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.

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.

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.

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 investigate the effects of propofol on ketamine-induced HSP 70 mRNA and protein expression in the rat posterior cingulate cortex and to explore the possibility of using propofol to prevent or treat ketamine-induced psychotomimetic effects and neuronal damage. Methods Thirty male Wistar rats weighing 250-300 g were randomly divided into 5 groups with 6 animals in each group: group 1 received normal saline intraperitoneally ip (NS); group 2 received ketamine 100 mg? kg-1 ip (K); group 3 received propofol 100 mg ? kg-1 ip (P); group 4 received propofol 50 mg?kg-1 + ketamine 100 mg?kg-1 ip (P1 K) and group 5 received propofol 100 mg?kg + ketamine 100 mg?kg-1 ip (P2K) . In group 4 and 5 the interval between propofol and ketamine administration was 15 min. Twenty-four hours after ketamine and/or propofol administration, the animals were decapitated and brain was removed. HSP 70 mRNA expression in the posterior cingulate cortex was detected by using semi-quantitative RT-PCR technique; HSP 70 protein expression in posterior cingulated cortex was determined by immuno-histochemical method. Results The levels of HSP 70 mRNA and HSP 70 protein expression were significantly different among the 5 groups. Ketamine induced marked HSP 70 mRNA and HSP 70 protein expression in the posterior cingulated cortex. Propofol itself did not induce HSP 70 gene expression in this brain region. Propofol significantly inhibited ketamine-induced HSP 70 mRNA and HSP 70 protein expression in the posterior cingulate cortex in a dose-dependent manner. Conclusions Propofol pretreatment can significantly inhibit ketamine-induced HSP 70 mRNA and protein expression in the posterior cingulated cortex. It may be one of the mechanisms of inhibition of ketamine-induced psychotomimetic effect and neuronal damage by propofol.

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