Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: a multicentre randomised trial.

BACKGROUND: Delirium is a common and disturbing postoperative complication that might be ameliorated by propofol-based anaesthesia. We therefore tested the primary hypothesis that there is less delirium after propofol-based than after sevoflurane-based anaesthesia within 7 days of major cancer surgery. METHODS: This multicentre randomised trial was conducted in 14 tertiary care hospitals in China. Patients aged 65-90 yr undergoing major cancer surgery were randomised to either propofol-based anaesthesia or to sevoflurane-based anaesthesia. The primary endpoint was the incidence of delirium within 7 postoperative days. RESULTS: A total of 1228 subjects were enrolled and randomised, with 1195 subjects included in the modified intention-to-treat analysis (mean age 71 yr; 422 [35%] women); one subject died before delirium assessment. Delirium occurred in 8.4% (50/597) of subjects given propofol-based anaesthesia vs 12.4% (74/597) of subjects given sevoflurane-based anaesthesia (relative risk 0.68 [95% confidence interval {CI}: 0.48-0.95]; P=0.023; adjusted relative risk 0.59 [95% CI: 0.39-0.90]; P=0.014). Delirium reduction mainly occurred on the first day after surgery, with a prevalence of 5.4% (32/597) with propofol anaesthesia vs 10.7% (64/597) with sevoflurane anaesthesia (relative risk 0.50 [95% CI: 0.33-0.75]; P=0.001). Secondary endpoints, including ICU admission, postoperative duration of hospitalisation, major complications within 30 days, cognitive function at 30 days and 3 yr, and safety outcomes, did not differ significantly between groups. CONCLUSIONS: Delirium was a third less common after propofol than sevoflurane anaesthesia in older patients having major cancer surgery. Clinicians might therefore reasonably select propofol-based anaesthesia in patients at high risk of postoperative delirium. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR-IPR-15006209) and ClinicalTrials.gov (NCT02662257).

Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial.

BACKGROUND: Experimental evidence indicates that i.v. anaesthesia might reduce cancer recurrence compared with volatile anaesthesia, but clinical information is observational only. We therefore tested the primary hypothesis that propofol-based anaesthesia improves survival over 3 or more years after potentially curative major cancer surgery. METHODS: This was a long-term follow-up of a multicentre randomised trial in 14 tertiary hospitals in China. We enrolled 1228 patients aged 65-90 yr who were scheduled for major cancer surgery. They were randomised to either propofol-based i.v. anaesthesia or to sevoflurane-based inhalational anaesthesia. The primary endpoint was overall survival after surgery. Secondary endpoints included recurrence-free and event-free survival. RESULTS: Amongst subjects randomised, 1195 (mean age 72 yr; 773 [65%] male) were included in the modified intention-to-treat analysis. At the end of follow-up (median 43 months), there were 188 deaths amongst 598 patients (31%) assigned to propofol-based anaesthesia compared with 175 deaths amongst 597 patients (29%) assigned to sevoflurane-based anaesthesia; adjusted hazard ratio 1.02; 95% confidence interval (CI): 0.83-1.26; P=0.834. Recurrence-free survival was 223/598 (37%) in patients given propofol anaesthesia vs 206/597 (35%) given sevoflurane anaesthesia; adjusted hazard ratio 1.07; 95% CI: 0.89-1.30; P=0.465. Event-free survival was 294/598 (49%) in patients given propofol anaesthesia vs 274/597 (46%) given sevoflurane anaesthesia; adjusted hazard ratio 1.09; 95% CI 0.93 to 1.29; P=0.298. CONCLUSIONS: Long-term survival after major cancer surgery was similar with i.v. and volatile anaesthesia. Propofol-based iv. anaesthesia should not be used for cancer surgery with the expectation that it will improve overall or cancer-specific survival. CLINICAL TRIAL REGISTRATIONS: ChiCTR-IPR-15006209; NCT02660411.

Optimal impression materials for implant-supported fixed complete dentures: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Although polyvinyl siloxane (PVS) materials and polyether (PE) materials have been the recommended materials for making impressions for implant-supported fixed complete dentures (IFCDs), a consensus regarding the optimal impression materials has yet to be established. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the effect of impression materials on the accuracy of conventional impressions for IFCDs and to provide guidance for selecting the optimal impression material. MATERIAL AND METHODS: The PubMed, Web of Science, and Embase databases were searched and supplemented via hand searches. Studies comparing the accuracy of conventional impressions for IFCDs by using PVS and PE materials with either direct (open-tray) or indirect (closed-tray) techniques were included. Linear distance deviations and angular deviations between adjacent implants were evaluated. The mean difference (MD) with a 95% confidence interval (CI) was calculated for continuous data. A subgroup analysis was conducted to evaluate the impact of implant angulation (α=.05). RESULTS: Among the 597 publications identified, 27 in vitro studies were included for qualitative analysis, and 12 were included for quantitative analysis. The general analysis revealed no significant differences in linear distance and angular deviations between the 2 impression materials with the direct or indirect technique. The subgroup analysis found that a statistically significant difference in linear distance deviations was found when implants were placed at an angle greater than 15 degrees, favoring PE materials when using the direct technique (P=.010, MD: 32.54 µm; 95% CI: 6.83 to 58.24) and indirect technique (P=.020, MD: 138.15 µm, 95% CI: 19.17 to 257.13). However, only 2 relevant studies assessed the indirect technique. CONCLUSIONS: When providing IFCDs, conventional impressions obtained by using PVS and PE materials were found to have similar accuracy in most scenarios. PE materials yielded better outcomes when implants were placed at an angle greater than 15 degrees.

Monitoring soil biological properties during the restoration of a phosphate mine under different tree species and plantation types.

Open-pit mining activities for minerals and metals have left an international legacy of highly polluted soils and degraded landscapes. Reforestation is usually supposed to restore soil fertility and ecosystem services, and therefore to remediate and recover polluted sites. However, our understanding of the effects of tree species and recovery time on the restoration of abiotic and biotic soil properties remains scarce. In this study, the effects of a series of restoration chronosequence (unrestored control, 10-year, 20-year, and natural forest) and plantation types (nitrogen-fixing broad-leaved Alnus nepalensis and coniferous Cupressus torulosa monocultures, as well as their mixed plantation) on soil physicochemical and biological properties were explored in a phosphate mine. Our results showed that soil quality index (SQI), which integrates important soil physical, chemical, and biological parameters including bulk density, soil organic carbon and microbial biomass, could provide valuable information about soil health. The average SQI values of 20-year plantations were 1.55 times of 10-year plantations, and the mixed plantation was 1.13 and 1.27 times of A. nepalensis and C. torulosa monoculture, respectively. Thus, recovery time, as well as plantation type, were the main determinants of the alterations in key soil conditions during the phosphate mining restoration. At the beginning restoration (10 years), A. nepalensis monoculture performed better than C. torulosa, providing an efficient restoration strategy for early revegetation. The mixed plantation of C. torulosa and A. nepalensis showed the higher moisture and soil organic carbon than did the monocultures, especially after 20 years of revegetation. Hence, our findings address a helpful guideline for selection of tree species and plantation practices, thereby aiding in long-term success of restoration.

Influence of ambient light conditions on intraoral scanning: A systematic review.

PURPOSE: To systematically assess the influence of ambient light on the accuracy and scanning time of intraoral scanning. STUDY SELECTION: The present systematic review (CRD 42022346672) was registered at the International Prospective Register of Systematic Reviews (PROSPERO) and was performed based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Electronic searches were conducted using PubMed, Web of Science, and EMBASE, complemented by gray literature, references, and citations of the included studies. The primary outcome was accuracy, and the scanning time was a secondary outcome. Owing to the high heterogeneity, the pooled data were analyzed descriptively. RESULTS: Six in vitro and two in vivo experiments were performed. Three in vitro studies reported both the accuracy and scanning time of the intraoral scans, whereas the remaining studies exclusively evaluated the accuracy. The studies mainly investigated the influence of illumination levels (0-11000 lux) on intraoral scanning. Intraoral scans revealed optimal accuracy at 1000-lux illumination for complete-arch dentition scans, whereas the influence of illumination levels on 4-unit or shorter scans was not clinically significant. The intraoral scans obtained using confocal microscopy were less affected by the illumination levels than those obtained using the active triangulation technique. Furthermore, the scanning time tended to increase with increasing illumination. CONCLUSIONS: Evidently from the limited number of studies conducted, ambient light illumination had considerable influence on the accuracy and scanning time of intraoral scanning, which appeared to be related to the scanning range and imaging technology.

[Expression and significance of UNC-112 protein in lung cancer].

OBJECTIVE: To investigate the expression of UNC-112 protein in lung cancer and discuss its value. METHODS: The method of immunohistochemical SP was employed to detect the expression of UNC-112 protein in 210 cases of lung cancer, and evaluate its correlation with pathological classification. RESULTS: UNC-112A and UNC-112B protein were highly expressed in non-small cell lung cancer, not expressed or expressed at very low levels in small cell lung cancer(P < 0.05);the expression of UNC-112A protein in squamous cell carcinoma was significantly higher than those in adenocarcinoma (P < 0.001)and large cell lung cancer (P < 0.01), but there is no significant difference between adenocarcinoma and large cell lung cancer (P = 0.18).UNC-112A protein expression level was positively correlated with the differentiation of squamous cell carcinoma(P = 0.0024). The expression of UNC-112B protein was significantly higher in large cell lung cancer than those in adenocarcinoma (P = 0.002) and squamous cell carcinoma (P < 0.01), and it was significantly higher in adenocarcinoma than squamous cell carcinoma (P = 0.005). CONCLUSIONS: UNC-112 protein may be related to the heterogeneity of lung cancer, UNC-112A and UNC-112B protein play different roles in invasion and migration of lung cancer.

Influence of intraoral conditions on the accuracy of digital and conventional implant impression techniques for two-implant-supported fixed dental prostheses.

PURPOSE: To compare the trueness and precision of different impression techniques for two-implant-supported fixed dental prostheses between extraoral and intraoral conditions at different locations. METHODS: Six volunteers participated in this study. A resin block with two parallel analogs was fabricated as an implant site simulator (ISS). The ISS was bonded to a molded ethylene vinyl acetate sheet to create a reference model. For each participant, four reference models were prepared based on the locations of the ISSs: maxillary posterior/anterior region (MaxP/MaxA) and mandibular posterior/anterior region (ManP/ManA). Five impressions were taken extraorally using the open-tray (conventional implant impression technique, CIT) and intraoral scanning (digital implant impression technique, DIT) techniques. The reference models were positioned in the participants' mouths, and impressions were obtained intraorally using the CIT and DIT. The interanalog distance (d) and angulation (θ) were measured to calculate trueness (Δd, Δθ) and precision (dP, θP). Two-way ANOVA and t tests were performed (α=0.05). RESULTS: For the DIT, under intraoral conditions, the Δd and Δθ in MaxP and Δθ in ManP were significantly higher than those under extraoral conditions. For the CIT, under intraoral conditions, the Δd and Δθ in ManA and ManP and Δθ in MaxP were significantly lower than those under extraoral conditions. No significant differences in the dP and θP of either DIT or CIT were observed between the two conditions. CONCLUSIONS: Intraoral conditions affected the trueness of DIT and CIT in different regions but had no influence on precision.

Effects of the Oat Hay Feeding Method and Compound Probiotic Supplementation on the Growth, Antioxidant Capacity, Immunity, and Rumen Bacteria Community of Dairy Calves.

This study aimed to investigate the effects of the oat hay feeding method and compound probiotics (CMP) on the growth, health, serum antioxidant and immune indicators, rumen fermentation, and bacteria community of dairy calves from 3 to 5 months of age. Forty-eight female Holstein calves (80 ± 7 days of age, 93.71 ± 5.33 kg BW) were selected and randomly divided into four groups. A 2 × 2 factorial design was adopted for the experiment, with the factors of the oat hay feeding method (fed as free-choice or 16.7% in the diet) and compound probiotics (CMP) inclusion (0.15% or 0%) in the pelleted starter. The results showed that, compared with giving oat hay as free-choice, feeding a diet of 16.7% oat hay increased the pelleted starter intake at 1-84 d (p < 0.05), with an average daily gain (ADG) at 61-84 d (p = 0.02); adding CMP to the pelleted starter did not significantly affect body weight, and reduced the fecal index (p < 0.05). Feeding 16.7% oat hay increased the concentration of IgA, IgG, and IgM (p < 0.01), while adding CMP increased the catalase (p < 0.01) and decreased the concentration of malondialdehyde (p < 0.01) in serum. Feeding 16.7% oat hay increased the ruminal concentration of propionic acid (p < 0.05) and isobutyric acid (p = 0.08), and decreased the ruminal pH (p = 0.08), the concentration of acetic acid (p < 0.05), and the ratio of acetic acid to propionic acid (p < 0.01). Feeding 16.7% oat hay reduced the relative abundance of ruminal Firmicutes, Unidentified-Bacteria, Actinobacteria, Prevotella, NK4A214-group, Olsenella, and Actinobacteriota (p < 0.05); adding CMP increased the relative abundance of ruminal Prevotella, Rikenellaceae-RC9-gut-group, Ruminococcus, NK4A214-group, and Ruminococcus (p < 0.05), and decreased the abundance of Desulfobacterora, Prevotella-7, and Erysipelotricaceae-UCG-002 (p < 0.05). In conclusion, feeding a diet of 16.7% oat hay increased the pelleted starter intake and average daily gain, while slightly reducing the ruminal pH values; adding CMP to the pelleted starter resulted in reduced diarrhea incidence, increased serum antioxidant capacity and immunity, as well as ruminal richness and diversity of microorganisms in dairy calves from 3 to 5 months of age.

[Prognostic analysis of N2 non-small cell lung cancer].

OBJECTIVE: To evaluate the surgical therapeutic strategy and prognostic factors for non-small cell lung cancer (NSCLC) with mediastinal lymph node metastasis (N2). METHODS: The survival rate of 117 patients with N2 NSCLC treated surgically from January 1999 to May 2003 were analyzed. There were 88 male cases and 29 female cases, aged from 29 to 79 years. The procedure of operation (lobectomy, pneumonectomy and palliative resection), histological classification (squamous cell carcinoma, adenocarcinoma, mixed carcinoma, and large cell carcinoma and others), T primary tumor status, and adjuvant therapy were analyzed to determine their impact on the 5-year survival rate. RESULTS: The median survival time was 22 months, and the over-all 3- and 5-year survival rate was 28.1% and 19.0%. Survival was higher in patients with lobectomy than with palliative resection, with T1 and T2 than with T4. The 5-year survival rate had no deference in age, sex and different histological classification. The 5-year survival rates of lobectomy and pneumonectomy (22.2% and 25.0% respectively) was higher than palliative resection (9.1%). CONCLUSIONS: Surgical procedures (especially lobectomy) is the best choice for N2 NSCLC patients with T1 or T2. But it can not prolong T4 patients' life significantly.

[The cryosurgery of central lung cancer by rigid bronchoscopy].

OBJECTIVE: To evaluate the method and effectiveness of rigid-bronchoscopic cryosurgery for advanced central lung cancer. METHODS: Forty-eight patients were enrolled in this study from June 2002 to December 2008, including 33 male and 15 female. The average age was 70 years (ranged from 45 to 83 years old). For the 48 patients, 38 cases were patients with advanced central lung cancer who were not suitable for surgery, and the remaining 10 cases were patients with local recurrence in trachea or main bronchus postoperatively. Cryosurgery was performed 120 times for all patients, 2.5 times per patient on average. The trachea or bronchus station, symptom such as dyspnea, hemoptysis, respiratory function and quality of life were observed. RESULTS: The unblocked ratio of trachea and bronchi was 97%. All patients got satisfied improvement ratio of symptoms, 87.5% for dyspnea, 72.9% for cough, 93.8% for hemoptysis and 62.5% for chest pain. Respiratory function tests showed that both the mean forced expiratory volume in first second and forced vital capacity got an improvement from (1.03+/-0.05) L to (1.85+/-0.13) L and from (1.69+/-0.18) L to (2.96+/-0.14) L respectively (P<0.01). Karnofsky score also got no less than 20 scores improvement. The Follow-up time was 6 to 62 months. The longest survival was 62 months. The median survival time was 20 months. There was no severe perioperative complications and mortality except for 3 cases of moderate exeduation. CONCLUSIONS: Cryosurgery is easy to perform with minimal complications. Not only could it provide an effective and rapid control of symptoms caused by central lung cancer, it could also unobstructed bronchus promptly and improve patients' quality of life.

[Results of myasthenia gravis treated with thymectomy].

OBJECTIVE: To evaluate the effectiveness of thymectomy for myasthenia gravis (MG) and the relative risk factors for postoperative myasthenic crisis. METHODS: The clinic data of 78 cases with MG who underwent thymectomy from June 1985 to June 2005 were analyzed retrospectively. The relative risk factors of postoperative myasthenic crisis were analyzed and the differences between new and old region of perioperative management were compared. RESULTS: The symptom of MG was complete remission in 21 cases, significantly improved in 38 cases, improved in 11 cases and unchanged in 8 cases, respectively. The symptom duration before operation, preoperative serum level of anti-acetylcholine receptor antibody, Osserman stage and pathological type of thymoma were independent relative risk factors for postoperative myasthenic crisis. The new region of perioperative management was significant better than the old one. CONCLUSION: Surgical treatment shows significant clinical benefits for patients with MG.

Impact of inhalational versus intravenous anaesthesia on early delirium and long-term survival in elderly patients after cancer surgery: study protocol of a multicentre, open-label, and randomised controlled trial.

INTRODUCTION: Elderly patients who have solid organ cancer often receive surgery. Some of them may develop delirium after surgery and delirium development is associated with worse outcomes. Furthermore, despite all of the advances in medical care, the long-term survival in cancer patients is far from optimal. Evidences suggest that choice of anaesthetics during surgery, that is, either inhalational or intravenous anaesthetics, may influence outcomes. However, the impact of general anaesthesia type on the occurrence of postoperative delirium is inconclusive. Although retrospective studies suggest that propofol-based intravenous anaesthesia was associated with longer survival after cancer surgery when compared with inhalational anaesthesia, prospective studies as such are still lacking. The purposes of this randomised controlled trial are to test the hypotheses that when compared with sevoflurane-based inhalational anaesthesia, propofol-based intravenous anaesthesia may reduce the incidence of early delirium and prolong long-term survival in elderly patients after major cancer surgery. METHODS AND ANALYSIS: This is a multicentre, open-label, randomised controlled trial with two parallel arms. 1200 elderly patients (≥65 years but <90 years) who are scheduled to undergo major cancer surgery (with predicted duration ≥2 hours) are randomised to receive either sevoflurane-based inhalational anaesthesia or propofol-based intravenous anaesthesia. Other anaesthetics and supplemental drugs including sedatives, opioids and muscle relaxants are administered in both arms according to routine practice. The primary early outcome is the incidence of 7-day delirium after surgery and the primary long-term outcome is the duration of 3-year survival after surgery. ETHICS AND DISSEMINATION: The study protocol has been approved by the Clinical Research Ethics Committees of Peking University First Hospital (2015[869]) and all participating centres. The results of early and long-term outcomes will be analysed and reported separately. TRIAL REGISTRATION NUMBER: ChiCTR-IPR-15006209; NCT02662257; NCT02660411.

For non-small cell lung cancer with T3 (central) disease, sleeve lobectomy or pneumonectomy?

BACKGROUND: Pneumonectomy (PN) has traditionally been the treatment of choice for central lung tumors for which the alternative is sleeve lobectomy (SL). The aim of this study was to compare early and long-term results after SL and PN in focusing on T3 central non-small cell lung cancer (NSCLC). METHODS: Patients who underwent SL (n=58) or PN (n=42) were retrospectively analyzed. For bias reduction, these 100 patients had been selected according to the following criteria: (I) tumor located in the main bronchus less than 2 cm distal to the carina; (II) there were no N2 disease; (III) no induction therapy was applied; (IV) complete resection (R0) was achieved. RESULTS: SL and PN patients had comparable mean ages, gender distribution, mean forced expiratory volume in 1 second (FEV1), stage and tumor grade. Postoperative mortality (3.4% vs. 4.8%, P=1.0) and morbidity (41% vs. 38%, P=0.74) were similar between the two groups. Recurrences occurred in 48% of patients after SL and in 31% of those after PN (P=0.08). The 5-year survival after SL (64.8%) and PN (61.4%) was not significantly different (P=0.20). Multivariable survival analysis showed that there were no independent prognostic factors. CONCLUSIONS: SL does not compromise survival for NSCLC with T3 central disease compared with PN. It is an adequate oncologic resection and should be treated as the first line intervention whenever complete resection can be achieved.

Down-regulation of microRNA-144 in air pollution-related lung cancer.

Air pollution has been classified as a group 1 carcinogen in humans, but the underlying tumourigenic mechanisms remain unclear. In Xuanwei city of Yunnan Province, the lung cancer incidence is among the highest in China, owing to severe air pollution generated by the combustion of smoky coal, providing a unique opportunity to dissect lung carcinogenesis. To identify abnormal miRNAs critical for air pollution-related tumourigenesis, we performed microRNA microarray analysis in 6 Xuanwei non-small cell lung cancers (NSCLCs) and 4 NSCLCs from control regions where smoky coal was not used. We found 13 down-regulated and 2 up-regulated miRNAs in Xuanwei NSCLCs. Among them, miR-144 was one of the most significantly down-regulated miRNAs. The expanded experiments showed that miR-144 was down-regulated in 45/51 (88.2%) Xuanwei NSCLCs and 34/54 (63%) control region NSCLCs (p = 0.016). MiR-144 interacted with the oncogene Zeb1 at 2 sites in its 3' untranslated region, and a decrease in miR-144 resulted in increased Zeb1 expression and an epithelial mesenchymal transition phenotype. Ectopic expression of miR-144 suppressed NSCLCs in vitro and in vivo by targeting Zeb1. These results indicate that down-regulation of miR-144 is critical for air pollution-related lung cancer, and the miR-144-Zeb1 signalling pathway could represent a potential therapeutic target.

Tobacco smoke induces production of chemokine CCL20 to promote lung cancer.

Tobacco kills nearly 6 million people each year, and 90% of the annual 1.59 million lung cancer deaths worldwide are caused by cigarette smoke. Clinically, a long latency is required for individuals to develop lung cancer since they were first exposed to smoking. In this study, we aimed to identify clinical relevant inflammatory factors that are critical for carcinogenesis by treating normal human lung epithelial cells with tobacco carcinogen nicotine-derived nitrosaminoketone (NNK) for a long period (60 days) and systematic screening in 84 cytokines/chemokines. We found that a chemokine CCL20 was significantly up-regulated by NNK, and in 78/173 (45.1%) patients the expression of CCL20 was higher in tumor samples than their adjacent normal lung tissues. Interestingly, CCL20 was up-regulated in 48/92 (52.2%) smoker and 29/78 (37.2%) nonsmoker patients (p = 0.05), and high CCL20 was associated with poor prognosis. NNK induced the production of CCL20, which promoted lung cancer cell proliferation and migration. In addition, an anti-inflammation drug, dexamethasone, inhibited NNK-induced CCL20 production and suppressed lung cancer in vitro and in vivo. These results indicate that CCL20 is crucial for tobacco smoke-caused lung cancer, and anti-CCL20 could be a rational approach to fight against this deadly disease.

[Results of unilateral lung volume reduction surgery in twenty-five patients with chronic obstructive pulmonary disease].

OBJECTIVE: To evaluate the effectiveness of unilateral lung volume reduction surgery (LVRS) in patients with chronic obstructive pulmonary disease (COPD). METHODS: The follow-up data of 25 patients with COPD who had underwent unilateral LVRS between January 1996 to December 2002 in department of thoracic surgery, China-Japan friendship hospital were analyzed retrospectively. The operative target was determined by pre-operative CT and pulmonary ventilation-perfusion (V/Q) scintigraphy. LVRS was performed in 21 patients through video assisted thoracoscopy surgery (VATS) or VATS with adjuvant small lateral thoracotomy. In 4 patients LVRS was performed through posterolateral thoracotomy. Destroyed pulmonary tissue was resected by liner stapler or Endo GIA. To evaluate the effectiveness of unilateral LVRS, the changing of dyspnea score, pulmonary function and the quality of life were analyzed. RESULTS: The postoperative follow-up interval range was 2 years. The mean postoperative FEV(1) increased by (35 +/- 9)%, and six minute walking distance (6MWD) increased by (88 +/- 22)%. For dyspnea score, among 16 patients with a preoperative grade of IV, 4 patients improved to grade I, 12 improved to grade II; among 9 patients with a preoperative grade of V, 1 improved to grade I, 1 improved to grade II, 4 improved to grade III, and the other 3 improved to grade IV. Karnofsky score increased by (44 +/- 10) in average. One and two year survival rates was 96% and 92%, respectively. There was no perioperative death in this group, and the total postoperative morbidity was 32%. CONCLUSIONS: Unilateral LVRS shows significant clinical benefits for the majority of patients with COPD. It is associated with lower operative mortality and morbidity, and has a wide range of indications. The key points of the operation are to resect dysfunctional lung tissues as much as possible and to prevent pulmonary air leak. Preoperative and postoperative breathing training plays a very important role in the postoperative recovering of lung function.

Expression of CCL2 and CCR2 in the hippocampus and the interventional roles of propofol in rat cerebral ischemia/reperfusion.

The aim of the present study was to determine the roles of the chemotactic factor, chemokine ligand 2 (CCL2), and its receptor, chemokine receptor type 2 (CCR2), in the hippocampus of rats with cerebral ischemia/reperfusion injury. In total, 24 Sprague-Dawley rats, weighting 250-300 g, were randomly divided into three groups (n=8): Sham-operated (C group), cerebral ischemia/reperfusion injury (I/R group) and propofol-intervention (P group) groups. The rats were sacrificed at 6 h after the ischemia/reperfusion surgery, and the brains were obtained to isolate the hippocampus. The mRNA expression levels of CCL2 and CCR2 in the hippocampus were analyzed by quantitative polymerase chain reaction, while the protein expression levels of CCL2 and CCR2 were determined by western blot analysis. The expression levels of CCL2 and CCR2 in the procerebrum were markedly elevated in the I/R and P groups at 6 h after the ischemia/reperfusion surgery when compared with the C group (P<0.05). In addition, the mRNA expression levels of CCL2 and CCR2 decreased significantly in the P group as compared with that in the I/R group (P<0.05). Therefore, CCL2 and CCR2 may be involved in the mechanisms underlying cerebral ischemia/reperfusion injury, and propofol may protect the brain through regulating the expression of CCL2 and CCR2.

[Role of aerodynamic parameters in voice function assessment].

OBJECTIVE: To investigate the application and significance of aerodynamic parameters in voice function assessment. METHODS: The phonatory aerodynamic system (PAS) was used to collect aerodynamic parameters from subjects with normal voice, vocal fold polyp, vocal fold cyst, and vocal fold immobility. Multivariate statistical analysis was used to compare measurements across groups. RESULTS: Phonation threshold flow (PTF), mean flow rate (MFR), maximum phonation time (MPT), and glottal resistance (GR) in one hundred normal subjects were significantly affected by sex (P < 0.05), while phonation threshold pressure (PTP), subglottal pressure (SGP), and vocal efficiency (VE) were not (P > 0.05). PTP, PTF, MFR, SGP, and MPT were significantly different between normal voice and voice disorders (P < 0.01), and there were no significant differences among the three disorders (P > 0.05). Receiver operating characteristic (ROC) analysis found that PTP, PTF, SGP, MFR, MPT, and VE in one hundred thirteen voice dis orders had similar diagnostic utility (P < 0.01), with PTP exhibiting the highest area under the curve. The aerodynamic parameters of the three degrees of voice dysfunction due to vocal cord polyps were compared and found to have no significant differences (P > 0.05). PTP, PTF, MFR, SGP and MPT in forty one patients with vocal polyps were significantly different after surgical resection of vocal cord polyps (P < 0.01). CONCLUSION: The aerodynamic parameters can objectively and effectively evaluate the variations of vocal function, and have good auxiliary diagnostic value.