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 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.

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

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.

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.

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.

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.

Objective To evaluate the analytical performance of lipid testing with six sigma(a) in order to promote the quality improvement.Methods Sixty-four Laboratories participated in trueness verification program and Internet-Based Interlaboratory Comparison of Internal Quality Control Data program lipid testing in 2012 were included in this study.The CVs and Bias of TC,TG,HDL-C,and LDL-C for each laboratory were evaluated from the reporting data.The sigma metrics based on the Tea from National Cholesterol Education Program according to the formula:σ =(TEa-Bias)/CV for each analyte.Quality goal index (QGI) was also calculated to investigate the reason for dissatisfied performance as follows:QGI =Bias/ (1.5CV).Results The rates for σ≥6 of TC,TG,HDL-C,and LDL-C were 21.9％,34.4％,9.38％,and 18.8％,respectively.The corresponding rates for 3 ≤ σ ＜ 6 were 31.3％,29.7％,29.7％,and 34.4％,while the rates for σ ＜ 3 were 46.9％,35.9％,60.9％,and 46.9％,severally.For analytes which σ were less than 3,91.3％-100％ of the laboratories should improve the trueness first,0.00％-8.75％ of the laboratories should improve the precision,and 0.00％-2.08％ should improve both.Conclusions Six sigma is an effective tool for quality control in clinical laboratory,which can help improve the quality level for laboratory testing.The analysis of performance of the lipid testing shows that further effort is acquired to enhance the supervision of the trueness verification.

Objective To describe and compare the roles of 3 external quality assessment programs in assessment of analytical quality of serum creatinine and urea.Methods Research in quality management methods.Sixty-five laboratories those enrolled in the Natonal Center for Clinical Laboratories′programs of routine chemistry external quality assessment ( EQA ) , trueness verification ( TV ) for small molecular metabolites and external comparison of internal quality control ( IQC) simultaneously in 2013 were selected , the performances of those laboratories of serum creatinine (crea) and urea in terms of total errors(TE), bias and CV were obtained by using the above 3 programs, and these performance were assessed against the criterion listed in the analytical quality specifications for routine analysis in clinical biochemistry ( WS/T 403-2012).The failure ratio of 65 laboratories on each performance was calculated , the sensitivity of 3 external quality assessment programs in detection of analytical quality deficiency among clinical laboratories were compared.Results Only 1 laboratory failed in the 1st routine chemistry EQA in terms of TE of creatinine , failure ratio is 1.5%(1/65).Three laboratories failed in the 2nd EQA and caused a failure ratio of 4.6%(3/65).For serum urea, 3 laboratories failed in the 1st routine chemistry EQA with a failure ratio of 4.6%(3/65).Two laboratories failed in the 2nd EQA with a failure ratio of 3.1%(2/65).The failure ratios of creatinine determination in two samples in TV were 41.5%(24/65) and 21.5%(14/65) respectively, and the failure ratio of urea determination were 53.8%( 36/65 ) and 32.3%( 21/65 ) respectively.In the program of external comparison of IQC , the CVs of creatinine and urea determination ranged from 0.7% to 6.2%and from 1.0%to 7.2%respectively, their respective failure ratio range were 15.4%(10/65) and 40.0%(26/65).The failure ratio in routine EQA were much less than those in the other two programs , the laboratories failed in routine EQA program were all failed in trueness verification or /and the comparison of IQC programs, but not vice versa.Conclusions By participating in the programs of routine EQA , TV and comparison of IQC laboratories could assess the performances of inaccuracy , bias and imprecision.Laboratories should participate in different external quality assurance programs to detect their quality issues and get improved.

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.