BACKGROUND: Inadequate hyperventilation may trigger cerebrovascular contraction and lead to lowered cerebral perfusion and oxygen supply-demand imbalance.OBJECTIVE: To investigate the influence of hyperventilation on oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the cerebral arteries and veins in patients with serious traumatic brain injury.DESIGN: Case analysis.SETTING: Department of Anesthesiology, First Hospital Affiliated to Shantou University.PARTICIPANTS: Sixteen patients who received emergency operations in the First Hospital Affiliated to Shantou University between January and July 2002.METHODS: Patients with traumatic brain injury underwent operation under general anesthesia, and the PaCO2 was maintained at 30 mm Hg for 15 minutes by regulating the respiration rate, followed by decrease to 25 mm Hg, maintained for 15 minutes before restoration to 30 mm Hg for 15 minutes. The fractional concentration of inspired oxygen was adjusted to maintain blood PaO2 at around 100-150 mm Hg, and the blood sample was collected from the artery and internal jugular vein 15 minutes after adjustment of PaCO2 for blood gas analysis. The PaO2 was then increased to 200-250 mm Hg by increasing the fractional concentration of inspired oxygen, and the PaCO2 was adjusted from 30 to 25 and then back to 30 mm Hg in the described manner, and the oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the arteries and the veins were measured.MAIN OUTCOME MEASURES: Influence of blood PaO2 and PaCO2 on oxygen saturation in the internal jugular vein, difference in oxygen and lactic acid contents between the arteries and the veins.RESULTS: Sixteen patients met the diagnostic criteria and completed data collection. The arterial PaCO2 decreased from 30 to 25 mm Hg when arterial blood oxygen pressure increased from 100-150 to 200-250 mm Hg, which leads to obvious decrease of oxygen saturation in the internal jugular vein and obvious increased difference in oxygen content between the cerebral artery and vein. However the absolute value of oxygen saturation in the internal jugular vein was obviously higher at PaO2 of 200-250 mm Hg than that at PaO2 of 100-150 mm Hg, while the absolute value of cerebral arteriovenous difference of brain oxygen content was obviously lower. Compared to the basal level, the arteriovenous lactic acid difference was obviously increased at PaO2 of 100-150 mm Hg,PaCO2 of 30 and 25 mm Hg, and at PaO2 of 200-250 mm Hg and PaCO2 of 25 mm Hg.CONCLUSION: Relatively higher PaO2 (200-250 mm Hg) and mild hyperventilation (PaCO2 of 30 mm Hg) has no obvious effect on brain oxygen supply-demand balance.

Oncogene Pim-1 has a close relationship with the occurrence and development of several tumours.It is involved in a number of signal transduction pathways and regulates the expression of the downstream biological factors or acts synergistically with other oncogenes.Pim-1 plays an important role in the clinical diagnosis,treatment and prognosis of some tumors,and provides a new potential target in the chemotherapy of tumors.Recently,Pim-1-targeting treatment strategy has be a research hotspot and it would be used for cancer clinical treatment hopefully.

Objective To investigate the preemptive analgesic effects of somato-visceral blockade in laparoscopic cholecystectomy (LC). Methods One hundred patients were randomly divided into four groups: Group A received peri-portal infiltration of 25 ml 0.25% bupivacaine (contained 1:200 000 epinephrine) before incision; Group B received intraperitoneal spray of 35ml 0.25% bupivacaine immediately after the establishment of pneumoperitoneum; Group C received the management of both Group A and Group B; Group D was control group without management. The extent and location of pain and nausea were recorded and assessed at 1, 2, 3, 6, 12, 24 and 48 postoperative hours, respectively. Results In the control group the incisional pain dominated over other pain locations within 24 hours postoperatively (P

Objective To investigate the effect of high iodine traditional Chinese medicine in the treatment of subclinical hypothyroidism in serum VB12,Hcy and thyroid function.Methods 84 patients of subclinical hypothyroidism from August 2014 to May 2016 in our hospital randomly divided into two groups,the control group of 42 cases were treated with levothyroxine sodium tablets treatment,42 cases in the experimental group received more with high iodine traditional Chinese medicine.The changes of serum VB12,Hcy and thyroid function were observed before and after treatment in two groups. Results Compared with before treatment, levels of blood lipid,Hcy and TSH in two groups significantly decreased,levels of VB12 increased(P<0.05);compared with the control group after treatment,levels of blood lipid,Hcy and TSH in experimental group were significantly lower than the control group, the level of VB12 was higher than the control group,the differences were statistically significant (P <0.05).Conclusion High iodine can effectively reduce blood lipids in patients with subclinical hypothyroidism,levels of Hcy and TSH in pregnancy,increased the levels of VB12,which has good clinical curative effect.

Objective To discus the diagnosis,favorabl management and diagnosis of pilocytastrocytoma.Methods Provided by the information from CT,MRI and operation,we try to discus and confirm the characteristics of this tumor.Results Pilocytastrocytoma commonly occurs in 20 years old or younger.The most frequent location involve by tumor were cerebellum.The most common presenting sympton was increased intracranial pressure,and then cerebellum symptoms such as incoordination.Final diagnosis made depending on mainly pathology.We found the relationship between prognosis and the extent of surgical removal.Conclusions Pilocytastrocytoma usually occur in children and adolescent.The most common site of these tumors are the cerebellum.And the more complete extent of surgical removal,the better prognosis.So it was called as "benign" tumors.If pilocyticastrocytoma were subtotally excised,the addition of postoperative irradiati could significantly prolong survival.

Objective To strengthen the understanding of the imaging features in congenital aberrant left pulmonary artery (CALPA). Methods All 4 patients underwent chest film and Doppler echocardiography. Thres cases were examined by enhanced spiral CT examination. In addition, MRI and DSA were performed in 2 cases respectively. Thres cases were proven by surgery or autopsy. Results (1) appearances on chest films included cardiomegaly, pulmonary overvascularity, left hilum a little lower than the right one, emphysema, atelectasis, and pneumonia. (2) bronchography showed stenosis of trachea and/or bronchia. (3) Barium esophagram showed an imprint on the left anterior wall of esophagus. (4) Contrast-enhanced spiral CT and MRI showed marked dilatation of main pulmonary artery (MPA) and the root of MPA extended backward to become right pulmonary artery (RPA), the left pulmonary artery (LPA) arose from the RPA directly. (5) echocardiography indicated LPA arose from RPA. (6) DSA showed MPA was marked dilated, and LPA arose from RPA. (7) other abnormalities included 3 PDA, 2 PLSVC, and ~1 ASD. Conclusion CT and MRI are the best methods to diagnose CALPA.

ObjectiveTo assess the values of 320-detector row dynamic volume CT angiography (CTA) and transthoracic echocardiography (TTE) in follow up of coronary artery aneurysm (CAA) caused by Kawasaki disease (KD).Methods320-de-tector row CTA and TTE were applied in long-term follow-up of 8 patients with CAA caused by KD.ResultsIn 8 patients, the mean age at onset was 41.63±22.70 months and the mean follow up time was 43.50±10.99 months. In acute phase, 3 cases of giant coronary artery aneurysms (GCAA) and 5 cases of mid-small CAA were diagnosed by TTE. A total of 16/32 arteries (50%) were involved. At the end of follow-up, 3 cases of GCAA and 2 cases of mid-small CAA were still diagnosed by TTE, and small CAAs were regressed in another 3 cases. A total of 6/32 arteries (18.75%) were involved. Simultaneously at the end of follow-up, a total of 7/32 arteries (21.9%) were involved by 320-detector row CTA. The distribution was consistent with that of TTE. Mean-while, there were one case of left circumlfex artery, one case of GCAA at distal of the right coronary artery, 2 cases of thrombus, 1 case of coronary stenosis and 2 cases of calciifcation.ConclusionsCAA caused by KD may be persistent for a long time. The thrombus, stenosis, and calciifcation of coronary can occurr at late phase in GCAA. TTE is sensitive and reliable to detect proxi-mal and middle segment of coronary lesions, but has limitations in detection of distal segment of coronary arteries. 320-detector row CTA has more comprehensively view of each coronary artery lesions and is especially sensitive and reliable to detect coro-nary thrombosis, calciifcation and narrowing in proximal and distal coronary arteries after acute phase.

Objective:To study the wound healing effects of the extracts of Shengji Huayu Fang with different solvents and demon-strate their important role in wound healing for deep second degree burn wound. Methods:Sixty Sprague-Dawley rats were randomly di-vidied into six groups(ten rats in each group): the control group (saline), the positive control group (asiaticoside group), Shengji Huayu Fang group respectively with petroleum ether, chloroform, ethyl acetate and n-butanol as the extraction solvent. The extracts of Shengji Huayu Fang with different solvents were applied in the rats with deep second degree burn wound, and the wound healing was e-valuated by the healing rate judged by naked eyes and computer image analysis, DNA cell cycle analysis using a flow cytometry, patho-logical reports and the degree of re-epithelialization studied by the other methods. Results:The mean healing time of the chloroform ex-tracts group [(15. 67 ± 1. 12)d] was much shorter than that of the control group [(22. 87 ± 1. 01)d, P<0. 01]. The hydroxyproline content and the percentage of S-phase cells in wound tissue in the chloroform extracts group was obviously higher than those in the con-trol group (P<0. 01). Conclusion:The present study indicates that topical application of chloroform extracts of Shengji Huayu Fang is beneficial to burn wound healing, and the chloroform extracts of Shengji Huayu Fang is the main bioactive fraction.

A giant basilar artery aneurysm of young woman with endocrine disturbance was misdiagnosed as a large pituitary adenoma and treated surgically via a trans-sphenoidal approach was planned.But the neurosurgery was finally aborted because of massive bleeding during the procedure. One year later, a cerebral angiography confirmed this basilar artery aneurysm was obviously regressed and then endovascular coiling was successfully performed. No neurological complication occurred post-procedure and the endocrine dysfunction symptom was obviously improved.

Objective:To explore the therapeutic regimen and key points in the pharmaceutical care for the elderly patients with a-cute exacerbation of the chronic obstructive pulmonary disease ( AECOPD) . Methods: On the basis of clinical pharmacist work, one typical case was selected. Referring to the COPD treatment guidelines, the treatment rationality was analyzed. Meanwhile, an individu-alized pharmaceutical care plan was established and carried out in whole process of the treatment. Results:The pharmacotherapy was effective and rational. By providing the pharmaceutical care for the AECOPD patient, the related problems in the treatment were solved promptly, and the rational advice on the drug treatment was provided. Conclusion:It is very important to enhance integrated pharma-ceutical care in the elderly patients with AECOPD.