Objective To observation the changes of left atrium and pulmonary veins(PV)in patients with atrial fibrillation(AF) by transthoracic two-and three-dimensional echocardiography. Methods Transthoracic echocardiography were applied in 126 patients,which were divided into sinus rhythm(SR) group(64 cases)and AF group(62 cases),AF group were further divided into two subgroups:the paroxysmal AF and non-paroxysmal AF group.Left atrial area(LAA),left atrial volume(LAV),left atrial diameter(LAD)were measured by 2-dimensional echocardiography imaging.PV diameters were measured by three-dimensional echocardiography. Results Compared with SR group,PV diameters were significantly increased in AF group(P＜0.05).In patients with AF,PV diameters in non-paroxysmal AF group were larger than paroxysmal AF group.The four PV diameters in SR,paroxysmal AF and non-paroxysmal AF group did not show statisticant difference(P＞0.05).Compared with SR group,LAD,LAA,LAV were increased in AF group.LAD,LAA,LAV were larger in non-paroxysmal AF group than SR group and paroxysmal AF group(P＜0.05).Conclusions Left atrium and PV dilate significantly in patients with AF,transthoracic echocardiography could be a non-invasive method to observe left atrium and PV.

[Objective] To research the sedative effect of intranasal dexmedetomidine and sufentanil for pediatric sedation for stomatological operation of outpatient department.[Methods] 60 children undergoing stomatological operation of outpatient department,age 3 ～ 7 years,weighing 10 ～ 32 kg,of ASA physical status Ⅰ ～ Ⅱ,were divided into the three groups (n =20) randomly using a random number table:group dexmedetomidine and sufentanil (group DS),group dexmetomidine (group D),group sufentanil (group S).Recorded the children's behavior using the Ohio State University behavior rating score (OSUBRS),the University of Michigan Sedation Score (UMSS),SBP,HR and side-effects when entry,during and leave operation and in post-anesthesia care unit,side-effects,the satisfaction of stomatological doctors and parents.[Results] The OSUBRS of group DS when entry,during operation were lower than group D (P ＜ 0.01).The UMSS of group DS were higher than group D and group S when entry and during operation (P ＜ 0.05).The success rate of group DS was higher than group D and group S (P ＜ 0.01).There was no different of mean percentage change in systolic blood pressure and heart rate from baseline between group DS and group D (P ＞ 0.05).There were no instances of respiratory depression,hypotension and bradycadia.[Conclusion] Intranasal dexmedetomidine and sufentanil provides satisfactory pediatric sedation for stomatological operation of outpatient department without side effects such as respiratory depression,bradycadia and hypotension.

Objective To assess the prognostic value of tissue Doppler imaging(TDI) parameters in aeute myocardial infarction(AMI) patients. Methods After one week of AMI,102 patients underwent twodimensional/Doppler echocardiography and TDI examination.Early and late transmitral flow velocity E,A,deceleration time(DT)were measured. The average velocity of mitral valve at septal and lateral weremeasured including the systolic velocity(Sm),early diastolic velocity(Em)and late diastolic velocity(Am),Em/Am,E/Em were calculated.After 1 year follow up,the patients were divided into two groups according to whether hospitalizated due to heart failure(HF)or not. Stepwise multivariate COX regression analysis was used to identify the predictors of the cardiac event. Results In patients with H F,Sm,Em were lower than those of no HF group(P＜0.05),E,E/Em were higher than those of no HF group(P＜0.05 and0.01 respectively). Stepwise multivariate COX analysis identified that the E/Em was the only independent predictors of HF.E/Em≥12 was a useful HF predictors with a sensitivity of 84.2%,specificity of 77.1%.Conclusions E/Em ratio may assist in the risk stratification in AMI,and is a powerful predictor of HF.

Talk teaching is an effective form of teaching research activity.It focuses on the teachers,teaching ideas and their abilities of curriculum development,curriculum designing and teaching practice.It is of great significance in optimizing pathophysiologic teaching,improving the teaching effect and teachers'quality.It is worth discussing and promoting.Talk teaching should be the basic skill necessary to the teachers of basic medicine.

Objective To explore the effect of comprehensive nursing on improving the capacity load, nutritional status and quality of life of patients with peritoneal dialysis.Methods A total of 200 patients underwent peritoneal dialysis were selected as study subjects.According to the different nursing methods, the patients were divided into control group (n=100) with routine nursing and intervention group (n=100) with comprehensive nursing intervention.Capacity load, nutritional status before and after care and quality of life were compared, and related complications after 6 months of discharge were analyzed.Results The blood pressure (systolic blood pressure, diastolic blood pressure, mean pressure) and body mass of the intervention group were lower than those of the control group (P<0.05);There was no significant difference in the type and numbers of antihypertensive drugs between the intervention group and the control group (P>0.05);The scores of serum albumin, hemoglobin level and quality of life in the intervention group were higher, and the incidence of complications was significantly lower than that in the control group (P<0.05).Conclusion Comprehensive care intervention for peritoneal dialysis patients can reduce its capacity load, prevent complications, improve quality of life and nutritional status.

Objective To explore the effect of comprehensive nursing on improving the capacity load, nutritional status and quality of life of patients with peritoneal dialysis.Methods A total of 200 patients underwent peritoneal dialysis were selected as study subjects.According to the different nursing methods, the patients were divided into control group (n=100) with routine nursing and intervention group (n=100) with comprehensive nursing intervention.Capacity load, nutritional status before and after care and quality of life were compared, and related complications after 6 months of discharge were analyzed.Results The blood pressure (systolic blood pressure, diastolic blood pressure, mean pressure) and body mass of the intervention group were lower than those of the control group (P<0.05);There was no significant difference in the type and numbers of antihypertensive drugs between the intervention group and the control group (P>0.05);The scores of serum albumin, hemoglobin level and quality of life in the intervention group were higher, and the incidence of complications was significantly lower than that in the control group (P<0.05).Conclusion Comprehensive care intervention for peritoneal dialysis patients can reduce its capacity load, prevent complications, improve quality of life and nutritional status.

Objective To investigate the effect of lower thoracic epidural block on intestinal epithelial cell apoptosis during hemorrhagic shock and resuscitation in rats.Methods Sixty-four male SD rats placed with lower thoracic epidural catheter were randomly divided into four groups (n=1 6 each):group Sham (sham operation),group HSR (hemorrhagic shock and resuscitation),group NS (hemorrhagic shock and resuscitation+epidural saline 100 μl/kg),and group TEA (hemorrhagic shock and resuscitation+epidural 0.075% ropivacaine 100 μl/kg).The hemorrhagic shock was made described by Chaudry.Rats were resuscitated by transfusing shed blood and normal saline 60 min after hemorrhagic shock.Malondialdehyde (MDA)content,superoxide dismutase (SOD)activity, and protein expression of Bax and Bcl-2 in intestinal epithelium were detected,and epithelial apoptosis index was calculated at 2 h after resuscitation.Results Compared with group Sham,intestinal epithe-lial MDA,Bax expression and epithelial apoptosis were significantly increased,while SOD activity were markedly decreased in groups HSR,NS and TEA (P<0.05).Compared with groups HSR and NS,intestinal epithelial MDA,Bax expression and epithelial apoptosis were significantly decreased, while SOD activity and Bcl-2 expression were markedly increased in group TEA (P <0.05 ). Conclusion Lower thoracic epidural block can enhance the antioxidant and anti-apoptotic ability,and inhibit the oxidative stress and cell apoptosis of intestinal epithelium.Therefore,it can promote the survival rate after hemorrhagic shock and resuscitation through protecting intestinal barrier.