ABSTRACT
OBJECTIVE:To observe the protective effect of ketamine and dexamethasone on lung injury in esophageal cancer thoracotomy. METHODS:60 patients with one-lung ventilation thoracotomy were randomly divided into 4 groups:blank group (group S),ketamine group(group K),dexamethasone group(group D)and ketamine and dexamethasone group(group KD)by number. After surgery,the patient-controlled epidural anaigesia (PCEA) was used to record the concentrations of IL-6,IL-8, TNF-α with the time point of preoperative 30 min (T0),60 min after one-lung ventilation (OLV)(T1),120 min after the OLV (T2),2 h after restore double-lung ventilation(T3),the changes of respiratory index(RI)in blood gas analysis and the analgesic effect and adverse reactions in 48 h after treatment. RESULTS:There was no obvious difference between the blood pressure and heart rate in 4 groups. Compared with T0,the RI values in T1,T2 and T3 were increased;compared with group KD,the RI values in T2 and T3 in group K,group D and group S were increased;compared with T0,the concentrations of IL-6 and IL-8 in T1,T2 and T3 were increased(P0.05)and the con-centration of TNF-α in 4 groups was lower than minimum detectable concentrations;compared with group KD,the scores of anal-gesia visual analogue scale(VAS)and Prince-Henry in postoperative 48 h in group K and group S were higher(P0.05). CONCLUSIONS:Ketamine and dexamethasone can reduce the release of inflammatory mediators,decrease the RI values,increase the analgesia effect and has certain protective effect on lung injury.
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Objective To investigate the peri-nasopharyngeal invasion patterns of nasopharyngeal carcinoma (NPC) on MRI and its relationship with tumor staging. Methods One thousand five hundred and seventy-three patients with newly diagnosed NPC which were histo-pathologically proved were retrospectively studied. The MRI manifestations and invasion patterns of the NPCs were elevated according to the 2008 Tstaging system of NPC. Z test was used to analyze the rate of adjacent structures invasion in NPCs. Results The structures invaded by NPCs included pharyngobasilar fascia in 1299 cases (82. 58% ); parapharyngeal space, 1090 ( 69. 29% ); nasal cavities, 304 ( 19. 33% ); oropharynx, 49 ( 3. 12% ); carotid space,514(32. 68% ); medial pterygoid muscle, 661 (42. 02% ); lateral pterygoid muscle, 210( 13. 35% ); skull base bones, 943(59. 95% ); cranial nerves, 630(40. 05% ) and paranasal sinuses, 242 ( 15.38% ). The T-stage distribution was T1, 242 cases ( 15.38% ); T2, 288 ( 18. 31% ); T3, 410 (26. 06% ) and T4,633 (40. 24% ). Among the cases with nasal cavities invasion, 90. 46% (275/304)showed the involvement of the structures seen in T3 or T4 stage, which was found in all cases with oropharynx invasion. In addition,69. 14% (457/661) of cases with medial pterygoid muscle invasion and 92. 15% (223/242) of cases with paranasal sinuses invasion showed the involvement of structures seen in T4 stage. As for the invasion patterns of NPC, the lateral invasion of pharyngobasilar fascia was more frequent than upward invasion of skull base (Z = 14. 025, P ＜ 0. 01 ) and downward invasion of oropharynx ( Z = 45.032, P ＜ 0. 01 ), and the downward invasion of oropharynx was less frequent than upward invasion of skull base ( Z = 34. 301, P ＜ 0. 01 ) and forward invasion of nasal cavities ( Z = 14. 404, P ＜ 0. 01 ). Conclusion NPC has a predilection of lateral invasion rather than upward and downward invasion, and its upward and forward invasion are more common than downward invasion.
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Objective To evaluate the accuracy and clinical practicality of DNA chip in comparison with serology in typing of human leukocyte antigen A (HLA-A) in Han's individuals of donor-recipients of transplantation. Methods 120 peripheral blood samples were obtained from donor-recipients of transplantation. Each sample was divided into two parts and HLA-A antigens were identified by DNA chip in one part and by serology in another. Samples in which the HLA-A typing results by these 2 methods were discordant were verified by polymerase chain reaction with sequence specific primers (PCR-SSP). Accuracy and clinical practicability of both methods were compared according to the typing results. Results Serological typing for HLA-A took 3 h, while DNA chip typing 4. 5-5 h. 112 samples have been typed successfully. Typing results were same in 91 samples and discordant in 21 cases. The verified results showed that DNA chip made 2 incorrect typing and the error rate was 2%. Meanwhile, serology made 19 mistakes, consisting of 5 antigens being incorrectly interpreted and 14 "blanks" turning out to be definable alleles. The discrepancy rate was 17 %. Conclusions DNA chip typing for HLA-A is suitable for clinical application in Chinese Han's population with a greater precision than serology. It may replace the serology in future after being improved and perfected.