objective To investigate the changes in angiotensin-Ⅱ (AT-Ⅱ), endothelin (ET) andcalcitonin gene-related peptide (CGRP) during clipping of intracranial aneurysm performed under desfiuraneanesthesia. Methods Forty-five ASAⅠ -Ⅱ patients (20 male, 25 female) aged 14-66yr undergoing electiveclipping of intracranial aneurysm two weeks after acute subarachnoid bleeding. Anesthesia was induced withmidazolam 0 .05 mg?kg~(-1), fentanyl 2?g?kg~(-1), propofol 2 mg?kg~(-1) and vecuronium 0.1 mg?kg~(-1). The patientswere mechanically ventilated after tracheal intubation and P_(ET)CO_2 was maintained at 30-35 mm Hg. Anesthesia wasmaintained with desflurane at 1 .0-1 .5 MAC with low flow (0.3-0.5 L?min~(-1) ) supplemented with intermittentintravenous boluses of vecuronium. Radial artery was cannulated for direct continuous BP monitoring. ECG, HR,SPO_2 and P_(ET) CO_2 were continuous monitored during operation. Blood samples were taken before induction ofanesthesia (T_1, baseline), when dura was opened (T_2 ), while aneurysm was being clipped (T_3 ) and 30 min afterclipping for determination of plasma concentrations of AT-Ⅱ, ET and CGRP. Results Plasma concentration ofAT-Ⅱ did not change significandy throughout the surgery. Plasma ET concentration decreased significantly at T_2and T_3 compared with the baseline (P

BACKGROUND:Though the high-resolution CT(HRCT)could identify the inner structures of temporal bone.its tiny parts could hardly be observed accurately and clearly by the imaging examinations of auriculotemporal portion,with the influence of scanning layers as well as the partial volume phenomenon.However,it could be easily identified by the combination of thin sections and HRCT images.OBJECTIVE:To introduce a method which could locate the posterior tympanum and its neighboring structures using HRCT images and to provide an anatomical base for the imaging diagnosis and operative treatment on this area.DESIGN,TIME AND SETTING:The observations between the auriculotemporal sections and CT images were finished both in thc Department of Sectional and Imaging Anatomy,Medical College,Nanchang University and the Center of Medical lmageology.Jiangxi Provincial People's Hospital from July 2004 to June 2007.MATERIALS:Fifteen normal adult cadaveric heads(30 sides)which fixed by 100 g/L formaldehyde were scanned,with all the samples provided by the Department of Anatomy,Medical College,Nanchang University.The main equipment was GE Hi-speed Nx/i Sys CT equipment (GE Company,USA).METHODS:Tb obtain CT images of temporal bone(depth 1.00 mm,thickness 1.00 mm),15 normal adult cadaver heads were scanned by CT method taking callthomeatal line(CML)as the baseline.After that,specimens of auriculotemporal portion from temporal bone were taken,decalcified,desiccated and embedded.Sequential sections(thick 1.00 mm)were made.MAIN OUTCOME MEASURES:Comparing sequential sections with CT image,identified respectively the fossa incudis,chorda eminence,styloid eminence,tacial recess,sinus tympanl,ponticulus promontoni,suprameatal spine,etc.RESULTS:The depth of fossa incudas was about(1.49±0.05)mm,the distance from the fossa to pyramid segment of facial nerve was(5.67±0.1 4)mm.The distance from the medial wall of posterior tympanic sinus to the horizontal segment of facial nerve was(3.1 2±0.1 5)mm.The average distance from suprameatal spine to the vertical segment of facial nerve was (16.73±1.24)mm,to chorda tympani nerve(15.87±1.14)mm,to promontory(21.84±2.43)mm.CONCLUSION:Comparing the sectional antomy and CT image of auriculotemporal potion of temporal bone is valuable for the diagnosis and treatment of otopathy.

BACKGROUND: Cerebral vascular spasm is the main complication of intracranial aneurysm during perioperative period. Anesthesia of clamp operation of intracranial aneurysm not only meet the basic requirement of anesthesia, but also prevent cerebral vascular spasm and protect cerebral function possibly.OBJECTIVE: To observe the changes of angiotensin Ⅱ and endothelins of paitents with intracranial aneurysm under the anesthesia of desflurane during the clamp operation so as to discuss the effect of desflurane on cerebral protection.DESIGN: Case analysis.SETTING: Department of Neurosurgery and Department of Anesthesiology of Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences.PARTICIPANTS: Totally 64 patients, 30 males and 34 females, who were prepared for clamp operation of intracranial aneurysm, were selected from Department of Neurosurgery of Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences between October 2002 and June 2004.METHODS: After anesthesia induction, tracheal cannula was used to control respiration and desflurane was used to maintain the anesthesia. Totally 4 mL arterial blood were collected at the four time points: before anesthesia induction, cutting dura mater, clamp aneurysm and 30 minutes after clamp aneurysm. Levels of angiotensin Ⅱ and endothelins in plasma were assayed with radioimmunoassay.MAIN OUTCOME MEASURES: Levels of angiotensin Ⅱ and endothelins at the four time points: before anesthesia induction, cutting dura mater,clamp aneurysm and 30 minutes after clamp aneurysm.RESULTS: Aneurysm of two patients was disrupted during the operation of angiotensin Ⅱ was ranged normally before operation, and that at the other three time points during the anesthesia of desflurane did not changed endothelins: Level of endothelins at the three time points of cutting dura mater, clamp aneurysm and 30-minutes after clamp aneurysm was lower than that at the time point of pre-an esthesia induction [(40.4±10.3),(40.0±9.6), (40.7±12.3), (49.3±12.7) ng/L, (P=0.002, 0.001, 0.009)].CONCLUSION: Levels of angiotensin Ⅱ and endothelins which anesthetizes by desflurane are not increased during the whole clamp operation of intracranial aneurysm. However, level of endothelins is obviously lower than that at the time point of pre-anesthesia induction, and there is not significantly different from that at various time points of the operation. This suggests that anesthesia of desflurane can avoid the onset of acute cerebral vascular spasm induced by the increasing liberation of angiotensin Ⅱ and endothelins and decrease the onset of secondary cerebral ischemic injury so as to protect brain.

BACKGROUND: Cerebral ischemia and reperfusion affects not only cellular necrosis at acute stage, but also delayed neuronal apoptosis in central neural system.OBJECTIVE: To observe apoptosis rate, necrosis rate and expression of Bcl-2 and Bax apoptpsis-regulating proteins in hippocampal neurons at various reperfusion stages of complete cerebral ischemia in rats so as to probe into the regulation of injury induced by complete cerebral ischemia and reperfusion.DESIGN: Randomized control experiment.SETTING: Department of Neurosurgery and Department of Anesthesiology in Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences.MATERIALS: The experiment was performed in Beijing Institute of Neurosurgery Affiliated to Capital University of Medical Sciences from January 2003 to January 2004. Totally 33 healthy adult male Wistar rats of clean grade were employed, randomized in 5 groups, named ischemia +reperfusion 24 hours group (24 hours group) (7 rats), ischemia + reperfusion 48 hours group (48 hours group) (7 rats), ischemia + reperfusion 72hours group (72 hours group) (7 rats), ischemia + reperfusion 7 days group (7 days group) (7 rats) and sham-operation control (control) (5 rats).INTERVENTIONS: Model of complete cerebral ischemia and reperfusion was prepared in rat. Cerebral hippocampal tissues were collected in 24, 48,72 hours and 7 days after reperfusion successively. The flow cytometer was used to determine cellular apoptosis rate and necrosis rate and expression of Bcl-2 and Bax proteins in cerebral hippocampal neurons in rats.percentages of Bcl-2 and Bax proteins.hippocampal neurons in 7 days group was the highest [(24.59±0.97) %].The peak value of necrosis rate presented in 24 hours group [(16.67±1.04)%], which was remarkably higher than the control [(1.28±0.50)%,low [(1.07±0.27)%], but high expression of Bax presented [(46.09±5.37)%].and reperfusion [(14.41±0.67)%] and the peak value of Bax protein presented in 72 hours after ischemia and reperfusion [(77.38±1.52)%].CONCLUSION: Hippocampal neuronal apoptosis rate is increased gradually and expression of Bcl-2 and Bax apoptosis-regulating genes was increased abnormally after injury induced by complete cerebral ischemia and reperfusion, which suggests that Bcl-1 and Bax proteins are involved in apoptosis regulation in the injury induced by complete cerebral ischemia and reperfusion.

Objective To observe the influence of acupuncture treatment on parturition process.Methods 545 pregnant women delivered in our hospital were selected,excluding those with cesarean section indication.On voluntary principle and randomized principle,primipara aged from 22 to 30 who agreed with natural labor were divided into two groups:observation group and control group.Pregnant women in observation group were received acupuncture treatment during latent phase.The following indexes of the two groups were recorded and compared:labor time of the first stage and the second stage,the case for inertia of uterus,cesarean sections,postpartum hemorrhage amount and Apgar score of new-born.Results The labor time of the first stage and the second stage of the control group were (178.55 ± 56.87) min and (130.70 ± 77.22) min,and which of the observation group were (53.87 ±22.33) min and (33.25 ± 15.55) min,there was significant differenec between the two groups(t =3.97,4.11,all P ＜0.05).The differences in the pilot failed to cesarean section rate(14.2％ and 13.6％),postpartum hemorrhage and the perinatal outcome were not significant between the two groups.Conclusion Acupuncture and moxibustion can accelerate labor.

Objective To summarize the experience of surgical techniques and prevention of postoperative complications of giant intracranial meningiomas.Methods The clinical data of 32 patients with giant intracranial meningiomas were analyzed retrospectively.The cause of operative complications was analyzed and the experience was summarized.Results The meningiomas Simpson grade Ⅰ resection was 16 is.cases,grade Ⅱ resection was 9 cases,grade Ⅲ resection was 5 cases,grade Ⅳ resection was 2 cases.The postoperative complications included anemia was 14 cases,intracranial hemorrhage was 2 cases,severe cerebral edema was 4 cases,epilepsy was 3 cases,cerebral infarction was 2 cases,and recovered well after treatment.Conclusion Good surgical technique,advanced prevention of surgical complications,early diagnosis and treatment can significantly improve the prognosis.

Objective To evaluate the effect of clinical pharmacists on cases consultation by retrospective analysis.Methods Seven hundred and thirty-one consultation cases from January 2011 to December 2014 were systematically reviewed, and the clinical department, question classification, organ system of infection, consultation purpose, recommendation variety to infection problems, acception percentage, infection problem outcome were recorded.Furthermore, the typical cases were analysed.Results The number of consultations and clinical departments increased by years, formulating anti-infective therapeutic regimen, determining duration of therapy and drug dosage were the main purposes of consultation.The proportion of infection problems was 86.0%, adoption rate of recommendations was 83.6%, the clinical efficacy rate was 84.3% among them.The proportion of non-infectious problems was 14.0%, adoption rate of recommendations was 100.0%.Conclusion Clinical pharmacists' professional skills are respected by doctors.Anti-infection problem is a breakthrough point for deeply developing the work of clinical pharmacists.

Objective To observe the clinical efficacy ofTong Yuan(short forTong Du Tiao Shen,Yin Qi Gui Yuan, referring to unblocking the Governor Vessel, regulating mind, and guiding qi back to the origin) needling method plus Letrozol and human chorionic gonadotropin (HCG) in treating refractory sterility caused by polycystic ovary syndrome (PCOS).Method Sixty clomiphene citrate-resistant PCOS-induced sterility patients were recruited and randomized into two groups. The treatment group was intervened byTong Yuanneedling plus Letrozol and HCG, while the control group was intervened only by Letrozol and HCG, both for 3 months. Prior to and after the treatment,the levels of estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T) were detected; the endometrium, ovulation and pregnancy rates were also observed.Result After 3 menstrual cycles, the level of FSH increasedsignificantly (P<0.05), LH decreased significantly (P<0.05), LH/FSH declined significantly (P<0.05), and the level of T also dropped significantly (P<0.05) in both treatment group and control group; the level of E2also dropped significantly after the treatment in both groups (P<0.05), and the decrease in the treatment group was more significantly than that in the control group (P<0.05). The ovulation and pregnancy rates in the treatment group were significantly higher than those in the control group (P<0.05).Conclusion Tong Yuanneedling plus Letrozol and HCG can significantly down-regulate the levels of LH, E2and T, up-regulate the level of FSH, effectively improve the internal reproductive environment of refractory PCOS patients, and enhance the ovulation and pregnancy rates.

Objective To investigate whether problem-based learning (PBL) is suitable for medical imaging and whether PBL is more enlightening than lecture-based learning (LBL) mode in teaching of medical imaging.Methods Thirty-two students of clinical medicine specialty in Sun Yat-sen University were selected as teaching objects and were divided into 6 groups (5 students in four groups and 6students in 2 groups).Chapters of urinary and digestive system were taught by PBL mode while the rest chapters by LBL mode.Questionnaires were handed out to teachers and students by Email after class and the valid questionnaires were analyzed qualitatively.Results Thirty-one students and 5 teachers thought they were suitable for PBL teaching; 30 students and 5 teachers were willing to continue PBL.Thirty-one students and 5 teachers thought that PBL mode could let students learn more knowledge and was more revealing.Twenty-three students thought PBL teaching spent too much time can not promote in all chapters.Three teachers worried that PBL mode would cause poor organization form and teaching plans.Conclusions PBL is suitable for medical imaging teaching.PBL could let students learn more knowledge and is more revealing compared with LBL,however,PBL is time-consuming and laborious,therefore LBL and PBL should be combined.

Cardiac surgery associated-acute kidney injury (CSA-AKI) is a common postoperative complication which seriously affects prognosis of patients. In recent years, various intelligent warning systems for early detection of CSA-AKI have been developed in combination of biomarkers and machine learning, but its clinical application value remains to be clarified. This article provides a review on the progress of the application of intelligent warning systems for CSA-AKI.