Hemodynamic therapy in critically ill patients is based on the theory of hemodynamics, combined with characteristics and patterns of the circulatory system, to improve the outcome of patients.The basic direction of critical care ultrasound is to improve tissue perfusion, implement the target-goal hierarchical management, and distinguish appearance and essence.Through continuous monitoring, integrated clinical information and dynamic assessment, rapid screening of the etiology of shock and hemodynamic abnormalities are in order to optimize therapy for reducing or avoiding reinjury during treatment.Finally, organization of therapy and protection of organs are realized.The interpretation of ultrasound images, the analysis of etiology as well as the judgement of illness, the information of treatment decisions, and the fine adjustment of therapic direction and intensity are inseparable from the in-depth understanding of the medical laws and pathophysiological characteristics of severe diseases.

Acute kidney injury is one of a number of conditions that affect kidney structure and function,which is a broad clinical syndrome encompassing various etiologies.There are general management principles that are common to all patients and these will be discussed here.Management of patients with acute kidney injury according to the stage and cause include hemodynamic monitoring,ensuring volume status,discontinuing all nephrotoxic agents,and nutritional support.

Hemodynamic monitoring is essential in titrating fluid therapy,in order to avoid the deleterious effects of over-and under-filling.Not all patients will respond to a fluid challenge.Therefore,it is useful to predict fluid responsiveness to identify those patients in whom fluid therapy will be of benefit.However,studies performed during the past decade have demonstrated the benefits of using dynamic parameters of filling to assess fluid responsiveness over static parameters during mechanical ventilation or after passive leg raising or volume challenge.

Objective To investigate mechanisms of resistance to adriamycin(ADR)by human breast cancer cell line MCF-7 and to find the alteration of features and celluar behavior of MCF-7 after exposure to ADR.MethodsProliferation speed,population doubling time of MCF(wild type),MCF-7/ADR(exposure to adriamycin)and withdrawl group were respectively tested.Cell phenotype alteration was detected using SP immunohiatochemistry methods.Results No significant difference of proliferation speed was found between MCF-7/ADR and MCF cells.As exposure time prolonged,withdrawl group cells grew faster,thus population doubling time shortened.Differentiation of MCF-7/ADR and wthdrawl group was lower than wild group.The expression of drug resistance associated marker of MCF-7/ADR such as Pgp,LRP,GST-pi,TOPOⅡwas higher than that of MCF-7,ER turned to express negatively,and expression of PR gradually decreased as exposure continued.Conclusion MCF-7 cells exposed to ADR got drug resistant,their proliferation was not suppressed by withdrawl of ADR and even grew faster.Drug resistant cells gained dedifferentiation ability.Their heredity and biochemistry features changed,expression of target enzyme also altered and was reversible by drug withdrawl.

Objective To explore the use and advantages of the Hem-o-lok ligating clip in laparoscopic cholecystectomy (LC). Methods A 3-port approach laparoscopic cholecystectomy by applying the Hem-o-lok ligating clip was performed in 288 patients with cholecystolithiasis or cholecystic polypoid lesion. Results All the operations were successfully fulfilled, without conversions to open surgery. A middle-to-large sized clip was used in 264 patients (92%), who almost had no painful feeling in the xiphoid process incision and had a mean postoperative hospital stay of 2.7 days(1~3 days). A large sized clip was successfully utilized in 24 patients because of the difficulty encountered during the ligation using the middle-to-large sized clip. No hemorrhage, biliary leakage, or bile duct injuries happened. Conclusions Laparoscopic cholecystectomy using the middle-to-large sized ~Hem-o -lok ligating clip and other routine laparoscopic devices can minimize the xiphoid process incision as short as 5 mm.

Objective To explore the clinical value and feasibility of the open bile duct operative instruments in laparoscopic common bile duct exploration.Methods 43 operations of laparoscopic common bile duct exploration were accomplished by using open bile duct operation instruments for exploring common bile duct and removing stones without choledochofiberscopy.Results 43 operations of laparoscopic common bile duct exploration were achieved successfully by exploring common bile duct and removing stones with open bile duct operative instruments with no postoperative remanent stones of the common bile duct and no open operation was needed.The follow-up in 38 patients for 6 months showed that there was no postoperative complication.Conclusions This method has the advantages of convenient manipulation,safety and better effect,low cost.It was deserved to be extended.

The de novo transcription of hTERT gene represents a rate-limiting step in the activation of human telomerase.The expression of hTERT is strictly regulated with several oncogene products and tumor suppressor gene products in normal cells.The construction of a reverse-transcriptional virus vector that contains the promoter of hTERT without losing its specificity can dramatically augment the expressions of anticancer genes in telomerase-positive cancer cells,which prompts the use of an hTERT promoter for anticancer gene therapies.Firstly,we briefly introduce the structure and regulation of hTERT gene,and then we also review the present knowledge of its biological function in cancer progression.

AIM: To compare the efficiency and safety of torsional phacoemulsification with or without intelligent phacoemulsification ( IP ) software in hard nucleus cataract extraction.
METHODS: Ninety two eyes with Ⅳ - Ⅴ grades cataracts were enrolled in this randomized prospective study. Operated eyes were divided into two groups -those operated without IP software ( non- IP group, n =43) and those operated using IP software (IP group, n =49 ). The two groups were compared in terms of ultrasound time (UST) and cumulative dissipated energy (CDE). Post- operative outcome measures included the corneal edema and best-corrected visual acuity (BCVA) at 1,7d and 3mo postoperatively, corneal endothelial cell density and percentage of hexagonal cell at 7d and 3mo postoperatively.
RESULTS: UST was measured as 52. 51±9. 64s in non-IP Group and 48. 79±7. 13s in IP Group (P = 0. 030). CDE was 15. 78±3. 73% in non-IP Group and 14. 29±2. 77% in IP Group ( P = 0. 026). At the first postoperative day, the rate of BCVA>0. 1 in non-IP Group was 56%, and the rate in IP Group was 79% (P= 0. 066). Corneal edema in non-IP Group was 2. 98±0. 77 scores, and in IP Group it was 2. 61±0. 64 scores (P = 0. 021). At the postoperative 7 and 30d, the BCVA and corneal edema were no differences between two groups. At the postoperative 7d, corneal endothelial cell density in non- IP Group were 2497. 95 ±211. 48 / mm2 , less than 2586. 26±154. 71 / mm 2 in IP Group (P= 0. 029);percentage of hexagonal cell in IP group was 48. 33±8. 69%,higher than 44. 19±9. 48% of non-IP group(P= 0. 030).CONCLUSION: In hard nucleus cataract extraction, the IP software can combine the advantages of the two kinds of ultrasonic modes, which is more effective with lower ultrasound energy and less injury for the corneal endothclium, and is helpful for the recovery of vision at early stage after surgeries.

Objective To study the effects of thrombolysis on short- and long-term outcome in acute cerebral infarction patients. Methods The patients accepted thrombolysis and remained severe neurologic deficits were as observation group (n=29), and the patients without thrombolysis matching the onset time and severity of disease were as control group (n=94). They were assessed with National Institute of Health Stroke Scale (NIHSS), Manual Muscle Test (MMT), Brunnstrom Grade, modified Barthel Index (MBI) when they admitted and discharged, and with modified Rankin Scale (mRS) 6 months later. Results The scores of MMT, MBI and Brunnstrom grade improved in both groups when discharged (P<0.05), except the NIHSS in the control group, and the scores of NIHSS and MBI improved more in the observation group than in the control group (P<0.05). The score of mRS was better in the observation group than in the control group 6 months later (P<0.05). Conclusion Thrombolysis can improve the neurologic function and activities of daily living in the acute stage of cerebral infarction, as well as the long-term outcome of activities.