Objective To evaluate the accuracy of stroke volume variation (SVV) in monitoring blood volume during one-lung ventilation in patients undergoing thoracoscopy operation. Methods Twenty-two ASA Ⅰ or Ⅱ patients ( 12 male, 10 female) aged 18-60 yr undergoing thoracoscopy operation under general anesthesia were studied. Anesthesia was induced with midazolam, sufentanil, propofol and rocuronium and maintained with TCI of propofol and remifentanil and intermittent iv boluses of vecoronium. Robertshow double-lumen endobronchial tube was inserted. Correct position of the tube was verified by fiberoptic bronchoscopy. The patients were mechani40 mm Hg. Radial artery was cannulated and connected to FloTrac pressure transducer and Vigileo monitor. A loading dose of 6% HES 5 ml/kg was infused over 10 min. MAP, HR, CO and SVV were recorded before and at 3 min after loading dose. The change rate of SVV (SVV) and CI (△CI) were calculated. Increase in CI by 11% was considered effective volume expansion. The ROC curve for SVV in determining the volume expansion efficacy was plotted. The area under the curve for SVV and 95% confidence interval were calculated. Results (1) CO were significantly increased while SVV decreased after a loading dose of HES. (2) During two-lung ventilation 12 patients responded to the 6% HES loading dose.SVV correlated with△CI ( - 0.710, P ＜ 0.05). The volume expansion efficacy was determined by SVV 11.5 % (sensitivity = 82 %, specificity = 92 % ). The area under the curve for SVV and 95% confidance interval were 0.880 (0.580-0.987). (3) During one-lung ventilation 11 patients responded to the 6 % HES loading dose. SVV correlated with CI ( - 0.668 , P ＜ 0.05). The volume expansion efficacy was determined by SVV 9.5 % ( sensitivity = 77 %, specificity = 63 % ). The area under the curve for SVV and 95% confidance interval were 0.971 (0.917-1.024). Conclusion One-lung ventilation does not alter the ability of SVV in monitoring blood volume in patients undergoing thoracoscopy operation.

Objective To study the clinical characteristics of tracheotomy in patients with critical diseases and obesity aged 80 years and over. Methods A total of 120 patients with critical diseases and obesity undergoing tracheotomy from July 2006 to August 2011 were retrospectively reviewed,and divided into advanced age group(aged 80-99 years,n=60) and control group(aged 60-79 years,n=60).Surgery time,operation preparation,surgery skill and complication after surgery were compared between the two groups. Results A total of 60 patients undergoing tracheotomy were successfully performed by relative surgery skills according to characteristics of critical obesity in advanced age group.There was 1 case (1.7％) and 0 case with trachea cannula exodus,3 cases (5.0％) and 4 cases(6.7％) with cuff leak,4 cases (6.6％) and 3 cases(5.0％) with stoma bleeding,5 cases (8.3％) and 7 cases (11.4％) with subcutaneous emphysema in advanced age and control groups,respectively.Total complication rate was similar between the two groups of patients [13 cases (21.7％) vs.14 cases (23.3％),x2 =1.00,P＞0.05]. Conclusions Individualized procedure of tracheotomy may reduce complication of patients with critical diseases and obesity aged 80 years and over.

AIM: To explore the expression of nuclear factor-?B(NF-?B) in asthmatic guinea pigs, and the effect of erigeron breviscapus, a protein kinase C(PKC) inhibitor, on the expression of nuclear factor-?B(NF-?B). METHODS: 48 guinea pigs were randomly divided into 6 groups ( n= 8). Airway resistance and eosinophilic inflammation of airway wall were examined, the expression of NF-?B in the lung tissue was detected by immunohistochemical staining. RESULTS: The expression of NF-?B was mainly found in airway epithelium, all the asthmatic animals showed significantly higher optical densities than that of the normal control group( P

OBJECTIVE To discuss the operative plan for nasal cavity abnormality and evaluate the effect of revision FESS. METHODS A retrospective study of 36 revision FESS performed during 2002.3-2005.5 (age from 17 to 55 years old) is presented. Patients were evaluated with endoscopic examination of the nasal cavities and computed tomography of the sinuses and nasal cavities. Information was also collected during the revision surgery. The plan was designed according to nasal cavity abnormality. RESULTS The reasons of revision FESS: Among 36 cases there are 24 ethmoid sinusitis, 16 cases with recurrence of polyps,13 middle meatal stenosis, 11 middle turbinate adhesion, 10 septal deviation, 5 frontal recess stenosis, 5 sphenoid sisusitis, 3 maxillary ostium obstruction,3 inferior turbinate hypertrophy. Follow up for 6 month～43 month after revision FESS, 22 cases were successful, 10 satisfied and 4 inefficacy. CONCLUSION The primary FESS failure was associated with nasal cavity structure diseases. Meticulous attention in these areas and correcting it during surgery may reduce recurrence and ensure operative effect after revision FESS.

OBJECTIVE: To master the clinical manifestations of rhinogenic headache and improve the diagnostic ability of chronic rhinosinusitis accompanied by primary headache. METHOD: The clinical manifestations, the diagnostic process, and the treatment of 1 patient with headache were analyzed, and also the related articles were studied. RESULT: Rhinogenic headache and primary headache had different clinical features and different treatment. In clinical work misdiagnosis were easily made if not being carefully analyzed. CONCLUSION Diagnosis of rhinogenic headache do need strong clinical evidence, but the differential diagnosis of other headache should be made.
Cluster Headache ; complications ; Humans ; Male ; Middle Aged ; Sinusitis ; complications

OBJECTIVE: To investigate the acoustic characteristics of snoring sound in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHOD: Thirty-one patients with OSAHS were included in this study. Natural overnight snoring was digitally recorded and polysomnography (PSG) was performed simultaneously. Thirty hundred and ten snores which after obstructive apnea and 310 continuous snores which not after obstructive apnea were extracted and peak frequency, maximal frequency, mean frequency,central frequency and power ratio were analyzed. RESULT: The maximal frequency, peak frequency, mean frequency and central frequency of the snores which after obstructive apnea was higher than that of the continuous snores. But 800 Hz power ratio of the snores which after obstructive apnea was lower than those of the continuous snores. The differences of all parameters were of statistical significance (P<0.01 or 0.05). The patients were divided into mild, moderate and severe groups according to AHI, it were seen that in mild patients group peak frequency, central frequency and 800 Hz power ratio were of statistical difference (P<0.01); and in moderate and severe patients groups,in addition to fc, the rest of the index difference was statistically significance except central frequency (P<0.01 or 0.05). CONCLUSION 800 Hz power ratio is a good index for distinguishing the two kind of snores of OSAHS patients. It indicates that it is feasible to study the OSAHS by way of snore monitoring and analyzing technique employed in this study.
Acoustics ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; Sleep Apnea, Obstructive ; physiopathology ; Snoring ; physiopathology

This study compared the efficacy and safety of tiotropium bromide inhalation powder (spiriva) and doxofylline oral tablet (doxofylline) in the treatment of chronic obstructive pulmonary disease (COPD). A multi-center, randomized, double-blind, double-dummy, parallel-controlled study involved 127 eligible stable moderate to severe COPD patients treated with inhaled tiotropium dry powder (18 μg/day) or oral doxofylline tablets (0.2 g/time, 2 times a day) for 12 and 24 weeks. Before and after treatment for 12 weeks and 24 weeks, respectively, pulmonary function, 6-min walking distance and dyspnea index were recorded. The results showed that in both tiotropium group and doxofylline groups, after 12-week treatment, FEV(1), FEV(1)/FVC% and 6-min walk distance were significantly higher than those before the medication, while dyspnea index decreased as compared with that before treatment. After 24-week treatment, a slight improvement in the measures was observed as compared with that of 12-weeks treatment, but the difference was not statistically significant. With both 12-week and 24-week treatment, the effect of tiotropium was slightly better than that of doxofylline tablets, with the difference being statistically insignificant. The major adverse events in the tiotropium group and doxofylline group were observed in 9 cases (9.9%) and 12 cases (12.9%), respectively, and no statistically significant difference was found between them. We are led to conclude that both tiotropium at 18 μg a day and doxofylline tablets at 0.2 g/day (two times a day) are effective and safe for the treatment of COPD.

Objective:This study was designed to observe the dizziness handicap inventory (DHI) scores in patients with BPPV (benign paroxysmal positional vertigo) before and after maneuver repositioning and aimed to discuss the values of DHI scores in the diagnosing and treatment of BPPV. Method:Charts of 72 patients with BPPV diagnosed by positioning test were reviewed. Four DHI scores were used including the total score (DHIT), the functional score (DHIF), the emotional score (DHIE), and the physical score (DHIP). We compared the pre-repositioning DHI scores and post-repositioning scores of patients, and also compared the DHI scores of patients with and without residual dizziness. Result:All of the 72 patients were underwent maneuver repositioning and recorded the DHI scores. The mean post-repositioning scores were dramatically decreased compared with pre-repositioning scores, and the difference was significant (P<0.01). The differences of the DHIP scores between the residual dizziness group and the non-residual dizziness group was not significant, while the DHIF scores, the DHIE scores and the DHIT scores between the two groups were statistically different. Conclusion:After maneuver repositioning the dizziness handicap of BPPV patients could be significantly improved. The next treatment program for residual dizziness patients after successful repositioning could be aimed at the functional and emotional dizziness.

This study compared the efficacy and safety of tiotropium bromide inhalation powder (spiriva) and doxofylline oral tablet (doxofylline) in the treatment of chronic obstructive pulmonary disease (COPD).A multi-center,randomized,double-blind,double-dummy,parallel-controlled study involved 127 eligible stable moderate to severe COPD patients treated with inhaled tiotropium dry powder (18 μg/day) or oral doxofylline tablets (0.2 g/time,2 times a day) for 12 and 24 weeks.Before and after treatment for 12 weeks and 24 weeks,respectively,pulmonary function,6-min walking distance and dyspnea index were recorded.The results showed that in both tiotropium group and doxofylline groups,after 12-week treatment,FEV1,FEV1/FVC％ and 6-min walk distance were significantly higher than those before the medication,while dyspnea index decreased as compared with that before treatment.After 24-week treatment,a slight improvement in the measures was observed as compared with that of 12-weeks treatment,but the difference was not statistically significant.With both 12-week and 24-week treatment,the effect of tiotropium was slightly better than that of doxofylline tablets,with the difference being statistically insignificant.The major adverse events in the tiotropium group and doxofylline group were observed in 9 cases (9.9％) and 12 cases (12.9％),respectively,and no statistically significant difference was found between them.We are led to conclude that both tiotropium at 18 μg a day and doxofylline tablets at 0.2 g/day (two times a day) are effective and safe for the treatment of COPD.

Epilepsy is a disorder of the brain charac-terized by abnormal neuron excitability.However,the underlying molecular mechanism of neuron excitability modulation remains elusive.With the help of bioinformatic methods,we have identified receptor-type tyrosine-pro-tein phosphatase-like N(PTPRN)as a critical gene dur-ing epileptogenesis.PTPRN recruits NEDD4L ubiquitin E3 ligase to NaV1.2 sodium channels,facilitating NEDD4L-mediated ubiquitination and endocytosis.Knockout of PTPRN endows hippocampal granule cells with augmented depolarization currents and higher intrinsic excitability,which is reflected by increased seizure susceptibility of transgenic mice.On the contrary,reduced neuron excit-ability and decreased seizure susceptibility are observed after PTPRN overexpression.Meanwhile,we find that a 133 aa fragment recaptures modulation effect of PTPRN full-length,and this fragment shows therapeutic potential towards epilepsy caused by NaV1.2 gain of function vari-ants.In brief,our results demonstrate PTPRN playsa criti-calroleinregulatingneuronexcitability,providing a poten-tial therapeutic approach for epilepsy.