Objective To investigate the significance of pulse indicating the continuous cardiac output (PICCO) technique in patients with post-trauma capillary leak syndrome (PTCLS). Methods Twenty traumatic patients with PTCLS received PICCO monitor from 2011 to 2014 were enrolled in this study. analyzed, The patients, with twelve males and eight females, aged from twenty three to fifty. And twenty patients in the control group, with ten males and ten females, aged from twenty one to fifty two. Twenty six patients were injuried by traffic, ten patients were injuried by crash and four patients were injuried by sword. No significant differences were found in age、gender、weight、scores of ISS、Murray and APACHEⅡof all patients. All patients were survived. The balance of fluids, Lactate, Central venous oxygen saturation (ScvO2) and the mean artery pressure (MAP) were compared at 0, 24, 48 and 72 h after entering into the ICU. The duration of ICU stay and ventilation were also compared. Results (1)No significant differences in MAP、Lac and ScvO2 were observed in two groups. (2)No significant differences in the balance of fluids when patients entered into ICU, but significant differences were found at 24, 48 and 72 h post-entering into ICU (P < 0.05). (3)Significant differences in the duration of ICU stay and ventilation between the two groups were observed (P < 0.05). Conclusion PICCO technique can provid a quantitative target for PTCLS patients, with decreasing fluid infusion, and reducing the duration of ICU stay and ventilation.

Objective:To investigate the gene expression variety of different genotype of F-ATPase subunit uncEBF in Streptococcus mutans (S.mutans) and to evaluate the relationship among uncEBF gene expression levels, genotypes and the acidurance ability of S.mutans. Methods:The relative expression quantity of uncEBF gene against the housekeeping gene recA was determined by the two-step method of semi-quantitative RT-PCR in 18 clinical isolates of S.mutans(7 with genotype A uncEBF and 11 with genotyp B,10 with high acidurance and 8 with low). A gel documentation system and QUANTITY ONES software were used to assay the data. Results:uncEBF mRNA expression level in the isolates with genotype A uncEBF was higher than that in those with genotype B(P

Objective To explore the new operation approach and the effect of surgical therapy on cardial carcinoma. Methods A total of 78 patients with cardial carcinoma received surgical therapy by the transabdominal route from January 1992 to January 2002, of which 30 cases were treated by total gastrectomy by substitution of P shaped jejunum and 48 cases were treated by subtotal gastrectomy. All patients were followed-up postoperatively from 6 months to 5 years. Results The average length of resected lower part of the esophagus above the tumors was over 5cm, without cancer tissue retained in resected edge. The rate of intramediastinal lymph node metastasis was 18.4%. 5-year survival rate of the patients with total gastrectomy was higher than that of the patients with subtotal gastrectomy, and the morbidity rate of reflux esophagitis of the former was lower than that of the latter. Conclusions The patients of cardial carcinoma in Ⅲ stage or Ⅱstage with lymph node metastasis of 5 or 6 groups should be treated by radical total gastrectomy. The P shaped reconstruction of stomach with jejunum as a replacement satisfies the physiological needs and causes less compications.

Objective To compare the efficacy of ultrasound-guided continuous fascia iliac compartment block (cFICB) and neurostimulator-guided continuous femoral nerve block (cFNB) for postoperative analgesia in patients undergoing total knee arthroplasty.Methods Sixty-six ASA Ⅰ or Ⅱ patients,aged 46-78 yr,weighing 45-88 kg,scheduled for unilateral total knee arthroplasty,were randomly divided into 2 groups (n =33 each):cFNB group (group Ⅰ) and cFICB group (group Ⅱ).At 30 min before surgery,the patients received FNB guided by neurostimulator in group Ⅰ and FICB guided by ultrasound in group Ⅱ.A bolus of 0.5％ ropivacaine 20 ml was injected and a catheter for continuous nerve block was inserted in both groups.At 0.5 h after surgery,the catheter was connected to a patient-controlled analgesia (PCA) pump.PCA with 0.2％ ropivaeaine was used for postoperative analgesia (48 h).The PCA pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤ 3.The distribution of sensory block was assessed at 10 min after the first administration,and at 0.5,4 and 24 h after surgery.The effective rate of sensory block was calculated.When VAS score ＞ 4,tramadol 50 mg was given intravenously or orally every 12 h as a rescue analgesic.When VAS score ＞ 5,pethidine 50 mg was injected intramuscularly as a rescue analgesic.The number of attempts was recorded during 0-4 h,4-12 h and 12-24 h after surgery.The consumption of tramadol and pethidine was also recorded during 0-24 h and 24-48 h after surgery.The sleep quality score during the nighttime was also recorded during 0-24 h and 24-48 h after surgery.Vascular puncture and parasthesia during nerve block were recorded.The toxic reaction,severe nausea and vomiting (lasting for more than 1 day) and nerve damage were recorded after surgery.Results Compared with group Ⅰ,the effective rate of sensory block in the medial aspect of the thigh was significantly decreased at 10 min after the first administration,and the effective rate of sensory block in the lateral aspect of the thigh was significantly increased at 0.5 h after surgery in group Ⅱ (P ＜0.05).There was no significant difference in the number of attempts,consumption of tramadol and pethidine,and sleep quality score during the nighttime during different time periods between the two groups (P ＞ 0.05).No vascular puncture or parasthesia was found during nerve block in the two groups.No toxic reaction,severe nausea and vomiting or nerve damage was found after surge,y in the two groups.Conclusion Ultrasound-guided cFICB has the similar analgesic efficacy with neurostimulator-guided cFNB after operation,but it can provide a wider distribution of sensory blockade in patients undergoing total knee arthroplasty.

Objective To evaluate the efficacy of dexmedetomidine injected into axillary sheath in alleviating the tourniquet pain during brachial plexus block with ropivacaine.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 18-60 yr,weighing 52-85 kg,scheduled for the replantation of amputated finger,were randomly divided into 2 equal groups (n =30 each):ropivacaine group (group R) and dexmedetomidine mixed with ropivacaine group (group DR).All patients underwent axillary brachial plexus block guided by a nerve stimulator.When the intensity of electric stimulation ≤ 0.4 mA,flexion of fingers or wrist still existed,and the local anesthetic was injected into the axillary sheath.0.5％ ropivacaine 40ml was injected in group R.0.5％ ropivacaine mixed with 100μg dexmedetomidine 40ml was injected in group DR.The pressure of inflation was set at 200-250mmHg,and the stress duration was 120 min.Tourniquet pain and the level that the patients could tolerate was evaluated using visual analog scale (VAS) at 120 min of stress status.The patient' s satisfaction with anesthesia was rated and the development of adverse cadiovascular events and local and systemic adverse reactions were recorded.Excessive sedation was measured with Ramsay score in group DR.Results Compared with group R,the tourniquet pain that the patients could tolerate was significantly increased,the severity of tourniquet pain was reduced and the incidence of adverse cadiovascular events was decreased in group DR (P ＜ 0.01).No serious tourniquet-related complications were observed in both groups.No patients developed excessive sedation in group DR.Conclusion Dexmedetomidine 100μg injected into the axillary sheath can safely and effectively alleviate the tourniquet pain when used during brachial plexus block with ropivacaine.

Objective To evaluate the relationship between the optimum preoperative fasting time and in tervals between eating and trauma in pediatric patients undergoing emergency orthopedic surgery by measuring the gastric antral cross-sectional area (CSA) using ultrasound.Methods Fifty ASA physical status Ⅰ or Ⅱ pediatric patients,aged 2-7 yr,weighing 10-25 kg,undergoing elective orthopedic surgery,were randomly divided into 2 groups (n =25 each) using a random number table:6-h fast group (group CA) and 8-h fast group (group CB).Seventy-five ASA physical status Ⅰ or Ⅱ pediatric patients,aged 2-7 yr,weighing 10-25 kg,undergoing the emergency orthopedic surgery,were randomly divided into 3 groups according to the interval between eating and trauma:interval ≤ 1 h group (TA group,n =22),1 h ＜ interval ≤ 4 h group (TB group,n =26) and interval ＞ 4 h group (TC group,n =27).CSA was measured at 6 h after the last eating (T1) in group CA,8 h after the last eating (T2) in group CB and T1 and T2 in TA,TB and TC groups.Results There was no significant difference in CSA between group CA and group CB (P ＞ 0.05).Compared with group CA,CSA was significantly enlarged in TA and TB groups (P ＜ 0.05) and no significant change was found in group TC (P ＞ 0.05).Compared with group CB,CSA was significantly enlarged in TA group (P ＜ 0.05),and no significant change was found in TB and TC groups (P ＞ 0.05).Compared with group TA,CSA was significantly decreased at T1 in TC group and T2 in TB and TC groups (P ＜ 0.05),and no significant change was found at T1 in TB group (P ＞ 0.05).Compared with group TB,CSA was significantly decreased at T1 (P ＜ 0.05),and no significant change was found at T2 in TC group (P ＞ 0.05).Compared with the CSA measured at T1,CSA was significantly decreased at T2 in TB group (P ＜ 0.05),and no significant change was found at T2 in TA and TC groups (P ＞0.05).Conclusion For the pediatric patients undergoing emergency orthopedic surgery,when the interval between eating and trauma is within the period of 1-4 h,an 8-h preoperative fast is recommended; when the interval ＜ 1 h,an 8-h preoperative fast is still not able to achieve the aim of fasting and measures should be taken to avoid regurgitation of gastric contents; when the interval ＞ 4 h,the preoperative fasting time can be properly shortened to 6h.

Objective To assess the accuracy of ultrasonographic measurement of gastric fluid volume in predicting the occurrence of nausea and vomiting during and after emergency cesarean section.Methods Seventyseven ASA Ⅰ-Ⅲ patients aged 18-35 yr weighing 66-87 kg undergoing emergency cesarean section were divided into 3 groups according to the preoperative gastric fluid volume:group A ≤ 0.4 ml/kg (n =21); group B 0.4-0.8ml/kg (n =34) and group C ＞ 0.8 ml/kg (n =22).Gastric fluid volume was calculated by Bouvet regression equation,based on antral area of the stomach measured with M-Turbo ultrasonography system (Somo Site Co.USA).Cesarean section was performed under combined spinal-epidural anesthesia with 0.4％ ropivacaine.BP,HR and SpO2 were measured and recorded after entering the operating room,at skin incision and at the end of operation.The occurrence of nausea and vomiting was recorded during operation and within 1 h after operation.Results There was no significant difference in hemodynamic variables among the 3 groups.The incidence of nausea was comparable among the 3 groups:33％ in group A,35％ in group B and 46％ in group C,while the incidence of vomiting was significantly higher in group C (46％) than in group A (10％) and group B (15％).Conclusion The incidence of vomiting is significantly higher during and within 1 h after emergency cesarean section in patients with preoperative gastric fluid volume ＞ 0.8 ml/kg,but the incidence of nausea is not related to preoperative gastric fluid volume.

Objective To evaluate the value of probe sterile protective film when applied to ultrasound-guided peripheral nerve block.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱpatients who required ultrasound-guided lumbar plexus block,aged 18-60 yr,weighing 55-85 kg,were randomly divided into 3 groups (n=30 each):sterile protective film group (group F),traditional physical method group (group TP) and traditional chemical method group (group TC).The probe was sterilized using a sterile protective film in group F,using a sterile glove in group TP,and using 70%-80% alcohol in group TC.Microbiological detection of probe was carried out subsequently,and the relative sterility was defined as the total number of colonies was less than or equal to 5 cfu/cm2.The time spent in sterilizing probe and in performing lumbar plexus block was recorded.The sterile qualified rates of scanning surface and handle of probe were calculated.The ultrasonic image quality was assessed by using a 4-point scale,and the number of display areas was recorded by Moro method.Results Compared with group TP,the time spent in sterilizing probe and in performing lumbar plexus block was significantly prolonged,the sterile qualified rate of probe handle and ultrasonic image quality were increased,and the number of display areas was increased in group F (P<0.05).Compared with group TC,the time spent in sterilizing probe was significantly shortened,and the sterile qualified rates of scanning surface and handle were increased in group F (P<0.05 or 0.01).Conclusion The probe sterile protective film exerts simple operation,strict sterile effect and little influence on ultrasonic image,the efficacy is superior to that of traditional methods,and it is more suitable for probe sterilization when applied to ultrasound-guided peripheral nerve block.

BACKGROUND:Previously, serious thoracolumbar burst fractures with spinal cord injury were mainly treated by anterior surgery. The superiority of conventional posterior repair lies in strong reduction and fixation effects. However, it is difficult to fuly decompression. The anterior and central cylinders of the injured vertebra cannot receive good reconstruction. Loss of correction and internal fixation failure always appear. It remains controversial which repair method is more ideal. OBJECTIVE:To comparatively analyze the effect of posterior and anterior approaches with subtotal vertebrectomy, decompression, reconstruction of spine, and internal fixation for patients with thoracolumbar burst fractures. METHODS: The data of 42 patients with thoracolumbar burst fracture treated by anterior and posterior approaches with subtotal vertebrectomy, decompression, and reconstruction of spine from May 2006 to December 2012 was retrospectively analyzed. They were divided into two groups according to the surgical procedures: anterior approach group (n=23) and posterior approach group (n=19). They were folowed up for at least 24 months. Repair results and imaging results were compared in patients of both groups. RESULTS AND CONCLUSION:None patients in the two groups affected fixator loosing or breakage, and obtained good bone fusion. The intraoperative blood loss was more and operative time was longer in the anterior approach group than in the posterior approach group, showing significant difference (P < 0.05). The pulmonary function was significantly better in the posterior approach group than in the anterior approach group (P < 0.05). Visual Analog Scale score, Japanese Orthopaedic Association score for back pain and Frankel classification were significantly improved during final folow-up compared with pre-treatment in both groups, but no significant difference was found between groups (P > 0.05). No significant difference in the anterior vertebral height and kyphosis Cobb angle was detected before treatment, at 1 week after treatment and during final folow-up (P > 0.05). The incidence of postoperative complications was significantly higher in the anterior approach group than in the posterior approach group (P < 0.05). These findings confirm that subtotal vertebrectomy through anterior approach and posterior approach can effectively repair thoracolumbar burst fractures. However, the complications of posterior approach are less, and posterior approach has few impacts on the pulmonary function, is safe, and has good biocompatibility with the host.

Objective To evaluate the effect of carbon fiber couch on dose distribution of radiotherapy planning and verification pass rate.Methods Establishing the carbon fiber treatment couch model in Pinnacle8.0m Treatment Planning system (TPS),and then this model was used to correct dose calculations of oblique fields in the treatment plans of 10 cases of nasopharyngeal carcinoma,10 cases of breast cancer and 10 cases of lung cancer and evaluate the effect of carbon fiber couch on the whole dose distribution of the plans.Then these plans were measured by three-dimensional dose verification equipment Delta4 to confirm the improvement extent of Gamma pass rate after considering the carbon fiber treatment couch.Results For the majority of plans,when the carbon fiber couch was taken into consideration,the target doses was significantly reduced (4772 cGy-7266 cGy vs.4859 cGy-7347 cGy,P=0.000-0.002) and the relative deviation of D95 was 1％ to 3％.Measurement results of Delta4 showed that Gamma pass rate (3 mm/3％ criteria) increased in all plans (96.4％-98.8％ vs.93.4％-97.3％,P =0.000),some of that were up to 5 percentage when the couch model was applied.Conclusions Target doses will be overestimated if the treatment couch is ignored in TPS measurement.,However it should arouse enough attention when the disease with smaller doses corresponding gradient.