ObjectiveTo compare the changes in renal blood flow in elderly and adult patients during laparoscopic cholecystectomy.MethodsSixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-75 yr,weighing 48-78 kg,undergoing elective laparoscopic cholecystectomy were enrolled in this study.The patients were divided into 2 groups according to the age ( n =30): group Ⅰ young and middle-age (18-60 yr) and group Ⅱ elderly (61-75 yr).Anesthesia was induced with midazolam,fentanyl,propofol and vecuromium and maintained with infusion of propofol and remifentanil,isoflurane inhalation and intermittent iv boluses of vecuromium.The patients were intubated and mechanically ventilated.PETCO2 was maintained at 30-40 mm Hg.The probe of transesophageal echocardiography (TEE) was inserted into esophagus after tracheal intubation.The internal diameter and time integral of left renal artery were measured by TEE before pneumoperitoneum (baseline) and at 1,5,10,15,20 and 30 min of pneumoperitoneum and 1,5 min after deflation.The blood flow of left renal artery (LRAF) was calculated.The maximal derease in LRAF during pneumoperitoneum was analyzed.ResultsThe internal diameter and time integral of left renal artery and LRAF were significantly decreased during peumoperitoneum and at 1 min after deflation in both groups ( P ＜ 0.05).LRAF before peumoperitoneum was significantly lower,and the time point of LRAF maximum decrease during pneumoperitoneum was later in group Ⅱ than in group Ⅰ ( P ＜ 0.05).ConclusionThe renal blood flow is temporary decreased during laparoscopic cholecystectomy both in young and middle age and elderly patients.The time point of LRAF maximum decrease in elderly patients is later than that in adult patients.

Objective To evaluate the blood-saving effect of different doses of tranexamic acid in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Ninety ASA physical status l-Ⅲ patients,aged 18-60 yr,with body mass index of 16-25 kg/m2,scheduled for elective cardiac valve replacement with CPB,were equally and randomly divided into 3 groups using a random number table:control group (group C),large-dose tranexamic acid group (group TL) and small-dose tranexamic acid group (group TS).Anesthesia was induced with iv injection of midazolam,sufentanil and pipecuronium.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of isoflurane and iv injection of midazolam,sufentanil and pipecuronium.After induction of anesthesia,tranexamlc acid 20 mg/kg was intravenously infused over 30 min,followed by continuous infusion at 20 mg· kg-1 · h-1 until the end of operation in group TL,tranexamlc acid 10 mg/kg was intravenously infused over 30 min,followed by continuous infusion at 10 mg· kg-1 · h-1 until the end of operation in group TS,while the equal volume of normal saline was given instead in group C.Venous blood samples were taken before induction,at the end of operation and at 24 h after operation for determination of hemoglobin (Hb),hematocrit (Hct),and platelct count (Plt).The volume of chest tube drainage was collected and recorded at 6 and 24 h after operation.The requirement for transfusion of allogeneic red blood cells was also recorded.The development of death and complications during days of hospitalization was recorded.Results Compared with group C,the volume of chest tube drainage was significantly decreased,the requirement for transfusion of allogeneic red blood cells was reduced (P ＜ 0.05),while no significant changes were found in Hb,Hct and Plt at each time point in TL and TS groups (P ＞ 0.05).There was no significant difference in the parameters mentioned above between group TL and group TS (P ＞ 0.05).The development of death and complications during days of hospitalization was not observed in the three groups.Conclusion Small-dose tranexamlc acid is suitable for blood-saving effect in patients undergoing cardiac valve replacement with CPB,that is loading dose of 10 mg/kg and maintenance dose of 10 mg· kg-1· h-1.

Recent studies suggest that lacunar infarction is a high risk ischemic cerebrovascular disease highly correlated with the time, which optimistic prognosis is not as good as previously thought.In addition, the role of macrovascular diseases has not been paid attention, it is not conducive to secondary prevention and early intervention for the etiology of lacunar infarction.This review focu-ses on application of imaging diagnosis of lacunar infarction, the etiology of non-lacunar infarct, and differential diagnosis of lacunar in-farction.

Objective To investigate the effects of different doses of dexmedetomidine used in SEP and MEP monitoring in patients undergoing neurosurgery. Methods Eighty patients undergoing neurosurgery receiving SEP and MEP monitoring were randomly divided into 4 groups(n = 20 each):group C,group D1,group D2 and group D3. In groups D1 ,D2 and D3 ,dexmedetomidine 0.5 μg/kg was infused over 10 minutes before anesthesia induction,and then was infused at a rate of 0.1,0.3 and 0.5μg/(kg·h)respectively toward the end of operation. Group C received the equal volume of normal saline. HR ,MAP and BIS were recorded at admission to the operating room(T1),skin incision(T2),when the muscle relaxants were stopped(T3)and 50 minutes later(T4). The current intensity and the time when first MEP was induced after muscle relaxant was stopped ,the amplitudes and latencies of SEP(N20-P25,N20)and MEP on thenar muscle at T4,the total consumption of propofol,and development of adverse affects were also recorded. Results Compared with groups C and D1,HR and MAP were decreased at T2-T4 in groups D2 and D3(P<0.05). The amount of propofol consumed were lower in groups D2 and D3 than in groups C and D1(P < 0.05). The current intensity inducing MEP was lower and the amplitude of MEP at T4 was higher in group D2 than in groups C,D1 and D3,and the situation was same in group D3 than in group C (P<0.05). No significant change was found in the other parameters in groups C ,D1 ,D2 and D3(P>0.05). Conclusion Dexmedetomidine infused at 0.3 μg/(kg · h) after infusion of a loading dose of 0.5 μg/kg could improve monitoring quality of MEP through reducing the amount of propofol consumed ,have less inhibition on MEP than other groups,have no obvious effects on SEP,andmaintain hemodynamic stability.

Objective To observe the feasibility and safety of dexmedetomidine used in motor evoked potentials(MEP)monitoring in patients undergoing neurosurgery.Methods Thirty ASA Ⅰ orⅡ patients,male 1 5 cases,female 1 5 cases,aged 20-60 years,weighing 40-80 kg undergoing neuro-surgery receiving MEP monitoring were randomly divided into 2 groups (n =1 5 each):control group (group C)and dexmedetomidine group (group D).In group D,dexmedetomidine 0.5 μg/kg was in-fused over 10 minutes before anesthesia induction,and then was infused at a rate of 0.5 μg·kg-1 · h-1 toward the end of operation.Group C received the equal volume of normal saline.HR,MAP and BIS were recorded at admission to the operating room (T0 ),skin incision (T1 ),when the muscle re-laxants were stopped (T2 )and 50 minutes later (T3 ).The current intensity and the time when first MEP was induced after muscle relaxant was stopped,the amplitudes and latencies of MEP on thenar muscle at T3 ,the total consumption of anesthetics,and development of adverse effects were also re-corded.Results Compared with T0 ,HR in group C at T1 ,T3 and MAP in group C at T1-T3 was in-creased,HR in group D was decreased at T2-T3 (P <0.05).Compared with group C,HR and MAP were decreased at T1-T3 in group D(P <0.05).The amount of propofol consumed and the current in-tensity inducing MEP were lower in group D than in group C (P <0.05).The amplitude of MEP at T3 was higher in group D than in group C (P <0.05).Compared with group C,the incidences of hy-pertension and tachycardia were decreased in group D,and the incidence of bradycardia was increased (P <0.05).Conclusion Dexmedetomidine used in MEP monitoring in patients undergoing neurosur-gery can meet the operation requirements,maintain hemodynamic stability,reduce the incidences of adverse reactions,and improve monitoring quality of MEP.It is a safe and feasible anesthesia method.

It is confirmed that the adult cells can be re-programmed to embryonic stem cells(ESCs) by presenting some certain factors in oocytes in the clone process of animals. In recent years, some transcription factors that can induce pluripotent stem cells(iPS) have been identified and which made it possible to obtain induced pluripotent stem cells similar to embryonic stem cells. iPS provides a unique platform to study the pluripotent mechanism and to establish some specific disease models. This major scientific discovery can not only avoid the use of ES which involves ethics debate, but also lead the stem cell research to a new field.

Objective To evaluate the effects of pulmonary static inflation with different pressures on postoperative lung function in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Sixty ASA Ⅱ or Ⅲ patients,aged 26-70 yr,weighing 47-78 kg,undergoing elective cardiac valve replacement with CPB,were randomly divided into 2 groups (n =30 each):pulmonary static inflation with 5 cm H2O group (group L) and with 10 cm H2O group (group H).In L and H groups,pulmonary static inflation was performed with the pressure maintained at 5 and 10 cm H2O,respectively,after stopping mechanical ventilation during CPB.Arterial blood samples were taken before skin incision and at 1,3 and 6 h after termination of CPB for blood gas analysis.The alveolar-arterial oxygen pressure difference (D(A-a)O2),respiratory index (RI) and oxy.genation index (OI) were calculated.The indwelling time of endotracheal tube after operation and duration of ICU stay were recorded.Results Compared with group L,D(A-a)O2 and RI were significantly decreased and OI was increased at 1,3 and 6 h after termination of CPB,the incidence of OI less than 300 mm Hg was decreased (P ＜ 0.05),and no significant change was found in the indwelling time of endotracheal tube after operation and duration of ICU stay in H group (P ＞ 0.05).Collusion Pulmonary static inflation with 10 cm H2O can better improve postoperative pulmonary diffusion function than with 5 cm H2O in patients undergoing cardiac valve replacement with CPB.

DNA, Mitochondrial ; genetics ; Deafness ; chemically induced ; genetics ; Haplotypes ; Humans ; Mutation

Ovbective To evaluate the role of electron beam computed tomography (EBCT) in diagnosis of anomalous pulmonary venous connection. Methods Retrospective analysis on 20 cases diagnosed as anomalous pulmonary venous connection by EBCT. The slice thickness and scan time was 1.5～3mm and 100ms respectively. 3～4ml/s non-ionic contrast medium was injected. Three-dimensional reconstruction of EBCT images was carried out in all cases with special workstation. Meanwhile,ultrasound echocardiography was performed on all patients and conventional cardiovascular angiography was performed on 10 patients as control. 14 cases were operated. Results (1) 4 patients with total anomalous pulmonary venous connection and 16 patients with partial pulmonary venous connection were diagnosed by EBCT preoperatively. (2) Compared with the findings from operations (14 cases),CT results (14 cases) corresponded well in 13 cases and corresponded partially in other 1 case. Meanwhile,ultrasound echocardiography (14 cases) only corresponded partially in 2 case and suggested suspected APVC (without any exact number and connective location of APVC were mentioned) in other 8 cases. Cardiovascular angiography was performed in 6 of 14 cases and APVC was found in 4 of them. (3) In 6 non-operation cases,four underwent conventional cardiovascular angiography. APVC were diagnosed in 2 only of these 4 cases. Meanwhile,the diagnoses of these 6 cases were all confirmed by CT ultrasound,echocardiography didn't yield positive findings of APVC. Conclusion EBCT might be significantly superior to UCG and angiography in the detection of anomalous pulmonary venous connection. According to our experience,EBCT with 3-D reconstruction was a noninvasive,effective method in the diagnosis of APVC.

Objective In order to investigate the interactions between the activities of daily living of children with post poliomyelitis and depression of their parents.Method 40 cases whose children were with post poliomyelitis were tested by SDSCR.Children's activity of daily living were tested with Barthel's index.Result 65％ of parents whose children with post polimyelitis were depression.Their symptoms of depression were mainly moderate level.There are marked difference comparing with the domestic normal analyzing model.The activities of daily living of the post poliomyelitis's children was worse,the older their parent's age was the higher the incidence of depression occurred was.Conclusion We should pay attention to their parents emotion changes when we carry out the community rehabilitation of post poliomyelitis's children,and strive them for positive coperating our rehabilitation training.