Objective To determine the risk factors for acute kidney injury following type Stanford A Aortic Dissection surgeryies.Methods It's a restrospective study.The clinical data of 176 patients undergoing type Stanford A Aortic Dissection surgery from Septerary 2009 to December 2011 were retrospectively analyzed.There were 115 males and 61 females with mean ages(43.20 ± 10.14)years old.The patients were divided into two groups according to whether AKI occurred after operation.Univariate and multivariate analyses were used to evaluate possible pre-,intra-,and post-operative parameters associated with AKI according to AKI Network.Results Among all the patients,AKI occurred in 78 (44.32％),21 (11.93％) of whom underwent continuous renal replacement therapy (CRRT).In hospital mortality was 3.41％ in all discharges while 6.45％ in AKI patients (P ＜ 0.01).Conclusion Multivariate Logistic regression analysis revealed that increased age,pre-operative left ventricular insufficiency,pre-operative renal insufficiency and long extracorpeal circulation (CPB) time ＞ 140 min were risk factors for the development of AKI.AKI is the most common complication of type Stanford A Aortic Dissection surgery,and is the risk factor of mortality after the surgery.It is important to enhance peri-operative protection of the renal function.

Leptin is a kind of energy-modulation hormone expressed by fat tissue. Its receptor has a wide distributing in human body which affects much physiological systems and metabolize access. With the further researches to leptin, its function is not localized fatness and thinness. Leptin is closely associated with the function of gastric mucosa. It attends the pathophysiological course of gastric cancer and gastric -related disease.

Sixty gynecological patients undergoing laparoscopic surgery during October 2010 to June 2011were randomly divided into 2 groups:laryngeal mask airway proseal ( PLMA group,n =30 ) and laryngeal mask airway classic (CLMA group,n =30).Laryngeal mask was inserted after induction.The heart rate (HR),mean arterial pressure (MAP),airway sealing pressure,the average time of placement,the pulmonary satisfaction and complications were recorded.There was no significant difference in heart rate and MAP between the two groups(P＞0.05).The airway sealing pressure [ (26 ±6) cm H2O ( 1cm H2O =0.098 kPa) vs.(16±5) cm H2O],the average time of placement [(36±5) vs.(24±6) s)] and the excellent lung ventilation(90％ vs.73％ ) in the PLMA group were more significantly increased than those in the CLMA group(P ＜0.05).PLMA can assure good airway sealing and is more suitable for gynecological patients undergoing laparoscopic surgery.

Objective To discuss the clinical epidemiology features and change trend of aortic dissection (AD) in Henan Province.Methods Retrospective analysis of consecutive 906 patients with AD over 10 years in Henan Provincial People' s Hospital,the First Affiliated Hospital of Zhengzhou University and Henan Provincial Chest Hospital.Hospital records and prognosis were compared between two five-year periods.Results 906 cases with AD were hospitalized during the past 10years.The mean age was (50.2 ± 9.8) years.The male/female ratio was 3.49 ∶ 1.Hypertension was present in 60.3 ％ of all patients.Heavy smoking history was elicited in 32.2％ of all patients.Type A dissection were identified in 57.8％ of all the cases,and type B in 42.2％.In-hospital mortality of acute type A dissection was 21.8％,acute type B dissection 6.8％.In two five-year periods,the total number of cases increased by 216％,among which type A was the fastest,increased by 294％,Changes of mean age and male/female ratio were not significant.For acute AD,changes of prognosis in one year improved,and reach statistical significance (P ＜ 0.05).Conclusion This study provides insight into current regional profiles of AD.The number of hospitalized patients with AD is increasing dramatically.The mean age of the first-attack is much younger and the male ration is much higher than that reported by other regional researchers.These data support the urgent need for further improvement in prevention and treatment of AD.

Objective To develop a new ambulance aid on airport rescue of pilot and solve the difficult problems on medical staff, which carry the wounded from high aircraft cabin to the ground. Methods The device owned QG 0.85 trailer chassis. On the basis of it, self-made manual flexible extension-jib, flexible extension ladders and safety board were designed. The safety board was used to fix wounded pilots to protect secondary injury of backbone and C-spine. Results The maximal speed of equipment was 80km/h and spreading time is 3～7min, operating time is 4min and lifting height is 6 000mm. Conclusion The ambulance aid can be used in the location of flight accident quickly and rescued the pilots rapidly, adapted to any type fighters and met the needs of medical support in flight.

Objective To investigate the effects of different values of PEEP on cardiac index (CI), stroke volume variation (SVV) and oxygen transport index (DO2I) in patients monitored by FloTrac/Vigileo system, and to provide some references for the hemodynamic management and improvement of oxygenation for patients. Methods Sixty patients scheduled for elective television (TV) auxiliary thoracoscope radical operation for esophageal cancer were included in this study. Data of CI, SVV and DO2I were observed by the FloTrac/Vigileo system. Changes of CI, SVV and DO2I were recorded after anesthesia induction and turn left side (T0), artificial pneumothorax with 0 PEEP after 5 minutes (T1), artificial pneumothorax with 5 PEEP after 5 minutes (T2), artificial pneumothorax with 10 PEEP after 5 minutes (T3), and artificial pneumothorax with 15 PEEP after 5 minutes (T4). Results Compared with T0, CI decreased and SVV increased significantly at T1, T2, T3 and T4(P<0.05). Compared with T1, CI decreased and SVV increased at T4. DO2I increased at T2 and T3 compared with that of T1(P<0.05). Conclusion PEEP may have a certain influence on CI and SVV in the process of operation. The values of 5-10 PEEP can significantly improve oxygenation and have a less influence on hemodynamics, which can be appropriately used in clinical care.

Objective To investigate the influence of different respiratory parameter setting during gynecological laparoscopic surgery on early postoperative cognitive function.Methods Eighty patients undergoing elective ovarian cancer or cervical cancer were grouped randomly into groups A, B,C and D.In group A patients were ventilated with respiratory parameters of VT 8 ml/kg,RR 12 times/min.While patients in groups B,C and D with identical minute volume 105 ml/kg though with respective RR of 12,1 5 and 18 times/min respectively.Patients in four groups were all graded by the MMSE at time points of preoperation(T0 ),postoperative 1 h(T1 ),6 h(T2 ),24 h(T3 ),48 h(T4 ), 72 h(T5 ).PaCO2 of arterial blood gas were tested before pneumoperitoneum(Ta)and immediately af-ter pneumoperitoneum(Tb).Results PaCO2 at Tb was higher in each group than that at Ta(P <0.05).Patients in group A showed the highest PaCO2 at Tb while PaCO2 in group C were lowest. The MMSE scores in group C were significantly higher than those in other groups at T1-T3 (P <0.05).The values at T4 in group A were lower (P <0.05)than those in other groups.Values at T1-T4 in group A were lower than that at T0 (P <0.05).In groups B and D at T1-T3 MMSE scores were lower than those at T0 and patients in group C showed lower MMSE scores at T1 and T2 (P <0.05).Conclusion Early postoperative cognitive function can be improved by regulating intraoperative respiratory parameters properly and increasing minute volume adequately in gynecological laparoscopic surgery.

Objective To investigate the significance of 25 hydroxyvitamin D3 (25 (OH)D3) in patients with type 2 diabetes mellitus by comparing the differences of serum 25-hydroxyvitamin D levels between type 2 diabetes mellitus patients and healthy people.Methods One hundred and forty-seven patients with type 2 diabetes mellitus were selected as the T2DM group,and 135 healthy people were selected as the normal control (NC) group.The level of serum 25 (OH) D3 was detected by ELISA.Clinical data were recorded and biochemical indexes were also detected.Statistical analysis was performed.Results (1) Serum 25 (OH) D3 level in T2DM group was low,but there was no significant difference between two groups((23.10 ± 1.59) μg/L vs.(23.11 ± 1.65) μg/L; t =0.064,P =0.949),as well as between men and women in the 2 populations (T2DM men vs.women(23.22 ± 1.54) μg/L vs.(22.95 ± 1.65) μg/L; t =0.209,P ＞0.05; NC men vs women(23.03 ± 1.73) μg/L vs.(23.18 ± 1.59) μg/L; t =0.436,P ＞0.05) ; (2)The prevalence of vitamin D insufficient and deficiency in T2DM group was high,but it was not statistically significant between two groups (98.0％ vs.94.8 ％ and 2.0％ vs.5.2％ ; x2 =2.034,P =0.154) ; (3) Serum 25 (OH) D3 in T2DM group has a significant negative correlation with triglycerides (r =-0.218,P ＜ 0.01).Conclusion (1) Vitamin D level was low in both the healthy and T2DM populations in the southern region of China,the prevalence of vitamin D insufficient and deficiency was up to 90％.(2)Triglyceride is the only independent risk factor to T2DM population.

Objective To demonstrate medical aid techniques and ways of rescue helicopter,explore the variety and quantity of equipped medicines and instruments,develop medical aid equipment on board and solve the problems of lacking standard medical aid equipment in the rescue helicopter of our army.Methods The service demand of medical aid equipment in rescue helicopter was demonstrated by means of investigating and material analyzing.The medical aid equipment was developed.Results The technical specifications of technical methods,treatment principles and drugs,the volume of equipment goods and equipment were formed.The medical aid helicopter has features of small size and light weight,and has a fully furnished on fixation and spread of medical equipment.The helicopter of vibration,noise,jolt,low pressure has no effect on job status of the equipment,which performance stability and reached the design requirements.Conclusion The medical aid technique,method and equipment of rescue helicopter are researched to meet the needs of curing the wounded pilots who had to parachute in emergency situation and solve the problem of training demand in the army.

Objective To investigate the effect of remote ischemic preconditioning (RIPC) on the lung injury during one-lung ventilation (OLV) in the patients undergoing thoracic surgery.Methods Eighty patients scheduled for elective radical operation for esophageal cancer,were randomly divided into 2 groups (n=40 each) using a random number table.control group (group C) and group RIPC.At 0 (T1),30 min (T2),1 h (T3) and 2 h (T4) of OLV,blood samples were obtained from the radial artery for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1ββ) and IL-10.Oxygenation index(OI),respiratory index(RI) and PaO2/PAO2 were calculated.Exhaled breath condensate was collected and the pH value was measured.Results Compared with group C,Oxygenation index was significantly increased,and respiratory index was decreased at T2-T4,the plasma concentrations of TNF-α and IL-1β were decreased,and the pH value of exhaled breath condensate was increased at T3-T4,and the plasma concentration of IL-10 was increased at T4 in group RIPC.Conclusion RIPC can inhibit inflammatory responses and reduce airway acidification,thus attenuating the lung injury during OLV in the patients undergoing thoracic surgery.