Objective To analyze the feasibility and advantages of non-intubated anesthesia in thoracoscopic lobectomy. Methods The clinical data of 59 patients with thoracoscopic lobectomy and non-intubated anesthesia in the Department of Thoracic Surgery, Tongji Hospital from January 2015 to December 2017 were retrospectively reviewed, including 24 males and 35 females, aged 56.86±7.13 years (an observation group); 59 patients with thoracoscopic lobectomy undergoing general anesthesia with tracheal intubation in the same period were randomly selected, as a control group, including 27 males and 32 females, aged 55.37±6.86 years. Complications such as airway injury, refractory cough, pharyngalgia, nausea and vomiting were compared between the two groups. Postoperative inflammatory factor levels, postoperative hospital stay, and intraoperative and postoperative hospitalization costs were also compared. Results There was no difference between the two groups in general conditions such as age, gender, body mass index. There was also no difference in operation time, intraoperative bleeding volume or lymph node dissection. But the observation group had lower levels of procalcitonin and C reactive protein at postoperative 1 d (0.12±0.51 ng/ml vs. 0.14±0.70 ng/ml, P=0.03; 11.30±3.60 mg/L vs. 13.33±4.41 mg/L, P=0.01), lower rate of postoperative complications of refractory cough, pharyngalgia, nausea and vomiting (3.38% vs. 15.25%, P=0.03; 5.08% vs. 20.33%, P=0.01; 3.38% vs. 15.25%, P=0.03), less retain time of thoracic duct, postoperative hospital stay, and lower intraoperative and postoperative hospitalization costs (5.89±1.37 d vs. 7.00±1.73 d, P=0.00; 10.01±1.85 d vs. 11.37±2.45 d, P=0.00; 53 810.94±5 745.44 yuan vs. 58 223.16±6 445.08 yuan, P=0.00). Conclusion Thoracoscopic lobectomy with non-intubated anesthesia can avoid traditional airway injury caused by endotracheal intubation, reduce postoperative symptoms such as refractory cough, pharyngalgia, nausea and vomiting caused by general anesthesia, reduce or even avoid lung injury caused by one-side lung ventilation, promote recovery after surgery, reduce antibiotic use, and shorten hospital stay, which is more consistent with the requirements of the concept of overall minimal invasiveness and enhanced recovery.

Objective To investigate the clinical significance of Wiguide needle guidance ultrasound technology in radial artery puncture . Methods One hundred and thirty‐five patients who would receive elective surgery requiring radial artery puncture and catheterization to monitor invasive blood pressure were randomly divided into 3 groups( n ＝45) :blind puncture group( group A ) ,ultrasound puncture group( group B) and Wiguide needle guidance ultrasound puncture group ( group C ) . T he diameter and depth of radial artery ,blood return time ,puncture time for the process and the puncture success rate were recorded and compared . Results T here was significant diffeence in the blood return time among three groups ( P ＝0 .039) ,the blood return time in group B was higher than in group A and C ( P ＝ 0 .029 ,0 .027 ) . T he difference was statistically significant in the puncture time among three groups ( P ＝0 .002) ,the puncture time in group B was higher than in group A and C ( P ＝0 .009 ,0 .001) . T he puncture success rate in group A was 71 .11% ,the puncture success rate were 100% in both group B and C . Conclusions Wiguide needle guidance ultrasound technology could effectively improve the skill of vascular puncture ,which shortens the puncture time and improves the success rate of puncture . Wiguide needle guidance ultrasound technology provides benefits to master the ultrasound‐guided vascular puncture for clinical work .

Objective: To investigate the clinical significance of Wiguide needle guidance ultrasound technology in radial artery puncture. Methods: One hundred and thirty-five patients who would receive elective surgery requiring radial artery puncture and catheterization to monitor invasive blood pressure were randomly divided into 3 groups(n=45): blind puncture group(group A), ultrasound puncture group(group B) and Wiguide needle guidance ultrasound puncture group(group C). The diameter and depth of radial artery, blood return time, puncture time for the process and the puncture success rate were recorded and compared. Results: There was significant diffeence in the blood return time among three groups (P=0.039), the blood return time in group B was higher than in group A and C (P=0.029, 0.027). The difference was statistically significant in the puncture time among three groups (P=0.002), the puncture time in group B was higher than in group A and C (P=0.009, 0.001). The puncture success rate in group A was 71.11%, the puncture success rate were 100% in both group B and C. Conclusions Wiguide needle guidance ultrasound technology could effectively improve the skill of vascular puncture, which shortens the puncture time and improves the success rate of puncture. Wiguide needle guidance ultrasound technology provides benefits to master the ultrasound-guided vascular puncture for clinical work.

Objective To explore the correlation between apolipoprotein E (ApoE) gene polymorphism and urine Alzheimer-associated neuronal thread protein (AD7c-NTP) level in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI).Methods The cognitive function of 30 AD patients (AD group),30 MCI patients (MCI group) and 30 normal controls (NC group) was evaluated by neuropsychological batteries like MMSE,the Cambridge Cognitive Examination-Chinese Version (CAMCOG-C),etc.ELISA was used to test the urine level of AD7c-NTP.The genotypes of ApoE were analyzed by the high-resolution melting assay in blood samples.Results Compared with the NC group (0.59 (0.40,0.66) ng/ml),the urine level of AD7c-NTP in the AD group (1.03(0.80,1.41) ng/ml) and the MCI group (0.69(0.53,0.91) ng/ml) was increased (Z =33.727,P ＜0.01).The urine level of AD7c-NTP in the AD group was higher than that in the MCI group (Z =8.232,P ＜ 0.05).The level of AD7c-NTP in urine was negatively correlated with MMSE and CAMCOG-C scores (rMMSE =-0.604,P ＜ 0.01;rCAMCOG-C =-0.486,P ＜ 0.01).According to receiver operating characteristic curve,the optimal cutoff point of AD7c-NTP in urine for diagnosis of patients including AD and MCI was 0.70 ng/ml,with sensitivity of 71.7％ and specificity of 83.3％,and area under the curve of 0.82 (95％ CI 0.73-0.90,P ＜0.05).There were four genotypes comprising ε2/3,ε3/3,ε3/4 and ε4/4 for ApoE gene.The frequencies of ε4 carriers were 46.7％ (14/30),23.3％ (7/30) and 23.3％ (7/30) in the AD,MCI and NC groups,respectively.There was a notable increase in urine AD7c-NTP and a significant decrease in CAMCOG-C scores in MCI patients who harbored the ApoE ε4 allele (ZAD7c-NTP =4.857,P ＜ 0.05;ZCAMCOG-C =4.284,P ＜0.05).Conclusions The urine level of AD7c-NTP was significantly increased in AD and MCI patients,the higher the level of AD7c-NTP,the more serious the cognitive impairment.The ε4 carriers exhibited higher urine level of AD7c-NTP,but worse cognitive function compared to ε4 non-carriers in the MCI group.

Objective To make a comparison between noninvasive blood pressure (NIBP) and invasive blood pressure (IBP). Method Totally 450 patients undergoing selective surgery received radial artery or dorsalispedis artery puncture and catheter under local anesthesia to figure out the difference between NIBP and IBP. Results The systolic blood pressure difference of IBP from different positions and NIBP were as follows:left radial artery group (18.20 ± 0.67, 15.27 ± 0.62) mmHg, right radial artery group (18.54 ± 0.79, 14.68 ± 0.77) mmHg, left foot dorsal artery group (41.98 ± 2.26, 40.54 ± 1.77) mmHg and right foot dorsal artery group (37.57 ± 0.01, 37.93 ± 2.90) mmHg. The noninvasive systolic blood pressure difference between left and right arms was (2.84 ± 0.45) mmHg, the noninvasive diastolic blood pressure difference (3.19 ± 0.34) mmHg, and the noninvasive mean blood pressure difference (2.85 ± 0.35) mmHg. The NIBP of right arm was higher than that of left arm. Conclusions IBP is higher than NIBP, and the invasive artery systolic blood pressure is about 20mmHg higher than noninvasive systolic blood pressure. Meanwhile we confirm that systolic blood pressure gradually rises over 30 years old, and diastolic blood pressure increases while gradually declines after 50.

Objective To evaluate the correlations between arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and age in the population of Han nationality aged over 15 years old. Methods Three hundred Chinese Han nationality patients who underwent elective surgery were selected. They were involved in ASA class Ⅰ-Ⅲ, including 162 male and 138 female. Radial artery or dorsalis pedis artery was punctured, performed indwelling catheter, and connected the pressure transducer under local anesthesia. Blood gas analysis was collected before anesthesia. Results The linear regression trend diagram showed that the level of PaO2 had linear negative correlation with age . The calculating formula was PaO2(mmHg) = 101.7- 0.278 × age (years) (1 mmHg = 0.133 kPa, R2=0.903). The level of PaCO2 didn′t change with age, and average was (38.2 ± 2.8) mmHg. Conclusions The level of PaO2 is gradually decreased with age, but the level of PaCO2 isn′t affected by age.

Objective To measure the effect of one-stage transplantation of reverse-flow vascular pedicle fibular grafts in treatment of infected nonunion of the distal tibia.Methods From January 2001 to December 2012,23 patients sustaining the infected nonunion of the distal tibia were transplanted with reverse-flow vascular pedicled fibular grafts in one-stage.There were 13 males and 10 females,aged 26 to 59 years (mean,38.7 years).Tibial nounion based on the Jain-Sinha classification was rated as Type A in 6 patients and Type B in 17 patients.After the operation,the patients received 2-3 weeks of intravenous antibiotic treatment and then 4-week oral antibiotic therapy.Wound healing,limb and ankle joint fucntion and outcomes in fibular transplantation were observed.Results Duration of follow-up was 16-46 months (mean,28.6 months).There were no exudates and ulcerations of the skins.Smooth healing was achieved in all the patients except that fibular fracture was noted in one patient healed after cast immobilization.Healing time ranged from 12 to 28 weeks (mean,15.6 weeks).Limb function evaluated with Ennecking system had (87 ± 11) ％ restoration.According the Olerud-Molander scoring system,ankle function was excellent in 16 patients and good in 7 patients,with the excellent-good rate of 100％.Conclusion One-stage reverse-flow vascular pedicle fibular grafting is an optional procedure for treatment of infected nonunion of the distal tibia,due to the technique is easy and effective.

ObjectiveTo investigate the accuracy of automated breast volume scanning (ABVS) for the measurement of breast tumor size.MethodsSixty-two breast tumors in 59 patients were included in this study and were examined using conventional ultrasound and ABVS to measure the maximal diameters of the tumors. And the measurement results were compared with the pathological maximal diameters.Results There were 21 malignant and 41 benign tumors according to histopathological evaluation. There were no signifi cant differences between the maximal diameters on ABVS and on pathological measurements for both benign tumors and malignant tumors (Z=1.761, 0.262,P=0.078, 0.794). However, for malignant tumors, the maximal diameters on conventional ultrasound were significantly smaller than those on pathological measurements (Z=3.743,P=0.000). For benign tumors, the maximal diameters on conventional ultrasound were similar with those on pathological measurements (Z=1.935,P=0.053). The measurement values of conventional ultrasound and ABVS were both positively correlated with those on pathological values (r=0.935, 0.964,r=0.870, 0.964). And the correlation coeffi cients between ABVS and pathological measurement values were higher than those between conventional ultrasound and pathological measurement values for both benign and malignant tumors. ConclusionABVS can assess the size of breast tumor more accurately than conventional ultrasound, especially for the malignant tumors.