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.

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 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.

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.

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

Objective To evaluate the effects of small dose of dopamine on the renal blood flow in the elderly patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Sixty elderly patients,of ASA physical status Ⅱ or Ⅲ,aged 65-74 yr,weighing 52-77 kg,scheduled for elective cardiac valve replacement under CPB,were randomized to receive either normal saline (group C,n =30) or dopamine (group D,n =30).After beginning of surgery,CPB was established routinely.In group D,dopamine was continuously infused for 20 min at a rate of 2 μg· kg-1 · min-1 starting from 10 min after the hearts were perfused with cardioplegic solution for the first time,while the equal volume of normal saline was given in group C.The left renal blood flow velocity was measured by transesophageal echocardiography and mean arterial pressure was recorded before and after dopamine infusion.Blood samples were obtained before surgery and at 24 h after surgery for determination of blood urea nitrogen concentrations.Results Blood urea nitrogen concentrations were significantly increased at 24 h after surgery than that before surgery in the two groups.There was no significant difference in mean arterial pressure and the left renal blood flow velocity before and after dopamine infusion between the two groups.Conclusion Small dose of dopamine (2 μg· kg-1· min-1) dose not increase the renal blood flow or improve the postoperative renal function in the elderly patients undergoing cardiac valve replacement under CPB.

Epidermal growth factor receptor (EGFR) inhibitors are currently widely used for targeted lung cancer therapy. Target-ed therapy evaluation principally relies on genetic testing or rough clinical estimation. PET receptor imaging is highly sensitive and spe-cific. According to domestic and foreign literature, PET imaging using radiolabeled EGFR-targeting agents can be used to predict and monitor therapy response. This paper presents new evaluating methods for targeted lung cancer therapy.

Objective To evaluate the left ventricular function in patients with different extents of coronary stenosis by the left ventricular pressure volume loop Methods In 65 patients who were undergoing coronary angiography and left ventriculography examinations, materials of clinical and cardiac catheter examinations were collected In right anterior oblique 30 degrees the left ventriculography was progressed The pressure curves of the left ventricle and the aorta were recorded continuously and volumes of the left ventricles were measured with the dot tracing method Pressure volume loop was set up and ventricular energy indexes embodied by the pressure volume loop were measured and calculated Results In normal group, pressure volume loop was located in the left and lower portion of the coordinate system Along with the levels of the coronary stenosis becoming more severe, pressure volume loops moved to the right and upper portion of the coordinate system Little changes occurred in ejection fraction except that there was a decreasing in patients with lesions of three branches; Stroke work showed no obvious changes; Filling energy became larger; Total energy increased obviously in both groups with lesions of double branches and three branches; End systolic energy increased gradually while energy efficiency decreased gradually Conclusion The ventricular pressure volume loop can be obtained in routine ventriculography which can reflect many indexes of ventricular function quantitatively The ventricular energy indexes change correspondingly with coronary artery lesions and may be useful to assess ventricular function in patients with different levels of coronary stenosis

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.