OBJECTIVE:To study the impacts and safety evaluation of aldactone on six-minute walk test performance in patients with high altitude heart disease and heart failure.METHODS:41 inpatients with high altitude heart disease from Feb.2004 to Jun.2009 were randomly divided into treatment group (n=21) and control group (n=20).Both groups were given captopril,furosemide and digoxin,etc.for three months.Treatment group were additionally treated with aldactone (40～60 mg?d-1).RESULTS:The six-minute walking distances were increased in two groups after the treatment (P0.05).CONCLUSION:Aldactone shows sound effect on improvement of heart functions in patients with high altitude heart disease,at the same time it can improve motor functions and life quality of patients.So it is safe to administer aldactone in a short period.

10.3969/j.issn.2095-4344.2013.26.003

This case report presents an extracted maxillary third molar,which have 3 separate roots with 5 canals,the canal configuration in mesiobuccal root are 3 separate orifices and canals,1 apical foramen.The clinician should be aware of this anatomical variation,avoid the missed canals.

Objective: To investigate the appropriateness of desflurane anesthesia used in patients undergoing intracranial operations. Methods: Sixteen patients were scheduled for removal of supratentorial mass. A radial artery catheter and a subarachanoid catheter were placed respectively prior to induetion of anesthesia. MAP, cerebrospinal pressure (CSFP), PETCO2 and HR were monitored. Anesthesia was induced with intravenous midazolan, fentanyl, propofol and vecuronium. After endotracheal intubation, anesthesia was maintained by desfurane inhalation in a concentration of 6 % (1MAC) throughout the operation. MAP, CSFP and PETCO2 were recorded before and during induction, at 20min, 30min, 40min and 50min during desflurane inhalation. Results: Compared with the baseline data recorded before anesthesia, CSFP and MAP were decreased significantly during induction. The CSFP tended to increase at 20 min after inhalation of 6 % desflurane, but remained below the baseline till 50min. MAP was decreased following inhalation of 6 % desflurane and kept relatively stable thereafter. No significnt change in HR was noted. Conclusion:Under the condition of PETCO2 28-30mmHg, 1MAC desflurane anesthesia can be used safely without any increase in ICP in patients undergoing intracranial operations.

AIM To study the effects of neferine on gastric car cinoma apoptosis induced by vincristine in vitro. METHODS Cytotoxicity assay was tested by MTT method. The influence of neferine to affect vincristine to induce gastric carcinoma apoptosis was detected by PI staining flow cytometry, AO/EB double fluorescence stain and terminal deoxynucleotidyl transferase mediated nick end labeling (TUNEL). RESULTS 2 5, 5,10 ?mol?L -1 neferine enhanced vincristine to inhibit the proliferation of SGC7901 cells; 10 ?mol?L -1 neferine enhanced vincristine (0 1, 0 5, 2, 4 mg?L -1 ) to induce SGC7901 cells apoptosis. CONCLUSIONS Neferine enhanced vincristine to induce gastric carcinoma cells apoptosis. It is inferred a kind of low poisonous and high effective chemosenstizers.

Objective To study effect of general anesthesia combined with epidural anesthesia on analgesia and microcirculation in patients undergoing total hysterectomy. Methods 92 patients of total hysterectomy who received therapy were selected, according to random number table,those patients were divided into the observation group (n=42) and the control group (n=48),the observation group received general anesthesia combined with epidural anesthesia, the control group were only given general anesthesia.The operation condition, hemodynamics and stress response before anesthesia(T0), at tracheal intubation(T1), after pneumoperitoneum 10min(T2), after surgery(T3), at extubation(T4) were compared,and postoperative pain (VAS) score was compared. Results There was no significant difference in operation time and fluid volume between the two groups. In the control group,the levels of mean arterial pressure (MAP), heart rate (HR) at the time of T1, T2, T3 were significantly increased(P<0.05), the levels of MAP and HR at the time of T1,T2,T3 in the observation group were lower than the control group(P<0.05). The cortisol (Cor), epinephrine (E), norepinephrine (NE) at the time of T1,T2,T3,T4 in the observation group were lower than the control group(P<0.05). Two groups of patients in the postoperative 12h, 6h, the VAS scores in the resting state and cough state were higher than the postoperative 1h(P<0.05),but the scores in the observation group were lower than the control group(P<0.05). Conclusion General anesthesia combined with epidural anesthesia is well for total hysterectomy,which can maintain hemodynamic stability during surgery, relieve stress reaction, alleviate postoperative pain, it is worthy of application and promotion.

Objective To investigate the urodynamic measurements in later pregnant women with urinary incontinence. Methods According to the symptoms, a total of 63 volunteers in later pregnancy were divided into two groups including urinary incontinence group and no symptom group. Fourteen women who were married but not delivered were included in control group. Urodynamic study was performed on all women. Results The occurrence rate of urinary incontinence in later pregnancy was 26.98%. The valsalva leak point pressure only occurred on two pregnant women were 50 cmH2O and 67 cmH2O respectively. Compared with the no symptom group, the maximum urethral closure pressure[(83.69±42.55)mmHg vs(108.09±34.95)mmHg, P＜0.05])and the functional urethral length [(30.45±8.42)mm vs (37.60±18.45)mm ,P＜0.05]of urinary incontinence group were decreased obviously. Conclusions The main reason of urinary incontinence in pregnancy was that the maximum urethral closure pressure could not sufficiently increase to compensate for the progressive increase in bladder pressure during pregnancy and functional urethral length could not correspondingly increase along with the pregnancy.

OBJECTIVE:To apply the kinetic turbidimetric Limulus test to the endotoxin assay of Levocarnitine sodium chloride injection.METHODS:The16-fold dilution of Levocarnitine sodium chloride injection was prepared.The content of bacterial endotoxin in Levocarnitine sodium chloride injection was determined with kinetic turbidimetric Limulus test after screen test and validation test.RESULTS:The16-fold dilution of Levocarnitine sodium chloride injection was effective to e?liminate the interference in Limulus test.The average recovery was in the range of50%～200%.CONCLUSION:The kinetic turbidimetric Limulus test provides a new and quick method for the quantitative determination of bacterial endotoxin in Levo?carnitine sodium chloride injection.

AIM: To investigate the effect of neferine (Nef) on human gastric carcinoma cell line with multidrug resistance (MDR). METHODS: The cytotoxic effect of vincristine (VCR) was evaluated by MTT assay. The cell apoptosis induced by VCR was determined by flow cytometry, and the expression of P-glycoprotein (P-gp) and multidrug-resistance-associated protein (MRP) in cells was examined by immunofluorescence flow cytometry. RESULTS: MTT assay showed that Nef at the concentration of 5 ?mol?L~(-1) to 10 ?mol?L~(-1) have no cytotoxicity to parent human gastric carcinoma cell line (SGC7901) and its VCR-resistant variant cell line (SGC7901/VCR). The IC_(50) value of VCR to SGC7901 cell line was 0.06 mg?L~(-1)and that of to SGC7901/VCR cell line was 2.32 mg?L~(-1), which indicated SGC7901/VCR cell line were 39 times more resistant to VCR in comparison with the parent SGC7901 cell line. After treatment with Nef at the concentrations of 2.5, 5 and 10 ?mol?L~(-1), the IC_(50) value of VCR to SGC7901/VCR cell line decreased to 0.34, 0.12 and 0.05 mg?L~(-1), respectively and those increased by 6.8-, 18.1- and 43.8- fold in the chemosensitivity, respectively. Flow cytometry showed that SGC7901/VCR cells were resistant to apoptosis induced by VCR. After 24 h treatment with Nef (2.5, 5 and 10 ?mol?L~(-1)) and VCR, the apoptosis of SGC7901/VCR cells increased, which indicated Nef could abolish resistance of SGC7901/VCR cells to VCR-induced apoptosis. Furthermore, the action of Nef was more potent than verapamil. The expression of P-glycoprotein and multidrug resistance associated protein was strongly positive in SGC7901/VCR cells, and the expression level of P-gp and MRP in SGC701/VCR cells was significantly down-regulated at 24 h after treatment with Nef (10 ?mol?L~(-1)). CONCLUSIONS: Nef can reverse MDR in multidrug-resistant human gastric carcinoma SGC7901/VCR cell line. Its mechanism might be associated with down-regulation of expression of P-gp and MRP in SGC7901/VCR cells.

Objective To approach the design and clinical application of large anterolateral thigh flap and its effect in wound repair.Methods The flaps were designed according to the anatomical features of perforating branches in the anterolateral thigh flaps.When a flap was chipped,a thick branch or a terminal branch of original vessel was reserved,another suitable perforating branch was selected in the proximal or distal end of the flap,and then the two vessels were anastomosed to enlarge the range of blood supply.If the vessel pedicle of a flap was a musculocutaneous perforating branch,the perforating branch of anastomosis was cut at out-point of muscle.If the vessel pedicle of a flap was a intermusclar branch or a direct skin artery,the perforating branch of anastomosis was cut widely.From May 2006 to May 2012,the technique was applied in 28 patients with large skin defect of limbs.The diameters of perforating branches obtained at out-point of muscles were measured during surgery.The survival of flaps was observed after surgery and complications in donor sites were checked during follow-ups.Results There were 18 flaps whose vessel pedicle were musculocutaneous perforating branches.The branches were cut at outpoint of muscles.The diameters of these vessels were measured during surgery.They ranged from 1.3 mm to 1.8 mm with an average of 1.45 mm.All of the vessels could be anastomosed.All 28 flaps survived.All flaps survived.The areas of the flaps ranged from 22 cm × 15 cm to 42 cm × 14 cm.Artery crisis happened in 2 flaps whose vessel pedicle were musculocutaneous perforating branches.The second look operation found that the areas of artery anastomosis of perforating branches and vessel pedicles were compressed by hematoma and thrombus formed.The 2 flaps survived after the hematoma was cleared away and the vessels were reanastomosed.There were no infections.Both the donor and recipient site healed by first intention with no necrosis of flap margin.All 28 patients were followed up by 4-13 months with an average of 8 months.There were no apparent collapse deformities,muscle necrosis,declines of muscle strength and muscle hernia in the donor sites.The appearance of flaps was flat,the color was close to normal and the quality was fine.Conclusion It is a safe and effective method to repair wound surface by large anaterolateral thigh flap obtained by the modus operandi of perforating branch anastomosis.