ObjectiveTo analyze the influencing factors of the blood pressure fluctuation during the perioperative period of pheochromocytoma,and discuss the ways to improve the hemodynamics.Methods The clinical data of patients with pheochromocytoma who had received operation from 2000 to 2010 werestudied retrospectively.The influencing factors of perioperative blood pressure fluctuation were analyzed by statistical methods including Pearson correlation analysis and Logistic regression.ResultsAccording to Pearson correlation analysis,the influencing factors of the highest fluctuation value of the systolic blood pressure ( △ SBP) during the operation included the preoperative highest systolic blood pressure (r =0.196,P =0.013 ),the content of preoperative 24-hour urine epinephrine ( r =0.207,P =0.008 ) and the lost blood volume during the operation (r =0.253,P=0.003).Logistic regression analysis showed that the postoperative persisting hypotension was influenced by the content of preoperative 24-hour urine norepinephrine(OR =1.273,P =0.002) and preoperative preparation duration(OR =0.921,P =0.034);the risk factors of postoperative hypertension were residual tumor (OR =16.920,P =0.001 ) and the preoperative hematocritchange(OR =1.467,P =0.018).ConclusionsIn spite of the adequate preoperative preparation,great changes of blood pressure would still occur during the perioperative period of pheochromocytoma,and it is influenced by many factors.Corresponding measures aiming to these factors should be taken to decrease the perioperative blood pressure fluctuation and surgical risks.

OBJECTIVE:To provide reference for the effective integration of standardization strategy of traditional Chinese medicine (TCM) and intellectual property. METHODS:Through analyzing the conflict between standardization requirement of TCM and intellectual property system,the coordination between TCM standards and intellectual property especially the trade secret rights was explored. RESULTS:The information disclosure of TCM standards and intellectual property strategy especially protec-tion of TCM trade secrets faced confrontation and conflict in system and design. For the suggestions to solve it,one is to reconfirm the role and positioning of the government on the adaption of standardization in public law field;another is to establish coordina-tion principle of information disclosure and confidentiality in private law field,and achieve difference open and moderate open of information. CONCLUSIONS:The TCM standardization is not absolute,the pros and cons is the precondition to solve the conflict between the standardization strategy and trade secret system in TCM in terms of protection of information freedom and secret infor-mation.

Objective To evaluate the combined effects of vascular endothelial growth factor (VEGF) and placental growth factor (PLGF) on angiogenesis and cardiac function and compare with VEGF or PLGF only in acute myocardial infarction rats.Methods Seventy-five males Sprague-Dawley(SD) rats were randomly divided into five groups:sham group,NS group,VEGF group,PLGF group,and VEGF + PLGF group with 15 rats in each group.All the rats underwent LAD ligation and injection of NS,VEGF,PLGF,VEGF + PLGF,in the peri-infarct area,respectively,besides the sham group.Three weeks after coronary artery ligation and different agents injection,cardiac function,myocardial scar area,angiogenesis and arteriogenesis were studied.Cardiac structure and function,and infarct size were assessed by echocardiography.The number of new vessels and the number of new arterioles were evaluated by haematoxylin-eosin staining and immunohistochemistry staining.Results Three weeks after LAD ligation and different agents injection,the LVEDD and LVESD were significantly decreased (P ＜ 0.01)in NS group,VEGF group and PLGF group.While the LVEF and LVFS were higher in VEGF + PLGF group than that in other groups.Myocardial infarct size was reduced in VEGF group (P ＜ 0.05).Angiogenesis and arteriogenesis were higher in VEGF + PLGF group than that in VEGF group (P ＜ 0.01) and PLGF group (P ＜0.05).Angiogenesis and arteriogenesis were significantly higher in PLGF group than that in VEGF group (P＜0.01).The density of microvessels in VEGF group was higher than that in NS group (P ＜ 0.05),while arteriogenesis was of no statistical difference.Conclusion The combination of half VEGF and PLGF can increase angiogenesis and arteriogenesis in the ischemic marginal zone of myocardial infarction,decrease myocardial infarction area,and improve cardiac function.

Objective To observe the ventilation effect of I-gel laryngeal mask in endoscopic thyroid surgery under general anesthesia. Methods A total of 60 cases of endoscopic thyroid surgery under general anesthesia, were randomly di?vided into 3 groups (n=20):the group that patients used endotracheal intubation (Group Q);the group that patients employed Supreme laryngeal mask (Group S);the group that patients wore I-gel laryngeal mask (Group I). Success rate of insertion, du?ration of insertion, endotracheal pressure of Group S and Group I worerecored, and fiberoptic bronchoscopy was performed in Group S and I to evaluate the position of laryngeal mask. Mean arterial pressure(MAP), heart rate(HR), pulse oxygen satura?tion (SpO2) at time points of before insertion (T0), 1 min after insertion (T1), 3 min after insertion (T2), before the establishment of CO2 operating space (T3), 30 min after the establishment of CO2 operating space (T4), 10 min after the resection of speci?mens (T5), 1 min before removal of laryngeal mask (T6) and 1 min after the removal of laryngeal mask (T7) were recorded and the end-tidal carbon dioxide pressure [ p(CO2) ]and peak airway pressure (Ppeak) form T1 to T5. were also recorded. Occur?rence of nausea and vomiting, sore throat and other adverse reactions after removal of laryngeal mask were also noted. Re?sults The successful rate of insertion was not significant different among all three groups. Compared with Group Q, inser?tion time was significantly shorter in Group I and S (P<0.05). Endotracheal pressure and fiberoptic bronchoscopy score are not statistically different between Group S and I. Compared with Group Q, MAP and HR in T1, T6 and T7 were significantly lower in Group S and I (P<0.05). SpO2,p(CO2) and Ppeak show no statistical difference between three groups. Compared with Group S and Q, the occurrence of sore throat, painful swallowing and bleeding which is indicated by the appearance of blood in laryngeal were all significantly lower in Group I (P<0.05). Conclusion Both I-gel laryngeal mask and Supreme laryngeal mask can be used safely and effectively in airway management of endoscopic thyroid surgery patients while I-gel laryngeal mask is less hurting and more comfortable than Supreme laryngeal mask.

Objective To study the correlation between the level of serum high sensitivity C-reactive protein (hs-CRP) and induced sputum cell counts,pulmonary function and asthma control test (ACT) in order to investigate the clinical application value of serum hs-CRP for the acute exacerbation bronchial asthma patients.Methods Thirty acute exacerbation bronchial asthma patients were collected as asthma group,14 healthy people during the same period were collected as control group.The fasting serum hs-CRP was examined in control group and before and after treatment of 5-7 d in asthma group.The induced sputum was obtained by ultrasonic atomizer 4.5％ sodium chloride,and the percentage of eosinophils (EOS％),neutrophil,macrophages,lymphocytes was calculated.The pulmonary function index was determined in control group and before and after treatment in asthma group.ACT score was performed in asthma group.The correlation between the serum hs-CRP and induced sputum differential leukocyte count,the pulmonary function index and ACT score was analyzed by Spearman correlation analysis.The effect of the serum hs-CRP and induced sputum EOS％ on inflammatory response of acute exacerbation bronchial asthma was evaluated by receiver operating characteristic (ROC) curve analysis.Results Two cases were excluded in asthma group.The serum hs-CRP before and after treatment in asthma group was higher than that in control group[4.18(2.12-11.12) and 3.40(2.02-8.91) mg/L vs.1.48(1.03-4.81) mg/L,H =18.939,P＜ 0.01].The serum hs-CRP before treatment was higher than that after treatment in asthma group (P ＜ 0.01).In asthma group,the serum hs-CRP had positive relationship with induced sputum EOS％ (r =0.849,P =0.000).There were negative correlations between the serum hs-CRP and the pulmonary function index such as one second forced expiratory volume percent predicted,one second forced expiratory volume occupied vital capacity ratio,maximum mid-expiratory flow percentage of predicted (r =-0.617,-0.559,-0.398,respectively,P =0.000,0.002,0.036,respectively).It was also found that the serum hs-CRP and ACT score had the remarkable Spearman linear correlation (r =-0.511,P =0.005).The area under the ROC curve of the serum hs-CRP was 0.713 (P =0.003).Conclusions There are significant correlations between the serum hs-CRP and induced sputum EOS％,pulmonary function,ACT score in the acute exacerbation bronchial asthma patients.It is found that hs-CRP could be considered as one of the potential marker to evaluate the systemic inflammation level of bronchial asthma.

ole on the development of septic AKI. It's useful to decrease the incidence of AKI by elevating the blood pressure and C1, but super-normal goal won't work better.

Objective To explore the role and mechanisms of ω-3 polyunsaturated fatty acids (ω-3PUFA) alone or in combination with dexamethasone ( DEX) in inducing cell apoptosis and anti -proliferation in multiple myeloma(MM).Methods DEX resistance MM cell line MM1R were treated with different concentra-tions of Eicosapentaenoic acid(EPA)or Docosahexaenoic acid(DHA)alone or in combination with DEX for 24hrs or 48hrs.Cell proliferation was detected by MTT .Cell cycle and apoptosis were measured by flow cytometry .The levels of apoptosis related proteins were analyzed by Western blot .Results The proliferation of MM1R was in-hibited by different concentrations (10,20,50,100μM)of EPA or DHA alone or in combination with 10μM DEX in a dose-and time-dependent manner .Inhibition effect was significantly higher in combinative groups than in single agent groups(P<0.05).The percentage of G0/G1 phase and cell apoptosis rate in MM1R treated with dif-ferent concentrations of EPA or DHA alone was increased in a dose -dependent manner ,and being significantly higher in combinative groups than in single agent groups (P<0.05).The expressive levels of cleaved caspase -3 and Bax were up-regulated ,while pro-caspase-3 and BCL-2 were down-regulated in a dose-dependent manner.Conclusion ω-3PUFA can inhibit DEX resistant MM cell proliferation ,arrest cell cycle and induce cell apoptosis ,and has a synergistic anti -resistant effect in combination with DEX ,may serve as a new ,effective MM drugs.

90 min, isoflurane concentration was increased or a bolus dose of fentanyl (25-50 ?g) was given i.v.. The BIS values before and during anesthesia and at extubation, emergence time, extubation time, the time between the end of operation and Aldrete anesthesia recovery score≥9, MMSE score and isoflurane consumption were recorded and compared between the two groups. Results The total amount of isoflurane consumed was 34% lower in BIS group than in control group. The average BIS values were higher and end-tidal isoflurane concentration was lower in BIS group than in control group. The time from the end of surgery to eye-opening, to extubation and Aldrete score≥9 were significantly shorter in BIS group than in control group. The MMSE score was significantly decreased at 1 h after operation as compared to the baseline score before induction of anesthesia while in control group MMSE score was still significantly decreased at 2 h after operation. Conclusion Titration of isoflurane using BIS monitoring can reduce the dose of isoflurane during operation and contribute to faster recovery from anesthesia in elderly patients undergoing intra-abdominal surgery.

Objective To assess whether end-tidal carbon dioxide partial pressure (PET CO2) can predict the fluid responsiveness in septic shock patients.Methods Septic shock patients under mechanical ventilation without spontaneous breathing and with the need of a fluid challenge test were included in this study.Heart rate,central venous pressure,pulse pressure,PErCO2,and CI before and after the fluid challenge test were conducted in all the patients.Results Of the 48 septic shock patients included,34 had preload responsiveness,14 had no responsiveness.△CI and △PET CO2 after the fluid challenge test involume responders were (0.85 ± 0.47) L · min-1 · m-2 and (3.5 ± 2.5) mmHg respectively,which were higher than those in no volume responders (P ＜ 0.05).The fluid-induced changes in PET CO2 and CI were correlated (r =0.072,P ＜ 0.05).The AUCRoc of fluid challenge-induced △PET CO2 as the predictor for volume responsiveness was 0.943,and its sensitivity was 87.9％ and specificity was 93.4％ with a critical value of 5％.The AUCRoc of △PP as the predictor for volume responsiveness was 0.801,and its sensitivity was 68.1％ and specificity was 73.2％ with a critical value of 10％.Conclusion The changes of PETCO2 induced by a fluid challenge test can predict fluid responsiveness with reliability,and have a better sensitivity and specificity than the changes of PP.

Based on the theoretical connotation of internal stirring of collateral wind in atherosclerosis (AS) and combined with the concepts related to collateral disease and diseased collaterals,this article suggests that angiogenesis in AS plague belong to collateral disease,of which many are deficiency,stasis and full of changes.Since its pathological changes resemble a lot to wind syndrome,this article suggests that the internal stirring of collateral wind is the core pathogenesis of angiogenesis in AS plague.According to the model building of internal stirring of collateral wind,the high correlation between angiogenesis in AS plague and the internal stirring of collateral wind is proved,which provides a new thought in prevent and treat AS with integrative medicine.