Objective To study the diagnostic value of transperineum color Doppler ultrasonography (TPCDU) and transabdominal color Doppler ultrasonography (TACDU) in pelvic varicosis (PV). Methods Thirty-eight patients with PV were detected by using TACDU and TPCDU separately, and the diagnostic value between the two ways was compared. Operational results was used as standard, and the degree of lesion in patients with PV was evaluated based on the results of surgery. Results The rate of diagnostic accuracy was high in both methods (TACDU 92% and TACDU 79%, separately). However, the rate of diagnostic accuracy and the site detectable were significantly higher by TPCDU than by TACDU (P

(0.05)).② The differences in D_R,D_V,Vmax and T_R between the study group and control group were statistically significant (P

Objective To study the relationship between ultrasonography of arteria dorsalis pedis and Hemorheology in patient with diabetic foot.Methods According to with or without frank anabrosis,51 patients were devided into two sub-groups:anabrosis group (23 patients) and no-anabrosis group (28 patients).The correlativity was analysed between the parameters of ultrasonography in arteria dorsalis pedis and hemorheological indices on patients with diabetic foot.Results When compared to patients without ulcers,vascular inner diameter (D),peak systolic velocity (PSV),resistent index (RI) and pulsatility index (PI) on patients with frank anabrosis were decreased significantly,but whole blood viscosity at high shear rate (BVH),whole blood viscosity at low shear rate (BVL),plasma viscosity (PV),fibrinogen (Fib) were increased.Multiple regression analyses indicated that the relationship between BVH,BVL and D was presence,partial regression coefficient (r) was -0.004 and -0.009 ; the relationship between PSV and BVH,PV was intimate,r was -0.957 and -25.655 ; the relationship between RI and BVH,PI and BVH,PV,Fib were relatively intimate,r was -0.009 , -0.141 , -2.666 , -0.383 ,respectively.Conclusions The changes of hemorheology can aggravate the abnormality of hemodynamics and the degree of vascular lesion in small vessels of lower limb,so it is one of influencing factor leading to lower limb arterial ischaemia and diabetic foot deterioration.

Objective To determine the optimum cuff pressure of the flexible laryngeal mask airway (LMA) for airway management in pediatric patients.Methods One hundred and twenty pediatric patients undergoing strabismus surgery with general anesthesia,of American Society of Anesthesiologists physical status Ⅰ or Ⅰ,aged 3-10 yr,were randomly divided into 3 groups (n=40 each) according to the cuff pressure of the flexible LMA:20 cmH2O pressure group (group A),40 cmH2O pressure group (group B) and 60 cmH2O pressure group (group C).The cuff was inflated to the predetermined pressure using the inflatable cuff manometer in each group.Oropharyngeal leak pressure was measured after LMA placement.Peak airway pressure and the difference between inhaled and exhaled tidal volume were recorded at 5 min of positive pressure ventilation.The LMA insertion condition,LMA removal time,and development of sore throat,hoarseness,dysphagia and abdominal distention within 24 h after operation were recorded.Results There were no significant differences in the success rate of LMA placement at first attempt,peak airway pressure,or incidence of sore throat among the three groups (P＞0.05),and no hoarseness or dysphagia was found in the three groups.Compared with group A,oropharyngeal leak pressure was significantly increased,and the difference between inhaled and exhaled tidal volume and incidence of abdominal distention were decreased in B and C groups (P＜0.05).There was no significant difference in the parameters mentioned above between group B and group C (P＞0.05).Conclusion The optimum cuff pressure of the flexible LMA is 40 cmH2O when used for airway management in the pediatric patients.

Objective To investigate the effects of different infusion rates of remifentanil infusion on spontaneous ventilation in children received sevoflurane anesthesia. Methods A total of 120 children underwent strabismus surgery were randomly assigned to four groups: C group (administration of saline), L group (remifentanil 0.03 μg · kg-1 · min-1), M group (remifentanil 0.06μg · kg-1 · min-1) and H group (remifentanil 0.09μg · kg-1 · min-1). The mean blood pressure (MBP), heart rate (HR), respiratory rate (RR), tidal volume (VT), minute ventilation (MV), endtidal CO2 [p(CO2)] and endtidal SEV were recorded after laryngeal mask insertion (T1), an initial bolus dose of remifentanil (T2),10 mins after remifentanil infu-sion (T3),15 mins after remifentanil infusion (T4) and laryngeal mask remove (T5) respectively. The adverse events and time of induction, maintenance and emergence were also recoded. Results There were no significant differences in patient age, body mass index, anesthesia time, operation time, HR and MBP at different time points between four groups. No body movement and hypoxemia were observed. The values of RR and MV at T3, T4 and T5 were significantly lower in H group than those of other three groups (P <0.05). Values of p(CO2)at T3 and T4 were significantly higher in H group than those of other three groups (P<0.05). The values of RR at T3, T4 and T5 were significantly lower in L group and M group than those of C group. The values of MV at T3 and T4 were significantly lower in L group and M group than those of C group. p(CO2)at T4 was significantly higher in L group and M group than that of C group(P<0.05), but no significant difference was found be-tween L group and M group. There was no significant difference in value of VT between four groups. Conclusion Remifent-anil infusion at a rate of 0.03~0.09μg·kg-1·min-1 could depress spontaneous ventilation in children received sevoflurane an-esthesia. The respiratory depression effect is mainly manifested by reduction of RR. It is a good option to choose 0.03~0.06μg · kg-1 · min-1 infusion to keep spontaneous ventilation and avoid severe respiratory depression according to the demand of operations in children.

Progressing vasopressor-refractory hypotension is a major contributor to the high mortality of septic shock.The effect of corticosteroids on peripheral vascular circulation recovery and immune modulation is crucial to the survival of patients with septic shock .However, despite more than fifty years of animal experiments and human trials, the role of corticosteroid therapy in septic shock , its proper applications including dosage, duration and withdrawal remain uncertain and controversial .This paper reviews the development of research , the mechanism, application, and the future direction of low-dose glucocorticoids in the treatment of septic shock .

ObjectiveTo assess the related risk factors of myocardial lesion in diabetes patients and the value of ultrasonic integrated backscatter in the assessment. MethodsThirty diabetes patients, which were divided into two groups based on their blood pressure, and twenty controls undergone conventional echocardiography and ultrasonic integrated backscatter analysis. Data reflecting the glycemic control (FA) were also collected and analyzed.ResultsThere was a significant difference in IB%, CVIB and THIB% between diabetes patients and controls. Greater THIB% was shown in diabetes patients with hypertension compared to that of diabetes patients without hypertension. THIB% correlated with FA significantly. Conclusions Hypertension and the poor glycemic control are two risk factors to myocardial lesion in diabetes patients. The ultrasonic integrated backscatter is useful in assessing the effects of the two factors to the myocardial lesion in diabetes patients.

Objective:To evaluate the effect of hydrogen on the immunosuppressive status of septic rats.Methods:SPF healthy adult male Sprague-Dawley rats, aged 7-8 weeks, weighing 220-260 g, were studied.This study was performed in two parts.Part Ⅰ The rats were divided into 2 groups: sepsis group (Sep group, n=36) and sham operation group (Sham group, n=12). The model of sepsis was established by cecal ligation puncture in anesthetized rats.The histocompatibility DR antigen (HLA-DR)/CD14 + monocyte level in peripheral blood was detected by flow cytometry immediately after CLP and at 1, 2, 3 and 4 days after CLP.The establishment of sepsis-induced immunosuppression model was considered successful when the levels of HLA-DR/CD14 + monocyte in peripheral blood were <30%.Part Ⅱ Twelve rats with sepsis-induced immunosuppression were randomly selected and divided into 2 groups ( n=6 each) by a random number table method: sepsis immunosuppression group (Sep-IS group), sepsis immunosuppression plus hydrogen treatment group (Sep-IS+ H group). Another 12 rats were selected and divided into 2 groups ( n=6 each) by a random number table method: sham operation group (Sham group) and sham operation plus hydrogen group (Sham+ H group). In Sep-IS+ H group, 67% hydrogen was inhaled for 1 h starting from the time point immediately after successful establishment of sepsis-induced immunosuppression and from 6 h after establishment, and 67% hydrogen was inhaled for 1 h at the corresponding time points in Sham+ H group.The levels of helper T lymphocytes 17 (Th17 cells), regulatory T lymphocytes (Treg cells) and HLA-DR/CD14 + monocyte in peripheral blood were determined by flow cytometry immediately after the end of hydrogen inhalation mentioned above (T 0, T 1) and at 12 h after establishing the model (T 2). Results:Part Ⅰ Compared with Sham group, the levels of HLA-DR/CD14 + monocyte in peripheral blood were significantly decreased at 1-4 days after CLP in Sep group ( P<0.05). Part Ⅱ Compared with Sham group, the level of HLA-DR/CD14 + monocytes in peripheral blood was significantly decreased, and the levels of Treg and Th17 cells were increased at each time point in Sep-IS and Sep-IS+ H groups ( P<0.05), and no significant change was found in the parameters mentioned above in Sham+ H group ( P>0.05). Compared with Sep-IS group, the level of HLA-DR/CD14 + monocytes in peripheral blood was significantly increased at T 1, 2, the levels of Th17 cells were increased at T 2, and the levels of Treg cells were decreased at T 1, 2 in Sep-IS+ H group ( P<0.05). Conclusion:Hydrogen can improve the immunosuppressive state of septic rats.

Objective To compare the efficacy of different sedation depths of monitored anesthesia care (MAC) in vitrectomy.Methods Ninety-six patients of both sexes,aged 40-64 yr,with body mass index ≤ 35 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective vitrectomy,were randomly divided into 2 groups (n =48 each) using a random number table:mild sedation group (group Ⅰ) and profound sedation group (group Ⅱ).Anesthesia was induced with iv midazolam 0.02 mg/kg and sufentanil 0.15 μg/kg.Anesthesia was maintained with iv infusion of propofol 0.5-2.0 mg · kg-1 · h-1 maintaining bispectral index (BIS) value＞80 in group Ⅰ,or with iv infusion of propofol 2-6 mg · kg-1 · h-1 maintaining BIS value at 65-80 in group Ⅱ.The occurrence of unexpected head movement,SPO2＜90％,snoring,and oculocardiac reflex during the procedure,postoperative nausea and vomiting,and the time when the patients in supine position were turned to prone position were recorded after surgery.Results Compared with group Ⅰ,the incidence of unexpected head movement,SpO2 ＜90％,and snoring was significantly increased,and the time when the patients in supine position were turned to prone position was prolonged (P＜0.05),and no significant difference was found in the incidence of postoperative nausea and vomiting and oculocardiac reflex during the procedure in group Ⅱ (P＞0.05).Conclusion Mild sedation of MAC (BIS value ≥ 80) provides better efficacy than profound sedation (BIS value 65-80) when used for vitrectomy.

Objective To investigate whether transcatheter renal sympathetic denervation (RSD) by radiofrequency ablation interfere with the development of left ventricular (LV) mechanical dyssynchrony during the progression of heart failure (HF).Methods Nineteen beagles were randomly divided into sham-operated group (six dogs),control group (seven dogs),and RSD group (six dogs).Sham-operated group were implanted with pacemakers without pacing;Control group were implanted with pacemakers and underwent 3 weeks of rapid right ventricular pacing;and RSD group underwent catheter-based RSD bilaterally and were simultaneously implanted with pacemakers.LV dyssynchrony was analyzed via 2D speckle-tracking strain echocardiography to evaluate LV function.Longitudinal dyssynchrony was determined as the standard deviation for time-to-peak speckle-tracking strain on apical 4-and 2-chamber views.Radial and circumferential dyssynchrony was determined as the standard deviation for time-to-peak speckle-tracking strain in mid-and base-LV short-axis views.LV systolic pressure (LVSP) and LV end-diastolic pressure (LVEDP) were measured.The LV interstitial fibrosis was determined by histological analysis.Results After 3 weeks,all of the dogs in both the control and RSD groups showed greater LV end-diastolic volume compared with the sham-operated group;however,the dogs in the RSD group had a higher LV ejection fraction (LVEF) than the dogs in the control group (P ＜0.001).The LV systolic strains were higher in the RSD group than in the control group (P ＜0.001 for longitudinal,circumferential and radial strain,respectively).The levels of LV dyssynchrony were lower in the RSD group than in the control group (P ＜ 0.001 for longitudinal,circumferential and radial dyssynchrony,respectively).Compared with control group,RSD group had lower LV end-diastolic pressures and less fibrous tissue.Conclusions RSD inhibites the development of left ventricular mechanical dyssynchrony during the progression of heart failure in dogs.