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 study the effect of inhalation combined salmeterol plus fluticasone propionate in treatment of asthma in children between 4 ～ 5 years old.Methods Seventy-four children (age range,4 ～ 5 years) were enrolled for our study,they were randomly divided into 2 groups (one group inhaled combined salmeterol plus fluticasone,37 children;the other group inhaled fluticasone,37 children).Comparative studies of clinical efficacy,quantified symptom score,and regular follow-up observations were conducted at the interval of one week,one month,three months.Results In the first week and first month during the treatment,there were no difference between salmeterol plus fluticasone group and fluticasone group (P ＞ 0.05).In the third month during the treatment,the daytime ratings(0.16 ± 0.09 vs 0.32 ± 0.11,P ＜ 0.05) and night ratings(0.04 ± 0.01 vs 0.14 ±0.00,P ＜0.05) of salmeterol plus fluticasone group were significantly better than those of fluticasone group.After three months,more children in salmeterol plus fluticasone group were responsive to the decreased dose of the drug than those of fluticasone group (x2 =4.57,P ＜ 0.05).Conclusion In the follow-up of exacerbatious,treatment with combined salmeterol and fluticasone propionate was as efficient as that of fluticasone in alleviating symptoms.During remission of asthma,combined salmeterol and fluticasone propionate was probably better than fluticasone for control of symptoms.

Objective To investigate the influence of TRF on high-intensity cerebrospinal fluid artifacts in T2-FLAIR MR imaging.Methods In a GE Signa Twinspeed 1.5T system,50 cases were examined with T2-FLAIR sequences including 2 different optional imaging parameters according to the augmentation of TRF.Results TRF pulses significantly improved image quality(P

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 design leaf patterns for Multileaf Collimator(MLC)routine quality assurance(OA)with a 2D diode array.Methods According to the detector distribution characteristic of the 2D diode array and basillg on the"picket fence"pattern,design the"stepwise"pattern.For each diode involving MLC QA,a calibration curve of relative output versus leaf positioning error was measured through delivering a set of patterns with different intentionally introduced positioning errors.When this proposed technique was delivered,the referenced patterns were exposed,and the calibration curves were used as a mean to quantitative determination of the leaf possible positioning errors through the detector readings.Results Compared with the"picket fence"pattern,the"stepwise"pattern not only had a high detecting efficiency,but also increased the dosimetric sensidvity to leaf positioning error.A 1 mm Ieaf positioni.error corresponds to a dose variation of 25% for the"stepwise"pattern,while for the"picket fence"pattern the same positioning error just causes a 17% dose vailation.Conclusions The new"stepwise"pattern is more efficient to be carried out,and more sensitive to sub-millimeter changes of leaf positioning.

To explore the effect of insulin therapy on serum level of insulin-like growth factor-I(IGF-I)in patients with type 2 diabetes mellitus.The results showed that serum IGF-I level increased[(126.70±51.91 vs 90.04±43.68)μg/L,P<0.01]and was positively correlated with insulin level in patients with type 2 diabetes mellitus after exogenous insulin therapy(r=0.298,P<0.05).

Objective:To investigate the frequency and severity of systemic adverse reactions in children with allergic rhinitis (AR) undergoing subcutaneous immunotherapy (SCIT).Methods:The clinical data of 321 children with allergic rhinitis receiving SCIT at Department of Otorhinolaryngology, Changzhou Third People′s Hospital from January 2016 to January 2020 were retrospectively analyzed. There were 180 boys and 141 girls aged 5 to 14 years. Patients were injected subcutaneously with standardized dust mites allergen extract. The onset time, symptoms and signs and treatment of adverse reactions were documented. The relationship of adverse reactions with gender, age, treatment course and dosage of allergen injection were analyzed.Results:Patients received total 13 053 injections, and 115 adverse reactions (0.88%) occurred in 56 cases (17.45%). The incidence of adverse reactions in children aged 5-9 years was higher than in those aged 10-14 years, for both the number of cases and injections (χ2=4.41, P=0.04; χ2=9.13, P<0.01), but no significant differences were observed in gender of patients. The incidence of adverse reactions in the age group 2-3 years was lower than that in age groups<1 year and 1-<2 years in both of cases and injections (χ2=22.86, P<0.01; χ2=6.43, P=0.01; χ2=12.14, P<0.01; χ2=13.74, P<0.01). The incidence of adverse reactions in the high-dosage phase (100 000 SQ-U) was higher than that in the low-dosage phase (<100 000 SQ-U) (χ2=4.35, P=0.04). Conclusions:The study shows that the incidence of adverse reactions in children with allergic rhinitis receiving subcutaneous immunotherapy is less than 1% in the number of injections and most of them are grade Ⅰ adverse reactions. The study also shows that younger age, the early course of treatment and the high dosage of allergens are risk factors for adverse reactions.

Objective To investigate the value of the adaptive statistical iterative reconstruction (ASIR) algorithm for reducing the radiation dose and optimizing the image quality in the low-dose spectral CT scanning in GSl (Gemstone spectral imaging) of the liver.Methods A total of 60 patients who underwent hepatic spectral CT scanning in GSI were enrolled in this study.The patients were randomly divided into two groups according to priority with 30 cases per group.Low-dose spectral CT scanning was used for group A, and images were reconstructed by ASIR 0 and 50％ , marked as A1 and A2.Group B was scanned with conventional dose of spectral CT, and images were reconstructed by Filtered back projection (FBP).Effective doses (E) for each group were calculated.Image quality was assessed by two radiologists, and the radiation doses were compared between groups A and B.Results All image quality of each group were good enough for clinical diagnosis.E for group A and B were (3.2 ±0.2) and (5.8 ± 0.2) mSv, respectively.There was statistical difference with image noise between group A and B(Z =-6.784,P ＜ 0.05).The image noise, SNR and CNR had statistical differences between group A and B (F =24.013, 15.646, 8.285, P ＜0.05).Compared with group A1, the image noise was lower, and the SNR and CNR were higher in groups A2 and B(P ＜ 0.05).There were no statistical differences of image noise, SNR and CNR between groups A2 and B (P ＞ 0.05).There were no statistical differences of the image quality score between groups A1, A2 and B (F =102.38,105.768, P ＜ 0.05).Conclusions ASIR combined with low-dose spectral CT scanning was helpful to reduce radiation dose and could obtain better image quality in hepatic CT examination.

OBJECTIVE:To observe therapeutic efficacy and safety of benazepril combined with metoprolol in the treatment of elderly essential hypertension complicated with heart failure.METHODS:In retrospective analysis,100 elderly patients with essential hypertension complicated with heart failure were divided into control group (50 cases) and observation group (50 cases) according to drug plan.Based on routine treatment,control group was given Benazepril hydrochloride tablet 10 mg orally,once a day.Observation group was additionally given Metoprolol tartmte tablet with initial dose of 6.25 mg,twice a day,then increased 50-100 mg based on the improvement,twice a day,on the basis of control group.Relevant indicators were observed after 6 months of treatment.Clinical efficacies as well as SBP,DBP,brachial-ankle pulse wave velocity (baPWV),resting heart rate,LVEF,SV and the occurrence of ADR before and after treatment were observed in 2 groups.RESULTS:Total response rate of observation group (88.0％) was significantly higher than that of control group (62.0％),with statistical significance (P＜0.05).Before treatment,there was no statistical significance in SBP,DBP,baPWV,resting heart rate,LVEF and SV between 2 groups (P＞0.05).After treatment,SBP,DBP and baPWV of 2 groups were significantly lower than before,and the observation group was significantly lower than the control group;LVEF and SV of 2 groups were significantly higher than before,and the observation group was significantly higher than the control group;resting heart rate of observation group was significantly lower than before and that of control group,with statistical significance (P＜0.05),but there was no statistical significance in resting heart rate of control group before and after treatment (P＞0.05).No significant ADR was found in 2 groups during treatment.CONCLUSIONS:Based on routine treatment,benazepril combined with metoprolol show significant therapeutic efficacy for elderly hypertension complicated with heart rate,can improve cardiac function and blood pressure with good safety.