Objective To investigate the effects of propofol and inhalation anesthetics on the implicit memory under general anesthesia and determine the critical value of auditory evoked potential index (AEI) at which implicit memory no longer exists. Methods Sixty ASA I-II patients of both sexes scheduled for elective abdominal surgery or surgery on lower limb were enrolled in the study. They averaged (41.25?9.25) years and (63.8?9.57) kg. Patients with psychoneural or memory disorders were excluded. The patients were randomly divided into five groups of 12 patients in each group: isoflurane, sevoflurane, desflurane, propofol and control group. Each inhalation anesthetic group was further divided into two subgroups based on their end-tidal concentration: 0.8 or 1 .0 MAC. Propofol group was divided into two groups based on the infusion rate: 8 mg.kg. h-1 or 10mg.kg.h-1 . In control group operation was performed under epidural anesthesia. The patients were unpremedicated. Anesthesia was induced with propofot 1 .5-2.0 mg.kg and vecuronium 0. 　-0.2mg.kg-1, and maintained with inhalation anesthetic or propofol infusion supplemented with intermittent boluses of fentanyl and vecuronium. AEI was continuously monitored and recorded before anesthesia (T0), when the patient was sleepy (T1 ) and did not respond to verbal command (T2 ), after intubation (T3), after skin incision (T4), when peritoneum was being closed (or 30 min before the surgery) ( T5 ) and during emergence from anesthesia ( T6 ) . Eight hours after surgery muddy identified hearing rate was determined. Hemodynamic parameters were continuously monitored during operation. Results There was significant difference in AEI between the two subgroups before and after induction (P

Red blood cell sorbitol contents were determined with a enzymatic method in 37 diabetics and 19 controls. The fasting blood glucose (FBG) levels and RBC sorbitol contents in the diabetics were significantly higher than that in the controls. RBC sorbitol was positively correlated to FBG, but not to the age of the patients or the type and duration of diabetes mellitus. In 9 patients whose nerve conduction velocity was measured, RBG sorbitol content was negatively correlated with motor nerve conduction velocity of median nerve (r =-0.768, P

OBJECTIVETo analyze causes of missed diagnosis of hiding post-malleolar fractures in treating ankle joint fractures of pronation-external rotation type according to Lauge-Hansen classification and assess its medium-term outcomes.

METHODSAmong 103 patients with ankle joint fracture of pronation-external rotation type treated from March 2002 to June 2010,9 patients were missed diagnosis,including 6 males and 3 females,with a mean age of 35.2 years old (ranged, 18 to 55 years old) . Four patients were diagnosed during operation, 2 patients were diagnosed 2 or 3 days after first surgery and 3 patients came from other hospital. All the patients were treated remedially with lag screws and lock plates internal fixation. After operation,ankle joint function was evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS).

RESULTSAll the 9 patients were followed up, and the duration ranged from 14 to 30 months (averaged, 17 months). No incision infection was found, and all incision healed at the first stage. At the latest follow-up, AOFAS was 83.0 +/- 4.4, the score of 4 patients diagnosed during operation was 85.0 +/- 2.9, and the score of 5 patients treated by secondary operation was 81.0 +/- 5.3. All the patients got fracture union observed by X-ray at a mean time of 2.2 months after operation. There were no complications such as internal fixation loosing, broken and vascular or nerve injuries.

CONCLUSIONAnkle joint fracture of pronation-external rotation type may be combined with hiding post-malleolar fractures. So to patients with ankle joint fracture of pronation-external rotation type, lateral X-ray should be read carefully, and if necessary, CT or MRI examination should be performed. If adding lateral X-ray examination after reduction of exterior and interior ankle joint fixation, the missed diagnosis may be avoided.

Adolescent ; Adult ; Ankle Fractures ; False Negative Reactions ; Female ; Fractures, Bone ; diagnosis ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Pronation ; Rotation ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

Objective:To investigate the expression and function of CD226 on NK s ubsets and its coexpression with other activation receptor and inhibition recept or on NK cells. Methods:The expression of CD226 on CD56 bright and CD56 dim NK subsets and coe xpress ion with CD16 and NKG2A in PBMC and MLC in the presence or absence of IL-2 or IL-15 were detected by double fluorescent staining and flow cytometry analysis. The level of IFN-? in the supernatants of PBMC culture and MLC treated with o r without IL-2 or IL-15 were evaluated by ELISA. 51Cr release assay w as employed to measure the specific lysis of NK cells killing target K562 cells. Results:CD226 was mainly expressed on CD56 dim NK subsets in PBMC. When s imulated by IL-2, CD226 expression was shifted to CD56 bright NK subsets, while IL-15 increased the subpopulation of NKG2A+CD226+double positive cell s. In MLC-generated NK cells, CD226 was mainly expressed on CD56 dim NK su bsets, and also shifted to CD56 bright NK subsets in the addition of IL-15 . Furt hermore, the percentage of CD16+CD226+和NKG2A+CD226+ subsets were increa sed when stimulated by IL-2 or IL-15. There was great increase in IFN-? lev el in the supernatants of PBMC culture in the presence of IL-2 or IL-15, but no difference in the supernatants of MLC treated with or without two cytokine s. Moreover, the cytotoxicity of NK cells in PBMC and MLC were greatly enhanced by IL-2 or IL-15. Conclusion:CD226 is mainly expressed on CD56 bright NK subsets in IL-2 or IL-1 5 activated NK cells, and is coexpressed with CD16 and NKG2A preferentiatly, whi ch maybe involve in the modulation of cytotoxicity of NK cells based on the balance of coexpressed activation and inhibition receptors. [

Objective To investigate the effects of propofol and sevoflurane on oxidative stess response induced by short period pure oxygen inhalation during general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 20-60 yr weighing 50-85 kg undergoing elective abdominal surgery under general anesthesia were randomly divided into 2 groups (n=30 each):group propofol (group P) and group sevoflurane (group S).Each group was further divided into 2 subgroups inhaling 40% O2 (P0.4,S0.4) and 100%O2(P1.0,S1.0) respectively during operation.Anesthesia was induced with propofol 1-2 mg/kg,midazolan 0.02 mg/kg and sufentanil 0.1-0.2 mg/kg.Tracheal intobation was facilitated with rocuronium 0.6-0.8 mg/kg.The patients were mechanically ventilated(VT 8 ml/kg,RR 12 bpm).PET CO2 was maintained at 35-40 mmHg.Anesthesia was maintained with in both groups.BIS was maintained at 40-60.Arterial blood samples were collected immediately before induction of anesthesia (baseline),at 2,4,6h after tracheal intubation(T1-3) and 24h after operation(T4) for determination of PaO2,serum 8-iso-PGF2α and MDA concentrations and SOD activity.PaO2/FiO2 was calculated.Results In subgroup S1.0 the serum 8-iso-PGF2α and MDA concentrations were significantly increased while serum SOD activity was significanfly decreased at T1-3 as compared with the baseline.Serum 8-iso-PGF2α and MDA concentrations were significantly higher while serum SOD activity and PaO2/FiO2 were significantly lower at T1-3 in subgroup S1.0 than in stress response induced by≤6h pure O2 inhalation but inhalation of 1.5%-3.0% sevoflurane can not.

Objective To investigate the early diagnostic value of cornel confocal microscopy for the screening of small neuropathy in elderly patients with type 2 diabetic mellitus.Methods In the prospective study,96 elderly patients with diabetes as study group and 46 patients with non-diabetes as the control group were continuously collected from our hospital endocrinology and ophthalmology out patients during May 2014 to February 2016.The 96 cases of type 2 diabetes were subdivided into 47 patients with diabetic peripheral neuropathy (DPN)and 47 patients with nowdiabetic peripheral neuropathy(non DPN).Results The diabetes course was shorter in non-DPN group than in DPN group(P=0.000).The levels of glycosylated hemoglobin and urine albumin were lower in the nonDPN than in the DPN(P =0.072,0.007,respectively).The corneal nerve fiber density was lower in the DPN group than in NDPN group (P =0.000).Corneal nerve fiber density was higher in control group than in DPN and NDPN group.The differences in number of corneal nerve fibers showed no statistical significance between DPN and NDPN group (x2 =2.391,P =0.314).But the number of corneal nerve fibers was significant less in DPN and NDPN group than in control group(x2 =16.014,P =0.000).The negative correlation was found between the course of disease and corneal fibrous density by using single factor linear regression analysis.The number of corneal nerve fibers was lower in smoking group than in non-smoking group(P=0.003).The multiple linear regression analysis showed that duration of diabetes was a risk factor for diabetic neuropathy.Conclusions In some elderly diabetic patients with non-neuropathy,corneal nerve fiber density and number have been significantly decreased before nerve conductive velocity is reduced.Therefore,corneal confocal microscopy can be used to detect and diagnose small diabetic neuropathy in elderly patients with diabetes mellitus.

OBJECTIVE To investigate the bacterial distribution and antibiotic resistance situation with urinary tract infection(UTI) for the guidance of rational use of antibiotics.METHODS The antibiotic resistance of clinical isolates from urinary tract infection from Mar 2005 to Jul 2006 was analyzed. RESULTS The most common pathogens in urinary tract infection were Escherichia coli(50.2%),Enterococcus(14.4%),Staphyloccus aureus(8.7%),Klebsiella pneumoniae(7.3%),and Proteus mirabilis(3.9%).E.coli,K.pneumoniae,and P.mirabilis were found to be highly resistant to ampicillin,quinolones and SMZ(70.6-100.0%).Enterococcus were highly resistant to penicillin and quinolones(81.0-96.8%).41.4% of E.coli and 31.3% of K.pneumoniae isolates produced ESBLs.HLGR-Enterococcus were 79.4%.78.9% S.aureus isolates were resistant to oxacillin.CONCLUSIONS The high antibiotic resistance of commonly encountered pathogens is a serious problem and much attention should be paid to detect pathogens and their antibiotic resistance.

Objectives Understanding the characteristic changes of Keshan disease (KD) in different epidemic period to provide reference basis for prevention and teatment. Methods On the basis of medical record as fundamental element, the relative conditions of Keshan disease's prevailing and spreading period were compared. Results In high incidence years, familial aggregation [accounted for 12%(6/50)] and seasonal aggregation were found, and KD cases occurred mainly from May to September, which was 78% (39/50)of the total cases in the whole year. Circulatory dysfunction(gallop rhythm, pulmonary role, jugular venous engorgement, cyanosis of lips) was more severe in high incidence years than that in low incidence years(X2=8.53,P<0.01). The average age of incidence was (4.07±1.46) years old in high incidence years and (6.11±2.71) years old in low incidence years. The type constitution in high incidence years was significantly different from that in low incidence years (X2=40.68, P<0.01), and chronic type of KD accounted for 22.85%(707/3094),46.09%(53/115), respectively, in high and low incidence years. Conclusions Making a further research of seizure of disease, and improving diagnosis and cure management level are also the important content for prevention and cure research work of Keshan disease at right time.

Objective To observe the effect of short-term treatment with metfbrmin on psychological distress and metabolic feature in patients with polycystic ovary syndrome(PCOS).Methods Ninety women were diagnosed as cases of PCOS based on the 2003 Rotterdam criteria.These patients were divided into three groups:group A,consisted of 26 subjects treated with mefformin only; group B,36 cases treated with metformin plus Dane-35 ; and group C,28 cases treated with placebo and Dane-35.The treatment was carried out for 3 months.Clinical and metabolic parameters were observed.The psychological distress was evaluated by the hospital anxiety and depression scale(HAD scale).Results Compared with group C,patients in group A and B showed significantly lower body mass index(BMI),waist circumference (WC),waist-hip ratio (WHR),serum fasting insulin,homeostasis model assessment for insulin resistance (HOMA-IR),total cholesterol (TC),triglyceride (TG),low density lipoproteincholesterol(LDL-C) levels as well as anxiety and depression scores,but higher high density lipoprotein-cholesterol (HDL-C) levels (all P＜0.05).Compared with group A,patients in Group B had significantly higher WC,WHR,and LDL-C levels(all P＜O.05).No significant differences in BMI,TG,HDL-C,anxiety and depression scores were found between group A and B (all P＞0.05).In group A,a positive correlation was found between the changes of metabolic feature (BMI,WHR,and HOMA-IR) and the changes of anxiety and depression scores (all P ＜0.05).Conclusion Short-term treatment with metformin will benefit patients with polycystic ovary syndrome,regarding psychological distress and metabolic features.

65Y) on maintenance hemodialysis at our hospital from Jan 2005 to Oct 2006 was selected.All subjects were divided into two groups according to serum albumin level:group A(ALB0.05);and mortality was higher in group A than in group B(P