Objective To investigate the correlation between PaCO2 and cerebral blood flow (CBF), cerebral metabolism of oxygen (CMRO2), glucose (CMRglu) and lactate (CMRlact) and intracranial pressure during intracranial surgery. Methods Twenty ASA Ⅰ - Ⅱ patients (6 male, 6 female), aged between 26-54yr, weighing (65 ? 11) kg scheduled for elective intracranial surgery were studied. The patients were unpremedicated. Before general anesthesia radial artery was cannulated and a catheter was inserted into internal jugular vein and advanced cranially until jugular bulb. Lumber puncture was performed at L3-4 and a catheter was inserted into subarachnoid space for 3 cm, for pressure monitoring and CSF sampling. Anesthesia was induced with diazepam 10mg, fentanyl 3-4?g?kg-1, propofol 2mg?kg-1 and vecuronium 0.08mg?kg-1 iv. The patients were mechanically ventilated with a mixture of oxygen and argon (O2 : argon = 3 : 1) after tracheal intubation. Anesthesia was maintained with sevoflurane and intermittent iv boluses of vecuronium. Arterial and cerebral venous blood gases, glucose and lactate levels, CBF, ICP and CSF level of lactate were determined before anesthesia when patients were awake(Ⅰ) and during anesthesia when PETCO2 = 40, 30, 20 mm Hg (Ⅱ,Ⅲ,Ⅳ). CBF was measured by modified Kety-Schmidt inert gas saturation technique with argon. CMRO2 and CMRglu were calculated based on the difference in their arterial -cerebral venous blood levels. Results At PETCO2 20mm Hg (Ⅳ) CBF decreased by 57.75% and CMRO2 by 58.70% as compared with the baseline; CMRglu decreased by 46.93% as compared with the baseline. There was no significant change in lactate level, jugular venous blood O2 saturation and pH. ICP decreased from (22.14 ? 7.88)mm Hg( Ⅰ) to (17.57?5.03)mm Hg( Ⅱ ),(13.43?4.89)mm Hg(Ⅲ) and (10.00? 2.31)mm Hg(Ⅳ) and the differences were significant. All measurements were done when MAP and HR were stable. PET CO2 was (10? 2) mm Hg lower than PaCO2 . Conclusions Cerebral blood flow, cerebral oxygen and glucose metabolism and intracranial pressure change with changes in PET CO2 . Cerebral vascular reactivity to CO2 is not impaired by 1.3 MAC sevoflurane. Mild hypocapnia is necessary during neurosurgery.

The paper studied the textual research and the original meaning of 'the liver is the essence of Piji'.It believed that 'the liver is the essence of Piji' contained the main physiological functions of liver but not specific function,and to be expressed through the main functions of liver.It should be understood as regulating the base of human life activities.It revealed the main physiological functions of liver from another aspect,so as to help sub-health research and clinic.

Objective To investigate and evaluate the method of PCR amplification blocking associated with fluorescent probe for the detection of pre-C region of HBV G1896A gene mutation.Methods The primers were designed based on the mutation of HBV DNA 1896 locus.The 3′end of primers was at 1896 site,and it was complemented with the base sequence of mutation template of 1896 site.The mismatching bases were separately introduced into the second and the third base of the primer by inverse counting from the 3′end for increasing the specificity of reaction.Results The PCR amplification for wild plasmid with the mutant primer showed an effectively blocking,but not showed blocking for the mutant plasmid (G1896A).The sensitivity of detection for the mutant plasmid was 5?103 copies/ml.Ninety-five cases of HBV-positive serum was selected randomly and amplified with the mutant primer,and 8 cases were positive HBV G1896A gene mutant(mutant rate of 8.4%).Conclusion The amplification blocking associated with fluorescent probe for the detection of HBV G1896A gene mutation is a effective,convenient method for the detection of clinical samples.

Objective:To research the effects and mechanism of Fuganning(FGN) on rats with hepatic fibrosis.Methods:Rat immuno hepatic fibrosis model was induced by intraperitoneal injection of porcine serum,to observe the effect of FGN on HA,LN,CⅣ,the pathological and ultrastructure chages of hepatic tissue.Results:The level of HA,LN,CⅣ decreased,the pathological chages and the collagen fibresis decreased significantly in FGN group,this groups had significanc difference to model group(P

Objective To observe the value of non-invasive positive pressure ventilation for the overlap syndrome complicated with pulmonary encephalopathyt.Methods Fifty-six patients with the overlap syndrome complicated with pulmonary encephalopathy were divided into the experinental group and the controlled group.The experimental group was treated with non-invasive positive pressure ventilation and conventional clinical therapy (drugs and oxygen).The controlled group was treated with conventional clinical therapy.Results The experimental group was better than tche Controlled group in blood gas analysis (PH、PaCO2) in the second hour and the twentyfourth hour after treatment (P ＜ 0.05).The experimental group was more than the controlled group in the improvement of consciousness disorder (P ＜ 0.05).The experimental group was less than the controlled group in tracheal intubation (P ＜ 0.05).Conclusion Non-invasive positive pressure ventilation could improve consciousness disorder of the overlap syndrome complicated with pulmonary encephalopathy,and reduce tracheal intubation.

Objective To evaluate if continuous hemihepatic inflow occlusion(HH)during hepatectomy can be as safe and effective as intermittent total hepatic inflow occlusion(TH)in reducing blood loss during hepatectomy.Methods From November 2001 to March 2006.eighty patients undergoing liver resections were included in a prospective randomized study comparning the intra-and postoperative course underTH(n=40)or HH(n=40).TH was performed with periods of 20 minutes of occlusion and 5 minutes of releasing,while HH with continuous occlusion.The surface area of liver transection was measured and blood loss was calculated.The amount of blood loss,levels of alanine aminotransferuse (ALT)and aspartate aminotransferase(AST),and postoperative course were recorded. Results The total ischemic time of the HH groups was longer than in the TH group[(42±13)min,(31±13)min,P=0.37],and the operative time in the HH group was longer than in the TH group[(236 ±49)min,(204±38)min,P=0.02 ].No signincant difierenee was found between HH and TH group in blood loss during liver parenchyma transection[(500 ±269)ml,(416 ±235)ml,P=0.14]and in the changes of ALT and AST on the first postoperative day[ALT:(677±572)IU/L,(577 ±327)IU/L,P=0.12;AST:(591 ±468)IU/L,(512±301)IU/L,P=0.66].There were no difierences on postoperative morbidity between the two groups(22.5%versus 20.0%,P=0.35).Conclusion The technique of continuous hemihepatic inflow occlusion is as safe and effective as intermittent total hepatic inflow occlusion.

Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascuiarization. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. The HAF (hepatic artery flow), PVF (portal venours flow) and hepatic arterial RI(resistant index) were measured with Doppler sonography. The EHBF(effective hepatic blood flow) and ICGR15 (indocyaninegreen retention rate at 15 minutes) were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy (19±4) mm Hg, ligating the splenic artery(14±4) mm Hg, splenectomy(14±3)mm Hg and periesophagogastric devascularization (12±4) mm Hg showed a tendency to decrease progressively. The PVF decreased [from (42±14) ml/s to (16±8) ml/s] and HAF increased in compensation after operation. The EHBF increased [from (0.48±0.10) L/min to (0.56±0.10) L/min], and the ICGR15 decreased (from 23%±8% to 18%±4%) postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.

Objective:To investigate the difference of brain activity intensity between abstinent methamphetamine-dependent (AMD) patients and healthy controls using amplitude of low-frequency fluctuation (ALFF).Methods:From April 2016 to March 2017, 29 male AMD patients from Pingtang compulsory rehabilitation center in Changsha City, Hunan Province and 31 healthy male controls were prospectively recruited. The general conditions of all AMD patients, including age of first use of MA, months of MA use, monthly MA consumption, MA use frequency of the last year and the last month, current months of drug withdrawal, times of drug withdrawal, self-assessment score of drug craving when taking drugs, smoking history (whether smoking and smoking years), drinking history (whether drinking and drinking years). The rest functional MRI data were collected. DPABI software package was used to preprocess the data and calculate ALFF value of each voxel in the whole brain of the subjects of two groups. Two samples t-test and alphasim multiple comparison correction were used. Nuclei with voxel level P<0.01 and voxel number>71 were considered as regions with significant differences between two groups, corresponding to corrected P<0.05. ALFF mean value was extracted for each region with significant differences. Taking smoking and drinking as covariates, the correlations between the mean ALFF values of regions with significant differences and MA use and abstinence were analyzed. Results:Compared with the healthy control group, it was found in the AMD group that ALFF value of left middle frontal gyrus was significantly lower ( t=-4.707), and that of right inferior frontal gyrus was significantly higher ( t=4.445). The results of correlation analysis showed that the ALFF value of right inferior frontal gyrus was negatively correlated with the frequency of MA use and the MA amounts used in the last month ( r=-0.396, P=0.034; r=-0.429, P=0.020). Conclusions:Abnormal brain activity intensity is found in AMD patients compared with healthy controls, with abnormalities mainly found in the prefrontal lobe, which is involved in cognitive, executive and emotion functions. The more MA is used, the more damages or alterations may exist in these regions.

Objective To investigate the changes of brain gray matter volume (GMV) and brain activity in patients with long?term methamphetamine (MA) abstinence compared with healthy controls. Methods This study included 44 abstinent MA patients and 40 demographically equivalent healthy controls. Structural magnetic resonance imaging (MRI) and resting?state functional MRI (rs?fMRI) were obtained on Siemens 3.0 T MR. Differences in GMV between abstinent MA group and control group were assessed using voxel?based morphometry (VBM) method. Within each region showed significant differences between two groups, the value of the fractional amplitude of low frequency fluctuation (fALFF) was calculated using the rs?fMRI data. Differences of fALFF between groups were also evaluated. Furthermore, partial correlation coefficients adjusted for age, years of education, smoking and drinking were calculated in the abstinent MA group to assess associations between the mean GMV and fALFF values in significant clusters and variables of MA use and abstinence. Results Compared with controls, abstinent MA group showed increased GMV in the right cerebellum crus and decreased GMV in the right calcarine. While fALFF values within bilateral cerebellum crus in abstinent MA patients were significantly increased. Moreover, GMV of the left cerebellar crus was positively correlated with the withdrawal time among abstinent MA patients. Conclusions Both structural and functional abnormalities were found in abstinent MA patients even after long?term abstinence. The positive correlation between GMV of left cerebellum crus and abstinent duration suggested that prolonged abstinence may be beneficial to brain recovery. The fALFF of the right calcarine was increased even with decreased GVM in the abstinent MA group. It indicates that the brain activity of this area is increased, which may imply that drug cue?induced craving is significant among methamphetamine patients even after long?term abstinence.

Objective To observe the missed diagnosis of invasive carcinoma under the microscope (ICUM) in high grade squamous intraepithelial neoplasia (HSIL), and analyze associated factors influencing missed ICUM. Methods A retrospective study was performed on patients diagnosed with HSIL by colposcopy-guided biopsy and treated with loop electrosurgical excision procedure(LEEP)at the First Affiliated Hospital of Nanjing Medical University, from December 2014 to December 2016. They were non-pregnant, ≤50 years old and the cervical volume without obvious enlargement and exogenous surface without and ulcerative lesions. A total of 283 cases with early cervical cytology results, never received cervical traumatic treatment or cervical biopsy in another hospital before, and their colposcopic images were clear enough to reevaluate. The ultimate pathological diagnosis was based on the higher-level pathological diagnosis between the results of cervical biopsy and LEEP to evaluate ICUM missed in HSIL and the risk factors. Results (1) Among the 283 cases with HSIL diagnosed by colposcopy-directed biopsy,44 cases (15.5％,44/283) were missed diagnosis of ICUM, which consisted of 29 cases Ⅰa1, 4 cases Ⅰa2 and 11 cases Ⅰb1 in the ultimate pathology.(2)Analysis of associated factors for missed ICUM:univariate analysis showed that,as the age increased, the risk of missed ICUM also increased(the rates of missed diagnosis for<30, 30-39, 40-50 years were 7.7％, 11.5％, 22.0％, respectively;χ2=6.254, P=0.012 by trend test). The more the number of high-grade features, the higher risks(the rates of missed diagnosis for 1, 2, 3, 4 high-grade features were 10.2％, 17.6％, 23.8％, 30.8％, respectively;χ2=7.686,P=0.006 by trend test). The locations of HSIL were only endocervical, only ectocervical and mixed, the risk increased by this sequence(2.8％, 5.1％, 28.7％; χ2=26.193,P<0.01 by trend test). The rate of missed diagnosis for not completely visible squamocolumnar junction(SCJ)was higher than that of the completely visible one(22.3％ vs 2.1％;χ2=19.680, P<0.01). The rate of missed diagnosis was higher for existing atypical vessels than those without(60.7％ vs 10.6％;χ2=48.279, P<0.01). The rate of missed diagnosis for visible lesion size≥40 mm2 was higher than that of<40 mm2(27.3％vs 4.2％;χ2=28.921, P<0.01). The rate of missed diagnosis for the proportion of visible lesion size in ectocervical size ≥0.75 was higher than that of <0.75 (83.3％ vs 14.1％;P<0.01). The rate of missed diagnosis for the maximum linear length of visible lesion≥10 mm was higher than that of<10 mm(46.9％vs 9.0％;χ2=44.473, P<0.01). But the different severity of cervical cytology before colposcopy was not associated with missed ICUM(P>0.05). Multivariable analysis found that visibility of SCJ, atypical vessels, visible lesion size and maximum linear length of visible lesion were associated with missed diagnosis of ICUM(all P<0.05). Conclusions The diagnostic value of HSIL by colposcopy is limited. Meanwhile, for the patients who are ≤50 years old with HSIL diagnosed by cervical biopsy, invisibility of SCJ, atypical vessels, visible lesion size and maximum linear length of visible lesion evaluated by colposcopy are the independent risk factors of missed ICUM. Thereby, it is necessary to take active intervention for HSIL with these risk factors.