to type II, 8 patients with injuries belong to type III. According to injury of ankle, 4 patients had injuries in one ankle, 28 patients had injuries in 2 ankles, and 12 patients had injuries in 3 ankles. All the patients were diagnosised definitely in sight of medical history, checking-up, iconography. The clinical effects were evaluated based on Baird-Jackson score and activity degree of ankle.

RESULTSAll the patient were followed up, and the duration ranged from 11 to 23 months, with an average of 15.7 months. No postoperative wound infection, nonunion, and tibiofibular syndesmosis separation again and other complications occurred. Postoperative Baird-Jackson score exhibited 91.56 ± 6.26 (75 to 99), and 26 patients got an excellent result, 10 good, 6 poor and 2 bad. One patient had nail broken after operation,and got good function after removing broken nail without external fixation. Other 1 patient had osteoarthritis to 1 degree, and got better result with the treatment of physical therapy and intra-articular injection.

CONCLUSIONCortex screw is the effective treatment for tibiofibular syndesmosis separation. Clear diagnosis, delicate operation and postoperative reasonable functional exercise are primary factor of prognosis.

Adult ; Ankle Fractures ; surgery ; Ankle Joint ; surgery ; Bone Screws ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Treatment Outcome

Child ; Exostoses, Multiple Hereditary ; genetics ; Female ; Humans ; Mutation ; N-Acetylglucosaminyltransferases ; genetics ; Pedigree

Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Retrospective Studies ; Tracheotomy

Objective To determine the efficacy of hysteroscopy and laparoscopy in differential diagnosis of pregnancy-related diseases,including gestational trophoblastic neoplasia(GTN),incomplete abortion and ectopic pregnancy.Methods Twenty-seven patients with a suspected diagnosis of GTN were transferred to Peking Union Medical College Hospital from September 2003 to March 2006,and underwent hysteroscopy and laparoseopy.Clinical data of patients were reviewed retrospectively.Most patients had abnormal vaginal bleeding and persistently elevated plasma beta human chorionic gonadotropin(?-hCG) level for a median(53?37)days(range,15-125 days)after evacuation.Ultrasound revealed a lesion with affluent blood flow in intrauterine,unilateral horn of uterus,or myometrium.No positive findings were revealed by computerized tomography or X-ray of the chest in all patients.Eleven patients underwent evacuation under hysteroscope,10 patients were diagnosed and treated by laparoscopy,and 6 by hysteruscopy and laparoseopy.Results Choriocarcinoma was diagnosed in 4 patients,who achieved complete remission by chemotherapy later.The diagnosis of GTN was ruled out in the other 23 patients, including cornual pregnancy in 12,pregnancy in rudimentary horn in 1,and incomplete abortion in 10,who were cured by hysteroscopic and laparoscopic surgery and postoperative adjuvant single dose methotrexate.Conclusions The major causes of pregnancy-related abnormal bleeding include incomplete abortion,eetopic pregnancy,and GTN.Hysteroscopy and laparoseopy are effective alternative of diagnosis for differentiation of GTN from non-GTN and can also offer therapeutic treatment.

0.05).Compared with control group,significant decrease in positive group was found in the interval from first evacuation of HM to resolution of serum ?-hCG level,(83?18) days versus(126?31)days(P0.05).Conclusions Once HM is diagnosed,evacuation should be performed as soon as possible,the later the evacuation begins,the higher the risks of lung metastasis and chemotherapy are.It is not necessary to worry about lung metastasis before evacuation of HM,the outcome of post- chemotherapy is very good.