Objective To observe the effects of propofol and enflurane on intrapulmonary shunt and the changes of plasma endothelin ( ET ) and nitric oxide ( NO ) in the pulmonary artery and vein during one lung ventilation ( OLV ) Methods Thirty patients undergoing elective thoracotomy with OLV were randomly allocated to receiving enflurane at an inspired concentration of 1 8%(enflurane group) or an intravenous infusion of propofol at rate of 6 mg?kg -1 ?h -1 The arterial and mixed venous blood gas analysis and the plasma concentrations of ET and NO in the pulmonary artery and vein were measured 30 min after beginning of two lung ventilation ( TLV ) , 30 min and 60 min after of beginning OLV Results In both groups , the venous admixture percentage(Qs/Qt) increased significantly 30 and 60 min after beginning of OLV compared with that 30 min after beginning of TLV (P0 05) ET concentration in the pulmonary vein increased significantly following OLV in propofol group (P0 05) Conclusion Propofol at clinical dosage does not inhibit hypoxic pulmonary vasoconstriction The atelectasis and hypoxic stimulus during OLV can make pulmonary endothelium release ET or inhibit pulmonary elimination of ET Enflurane can suppress the above process

Objective To compare the clinical efficacy of 3% hypertonic saline with 20% mannitol in the treatment of acute brain edema in children.Methods Twenty children with acute brain edema were randomly divided into hypertonic saline(HS) group and mannitol group.HS group and mannitol group were given 3% HS solution or 20% mannitol respectively.Main outcome measurements included intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure (CPP),serum electrolytes,plasma osmolality,renal function and urine volume.Results Both 3% HS and 20% mannitol were effective in reducing ICP(P ＜0.05).Therapeutic effect lasted(4.5±1.2) h in HS group and(3.2±1.5) h in mannitoi group.3% HS had a longer duration of action than marmitol(P＜0.05).At the time point of 2 hours after treatment,MAP and CPP of HS group increased more than those of mannitol group(P＜0.05).Conclusion Both 3% HS and 20% mannitol could rapidly decrease ICP.3% HS has a longer duration of action in reducing ICP than 20% mannitol.3% HS is more effective in stabilizing circulation and improving CPP than 20% mannitol.

RNA has received m ore attention in the field of forensic m edicine and the developm ent of the new biological m arkers based on RNA show s great significance in the analysis of com plex cases. circular RNA (circRNA ) is a kind of non-coding RNA w hich is w idely reported recently. A lthough the regulatory m echanism s of generation and expression are not fully clear, the existing research indicates that circRNA has im portant biological functions. C ircRNA has a cell-type-specific expression w ith great stability and a high expression level, w hich m akes it m eaningful in forensic applications potentially. In this paper, the research progress, the generation and regulation of circRNA as w ell as its biological characteristics and functions are sum m arized, w hich w ill provide references for related studies and foren-sic applications.

Objective To investigate the effects of sevoflurane postconditioning on lung function in patients undergo-ing heart valve prosthesis implantation with cardiopulmonary bypass (CPB). Methods Thirty patients, scheduled for heart valve prosthesis implantation, were randomly divided into control group (C, n=15) and sevoflurane postconditioning group (S, n=15). Anesthesia was maintained by intermittent intravenous injection of midazolam, fentanyl and pipecuronium. In group S, 2%sevoflurane was inhaled continuously for 15 min , 2 min before aortic unclamping. Blood samples were taken at 30 min before CPB (T2), 30 min after CPB (T3), 6 h (T4), 12 h (T5) and 24 h (T6) after operation. The values of p(O2), SaO2, airway peak pressure (Ppeak) and airway plateau (Pplat) pressure during the time of mechanical ventilation were recorded. Oxygen index (OI), alveolar arterial oxygen tension difference (AaDO2), dynamic pulmonary compliance (Cdyn) and static pulmonary compli-ance (Cstat) were calculated. Results Compared with group C, the values of SaO2 and Cdyn were significantly higher in group S after 30 min of CPB. The values of OI, p(O2), Cdyn and Cstat were significantly higher in group S than those of group C after 6 h of operation. The value of AaDO2 was significantly lower 12 h and 24 h after operation than that of group C (P＜0.05). Conclusion CPB led to the lung injury. The sevoflurane postconditioning has a protective effect on lung function in pa-tients undergoing cardiac valve replacement with CPB.

Objective To summarize the characteristics of ecthyma gangrenosum and explore its significance in early diagnosis of pseudomonas aeruginosa sepsis in children.Methods We retrospectively reviewed the medical records of 11 children with ecthyma gangrenosum who were hospitalized at Guangzhou women and children's medical center between May 2008 and Apr 2011.Results Eight cases were male and 7 were less than twelve months,the oldest was 2 years old,all of them were diagnosed as Pseudomonas aeruginosa spesis.Two patients had a single lesion,and the others had multiple lesions.Ecthyma gangrenosum located on the trunks in 7 cases,on anogenital areas in 5 cases,on extremities in 5 cases and on faces in 3.The lesions appeared on day 2 to day 10.On average,they developed on day 5.Seven patients developed ecthyma gangrenosum before admission,the course of the illness before admission was 6 days.Fever and multiple organ dysfunction occurred in all the patients and their cultures grew pseudomonas aeruginosa,blood cultures were positive in 8 cases,the others were isolated psudomonas aeruginosa from tissue of the lesion,discharge,ascites,pleural effusion,respectively.The time of ecthyma gangrenosum appeared was earlier than the time of the culture results reported.All of the patients were started empiric antibiotics therapy on admission,the initial antibiotic regimen was appropriate in 9 patients,8 needed surgical intervention,4 were treated with continuous blood purification.Ten patients survived and 2 died,the hospital stay was from 1 to 63 days,the average was 30.Conclusion Ecthyma gangrenosum is a known cutaneous manifestation of pseudomonas aeruginosa sepsis,which is helpful for early diagnosis and treatment,and then the outcome will be improved.

BACKGROUND: The stomach is usually used to substitute the diseased esophagus, which will change the physical digestive passage and results in some complications, such as back-streaming, poor food intake, and dyspepsia. If there is an artificial esophagus to replace the diseased esophagus, then the complications would be greatly reduced, and surgical procedures would be simplified. OBJECTIVE: To investigate the effects of artificial prosthesis of titanium-nickel alloy and silicone on repairing esophageal defect after part excision of esophagus. DESIGN, TIME AND SETTING: An in vivo observation experiment based on animals was performed at the animal laboratory of Second Affiliated Hospital of Guangzhou Medical College between May 1999 and May 2001. MATERIALS: Sixteen pigs of either gender, weighting 30 35 kg, were included. The artificial esophagus constructed by titanium-nickel alloy and silicone were provided by General Research Institute for Nonferrous Metals. Its length was 10 cm and its internal diameter was 20 mm. Its inner layer was made of silicone and its outer layer was titanium-nickel alloy net. METHODS: A segment of 7-cm thoracic esophagus was resected and was replaced by an artificial prosthesis constructed by titanium-nickel alloy and silicone. At 1, 2, 3, 4, 5, 6, 7, and 8 weeks, as well as 3, 4, 6, 8, 10, and 12 months after surgery, animals were sacrificed to take specimens. Sedal slices were stained by hematoxylin-eosin for pathological examination. MAIN OUTCOME MEASURES: Autopsy and histopathological findings of neo-esophagus. RESULTS: Of initial 16 pigs, 1 died owing to shock caused by hemorrhee, 1 died of excessive anesthesia, and the remaining 14 pigs survived a period from 7 days to 1 year. Following sacrifice, some vomicas containing yellow and white liquor purls on the chest wall of 4 pigs were observed, which were wrapped but did not communicate the thoracic cavity. One artificial esophagus was not in place but found in the stomach. One artificial esophagus was twisted and formed an esophagus diverticulum. The false passage around the prosthesis formed so long as the animals survived more than 1 week, which was called as neo-esophagus. The neo-esophagus was constructed primadly by granulation tissue within approximately 2 weeks, and then fibrous connective tissue replaced it. Four weeks later, esophageal epithelial cells covered the internal cavity of the "nee-esophagus". At this time, neonatal smooth muscle cells could be observed, but gland regeneration was not found. Following artificial esophagus displacement, the middle segment of "neo-esophagus" presented with stenosis to different degrees. The stenosis segment tended to stabilize with time (approximately 6 months later). CONCLUSION: Esophageal defect within a certain range of length can be repaired by an artificial esophagus constructed by titanium-nickel alloy and silicone.

Objective To study the spare demand rate and storage quantity probability model for military medical equipment in order to make a valuable reference to the decision-making of medical organization for the further medical support.Methods The reliability and maintainability of spare in the process of equipment maintenance were studied,and the signifi-cant factors which have influence on spare demand rate were analyzed.By using Passion theory,spare demand rate proba-bility model of medical equipment was deduced,especially for repairable components and un-repairable components spare.By calculating the probability of replaceable spare,a useful method to scientifically make out the storage quantity of mili-tary medical equipment was provided.Results The models of spare demand rate and storage quantity were made for mili-tary medical equipment maintenance.Conclusion The solution of the model is simple and convenient and the calculating results shows that the spare demand rate and storage quantity is close to the reality.It can meet the requirements of pre-diction of spare demand rate and determination of the storage quantity in maintenance support of medical equipment in peacetime.

Objective To establish a mouse ’ s cross-territory ear flap that enables chronic , in-vivo observation of the change of vascular morphology .Methods 30 ICR mice, weighing 25~40 g, were used for this study .Commercial depilatory cream was used to first remove the hair of the mice , after which the vascular pattern in the ears was investigated . According to the observation of the vascular pattern in the mouse ’ s ear, the eye scissors were used the sever the outer 2/3 of the base of the ear , in which process a ear ’ s flap based on a vascular pedicle but crossed three vascular territories was created.After the creation of the flap , the mice were placed on an automatic controlled movable machine with the ear ’ s flaps spread over a customized Plexiglas .Then the flaps were photographed under the stereoscope ( ×25) at the following time points:1,2,3,5,7,10,14,21,30 d.the necrosis of the flap, and the morphological change of the vessels within theflap were analyzed .Results The ICR mouse ’ s ear was supplied three angiosomes , which were respectively named as the cephalic , median and caudal angiosomes from inside out .Five days after the flap’s creating, necrotic rate of(15 ±7)%was developed .The choke vessels between the medial and median angiosomes expanded rapidly in diameter , reaching the plateau 10d after flap creation, resulting the dilated choke veins and arteries at their peak being 3.9 ±0.5 and 3.5 ±0.7, respectively, than their initial sizes.The diameter of the choke veins began to shrink at approximately 10d, stabilizing after 21d.The diameter of the choke arteries plateaued and stabilized at around 10d.Conclusion ①after harvest of extended flap, the dilation of veins seemed to passive , whereas the dilation of arteries seemed to active;②the number of the choke vessels between the dynamic and potential territories that are involved in dilation and extent of the dilation are much smaller than that of the choke vessels between the anatomic and dynamic territories;③the mouse ’ s ear flap is an excellent model of further study of mechanism underlining the dilation of choke vessels and for the screening of vasoactive drugs that augment the survival of the large flap .

Objective To investigate the relationship between the changes in intracranial excitatory amino acid(EAA) levels and the incidence of postoperative cognitive dysfunction (POCD) in eldedy patients after general anesthesia. Methods Forty ASA Ⅰ-Ⅲ patients of both sexes aged 65-79 yr weighing 48-76 kg undergoing elective non-cardiac surgery under general anesthesia were studied.Anesthesia was induced with midazolam,fentanyl,etomidate and succinylcholine and maintained with continuous iv infusion of propofol,remifentanil,isoflurane inhalation and intermittent iv boluses of vecuronium.The right internal jugular vein was cannulated with a catheter which was advanced cephalad until jugular bulb.The jugular bulb venous blood samples were taken before (T0,baseline),at the end of (T1) and at 24,48 and 72h(T2-4) after operation for measurement of plasma concentrations of glutamate (Glu),aspartate (Asp) and glycine (Gly) by RP-HPLC.The cognitive function was evaluated by mini-mental state examination (MMSE) at T0 and T4.Results Eleven of the 40 patients developed POCD (28%).The plasma Gh,Asp and Gly concentrations were significantly increased after operation as compared with the baseline values in POCD patients and were significantly higher than in non-POCD patients.The plasma concentrations of Glu and Asp were negatively correlated with MMSE score(Glu:r=-0.86.P<0.01;Asp:r=-0.99,P<0.01).Conclusion Elderly patients may develop POCD after operation performed under general anesthesia through increase in intracranial EAA levels.