Objective:To investigate the effect of different ventilation time in the prone position on patients with endogenous/exogenous ARDS.Methods:30 endogenous/30 exogenous ARDS patients were randomly devided into 4 groups,ventilation in the prone position for 2 h and 4 h.Recording the score of APCHEII,oxygenation index,the absorption situation in X-ray,HR,MAP,extubation time,the time out of ICU.Results:The APCHEII scores HR and MAP in four groups have no significant statistics (P＞0.05);4h ventilation for endogenous ARDS patients has a better indicators than 2 h in oxygenation index,the absorption situation in X-ray,extubation time and the time out of ICU (P＜0.05);2 h and 4 h ventilation for exogenous ARDS patients can improve indicators above,two groups have no significant statistics (P＞0.05),the results of exogenous groups are precede than endogenous group (P＜0.05).Conclusion:Ventilation in the prone position can improve the situation of ARDS patients,both endogenous patients and exogenous patients.Exogenous ARDS patients have a better treatment effect after the ventilation of 2h,however,endogenous patients need longer time and have a non-ideal prognosis.

Objective To study the clinical value of PgCO_2 measurement on the patients in ICU.Methods PgCO_2 were continuous measured 24 hours by using air-automated tonometry for 50 cases admitted in ICU.The heart rate,blood pressure,MAP,CVP,SpO_2,artery blood gas were measured at the same time.According to acute physiologic and chronic health evaluation(APACH Ⅱ) and MODS mark,the patients were divided into 2 groups,high-risk group and light-risk group.20 cases suffered from malignant tumour without functional failure of the organs were looked on as compared group.The results of measurement of every group were compared.Results Comparing with the three groups,the results of PgCO_2,Pg-aCO_2,Pg-etCO_2 were significantly different,but the Pg-aCO_2 and Pg-etCO_2 were the same.Conclusion PgCO_2 is an effective index for observing the conditional change of the high-risk cases.PgCO_2≥45mmHg,Pg-aCO_2≥15mmHg may be considered as a predictive signal that the patient well appears functional failure or death.Pg-etCO_2 may substitute Pg-aCO_2 as a continuous measurement index.

Background and purpose:Cancer-related pain is one of the most important symptoms of patients with advanced cancer. Chemotherapy sometimes induces peripheral neuropathy and pain. These symptoms seriously affect patients’ quality of life. Cancer pain assessment is now achieved by the subjective scales of patients, but lacking objective measurement. In this study, we used the neurotic electrophysiological method by way of PainVision system (PV system) to evaluate cancer pain quantitatively to detect and analyze degree of chemotherapy-induced neuropathy. Methods:We obtained numerical rating scale (NRS) scores from patients receiving analgesics and calculated the PainRatio from PV system at the same time. Then we analyzed the relationship between NRS and PainRatio scores. We detected current perception threshold (CPT) levels of patients receiving chemotherapy to ifnd the correlation between chemotherapy and CPT level, and attempt to evaluate chemotherapy-induced neuropathy.Results:PainRatio scores were linearly associated with NRS scores (Pearson correlation coeffcient=0.849,P<0.001). Patients with neuropathy symptoms got higher CPTs. However, no statistically signiifcant difference was observed between patients treated with oxaliplatin, paclitaxel and other agents.Conclusion:PainVision system can be used in cancer pain assessment quan-titatively, and be helpful in cancer pain assessment objectively. Patients with deifned neuropathy showed higher CPTs, indicating the potential clinical value of PV system in detecting and evaluating chemotherapy-induced neuropathy.

Objective To investigate the value of remnant stomach-jejunal dual pathways reconstruction after laparoscope-assisted radical proximal gastrectomy in the treatment of upper gastric cancer. Methods Twenty-five patients with upper gastric cancer underwent laparoscope-assisted radical proximal gastrectomy and the remnant distal stomach was preserved for side-to-side remnant stomach-jejunal anastomosis and end-to-side jejuno-jejunal anastomosis to reconstruct dual pathways. Results The mean operation time was (240±35) minutes, the mean number of lymph nodes dissected were 22±5, and all the incised margins were negative. No anastomotic leakage, obstruction or stenosis occurred. All patients received postoperative barium meal examination. A large amount of barium directly entered the jejunum, leaving a small amount of barium entered the jejunnum via the route of remnant stomach-duodenum, and was detained in the remnant stomach for 30-60 minutes. No esophageal reflux of barium was observed. All the patients were followed up for 4-18 months, no reflux esophagitis was detected and the short-term life quality was satisfactory. Conclusions Remnant stomach-jejunal dual pathways reconstruction prevents the reflux esophagitis and dumping syndrome, preserves the pathway of duodenum and promotes the life quality of patients.

Objective To investigate the effect of dexmedetomidine hydrochloride ( Dex ) preconditioning on renal function in rats after renal ischemia reperfusion injury under high glucose condition. Methods SD rats were randomly divided into 6 groups:NG-Sham operated group,NG-I/R group, NG-Dex group,HG-Sham operated group,HG-I/R group,HG-Dex group. Renal ischemia reperfusion model was established except Sham groups. Dex 50 μg·kg-1 was injected intraperitoneally 30 min before ischemia in the Dex preconditioning group,25% glucose 3 g·kg-1 was given intraperitoneally before the renal ischemia reperfusion model was established in high glucose groups. Blood glucose and renal function of each group were detected . Renal pathologic changes were observed with hematoxylin-eosin staining. Apoptosis of renal tissue was detected by TUNEL method. Results BUN,Cr and apoptosis rate in NG-I/R group were higher than those in NG-Sham operated group ( P<0.05);BUN,Cr and apoptosis rate in NG-Dex group were lower than those in NG-I/R group ( P<0.05);BUN,Cr and apoptosis rate in HG-I/R group and HG-Dex group were higher than those in NG-I/R group and NG-Dex group,respectively (P<0.05); However,there was no significant difference between HG-I/R group and HG-Dex group ( P>0.05) . Conclusion Dex has a protective effect on renal function after renal ischemia reperfusion, but this effect is inhibited in high glucose condition, which may relate to the increasing of kidney cells apoptosis.

Objective To observe intravenous lidocaine in patients undergoing hysteroscopy surgery under Narcotrend monitoring. Methods 80 patients undergoing elective hysteroscopy surgery were randomly divided into normal saline group(group S)and lidocaine group(group L). Before anesthesia induction ,group L was given lido-caine injection of 1.5 mg/kg,then with 2 mg/(kg·h)for infusion to the end of surgery. Group S received normal sa-line instead of lidocaine as the control. All patients received Narcotrend(NT)monitoring anesthesia depth of seda-tion and received intravenous anesthesia with propofol and remifentanil. Operation time (T1),dosage of propofol and remifentanil,total waking time(T2),postoperative pain of 0.5 h(T3),4 h(T4),24 h(T5)by postoperative visual analogue scale(VAS),incidence of sore throat,lidocaine adverse reactions were recorded. Results Age, weight,T1,T2 and dosage of propofol between two groups had no statistical significance (P > 0.05). Dosage of remifentanil of group L was obviously less than that in group S (P < 0.05). VAS score T3 ,T4 of group L was obviously less than those in group S(P < 0.05). No significant difference was found on T5. Sore throat incidence of group L was lower than that in group S(P < 0.05). Lidocaine adverse reactions were not found in L group. Conclusions Intravenous lidocaine in hysteroscopy surgery is safe and effective under Narcotrend monitoring.

Objective To evaluate the role of thioredoxin?interacting protein(TXNIP)∕oligomer?ization domain?like receptor family pyrin domain?containing 3(NLRP3)signaling pathway in renal ische?mia?reperfusion(I∕R)injury in diabetic rats. Methods Pathogen?free healthy male Sprague?Dawley rats, aged 8-12 weeks, weighing 200-220 g, were used in the study. Diabetes mellitus was induced by intrap?eritoneal injection of 1% streptozotocin 65 mg∕kg and confirmed by blood glucose≥16.7 mmol∕L 3 days lat?er. Twenty?four diabetic rats were divided into 3 groups(n=8 each)using a random number table: sham operation group(group S), renal I∕R group(group I∕R)and resveratrol(TXNIP inhibitor)group (group R). Resveratrol 10 mg∕kg was intraperitoneally injected every day for 7 consecutive days starting from 3rd week after successful establishment of the model in group R. At 4th week after successful establish?ment of the model, renal I∕R was produced by occlusion of bilateral renal pedicles for 25 min followed by reperfusion in anesthetized rats in group R. The animals were sacrificed at 48 h of reperfusion, and renal specimens were obtained for microscopic examination of pathologic changes and for measurement of malondi?aldehyde(MDA)content, superoxide dismutase(SOD)activity and superoxide anion scavenging capa?bility(using colorimetric method), interleukin?1beta(IL?1β)and IL?18 contents(by enzyme?linked immunosorbent assay), cell apoptosis(using TUNEL)and expression of TXNIP, NLRP3 and caspase?1 in renal tissues(using Western blot). Blood samples were obtained from the left ventricle for determination of serum urea nitrogen(BUN)and creatinine(Cr)concentrations. Results Compared with group S, the serum Cr concentration and apoptosis index were significantly increased, superoxide anion scavenging capability in renal tissues was decreased, and the expression of TXNIP, NLRP3 and caspase?1 was up?reg?ulated in I∕R and R groups, and the serum BUN concentration and contents of MDA, IL?1β and IL?18 in renal tissues were increased, the SOD activity was decreased(P<0.05), and the pathological changes of renal tissues were aggravated in group I∕R. Compared with group I∕R, the serum BUN and Cr concentra?tions were significantly decreased, the contents of MDA, IL?1β and IL?18 and apoptosis index were de?creased, the SOD activity and superoxide anion scavenging capability were increased, the expression of TXNIP, NLRP3 and caspase?1 was down?regulated(P<0.05), and the pathological changes of renal tis?sues were significantly attenuated in group R. Conclusion The pathophysiological mechanism of renal I∕R injury is associated with the activation of TXNIP∕NLRP3 signaling pathway in diabetic rats.

Objective:To explore the comparative study of video laryngoscopy combined with bronchial blocker and video laryngoscopy combined with double-lumen tube in the teaching of endotracheal intubation in thoracic surgery in the standardized residency training of anesthesia.Methods:The trainees of the standardized residency training were randomly divided into control group and experimental group for clinical teaching, with 25 ones in each group. The experimental group was treated with visual laryngoscopy combined with bronchial blocker, while the control group was treated with visual laryngoscopy combined with double-lumen tube group. The intubation time, intubation success rate, positioning time, hemodynamic changes, and complication incidence during intubation, as well as student assessment results were recorded. GraphPad Prism 6.0 was used for t test and Chi-square test. Results:The time of endotracheal intubation [(95.3±10.1) vs. (137.5±13.5)] and positioning time [(100.8±11.7) vs. (155.4±15.3)] in the experimental group were both shorter than those of the control group ( P< 0.001), the hemodynamic changes in patients with immediate intubation were smaller ( P<0.001), the success rate of intubation was higher (92% vs. 68%) ( P<0.001), the complication incidence was lower ( P<0.001) and the students' performance was higher ( P<0.001). Conclusion:In the anesthesia teaching of thoracic surgery, bronchial blocker can reduce the time of endotracheal intubation, lower the hemodynamic changes during intubation, cut down the incidence of complications, improve the success rate of endotracheal intubation and enhance the confidence of students.

Objective:To investigate the relationship between indicators of carotid atherosclerosis and onset of ischemic stroke in patients with non-valvular atrial fibrillation (NVAF).Methods:This is a case-control study, a total of 397 NVAF patients with newly diagnosed ischemic stroke (case group) and 3 038 NVAF patients without ischemic stroke (control group) from January 2015 to December 2017 were included in the study. Differences in general clinical features and carotid atherosclerosis indexes between the two groups were compared. Univariate and multivariate logistic regressions were used to analyze the correlation between carotid atherosclerosis indexes and ischemic stroke.Results:Proportions of patients with carotid intima thickening, carotid plaque, stable plaque, unstable plaque, and moderate to severe stenosis were higher in the ischemic stroke group than those in the control group (82.1% vs. 64.4%, 69.3% vs. 50.3%, 43.6% vs. 30.6%, 25.7% vs. 19.7%, and 7.3% vs. 4.0%, respectively, all P <0.05). After adjustment of age, gender, heart failure, hypertension, low density lipoprotein -cholesterol and drug use, multivariate analyses showed that subjects with carotid intima thickening, carotid plaque, stable plaque, unstable plaque, moderate to severe stenosis had 1.766, 2.111, 1.892, 2.256 and 1.824 times the risk for the development of ischemic stroke compared with the subjects without any carotid atherosclerosis indicators. Conclusion:Carotid atherosclerosis, especially with unstable carotid plaque, is associated with ischemic stroke in patients with NVAF.

ObjectiveTo study the expression changes of Lon protein and mitochondrial dynamics-related protein in the hippocampus of SAMP8 mice and provide a theoretical basis for the treatment of Alzheimer's disease by invigorating the spleen and supplementing Qi. MethodEight 3-month-old SAMR1 mice were used as the normal group， and 32 3-month-old SAPM8 mice were divided into model group， western medicine group （0.013 g·kg^-1）， low-dose Si Junziwan group （3.24 g·kg^-1）， and high-dose Si Junziwan group （12.56 g·kg^-1）， with 8 mice in each group. The western medicine group was gavaged with donepezil， and the Si Junziwan low- and high-dose groups were gavaged with Si Junziwan for 30 days. The positioning navigation experiment of the water maze was started on the 25^th day， and the space exploration experiment of the water maze was started on the 30^th day. On the 30^th day， the protein expression of mitofusin 2 （MFN2） was detected by immunohistochemistry， the expression of adenosine 5'-monophosphate （AMP）-activated protein kinase （AMPK） was detected by enzyme-linked immunosorbent assay （ELISA）， the content of ATP was detected by colorimetry， the microstructure of neuron mitochondria was detected by electron microscope， and the expressions of Aβ protein， Lon protein， dynamin-related protein 1 （DRP1） protein， and MFN1 protein were detected by Western blot. ResultAs compared with the normal group， the latency escape period increased， the number of crossings decreased， the expression of AMPK increased， and the content of ATP decreased in the model group. The expressions of Aβ protein and DRP1 protein increased （P<0.01）， whereas the expressions of Lon protein， MFN1 protein decreased in the model group （P<0.05，P<0.01）， and MFN2 protein decreased. The vacuolation of mitochondria increased and the cristae broke in the model group. As compared with model group， the time of the latent escape period decreased （P<0.01）， and the number of crossings increased in the low-dose and high-dose Si Junziwan groups （P<0.05）. The expression of AMPK （P<0.01） decreased， the content of ATP increased （P<0.01）， the expression of Aβ and DRP1 protein decreased （P<0.05， P<0.01）， and the expression of MFN1 protein was up-regulated （P<0.05） in high-dose Si Junziwan groups. The vacuolation was more obvious in the low-dose Si Junziwan group， whereas the vacuolation was restored and the ridge was clear in the high-dose Si Junziwan group. ConclusionSi Junziwan treats Alzheimer's disease by up-regulating the protein expression of Lon， correcting the disorder of mitochondrial division and fusion protein， and changing the memory function of SAMP8 mice.