Objective To study the performance of deep hypothermic circulatory arrest and the anesthestic management for giant intracranial basilar artery aneurysm. Methods Seven patients undergoing resection of giant intracranial basilar artery aneurysm were included in the study. By monitoring cerebral oximetry (rSO_2), body temperature and electrocardiogram (ECG), brain and other vital organs were guaranteed to maintain oxygen supply/demand balance in perioperative management, especially during the circulatory arrest period under deep hypothermia. The measured parameters, the outcome of patients and the complications were observed and recorded. Results Even in profound hypothermic condition, rSO_2 was degraded significantly during circulatory arrest, and recovered after in circuit. Low flow perfusion maintained cerebral oxygen supply/demand balance better than circulatory arrest. In all 7 cases, cerebral anoxia caused by circulation arrest after operation were not observed. Conclusion Deep hypothermic circulation arrest could be applied effectively in the resection of giant intracranial basilar artery aneurysm with brain protective measure and monitoring. To improve the outcomes of the patients, avoiding cerebral anoxia and of local vessel injuries is important.

To study retrospectively on extracorporeal circulation (ECC) in pediatric patients with congenital heart diseases. 1286 cases were divided into two groups. In groupⅠ( n =883) ECC were performed with nonpatterned tubing system, and in group Ⅱ( n =403) patterned tubing system was used. GroupⅠandⅡwere both primed with Ringer′s solastion and colloid. There were no stastistically significant difference in age or body weight between groupⅠand Ⅱ. The crystalloid priming volume in group Ⅱ was less than that in groupⅠ( P

To summarize the experience of application of the cardiopulmonary bypass (CPB) technique in non cardiac surgery in 28 patients, including 22 cases of Budd Chiari syndrome, 2 cases of renal cell carcinoma with cancer cell emboli in the inferior vena cava, 2 cases of tracheal carcinoma, 1 case of intracranial basilar artery aneurysm, and 1 case of leiomyolipoma of the liver with excision and replantation of remaining liver. Different types of CPB were adopted as follows: 10 cases were supplemented by hypothermia and low flow perfusion, 15 cases by deep hypothermia and circulation arrest (DHCA) and 3 cases with vena vena bypass in normothermia, respectively. 2 patients died in early post operative period. It is our opinion that CPB can be used in non cardiac surgery, when it is difficult or almost impossible to carry out with routine surgical technique. The technique can make operations more convenient and safer to perform, even though there are some disadvantages, such as more trauma and higher cost.

cases of coronary artery bypass grafting (CABG) were analyzed retrospectively. They were divided into four groups. In group 1 ( n =63,1985～1996), group 2 ( n =160, 1997～1999), and group 3 ( n =209, 2000～2002), CABG was performed with cardiopulmonary bypass (CPB). In group 4 ( n =291, 2000～2002) CABG was performed with off pump (OP). The durations of CPB and aortic cross clamp (ACC), temperature, hemodilusion, duration of using ventilator postoperatively, and ICU stay days were analyzed and compared. The patients in the groups 3 and 4 were older than those of the group 1, but younger than group 2. Pre operative supersonic EF value was lower in patients in the group 3 compared with group 2. A tendency of shortening of CPB time and ACC time, raising of temperature, lowering of hemodilusion, and shortening of ventilator time and ICU stay days could be discerned from group 1 down to group 4 ( P

Objective To analyze and evaluate the effect addition of albumin to the extracorporeal circulation (CPB) in patients undergoing valve replacement. Methods 62 patients under 60 years of age, with the blood level of albumin nearly normal, undergoing mitral valve replacement or aortic valve replacement were randomly divided into two groups. In 34 patients albumin was added to the priming fluid of extraporeal circulation, and in 28 patients it was not. The pre-operative and postoperative serum albumin levels, the duration of assisting ventilation, and the amount of albumin needed between the time of operation to 7 am of the first postoperative day were compared. In both groups the primary priming fluid consisted of balanced electrolyte solution, hydroxyethyl starch, 5% sodium bicarbonate, and 25% mannitol. Results All the indexes, including the preoperative level of albumin, the amount of albumin needed from operation to 7 am of the first postoperative day, and the albumin level at 7 am of the first postoperative day showed no notable differences. Conclusion For patients with no hypoalbuminemia, mitral valve replacement or aortic valve replacement is safe to withhold the addition of albumin to the priming fluid for CPB.

Objective To explore the application and management of deep hypothermic extracorporeal circulation (DHECC) in surgical procedures. Methods From Dec. 1997 to Dec. 2007, DHECC was applied in 54 patients suffered from great vessel diseases (34/54), complex congenital heart disease (10/54), giant basilar artery aneurysm (5/54), and abdominal tumor with tumor embolus intruding into right atrium or inferior vena cava (5/54) in the General Hospital of PLA. Extracorporeal circulation was performed with arterial perfusion by ascending aorta (n=25), axillary artery (n=18) and femoral artery (n=11), and venous drainage by superior vena cava and inferior vena cava (n=21), right atrium (n=25), and femoral vein (n=8). Clinical data were analyzed retrospectively including extracorporeal circulation (ECC) time, aortic clamping time, deep hypothermic circulation time, the lowest temperature, and the use of ultrafiltration. Results The ECC time was 63-414 (178.55?74.42)min. Aortic clamping time was 16-259 (123.39?52.21) min in 46 patients. Deep hypothermic circulatory arrest (DHCA) was performed in 43 patients, and the duration was 2-109 (30.00?22.37)min. The lowest nasopharyngeal temperature was 13.6-25.7 (19.61?3.40)℃, and the lowest rectal temperature was 15.2-30.5 (21.58?3.63)℃. Ultrafiltration technique was used in 49 cases. 36 of 54 cases (66.7%) self-awakened. Four cases (7.41%) died in the early post-operation period. Conclusion The DHECC can offer a clear and exsanguinated operating field, and is helpful to execute complicated or major operations which are hard to complete with common techniques.

Objective To observe the effects of velcade on inflammatory reaction and cell apoptosis after ischemia-reperfusion injury, and to explore the neuroprotective mechanism of velcade.Methods The 15 male Wistar rats were randomly divided into sham-operated group, physiological saline control group and velcade-treated group (n= 5, each). The model of temporary middle cerebral artery occlusion (MCAO) was applied and reperfused after 2 hours. Immediately after the reperfusion, all rats were performed intraperitoneal injection with velcade 0. 2 mg/kg in velcadetreated group, and with the same volume of physiological saline in control group. After 24 hours, the rats were decapitated in all groups. The apoptosis cells were found by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and the expressions of nuclear factor-κBp65 (NF-κBp65) and interleukinh-1β (IL-1β) were detected by immunohistochemistry. Results The immunologically positive cells of NF-κBp65, IL-1β and apoptosis cells were occasionally found in shamoperated group [(1.21 ± 0. 16)/400 power, (11.56 ± 0. 99)/400 power and (2. 88 ± 0. 27)/400 power], while a lot of immunologically positive cells of NF-κBp65, IL-1β and apoptosis cells were found in velcade-treated group and control group. The control with compared group, these cells were significantly more in the velcade-treated group [(56.28± 1.95)/400 power vs. (29. 76±2.53)/400 power, (47. 64±2.06)/400 power vs. (29.6±1. 61)/400 power and (51. 05±4. 23)/400 power vs.(33.44±2.06)/400 power, all P＜0. 05]. Conclusions The velcade could decrease the expressions of the NF-κBp65 and IL-1β and diminish the neuronal apoptosis. The neuroprotective mechanism of velcade may lie in decreasing apoptosis through inhibiting inflammation.

Objective To discuss the way and management of extracorporeal circulation (ECC) for totally robotic assisted cardiac surgery. Methods A Total of 226 patients underwent cardiac surgery using da Vinci S robotic surgical system, including 111 patients underwent atrial septal defect repair ( ASDR) , 9 patients underwent ventricular septal defect repair ( VSDR) ,51 patients underwent mitral valvuloplasty ( MVP) , 20 patients underwent mitral valve replacement( MVR) , 27 patients underwent left atrial myxoma excise and 4 patient underwent right atrial myxoma excise. ECC for most of patients was achieved with femoral arterial cannula, femoral venous cannula and right internal jugular venous cannula, except for 1 patient underwent MVP with femoral arterial cannula and femoral two-stage venous cannula. In all the cases, vacuum-assist venous drainage ( VAVD) , continuous blood gas monitoring and ultrafiltration were used during ECC. myocardial protection was pertic cross-clamp time was 40 ～219 (105.9+38. 8)min and 21 ～166 (69.5±30.0)min respectively. During ECC, the mean urine volume was 100-2100 (771.7±477.6) ml, ultrafiltration volume was 1000-4800 (2495.4 ±811.6) ml, and the total fluid balance was subzero-balanced (172 cases) or zero-balanced(13 cases) in most of patients. Conclusion The establishment of ECC system through peripheral vessels, using VAVD and continuous blood gas monitoring are the key points of ECC for totally robotic assisted cardiac surgery, also certain learning curve of perfusion technique and close communication between the surgical team are essential during ECC.

Objective To explore the epidemiology and risk factors of toenail onychomycosis among traffic police-men in Tianjin, and to prevent and control its prevalence. Methods Epidemiological surveys were performed to a total of 1 270 traffic policemen during physical examination in Public Security Hospital in Tianjin using cross-section study. Fungi in feet and the prevalence of toenail onychomycosis were examined simultaneously during questionnaires. Logistic regression of single factor and multiple factors were applied to analyze the risk factors. Results The prevalence of toenail onychomyco-sis in Tianjin traffic policemen is 32%. Age (OR=1.455), police boots (OR=1.047), history of tinea pedis (OR=7.521) and his-tory of diabetes (OR=1.820) are the main risk factors. Conclusion The prevalence of onychomycosis among Tianjin traffic policemen is high. Synthetic and effective interventions should be employed to deal with the risk factors.

Objective To study the relationship between expression of cyclooxygenase-2 (COX-2) and vas-culax endothelial growth factor (VEGF) with liver sinusnidal capillarization (LSC) of chronic hepatitis B (CHB). Methods We studied liver biopsies from 200 patients with CHB COX-2 ,VEGF immunohistochemical stain were ob-served to accomplish relationship between expression of COX-2,VEGF and LSC. Results LSC occupy above 80% in the group. There were manifestation in mild-LSC (focal) , middle-LSC (sheet-shape) and severe-LSC (widespread). Electron microscope shown the laceration in the endothelium of sinuses and formation of basal lamina and budding for-mation lumen of blood vessel and fat-storing cell convert myofibroblast. Expression of COX-2, VEGF, Co-Ⅳ and retic-ulum, collagen and elastic fibers with mild or severe in LSC is manifest locking relate. Conclusion Increased ex-pression of COX-2 ,VEGF in liver tissue of CHB may facilitate LSC and hepatic fibrosis.