Objective To assess the influence of changes in alveolar ventilation on gastro-intestinal perfusion measured via a nasogastric tonometer.Methods Sixteen ASA Ⅰ - Ⅱ patients ( 7 male, 9 female) aged 15-67 yr, undergoing elective intracranial operation were included in this study. The patients were premedicated with oral ranitidine 150 mg and intramuscular phenobarbital 0.1 g and atropine 0.5 mg. Anesthesia was induced with midazolam 1-2 mg, fentanyl 2 ?g? kg-1 , propofol 1.5-2.0 mg ? kg-1 and vecuronium 0.1 mg ? kg-1 , and maintained with 0.5%-2.0% isoflurane inhalation and intermittent iv boluses of fentanyl and vecuronium. The patients were intubated and mechanically ventilated after induction of anesthesia. The ventilatory settings were : RR 10 bpm; FGF 1 L? min-1; I: E = 1:2; the initial VT was 7 ml? kg-1 (T1 ) which was gradually increased to 8 ml ?kg-1(T2), 9ml?kg-1(T3) and 10 ml?kg-1 (T4) and then returned to 7 ml ? kg-1 again. Each VT was maintained for 1 h. A nasogastric tonometer (Tonocap, Datex-Ohmeda, Finland) was inserted into stomach and automatically measured gastric intramucosal CO2 tension (PgCO2) every 10 min. Radial artery was cannulated for direct MAP monitoring and blood sampling. Blood gas analysis was performed every hour at various VT levels. Gastric-to-arterial pH gap and gastric-to-arterial PCO2 gap [P(g-a)CO2] were calculated.Results PgCO2 decreased during T2_4 (hyperventilation phase) (P

Objective Controlled hypotension induced by different drugs may have different effects on splanchnic perfusion. The purpose of this study was to assess the effects of nicardipine- induced hypotension on splanchnic perfusion. Methods Twenty-three ASA Ⅰ-Ⅱ patients (14 male, 9 female) aged 21-60 yr undergoing meningioma resection were studied. The patients were premedicated with ranitidine 150 mg per os and atropine 0.5 mg i.m. Anesthesia was induced with propofol 1.5-2.0 mg?kg-1 , fentany1 2.0?g?kg-1 and vecuronium 0.1 mg? kg-1 and maintained with isoflurane inhalation and intermittent i. v. boluses of fentanyl and vecuronium. The patients were mechanically ventilated after tracheal intubation and PETCO2 was maintained at 33-35 mm Hg. Nicardipine-induced hypotension started from opening of mininges to the resection of tumor. 0.01% nicardipine infusion was started at 30 ml?h-1 and adjusted to reduce systolic blood pressure by 30% of the baseline or MAP to≥60 mm Hg. The adequacy of splanchnic perfusion was defined by gastric intramucosal CO2 tension (PgCO2), the intramucosal pH (pHi) and the difference between intramucosal and arterial PCO2(PCO2 gap) and was assessed before induction of anesthesia, the 1st, 2nd and 3rd hour during controlled hypotension and 1, 2 hour after termination of controlled hypotension. Results The MAP was maintained at about 62 mm Hg during controlled hypotension. The heart rate was stable. Hct was significantly decreased at 1st, 2nd and 3rd hour of hypotension compared with baseline but the mean Hct was greater than 30% . The intramucosal pH decreased slightly with no statistical significance and pHa, PaCO2 , PgCO2 and PCO2 gap were almost unchanged during controlled hypotension compared with the baseline values. Conclusion Nicardipine-induced hypotension is safe when MAP is maintained at≥60 mm Hg and has no adverse effects on splanchnic perfusion.

Objective The present study was designed to compare the effects of different intra-abdominal pressure and the duration of pneumoperitoneum on splanchnic perfusion during laparoscopic cholecystectomy. Methods Fifty ASA Ⅰ or Ⅱ patients aged

p16 gene was a tumor supressor gene found recently. The p16 protein is a negative regulator of cell proliferation . Loss of normal p16 function is associated with the development of neoplasms. To detect antitumorigenic effect of p16 on human lung adenocarcinoma cells, we cloned a p16 cDNA into the pcDNA3 vector at the sites of BamHl and Xho I to gain a p16 gene recombinant expression vector plasmid. We then transferred the p16 gene recombinant plasmid into human lung adenocarcinoma cell line (NCI-H460) by electroporation method. After G418 selection we assessed cell growth properties and cell cycle pattern by flow cytometry to G418-resistant clones of NCI-H460-pl6 and NCI-H460-vect respectively. The results show that human p16 gene could suppress the phenotype of NCI-H460 cell line and p16 gene therapy plays a positive role in human lung adenocarcinoma treatment.

Objective To evaluate evidence-based practice of catheter removal strategy in patients with short-term indwelling catheter after partial nephrectomy. Try to apply the best evidence into practice, and further to improvethe quality of clinical nursing through quality review. Methods Two rounds of quality review were carried out in the 2 wards from July to December in 2016. Using the 5 review criteria of best evidence, we reviewed baseline of catheter removal strategies for patients with short-term indwelling catheter after partial nephrectomy and developed appropriate evidence-based practice. Further, the best evidence was integrated into clinical nursing practice, and the prognosis was reviewed after then. Results In the baseline review, the compliance of the 5 review criteria was 0. However, after introducing the best evidence into nursing practice,the compliance was up to 100%. The mastering of evaluation knowledge of catheter removal of nurses increased from 73.00 ± 9.35 to 94.81 ± 3.38 with significant difference (t=12.72, P<0.01). The indwelling time of catheter shorted from (5.69±0.79) d to(4.24±0.82) d. The difference was significant (t=5.47, P<0.01). Conclusions Evidence-based nursing practice improvesthe strategies of short-term catheter removal after partialnephrectomy, while closer cooperation between nurses and doctors are still needed to promote the continuous improvement of nursing quality.

BACKGROUND: Dysfunction of vascular endothelium is the initial event of atherosclerosis. Although there are many approaches to evaluate the function of vascular endothelium, few are widely used in clinic. OBJECTIVE: To evaluate the brachial and superficial femoral endothelium-dependent dilation, i.e. flow-mediated dilation (FMD) and endothelium-independent dilation, i.e. nitroglycerin-mediated dilation (NMD), of elderly patients with peripheral artery disease (PAD), and to investigate the correlation and characteristics between brachial and superficial femoral FMD and NMD.DESIGN, TIME AND SETTING: Non-randomized concurrent control trial was performed at Department of Geriatric Cardiology, Chinese PLA General Hospital from October 2000 to May 2002.PARTICIPANTS: Thirty-three PAD patients were selected as PAD group, including 27 male and 6 female, aged (79±6)years, who had more than one focus of plaque and arterial stenosis more than 50% in artery of lower extremity by Doppler ultrasound. Accorded with the standard for Health of China Academy of Geriatrics in 1995, 40 healthy retired cadres undergoing health examination were selected as control, including 29 male and 11 female. In addition, 30 patients with coronary arteriosclerotic heart disease or cardiovascular risk factors (excluding age and sex) were selected as risk factor group.METHODS: Using non-invasive approach, high resolution color Doppler ultrasound diagnosis system was applied to detect the basic caliber of upper and lower extremtity arteries in all participants, then the blood flow of the tested artery was blocked and the vascular caliber was detected again after the blood flow was restored to evaluate the endothelium-dependent dilation. The tested subjects took 0.6 mg nitroglycerin to induce vasodilatation after detecting the basic caliber of upper and lower extremtity arteries, then the difference between the two detections was regarded as the endothelium-independent dilation.MAIN OUTCOME MEASURES: The endothelium-dependent dilation and endothelium-independent dilation of upper and lower extremtity arteries.RESULTS: Both FMD and NMD of the brachial artery and the superficial femoral artery in 33 PAD patients were significantly lower than those of healthy controls and non-PAD patients with cardiovascular risk factors (t=-11.82-10.91, P <0.05). In old PAD patients, the superficial femoral FMD and NMD were significantly lower than brachial FMD (t=3.535,3.315, P < 0.01); There was close relationship between the brachial and superficial femoral FMD (r=0.931 4, P < 0.01), so was the NMD (r=0.919 1, P < 0.01).CONCLUSION: The superficial femoral FMD and NMD may reflect the vasoreactivity of PAD patients more directly and sensitively than those of brachial artery. There is close relationship between brachial and superficial femoral arteries.

Objective To evaluate endothelium-dependent dilation (flow-mediated dilation, FMD) and endothelium-independent dilation(nitroglycerin-mediated dilation, NMD) of the brachial and superficial arteries in elderly patients with atherosclerotic disease(LEASD) of the lower extremity, and to evaluate the correlation between brachial and superficial femoral FMD and NMD and their characteristics. Methods Both FMD and NMD of the brachial artery and the superficial femoral artery were determined in 33 old LEASD patients with the high-resolution ultrasound, and the results were compared with that of 40 healthy elderly controls and 30 non-LEASD elderly patients with cardiovascular risk factors, respectively. Results Both FMD and NMD of the brachial artery and the superficial femoral artery were significantly lower in 33 elderly LEASD patients compared with those of 40 healthy elderly controls and 30 non-LEASD elderly patients but with cardiovascular risk factors (P

Objective To explore the effect of rehabilitation training combined with rational-emotive therapy on post-stroke depression (PSD).Methods 51 PSD patients were randomly divided into the treatment group (n=25) and control group (n=26). All patients received routine rehabilitation training, simultaneously took 20 mg of fluoxetine hydrochloride dispersible tablets per day. Based on above, the treatment group was given physiological rehabilitation treatment with rational-emotive therapy in early stage, 30 min each time, continuously 6 weeks. The two groups were assessed with Zung Self-rating Depression Scale and Fugl-Meyer Motor Scale before and after treatment.Results Afer treatment, the scoers of Zung Self-rating Depression Scale and Fugl-Meyer Motor Scale of the treatment group was higher than that of the control group ( P<0.05).Conclusion The rational-emotive therapy might improve the depression condition of post-stroke, enhance patients' motor function.

Objective This trial was to observe the effect of Ulinastatin on coagulation functions in patients during operation period,and to investigate the protective mechanisms of Ulinastatin.Methods Forty patients were randomly divided into Ulinastatin group (Group U,n =20) and control group (Group C,n =20).Group U was infused intravenously ulinastatin 4000 U/kg (diluted with saline to 30 ml,20min losers) after anesthesia and before cutting skin,while Group C received the same volume of normal saline.All patients were phlebotomized 1 ml peripheral blood before administered (T0) and after 1 hour (T1),respectively.Coagulation activation time (SonACT),clot rate (CR) and platelet function (PF)were detected by sonoclot coagulation analyzer and platelet function analyzer.Results Compared with group C (controlled group),SonACT of Group U was prolonged significantly at T1 (P ＜ 0.05),and PF were increased at T1 (P ＜ 0.05) ; Compared with T0,SonACT and PF were increased at T1,respectively (P ＜ 0.01).Conclusions Ulinastatin can improve perioperative coagulation function and platelet function.It may reduce intraoperative micro-thrombosis syndrome and postoperative deep vein thrombosis.

Objective To investigate the relationship of androgen receptor (AR) CAG repeat polymorphism and coronary artery disease (CAD) in elderly men and its potential mechanism.Methods Totally 296 elderly men undergoing coronary angiography were enrolled in this study.Serum total testosterone (TT) and free testosterone (FT) levels were measured.Androgen receptors (ARs) in peripheral lymphocytes were determined by flow cytometry.Genome DNA was extracted from peripheral leucocytes using standard techniques.Gene fragments containing AR CAG repeats were amplified by PCR with specific fluorescent labeled primers.PCR products were separated with agarose gels.CAG repeat number of each sample was obtained by genotyping.Results AR CAG repeats varied from 11 to 28 (P25-P75:18-22; median:20) in elderly male patients.They were divided into the long AR group (CAG repeats≥22,n=82) and the short AR group (CAG repeats＜22,n=214).Compared with the long AR group,serum FT level was much lower in the short AR group [(24.1±23.1) ×10-6mmol/L vs.(31.2±27.8)×10-6mmol/L,P＜0.05].The prevalence of coronary artery disease was higher in the short AR group than in the long AR group [84.1％ (180 cases) vs.69.5％(57 cases),P＜0.05].The FT level was lower in the short AR group combined with CAD than in the control group [(22.4±20.5) ×10-6mmol/L vs.(33.6±32.4)×10 6mmol/L,P＜0.01].There were no significant differences in serum TT and AR levels between the long and short AR groups.No significant correlations were found in the AR CAG repeats polymorphism with FT,TT or AR levels.Age was the main risk factor for FT and AR levels.Logistic regression analysis showed that FT level was negatively correlated with CAD (OR=0.98,95 ％ CI:0.973-0.998,P=0.01),and short AR increased the risk of CAD in elderly male patients (OR=3.44,95％CI:1.887-6.264,P＜0.01).Conclusions Serum FT level is correlated with age and is significantly decreased in elderly male patients with short AR repeats,which may increase the risk of CAD in elderly men.