Objective To evaluate effects of different concentration of sevoflurane anesthesia on left ventricular function in elderly patients by cardiac ultrasound.Methods One hundred and twenty patients (59 males,61 females,aged 65-69 years,ASA gradeⅠor Ⅱ)undergoing elective surgery having general anesthesia were divided into 4 groups according to minimum alveolar concentration (MAC)using random number table method,30 in each.To maintain the MAC at 1.0,1.5,2.0,2.5,fentanyl and suc-cinylcholine were used for rapid induction,followed by endotracheal intubation.Mechanical ventilation was maintained at the preset value for 10 minutes,then the concentration of sevoflurane was adjusted.Left ven-tricular end-diastolic diameter (LVEDD),left ventricular end-systolic diameter (LVESD),left ventricular ejection fraction (LVEF),left interior diameter shortening rate (LVFS),cardiac output by cardiac ultra-sound,noninvasive arterial systolic pressure,diastolic pressure,heart rate were recorded prior to the induc-tion (T0 )and after 3 min (T1 ),5 min (T2 ),8 min (T3 ),10 min (T4 )of reaching the target concentra-tion.Cardiovascular event was also documented if there was any during the study.Results Compared with T0 ,the systolic pressure and diastolic pressure of 4 groups decreased at T1-T4 time point,LVEF,LVFS and cardiac output of group S2,S3,S4 decreased at T2-T4 time point,LVESD of group S3 and S4 increased at T2-T4 time point,with significant differences (P <0.05).Compared with group S1,group S2,S3 and S4 at T2-T4 time point,LVEF,LVFS and cardiac output decreased,LVESD of group S3 and S4 increased, the difference being statistically significant (P <0.05).Compared with group S2,LVESD of group S3 and S4 increased with significant difference (P <0.05).No hypotension occurred in group S1 and S2.Hypoten-sion in group S3 and S4 occurred in a rate of 20% and 30% respectively.Compared with group S1 and S2, the incidence of hypotension of group S3 and S4 increased (P <0.05).Conclusion Low concentration of sevoflurane anesthesia exerts no obvious effect on left ventricular function of elderly patients,however high concentration of sevoflurane anesthesia has obvious inhibition on left ventricular systolic function,but had no effect on left ventricular diastolic function.

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Objective To evaluate the perfectibility of colposcopy directed biopsy for the diagnosis of cervical intraepithelial(CIN)through cervial conization by loop electrosurgical excision procedure(LEEP).Methods Biopsy by colposcopy and biopsy after LEEP were analyzed retrospectively in 108 cases of cervical intraepithelial neoplasia to study the related factors of affecting the coincidence rate.Results Comparison of pathological hanges following both LEEP and colposcopy showed that 69 cases were the same,24 upgrade,and 15 downgrade.Conclusion LEEP is a kind of effective and perfect method for the specific diagnosis and treatment of CIN.Colposcopically directed biopsy has its limitations.

OBJECTIVE To study the drug-resistant diversity of Gram-negative bacilli isolated from inpatients during recent five years.METHODS A total of 1 464 Gram-negative bacilli isolated were detected and retrospectively analyzed from 1999 to 2003.Antimicrobial susceptibility testing was performed using Kirby-Bauer method.RESULTS The resistance of Pseudomonas aeruginosa to piperacillin rised from 17.6% of 1999 to 79.2% of 2003,and that to ciprofloxacin rised from 4.3% of 1999 to 36.0% of 2003.The resistance of Escherichia coli to quinolones was above 50%,while to third-generation cephalosporins was 30-40%;the resistance of E.coli to piperacillin rised from 42.9% of 1999 to 68.9% of 2003,and that to ciprofloxacin rised from 40.0% of 1999 to 73.5% of 2003.The resistance of Acinetobacter to piperacillin rised from 31.2% of 1999 to 67.5% of 2003,and that to ceftriaxone rised from 36.0% of 1999 to 74.1% of 2003.The resistance of Serratia to ceftazidime,ceftriaxone,gentamicin,amikacin and piperacillin rised sharply.Imipenem was the most active antibiotic tested against Gram-negative bacilli.Cefoperazone/sulbactam and piperacillin/tazobactam also showed excellent activity against Gram-negative bacilli.CONCLUSIONS During recent five years,the resistance of the most common Gram-negative bacilli has increased rapidly.How to delay the resistance development of common strains become a global problem.

Objective To investigate the application and clinical significance of 24-hour multichannel intraaluminal impedance-pH (MII-pH) monitoring in gastroesophageal reflux disease (GERD).Methods Fiftythree patients with GERD were enrolled in this study according to the Montreal consensus (consulting for twice reflux a week or above) from July 2011 to June 2012.Patients were divided into erosive esophagitis (EE,n =25)group and non-erosive reflux disease (NERD,n =28) group after endoscopy and MII-pH monitoring.Fifteen healthy volunteers were recruited as the normal controls.The change of pH and MII-pH parameters were compared among the three groups and the significance of the change was investigated.Results Twenty-four-hour pH monitoring showed that all the acid reflux events in the EE and the NERD groups were significantly higher than those in the control group (P ＜ 0.05).MII-pH monitoring showed that the frequencies of total reflux,acid reflux,weakly acidic reflux and percentage of acid reflux in the GERD group were higher than in the control group (total reflux:83 (54,118) vs.62 (44,111) vs.42 (20,70),P =0.003 ; acid reflux:45 (25,79) vs.22 (11,45) vs.3(1,10),P =0.000 ;weakly acidic reflux:36(18,47) vs.43(21,82) vs.23(11,43),P =0.001 ;percentage of acid reflux:53％ (37％,81％) vs.32％ (13％,48％) vs.11％ (1％,23％),P =0.002).The frequency and percentage of acid reflux in the EE group were higher than those in the NERD group (P =0.000)The percentage of weakly acidic reflux in the NERD group was higher than in the EE group (66％ (43％,79％) vs.46％ (21％,57％),P ＜0.01).The frequencies of liquid reflux and mixed reflux in the GERD groups were higher than those in the control group (22 (12,40) vs.18 (12,26) vs.9 (4,18) ; 54 (39,79) vs.42 (25,77) vs.29(14,48) ;P ＜0.01).The frequency of gas reflux in the control group was higher than in the GERD group (86(56,207) vs.31 (14,62) vs.34 (15,119),P ＜ 0.01).The frequency and percentage of proximal reflux in the GERD group were significantly higher than in the control group (28(18,41) vs.16(12,34) vs.3 (2,9) ; 33％ (22％,49％) vs.29％ (22％,35％) vs.11％ (6％,22％),P ＜ 0.001).The percentage of symptom positive index in patients with acid reflux,non-acidic reflux and total reflux in the EE group were 36.0％ (9/25),20.0％ (5/25) and 56.0％ (14/25) respectively which were higher than in the NERD group (21.4％ (6/28),14.3％ (4/28) and 35.7％ (10/28)).Conclusion MII-pH monitoring can detect more reflux events.Acid reflux plays an important role in GERD.The detective rate of GERD will be elevated when combined with MII-pH monitoring in the diagnosis.MII-pH monitoring has a distinct advantage in diagnosing GERD.

Objective To investigate the relationship between cardiovascular risk factors and arterial elasticity in elderly hypertensive patients.Methods 253 subjects were divided into two groups:hypertension group (n=141) and non-hypertension group (n =112).Carotid-femoral pulse wave velocity (C-FPWV),carotid-radial PWV (C-RPWV),height and weight were determined.Fasting plasma levels of blood glucose (BG),blood lipids,insulin,endothelins (ET),nitric oxide (NO) and high sensitivity C-reactive protein (hsCRP) were assessed.Results C-FPWV and CRPWV were higher in hypertension group than in non-hypertension group [(11.7±1.9) m/s vs.(9.7±1.1)m/s,(11.7±1.7) m/s vs.(9.4±1.1)m/s,t=8.43 and-6.30,both P＜0.01].Body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),levels of triglyceride (TG),BG,ET,NO and hsCRP,HOMA-IR had significant differences between the two groups (t=-5.27,-4.18,-6.00,6.29,-4.18,-4.86,-3.41,respectively,all P＜0.05).Pearson correlation analysis showed that CFPWV was correlated with SBP,age,DBP,fasting BG,NO,ET,TG,HOMA IR,cholesterol (CHO),hsCRP (r=0.534,0.374,0.340,0.338,-0.306,0.242,0.228,0.225,-0.218,0.178,respectively,all P＜0.05); C-RPWV was correlated with age,DBP,SBP,NO,TG (r=0.312,0.319,0.241,-0.197,0.151,respectively,all P＜0.05).Multiple regression analysis demonstrated that C-FPWV=4.640 + 0.081× HOMA IR+ 0.047× age+0.035×SBP+0.29×TG-0.017×NO+0.014×ET+0.132×hsCRP,r2=0.514; CRPWV=3.161+0.034×age+0.033×DBP+0.313×fastingBG+0.013×ET-0.013×NO,r2=0.390.Conclusions The decreases of arterial elasticity are closely related with endothelial function,insulin resistance,levels of blood lipids and hsCRP in elderly patients with hypertension.

Functional constipation (FC) is a common functional bowel disorder disease that affects life quality of a large number of people. This study aimed to explore the impact of different intensities of electro-acupuncture (EA) treatment for FC patients. Totally, 111 patients with FC meeting the Rome III criteria were randomly assigned to different intensities of EA groups (low and high intensity of EA groups) and medicine-controlled (MC) group. In EA groups, patients were treated with EA at quchi (LI11) and shangjuxu (ST37) bilaterally for 4 weeks, 5 times/week in the first 2 weeks, and 3 times/week in the last 2 weeks. In MC group, 5 mg mosapride citrate was administered orally 3 times/day for 4 weeks. Spontaneous bowel movement frequency each day was recorded using a constipation diary. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the patients' psychological state. Cortisol (CORT), substance P (SP), and vasoactive intestinal polypeptide (VIP) were evaluated at baseline and at the end of 4 weeks after treatment. As compared with the baseline, there was statistically significant increase in stool frequency every week (P<0.01), but there was no statistically significant difference among the three groups. As compared with the baseline, after 4 weeks of EA therapy, the scores of SDS and serum levels of CORT were decreased significantly in low intensity of EA group (P<0.01), and the serum levels of SP and VIP were increased significantly (P<0.05); the scores of SAS and SDS and serum levels of CORT were decreased significantly in high intensity of EA group (P<0.05), and the serum levels of SP and VIP were increased significantly (P<0.05); the serum levels of CORT and VIP were increased significantly in MC group (P<0.05). As compared with MC group, after 4 weeks of treatment, the serum levels of SP were signifcicantly increased in low intensity of EA group (P<0.01). Low and high intensities of EA could increase the stool frequency, improve the FC patient's anxiety and depression, reduce the serum levels of CORT, and increase the serum levels of SP and VIP effectively. It is concluded that both low and high intensities of EA are effective for FC patients, but there is no significant difference between the low and high intensities of EA.

AIM:To investigate peripapillary vessel density and its relationship with other ocular parameters in highly myopic eyes with peripapillary intrachoroidal cavitation (PICC), and to analyze risk factors for PICC.METHODS:Cross-sectional study.A total of 35 highly myopic eyes with PICC, 40 highly myopic eyes without PICC and 35 normal eyes were included in this study.All participants underwent fundus photography and spectral-domain optical coherence tomography (SD-OCT).OCT angiography was also performed to image the retinal vasculature in the peripapillary areas of different sectors, including the radial peripapillary capillaries (RPC) and optic nerve head (ONH) layer.The difference of morphology changes in optic disc and peripapillary vessel density between these three groups were compared.Correlations between peripapillary vessel density and PICC and risk factors for the presence of PICC were analyzed.RESULTS: Significant differences were found among the three groups in spherical equivalent refraction (SER), best-corrected visual acuity (BCVA), axial length, peripapillary atrophy β-zone (β-PPA) area, retinal nerve fiber layer (RNFL) thickness and the presence of tilted optic disc, posterior staphyloma and myopic maculopathy (MMD) (P<0.05).There were significant differences among the three groups in the peripapillary vessel density both in RPC (54.34±5.58, 57.54±7.44, 64.42±3.50) and ONH (51.24±7.43, 52.75±9.96, 61.25±4.15) layers (P<0.001).In highly myopic eyes, vessel density was significantly lower in eyes with PICC than in those without in inferotemporal area both in the RPC (56.76±6.62,63.84±6.02,67.52±4.78) and ONH (56.47±5.79,60.38±4.72,64.18±4.37) layers.The vessel density was significantly correlated with the presence of MMD, β-PPA area and RNFL thickness in the RPC layer, whereas correlated with the presence of MMD, PICC and RNFL thickness in the ONH layer (P<0.05).Tilted optic disc and posterior staphyloma were independent risk factors for the presence of PICC (OR=8.007, 95%CI: 2.045-31.348;OR=7.558, 95%CI: 1.398-50.026).CONCLUSION:Highly myopic eyes with PICC had relatively lower peripapillary vessel densities, especially in the temporal area, than those without.Tilted optic disc and posterior staphyloma were independent risk factors for the presence of PICC.

Objective To investigate the management and control of hypertension in patients with chronic kidney disease(CKD) and its associated factors.Methods Data of 726in-patients with CKD and hypertension who hospitalized in our hospital from March 2009 to April 2010 were studied.Results 91.74％ of patients was treated with antihypertensive medications,and 21.21％, 22.59％, 19.56％, 28.37％ of patients received 1, 2, 3, ≥4 antihypertensive drugs,respectively.42.4％ of patients with CKD and hypertension could be controlled up to the standard,and the mean blood pressure was(137.86±20.75)/(76.30±11.35) mm Hg.There was significant difference among stage 1 plus 2, 3, 4 plus 5 (non-dialysis), 5 (dialysis) kidney diseases, with the hypertension control rate being 50.8％, 46.7％, 42.0％, 33.5％, respectively.The hypertension control rate of non-dialysis patients was significantly higher than that of dialysis (44.9％ vs 33.5％,P＜0.05).There was no significant difference between blood dialysis group and peritoneal dialysis group(32.3％ vs 38.7％, P＞0.05).Multivariate Logistic regression analysis showed that female (OR=1.787, 95％CI 1.045-3.056)and ACEI application (OR=4.378, 95％CI1.830-10.472) were positively associated with hypertension control.Whereas, diabetes (OR=0.415, 95％CI 0.188-0.919)and pulse pressure (OR =0.847, 95％ CI 0.811-0.885) were associated with inadequate blood pressure control.ConclusionsDespite almost universal hypertension treatment is used in patients with CKD and high blood pressure, the hypertension control rate is still suboptimal.Female and ACEI are positively associated with adequate hypertension control, whereas diabetes and pulse pressure are negatively associated with the standard.

Chronic myeloid leukemia (CML) is characterized by the accumulation of active BCR-ABL protein.Imatinib is the first-line treatment of CML;however,many patients are resistant to this drug.In this study,we aimed to compare the differences in expression patterns and functions of time-series genes in imatinib-resistant CML cells under different drug treatments.GSE24946 was downloaded from the GEO database,which included 17 samples of K562-r cells with (n=12) or without drug administration (n=5).Three drug treatment groups were considered for this study:arsenic trioxide (ATO),AMN107,and ATO+AMN107.Each group had one sample at each time point (3,12,24,and 48 h).Time-series genes with a ratio of standard deviation/average (coefficient of variation) ＞0.15 were screened,and their expression patterns were revealed based on Short Time-series Expression Miner (STEM).Then,the functional enrichment analysis of time-series genes in each group was performed using DAVID,and the genes enriched in the top ten functional categories were extracted to detect their expression patterns.Different time-series genes were identified in the three groups,and most of them were enriched in the ribosome and oxidative phosphorylation pathways.Time-series genes in the three treatment groups had different expression patterns and functions.Time-series genes in the ATO group (e.g.CCNA2 and DAB2)were significantly associated with cell adhesion,those in the AMN107 group were related to cellular carbohydrate metabolic process,while those in the ATO+AMN107 group (e.g.AP2M1) were significantly related to cell proliferation and antigen processing.In imatinib-resistant CML cells,ATO could influence genes related to cell adhesion,AMN107 might affect genes involved in cellular carbohydrate metabolism,and the combination therapy might regulate genes involved in cell proliferation.