Objective To investigate the clinical effects, therapy safety and maintenance time of recruitment maneuvers (RM) combined with lung protective strategy in patients with acute respiratory distress syndrome (ARDS). Methods Thirty-two ventilated patients with ARDS underwent RM using a pressure of 30cmH_2O for 30s, without any sedatives and neuromuscular blocking agents. Results Compared with before RM, both oxhemoglobin saturation measured by pulse oximetry (SpO_2) and partial pressure of arterial oxygen (PaO_2) were significantly increased during one hour after applying RM. SpO_2 increased significantly within two hours after RM. The peak inspiratory pressures (PIP), heart rate (HR) and Pplateau inspiratory pressures (Pplate) had not significant difference between after and before RM, but respiratory system compliance (Crs) increased markedly in one hour after RM (P

Objective To compare the efficacy of retrograde cardioplegia for myocardial perfusion with that of antegrade cardioplegia at the same flow rate using magnetic resonance techniques. Methods Myocardial perfusion was evaluated with magnetic resonance imaging in isolated pig hearts during antegrade and retrograde cardioplegia. Phosphorus 31 magnetic resonance spectroscopy was used to determine the efficacies of both cardioplegic techniques in sustaining myocardial energy metabolism. Results Magnetic resonance images showed that contrast-enhanced signal-time courses obtained from different regions of the myocardium during retrograde cardioplegia varied significantly, whereas signal-time courses acquired during antegrade cardioplegia appeared more uniform. Localized phosphorus 31 spectra showed that retrograde cardioplegia resulted in myocardial ischemia at the flow rate of 10 ml/min. However, no significant changes were observed in myocardial energy metabolites until the flow rate was decreased to 3 ml/min during antegrade cardioplegia. Conclusion Microvascular perfusion provided by retrograde cardioplegia varies more significantly among various small areas of the myocardium than that did by antegrade cardioplegia. Moreover, the efficacy of retrograde cardioplegia in sustaining normal myocardial energy metabolism is lower than that of antegrade cardioplegia.

Purpose To study the clinicopathologic features of juxtaglomerular cell tumor ( JGCT) . Methods The microscopic and immunohistochemical features were examined in 5 cases of JGCT, with review of related literatures. Results Four patients were fe-males and 1 was male, average aged 39 years ( range, 26-60 years) . Four patients had hypertension at diagnosis. Postoperative serum renin and aldosterone levels decreased obviously than before the operation in one patient. In one patient tumor had metastasized to liver and bone and died 14 months after operation. Microscopically, the tumors were well circumscribed and at least partially invested by a thick fibrous capsule. Entrapped tubules were identified. Numerous hemangiopericytoma-like vessels were focally present. The tumor tissue was made up of sheets of ovoid to polygonal cells with regular nuclei, distinct cell borders, moderately abundant eosinophilic cy-toplasm. Mast cells and lymphocyte were common. Thick-walled hyalinized blood vessels were obvious. Necrosis and high mitotic ac-tivity were identified in one case. Immunohistochemically, tumor cells were positive for renin, CD34, vimentin, and SMA (focally). Conclusions JGCT is a rare renal neoplasm. Its diagnosis and differential diagnosis must be established on the clinicopathologic fea-tures, immunohistochemical findings and ultrastructural features. Malignant JGCT is very rare. Its criteria are unknown, but malignant JGCT include histological vascular invasion, a large tumor size, relatively advanced patient age or child, necrosis and/or high mitotic activity.

Objective:To observe the effects of remifentanil on hemodynamics and plasma angiotentratin-Ⅱ (AgⅡ) level in children with cleft palate undergoing repair operation.Methods:Fifty patients,ASA Ⅰ-Ⅱ, were randomly divided into two groups,remifentanil group (R group) and fentanyl reoup (F group).Patients in R group received remifentanil combined with propofol anesthesia,those in F group received fentanyl combined with propofol anesthesia.Vecuronium bromide was given as muscle relaxant in both groups.ECG,HR,BP and SpO_2 were monitored in all the patients during operation,and peripheral venous blood samples were taken 1 d before operation(T1 ),at the time of endotracheal intubation(T2),10 min after operation beginning(T3),5 minutes after extubation(T4) for the check of plasma AgⅡ level.Results:At T2 and T3 HR,SBP,DBP and plasma AgⅡ level were significant lower in both group of the patients (P

Objective:To investigate the effect of the combined general and epidural anesthesia on tissue perfusion and intestinal barrier in elderly patients undergoing radical resection of colorectal cancer.Methods:A total of 118 elderly patients with colorectal cancer admitted to our hospital from January 2018 to September 2019 were randomly divided into two groups: a single general anesthesia(control, n=59)and combined general and epidural anesthesia(observation, n=59). Two groups underwent radical resection of colorectal cancer.The perioperative parameters were compared between the two groups, including tissue perfusion[central venous-to-arterial carbon dioxide difference(Pcv-aCO 2), oxygen delivery index(DO 2I), oxygen consumption index(VO 2I), difference between central venous and arterial lactate(Dcv-aLac), oxygen extraction rate(O 2ER), central venous oxygen saturation(ScvO 2)], and intestinal barrier[diamine oxidase(DAO), D-lactic acid(D-Lac)]. Results:Compared with the control group, the ScvO 2 during T2-T4 periods was increased in the observation group, and the VO 2I, Dcv-aLac and Pcv-aCO 2 during T1-T4 periods were reduced in observation group( P<0.05). The DO 2I during T1-T4 periods was slightly higher in the observation group than in the control group, and the O 2ER was slightly lower in the observation group than in the control group, but the differences were not statistically significant, ( P>0.05). In the both two groups, the D-Lac and DAO levels showed a gradual upward trend during T1-T5 periods and a gradual downward trend during T5-T6 periods.The D-Lac and DAO levels during T2-T6 periods were lower in observation group than in the control group( P<0.05)[during abdominal exploration(T1); invitrolesion(T2); before abdominal closure(T3); after surgery(T4); postoperative day 1(T5); postoperative day 3(T6)]. Conclusions:General anesthesia combined with epidural anesthesia in elderly colorectal cancer patients undergoing radical resection can stabilize perioperative tissue perfusion, decrease intestinal barrier injury and increase anesthetic effect.

ObjectiveTo explore the cause and treatment of multi-drug resistant pulmonary tuberculosis (MDR-TB) in patients with human immunodeficiency virus (HIV) infection. Methods24 cases with HIV and MDR-TB who were found in some AIDS-high areas in Henan were analyzed.ResultsAll cases were later-required drug-resistant ones. The main reasons were unreasonable plan for chemotherathy,improper management to the patients, side-effect of drugs,immunosuppression and low drug-tolerance. After anti-virus and 9～12 months long anti-tuberculosis chemotherathy,7 cases died and other 17 survival patients improved in clinical symptoms and signs, including no tubercle bacillus were found in sputum of 15 cases,the focal of infection were absorbed in 16 cases,the pulmonary cavity closure rate was 66.7%(4/6)and the count of CD4+ lymphocyte was higher than before.ConclusionThe patients with HIV and MDR-TB are difficult to cure and the mortality rate is high;the short-term effect of the anti-virus and multi-drug antituberculosis chemotherathy is better.

Objective To investigate the necessity and feasibility of setting up elective course of children's paychological problems in medical colleges and universities.Methods The course was practiced by using varied teaching methods such as theory teaching,psychological chat show video,seminar,students speaking,writing paper and etc.Results The attendance was more than 95％ and more than 90％ students submitted the lesson summary and spoke positively in classroom.The scores of 90％ students were more than 80 points and the course evaluation results were good.Conclusion It's important to set up this elective course and this course is worth further developing.

Objective To Evaluate the environment quality in underground construction site based on the measurement of atmosphere composition and microclimate. Method Concentrations and composition of gases were analyzed by combined detection with mass spectrometer and gas chromatograph. Microbial content was detected by striking method. A microclimate model was built based on the measurements of temperature, humidity and wind speed in two years. Result Concentrations of inorganic gas was higher than national standard. Total volatile organic compounds were in the range of 4～6 mg/m3, which highly exceeded the national standard. Concentration of O2 descended obviously at the time when personnel went into the construction site, and was lower than the national standard of 299 mg/m3 after continuous working for 3 h. When an aerator was started, the average noise level was in the range of 70～93 dB, which was higher than the national standard(55～70 dB). In the course of working, the average microbial content reached 4 000 cfu/m3 which was 3 times as high as the background level. The microclimate characteristic with high humidity, low temperature and inadequate sunshine was unsuitable for dwelling. Conclusion Environment in the underground construction site is unfavorable as compared with that on the ground. The physiological function of working staff may be influenced obviously due to cumulative effect of the above mentioned factors, and may lead to aprosexia, hypomnesis, fatigue, etc. Six kinds of protection means are suggested in the paper.

Objective The antioxidative activities of extracts from Undaria pinnatifida in vitrowere tested. Methods Using the assay system of peroxide value (POV), diphenyl picryl-hydrazyl (DPPH), the antioxidative activities of various extracts were studied and comparedwith VE and VC. Results Different extracts from Undaria pinnatifida showed antioxidativeactivities, and petroleum ether extract showed the highest free radical scavenging efficiency.Conclusion petroleum ether extract has stronger antioxidative effect than others.

Objective At present, the methods of separating and identifying nasopharyngeal cancer stem cells are not yet mature.This study was to explore the methods of culturing nasopharyngeal cancer stem cell microspheres and identify the cancerous stem cell biological features of CNE-2 cell microspheres. Methods We conducted suspension culture of human nasopharyngeal cancer CNE2 cells and C666-1 cells in serum-free medium ( SFM) containing growth factors.Then we measured the proportion of CD133 +cells in CNE2 monolayer ( CNE2-MN) and CNE2 microsphere cells ( CNE2-SC) by flow cytometry, determined their in vitro invasiveness through Transwell chamber experiments, and detected their in vivo tumorigenicity via nude mouse experiments.We ob-served the differentiation potency of the CNE2-SCs in the adherent-cultured serum-containing medium and detected the expressions of the cancer stem cell-related genes Bmi-1, Oct4, and Twist1 in CNE2-MN and CNE2-SCs by flow cytometry and RT-PCR analysis. Results In the special blend of SFM, both of the cell lines can form microspheres that can be stably transferred.Fresh SFM prepara-tion, substituting cell separation agent Accutase for pancreatic enzyme for transfer, and maintaining the state of cell suspension contrib-uted to the formation and proliferation of microspheres.Adherent culture with serum-containing medium induced the differentiation of CNE2-MN cells, which exhibited no significant difference from the CNE2 microsphere cells.The CD133 +cells accounted for 98.79%in the CNE2 microspheres, significantly higher than 0.98%in the CNE2 cells (P<0.01).Compared with the CNE2-MN cells, the CNE2-SCs showed highly increased expressions of Bmi-1, Oct4, and Twist1 (P<0.01).The numbers of membrane-penetrating cells in the CNE2-SCs and CNE2-MN cells were 122 ±6 and 36 ±7 per visual field, the former with a stronger invasive ability than the latter genesis of 1 ×106 CNE2-SCs vs that of the same number of CNE2 -MNcells was (2.332 ±0.549) cm 3 sv (0.669 ±0 .278) cm3 ( P<0.01). Conclusion Using suspension culture with a specially prepared SFM, nasopharyngeal cancer CNE2 microsphere cells can be obtained, in which there are large numbers of cancer stem cells.This culture method may provide a base for further studies of naso-pharyngeal cancer stem cells.