Xuzhou Medical University Research Articles

Association of pregnancy-associated plasma protein A and vascular endothelial growth factor with pregnancy-induced hypertension.

The present study aimed to evaluate changes of pregnancy-associated plasma protein A (PAPP-A) and vascular endothelial growth factor (VEGF) in pregnancy-induced hypertension (PIH). A total of 105 cases (observation group) with complete data that underwent delivery and suffered from PIH in The Affiliated Hospital of Xuzhou Medical University from February 2015 to February 2017 were retrospectively analyzed. The observation group was further divided into the mild observation and severe observation groups according to severity degree of the disease. Another 65 asymptomatic pregnant women were recruited as the healthy control group. Basic data, obstetric data, PAPP-A and VEGF and data of perinatal infants were compared and analyzed. The Logistic regression model was adopted to screen out risk factors for PIH. In the observation group, the rate of periodic antenatal care was lower, and there were more primigravidas and housewives, with lower education level and economic income (P<0.05). In the observation group, the occurrence rates of placental abruption as well as turbid and bloody amniotic fluid were higher than those in the healthy control group (P<0.05). The neonatal birth weight was lower in the observation group than that in the healthy control group, while the occurrence rates of neonatal department transfer, small for gestational age (SGA), neonatal asphyxia and survival rates of perinatal infants were higher (P<0.05). PAPP-A levels at 34–40 gestational weeks in the observation group were significantly higher than those in the healthy control group (P<0.05). VEGF levels were lower than those in the healthy control group (P<0.05). Multivariate analysis revealed that high PAPP-A value [odds ratio (OR)=3.736] and identity of housewife (OR=2.514) were risk factors for PIH, while high VEGF value (OR=5.258), non-primigravid (OR=2.173), higher economic income (OR=4.162) and periodic antenatal care (OR=1.201) were regarded as protective factors. Therefore, enhancement of gestational management, early discovery and early treatment are critical for improving the prognosis of pregnant women and infants.

Changes in methylation status of the whole genome and GCH1 gene in patients with herpes zoster neuralgia

Objective To analyze the correlation between herpes zoster neuralgia and the methylation status of the whole genome and GCH1 gene. Methods From June to October in 2017, patients with confirmed herpes zoster and obvious neuralgia were selected in Department of Dermatology, The Affiliated Hospital of Xuzhou Medical University, who achieved complete remission (no effect was observed on normal sleep) of neuralgia after antiviral and neurotrophic treatment. Finally, 36 patients and 36 healthy controls were enrolled into this study. Peripheral blood samples were obtained from the healthy controls and patients before and after the treatment. Dot-blot hybridization assay was performed to determine the methylation status of the whole genome, methylated-DNA IP kit was used to enrich the methylation sites of the GCH1 gene, and real-time quantitative PCR was conducted to detect changes in methylation status of the GCH1 gene. Statistical analysis was carried out with GraphPad Prism v7.00 software by using paired t test for the comparison of methylation status before and after the treatment, and two-sample t test for the comparison between the patient group and control group. Results The relative methylation level of the whole genome was 135.94 ± 2.52 in the patients before treatment, significantly lower than that in the patients after treatment (144.76 ± 3.48, t=2.056, P 0.05) . Compared with the patients after treatment (0.89 ± 0.13) and healthy control group (0.97 ± 0.07) , the methylation status of the GCH1 gene significantly decreased in the patients before treatment (0.65 ± 0.17; t=3.977, 4.648 respectively, P 0.05) . Conclusion The methylation status of the whole genome and GCH1 gene markedly decreased in the patients with herpes zoster neuralgia. Key words: Neuralgia, postherpetic; Methylation; Epigenomics; GCH1 gene

Correlation analysis between mechanical power and lung ultrasound score and their evaluation of prognosis in patients with acute respiratory distress syndrome

To investigate the clinical correlations between mechanical power (MP) and lung ultrasound score (LUS), and analyze their evaluation value of prognosis in patients with acute respiratory distress syndrome (ARDS). Patients with moderate to severe ARDS, who underwent invasive mechanical ventilation admitted to intensive care unit (ICU) of the Lianyungang Affiliated Hospital of Xuzhou Medical University from January 2017 to March 2019 were enrolled. The MP and LUS were recorded 0, 24, 48 and 72 hours after ICU admission. The patients were divided into death group and survival group according to the 28-day prognosis. The trends of MP and LUS in the two groups and their differences between groups were analyzed. Then the MP and LUS were analyzed by bivariate correlation analysis, and their correlations with acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), oxygenation index (PaO2/FiO2), and blood lactate (Lac) were also analyzed. The predictive value of MP and LUS 0 hour and 72 hours in ICU for 28-day mortality in patients with moderate to severe ARDS was analyzed by receiver operating characteristic (ROC) curve. At the end, 83 patients were enrolled, with 32 died and 51 survived in 28-day. The Lac level, APACHE II and SOFA in the death group were significantly higher than those in the survival group, while PaO2/FiO2 was significantly lower than the survival group, and the other baseline indicators were not statistically significant between the two groups. As the treatment time increased, the MP and LUS of the survival group showed a significant decrease trend, while the death group showed a significant upward trend. The MP and LUS of the death group 0, 24, 48, 72 hours after ICU admission were significantly higher than those of the survival group [MP (J/min): 20.97±3.34 vs. 17.20±4.71, 21.56±3.48 vs. 16.87±3.85, 22.72±2.97 vs. 16.13±3.52, 25.81±3.46 vs. 15.24±3.78; LUS: 19.17±3.31 vs. 16.27±4.28, 20.28±3.65 vs. 15.27±3.23, 21.53±4.32 vs. 13.63±3.71, 23.94±3.82 vs. 12.53±2.94, all P < 0.05]. There was a significant positive correlation between MP and LUS 0, 24, 48, 72 hours after ICU admission (r value was 0.547, 0.577, 0.754, and 0.783, respectively, all P < 0.01). The MP and LUS at 0 hour of ICU admission were significantly positively correlated with SOFA and PaO2/FiO2 (r value was 0.421, 0.450, and 0.409, 0.536, respectively, all P < 0.01), but no correlation with Lac and APACHE II was found. The ROC curve analysis showed that the MP and LUS at 0 hour and 72 hours had predictive value for the 28-day mortality [the area under the ROC curve (AUC) of MP was 0.836, 0.867; and the AUC of LUS was 0.820, 0.891, all P < 0.01]. There was a significant correlation between MP and LUS in patients with moderate to severe ARDS. The MP and LUS could be used early to evaluate the 28-day prognosis of patients with moderate to severe ARDS.

Multivariate Analysis of Factors Influencing Recovery from Hemorrhagic Cystitis after Allo-HSCT

To analyze the incidence of hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation and the factors affecting HC, so as to provide clinical evidence for further treatment of HC. The HC of 113 patients after allogeneic hematopoietic stem cell transplantation in Affiliated Hospital of Xuzhou Medical University between the years 2014-2016 was analyzed respectively. All cases of HC were divided into HC group and non-HC(control) group. The follow-up time: from preeonditionig day to 180 d after transplantation. The 10 clinical parameters were selected for univariate analysis with COX regression analysis: sex, age (＜25 years and 25 years), primary disease, conditioning regimen with anti-thymoglobulin(ATG), sex-mismatch in recipients, haploidential HSCT, cytomegalovirus (CMV) viremia, EB viremia, graft-versus-host disease (GVHD), and primary disease relapse, the factors significant at the 0.1 level in univariate analysis should be further evaluated by multivariate analysis using a COX regression analysis. The difference was significant at P＜0.05 in multivariate analysis. The HC occured in 31 of 113 patients (27.4%), with 5 cases of grade I (5.5%), 19 of grade II (16.8%), 5 of grade III (4.4%), and 2 of grade IV (1.8%). The median time of HC onset was 37 days (26-70 d) after transplantation. The median duration of HC was 14 days (5-55d). Univariate analysis showed that conditioning with anti-thymoglobulin (ATG) (RR=6.170, 95%CI: 1.875-20.306, P＜0.01), CMV viremia (RR=7.633, 95%CI：2.318-25.133) (P＜0.01), haploidentical HSCT (RR=0.307, 95%CI：0.137-0.686, P＜0.01), GVHD (RR=1.891, 95%CI：0.918-3.898, P＞0.05) were the risk factors for recovery from HC. The multivatiate analysis of above-mentioned risk factors with statistical significance showed that only CMV viremia (RR=4.770, 95%CI: 1.394-16.326, P＜0.05) was the indentified risk factor affecting the recovery from HC. Monitoring CMV viremia and antivirotic treatment are effective measurs to prevent the occurrence of HC and promote the recovery from HC.

Preliminary application of three-dimensional visualization in interventional treatment of Budd-Chiari syndrome

Objective To analyze the application of three-dimensional visualization in interventional treatment of Budd-Chiari syndrome (BCS) with the hepatic vein occlusion type. Methods A retrospective study was conducted on 15 patients with BCS of the hepatic vein occlusion type who were admitted to the Affiliated Hospital of Xuzhou Medical University from January 2017 to June 2018. The study included 8 males and 7 females with a mean age of (36.7±14.4) years. All patients were examined with MRI enhanced scanning and the original MRI data of the DICOM format were extracted. The digital data were then extracted and reconstructed by the Mimics software to obtain a three-dimensional visualization model. The hepatic vein was recanalized under the guidance of the three-dimensional visualization model. Results The three-dimensional visualization model was successfully constructed. Of all the 15 three-dimensional visualization models, right hepatic vein ostial stenosis occurred in 4 patients and occlusion in 11 patients. The middle hepatic vein and the left hepatic vein formed a common trunk in 15 patients, and ostial stenosis and occlusion of the common trunk occurred in 3 and 12 patients, respectively. Communicating branches between the right and middle hepatic veins occurred in 6 patients. Accessory hepatic veins occurred in 3 of 15 patients, and the accessory hepatic vein ostium was stenosed in 3 patients. Communicating branches between the accessory hepatic vein and the right hepatic vein occurred in 2 patients, and communicating branches between the accessory hepatic vein and the middle hepatic vein occurred in 1 patient. All patients were treated successfully with interventional treatment without any complications. One, 2, and 3 hepatic veins were recanalized in 7, 5 and 3 patients, respectively. Conclusion The three-dimensional visualization was valuable in displaying the location, pattern and collateral vessels of the hepatic veins in BCS patients with the hepatic vein occlusion type. It was helpful for accurate preoperative assessment and to make individualized interventional treatment plans. Key words: Budd-Chiari syndrome; Hepatic vein; Imaging, three-dimensional; Interventional treatment

Preliminary observation on the changes of T(1) weighted signal of globus pallidus after multiple intravenous injection of linear gadolinium contrast agent

Objective: To explore the changes in signal intensity (SI) ratios of globus pallidus (GP) on unenhanced T(1)-weighted(T(1)WI)magnetic resonance imaging (MRI) scans between the first and last MRI using the linear gadolinium-based contrast agent (GBCAs) intravenously. Methods: Clinical and imaging data of 114 patients who underwent at least 4 consecutive enhanced MRI examinations at the Affiliated Hospital of Xuzhou Medical University between January 2016 and April 2018 were analyzed. The SI ratio of GP, thalamus and cerebrospinal fluid (CSF) were measured on unenhanced T(1)WI. The GP to thalamus SI ratio was calculated by dividing the SI in the GP by that in the thalamus, and so was the GP to CSF SI ratio. The difference of SI ratio in the same patient was analyzed by nonparametric tests, linear regression analysis was used to analyze clinical factors. Results: The SI ratio of GP-to-thalamus and GP-to-CSF after multiple enhancement were higher than before, and the difference was statistically significant. The SI ratio of GP-to-thalamus and GP-to-CSF before and after repeated contrast-enhanced were 1.036(1.010, 1.075), 1.104(1.074, 1.168); 4.215(3.590, 5.614), 5.409(4.213, 6.502), all P<0.01. The SI ratio differences showed a significant positive correlation with the number of enhanced examination(pons:b=0.023, P<0.01,CSF:b=0.279,P=0.034), and a significant negative correlation with the interval (pons: b=-0.002,P< 0.01, CSF: b=-0.023, P=0.039). There was no correlation with other clinical factors (all P>0.05). Conclusions: There is an increase in SI in the GP after serial injections of linear GBCAs, and there is a positive correlation with the times of enhanced examination, and a negative correlation with time interval.

Clinical efficacy of montelukast sodium combined with budesonide or combined with loratadine in treating children with cough variant asthma and influence on inflammatory factors in the serum.

Clinical efficacy of montelukast sodium combined with budesonide or combined with loratadine in children with cough variant asthma was investigated. A retrospective analysis of the medical records of 72 children with cough variant asthma who were treated in Xuzhou Children's Hospital, Xuzhou Medical University from April 2015 to August 2017 was performed and the 72 child patients were divided into two groups: 35 children were treated with montelukast sodium combined with budesonide in Group A, and 37 children were treated with montelukast sodium combined with loratadine in Group B. The clinical efficacy of the two groups was evaluated according to the lung function indexes [forced expiratory volume in the first second (FEV1), ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV1/FVC), the peak expiratory flow (PEF)], the inflammation biomarkers [tumor necrosis factor-α (TNF-α) and interleukin-4 (IL-4)], the level of eosinophil granulocyte, and the level of IgE at three time-points: before treatment, the 4th week after treatment, and the 12th week after treatment as well as adverse reactions, recurrence of symptoms, and treatment compliance were recorded. After treatment, the levels of FEV1, FEV1/FVC, PEF, TNF-α and IL-4, eosinophil granulocyte and IgE in the two groups were significantly improved (P<0.05). The treatment compliance of Group A was significantly lower than that of Group B (P<0.05). In conclusion, the method of montelukast sodium combined with budesonide or loratadine are both worthy of clinical promotion because they have equivalent efficacy in the treatment of cough variant asthma to effectively improve the lung function and inflammatory response in patients and both bring less adverse reactions and lower recurrence rate.

A study on clinical characteristics and the causes of missed diagnosis of reversible posterior leukoencephalopathy syndrome in eclampsia.

To explore the clinical and imaging characteristics and summarize the causes of missed diagnosis of reversible posterior leukoencephalopathy syndrome (RPLS) in eclampsia. We collected the data of a total of 45 patients with RPLS who were misdiagnosed initially (27 cases were confirmed and 18 cases were suspicious) out of 804 patients with severe eclampsia who had presented themselves to the Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2016. We summarized the clinical and imaging characteristics of the patients and analyzed the possible causes of the misdiagnosis. Among the 804 patients with eclampsia, 45 were misdiagnosed the first time. Their clinical manifestations included headache (20 cases), epilepsy (13 cases), blurred vision (11 cases), disturbance of consciousness (2 cases), and drowsiness (3 cases). The parietal lobe was involved in 22 cases, the occipital lobe in 15 cases, the frontal lobe in 20 cases, basal ganglia in 9 cases, and the temporal lobe in 8 cases. Low-density lesions were observed on computed tomography (CT) scans. Head magnetic resonance (MR) scans showed hypo-intense lesions on T1-weighted image (T1WI), hyper-intense lesions on the T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR), iso-intense or slightly hyper-intense lesion on diffusion-weighted imaging (DWI), and slightly hyper-intense or hypo-intense lesion on apparent diffusion coefficient (ADC). The incidence of reversible posterior leukoencephalopathy syndrome is extremely high. The clinical features include headache, mental disturbance, seizures, blurred vision, and other neurological symptoms. The lesion area is mainly limited to the parietal and occipital lobes; however, the frontal lobe, basal ganglia, temporal lobe, corpus callosum, and cerebellum can also be involved. The prognosis is good with timely and appropriate treatments.

Expression of BMP-4 and Smad1 in patients with Hirschsprung disease and its clinical significance.

Expression and clinical significance of bone morphogenetic protein (BMP)-4 and Smad1 in patients with Hirschsprung disease (HD) were investigated. A retrospective analysis of 96 HD patients (experimental group) admitted to Xuzhou Children's Hospital, Xuzhou Medical University from June 2015 to June 2017 was performed. According to the samples, the experimental group was divided into the stenosis group, the transition group and the expansion group. Forty-seven children with colostomy due to intestinal obstruction were selected as the control group. The expression levels of BMP-4 and Smad1 proteins were detected by immunohistochemical staining. The expression levels of BMP-4 and Smad mRNA were detected by real-time quantitative PCR (RT-qPCR), and were quantified and compared. Via immunohistochemistry, BMP-4 and Smad1 proteins were detected in the samples of different parts of HD patients and children with intestinal obstruction. The positive expression levels of BMP-4 and Smad1 proteins in the transition group were decreased compared with those in the expansion and control groups (P<0.05), and the positive expression levels of BMP-4 and Smad1 proteins in the stenosis group were decreased compared with those in the transition, expansion, and control groups (P<0.05). Also, the gene expression levels of BMP-4 and Smad1 in the transition and stenosis groups were successively decreased, and the differences were statistically significant (P<0.05). In conclusion, the expression of BMP-4 and Smad1 in the intestinal plexus of HD lesions was significantly reduced, indicating that BMP-4 and Smad1 are closely related to the occurrence of HD, and it is suspected that they have a certain influence on the intestinal development of congenital digestive tract malformations.

Application value of inferior vena cava venography in correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction in Budd-Chiari syndrome

Objective To investigate the application value of inferior vena cava venography in correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction in Budd-Chiari syndrome (BCS). Methods The retrospective cross-sectional study was conducted. The clinical data of 41 patients with BCS who were admitted to the Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2016 were collected. There were 29 males and 12 females, aged (53±10)years, with a range of 34-70 years. Forty-one BCS patients underwent computed tomography (CT), inferior vena cava CT venography and digital subtraction angiography (DSA) within 2 weeks. Balloon dilatation and (or) endovascular stent implantation of inferior vena cava were performed according to calcification morphology and location of the inferior vena cava obstruction detected by DSA. Observation indicators: (1) calcifications of inferior vena cava obstruction; (2) intraoperative situations of interventional therapy; (3) correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction; (4)follow-up and survival situations. Follow-up using outpatient examination of inferior vena cava venography was performed at 3, 6, 12, 24, 36, 48 months postoperatively to detect postoperative clinical manifestations, complications and survival situations up to December 2018. Measurement data with normal distribution were represented as Mean±SD. Count data were represented as absolute number and comparison between groups was analyzed using the chi-square test. The likelihood ratio test was used to analyze the correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction. The degree of correlation was detected by Cramer′s V contingency coefficient. Results (1) Calcifications of inferior vena cava obstruction: of 41 patients, 17 had no calcification at the inferior vena cava obstruction and 24 had calcifications at the obstruction. Calcification location in 24 patients: there were 17, 4 and 3 patients with proximal, distal, both proximal and distal calcifications at the inferior vena cava obstruction, respectively. Calcification morphology: punctate and irregular calcifications were detected in 20 and 4 patients, respectively. Calcification distribution: 20, 3 and 1 patients had scattered, cluster and diffuse distribution, respectively. (2) Intraoperative situations of interventional therapy: of 41 patients, 21 underwent balloon dilatation and 20 underwent balloon dilatation combined with endovascular stent implantation. Two patients were detected hematoma at the puncture site of right femoral vein and treated using pressure dressing. One patient encountered rupture of balloon due to diffuse calcifications at the inferior vena cava obstruction and was improved after continual replace of balloon for 3 times. One patient had pulmonary embolism caused by detachment of the thrombosis at the distal obstruction during the balloon dilatation and was given anticoagulation therapy combined with thrombolytic therapy using large-dose of urokinase. The other 37 patients underwent successful interventional therapy without exceptional circumstances. (3) Correlation between the subtypes of inferior vena cava obstruction and calcifications at the obstruction: of 24 patients with calcifications at the inferior vena cava obstruction, 13 had membrane obstruction, 7 had segmental obstruction and 4 had fenestrated membrane obstruction. Of 17 patients without calcifications at the inferior vena cava obstruction, 3 had membrane obstruction, 13 had segmental obstruction and 1 had fenestrated membrane obstruction. The likelihood ratio test showed that the subtypes of inferior vena cava obstruction were associated with calcifications at the obstruction (χ2=9.293, P 0.05). (4) Follow-up and survival situations: 41 patients were followed up for 24.0-48.0 months, with a median time of 37.1 months. Postoperative ultrasound showed smooth backflow in the inferior vena cava, different degree of improvements in the lower limb swelling and varicosity in 38 patients. Embolisms in the inferior vena cava obstruction remained existent in 3 patients, 1 of whom showed significant decreasing of embolisms. There were 2 patients found restenosis and undergoing endovascular stent implantation. All the 41 patients survived. Conclusions The subtypes of inferior vena cava obstruction are associated with calcifications at the obstruction in BCS. Inferior vena cava venography evaluating calcifications at the inferior vena cava obstruction in BCS can be helpful for diagnosing the subtypes of inferior vena cava obstruction and guiding its interventional therapy. Key words: Budd-Chiari syndrome; Inferior vena cava; Calcification; Computed tomography, X-ray; Digital subtraction angiography

Effect of rehabilitation therapy and nursing intervention on postoperative recovery of patients with hypertensive intracerebral hemorrhage.

Rehabilitation therapy combined with nursing intervention in postoperative recovery of patients with hypertensive intracerebral hemorrhage was investigated. Retrospective analysis was carried out in 78 patients with severe HICH hematoma evacuation after treatment in Xuzhou No. 1 People's Hospital, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from March 2014 to July 2017. The 28 patients who received routine treatment and nursing care were regarded as the control group, the 27 patients who underwent rehabilitation training based with routine treatment and nursing care were the rehabilitation training group. Moreover, the 23 patients who underwent rehabilitation training and nursing intervention based on routine treatment were regarded as the nursing intervention group. Systolic blood pressure, diastolic blood pressure, and Fugl-Meyer scores were compared immediately after surgery (T1), 4 weeks after treatment (T2) and 12 weeks after treatment (T3). During the period of T3, the total effective rate and adverse reactions were compared among the three groups of patients. The systolic blood pressure and diastolic blood pressure at T3 among the three groups were significantly lower than both T2 and T1, and the systolic and diastolic blood pressure of T2 was lower than T1 (P<0.05). Among the three groups of patients, the Fugl-Meyer score at T3 was significantly higher than both the T2 and T1, and the Fugl-Meyer score at T2 was higher than T1 (P<0.050). In the control group, the number of patients with shoulder-hand syndrome, hemorrhoids, and depression was significantly higher than both the rehabilitation training group and the nursing intervention group (P<0.050). The number of people with depression in the rehabilitation training group was significantly higher than the nursing intervention group (P<0.050). Rehabilitation therapy and nursing intervention are better than routine treatment and nursing for postoperative recovery of HICH patients, and has a lower adverse reaction rates after surgery, it is worthy of promotion clinically.

Comparison of desflurane and sevoflurane on postoperative recovery quality after tonsillectomy and adenoidectomy in children.

Comparison of desflurane and sevoflurane on the postoperative recovery quality after tonsillectomy and adenoidectomy in children was carried out. A retrospective analysis was performed on the medical records of 165 children who underwent tonsil and adenoid radiofrequency ablation under low-temperature plasma and were admitted to the Xuzhou Children's Hospital, Xuzhou Medical University from February 2014 to May 2017. In total, 79 children with sevoflurane anesthesia were in the sevoflurane group, and 86 children with desflurane anesthesia in the desflurane group. The non-invasive blood pressure (NIBP), heart rate (HR) and oxygen saturation (SpO2) level, the postoperative sedation (Ramsay) scores, the modified objective pain score (MOPS) of children were recorded. The pediatric anesthesia emergence delirium (PAED) scores of children were recorded. Children in the sevoflurane group had longer operation time, anesthesia time, extubation time and coincidence time than those in the desflurane group (P<0.05). At the beginning of operation (t1), 10 min after operation (t2), at the time of entering anesthesia recovery room (t3), at the time of tracheal catheter extubated (t4), 10 min after extubation (t5), and at the time of leaving the anesthesia recovery room (t6), children in the sevoflurane had higher NISBP and NIDBP, lower HR than those in the desflurane group (P<0.05). At the time of the tracheal catheter extubation (c2), 10 min after extubation (c3), 30 min after extubation (c4), children in the sevoflurane group had lower Ramsay scores and higher PAED scores than those in the desflurane group (P<0.05). More suitable as an anesthetic maintenance drug for tonsillectomy and adenoidectomy in children, desflurane has a better anesthetic effect and is safer. In addition, children with desflurane anesthesia have high postoperative recovery quality and quick recovery in the short term, with better sedative and analgesic effects. Therefore, it is worthy of promotion in clinic practice.

The aetiologies of unilateral oculomotor nerve palsy: a clinical analysis on 121 patients

Background and purpose: To strengthen the understanding, increase the early diagnostic rate, and improve the outcome of unilateral oculomotor nerve palsy through the analysis of the 121 patients suffering from this disease in our hospital.Methods: A retrospective study was performed on the 121 patients with unilateral oculomotor nerve palsy diagnosed at the Affiliated Hospital of Xuzhou Medical University from October 2014 to October 2015. The clinical data, such as gender, age, aetiology, clinical features, laboratory tests, and six months follow up reports were analyzed.Results: The main causes identified in the 121 patients with unilateral oculomotor nerve palsy were intracranial aneurysm (29.8%), diabetic peripheral neuropathy (26.5%), painful ophthalmoplegia (9.9%), and other causes (33.9%). The results from the six month follow up showed that in all the patients, 53.7% were fully recovered, 38.0% improved, and 8.3% had no significant change in symptoms. The results also indicated that the patients with diabetic peripheral neuropathy had the best outcome with 71.9% full recovery rate, which was significantly higher than that in the patients with intracranial aneurysm (36.1%, p < .05), and idiopathic causes (44.5%, p < .05).Conclusions: Our data indicates that intracranial aneurysm is the leading cause of unilateral oculomotor nerve palsy, and that diabetic peripheral neuropathy has better outcome. Understanding the common causes and clinical features of unilateral oculomotor nerve paralysis is helpful for its early diagnosis and treatment.

Survey and Establishment of the Hematological Parameter Reference Intervals for Adult in Xuzhou Area of China

To establish the reference intervals of the hematological parameters in normal adult people of Xuzhou erea. The red blood cells (RBC), platelets, white blood cells (WBC) and related parameters were detected by hematoanalyzers in 82514 healthy people including 41257 males and 41257 females in the Medical Center of the Affiliated Hospital of Xuzhou Medical University. The range of RBC count: (4.33-5.51) ×1012/L in male and（3.82-4.85）×1012/L in female, the range of Hb level: (132-172) g/L in male and（107-145）g/L in female, the range of HCT: 40 %-50 % in male and 34 %-44 % in female, the range of platelet count: (113-268) ×109/L in male and (126-289) ×109/L in female, the range of WBC count: (4.00-9.40) ×109/L in male and （3.54-9.30）×109/L in female, the range of NEUT count: (1.91-5.76) ×109/L in male and（1.67-5.30）×109/L in female, the range of MONO count: (0.18-0.58) ×109/L in male and（0.16-0.52）×109/L in female, the range of LYM is（1.3-3.4）×109/L in male and（1.2-3.1）×109/L in female, etc.Conclusion: There is significant difference in the blood cell parameters between Xuzhou and other areas. Among them, the lower limit of Hb reference interval for adult women in Xuzhou area is obviously lower, and the upper and lower limits of adult Plt reference interval are significantly lower than other areas in China and abroad. The upper and lower limits of the WBC reference interval are close to the domestic areas, but lower than that in some foreign regions. Through this survey, the reference intervals of different hematologic parameters of healthy people in Xuzhou area primarily has been established, Some of the indexes, such as RBC, Hb, HCT, and Plt have significant sex differences. The reference intervals for them have been estublisted respectively.

Efficacy and safety of propofol in preventing emergence agitation after sevoflurane anesthesia for children.

Application of propofol in preventing emergence agitation after sevoflurane anesthesia in children was evaluated. Clinical data of 200 children who received sevoflurane anesthesia in Children's Hospital of Xuzhou Medical University were retrospectively analyzed. Among them, 120 patients who received inhaled sevoflurane for pediatric anesthesia and intravenous infusion of propofol (2 mg/kg) were included in observation group. The remaining 80 cases who were directly anesthetized by sevoflurane alone were the control group. T PAED scores, modified Aldrete scores, extubation time, PACU time and adverse reactions (gastrointestinal tract and respiratory response) were analyzed and compared between the control and observation group. PAED scores, extubation time, PACU time and incidence of adverse reactions were significantly lower in observation than in control group, and the modified Aldrete scores were higher in observation than in control group (P<0.05). Spearman's correlation analysis showed that the PAED scores were negatively correlated with modified Aldrete scores and positively correlated with extubation time. There was positive correlation between the PACU time and incidence of adverse reactions and between the PAED scores and extubation time. There was negative correlation between PACU time and incidence of adverse reactions and between Aldrete scores and extubation time (P<0.05). Therefore, we conclude that propofol can be used to prevent agitation after sevoflurane anesthesia in children.

Risk factors of coronary artery stenosis in the patients with obstructive sleep apnea: a prospective study

To investigate the prevalence of coronary artery disease and characteristics of coronary artery in patients with obstructive sleep apnoea.The prospective study was conducted at the Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China, from January, 2012, to June, 2015, and comprised consecutive patients with diagnosed obstructive sleep apnoea. High-resolution 320-slice coronary computed tomography was performed in all the patients. Data was evaluated for the presence of coronary lumen narrowing. Demographic, clinical, laboratory, and echocardiographic characteristics were carefully recorded. Logistic regression was used for multivariate analysis of independent risk factors. SPSS 16 was used for data analysis.Of the 277 patients, 186(67.14%) were males. The overallmean age was 55.1±14.3 years. Coronary artery disease was found in 41(14.8%) patients. Prospective Cardiovascular Münster score, uric acid, triglyceride, C-reactive protein, apnoea hypopnoea index, Epworth sleepiness scale values were significantly higher in patients with the disease (p<0.05 each). Higher Prospective Cardiovascular Münster score, C-reactive protein, apnoea hyponoea index levels had a significant ability to reflect the occurrence of coronary artery disease (p<0.05 each).Coronary heart disease occurrence in obstructive sleep apnoea patients was found to be strongly related to Prospective Cardiovascular Münster score, apnoea hyponoea index and Creactive protein level.

The clinical and imaging features of gray matter heterotopia: a clinical analysis on 15 patients.

To investigate the clinical and imaging features of gray matter heterotopia (GMH) and improve the clinicians' understanding of the disease. A retrospective study was performed on 15 patients with GMH diagnosed at The Affiliated Hospital of Xuzhou Medical University from November 2014 to November 2016. Their clinical and imaging features are also summarized. The proportion of male and female patients was 2:1. The age of onset was 2~45years and the average age was 19.1years. There were 13 patients with epilepsy who also had cognitive decline (5 cases) and neurological deficit (3 cases). There were 2 patients with headache or dizziness. The imaging findings of GMH are unilateral or multiple spots in the periventricular or subependymal, subcortical, and centrum semiovale and are often accompanied by other cerebral malformations. We found that 10 patients had the subcortical type of GMH and 5 patients had the subependymal type or periventricular nodular heterotopia type. There were 8 cases of ventricular compression, 5 cases of ventriculomegaly, 5 cases of cerebral fissure malformation, 3 cases of pachygyria, 1 case of callosal agenesis, and 1 case of undeveloped septum pellucidum. All the patients were given symptomatic and supportive therapies and 3 patients were treated with antiepileptic drugs. Seizures were, however, poorly controlled. GMH should also be suspected in patients with juvenile onset of seizures, cognitive decline, and neurological deficits. Magnetic resonance scans may show lesions in the white matter of the brain with signals similar to the normal gray matter.

Effects of mindfulness-based stress reduction on anxiety and depression among breast cancer patients undergoing postoperative chemotherapy

Objective To explore the effects of mindfulness-based stress reduction on anxiety and depression among breast cancer patients undergoing postoperative chemotherapy. Methods A total of 83 cases of breast cancer patients in the Department of Cancer Chemotherapy of Lianyungang Hospital Affiliated to Xuzhou Medical University undergoing postoperative chemotherapy were recruited and randomly divided into experimental group (n=42) and control group (n=41) . The control group received the routine care, while the experimental group received an 8-week mindfulness-based stress reduction therapy on the basis of routine care. A research assistant who was blinded to the intervention collected the data using Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) at baseline and immediately after the intervention. Results No significant difference was detected between the experimental and control group in anxiety and depression at baseline (P>0.05) . A significant difference was found between the experimental group and the control group after the intervention in anxiety and depression (P<0.05) . In the experimental group, a significant reduction in anxiety and depression was obtained after the intervention (P<0.05) . Conclusions Mindfulness-based stress reduction effectively reduced the level of anxiety and depression of breast cancer patients undergoing postoperative chemotherapy. It could be integrated into routine care or continuing nursing care. Key words: Breast neoplasms; Anxiety; Depression; Mindfulness-based stress reduction

Clinical analysis on one patient with hemophilia A complicated with primary immune thrombocytopenia

Objective To investigate the diagnosis, treatment and prognosis of hemophilia A combined with primary immune thrombocytopenia (ITP). Methods The hemophilia A patient with ITP (male, 30 years old)admitted to the Department of Hematology, Xuzhou Medical University Affiliated Hospital on February 21, 2017 was selected as the study subject. During hospitalization, he was repeatedly treated with coagulation factor replacement therapy strategy, as well as symptomatic treatment measures such as hemostasis, platelet transfusion, intravenous infusion of glucocorticoids, and intravenous immunoglobulin (IVIG). By retrospective analysis, his clinical data were collected, and the clinical features, diagnosis and treatment were summarized. This study met the requirements of the Helsinki Declaration of the World Medical Association revised in 2013, and the informed consent of the subjects was obtained, and informed consent was signed with him. Results ① This patient was diagnosed as hemophilia A more than 20 years ago. During that period, the patient achieved a obvious effect by cryoprecipitation and recombinant human FⅧ infusion. About a month ago, without obvious inducement, the patient developed hematuria, epistaxis and oral hemorrhage. His activity of FⅧ was only 21.3%, and the platelet count was just 3×109/L. The patient received phenethylamine, recombinant human FⅧ, methylprednisolone, and intravenous immunoglobulin (IVIG) , but which was not effective for him. ② After admission to our hospital on February 21, 2017, the results of laboratory tests showed that the patient′s platelet count was very low, only for 2×109/L. His activity of FⅧ was 14.3%, and activity of FⅨwas 49.8%. Activated partial thromboplastin time (APTT) prolonged to 50.2 s, APTT was 32.1 s after correction, APTT (incubated at 37 ℃ for 2 h) prolonged to 50.0 s, and APTT (incubated at 37 ℃ for 2 h) was 37.9 s after correction. Morphological examination of bone marrow cells showed that bone marrow cells proliferated actively, granulocytes and erythroid line cells were proliferated, and the morphology was normal, as well as megakaryocyte maturation was accompanied by thrombocytopenia. Abdominal ultrasound results showed that the liver area was dense, the gallbladder wall was rough, and the spleen was not large (about 9.7 cm × 7.0 cm). ③ After admission, combining with previous medical history, results of relevant laboratory examinations and auxiliary examinations, the patient was diagnosed as hemophilia A combined with ITP by excluding other secondary diseases which caused thrombocytopenia. ④ After admission, the patient was repeatedly treated with recombinant human FⅧ. But the patient′s highest activity of FⅧ was only 25.8%, and APTT prolonged to 45.0 s, which suggested that the patient was partially tolerant to treatment. After receiving multiple platelet transfusions, the patient′s platelet count was still low, and did not exceed to 20×109/L, which suggested that the treatment is invalid. On May 5, 2017, the patient started oral eltrombopag (75 mg/d). After 3 months of treatment, the patient′s platelet count was up to 55×109/L, and the evaluation of efficacy was effective. However, after one month of discontinuation of eltrombopag, the patient′s platelet count fell to 10×109/L, which suggested that his disease relapsed. Conclusions Patients with hemophilia A combined with ITP, were clotting factor deficiency and thrombocytopenia, the risk of bleeding of them were high, and the treatment is difficult. In addition to infusion of recombinant human FⅧ, glucocorticoid and other drugs should be given to elevate platelet count, but the prognosis of this patient is not good. Patients with hemophilia A combined with ITP are rare in clinic, and its standard and effective treatment strategy requires a large sample size and multi-center study to further explore. Key words: Hemophilia A; Purpura, thrombocytopenic, idiopathic; Hemorrhage; Drug therapy; Prognosis; Primary immune thrombocytopenia

Risk factors affecting prognosis in post-traumatic hydrocephalus patients after traumatic brain injury

Objective To investigate the risk factors affecting the prognosis of patients with hydrocephalus after traumatic brain injury (TBI). Methods A retrospective case control study was performed to analyze the clinical data of 70 patients with hydrocephalus after TBI admitted to the Lianyungang Hospital of Xuzhou Medical University from March 2012 to October 2017, including 54 males and 16 females. The Glasgow Outcome Score (GOS) was used as an indicator to evaluate the prognosis of patients after 3 months of treatment. According to the GOS, the patients were divided into good prognosis group (GOS>3 points, 27 patients) and poor prognosis group (GOS≤3 points, 51 patients). A total of 18 factors including gender, age, Glasgow Coma Score (GCS) on admission, platelet count, coagulation function, plasma fibrinogen levels, D-Dimer concentration, brain contusion, subarachnoid hemorrhage, subdural hygroma, subdural hemorrhage, cerebral hernia, cisterna ambiens disappearance, decompressive craniectomy, cranioplasty, ventriculo-peritoneal (V-P) shunt implantation, intracranial infection, and duration of coma were first analyzed using univariate analysis. Multivariate logistic regression analysis was then performed on the statistically significant factors generated by univariate analysis. Results The univariate analysis indicated that the GCS at admission ≤8 points, cerebral hernia, subarachnoid hemorrhage, subdural hygroma, intracranial infection, cisterna ambiens disappearance, plasma fibrinogen increase, and duration of coma >2 months were associated with the prognosis of hydrocephalus after TBI (P 2 months, and plasma fibrinogen increase were significantly related to the adverse outcomes of hydrocephalus (P<0.05). The total consistence rate of the logistic regression equation for prognosis precliction was 89%. Conclusions The cisterna ambiens disappearance, duration of coma >2 months and plasma fibrinogen increase are the most important factors affecting the prognosis of hydrocephalus after TBI. Clinically, we should strictly control the indications of TBI and hydrocephalus after TBI, take active treatment measures, shorten the duration of coma, and timely monitor the changes in blood coagulation indexes such as plasma fibrinogen, thereby to improve the prognosis of patients with hydrocephalus after TBI. Key words: Hydrocephalus; Prognosis; Risk factor