Objective To investigate the effects of mild hypothermic cardiopulmonary bypass(CPB) on bax and bcl-2 protein expression and neuronal apoptosis in hippooampus CA1 region in rats. Methods Healthy male SD rats weighing 380-420g were randomly divided into 3 groups: (1)post-CPB 1h group (n=6); (2) post-CPB 6h group (n=6) and (3) sham CPB group(n=5). The animals were anesthetized with intraperitoneal fentanyl 150?g?kg~(-1), midazolam 1 mg?kg~(-1) and vecurunium 0.1 mg?kg~(-1), intubated and mechanically ventilated. Left femoral artery was cannulated for heparinizafion, BP monitoring and blood sampling. Artery in the tail and right jugular vein were cannulated for CPB. The animals in group 1 and 2 underwent 2 h mild hypothermic (26-28℃) CPB at a flow of 160 ml?kg~(-1)?min~(-1). 1h(group 1) and 6h(group 2) after CPB 4% polymerized formaldehyde was injected via the artery in the tail. Brains were immediately removed. Bax and bcl-2 protein expression in hippocampus CA1 region was determined by immuno-histochemistry method and neuronal apoptosis by TUNEL technique. Ultrastructural changes were examined with electron microscope. Results (1)Bax and Bcl-2 protein expressions were significantly higher in group 1(1h after CPB)than in sham CPB group. Bax protein expression was significantly higher but bcl-2 protein expression was significantly lower in group 2 than in group 1. bax/bcl-2 ratio in group 2(at 6h after CPB)was significantly higher than that in group 1(at 1h after CPB). (2) Neuronal apoptosis was significantly increased in group 1 and 2 compared to sham CPB group. (3) Electron microscopy showed that some mitochondria were moderately or severely swollen with vacuolizafion and decreased number of mitochondrial at 1h after CPB and at 6h after CPB there was shrinkage of neuronal cells with irregular shape of nucleus, notches in nuclear membrane and margination of nucleoli. Conclusion CPB induces upregulation of both bax and bcl-2 protein expression with predominance of the pro-apoptotic gene Bax leading to increased neuronal apoptosis, indicating that CPB can cause brain injury.

Objective To investigate the relationship between cerebral 0, metabolism during coronary artery bypass graft (CABG) performed with cardiopulmonary bypass (CPB) and postoperative mental disorders (POMD) in the elderly.Methods Thirty patients (13 male,17 female) aged 65-76 yr undergoing CABG performed with CPB were studied. Patients with senile dementia were excluded. The patients were premedicated with scopolamine 0.3 mg and pethidine 50mg. Anesthesia was induced with midazolam 0.05-0.1 mg?kg_(-1), propofol 0.2-0.5 mg?g_(-1), fentanyl 10-15?g?g_(-1) and vecuronium 0.1-0.3 mg?g_(-1) and maintained with isoflurane inhalation and intermittent iv boluses of fentanyl. Nasopharyngeal temperature (T) was maintained at 26℃-28℃) during CPB. Radial artery was cannulated for BP monitoring and blood sampling.Swan-Ganz was placed via right internal jugular vein (UV).Another catheter was inserted into right UV and threaded retrogradely until J point for blood sampling. Blood samples were taken from artery and UV simultaneously for blood gas analyses and determination of blood glucose and lactate concentration before anesthesia (T_1 ),immediately after induction of anesthesia (T_2), during splitting of sternum (T_3) when T was reduced to 28℃ (T_4) and rewarmed to 35℃(T_5 ) and at the end of bypass (T_6 ).Cerebral O2 delivery (CDO2 ),cerebral oxygen consumption (CMRO2),cerebral glucose consumption (CMRglu) and lactic acid production (ADVL) were calculated. POMD was assessed using CAM-ICU chart.Results (1)Seven patients developed POMD (7/30 or 23.3% ).(2) Low jugular bulb 02 saturation (SjO2 ≤50% or PjO2≤25% mm Hg) was observed in 8 patients during rewarming. The incidence was significantly higher in POMD patients (3/7 or 42.96%) than that in non-POMD patients (5/23 or 21.74%). (3) CBF/CMRO2 was significantly lower in POMD patients than in non-POMD patients during rewarming.(4) CMRO2/CMRglu was significantly lower but ADVL was significantly higher in POMD patients than in non-POMD patients during hypothermia, rewarming and at the end of CPB.(P

Objective To evaluate the efficacy of epidural block combined with general anesthesia for elderly upper abdominal surgery Methods Thirty-four elderly patients ,scheduled for elective upper abdominal surgery, ASA grade Ⅰ-Ⅱ, were divided randomly into study group (groupⅠ) and control group (group Ⅱ) In both groups anesthesia was induced with introvenous diazepam 0 1mg?kg -1, fentanyl 5?g?kg -1, etomidate 3mg?kg -1, atracurium 0 2 mg?kg -1 and succinylcholine 2 mg?kg -1, and was maintained with intravenous infusion of propofol 4-10ml/h and/or inhalation of 1% isoflurane and intermittent bolus of atracurium In groupⅠ epidural block was performed before induction Hemodynamics was measured with impendence cardiography and electroencephagram were monitored and intraoperative awareness, postoperative restlessness and anesthetic dosage were recorded, also the concentrations of plasma vasopressin and blood glucose were determined at pre-operation, incision and the end of surgery Results In group Ⅰ MAP,CO,HR incresed slightly during intubation, incision and extubation, and systemic vascular resistance (SVR) decreased during operation , but SVR was increased abruptly after extubation in group Ⅱ There were unsignificant changes in thoracic fluid index(TFI), stroke volume(SV), ejection volume index(EVI), EVI/TFI ratio in both groups during whole procedures SEF was recovered more earlier in group Ⅰthan that of in group Ⅱ after extubation The vasopressin and glucose levels increased significantly after-extubation compared with those before operation in group Ⅱ Conclusions The epidural block combined with general anesthesia can be more effectvely and safely applied to elderly upper abdominal surgery

Ⅳ, SVR and PVR decreased markedly at the same time MERO 2 and MDO 2/MVO 2 dod not change significantly but MVO 2/MDO 2 showed a tendency of decreasing after the inotropics administration compared with the control group Electronic microscopy examinations: 30min after the inotropics were stoped, the myocardial ultrastructure of ischemic area did not improved significantly in group Ⅱ and Ⅲversus the group Ⅰ, but in group Ⅵ, Ⅴ and Ⅳ, the interstitial and intracellular edema reduced markedly, the capillary stasis vanished, and very few vacuole could be seen in mitochondria Conclusions 1 The response of stunned myocardium to ? agonists decreases 2 Inotropic can restore regional work by restoring mechanical synchrony and improving energy efficiency, the effects of combined inotropics are better than the inotropics given alone in myocardial stunning

Objective To investigate the effects of regional myocardial stunning on systemic hemodynamics and myocardial oxygen balance Methods Thirty three open chest anesthetized dogs were subjected to 15min left anterior descending (LAD) coronary artery occlusion under normal temperature, the systemic hemodynamics, coronary blood flow (CBF), myocardial oxygen delivery(MDO 2) and consumption(MVO 2)were determined following reperfusion Results MAP decreased slightly during LAD occlusion, but returned to baseline following reperfusion CO, SV and LVSWI reduced rapidly after LAD occlusion, increased slightly 5min following reperfusion, followed by a more severe reduction , with the progressive increases of SVR and PVR during whole periods At the early stage of reperfusion (5min), CBF, MDO 2 and MVO 2 increased significantly, then decreased rapidly 10min following reperfusion Myocardial oxygen extraction rate remained stable during whole procedures Histological changes of ischemic area 30min following reperfusion showed interstitial and intracellular edema, mitochondrial vacuolization, and capillary stasis under electronic microscopy Conclusions Regional myocardial stunning may resulte in sinificant changes of systemic hemodynamics; at the early stage of reperfusion, oxygen consumption paradox occurres ,but MDO 2 matches MVO 2 10min following myocardial reperfusion

Objective To examine the changes in respiratory mechanics and efficacy of mechanical ventilation during perioperative period in patients undergoing valve replacement and determine the possible causes Methods Twenty ASA Ⅱ Ⅵ patients (8 male, 12 female), aged 24 65 years , undergoing valve replacement were studied The patients were premedicated with intramuscular phenobarbital 0.1g, pethidine 50mg and scopolamine 0 3mg Anesthesia was induced with midazolam, fentanyl and vecuronium and maintained with inhalation of low concentration of desflurane and intermittent intravenous boluses of fentanyl, midazolam and vecuronium Valve replacement was performed with moderate hypothermic cardiopulmonary bypass (CPB), The patients were mechanically ventilated with pure oxygen Tidal volume was maintained at 8 10ml/kg, frequency 12 15 bpm and I∶E ratio 1∶1 5 2 During CPB airway pressure was maintained below 5 cmH 2O After operation the patients were transferred to ICU and mechanically ventilated using Siemens 900C ECG, SpO 2, BP, CVP, left auricle pressure and urine output were routinely monitored Respiratory mechanics was measured with Novametrix 8100 multifunction respiratory monitor Mean airway pressure, peak airway pressure, airway resistance, chest lung compliance and respiratory work were measured 20 min after induction of anesthesia, 10 min before CPB, 10 min after termination of CPB, at the end of operation and 2, 6 and 18h after operation Results Work of breathing and airway resistance increased gradually after induction and reached the maximum at 6h after operation Dynamic compliance decreased significantly before CPB but increased slightly after CPB, then decreased again and to the minimum at 6h after operation Mean airway pressure and peak inspiratory pressure went up significantly after operation All parameters mentioned above returned to the preoperative levels before the patients were weaned from respiratory support in ICU Couclusions Thoracotomy and CPB are the main causes of changes in respiratory mechanics in patients undergoing valve replacement The effects reached the peak at 6 h after operation Therefore mechanical respiratory support is essential for the patients until respiratory function recovers and should be maintained for more than 6h after operation

0.05) . AEP index increased sharply from 42 to 67 when the patients regained consciousness (OAA/S increased from 2 to 3) but BIS increased gradually from 64 to 72 indicating that AEP index had better discriminatory performance. OAA/S correlated fairly well with BIS , AEP index and target-controlled concentration of propofol and r was 0.781, 0.684 and - 0.580 respectively. Conclusions Both AEP index and BIS can predict fairly well the level of sedation but AEP index prooes to be better in distinguishing conscious from unconscious.

Objective To compare the effects of expectoration by high frequency back tapping with both hands and traditional expectoration by tapping back with a single hand on pulmonary complications in esophageal cancer patients having undergone radical resection with video-assisted thoracoscopic surgery (VATS). Methods Sixty patients after radical resection for esophageal cancer with VATS from May 2013 to January 2014 were set as the control group, in which expectoration by tapping the back with a single hand. Another 60 patients after radical resection for esophageal cancer with VATS from February 2014 to July 2014 were set as the observation group, in which the expectoration by high frequency tapping the back with both hands. The two groups were compared in terms of pulmonary complications. Result The incidence of atelectasis and pulmonary infection in the observation group were lower than those with a single hand in the control group (all P<0.05). Conclusion For the patients having undergone radical resection of esophageal carcinoma with VATS, the expectoration with high frequency back tapping with both hands is more effective in lowering atelectasis rate than that with a single hand.

OBJECTIVE To analyze multi-drug resistant Acinetobacter baumannii(ABA) outbreak of nosocomial infection in the respiratory intensive care unit(RICU),to explore effective measures for prevention and control.METHODS In RICU on April 3 to 30 2009,patients under mechanical ventilation in the respiratory tract with MDRABA were conductd epidemiological surveys.RESULTS On 27 consecutive days,six cases occurred in mechanical ventilation in patients with lower respiratory tract MDRABA infection,of which 5 patients were cured;6 cases of lower respiratory tract of patients in sputum specimens isolated the same resistance spectrum MDRABA.CONCLUSIONS Medical personnel lack the consciousness of washing their hands.Indoor environment,air disinfection machine lack of supervision in mechanical ventilation patients with lower respiratory tract MDRABA,were the main reasons of infection outbreak.Strict isolation of patients should be strengthened,full implementation of hand-washing compliance,education,conventional screening,early intervention to prevent outbreak of hospital infection.

Objective: To evaluate the clinical application of MBT straight wire. Methods: 41 cases, 11 males and 30 famales aged 12-42 years old, with malocclusion were treated by MBT straight wire appliance in orthodontic clinics, follow-up was carried out. Results: Satisfactory effects were obtained in 11 completely treated cases, preliminary improvement of occlusion was observed in the other 30 cases being still in the treatment. Conclusion: MBT straight wire appliances may be used in the treatment of various malocclusion, but special consideration should be taken according to the type of occlusion in each case.