Objective To investigate the value of fluid resuscitation strategy in septic shock patients by pulse indicator continuous cardiac out ( PiCCO ) .Methods 42 septic shock patients were divided into the PiCCO group(n=26) and the control group(n=16).All patients measured heart rate(HR),mean artery pressure(MAP), central venous pressure(CVP);CI,GEDVI,SVRI,EVLWI,CVP as indicator of fluid resuscitation after 0h,6h,24h of the diagnosis were measured respectively in PiCCO group;CVP as guiding volume resuscitation was measured in the control group .The effect of fluid resuscitation was compared between two groups .To analyse the relationship between CVP,GEDVI and CI in PiCCO group .according to CVP increase 2mmHg ,GEDVI whether elevated 10%.Results After 6h EGDT treatment bundle HR ,MAP,APACHEII score and clearance rate of lactic in PiCCO group improved more than those in control group [(101.3 ±7.8) and (119.4 ±7.2),t=-7.520,P<0.05;(71.8 ±7.6) and (51.5 ±8.9),t=7.873,P<0.05;(17.0 ±3.4) and (22.7 ±4.1),t=-4.978,P>0.05;(53.6 ±11.5) and (-16.5 ±5.2),t =9.283,P <0.05].There were no differences in 28-Day mortality between two groups (t =-2.162,P>0.05),but ICU hospitalization time decreased in PiCCO group [(13.8 ±2.6) and (23.3 ±2.2),t=-5.075,P<0.05].Changes in GEDVI was positively correlated with Changes in CI (r=0.799,P<0.05),while changes in CVP was poorly correlated with CI (r=-0.446,P>0.05).Conclusion Hemodynamic monitoring by PiCCO directed fluid resuscitation strategy can elevate reversal rate .Compared with pressure index CVP ,GEDVI is a sensitive indicator of cardiac preload .Correlation between CVP and GEDVI can reflect cardiac function ,Especially for septic shock patients with cardiac depression .

Objective To explore the efficiency, complications and probability of preserving part renal function by local renal microwave ablation. Methods The fresh pig renal pelvis full filled with 30% diatrizoate meglumine and the dogs kidney taken arterial pyelography were both ablated with microwave. Dogs were divided into three groups: measuring temperature after ablation group, single point ablation both on the two kidneys group and double points ablation on unilateral kidney group. In measuring temperature after ablation group, DSA and pathology were performed immediately after ablation. In the other groups, DSA with blood and urine samplings were taken for routine tests including renal function right after the ablation and 10 days later. Results Experiment in vitro showed conspicuous renal pelvic contraction and convolution. The group under power rate of 70, 3 min produced urine leak easily. Preliminary test in vivo with DSA showed the disappearance of local kidney blood supply. The residual renal function was related to areas of necrosis. Acute stage pathology revealed acute renal cortex medulla and pelvic cells injury. DSA of chronic stage showed no change in size of the area of ablation. The blood supply of necrotic areas was not restored. The residual kidney possessed the excretion contrast medium with no urine leaks. Upper pole of right kidney adhered with adjacent tissue, together with thickened covering. Pathology revealed fibrous proliferation around the coagulative necrosis. Conclusion Microwave ablation can inactivate the local renal tissue, and, effectively preserve the big blood vessels and function of residual kidney. No urine leaks occurred in chronic stage but easily to produce adhesions with adjacent tissue.

To meet the cultivation objectives of postgraduate of anesthesiology from TCM colleges, the anesthesiology department carried out reform and exploration on cultivation program.This method has trained professionals of anesthesiology with the features of integrated traditional and western medicine knowledge.

BACKGROUND:Tol-like receptor (TLR) and its signaling pathway play an important role in autoimmune diseases, hypersensitivity, inflammation, apoptosis and transplant rejection; however, its effects on immune pathogenesis of Henoeh-Schonlein purpura in children have not been fuly elucidated. OBJECTIVE:To investigate the TLR2 expression in peripheral blood mononuclear cels in children with Henoeh-Schonlein purpura and its correlation with immune response. METHODS: Sixty-four children with Henoeh-Schonlein purpura were divided into two groups: non-renal damage group (n=36) and renal damage group (n=28). Meanwhile, another 30 healthy children subjected to health examination acted as control group. Flow cytometry and florescent quantitative PCR were employed to detect TLR2 protein and mRNA expression in peripheral blood mononuclear cels, respectively. ELISA was used to detect plasma interferon-γ and interleukin-4 levels and transforming growth factor β and interleukin-10 levels secreted from Treg cels. RESULTS AND CONCLUSION:Levels of interferon-γ and interferon-γ/interleukin-4 in the children with Henoeh-Schonlein purpura were significantly lower than those in the control group (P < 0.05), while the level of interleukin-4 was higher than the control group (P < 0.05). The expression of TLR2 protein and mRNA was significantly higher in the Henoeh-Schonlein purpura children than the healthy children (P < 0.05) and significantly higher in the renal damage group than the non-renal damage group (P < 0.05). Compared with the control group, the levels of interleukin-10 and transforming growth factor β were significantly higher in the children with Henoeh- Schonlein purpura (P < 0.05). These findings indicate that Henoeh-Schonlein purpura children have increased levels of TLR2 protein and mRNA in the peripheral blood mononuclear cels, and exhibit immune imbalance. TLR2 is involved in the pathogenesis of Henoeh-Schonlein purpura, and transforming growth factor β can be used to evaluate Treg immune response and provide reference for diagnosis, treatment of prognosis of Henoeh-Schonlein purpura children.

Objective To explore the correlation between mental health and social support of the seven countries peacekeeping soldiers,and provide theoretical guidance for the peacekeeping soldiers to improve the mental health status.Methods Through random cluster sampling,1143 peacekeeping soldiers were investigated with Chinese Military Mental Health Scale (CMMHS) and Social Support Scale (SSS).Results The total score of CMMHS and depression factor((61.06 ± 3.99),(10.11 ± 1.67)) of the suicidal ideation peacekeeping soldiers were significantly higher than the no-suicidal ideation peacekeeping soldiers ((59.97 ± 3.73),(8.97 ± 1.81))(P ＜ 0.05),CMMHS total score and each factors of the seven countries peacekeeping soldiers were significantly higher than the Chinese soldiers norms (P ＜ 0.05),and the total scores ((28.50 ± 1.69)) of the social support of the suicide idea peacekeeping soldiers was lower than the no-suicidal ideation peacekeeping soldiers ((28.92 ±1.78)) (P＜0.05).The obsessive-compulsive factor,anxiety factor,depression factor,phobic anxiety factor,somatization factor,neurastheria factor and interpersonal sensitivity factor of CMMHS were the risk factors arise the mental diseases of the peacekeeping soldiers,especially the depression factor(OR =27.00,x2 =439.46,P ＜ 0.05).The CMMHS total score and each factors had obvious negative correlation with social support scores(r =-0.199 ～0.434,P ＜ 0.05).Analysis of multiple stepwise back displayed that the age,gender,education and social support were main factors of influencing mental health of the seven-country peacekeeping soldiers (age:t =2.428,educational level:t =-3.310,social support:t =1.990,P =0.047 ～ 0.01).Conclusion The suicidal ideation has close relationship with peacekeeping soldiers' psychological disease,and the mental health of the peacekeeping soldiers is influenced by the age,gender,education level,and especially by social support.

Objective To observe the clinical effects of insulin glargine combined with novonorm in treatment of patients with newly diagnosed type 2 diabetes. Methods 112 cases of newly diagnosed type 2 diabetes patients were randomly separated into observation group(56 cases)and control group(56 cases). Observation group was treated with insulin glargine combined with novonorm. Control group was treated with novolin30R. The levels of FPG,2hPG and HbA1c before and after treatment,the control time of blood sugar,amounts of insulin and incidence of low blood sugar were observed in both groups. Results Compared with pre-treatment, FPG,2hPG and HbA1 c were significantly decreased (all P ＜0.05) after treatment, but there were no significant differences in both two groups (P ＞0. 05). The control time of blood sugar, amounts of insulin and incidence of low blood sugar in observation group were significantly lower than those in control group (all P ＜ 0.05). Conclusion Insulin glargine combined with novonorm in treatment of patients with newly diagnosed type 2 diabetes could effectively control blood sugar,shorten the control time of blood sugar,decrease amounts of insulin,and low incidence of low blood sugar.

Objective To explore correlation between alexithymia and resilience in military personnel.Methods 2802 subjects were chosen by random cluster sampling to outline the military personnel resilience scale and military alexithymia scale.The data were analyzed by t-test,chi-square test,ANOVA,correlation analysis and multiple linear regressions analysis.Results The prevalence rate of alexithymia was 6.85％,while resilience was 6.60％.Compared to sea force (45.62 ± 11.25 ) and air force (45.32 ± 9.98 ) subjects,land force (47.92 ± 9.92)had significantly higher total score in alexithymia(P＜ 0.05 ).Compared to sea force (87.35 ± 12.15 ) and air force ( 88.58 ± 10.39 ) subjects,land force ( 85.73 ± 10.70) had significantly lower total score in resilience(P ＜ 0.05 ).The total score and every factor score of subjects with alexithymia were significant lower than those of control group in resilience(P ＜ 0.05 ).Every factor of Resilience Scale were mild negative correlation with every factor of Alexithymia Scale (P＜0.01).Problem solving,volition,optimism and family supports were the main factors which had affected on the alexithymia.Conclusion The prevalence rate of alexithymia in military personnel is lower than ordinary people,but there are still issues in alexithymia and resilience,particularly in land force.The research show mild correlation between alexithymia and resilience in military personnel.

Objective To evaluate the health-related quality of life (HRQOL) and its influencing factors in pa tients with cervical cancer.Methods 120 inpatients with cervical cancer at Yunnan Tumor Hospital were investigated by functional assessment of cancer therapy-cervix (FACT-Cx),t-test,analysis of variance and multiple linear regression were used to analyze factors influencing the HRQOL.Results The total HRQOL score of patients was (104.88 ± 19.51),and the domain scores of physical well-being (PWB),social/family well-being (SWB),emotional well-being (EWB),functional well-being (FWB),cervical cancer subscale (CxS) were (20.41 ± 5.46),(17.17 ± 6.10),(15.73 ± 5.06),(13.34 ±5.83),(38.23 ±6.26),respectively.Based on multiple linear regression,the influencing factors of PWB were marital status and clinical stages,the influencing factor of SWB was marital status,the influencing factors of EWB were education levels and clinical stages,the influencing factors of FWB,CxS and total score were all marital status,clinical stages and education levels.Conclusions The HRQOL scores were influenced by a number of factors and it is significant to improve HRQOL in patients with cervical cancer by relieving symptoms and reducing treatment side effects according to patients' specialty,also psychological support and encouragement was essential.

Objective To establish a oligochip method for detection of HBV Lamivudine drug resistance and evaluate the clinical role of the chip system.Methods 388 HBV DNA positive sera from patients receiving lamivudine treatment and 559 chronic hepatitis B patients not receiving lamivudine treatment,and 359 sera from HBV DNA negative controls were assayed for HBV mutations utilizing oligonucleotide microarray.Meanwhile,these results were contrasted with Quantitative PCR and DNA sequencing method.Results The results of clinical evaluation shows that for the codons 528,552 and 555,the agreements between the microarray and sequencing data are 96.6%,98.5% and 100%,respectively.In the 559 samples,which were detected positive for HBV DNA by quantitative PCR,all but three weak positive samples were positive by the microarray,demonstrating an agreement of 99.7%.All the 359 HBsAg negative samples were shown to be negative for HBV DNA by the microarray method.Conclusions The HBV-Lamivudine oligochip is eligible to detecting wild type HBV and HBV lamivudine-mutants in patient's sera.It has great potential application of administration for lamivudine treatment in HBV patients.