Objective To study rational method for managing recurrent ventricular fibrillation during aortic valve replacement in patients with valvular aortic stenosis.Methods One hundred consecutive patients with valvular aortic stenosis who scheduled to receive aortic valve replacement were enrolled into the study.Three steps method was applied when ventricular fibrillation occurred after aortic unclamping.The first step was to correct disturbance of internal environment,intravenous lidocaine (100mg) and defibrillation (20-30 W/s); the second step was to inject norepinephrine to maintain mean arterial pressure 70-90 mm Hg (1mm Hg =0.133 kPa),then repeated defibrillation; the third step was infusion of magenisum sulphate (1g) and/or amiodarone (150 mg),then repeated defibrillation.Preoperative left ventricular mass index,mean arterial pressure,nasopharyneal temperature,serum potassium level and hematocrit after aortic unclamping were collected and compared.ResultsAfter aortic unelamping,56 patients recovered spontaneous rhythm without defibrillation,after the first step,16 patients could be defibrillated successfully,other 10 patients recovered spontaneous rhythm after the second step,still other 18 patients remained unresponse untill the third step.Patients who recovered spontaneous rhythm without defibrillation or needed the first step management had significant lower left ventricular ragas index when comparing with patients who entered the second step and third step management respectively [(184±43),(178±51)g/m~2 vs(237±61),(242±46) g/m~2,P＜0.05 ].Patients who needed the second step or third step management also had significant higher mean arterial pressure than the other patients.Conclusion Three steps method can be used to manage recurrent ventricular fibrillation during aortic valve replacement in patients with valvular aortic stenosis.

Objective To explore the clinical vaue of multilayer spiral CT in diagnosis of small intestinal tumor.Methods 36 cases with small intestinal tumor were selected as the research objects,the multi-slice spiral CT imaging results were analyzed retrospectively.Results Sensitivity of multi-slice spiral CT was 94.4％,accuracy of 88.9％.Conclusion Spiral CT is a safe,simple,non-invasive,effective method in diagnosis of small bowel tumors,it has high detection rate.

Glial cell line-derived neurotrophic factor(GDNF)is one of the numbers of neurotrophic factors.GDNF is involved in many physiological and pathological actions.Moreover,GDNF plays an important role in the neuropathic pain generation and development at central nerve system level,or at peripheral level.This paper provides an overview of the evolution of GDNF and neuropathic pain research in recent years.

Lornoxicam is a new non-steroidal anti-inflammatory drug,it can inhibit the activity of cyclooxygenases and the immunologic injury afteroperation.Its efficacies on preoperative,operative period and postoperative analgesia are similar to those of opioid.Lornoxicam can decrease the dosage of opioid drugs and has the good qualities of short half-life,few adverse effects and satisfactory tolerance.Lornoxicam can provide rapid and stable analgesic effect in perioperative phase.

Objective To investigate the characteristics,the incidence, relative factors of antibiotic associated diarrhea (AAD),and prevent and control it. Methods Retrospective analysis was performed in 78 patients with AAD. Results Prevalence ratio of AAD was 9.3%, the risk of AAD related to the kinds of using mix antibiotics and period of treatment, using many meddle measures for medical and age.The antibiotics causing AAD were extending penicillin or third cephalosporins, penicillin, carbapenemases, second cephalosporins.Conclusions Rational use of antibiotic,control use of antibiotic and reduce the state of consciousness are the key measures to prevent and control the AAD.

Astrocyte is the most amount cell population of the central nervous system, which has complex signal transduction pathway. Astrocyte involves in many physiological actions and pathological processes. Further more, Astrocyte plays an important role in neuropathic pain generation and development at central nerve system level, or at peripheral level. This paper reviewed the evolution of astrocyte and neuropathic pain research in recent years.

Objective To explore the difference between pressure-regulated volume controlled ventilation (PRVCV) and volume controlled ventilation (VCV) during videothoracoscopic bhb excision.Methods Consecutive 20 patients scheduled to undergo videothoracoscopic bleb excision were enrolled into the study.After induction, endotracheal blocker was advanced into endotracheal tube to establish one-lung ventilation,each patient was randomly assigned to receive successively PRVCV and VCV for 20 minutes.Ventilatory variables were kept constantly(tide volume 6 ml/kg, respiratory rate 15 breaths/min and I: E ratio 1: 2).Heart rate,blood pressure,peak airway pressure and blood gas parameters were compared.Results Peak airway pressure was significantly lower with PRVCV than that with VCV [(12.7±3.6 ) cmH_2O(1 cm H_2O =0.098 kPa) vs (18.2±4.3) cm H_2O,P < 0.01].However,there was no significant difference in arterial oxygen tension,arterlal partial pressure of carbon dioxide,heart rate and blood pressure between PRVCV and VCV.Conclusion During one-lung ventilation in videothoracoscopic bleb excision, PRVCV offers lower peak inspiratory airway pressures while maintaining equal oxygenation compared with VCV.

Objective To study the effect of endotracheal tube's resistance on the respiratory systolic variation test(RSVT).Methods The RSVT,a test to predict fluid responsiveness was performed in 20 patients.The test consisted of the delivery of three congecutive pressure-controlled breaths with incremental peak inspiratory pressures of 10,20 and 30 cm H2O(1 cm H2O=0.098 kPa).The minimal values of the systolic arterial pressure following each of these three breaths were measured and plotted against their respective airway pressures,producing the RSVT slope.RSVT slope were compared between normal airway resistance and increased resistance circumstances,and the latter was simulated by advancing a Cooperdech bronchial blocker into endotracheal tube.Results Under normal resistance,RSVT slope was(0.39±0.21) volumes were(461.5±95.9),(891.5±149.8)and(1207.5±159.1)ml,when peak inspiratory pressures of 10,20 and 30 cm H2O were dehvered.When bronchial blocker was advanced into endotrecheal tube, (0.27±0.17)mm Hg,cm H2O significantly(P<0.01),and tidal volumes decreased to(434.5±92.8), (796.5±96.6)and(1097.5±68.4)ml(P<0.05 or<0.01).Conclusion Changes in endotraeheal tube's resistance can distort the RSVT slope.

Objective To evaluate the effect of selective decontamination of digestive tract(SDD)on preventing ventilator-associated pneumonia by Meta-analysis based on theory and method of evidence-based medicine.Methods Six medical databases (PubMed,Excerpta Medica Database [EMBASE],China Biology Medicine disc[CBMdi-sc],China National Knowledge Infrastructure[CNKI],VIP database,from 1995 to 2014,and Cochrane Library of issue 12,2014 )were searched,literatures were selected,data were extracted,Meta-analysis was performed by using RevMan 5.3 software.Results 13 literatures were included (2 676 patients were involved),Meta-analysis revealed that the incidence of VAP in treatment and control group was 20.68% and 35.99% respectively (OR and 95%CI ,0.40 [0.28,0.56],P <0.001 ),the mortality rate of patients with mechanical ventilation in treatment group and control group were 20.60% and 20.03% respectively (OR and 95%CI ,0.99 [0.81 ,1 .20],P =0.91 ). Conclusion SDD can reduce the incidence of VAP in patients with mechanical ventilation,but can’t reduce mortali-ty rate.

Objective To study the effect of red blood cells on the secretion of white blood cells modulating globulin in patients with cancer with a new immunological reaction experimental system. Methods Cancer cells (S180, 5?10~6/ml) or 0.2ml of NS or 0.2ml of white blood cells and 0.3ml of plasma were added to anticoagulant suspension of white blood cells treated by citric acid and incubated for 1h at 37℃. The content of globulin (g/L) was determined by Olympus AU100 detector method. 0.2ml of cancer cells was added to 0.2ml of whole blood cells and 0.3ml of plasma in the whole blood experimental group. 0.2ml of NS was added to 0.2ml of whole blood cells and 0.3ml of plasma in the control group. 0.2ml of cancer cells was added to 0.2ml of white blood cells and 0.3ml of plasma in the white blood cell isolation experimental group. 0.2ml of NS was added to 0.2ml of white blood cells and 0.3ml of plasma in the control group. Results Activation rate (0.31?0.09) of globulin in whole blood cell experimental group of patients with cancer was significantly decreased compared to that (0.39?0.14) in normal people. Red cell adhesion rate (0.09?0.08) of globulin in control group was also significantly decreased compared to that (0.29?0.14) in normal people. Conclusion The results of our study indicate that the new experimental system can be used for detection of red blood cell-modulating globulin. The function of red blood cells in modulating globulin of patients with cancer is decreased.