ObjectiveTo investigate the effect of adaptive support ventilation (ASV) plus lung recruitment maneuvers (LRM) and intermittent positive pressure ventilation (IPPV) on respiratory mechanics, hemodynamics and oxygen delivery in trauma patients combined with acute respiratory distress syndrome (ARDS).MethodsTwenty-eight trauma patients combined with ARDS including 18 males and 10 females at age range of 19-48 years were mechanically ventilated by two modes, ie, IPPV and ASV + LPS.The patient was initially ventilated with IPPV for eight hours, with tidal volume (VT) of 10 ml/kg, PEEP = 0, oxygen delivery speed for 32 L/min and oxygen inhalation concentration of 60％.Then, one of ASV + LRM and IPPV was randomly selected for continual ventilation.There were three levels of positive end-expiratory pressure (PEEP,0,5 and 10 cmH2O).Each level of PEEP was maintained for 60 minutes.During the use of ASV + LRM, continuous positive airway pressure (CPAP) was at 45cmH2O and breath holding continued for 30 seconds.Then, the mode was turned to ASV and respiratory mechanics, hemodynamics and oxygen delivery were measured by using Swan-Ganz catheter, electrocardioscanner and ventilator when each level of PEEP was ventilated for 50 minutes.Results Compared with IPPV mode in the same level of PEEP, ASV + LRM mode had lower peak inflating pressure (PIP),airway plate pressure (Pplat) and intrapulmonary shunt (Qs/Qt) (P ＜ 0.05) but higher oxygenation index (PaO2/FiO2) and oxygen delivery (DO2) (P ＜ 0.05).There was no statistical difference in aspects of MAP, CI and SVRI during ventilation with IPPV and ASV (P ＞ 0.05).ConclusionASV + LPS model is better than IPPV in ventilation for trauma patients combined with ARDS.

Objective To investigate the effects of gastric bypass on glycometabolism and improvement of islet β cell function and insulin resistance in patients with type 2 diabetes. Methods Eight patients with type 2 diabetes combined with gastric carcinoma who treated with gastric bypass were studied prospectively. Fasting and postprandial plasma glucose levels, fasting and postprandial insulin C-peptide levels, and body mass index (BMI) were measured right before the surgery and at intervals of 1 week, 2 weeks, 1 month and 3 months after the surgery. Glycosylated hemoglobin (HbA1c) levels were measured before and 3 months after the surgery. The outcome of the diabetes after 3 months of the surgery was also monitored. Results Fasting and postprandial plasma glucose levels decreased (P ＜ 0.05) and fasting and postprandial insulin C-peptide levels increased (P ＜ 0.05) after the surgery. HbA1c levels also decreased (P ＜ 0.05) after 3 months of the surgery. There was no significant change of BMI at all intervals after the surgery(P＞ 0.05). All of the 8 patients reached the total effective standard and 6 patients reached the clinical remission standard after 3 months of the surgery. Conclusions It suggests that gastric bypass can significantly lower plasma glucose levels in type 2 diabetes, which does not depend on the loss of weight. The control of plasma glucose by gastric bypass may be due to the improvement of islet β cell function and increasing secretion of endogenous insulin.

Objective To evaluate the safety and efficacy of induction chemotherapy with gemcitabine followed by concurrent chemoradiotherapywith capecitabine in patients with locally advanced pancreatic cancer (LAPC).Methods A total of 42 patients with locally advanced pancreatic cancer were enrolled.All patients received seven cycles of induction chemotherapy of gemcitabine 1 000 mg/m2,once a week.Concurrent chemoradiotherapy began 1 week after completion of induction chemotherapy.Radiotherapy was delivered with a median dose of 54 Gy (34-64 Gy) with 1.8-2.0 Gy in a fraction.The radiotherapy was combined with capecitabin at a dosage of 825 mg/m2 twice daily,5 d/week.Results Twenty patients (47.6％) were evaluated as clinical benefit response (CBR).Two cases were observed with complete remission (CR),8 with partial remission (PR),27 with stable disease (SD),and 5 with progressive disease (PD).The median overall survival was 10.1 months (range of 4-36 months).The 1-,2-year overall survival rate was 38.2％ and 18.2％,respectively.Myelosuppression was recorded in 20 patients with grades 1-2,and 5 patients with grade 3.Twenty-two patients suffered from grade 1-2 gastrointestinal toxicities,while 4 patients suffered from grade 3.Conclusions The preliminary results showed that induction chemotherapy with gemcitabine followed by concurrent chemoradiotherapy with capecitabine in patients with LAPC might achieve encouraging efficacy with better tolerance.