2013年 · 第126卷第13期

Neck and head neoplasm,such as thyroid carcinoma,often has a high rate of regional lymph node metastasis.1 Neck dissection is a conventional option in management of head and neck neoplasm with confirmed or suspected neck lymph node metastasis.Chylothorax represents a relatively rare early post-operative complication of neck dissection.2 We retrospectively analyzed neck dissection associated chylothorax in patients with thyroid carcinoma in our hospital.Published reports on neck dissection associated chylothorax were also summarized to describe clinical manifestations and optimal managements。

Mucin-producing bile duct tumors (MPBTs) are characterized by intraductal papillary tumors producing large amounts of mucin.The tumor comprises macroscopically prominent intraductal papillary neoplastic epithelia and produces a large amount of viscid mucin,resulting in dilatation of the bile ducts.1 These tumors of the peripheral bile duct,which include benign and malignant lesions,have also been referred to as intraductal growthtype peripheral cholangiocarcinomas,2 mucin-producing cholangiocellular carcinomas,3 intraductal papillary neoplasms (IPNs) of the biliary tract,4 IPNs of the liver,5 or IPNs of the bile duct.6 MPBTs have been the subject of recent attention due to its peculiar histopathology,biological and clinical behavior,varied radiological manifestations,and good prognosis of the patients.7

Acommon dual pathology observed on presurgical magnetic resonance imaging (MRI) of epileptic patients is extrahippocampal lesions combined with mesial temporal sclerosis.The hippocampus was highly vulnerable to many types of insults.However,it is difficult to detect subtle hippocampal atrophy in some patients.The most reliable method to confirm epileptogenicity is chronic intracranial electroencephalography (EEG) monitoring.In this study,we recorded intracranial EEG signals in 11 patients with dual pathology。

In the past,the surgeons usually adopted ileal ureter plasty or ureter bladder flap plasty (Boari flap plasty) to restore long-term ureteral mucosal avulsions and long or entire ureteral segment defects caused mostly by ureteroscope operations.But there are still certain difficulties in the restoration of long segment ureteral defects (＞20 cm)using traditional methods.In order to overcome traditional surgical approaches,we designed a new ureteroplasty operation using spiral pedunculated bladder muscle flap to restore long segment ureteral defects。

Myelodysplastic syndrome (MDS) is a group of clonal hematopoietic stem cell disorders,characterized by varying degrees of peripheral cytopenia caused by ineffective dysplasia of the myeloid lineages.MDS also has a high risk of progression to acute myeloid leukemia.But the role of immune abnormalities in the pathogenesis of MDS is still not clear。

Hand,foot and mouth disease (HFMD) has become a major public health problem in China since 2008,which has been widely prevalent in children under 5 years of age.According to the data of the Ministry of Health,the number of cases with HFMD exceeded 1 million during the recent 4 years.The major etiologic agent of HFMD is enterovirus 71 and coxsackievirus A 16.The main clinical manifestations of the disease include fever,maculopapular skin vesicles on the hand,foot and buttock,oral herpes,ulcer;ation severe cases there can be central nervous system infection and/or pulmonary hemorrhage,which are mostly caused by EV71 and may be life-threatening with a fatality rate of 0.3 to 0.5 per thousand cases。

Adiscoid meniscus,found in 1％-5％ of the population,is a human anatomic variant that usually affects the lateral meniscus of the knee.A discoid meniscus is more prone to injury than a normally shaped meniscus.In 1941,1 Cave and Staples first reported discoid medial meniscus.A bilateral discoid medial meniscus is extremely rare.The first case of bilateral discoid medial meniscus was reported by Murdoch in 1956.2 Since then,no more than 20 case reports of bilateral discoid medial menisci have been published to date,and most have been single case reports.3 Treatment of a torn discoid medial meniscus is similar to the treatment of a tom lateral meniscus of the knee.In cases where there is a significant disability,surgical excision may be required.Traditionally,the treatment of choice for symptomatic torn discoid meniscus has been open total or partial meniscectomy.Currently,arthroscopic partial meniscectomy is commonly used.Either meniscectomy or conservative method for treatment of a discoid medial meniscus with no tear is a debatable issue.3

Vitreous seeds of retinoblastoma are one of the main reasons for treatment failure using globe-conserving therapy due to their poor response to therapy.This is most likely secondary to the difficulty for chemotherapeutic drugs to permeate into the vitreous cavity due to the bloodeye barrier) Currently,laser coagulation or cryotherapy is not used for vitreous seeds.External beam radiotherapy has been seldom used for vitreous seeds due to radiationrelated complications.2 Recently,several reports have showed repeated intravitreal injections of anticancer drugs,such as melphalan,may be an option for vitreous seeds.3 However,long-term efficacy of this approach is unsure and this treatment is unavailable at many treatment centers.Furthermore,repeated intravitreal injections entail an increased risk of extraocular dissemination of tumor cells。

Kounis syndrome is defined as a group of acute coronary syndromes that manifests as unstable vasospastic or nonvasospastic angina,and even as acute myocardial infarction triggered by the release of inflammatory mediators following an allergic insult.1 Kounis syndrome is a rare and complex syndrome.Instant treatment decisions need to be made once it happens.Here,we defined a case of severe Kounis syndrome,culminating in acute coronary syndrome,as a result of an acute allergic reaction,which was likely related to iodinated contrast media or dextran-40 use。

To the editor:The main side effects of topical imiquimod are dose-dependent application-site reactions.1 Recently,we found a Chinese couple developed vitiligo-like depigrnentation lesions and lichen planus with genital warts after treatment with 5％ imiquimod cream,respectively。

To the editor:A 19-year-old man was referred to our institution with a 1-month history of iron deficiency anemia and hyperpyrexia.The lowest hemoglobin was 4.0 g/dl and the highest temperature was 40.6℃.The clinical examination was generally unremarkable.His abdomen was nondistended except for mild epigastric tenderness on deep palpation.There were no other specific signs and findings elicited。

To the editor:We read with a great interest the article by Nienaber et al.1 They reported that Mayo Clinic has eight of 240 patients with artery dissections who had documented family history,and four of them were from German,English and Swedish families with no Marfan's syndrome.We report Chinese twins both with aortic dissection。

To the editor:According to an investigaion of 417 tertiary hospitals of recent ten years in China,pacemaker implantation has been raising at an average of 11％ per year.Overwhelming majority were received right-side DDD pacemaker.There are a great part need cardiac resynchronization therapy (CRT),especially when they had got cardiomyopathy and/or heart failure.No definite guidelines were for how to upgrade the resynchronization system in these patients.Here we provide one practical way in one case。

Abstract：Objective To review the functions of these intracellular signals in their regulation of retinal ganglion cell (RGC) axon regeneration.Data sources Relevant articles published in English or Chinese from 1970 to present were selected from PubMed.Searches were made using the terms "intrinsic determinants,axon regeneration,RGC,optic nerve regeneration,and central nervous system axon regeneration."Study selection Articles studying the mechanisms controlling RGC and central nervous system (CNS) axon regeneration were reviewed.Articles focusing on the intrinsic determinants of axon regeneration were selected.Results Like other CNS neurons of mammals,RGCs undergo a developmental loss in their ability to grow axons as they mature,which is a critical contributing factor to the failure of nerve regeneration and repair after injury.This growth failure can be attributed,at least in part,by the induction of molecular programs preventing cellular overgrowth and termination of axonal growth upon maturation.Key intracellular signals and transcription factors,including B cell lymphoma/leukemia 2,cyclic adenine monophosphate,mammalian target of rapamycin,and Krüppel-like transcription factors,have been identified to play central roles in this process.Conclusions Intense effort and substantial progress have been made to identify the various intrinsic growth pathways that regulate RGC axon regeneration.More work is needed to elucidate the mechanisms of and the interrelationship between the actions of these factors and to successfully achieve regeneration and repair of the severed RGC axons。

Abstract：Background Whether an addition of OAC to double antiplatelet therapy for patients with an indication of chronic oral anticoagulation undergoing PCI-S may improve clinical outcomes is still debated.This meta-analysis aimed to update and re-compare the benefits and risks of triple antithrombotic therapy (TT) with double anti-platelet therapy (DAPT) after in patients who requiring oral anticoagulation after percutaneous coronary interventions with stenting (PCI-s).Methods Ten reports of observational retrospective or prospective studies were retrieved,including a total of 6296 patients,follow-up period ranging from 1 year to 2 years.Results Baseline characteristics were similar in both groups.The main finding of this study is the overall incidence of major adverse cardiovascular events (MACE),myocardial infarction (MI) and stent thrombosis was comparable between two groups.Patients with П was associated with significant reduction in ischemic stroke (OR:0.27; 95％ CI:0.13-0.57;P=0.0006) as compared to DAPT.We reaffirmed triple therapy significantly increased the risk of major bleeding (OR:1.47;95％ CI:1.22-1.78; P ＜0.0001) and minor bleeding (OR:1.55; 95％ CI:1.07-2.24; P=0.02).Conclusions Triple therapy is more efficacious in reducing the occurrence of ischemic stroke in PCI-s patients with an indication of chronic oral anticoagulation (OAC),compared with DAPT.However,it significantly increased major and minor risk of bleeding.It is imperative that further prospective randomized controlled trials are required to define the best therapeutic strategy for patients with an indication of chronic OAC undergoing PCI-s。

Abstract：Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography (ERCP)pancreatitis (PEP) and hyperamylasemia remain inconclusive.This study aimed to examine whether high-dose,long-term continuous infusion of somatostatin can reduce the incidence of PEP and post-ERCP hyperamylasemia.Methods This was a randomized,placebo-controlled pilot trial.One hundred and twenty-four patients scheduled for ERCP from December 2008 to May 2010 randomly received one of the following three interventions:pre-ERCP somatostatin (0.5 mg/h for 24 hours,starting 1 hour prior to ERCP; n=36),post-ERCP somatostatin (0.5 mg/h for 24 hours,starting 1 hour after ERCP; n=47),or placebo (saline for 24 hours,starting 1 hour prior to ERCP; n=41).Serum amylase and lipase concentrations were measured 1 to 3 hours prior to ERCP and 6,24,and 48 hours after ERCP.Results The three groups did not differ in age,gender,medical history,or ERCP procedure (catheterization using contrast or guidewire,pancreatic duct visualization,procedure time,or procedure type).The rate of PEP was 13.7％ (17/124)in the overall study sample and 16.7％ (6/36),10.6％ (5/47),and 14.6％ (6/41) in the pre-ERCP somatostatin,postERCP somatostatin,and placebo groups,respectively (P=0.715).The rate of post-ERCP hyperamylasemia was 19.4％ (7/36),21.3％ (10/47),and 46.3％ (19/41) in the pre-ERCP somatostatin,post-ERCP somatostatin,and placebo groups,respectively (P=0.011).Conclusions High-dose,long-term continuous infusion (0.5 mg/h for 24 hours) of somatostatin,performed as either a pre-or post-ERCP,can reduce the incidence of hyperamylasemia,but not PEP。

Abstract：Background Currently available evidence suggests that outcomes are less favorable when left main (LM) bifurcation lesions are treated with 2-stent techniques compared with a single-stent technique.We aimed to evaluate the long-term outcomes of the 2-stent techniques for treating unprotected LM bifurcation lesions in Chinese patients.Methods We enrolled 301 consecutive patients treated with drug-eluting stents (DES) implantation using 2-stent techniques for unprotected LM bifurcation lesions (MEDINA 1,1,1,70.5％).The 2-stent techniques included crush technique,V stenting,T stenting,and Culottes stenting.After stenting,both vessels were redilated at a high pressure before final kissing balloon (FKB).Clinical and angiographic data were analyzed.The primary endpoints were major adverse cardiac events (MACE),whichincluded death,myocardial infarction,and target lesion revascularization.Results Immediate procedural success was obtained in all cases with a FKB success rate of 95.3％.Follow-up data were available for all patients.The overall incidence of angiographic in-stent restenosis (ISR) rate was 20.3％ and most ISRs were of the focal type.During long-term follow-up (mean duration,(54±22) months),the cumulative incidence of MACE was 11.0％,with 8 (2.7％) deaths,7 (2.3％) myocardial infarctions,and 18 (6.0％) repeated lesion revascularization.MACEs in high SYNTAX score terciles were significantly higher compared with those in low and intermediate SYNTAX score terciles (p=0.001).Conclusions Although percutaneous coronary intervention (PCI) with 2-stent technique for unprotected LM bifurcation lesions was accompanied with a slightly high incidence of ISR,the long-term clinical follow-up is acceptable.Technical modifications and stent innovations may further improve both the angiographic and clinical outcomes for patients with LM bifurcation disease treated by PCI。

Abstract：Background Robotic assisted minimally invasive cardiac sugery is a new technique that uses small port sites and peripheral vessel cannulation for cardiopulmonary bypass (CPB) has been used.The right internal jugular vein (IJV)is commonly used for intraoperative venous access to the central circulation and identified with an external landmark.Previous studies have demonstrated the superiority of ultrasound guidance over external landmark technique in anaesthetic and intensive care settings.The aim of the present study was to delineate the utility of ultrasound-guided cannulation of the IJV during establishment of peripheral CPB in robotic cardiac surgery.Methods We prospectively studied 296 adult patients undergoing ultrasound-guided right IJV cannulation during establishment of peripheral CPB in robotic cardiac surgery at our institute from January 2007 to October 2012 (ultrasound group).The success rate,the first attempt success rate,access time and the complication rate of ultrasound-guided method were compared with the landmark-guided method used for 302 historical control patients (landmark group).Results In the ultrasound group,296 consecutive adult patients underwent ultrasound-guided right IJV cannulation during establishment of peripheral CPB in robotic cardiac surgery.In the landmark group,302 patients underwent right IJV cannulation using the landmark-guided technique.The success rate and the first attempt success rate in the ultrasound group were significantly higher than that in the landmark group (100％ vs.88.1％,P ＜0.000 and 98.6％ vs.38.4％,P ＜0.000).Average access time in the ultrasound group was shorter than that in the landmark group ((6.3±13.6) seconds;interquartile range (4-62) seconds vs.(44.5±129.5) seconds; interquartile range (5-986) seconds).The complication rate in the ultrasound group was significantly lower than that in the landmark group (0.3％ vs.8.3％,P ＜0.000).Conclusion Compared with the landmark-guided approach,ultrasound-guided cannulation of the right IJV significantly improves success rate,decreases access time and reduces complication rate during establishment of peripheral CPB in robotic cardiac surgery。

Abstract：Background Tumor surgery in brain motor functional areas remains challenging.Novel techniques are being developed to gain maximal and safe resection for brain tumor surgery.Herein,we assessed the magnetic resonance diffusion tensor imaging (MR-DTI) and fluorescein sodium dyeing (FLS) guiding technique for surgery of glioma located in brain motor functional areas.Methods Totally 83 patients were enrolled according to our inclusion and exclusion criteria (56 patients in experimental group,27 patients in control group).In the experimental group,the surgical approach was designed by DTI imaging,which showed the relationship between the tumor and motor tract.The range of resection in the operation was determined using the FLS-stained area,which recognized the tumor and its infiltrated tissue.The traditional routine method was used in the control group.Postoperatively,all patients underwent enhanced brain MRI within 72 hours to ascertain the extent of resection.Patients were followed in our outpatient clinic over 6-24 months.Neurological deficits and Karnofsky scoring (KPS) were evaluated.Results There were no significant differences in balance test indexes of preoperative data (sex,age,lesion location and volume,and neurological deficits before operation) and diagnosis of histopathology between the two groups.There was a trend in the experimental group for greater rates of gross total resection (80.4％ vs.40.7％),and the paralysis rate caused by surgery was lower in experimental (25.0％) vs.control (66.7％) groups (P ＜0.05).The 6-month KPS in the low-grade and high-grade gliomas was 91±11 and 73±26,respectively,in the experimental group vs.82±9 and 43±27,respectively,in the control group (P ＜0.05 for both).Conclusions MR-DTI and FLS dye guiding for surgery of glioma located in brain motor functional areas can increase the gross total resection rate,decrease the paralysis rate caused by surgery,and improve patient quality of life compared with traditional glioma surgery。

Abstract：Background Surgical treatment of intracranial aneurysms is often compromised by incomplete exclusion of the aneurysm or stenosis of parent vessels.Intraoperative microvascular Doppler (IMD) is an attractive,noninvasive,and inexpensive tool.The present study aimed to evaluate the usefulness and reliability of IMD for guiding clip placement in aneurysm surgery.Methods A total of 92 patients with 101 intracranial aneurysms were included in the study.IMD with a 1.5-mm diameter,20-MHz microprobe was used before and after clip application to confirm aneurysm obliteration and patency of parent vessels and branching arteries.IMD findings were verified postoperatively with digital subtraction angiography (DSA) or dual energy computed tomography angiography (DE-CTA).Ninety consecutive patients,harboring 108 aneurysms,who underwent surgery without IMD was considered as the control group.Results The microprobe detected all vessels of the Circle of Willis and their major branches.Clips were repositioned in 24 (23.8％) aneurysms on the basis of the IMD findings consistent with incomplete exclusion and/or stenosis.IMD identified persistent weak blood flow through the aneurismal sac of 11 of the 101 (10.9％) aneurysms requiring clip adjustment.Stenosis or occlusion of the parent or branching arteries as indicated by IMD necessitated immediate clip adjustment in 19 aneurysms (18.8％).The mean duration of the IMD procedure was 4.8 minutes.The frequency of clip adjustment (mean:1.8 times per case) was associated with the size and location of the aneurysm.There were no complications related to the use of IMD,and postoperative angiograms confirmed complete aneurysm exclusion and parent vessel patency.About 8.3％ (9/108) aneurysms were unexpectedly incompletely occluded,and 10.2％ (11/108) aneurysms and parent vessel stenosis without IMD were detected by postoperative DSA or DE-CTA.IMD could reduce the rate of residual aneurysm and unanticipated vessel stenosis which demonstrated statistically significant advantages compared with aneurysm surgery without IMD.Conclusion IMD is a safe,easily performed,reliable,and valuable tool that is suitable for routine use in intracranial surgery,especially in complicated,large,and giant aneurysms with wide neck or without neck。

Abstract：Background The etiological spectrum of cirrhosis has changed over the years,but our knowledge of it is limited.The present study aimed to investigate the etiological features of cirrhosis inpatients and their variation in the past 18 years in Beijing.Methods A retrospective analysis was performed on all patients with cirrhosis diagnosed for the first time in Peking University People's Hospital from January 1,1993,to October 25,2010.Data were analyzed using SPSS 20.0.Results A total of 2119 cirrhosis inpatients were included in this study:1412 (66.6％) male and 707 (33.4％) female.Chronic hepatitis B accounted for 58.7％; chronic hepatitis C for 7.6％; chronic hepatitis B and hepatitis C virus co-infection for 0.8％ (16 cases); alcoholic liver disease for 9.4％ (200 cases); and autoimmune diseases for 9.4％ (199 cases).In the past 18 years,the percentage of chronic hepatitis B has decreased from 75.2％ to 48.7％; alcoholic liver disease has increased from 5.1％ to 10.6％; and autoimmune disease has increased from 2.2％ to 12.9％.The percentages of chronic hepatitis B and alcoholic liver disease were higher among men,whereas the percentages of chronic hepatitis C,autoimmune diseases and cryptogenic cirrhosis were higher among women.Conclusions Chronic hepatitis B was still the most common etiology of cirrhosis in China,but the percentage has been decreasing.The percentages of alcoholic liver disease and autoimmune diseases have been increasing.The etiological spectrum of cirrhosis inpatients differed significantly according to sex。

Abstract：Background Gastric stromal tumors are the most common type of tumor originating from mesenchymal tissue.The traditional method for the treatment of gastric stromal tumor is surgical operation or therapeutic laparoscopy.More recently,endoscopic micro-traumatic surgery has become possible for gastric stromal tumors,with any perforation caused by endoscopic therapy mended endoscopically.We assessed the effectiveness of endoscopic full-thickness resection (EFR)in the treatment of gastric stromal tumors arising from the muscularis propria.Methods Of the 42 gastric stromal tumors,each ＞2.0 cm in diameter,arising from the muscularis propria,22 were removed by EFR and 20 by laparoscopic surgery.Tumor expression of CD34,CD117,Dog-1,S-100,and smooth muscle actin (SMA) was assessed immunohistochemically.Operating time,complete resection rate,length of hospital stay,incidence of complications,and recurrence rates were compared between the two groups.Continuous data were compared by using independent samples t-tests and categorical data by using X2 tests.Results Comparisons of the 22 gastric stromal tumors treated with EFR and the 20 treated with laparoscopic surgery showed similar operation times (60-155 minutes (mean,(90±17) minutes) vs.50-210 minutes (mean,(95±21) minutes),P ＞0.05),complete resection rates (100％ vs.95％,P ＞0.05),and length of hospital stay (4-10 days (mean,(6.0±1.8)days) vs.4-12 days (mean,(7.3±1.7) days),P ＞0.05).None of the patients treated with EFR experienced complications,whereas one patient treated with laparoscopy required a conversion to laparotomy and one experienced postoperative gastroparesis.No recurrences were observed in either group.Immunohistochemical staining showed that of the 42 gastric stromal tumors diagnosed by gastroscopy and endoscopic ultrasound,six were leiomyomas (SMA-positive) and the remaining 36 were stromal tumors.Conclusions Gastric stromal tumors arising from the muscularis propria can be completely removed by EFR.EFR may replace surgical or laparoscopic procedures for the removal of gastric stromal tumors。

Abstract：Background Thin-flap laser in situ keratomileusis (LASIK) is the new trend of refractive error correction surgery,the formation of corneal flap is crucial for a success of LASIK surgery.This study aimed to assess and compare the variations of LASIK flap created by the IntraLase femtosecond laser,Moria One Use-Plus SBK and Moria M2 Single-Use 90 μm-head microkeratome using Anterior segment optical coherence tomography (Visante OCT).Methods One hundred and sixty-one eyes of 81 consecutive patients were enrolled in this prospective study and randomly divided into three groups depending on the flap creation method:flap creation with the the IntraLase femtosecond laser (IntraLase group,59 eyes),flap creation with the Moria One Use-Plus SBK (SBK group,44 eyes),and flap creation with the Moria M2 Single-Use 90 μm-head microkeratome (M2SU90 group,58 eyes).The nominal flap thickness was 110 μm for all patients and for the three devices.One month after surgery,Visante OCT was used to measure the flap thickness at 20 locations on each cornea and the results were assessed for uniformity,regularity,and accuracy.Results At 1 month after surgery,the mean central flap thickness was (111±3) μm in the IntraLase group,(114±8) μm in the SBK group,and (118±13) μm in the M2SU90 group respectively.The flaps in the IntraLase group and the SBK group were more regular,showing an almost planar configuration,than the meniscus-shaped flaps in the M2SU90 group.The maximum deviation from the intended flap thickness (110 μm) was 6 μm in the IntraLase group,10 μm in the SBK group,and 20 μm in the M2SU90 group respectively.A difference greater than 20 μm was observed in 0.42％ of measurements in the I ntraLase group; 2.95％ of the measurements in the SBK group and 21.12％ of measurements in the M2SU90 group.Conclusions The flaps created by the IntraLase femtosecond laser and Moria One Use-Plus SBK are more uniform;more regular,and more accurate than those created by the Moria M2 Single-Use 90 μm-head microkeratome.The first two methods can make precise flaps for Sub-Bowman Keratomileusis。

Abstract：Background Hypotension due to the induction of sedation with dexmedetomidine infusion may be harmful in critically ill patients.Changes in pulse pressure induced by the passive leg raising test (PLR-△PP) as marker of fluid responsiveness,assessed prior to sedation,may predict hemodynamic changes.The present study was to investigate the power of the PLR test in critically ill patients in predicting hypotension induced by the induction of dexmedetomidine sedation.Methods Fluid responsiveness was estimated by a passive leg raising (PLR) test before dexmedetomidine sedation.Patients were assigned to either the "Nonresponders" or "Responders" group according to their hemodynamic responses to the PLR test ("Nonresponders",PLR-△PP ＜10.3％; "Responders",PLR-△PP ＞10.3％).Sedation was performed with a dexmedetomidine infusion (0.5 μg/kg over a 10-minute loading period,then 0.2-0.7 μg-kg-1.h-1)and titrated to maintain the target Richmond agitation sedation scale (RASS) score in the range of-2 to-1 and the bispectral index value in the range of 60 to 75.Radial artery pulse pressure,heart rate (HR),and central venous pressure (CVP) were measured at each phase of the study procedure.Hemodynamic fluctuations during the use of dexmedetomidine sedation were recorded and compared between the two groups.Results Fifty patients had a median (25％-75％ interquartile range) of 71 (61-78) years old were studied.At baseline,39 of the 50 patients were "Nonresponders" and 11 were "Responders".Following dexmedetomidine sedation,patients classified as "Responders" had a significantly greater systolic blood pressure decrease during the induction of dexmedetomidine sedation than the "Nonresponders" ((-26.3 ± 6.8)％ vs.(-11.8 ± 8.5)％,P ＜0.001).In addition,the "Responders" group required significantly more fluid boluses (8 vs.3; P ＜0.001) and vasopressors (2 vs.0; P ＜0.05)than the "Nonresponders" group to restore blood pressure.Finally,PLR-△PP was positively correlated with changes in systolic blood pressure (PLR-△SBP) (r2 =0.576; P ＜0.001) and significantly correlated with dexmedetomidine infusioninduced changes in SBP (r2=0.202; P ＜0.05).AUC for PLR-△PP was 0.84 (95％C/0.71-0.93).PLR-△PP predicted hypotension with a sensitivity of 73％ and a specificity of 92％.Conclusions The fluid responsiveness assessment pre-sedation was found to predict blood pressure fluctuation during the induction of dexmedetomidine sedation.The PLR test conducted prior to sedation may be a useful tool to identify patients with a high risk of hemodynamic events and may be used to indicate the need for prophylactic treatment。

Abstract：Background As female sex workers (FSWs) were becoming the driving force behind the HIV epidemic in Central China,a project to promote condom use by FSWs was implemented from 2004 to 2009.In this study,we discussed the evaluation of the project,the factors associated with condom use among FSWs within the Chinese context,and proposed suggestions for future interventions for FSWs in China.Methods Two surveys using structured questionnaires were conducted in 2004 and 2009.Data collected from the surveys were analyzed and guided by a behavior change framework.We reviewed relevant articles to supplement the information that was not able to be obtained from the surveys.Results In general,the HIV prevalence among FSWs remained low (less than 1％) in the 5 years.With a high coverage of interventions for all FSWs in Central China,the project yielded better outcomes than the national average over the same time period.The awareness about HIV and condom use grew dramatically during the project period.The four factors/determinants that influence the behavior of FSWs using condoms are population characteristics,opportunity,ability,and motivation.Statistical model shows that the significant variables for using a condom are age,availability of services,HIV-related knowledge,and intention.Conclusions With a high coverage of interventions for FSWs,the project achieved its goals.The differences among workplaces of FSWs may serve as a symbol of their socioeconomic status,patterns of condom use,and therefore risks of acquiring HIV。

In the past 10 years,acellular dermal matrix (ADM) has been widely used in various fields of surgery,including cleft palate repair,abdominal wall repair,tendon repair,hernia repair,facial and eyelid soft tissue augmentation surgery,ulcer repair,and vaginal sling repair,among others.13 ADM not only provides initial structural strength and bulk,but also allows relatively rapid vascular growth and serves as a scaffold for "new" tissue formation.4 These properties have led to its application to resolving surgical problems where tissue deficiency remains an issue。

The prevalence of type 2 diabetes (T2DM),which is characterized by insulin resistance,is increasing dramatically worldwide,and it has become a major public health issue.T2DM and cancer are common diseases that are frequently diagnosed in the same individual and the relationship of them appears to be complex.Epidemiologic data have shown T2DM is significantly associated with cancer,but potential biologic links between the two diseases are not fully understood。

The discovery of the first miRNA,lin-4,in Caenorhabditis elegans initiated a new era of miRNA biology.Since then,thousands of miRNAs have been identified and annotated,many of which have been shown to play roles in a variety of biological processes,including development,differentiation,apoptosis,proliferation,and cell death.1 Furthermore,growing evidence indicates that miRNA deregulation is a critical cause of cancer formation.The biogenesis,function,and potential application of miRNAs have become active areas of research.With the development of molecular biological technologies,such as northern blotting with radio-labeled probes,cloning,quantitative PCR,serial analysis of gene expression (SAGE)-based techniques,bead-based profiling methods,and oligonucleotide microarrays,2 it is possible to conduct miRNA research precisely and comprehensively。

Primary immune thrombocytopenia (ITP) is the most common hemorrhagic disorder characterized by isolated thrombocytopenia in the absence of conditions known to cause thrombocytopenia.The incidence rate of ITP is similar in males and females;the incidence was significantly higher among patients older than 60 years.1 The clinical manifestation of bleeding varies with patient.The severity of bleeding ranges from mild mucocutanous bleeding (petechiae and ecchymoses) to life-threatening hemorrhages (intracranial or gastrointestinal bleeding);some patients have no bleeding manifestations.Fatal and major nonfatal hemorrhages were extremely higher in patients older than 60 years old.2