Objective To approach the effect of low damage endotracheal intubation on reducing the occurrence of cuff-related intubation complication and prolonging the intubation time. Methods On January 7th, 2015, 1 patient with respiratory failure after subarachnoid hemorrhage were admitted to Huludao Central Hospital. Immediate endotracheal intubation and ventilator assisted ventilation were performed. When the trachea was difficult to be removed in a short time, and tracheotomy was refused, a low damage endotracheal intubation was used for a long term. On the basis of the original high volume low pressure cuff, this tube was designed for inner cuff, the hole was allowed in the inner cuff to connect with the tube. During the period of ventilation, the cuff pressure changed with airway pressure automatically, therefore it would reduce the compression injury of tracheal mucosa, improve the tolerance of the patients, and prolong the intubation time. Results The patient was removed from the tube on October 12th, 2015 with an intubation day of 279, the intubation-related complications and severe aspiration pneumonia had not been observed during the application of low damage endotracheal intubation. Conclusions Design of this intubation ensured the cuff pressure changes with airway pressure, therefore, it could effectively avoid the cuff pressure become too high, and reduce the occurrence of intubation-related complication. This low damage endotracheal had an evident superiority in the aspects of cuff management. It has a better practical significance, especially for patients with long intubation time.

Objective To review the safety and efficacy of fast track surgery in gastrectomy for gastric cancer.Methods The computer retrieved databases, including Pubmed, Medline, Cochrane library and Web of science, to collect randomized controlled trials (RCT) or controlled clinical trials (CCTS) on FTS was used in gastrectomy for gastric cancer between January 1994 and march 2014, and manual retrieval in Google.Using RevMan5.0 software analysis data that extract from collect literature.Results A total of five RCTs and two CCTs, involving 636 patients,were included, there were 309 cases in experimental group (FTS group) and 327 cases in control group.Meta-analysis showed: the FTS group had earlier postoperative flatus [WMD =-18.74, 95％ CI (-34.31,-3.17), P ＜ 0.05], shorter postoperative hospital stay [WMD =-2.46, 95％ CI (-3.75,-1.17), P=0.000 2], and lower hospital charge [SMD =-0.67, 95％ CI (-1.00,-0.34), P ＜ 0.000 1].However, there were no statistically significant differences in operation time, intraoperative blood loss, the number of retrieved lymph node intraoperative, the time of catheter removal and postoperative complication rate (P ＞ 0.05).Conclusion FTS in gastrectomy for gastric cancer can promote postoperative bowel function recovery, decrease postoperative hospital stay and reduce hospital charge.

Objective To investigate the change of angiopoietin‐1(Ang‐1)in the peripheral blood of patients with acute re‐spiratory distress syndrome and its relationship with prognosis.Methods A total of 85 hospitalized patients with ARDS were recruited and divided into mild group(n=25) ,moderate group(n=36)and severe group(n=24)according to the oxidation states of patients.Another 40 hospitalized patients without ARDS were included as the control group.The basic clinical data of all pa‐tients were obtained.The expressions of Ang‐1 and Tie2 in the peripheral blood were detected by RT‐PCR.The correlation be‐tween the different variables was analyzed by using Pearson correlation analysis.All patients were divided into survival group(n=47)and death group(n=38)according to the deaths of patients after 28 days.The relevant factors for prognostic of patients with ARDS were analyzed by using multivariate Logistic regression analysis.The effectiveness of Ang‐1 in predicting ARDS was analyzed by using ROC curves.Results In ARDS patients relative to the control patients ,PaO2/FiO2 was decreased ,A‐PACHEⅡ score ,LIS score ,SOFA score ,C‐reactive protein(CRP) ,IL‐6 ,and mortality rates were increased ,and the relative ex‐pressions of Ang‐1 mRNA and Tie2 mRNA in the peripheral blood were decreased ,with the differences being statistically sig‐nificant(P<0.05).The relative expressions of Ang‐1 mRNA and Tie2 mRNA in the peripheral blood in severe group were much lower than in the mild group and moderate group ,those in the moderate group were lower than in the mild group ,and there were significant differences(P<0.05).Pearson correlation analysis showed that the expressions of Ang‐1 and Tie2 in the peripheral blood of patients with ARDS were positively correlated with PaO2/FiO2 (P<0.05) ,but were negatively correlated with APACHE Ⅱ score ,LIS score ,SOFA score ,CRP and IL‐6 levels(P< 0.05).Multivariate Logistic regression analysis showed that PaO2/FiO2 and APACHEⅡ score were independent risk factors for the mortality in patients with ARDS(P<0.05) ,while the relative expressions of Ang‐1 mRNA and Tie2 mRNA were protective factors for the mortality in patients with ARDS(P>0.05).ROC curve analysis showed that when the relative expression of Ang‐1 mRNA was used for the diagnosis of ARDS ,the area under the curve was 0.874(95% CI:0.809-0.938) ,the sensitivity was 72.5% ,and the specificity was 85.9% . Conclusion Down‐expression of Ang‐1 in the peripheral blood of patients with ARDS is closely related with the severity of the patient’s condition.It may accelerate the endothelial cell damage and increase the vascular permeability by reducing the binding to Tie2.It may be used as a prognostic indicator for patients with ARDS.

Objective To study the effect of perinatal exposure to sulphamethazine on the expression of neurotrophs(NGF and BDNF) in the hippocampus of offspring in rats.Methods The dams(SD rats) were fed with sulphamethazine at the doses of 50,100 and 200 mg/(kg.d) respectively from gestational day 7 to postpartum day 21.The brains of the pups aged 30 days were collected and the expression of NGF and BDNF was determined by immunohistochemistry staining.Results The expression of NGF in CA1 and CA3 of hippocampus significantly decreased in all pups of perinatal exposure to sulfamethazine(P

35 % and the intraoperative blood loss was expected to be 800-1 600 ml. The operations were performed under combined general-epidural anesthesia. General anesthesia was induced with fentanyl 2-4 ?g?kg-1 , thiopentone 5 mg?kg-1 and succinylcholine 1.5mg? kg-1 and maintained with isoflurane inhalation and intermittent iv boluses of vecuronium. Epidural anesthesia was performed at T5-6 (thoracic surgery), T10-11 (upper abdominal surgery) or L3-4 (lower abdominal surgery) . A mixture of 0.1% lidocaine +0.2% dicaine was used for epidural block during operation. The patients were randomly divided into 2 groups: (1) ANIH group ( n = 18) and (2) AHH group ( n = 20) . Blood volume (BV) was calculated according to following formula: BV (ml) (male) = Height (cm)? 28.5 + Body weight (kg) ? 31.6 - 2 820,BV(ml) (female) = Height(cm)? 16.25 + Body weight (kg) ? 38.46 - 1 369. 1 000-1 200 ml of 6% HES (200/0.5) and 500 ml of lactated Ringer's solution (about 25%-30% of BV) were infused at a rate of 50ml?min-1 when induction of anesthesia was started in both groups. In group I (ANIH) 400-600 ml of blood (about 10%-15% of BV) was removed through radial artery before induction of anesthesia. The removed blood was reinfused at the end of surgery. Vital signs (BP,HR,CVP and ST-T changes) , Hct, oncotic pressure and arterial blood lactate concentration were monitored during operation. Results The vital signs were fairly stable during perioperative period in both groups. Transient hypotension developed in 16.7% (3/8 in group Ⅰ ) and 15.0% (3/20 in group Ⅱ ) of patients during induction of anesthesia. CVP was significantly elevated in both groups but the increase in CVP was significantly higher in group Ⅱthan that in group Ⅰ . In group Ⅰ (AN1H) moderate hemodilution was achieved (Hct = 29.9% 2.9%) while in group Ⅱ (AHH) only mild hemodilution was achieved (Hct = 32.9% ?2.9%) .Hct was significantly higher in group Ⅰ(31.5% ?5.1%) than that in group Ⅱ (27.7% ?3.6%) at the end of surgery. Blood loss was comparable between the two groups, and oncotic pressure and blood lactate level were within normal range in both groups. Conclusion ANIH is more effective and safer than AHH without obvious adverse effects, and can avoid exceedingly high CVP commonly seen in AHH. ANIH is a hemodilution technique of choice in the elderly patients.

OBJECTIVE To explore the features,developing trend and factors of hospital infection in patients with iatrogenic injury.METHODS Retrospective surveys of hospital infections in 750 cases with iatrogenic injury were carried out in hospital between 2000 and 2007.RESULTS The incidence of hospital infection in patients with iatrogenic injury was 87.39%.Among them,hospital wound infection was the highest(87.39%),the second one was cavity infection(8.98%).The leading causative microorganisms were Gram-negative bacteria.CONCLUSIONS It is imperative to make effort to decvease the morbidity of hospital infections.We hope that the iatrogenic injury can be brought into the category of public health as soon as possible to enhance the medical care service and secure safty and health of the patients.

Background and purpose: Langerhans cell histiocytosis (LCH) is a rare complex reticulocndotheliai disease that often invades the head and neck. There in no consensus of treatment. Radiation is one of the treatment options for the localized lesions. Our aim in the study was to analyze the radiotherapeutic efficacy for LCH in the head and neck region. Methods: 8 patients with eosinophilic granuloma (EG) and 1 case with Hand-Schuller-Christian disease (HSC) were treated with radiotherapy in our hospital from July 2000 to May 2007. Their clinical data were retrospectively analyzed. Results: 5 cases of EG were treated with tumor partial excision and radiation, while the other 3 cases of EG were given radiation alone after biopsy. The HSC was administered with radiation and endocrine therapy. All the patients were followed up for 1.5-8 years. The response rate was 89%. Conclusion: Radiotherapy of LCH is an effective modality, but the optimal dose needs to be further studied.

BACKGROUND:There is no clear conclusion on whether the lung cancer stem cels can induce to spheroid formation and have tumorigenicity. OBJECTIVE: To observe the spheroid formation induced by human lung adenocarcinoma cel line SPC-A1 and the tumorigenic ability of lung cancer stem cels. METHODS:SPC-A1 at proliferating phase was cultured in serum-free DF12 culture medium, and then recombinant human insulin-like growth factor-1, recombinant human epidermal growth factor, and recombinant human fibroblast growth factor-10 were added to induce spheroid cels. Immune fluorescence detection and PCR amplification were done to understand the expression of stem cel associated markers. NOD-SCID immunodeficient mice were subcutaneously implanted with lung spheroid cels to observe the tumor growth.In vivo fluorescence imager was used for radiography. RESULTS AND CONCLUSION:After 5-10 days, lung spheroid cels were harvested. RT-PCR results showed that lung spheroid cels were positive for CD24, CD221, CCSP and SP-C. In addition, the lung spheroid cels and purified CD24+, CD221+ lung cancer stem cels were both positive for TTF-1 of lung stem cels, OCT4 and Nanog of embryonic stem cels and TTF-1 of Bmi-1 lung stem cels. The fluorescence detection showed that over 80% lung spheroid cels expressed CCSP and OCT4; SPC-A1 cels had the characteristics of alveolar type II cels, and also expressed SP-C protein, but only about 5% of the cels expressed CCSP and OCT4. At 50 days after subcutaneous implantation of lung spheroid cels, in vivo fluorescence imaging showed that the diameter of tumor in mice was 1 cm, indicating human lung adenocarcinoma cel line SPC-A1 can induce the spheroid formation, and lung cancer stem cels rich in the cel spheres have the tumorigenic ability.

Objective To evaluate the clinical significance of peripheral atheral atherosclerosis after treatment by folicacid in combination with mecobalarain in uremia patient using vascular ultrasound.Methods 99 cases of uremia patients with carotid atherosclerosis were treated with folie acid tablets and mecobalamin tablets for six months.The carotid intimia-media thiclmess(IMT),total plaque area,numbers and ultrasound types of carotid atherosclerotic before and after treatment were observed.Results After six months,carotid IMT became tinner significantly,and the totsl plaque area decreased(P＜0.05).The ultrasound types of carotid atherosclerotic plagues have changed after six montha.and the plaque numbers decreased significantly(P＜0.05).Conclusion Threatment by folie acid combination with mecobalamin in uremia patients maybe helpful to the progression of carotid athereaclerotie disease.