Objective To evaluate the accuracy of stroke volume variation(SVV)in blood volume monitoring during induction in patients undergo?ing coronary artery bypass grafting(CABG). Methods Thirty ASAⅡorⅢpatients,aged 53?74 year,BMI 21?27,NYHA classⅡorⅢ,scheduled for CABG were enrolled in this study. MAP,HR,CVP,SVV,cardiac output(CO),cardiac index(CI),stroke volume index(SVI)and systemic vascular resistance index(SVRI)were continuously measured by Vigileo/FloTrac system and recorded simultaneously at the following time points:T1(baseline level)and T2(after induction and before intubation). Calculate the changes of SVV,CVP and CI(△SVV、△CVP and△CI). Pa?tients whose△CI≥15%were defined as the responders to the insufficiency of blood volume. The receiver operating characteristic(ROC)curve for SVV and CVP were plotted,and the area under the curve were calculated. Results Compared with T1,significant decrease in CO,CI and SVI was observed at T2 . Meanwhile,SVV increased from 8%±5%to 17%±12%(P=0.012). Twenty?four patients were responders to intravascular volume insufficiency due to induction. SVV were significantly higher in responders than in non?responders(20%±13%vs 9%±4%,P=0.036). A threshold SVV value of 10.5%allowed discrimination between responders and non?responders to blood volume insufficiency,with a sensitivity of 75%and a specificity of 80%. The area under the curve for SVV was 0.875,and the 95%confidence interval was 0.689 to 1.000. Conclusion SVV exhibited reliable sensitivity and specificity in monitoring blood volume changes during induction in patients undergoing CABG.

Objective To investigate the effect of propofol on the expression of bone morphogenetic protein-7 ( BMP-7 ) mRNA in heart during ischemia-reperfusion ( I/R) in rats. Methods Thirty Wistar rats weighing 280-300 g were randomly divided into three groups of 10 animals : (1) control group; (2) I/R group and (3) propofol group. In control group sham operation was performed. Chest was opened and closed. In I/R group the anterior descending branch of the left coronary artery was reversibly blocked with a 3-0 thread. Ischemia of the myocardium was confirmed by the color of apex turning from bright to dark red. The block was maintained for 10 min, then relieved for reperfusion. In propofol group propofol 1mg?kg-1?min-1 was continuously infused iv during 10 min of myocardial ischemia. The animals were saclificed at the end of 4h reperfusion. Specimen was obtained from apex of heart for determination of expression of BMP-7 mRNA using RT-PCR. Results The expression of BMP-7 mRNA was 1.14 ?0.08 in control group, significantly higher than that in I/R group (0.9 ? 0.05) and propofol group (1 .00 ? 0.08) (P

Objective To observe the improvement effects of astragaloside Ⅳ (AS-Ⅳ)on the myocardial focal ischemia-reperfusion (I/R)injury and its influence in PI3K/Akt/mTOR pathway,and to clarify the protective effect of AS-Ⅳ on myocardial I/R inj ury and the possible mechanisms.Methods The left main coronary arteries of 60 Sprague-Dawley rats were occluded for 30 min followed by a 120-min reperfusion to induce I/R model.The rats with I/R inj ury were randomly divided into model group (normal saline), AS-Ⅳ group (intravenous inj ection of 10 mg·kg-1 AS-Ⅳ 5 min before reperfusion),PI3K inhibitor Wortmannin (WOR)group (intravenous injection of 0.6 mg·kg-1 WOR 10 min before reperfusion)and AS-Ⅳ+WOR group (intravenous injection of 10 mg·kg-1 AS-Ⅳ and 0.6 mg·kg-1 WOR 5 and 10 min before reperfusion,respectively).15 age-matched SD rats were chosen as control group.The heart mass,degrees of infarction and ischemia and cardiac function ,including left ventricular systolic mean pressure (LVSP),end-diastolic pressure (LVEDP),fractional shortening (FS)and ej ection fraction (EF),of the rats in all groups were analyzed. Western blotting method was used to measure the phosphorylation levels of Akt and mTOR(p-Akt and p-mTOR).The specific fluorescent probe DHE staining was employed to detect the myocardial reactive oxygen species levels. Results Compared with control group, the degrees of infarction and ischemia, LVEDP, myocardial levels of p-Akt/Akt, p-mTOR/mTOR and reactive oxygen species levels of the rats were increased (P<0.05).and the levels of LVSP,FS and EF were decreased in model group (P<0.05). Compared with the model group,the degrees of infarction and ischemia,LVEDP and reactive oxygen species level were decreased (P<0.05),while the levels of p-Akt/Akt,p-mTOR/mTOR LVSP, FS and EF of all rats in AS-Ⅳ group were increased (P<0.05).Compared with AS-Ⅳ group,the degrees of infarction and ischemia,LVEDP and reactive oxygen species levels of the rats in WOR group and AS-Ⅳ+WOR group were increased (P<0.05 ), and the myocardial p-Akt/Akt, p-mTOR/mTOR and LVSP, FS, EF were decreased (P<0.05).Conclusion AS-Ⅳ has improvement effect on myocardial I/R injury.AS-Ⅳ can reduce the extent of myocardial infarction and oxidative stress and improve the heart function,and its possible mechanism may be related to activating PI3K/Akt/mTOR signaling pathway.

Organic phosphorus pesticide poisoning is a common disease in emergency.Compared with other clinical disease teaching,the basic concepts and theories of this unit are relatively less and more fixed,which is conducive to the case-based learning(CBL).The CBL teaching curriculum of organic phosphorus pesticide poisoning includes three aspects:pre-class teaching design,classroom teaching,after-class teaching evaluation and feedback.Pre-class teaching requires teachers to carefully read the syllabus,choose the teaching content,and design typical cases and problems.Classroom teaching emphasizes a lively and relaxed atmosphere,Teachers should guide students to think about questions and find answers themselves,and cultivated the correct clinic ideation through the combination of their theoretical knowledge and clinical practice in a classroom environment.Teaching evaluation and feedback help teachers to summarize what they are teaching and promote the teaching,which benefits both the teachers and students.

Reduced responsiveness to reward stimuli is a central feature of major depressive disorder (MDD). Study on the changes of neural substrates and behavior contributes to understand the mechanism of MDD. Functional magnetic resonance imaging (fMRI) has the unique advantage of investigating reward processing, which is of importance in the brain imaging study. The progresses of event-related fMRI (ER-fMRI) in field of rewarding stimuli in major depressive disorder were reviewed in this article.

Objective To analyze the risk factors of mortality in hospitalized patients with peptic ulcer bleeding (PUB).Methods From January 2003 to December 2012,1 210 patients with PUB were collected.Among them,1 170 patients were cured (cured group) and 40 patients died (dead group).The general information and clinical data of patients were collected,which included gender,age,smoking history,non-steroidal anti-inflammatory drugs intake,haematemesis,shock,blood infusion and rebleeding.The information of patients combined with other diseases was also collected.The lab findings and gastroendoscopy findings were also collected,including hemoglobin,platelets,serum albumin,blood urea nitrogen,serum creatinine levels,coagulation,location of ulcer and Forrest classification.Chi-square test was performed for comparison between groups of count data.The t-test was used for comparison between groups of measurement data and normally distributed,and Mann-Whitney rank sum test was used for non-normal distribution.The risk factors of mortality of patients with PUB were analyzed by univariate and multivariate Logistic regression analysis.Results The rates of age over 65,combined with other diseases,shock,rebleeding,abnormal coagulation,Forrest classification above Ⅱ b,medicine spraying to stop bleeding under gastroendoscope,gastroendoscopic hemostasis with titanium clip and operation of dead group (57.5％,23/40; 27.5％,11/40; 25.0％,10/40; 42.5％,17/40; 25.0％,10/40; 35.0％,14/40; 15.0％,6/40; 12.5％,5/40 and 17.5％,7/40) were all higher than those of cured group (25.0％,293/1 170; 7.4％,86/1 170; 12.5％,146/1 170; 13.1％,153/1 170; 5.1％,60/1 170; 20.9％,244/1 170; 4.8％,56/1 170; 4.1％,48/1 170 and 6.5％,76/1 170).The differences were statistically significant (x2 =21.117,18.651,5.400,27.728,9.203,4.613,6.332,4.661 and 5.710,all P＜0.05).The serum albumin level of dead group ((28.71±7.13) g/L) was lower than that of cured group ((32.82±7.55) g/L) and the difference was statistically significant (t=2.215,P＜0.05).Between the groups,there were no significant differences in gender distribution,rate of patients smoking,rate of patients taking non-steroidal anti-inflammatory drugs,rate of patients with haematemesis,volume of blood infusion,location of ulcer,dosage of proton pump inhibitor (PPI),average hemoglobin level,blood urea nitrogen level,serum creatinine and platelet count (all P＞0.01).Age over 65,combined with other diseases and rebleeding were the independent risk factors of mortality of patients with PUB during hospitalization (OR=4.821,12.959 and9.627,all P＜0.01).Conclusion Age over 65,combined with other diseases and rebleeding are the independent risk factors of mortality of patients with PUB during hospitalization.

The rapid dlevelopment of life science,specially the coning technique,has made science and society,ethics and law become very complicated life science involved the stem cell of blood in the umbilical cord how to be transplanted and gene research.These problems have already ouched upon a series of law cond ethics.The paper stated the lawful and ethical problems about the blood in the umbilical cord from its belongs,management and privator rights.

The monoamine oxidase mutant A-1 (F210V/L213C) from Aspergillus niger showed some catalytic activity on mexiletine. To futher improve its activity, the mutant was subjected to directed evolution with MegaWHOP PCR (Megaprimer PCR of Whole Plasmid) and selection employing a high-throughput agar plate-based colorimetric screen. This approach led to the identification of a mutant ep-1, which specific activity was 189% of that for A-1. The ep-1 also showed significantly improved enantioselectivity, with the E value increased from 101 to 282; its kinetic k(cat)/K(m) value increased from 0.001 51 mmol/(L x s) to 0.002 89 mmol/(L x s), suggesting that catalytic efficiency of ep-1 had been improved. The mutant showed obviously higher specific activities on 7 of all tested 11 amines substrates, and the others were comparable. Sequence analysis revealed that there was a new mutation T162A on ep-1. The molecular dynamics simulation indicated that T162A may affect the secondary structure of the substrate channel and expand the binding pocket.
Aspergillus niger ; enzymology ; Catalysis ; Kinetics ; Monoamine Oxidase ; genetics ; metabolism ; Mutation ; Polymerase Chain Reaction ; Protein Engineering ; Protein Structure, Secondary ; Substrate Specificity

Objective To investigate the comparability between laboratories and the performance of precision in clinical laboratories for blood gas and acid-base analysis by external quality assessment (EQA) and internal quality control (IQC).Methods Fifteen vials of EQA materials were distributed to the laboratories by global Express Mail Services (EMS).The activities were carried out three times,five-level samples were determined every time.After the measurement results and coefficients of variation of internal quality control data of April were reported,the collected data were divided into peer groups based on laboratory instruments.The medians of each group were taken as the target value to analyse the pass rate and coefficient of variation (CV) of each group after the removal of outliers.Internal quality control data was collected by Web-based the EQA software acquisition system which collect the CVs of the control data of nationwide blood gas and acid-base analysis project in April 2012 internal quality control,the CVs of IQC data were compared according to analyzers and testing items after the removal of outliers.All the data were analyzed using EXCEL 2007 and SPSS.Results A total of 570 laboratories participate in the EQA scheme.The CV of Inter-laboratory of PO2 was largest in all the same instrument groups; For the same item,Siemens group displayed larger CVs than other instrument groups.A total of 525 laboratories returned internal quality control data in accordance with the provisions,there are no significant difference in CVs among the same instrument group and among the same test of inter-instrument.Conclusions The comparability of results for blood gas and acid-base analysis are mostly good between laboratories in China,besides,some of which need to improve.The laboratories should pay more attention to IQC so as to secure the reliability of results.

BACKGROUND:Excessive lateral pressure syndrome is often associated with lateral retinacular tension and radiographic patel ar tilt. CT scan displayed that lateral retinacular release can effectively correct patel ar tilt. OBJECTIVE:To study the effect of arthroscopic lateral retinacular release combined with intraosseous dril ing and decomposition in the treatment of excessive lateral pressure syndrome. METHODS:Thirty-two patients with excessive lateral pressure syndrome were treated by arthroscopic lateral release combined with intraosseous dril ing and decomposition. The Lysholm scoring system was used to evaluate the treatment effect. RESULTS AND CONCLUSION:The mean duration of fol ow-up was 12 months. After 1 month, pain of al patients was released or disappeared;after 1 year, pain of 26 cases disappeared basical y. Lysholm scoring system assessment showed 20 cases were rated as excellent, six cases were as good, four cases were as fair and two cases were as poor. The excellent and good rate was 83.6%. The patients’ subjective satisfaction rate was 92.8%. The results indicate that arthroscopic lateral release combined with intraosseous dril ing and decomposition is a good method to treat excessive lateral pressure syndromewere. It has the advantages of less trauma and rapid recovery. Patel ar decomposition has a good effect in the treatment of patel ofemoral pain associated with patel ar tilt outward and lightens articular cartilage degeneration without damage to patel ar cartilage surface.