The defects in observation methodology of diseases,in knowledge of diseases,and in doctors' clinical knowledge and skill were analyzed in this article,which were believed as main medical internal defects(MID).High risks as well as medical disputes cannot be avoided in medical practice due to MID,which also led to ethical challenges in medical disputes prevention and treatment.Emphasis on the knowledge of MID during public education on medical disputes prevention may decrease medical disputes.

Objective To evaluate the influence of dexmedetomidine（Dex） on sedation and requirement of propofol during anesthesia induction. Methods Thirty patients（ASA Ⅰ or Ⅱ） undergoing selective operation were randomly divided into 2 groups：Dexmedetomidine group （group D,n=15） or control group （group C,n=15）. Patients in the group D received 1 μg/kg dex diluted to 10ml over 10 min by pumped infusion and patients in the group C was simply recieved normol saline at the same way.Twenty minutes after administrating the drug,patients in both groups were pumped propofol at the speed of 0.4 mg·kg-1·min-1. When holding up jaw without movement,patients received 1 μg/kg fentanyl and 0.6 mg/kg rocuronium,and endotracheal intubated 1.5 minutes later. RE,SE,Ramsay sedation scale of the patients were recorded before（T0） and after 5,10,20 minutes（T1-T3） of drug adminstration.The minimum dose and total dose of propofol during induction were recorded.Results Compared with group C and T0,RE and SE in group D decreased obviously at T1-T3 （P0.01）,while Ramsay sedation scale rised significantly （P0.01）. Compared with group C,the minimum dose and the total dose of propofol decreased obviously in group D during induction （P0.01）.Conclusion Dexmedetomidine causes sadetive without respiratory depression,and has the propofol sparing effect during anesthesia induction.

BACKGROUND:Renal tubular-interstitial lesion and fibrosis induced by peritubular capil ary reduction is a common pathway for various chronic kidney diseases which eventual y develop into end-stage renal failure. How to increase the density of peritubular capil ary network is the key to resolving renal interstitial fibrosis. Netrin-1, as a potent mitogen of vascular endothelial cel s, can promote the migration and proliferation of vascular endothelial cel s and induce angiogenesis. OBJECTIVE:To observe the protective effects of naked netrin-1 plasmid transfer on the remnant renal function of 5/6 nephrectomized rats and the effects of naked netrin-1 plasmid transfer on peritubular capil ary network, and to further discuss the possible mechanism. METHODS:Thirty Sprague-Dawley rats were randomly divided into sham, model and treatment groups. Upper and lower one-third of the rat left kidney was resected in the model and treatment groups, and then the right kidney was resected after 1 week to prepare remnant kidney models in rats. IRES2-EGFP and pCMV6-XL5-Netrin-1-IRES2-EGFP pGenesil-NPs plasmids were intravenously injected into the left renal vein while resecting the right kidney of rats in the model and treatment groups, respectively. RESULTS AND CONCLUSION:Compared with model group, the levels of blood urea nitrogen and serum creatinine decreased, the degree of renal interstitial fibrosis al eviated, the density of peritubular capil aries increased, and the netrin-1 protein expression in renal tubular cytoplasm increased in the treatment group. These findings suggest that the naked netrin-1 plasmid transfer can significantly improve the renal function of the 5/6 nephrectomized rats, reduce the pathological lesion and renal interstitial fibrosis of the remnant kidney, increase the density of peritubular capil aries, and decrease the expression of hypoxia-inducible factor 1α, thereby improving the anoxic condition of renal interstitial tubules.

Objective To evaluate the value of Disposcope-guided the left-sided double-lumen tube (DLT) intubation.Methods Fifty ASA physical status Ⅰ or Ⅱ patients,aged 47-69 yr,without difficult airway,scheduled for elective thoracic surgery,were randomly divided into 2 groups (n =25 each) using a random number table:Disposcope (group D) and Macintosh direct laryngoscope (group M).Anesthesia was induced with iv injection of midazolam,propofol,sufentanil and rocuronium.Before induction (baseline,T1),before intubation (T2),immediately after successful intubation (T3),and at 1 and 3 min after intubation (T4-5),systolic blood pressure (SBP),mean airway pressure (MAP) and heart rate (HR) were recorded,and rate-pressure (SBP) product (RPP) was calculated.Arterial blood samples were obtained at T1-5 for measurement of plasma epinephrine (E),norepinephrine (NE),and dopamine (DOPA) concentrations.The success rate of DLT intubation at first attempt,total success rate of DLT intubation,intubation time,and development of sore throat within 24 h after surgery were recorded.Results Compared with group M,the intubation time was significantly shortened,the success rate of DLT intubation at first attempt was increased,the incidence of sore throat was decreased,and the levels of MAP,HR,RPP,E,NE and DOPA were decreased at T3-5 in D group (P ＜ 0.05).Compared with the baseline value at T1,the levels of MAP,HR,RPP,E,NE and DOPA were decreased at T3-5 in M group (P ＜ 0.05),and no significant change was found in D group (P ＞ 0.05).Conclusion Disposcope-guided left-sided DLT intubation provides significant clinical value.

Objective Toinvestigate the effects of carbon dioxide pneumoperitoneum on cardiovascular system by making use of arterial pressure waveform analysis( FloTrac/Vigileo system) to observe the change of heart function of patients undergoing laparoscopy cholecystotomy. Methods Forty patients scheduled for elective laparoscopy cholecystotomy were divided into two groups with 20 cases each by random sampling.Ventilatory capacity was fixed (tidal volume was 10 ml/kg, frequency was 12 times/min) in group A and adjusted to keep arterial carbon dioxide tension (PaCO2) and end expiration carbon dioxide tension(PETCO2)in normal range in group B. The parameters, such as mean arterial pressure (MAP), cardiac output(CO),stroke volume (SV), stroke volume variability (SVV), heart rate(HR), pulse oxygen saturation (SpO2),PETCO2, PaCO2 were recorded and analyzed. Results In group A:HR,MAP,CI,SVV,PaCO2 and PETCO2 were increased at 10,30 min after pneumoperitoneum (P ＜0.05 or ＜0.01),there was no significant difference in SVV between the end of pneumoperitoneum and 5 min after intubation [(8 ±2)% vs. (9 ±3 )%](P＞ 0.05 ) ,but HR, MAP, CI,SVI,PaCO2 and PETCO2 increased significantly (P＜ 0.05 or ＜ 0.01 ). In group B: HR, MAP, CI, SVI, PaCO2 and PETCO2 at 10,30 min after pneumoperitoneum were no changes (P ＞0.05 ), SVV was higher than that at 5 min after intubation (P ＜ 0.01 ), there was no significant difference in SVV between the end of pneumoperitoneum and 5 ain after intubation [(9 ± 2)% vs. ( 10 ± 2)%] (P ＞0.05 ). HR, CI, SVI, PaCO2, PETCO2 at 30 min after pneumoperitoneum and the end of pneumoperitoneun were significantly higher in group A than those in group B (P ＜ 0.05 or ＜ 0.01 ). Conclusions During carbon dioxide pneumoperitoneum, hypercapnia can increase MAP, HR, CO,SV significantly, and intra abdominal pressure can decrease preload by hindering the reflow of inferior vena cava and abdominal viscera veins. Arterial pressure waveform analysis can promptly reflect the effects of carbon dioxide pneumoperitoneum on cardiovascular system and be in favour of adjusting the respiration parameters and managing transfusion in laparoscopic surgery.

The present study was to examine the effect of stellate ganglion block (SGB) on bilateral regional cerebral oxygen saturation (rSO2) and postoperative cognitive function. Eighty patients undergoing selective coronary artery bypass graft with cardiopulmonary bypass (CPB) were randomly and equally divided into two groups. The patients in group S were given right SGB with ropivacaine, while the patients in group C were injected with normal saline. We compared the bilateral rSO2 after SGB. Minimum Mental State Examination (MMSE), Visual Verbal Learning Test (VVLT), and Digital Span Test (DST) were applied to observe the effect on cognitive function. We found that the incidence of postoperative cognitive dysfunction (POCD) 7 days after surgery in group S was lower than that in group C. The level of blocked side rSO₂ of S group were significantly higher before CPB time of rewarming than that before SGB (P < 0.05), much higher than corresponding non-blocked side rSO₂ before CPB (P < 0.05), and much higher than rSO₂ level in group C before CPB and after CPB (P < 0.05). The non-blocked side rSO₂ in group S before anesthesia were much lower than basic levels and those in group C (P < 0.05). It could be concluded from the above results that there was significant increase in the blocked-side rSO₂ compared to the non-blocked side and there was significant decrease in the incidence of POCD compared to the control group after SGB.
Autonomic Nerve Block ; adverse effects ; Cardiopulmonary Bypass ; adverse effects ; Cerebrum ; physiology ; Cognition ; Cognition Disorders ; Coronary Artery Bypass ; adverse effects ; Humans ; Incidence ; Oxygen ; physiology ; Oxygen Consumption ; Postoperative Complications ; Stellate Ganglion

To observe the effects of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and postoperative cognitive dysfunction (POCD) of elderly patients, we collected 80 elderly patients undergoing selective coronary artery bypass graft under cardiopulmonary bypass. The Mini Mental State Examination (MMSE) was applied to test the cognitive function. The SjvO2, Da-jvO2 and CEO2 were used for the analysis of the cerebral oxygen metabolism. We found that POCD was related to disequilibrium of cerebral oxygen metabolism. Ultrasound-guided SGB before surgery reduced the incidence of POCD because of the improvement of cerebral oxygen metabolism.
Aged ; Autonomic Nerve Block ; Cardiopulmonary Bypass ; Cognition Disorders ; prevention & control ; Coronary Artery Bypass ; Humans ; Neuropsychological Tests ; Oxygen Consumption ; Postoperative Complications ; Stellate Ganglion ; diagnostic imaging ; Ultrasonography

ObjectiveTo investigate the effect of hydrogen (H2 ) on acute lung injury (ALI) in septic mice.MethodsOne hundred and twelve male C57BL/6 mice,aged 5 weeks,weighing 20-25 g,were randomly divided into 4 groups ( n =28 each):sham operation group (group A),sham operation + H2 group (group B),sepsis group (group C) and sepsis + H2 group (group D).Sepsis was produced by cecum ligation and puncture (CLP).Groups B and D received 1 h inhalation of 2％ H2 at 1 and 6 h after CLP operation or sham operation.Twenty animals in each group were selected and observed for the 7 d survival rate.The left 8 animals in each group were sacrificed at 24 h after CLP operation.Venous blood samples and lung tissues were obtained to determine the levels of superoxide dismutase (SOD),catalase (CAT) and 8-iso-prostaglandin F2alpha (8-iso-PGF2α) in the serum and lungs,the concentration of protein in bronchoalveolar lavage fluid (BALF),and the activity of myeloperoxidase (MPO) in the lungs.The lung injury score (LIS) was assessed and W/D lung weight ratio was calculated.ResultsCompared with group A,the 7 d survival rate and activities of SOD and CAT in the serum and lungs were significantly decreased,and LIS,W/D ratio,the concentration of protein in BALF,MPO activity and 8-iso-PGF2α level in the serum and lungs were significantly increased in group C ( P ＜ 0.05 ).Compared with group C,the 7 d survival rate and activities of SOD and CAT in the serum and lungs were significantly increased,and LIS,W/D ratio,the concentration of protein in BALF,MPO activity and 8-iso-PGF2α level in the serum and lungs were significantly decreased in group C ( P ＜ 0.05).ConclusionH2 can alleviate ALI in septic mice via inhibiting oxidative stress response.

Objective To study the relationship between the changes of diffusion tensor imaging(DTI)and diffusion tensor tractography(DTT)of optic radiation and the defect of visual field.Methods DTI and DTT were performed in 37 patients with invasion of the optic radiation by intracranial lesions and in 20 normal control group at 3.0T MR scanner,the visual fields of all cases were examined.The relativity between FA values,ADC values and mean sensitivity(MS)values,mean defect(MD)values of visual field and the relativity between the morphological change of optic radiation and the defect of visual field were analysed.Results In comparison with control group,FA values decreased and ADC values increased in subject group,there were statistically significant differences(P＜0.001)between them.In disordered group,FA values were positive correlation with MS values(r=0.718)and negative correlation with MD values(r=-0.694);ADC values were negative correlation with MS values(r=-0.625)and positive correlation with MD values(r=0.538).DTT showed that the ventral tracts of optic radiation were damaged which oppeared as the defect of ditto quadrant of bilateral field vision in 9 cases,the dorsal tracts and the lateral tracts of optic radiation were damaged which appeared as the defect of inferior quadrant of bilateral field vision in 7 cases,the optic radiations were damaged extensively that caused symmetric or asymmetric congruous hemianopia of bilateral field vision in 21 cases.Conclusion DTI and DTT of optic radiation are intimately correlated with the examined results of visual field,it will be a objective index to extimate the function and the morphological changes of optic radiation.

Objective To explore the predictive capability of different methods for difficult la-ryngoscopy and analyze its optimal cutoff value.Methods Three hundred consecutive patients (aged 18-65 years,weighing 42-88 kg,ASA physical status Ⅰ or Ⅱ)scheduled to undergo general anesthe-sia and surgery were invited to participate.Difficult airway assessments were performed by thyromen-tal height (TMH),thyromental distance (TMD),sternomental distance (SMD),modified Mallam-pati test (MMT)and ratio of height and TMD (RHTMD)before anesthetic induction.Cormack-Le-hane (C-L)grade of laryngoscopy view was assessed after induction.Sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV)and accuracy of these tests were calculated. Receiver operator characteristic (ROC)curve of TMH was performed to determine the optimal cutoff value of TMH.Results There were 22 patients diagnosed as difficult airway.Sensitivity,specificity, PPV,NPV and accuracy of TMH were higher than those of TMD,SMD and MMT tests.Sensitivity of RHTMD was lower than that of TMH test,and specificity,PPV,NPV and accuracy of RHTMD were similar to that of TMH.The optimal cutoff value of TMH was 4.9 cm through ROC curve. Conclusion The optimal cutoff value of TMH detecting difficult laryngoscopy was 4.9 cm.Similar to RHTMD,TMH appears to be more effective for prediction of difficult laryngoscopy than TMD, SMD and MMT.