Objective To compare the effects of different levels of controlled low central venous pressure (CVP) on blood loss in patients undergoing hepatic lobectomy. Methods One hundred ASAⅠ -Ⅱ patients, aged 28-78 yr, weighing 39-90 kg, undergoing elective hepatic lobectomy under general anesthesia, were randomly divided into S groups ( n = 20 each) with CVP controlled at 1, 2, 3, 4 and 5 mm Hg during the course of operationrespectively (groups CVP1-5 ) . Anesthesia was induced with midazolam, fentanyl, etomidate and vecuronium. The patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with iv infusion of propofol and remifentanil, inhalation of isoflurane and intermittent iv boluses of vecuronium. CVP was maintained at the predetermined levels by restricted infusion or by administration of diuretics or vasoactive agents and so on during operation. The blood loss before, during and after removal of the diseased liver parenchyma ( V1-3 ) was recorded.The liver parenchyma transection area ( TA) was determined and the blood loss per transaction area ( VTA ) was calculated. Fluid infusion and blood transfusion were recorded during the three time periods mentioned above. MAP and HR were recorded before operation, at 5 min after removal of the diseased liver parenchyma was started and at the end of operation. Results Compared with group CVP5, the MAP during removal of the diseased liver parenchyma in groups CVP1,2 , V2 and VTA in groups CVP1-3,and the percentage of patients who needed blood transfusion during operation and the amount of fluid infused before completion of removal of the diseased liver parenchyma in groups CVP1-4 were significantly decreased ( P ＜ 0.05) . Compared with group CVP4 , V2 , VTA and MAP during removal of the diseased liver parenchyma were significantly decreased in group CVP2 and the amount of fluid infused was significantly increased before removal of the diseased liver parenchyma was completed in group CVP,( P ＜ 0.05) .Conclusion When CVP is controlled at 3 mm Hg, the hemodynamics is stable and blood loss is less during hepatic lobectomy.

Objective To evaluate the sensitivity, specificity and clinical significance of CK19 mRNA, CEA mRNA and LUNX mRNA for detecting micrometastasis by sampling the peripheral blood and regional lymph nodes of lung cancer patients. Methods Reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect LUNX mRNA,CK19 mRNA, CEA mRNA for micrometastasis by sampling the peripheral blood of 48 lung cancer patients and 44 regional lymph nodes of such patients treated by curative resection. Peripheral blood of 30 patients with pulmonary benign lesions and 10 normal healthy volunteers and lymph nodes of 6 patients with benign pulmonary diseases served as control. Results (1) LUNX mRNA, CK19 mRNA, CEA mRNA were expressed in all(35/35) lung cancer tissues. (2) In the peripheral blood from 48 lung cancer patients, 30(62.5%) were positive for LUNX mRNA, 24 (50.0% ) positive for CK19 mRNA and 32(66.7%) positive for CEA mRNA. The positive detection rates of micrometastasis in 44 lymph nodes from lung cancer patients were 36.4% (16 out of 44) for LUNX mRNA, 27.3%(12 out of 44) for CK19 mRNA and 40.9%(18 out of 44) for CEA mRNA. (3) In the 30 blood samples from patients with pulmonary benign diseases, 2 (6.7%) expressed CK19 mRNA, but none expressed LUNX mRNA or CEA mRNA. All the 3 molecular markers were negative in the 10 blood samples from healthy volunteers. In 11 lymph nodes from patients with pulmonary benign lesions, none was positive for any of the three markers.(4)In 44 regional lymph nodes from lung cancer patients,6(13.6%) were positive for metastasis by histopathological examination, with a positive rate significantly lower than that of the RT-PCR ( P

Objective To investigate the features and diagnostic value of computed tomography ( CT) in cys-titis glandularis .Methods The CT images and clinical data of 9 patients with cystitis glandularis confirmed by histol-ogy were studied retrospectively .Results The characteristics of cystitis glandularis ( location,shape,density and the relationship with adjacent tissues)were clearly displayed on CT.The lesion was located in the bladder trigone(n=5), right anterior wall(n=1),left posterior wall(n=2),diffuse lesion(n=1).According to the shape,8 lesions showed mass type,the range of these lesions were limited and some lesions were combined with cystic degeneration ,only one lesion showed a diffusely thickened bladder wall .After enhancement ,CT value increased from 14.0-45.0 HU to 25.0-62.0 HU.Conclusion CT has high sensitivity and accurate in diagnosis of cystitis glandularis .

Objective To observe the differences in functional areas of the brain in response to two different acupuncture techniques using functional magnetic resonance imaging (fMRI).Methods Deqi and non-deqi acupuncture were performed on twenty healthy right-handed volunteers.fMRI was conducted in the process of acupuncture.The experiment adopted a single-chunk design and the procedure contained periods of stimulation and rest.The brain regions stimulated during deqi and non-deqi acupuncture were assessed using xjview software.Results After acupuncture at the Zusanli point (ST36),differences in activity were observed between the deqi and non-deqi groups in the language,sports,perception and limbic systems.Conclusions ①Under deqi conditions,acupuncture at ST36 increases circulation and the activation of brain areas dealing with language,sports,perception and the limbic system.This may be one of the mechanisms by which acupuncture can improve aphasia,coordination and perception.②Under deqi conditions acupuncture at ST36 decreases circulation and deactivates brain areas associated with the limbic system.This may explain acupuncture's analgesia and regulation of autonomic nerve and endocrine function,its amelioration of internal organ functions and regulation of immunologic function.

The paper presented the principles and references for identifying services of the primary health care at townships and villages in Beijing, and proposed the screening criteria for primary health care package in rural Beijing. Studies made have identified the screening results for the package applicable to both townships and villages in Beijing, along with analysis for the rationale, applicability and operability of the package. Moreover, it probed into the assurance conditions for offering primary health care as a reference for other regions in the country.

Objective To retrospectively assess the diagnostic value of nuchal translucency (NT) thickness and facial profile ultrasonic markers [including frontomaxillary facial (FMF) angle,and the ratio of prenasal thickness to nasal bone length (PT/NBL)] for trisomy 21 syndrome in first-trimester fetuses.Methods Ultrasonograhic images of 35 fetuses with trisomy 21 syndrome and 70 gestational age matched normal fetuses were analyzed in first-trimester.NT,FMF angle and the PT/NBL ratio were measured retrospectively in stored images from digital database between January 2012 and December 2015.The diagnostic value of NT,FMF angle and PT/NBL ratio were compared with different combinations.Results (1) The mean NT was significantly higher in the trisomy 21 group than that in controls (t =7.401,P =0.00).The NT above 2.5mm was observed in 20 trisomy 21 fetuses (57.1％) and in 3 normal fetuses (4.3％).(2) The mean FMF angle was significantly higher in the trisomy 21 group than that in controls (t =-5.283,P =0.00).The FMF angle above the 95th percentile (93.6°) was observed in 13 trisomy 21 fetuses (37.1％) and in 1 normal fetus (1.4％).(3) The mean PT/NBL ratio was significantly higher in the trisomy 21 group than that in controls (t =-7.826,P =0.00).The PT/NBL ratio above the 95th percentile (0.93) was observed in 19 trisomy 21 fetuses (54.3％) and in 4 normal fetuses (5.7％).(4) The sensitivity and Youden index for trisomy 21 increased gradually,which were 57.1 ％ and 0.528 by using NT,and 74.3％ and 0.686 by using NT and FMF angle,and 91.4％ and 0.828 by using NT,FMF angle and PT/NBL ratio.There were significant differences in the detection rates of trisomy 21 among the three strategies,while the diagnostic specificity of the three strategies were more than 90％.Conclusions The three parameters are significantly increased in trisomy 21 fetus in first-trimester.First,increased NT was most commonly detected,followed by increased PT/NBL ratio,and increased FMF angle again.Detection rates for trisomy 21 fetuses in first-trimester by ultrasound screening can be significantly improved if combination of all three parameters rather than just one parameter are performed.

OBJECTIVE To understand the status of gastroscope contamination.METHODS The bacterial(cultivation) of samples derived from inside and outside gastroscope after using was conducted.RESULTS There were heavy(contaminations) inside and(outside) gastroscope after using.Except for normal microbial populations(existing) on pharynx nasalis,many(conditional) pathogenic bacteria had been detected,such as Streptococcus pyogenes,Moraxella catarrhalis,and(nonzymocyte).CONCLUSIONS Many species of bacteria are detected inside and outside(gastroscope) after using.They are normal microbial populations in pharynx nasalis and some conditional pathogenic bacteria.It is (necessary) to strengthen regulation of gastroscope cleaning and disinfection. We should follow Technological Regulations of Disinfection(Ministry of Health,2004) to clean and disinfect endoscope strictly in order to avoid(hospital) acquired infection due to insufficient cleaning and disinfection.

Background Posterior capsular opacification (PCO) is a primary complication after extracapsular cataract extraction.The mechanism of PCO is associated with proliferation,migration and epithelialmesenchymal transition (EMT) of human lens epithelial cells (LECs).To explore the target treatment of PCO is very important.Objective This study was to investigate the biological effects of second mitochondria-derived activator of caspases (Smac) on the proliferation and apoptosis of LECs.Methods Human LECs line (HLE-B3) and Smac-overexpressed LECs line were cultured,and the cells were transfected using small interfering RNA (siRNA)-Smac3 plasmid with green fluorescent protein (GFP) for 24 hours.Different concentration of transforming growth factor-β2 (TGF-β2) (5,10,20 and 50 μg/ml) or 200 μmol/L H2O2 were added respectively into the culture medium to establish PCO model and oxidative stress model.Cell counting kit-8 (CCK-8) assay was used to compare the cell proliferative activity among PBS group,TGF-β2 group and Smac-hyperexpression +TGF-β2 group.Flow cytometry was used to evaluate the apoptotic rate of the PBS group,H2 O2 group and siRNA-Smac+H2 O2 group.The expressions of Smac,caspase-3 and proliferating cell nuclear antigen (PCNA) mRNA and their proteins in the cells were detected by real-time quantitative PCR (RT-PCR) and Western blot.Results The GFP+ cells were≥ 80％ 12 hours after siRNA-Smac3 transfection,with the optimal plasmid of siRNA-Smac3.GFP+ cell rate was (72.32 ± 2.31)％ in the siRNA-Smac3 transfection group,which was significantly higher than that in the blank plasmid group ([4.91 ±0.24] ％) (t=116.342,P＜0.001).The relevant expression levels of Smac was 35.21 ±4.11 in the Smachyperexpression group,and that in the blank plasmid group was 15.24±2.48,with a significant difference between them (t =215.47,P＜0.05).The cell viability of 20 ng/ml TGF-β2 affected PBS group,TGF-β2 group and Smachyperepression+TGF-β2 group was (98.4 ± 1.7) ％,(98.9 ± 0.1) ％ and (64.2 ± 3.1) ％,and the cell viability of Smac-hyperepression+TGF-β2 group was significantly lower in the Smac-hyperepression+TGF-β2 group than that in the TGF-β2 group (P＜0.05).The apoptotic rate in the PBS group,H2 O2 group and siRNA-Smac+H2 O2 group were (2.9 ± 1.2) ％,(45.1 ±4.5) ％ and (27.5 ± 1.8) ％,and the apoptotic rate was evidently lower in the siRNA-Smac +H2O2 group than that in the H2O2 group (P＜0.05).RT-PCR results showed that the expression levels of caspase-3 mRNA in PBS group,H2 O2 group and siRNA-Smac + H2 O2 group were 0.321 ± 0.103,0.715 ± 0.112 and 0.479 ±0.209,respectively.Compared with the H2 O2 group,the relative expression level of caspase-3 mRNA in siRNA-Smac+ H2O2 group was significantly decreased,the difference was statistically significant (P＜ 0.05).The PCNA mRNA expression levels in PBS group,TGF-β2 group and Smac-hyperepression+TGF-β2 group were 0.299±0.013,0.645± 0.102 and 0.490±0.209,respectively.Western blot results showed that the relative expression of caspase-3 protein in siRNA-Smac+H2O2 group and H2O2 group was 0.712±0.012 and 0.973±0.051,with significant difference between the two groups (t =132.52,P＜0.05).The relative expression of PCNA protein in Smac-hyperepression+TGF-β2 group was 0.782±0.212,which was lower than 1.126±0.251 in the TGF-β2 group (P＜0.05).Conclusions Smac may prevent and treat PCO by inhibiting the proliferation and promoting apoptosis of human LECs.

Objective To explore the appropriate frequency of ventilator tube replacement by researching the influence of different ventilator circuit change frequency on ventilator-associated pneumonia (VAP).Methods A prospective randomized sampling study was conducted.The patients undergoing invasive mechanical ventilation over or equal to 3 days admitted to emergency intensive care unit (EICU) of the First Affiliated Hospital of Kunming Medical University from December 2012 to December 2015 were enrolled.The patients were divided into 3,7 and 10 days group according to the frequency of ventilator tube replacement.Bacteriology of ventilator tube and the incidence of VAP were compared among the groups.Results Ninety-eight patients were enrolled,mainly with the artificial airway of endotracheal intubation or tracheotomy,with 56 male and 42 female,aging 8 to 86 years with mean of (51.97 ± 17.56) years.There were no statistical differences in gender,age,Glasgow coma scale (GCS) score,cough function and application of glucocorticoid,enteral nutrition,atomization and sedative therapy among three groups,indicating that the risk factors among three groups were consistent.The bacteria detection rates of extension tube,breathe out tube,breathe in tube,and hydrops collection cup were 36.7％,36.7％,33.3％,and 33.3％ respectively in 3 days group,and they were 73.0％,67.6％,62.2％,and 62.2％ in 7 days group respectively,and were all 90.3％ in 10 days group.It was showed that the bacteria detection rate in different pipe parts was almost the same with the same change frequency,and the rate was higher with the longer usage of ventilator tube (x2 values were 20.599,19.879,21.975,21.975,all P =0.000).The longer of the tube used time,the higher incidence of VAP.The incidence of VAP in 3,7,10 days groups were 26.7％,59.5％ and 77.4％,respectively,but there was statistically significant difference among all groups (x2 =30.486,P ＜ 0.001).Based on the value of 3 days group,the incidence of VAP in the 7 days group was 15.950 folds of 3 days group,and the incidence of VAP in the 10 days group was 18.333 folds of the 3 days group (both P ＜ 0.001).Conclusion This study suggests that the longer of pipeline using time,the more serious degree of bacterial contamination of pipeline,the higher incidence of VAP.

[Abstrct] Objective To compare the short -term tumor response and adverse events of two chemoradio-therapy regimens for locally advanced non -squamous non-small cell lung cancer .Methods From March 2009 to January 2013 ,we recruited 42 patients with stage ⅢNSCLC who had received three -dimensional intensity -modulated radiotherapy combined with chemotherapy .group A treated with radiotherapy combined pemetrexed plus cisplatin and group B treated with radiotherapy combined docetaxel plus cisplatin .We compared the short -term tumor response and adverse events between the two regimens .Results There were 28 cases in group A and 14 cases in group B .There were no significant differences between the two groups in hematologic toxicities ,such as leukopenia,neutropenia,anemia and thrombocytopenia.In non-hematologic toxicities,radiation pneumonitis and cough were no significances respectively (P<0.05).There were no significant differences in other non -he-matologic toxicities,such as liver dysfunction,renal dysfunction,fever,dyspnea,radiation esophagitis,hypody-namia,weight loss,gastrointestinal reactions and skin reactions .The response rate displayed no differences be-tween two groups .Conclusion This study reveals Pemetrexed plus cisplatin group had less non -hematologic toxicities than Docetaxel plus cisplatin group in locally advanced non -squamous non -small cell lung cancer . But there are no differences in the short -term tumor response between the two regimens .