Objective To observe the influences of combined general and epidural anesthesia on hemodynamics.Methods Twenty one patients were randomly divided into two groups, general anesthesia (GA group, n=11) and combined general and epidural anesthesia (GA+EA group, n=10). With Swan Ganz technique, hemodynamic parameters were measured 5min following 0.6 and 1.0 MAC enflurane inhalation in GA group, and 5min following 0.6 MAC enflurane inhalation and 10min after combined epidural lidocaine in GA+EA group.Results Compared with the baselines, in both groups with 0.6 MAC enflurane inhalation, MAP decreased significantly (P0.05); in GA group with 1.0 MAC enflurane inhalation, MAP, HR, SVR, SI and CI decreased significantly (P0.05). As compared with those following 0.6 MAC enflurane inhalation, only in GA+EA group MAP and SVR decreased, and SI rose obviously (P

Autoimmune Diseases ; diagnosis ; immunology ; pathology ; therapy ; Child ; China ; Gastroenterology ; Hepatitis B ; diagnosis ; pathology ; therapy ; Humans ; Infant

Purpose To investigate the responsiveness of intracellular oxygen free radical and calcium on acrolein exposure and acrolein-induced cardiomyocytes apoptosis. Methods The viable adult mice cardiac myocytes were isolated by modified langendorff methods. We have examined the intracellular oxygen free radical and calcium concentration using DCF and Fura-2 AM, and the cardiomyocytes viability with WST assay. Are evaluated the DNA ladder pattern and cell apoptotic morphology on the adult mice cardiomyocytes that are exposed to acrolein. Results Our results show that acrolein can increase markedly the intracellular oxygen free radical and calcium concentration, that reach 12 fold and twofold respectively compared to the resting value when the cells were exposed to 1 μmol/L of acrolein. Moreover, the injury induced by acrolein in cardiac myocytes is concentration-dependent. The cardiomyocytes viability treated with 25, 50, 100 μmol/L of acrolein respectively were significantly lower compared to controls (P ＜ 0.01 ). DNA ladder pattern and apoptotic morphological changes were found after being exposed to acrolein in the adult mice cardiomyocytes. Conclusion It is concluded that acrolein induces adult mice cardiomyocytes apoptosis, and it may be due to the increased intracellular oxygen free radicals and calcium concentration.

Objective To investigate the effects of dexmedetomidine preconditioning on nitric oxide (NO)/endothelin (ET)-1 imbalance and remote lung injury induced by lower limb ischemia-reperfusion (LIR). Methods Sixty patients who scheduled for unilateral lower extremity surgery matched American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ, were randomized into two groups:control group (R group, n=30) and dexmedetomidine preconditioning group (PD group, n=30). Lumbar plexus combined with sciatic nerve block was performed guided by a nerve stimulator in both groups. In group PD, dexmedetomidine intravenous infusion was started at a dose of 0.125 mL/kg (4 mg/L) for 10 minutes before using tourniquet, whereas group R received an equivalent volume of normal saline. Artery blood gas analysis, respiratory index and oxygenation index were measured, and NO, ET-1, interleukin-8 (IL-8) and malondialdehyde (MDA) concentrations were determined from plasma samples 10 minutes before tourniquet inflation (T0), 15 minutes (T1), 2 h (T2), 6 h (T3) and 24 h (T4) after tourniquet deflation. Results Compared with T0, RI was higher at T3 in group R and OI was lower at T2-4 (P＜0.01). There were no significant differences in RI and OI of group PD between different time points (P＞0.05). In R and PD groups, ET-1, IL-8 and MDA concentrations were increased, while NO level and NO/ET-1 ratio were significantly decreased after tourniquet deflation (P＜0.05). Compared with group R, RI was lower and OI was higher at T3 in group PD (P＜0.01). The levels of ET-1, IL-8, MDA, NO and NO/ET-1 ratio were significantly different after tourniquet deflation between group PD and group R (P＜0.05). In group R, there was positive correlation between ET-1 and IL-8 levels with RI, and negative correlation between ET-1 and IL-8 levels with OI (P＜0.01). There was positive correlation between NO level, NO/ET-1 ratio and RI level (P＜0.01). Conclusion Lung function impairment induced by tourniquet application could be attenuated by dexmedetomidine preconditioning based on protecting endothelial cells and inhibiting lipid peroxidation.

Objective To understand the status quo of work satisfaction of the graduates of GP vocational training program by Zhongshan hospital Fudan university,to provide bases for making best GP career development strategy by health authorities.Methods Using short form of the career orientation inventory to conduct career investigation of the 152 graduates of GP vocational training program by Zhongshan hospital,Fudan university.152 questionnaires were issued and the effective response rate was 100％.Results The top of GPs' career anchor is job security orientation (106,69.7％),followed by technical competence (28,18.4％),service (8,5.3 ％),managerial (5,3.3 ％),autonomy (3,1.9％),lifestyle (1,0.7 ％),entrepreneurship (1,0.7 ％),pure challenge (0,0) and geographic security orientation (0,0).We found that for male GPs,they displayed higher score for entrepreneurship orientation than female GPs (t =2.775,P =0.006).Those older than 35 displayed higher score for geographic security orientation than those younger than 35 (t =-2.154,P =0.033).GPs with at least 10 years' work experience displayed higher score for geographic security orientation than those with less than 10 years' work experience (t =-2.414,P =0.017).The distribution of all types of career orientations of GPs was the same no matter how different their degrees and professional titles were.Conclusions Job security orientation and technical competence are the major job orientations of GP vocational training program by Zhongshan hospital,some career anchor orientations are related to age,gender and duration of work experience.Effective career management should be conducted based on these characters of the graduates' career orientation.

Objective To assess the efficacy and safety of co-administration of aspirin and low-dose clopidogrel in patients undergoing percutaneous coronary intervention (PCI) after 1 year.Methods From March 2004 to September 2010,a total of 3366 patients with successful drug-eluting stents implantation after 1 year were divided into group A (aspirin combined with low-dose clopidogrel,n=1682) and group B (aspirin alone,n=1684).The average follow-up period was (29.5±16.3) months (19 months-76 months).The major adverse cardiovascular and cerebrovascular events and clinical complications were evaluated.Results Rates of cardiovascular death were 0.1 ％(2 cases) in combination group and 0.9％ (15 cases) in aspirin group,the risk ratio (HR) was 0.154 [(95％ CI:0.035 0.675),P＜0.05].Myocardial infarction occurred in 9 patients (0.5％) in group A and 27 patients (1.6％) in group B,the risk ratio (HR) was 0.036 [(95％ CI:0.153-0.741),P＜0.01].Rates of stroke were 0.4％ (7 cases) in group A and 1.6％ (27 cases) in group B,the risk ratio (HR) was 0.301 [(95％ CI:0.131 0.693),P ＜ 0.01].Recurrent ischemia with rehospitalization occurred in 152 patients (9.0％) in group A and 274 patients (16.3％) in group B,the risk ratio (HR) was0.601 [(95％ CI:0.491-0.735),P＜0.01].The cumulative survival rate in patients died of cardiac causes was significantly better in group A than in group B (P＜0.01).The cumulative incidence of major adverse cardiovascular and cerebrovascular events was significantly lower in group A than in group B (P＜0.01).There were no significant differences in total number of deaths,target vessel revascularization,stent thrombosis,incidences of severe bleeding,mild bleeding,leukopenia and thrombocytopenia between the two groups (all P＞0.05).Conclusions In patients with PCI after 1 year,the co-administration of aspirin and low-dose clopidogrel reduces the risks of major adverse cardiovascular and cerebrovascular events,and does not increase the risks of bleeding and cytopenia.

Objective To explore how to optimize laboratory work flow in regional laboratory information management system (LIS) .Methods Upgraded both software and hardware ,reduced manual operation ,and to avoid the mistake and improve the effi‐ciency .Results Compared to the original process ,the optimized one reduces the time line by 57% .Furthermore ,time cost of other individual processes ,such as patient information input ,sample collection and sample classification were also shortened significantly . Conclusion By work flow rebuilding ,we not only improved the efficiency of laboratory work by saving time cost ,but also reduced the error rate ,which finally satisfied our patients .

Objective To summarize the clinical features,neuroimaging findings and pathological characteristics of demyelinating pseudotumors(DPT)of the brain,and to differentiate it from glioma. Methods The clinical features,neuroimaging findings and pathological characteristics of 35 patients with demyelinating pseudotumors of the brain were summarized,and the diagnosis for 18 of them was confirmed by bioscopy.Results Demyelinating pseudotumors affected adults of both sexes.The onset age of patients ranged from 9 to 69 years old.There was no definite antecedent,and the clinical syndromes were atypical. Neuroimaging scans showed multiple lesions in cerebral hemisphere,while the lesion in brain stem and spinal cord was single.The symptom and neuroimaging were not parallel.While with many or large lesions, the symptoms and signs were less.The lesions were not enhanced on CT scan,but appeared round or patch enhancement on MRI scan.Nine patients with DWI all appeared high density.The myelin basic protein was useful for diagnosis.The typical pathological changes were demyelination,perivascular inflammatory infiltration and reactive gliosis.The Creutzfeuldt cells were also found in these patients.The lesions might become small or disappear after treatment,but could not serve as the criterion to exclude brain neoplasm. Conclusions DPT is a distinct demyelination disease entity,which is confusable with brain neoplasm.It is difficult to distinguish DPT from brain neoplasm with the clinical features and conventional neuroimaging scan.But DWI scan is useful.The pathological changes accord with demyelination,and Creutzfeuldt cells are also found.It is important to apply corticosteroid treatment or biopsy rather than being anxious to excise the lesions.

BACKGROUND: Previous studies showed that donor systemic injection of B7/CD28 costimulatory blocker cytotoxic T lymphocyte associated antigen 4 immunoglobulin (CTLA-4Ig) needed in T cell activation can markedly prolong the survival time of rat renal allografts, which, however, has limitations, such as high dose, extensive influence, poor specificity, systemic adverse reactions.OBJECTIVE: In order to improve the targeting of CTLA-4Ig, we modified the dendritic cells of donors and recipients in vitro with CTLA- 4Ig and observed the influence of two kinds of dendritic cells applied alone or together on the survival of renal allografis in rats.DESIGN, TIME AND SETTING: The randomized controlled animal experiment was performed between April 2003 and July 2004 at Laboratory of Department of Urinary Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, China.MATERIALS: Kidney donor: inbred Brown-Norway rats, kidney recipient: inbred Lewis rats, unrelated lymphocyte donor: Wistar rats.METHODS: Bone marrow derived dendritic cells of Lewis and Brown Norway rats were modified with CTLA- 4Ig gene recombinant adenovirus in vitro. Animal models of kidney transplantation were built with Brown Norway rats as donors while Lewis rats as recipients. The modified dendritic cells were injected into Lewis rats through femoral vein 24 hours before kidney transplantation alone (group 1 (n=8), donor dendritic cells; group 2 (n=8), recipient dendritic cells) and in combination (group 3 (n=8), donor and recipient dendritic cells). While the recipients without injection were used as control (group 4 (n=6)).MAIN OUTCOME MEASURES: Survival time of renal allografts; the reaction degrees of splenocytes to donor and unrelated antigen determined by MTT method on day 20 postoperation.RESULTS: Survival time of renal allografts in group 2 was not prolonged compared with group 4 while the survival time was markedly prolonged in group 3 (P < 0.01). The response of rat splenocytes to donor antigen in group 1 and group 3 was obviously lower than that in group 4 (P < 0.01), while the response to unrelated antigen was similar to group 4.CONCLUSION: Donor dendritic cells modified with CTLA- 4Ig can significantly prolonged survival time of rat renal allografts and the administration of both donor and recipient dendritic cells modified with CTLA- 4Ig can induce a longer survival time of renal allografts. Recipient dendritic cells cannot prolong the survival time of renal allografts.