AIM: To explore the changes of von Willebrand factor (vWF) and soluble vascular-cellular adhesion molecule-1 (sVCAM-1), and the correlation of vWF, sVCAM-1 with acute myocardial ischemia. METHODS: By means of enzyme linked immunosorbent assay (ELISA), the changes of vWF and sVCAM-1 were measured in 73 patients with unstable angina (UA) during angina attack and relief period (24 h after attack) as well as in 50 controls. RESULTS: The levels of vWF and sVCAM-1 were significantly higher in UA patients than those in controls (P

Sleep deprivation, as a stress just like starvation and anoxia, can induce the physiological function changes, such as emotion disorders, cognition disorders, and immune disorders. Oxidative stress is common in cells and is closely related to aging, Alzheimer disease, Pakinson diseases, etc. Previous studies showed that sleep deprivation could induce oxidative stress via different pathways, namely, the increase of the metabolic rate and free radicals, the depress of antioxidant ability, and the indirect effects of endoplasmic reticulum stress. In this review we summarize the recent progress on the above fields.

Objective To observe the clinical effects of sufentanil combined with sevoflurane for anesthesia induction in the elderly.Methods A total of 84 patients undergoing elective laparoscopic were randomly divided into 4 groups by dose of Sufentanil (21 cases,each):0.25,0.50,0.75 and 1.00 μg/kg sufentanil.Mean arterial pressure (MAP)and heart rate (HR)were measured at baseline (To),immediately before intubation(T1),immediately,1,3 and 5 min after intubation(T2-5).Intubation scores were also recorded.Results The intubation scores including visual analogue score (VAS) and Ramsay score at 10 min,30 min and 60 min after tube drawing were as the following sequence:1.0 μg/kg ＞ 0.75 μg/kg ＞0.5 μg/kg ＞ 0.25 μg/kg sufentanil (F =5.78.P＜ 0.05).Compared with T0,MAP and HR decreased in each group at T1,while increased at T2 in group A (P＜0.05).As compared with T0,MAP was decreased and HR was slower at T1 in the 4 groups (F=34.99,P＜0.05),but MAP level was increased in 0.25 μg/kg sufentanil group at T2 (F=12.48,P＜0.05).Compared with group of 0.25 μg/kg sufentanil,MAP was reduced in 0.75 μg/kg and 1.00 μg/kg groups at T4 andT5 (F =6.98,6.25,P＜0.05).MAP was also lower in 0.75μg/kg and 1.00μg/kg groups than in 0.50 μg/kg sufentanil group at T2-T5(F=7.08,20.56,P＜0.05).Conclusions Sufentanil of 0.25 0.50 μg/kg combined with sevoflurane can provide excellent intubating conditions and stable hemodynamics during anesthesia induction in patients undergoing gynecologic surgery.

Objective To report the clinical features and treatment outcomes of 27 patients with fungal endophthalmitis (27 eyes)over a five year period.Methods The authors retrospectively reviewed the etiology,direct smear examination,fungal cul-ture and treatments of 27 patients with culture-proven fungal endophthalmitis at the affiliated Hospital of Medical College Qing-dao University from 2007 to 2012.Results Exogenous infection was defined in 21 patients (77.8%),including 20 associated with penetrating wound,and 1 following cataract surgery.Endogenous infection was found in 6 patients (22.2%),including 3 associated with recent use of high-dose steroids,1 after abortion,1 following pelvic fracture,and 1 with long-term use of im-munosuppressive agents.Fungal hyphae were found in 17 smears of 27 samples (63.0%)by direct microscopic examination. The fungal strains cultured from 27 samples belonged to 8 genus and 12 species.The most common isolates were Aspergillus , Fusarium and Candida species.A.flavus (22.2%)and A.fumigatus (18.5%)were the predominant Aspergillus species. F .moniliforme (14.8%)and F .oxysporum (11 .1 %)were the most predominant Fusarium species.Two eyes were eviscer-ated immediately due to the serious condition.Among the other 25 eyes,22 (88.0%)got improvement after at least one of such treatments as intravitreal injection of antifungal agent,vitrectomy or penetrating keratoplasty (PK).Conclusions Exoge-nous fungal endophthalmitis is the most common type of fungal endophthalmitis in this hospital.Penetrating wound is the main cause of such infections.Microscopic examination of hyphae and fungal culture were effective for the diagnosis of fungal endophthalmitis.Aspergillus is the predominant pathogens, followed by Fusarium.Intravitreal injection of antifungal a-gent combined with vitrectomy is an effective treatment of fungal endophthalmitis.

Objective To compare the therapeutic effect and complication of immediate and selective interlocked intramedullary nailing in treatment of open tibial shaft fractures. Methods A total of 123 open tibial shaft fractures of 102 cases were treated with immediate fixation with interlocked intramedullary nailing after debridement (Group A) and with selective fixation with interlocking intramedullary nailing after debridement and closing the wound (Group B). Results The follow up for more than half a year showed that all fractures were healed, with excellent joint function of knee and ankle. Of all, 12 cases with skin necrosis and defect but without deep infection were healed after pedicle flap reconstruction. The result of Group A was much better than that of Group B in regard of total operation time, hospital stay, cost, amount of antibiotics used and partial weight bearing. No statistical difference in therapeutic effects and complications was found between two group. Conclusion Infection is not the contra-indication of interlocked intramedullary nailing in open tibial fractures. Immediate operation can be done after thorough debridement.

Objective To determine the relationship between serum adiponectin level and cardiac structure and function in hemodialysis(HD)patients.Methods 46 MHD uremia patients and 20 healthy volunteers were included in this study.The serum adiponectin,total protein,albumin,triglyceride,cholesterol,were determined,and echocardiographic were perfomed.The association between ADPN and cardiac structure and function were analyzed respectively.Results Serum ADPN level was higher in HD patients than that in controls[(16.89?4.87)mg/L vs(7.24?2.56)mg/L,P

Objective To investigate the incidence and the relation between pulmonary hypertension (PH) and cardiac output in hemodialysis (HD) patients with PH. Methods The incidence of PH was estimated with Doppler echocardiography in 78 patients receiving HD. Left ventricular ejection fraction, cardiac volume, cardiac output and cardiac index were compared between patients with or without PH. Results PH was found in 20 patients (25.64%), among them15 had mild PH, 4 had moderate PH and 1 had severe PH. There was no statistical difference of ejection fraction, cardiac volume, cardiac output and cardiac index between the two groups. PH was not related to cardiac output. Conclusion HD can lead to PH, but cardiac output can not result in PH. Further investigations about the effect of elevated cardiac output induced by internal arteriovenous fistula and other factors on PH are needed.

Objective To investigate the prevalence ,clinical features and prognosis of pulmonary arterial hypertension (PAH) in maintenance bemodialysis (MHD) patients for early diagnosis and treatment. Methods Complete clinical data of 184 MHD patients in Beijing Chaoyang Hospital between January 2000 and December 2007 were retrospectively analyzed. PAH diagnosis depended on echocardiography. Results Sixty-five (35.3%) patients were found having PAH, including 31 females and 34 males, with mean (56.84±14.58) years old. The mean bemadialysis duration was (29.69±21.61) months. Among 65 patients with PAH, arteriovenous fistula was used in 61 patients and central venous catheter in 4 patients. The systolic pulmonary arterial pressure (SPAP) was (44.56±8.25) mm Hg (1 mm Hg=0.133 kPa) in PAH group, which was significantly higher than (30.28±3.92) mm Hg in non-PAH group. There were significant differences of interval dialysis weight gain (IDWG), Hb, Hct, right atrial diameter, pulmonary artery diameter and right ventricular diameter between PAH group and non-PAH group (all P<0.05). Multivariate analysis revealed anemia, IDWG and right atrial diameter were independent factors (P< 0.05). There were no significant differences of age, dialysis duration, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH) between two groups. Conclusions PAH is a common complication of MHD patients. Patients with mild PAH had few clinical manifestations and good therapeutic responses, but severe PAH may be associated with poor prognos is. Doppler echocardiography should be performed periodically to detect PAH in MHD patients.

To implement the excellent doctor education training plan and construct the training model of practical ability in clinical education,the researchers analyzed the problems existing in the training of clinical practice ability and put forward a new train of thought,and constructed a training method system of personal experience,reading classics,teacher guidance,simulation training,clinical practice and reflection strengthening.In addition,we also established a safeguard mechanism with the characteristics of the organizational corporation of teaching,the expert-oriented teaching team,team-oriented mentoring,pro-ject-oriented ability training,the diversification of evaluation system,the modernization of teaching platform and the realistic training environment,to train the qualified clinical medical talents.

A total of 60 ankylosing spondylitis patients scheduled for elective surgery with anticipated difficult airway were enrolled and randomly assigned into either dexmedetomidine (D) or midazolam plus sufentanil (MF) group.Group D:topical nasal anesthesia and a loading dose of dexmedetomidine at 1.0 μg/kg in 10 min; group MF:intravenous infusion of 0.05 mg/kg midazolam plus 3 μg/kg sufentanil.Fiberoptic bronchoscopic (FOB)-assisted awake nasotracheal intubation was performed.Mean arterial pressure (MAP),heart rate (HR),Pulse oxygen saturation (SpO2),Ramsay score and success rate of intubation were recorded and compared between two groups.The intubation conditions and level of comfort were also evaluated.MAP and HR of group D at FOB through postnaris (T1),peep the epiglottis(T2),intubation success immediately(T3)and 1 min after intubation(T4) were significantly lower (P ＜ 0.05 or P ＜ 0.01) than those of group MF while Ramsay sedation scores were obviously higher (P ＜ 0.05) than those of group MF.Group D with endotracheal intubation comfort level 5 score of grade 1-2 were 8 and 14 cases and were significantly higher than 4 and 10 cases of group MF.Immediately after intubation,level 3 scores in grade 1 of group D (n =21) were significantly higher than group MF (n =12) ; initial success rate of intubation in group D was obviously higher than that in group MF (70％,n =21 vs.47％,n =14).And the incidence of unpleasant intubation memory in group D was lower than that in group MF (37％,n =11 vs.67％,n =20).Fiberoptic bronchoscopic-assisted nasotracheal intubation offers better conditions for intubation and reduces the incidence rate of intraoperative awareness.