Objective To explore the best plan of perioperative individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery.Methods Eighty elderly patients with coronary heart disease undergoing gastrointestinal surgery were divided into experimental group and control group by random digits table method with 40 cases each.Conventional capcity treatment was given during surgery and postoperative period in control group.Individualized fluid therapy was used during surgery and postoperative period in intensive care unit of 24 h in experimental group,which was determined based on target controlled fluid therapy according to the cardiac index,stroke volume,and stroke volume variation.Traditional fluid therapy was used in control group in the intraoperative and postoperative period.The two groups were compared in terms of postoperative hemodynamic parameters,total fluid volume,incidence of adverse cardiac events,and recovery of gastrointestinal function.Results The mean arterial pressure at the beginning of the operation,the cardiac index at operation begining 1 h and at the end of operation were (80.4 ± 6.4) mmHg (1 mmHg =0.133 kPa),(4.0 ± 0.6) L/(min ·m2),(4.1 ± 0.8) L/(min ·m2) in experimental group and (76.9 ± 8.0) mmHg,(3.5 ± 0.4) L/(min· m2),(3.6 ± 0.3) L/(min · mè) in control group,and there were significant differences between two groups (P ＜ 0.05).During surgery and 24±hour stay in intensive care unit,the total fluid volume,crystal usage,urine and colloid usage were (2 915 ± 650),(2 715 ± 415),(1 515 ± 315),(1 225 ± 385),(419 ± 233),(619 ± 285),(1 015 ± 220),(1 535 ± 455) ml in experimental group and (3 645 ±770),(3 355 ±750),(2 315 ±320),(1 855 ±325),(602 ±31),(875 ±423),(805 ±250),(1 135 ± 205) ml in control group,and there were significant differences between two groups (P ＜ 0.05).The perioperative adverse cardiac events rate was 30％ (12/40) in experimental group,lower than 45％ (18/40) in control group,but the difference was no statistically significance (P ＞ 0.05).Conclusion In the elderly patients with coronary artery disease undergoing gastrointestinal surgery,individualized fluid therapy can effectively decrease adverse cardiac events,improve postoperative gastrointestinal function,and reduce length of hospital stay.

Objective To investigate the serum levels of soluble CD23 ( sCD23 ) and thrombopeietin (TPO) in chronic lymphocytic leukemia (CLL) and their correlation with other prognostic factors. Methods The serum levels of sCD23 and TPO of 25 CLL patients were detected with enzyme linked immunosorbent assay. Flow cytometry was employed to determine the expression of CD38 and ZAP-70 protein. Results TPO level in CLL patients was significantly higher than that in normal controls 67.22 - 1881.77 ng/L and 70. 29 - 147. 98 ng/L respectively, P =0. 003. sCD23 level in CLL patients was significantly higher than that in normal controls 129. 80-405. 31 U/ml and 0. 65 -32. 99 U/ml respectively, P =0. 000. TPO level was significantly correlated with Binet stage and CD38 expression. Patients in stage B and C had higher level of TPO than those in stage A 140. 57 -457.48 ng/L and 121.92 - 163.83 ng/L respectively, P =0.014,while TPO level was higher in patients with higher CD38 expression than in patients lower CD38 expression 113.23- 199. 10 ng/L and 141.34 -454. 92 ng/L respectively, P = 0. 033. No significant correlation of sCD23 and TPO levels with ZAP-70 protein, sex, age, peripheral lymphocyte count and lactate dehydrogenase were observed. Conclusion Serum TPO level might be a prognostic factor in CLL.

BACKGROUND:As the potent, specific immunosuppressants emerge, the survival rate after intestinal transplantation is improved to some extent. However, the adverse effects of immunosuppressants and expensive treatment costs are not tolerable for many patients. Therefore, it is clinical y meaningful to choose traditional Chinese medicine which presents immunosuppressive effects. Artesunate has immune suppression effect, reduces acute rejection fol owing smal intestine transplantation, and improves the success rate of smal intestine transplantation.
OBJECTIVE:To observe the effect and action mechanism of artesunate in acute rejection after smal intestine transplantation in rats.
METHODS:Al ogeneic smal intestine transplantation models were established in the closed group of
Sprague-Dawley rats and Wistar rats, and then were randomly divided into three groups, syngenic transplantation group (SD→SD), al ogeneic transplantation group (Wistar→SD), and artesunate treatment group (Wistar→SD+artesunate 60 mg/kg per day, intraperitoneal injection).
RESULTS AND CONCLUSION:Rats in syngenic transplantation group survived for more than 10 days and they were al kil ed on day 10. The average survival of rats in al ogeneic transplantation group and artesunate treatment group was respectively (6.73±0.58) days and (8.50±0.74) days, with significant differences between the two groups (P<0.01). Histopathological examination showed that, there was no apparent rejection in syngenic transplantation group specimens, but mild, moderate and severe rejections in al ogeneic transplantation group on days 3, 5, 7. In treatment group, some specimens had mild rejection, but appeared relatively late to a low degree. Enzyme linked immunosorbent assay results revealed that, serum interleukin-2 and interferon-gamma expression levels in al ogeneic transplantation group were significantly higher than other two groups after surgery (P<0.01), serum interleukin-2 gene expression level in treatment group was also higher than syngenic transplantation group, but there was no significant difference (P>0.05), serum interferon-gamma expression level in treatment group was higher than syngenic transplantation group (P<0.05). Artesunate can inhibit acute rejection after rat smal intestine transplantation, and its mechanism may be related to inhibition effect on the secretion and expression of interleukin-2, interferon-gamma and other cytokines.

Objective To evaluate the application value of confocal laser scanning microscopy(CLSM)in the differentiation between seborrheic keratosis and Bowen′s disease. Methods CLSM was used to observe typical skin lesions in 88 patients clinically diagnosed with seborrheic keratosis and 18 patients clinically diagnosed with Bowen′s disease. Then, tissue specimens were resected from these lesions and subjected to histopathological examination. Results CLSM imaging of seborrheic keratosis lesions showed gyrus?like structures and keratin?filled inclusion cysts in the epidermis with trabecula?like extension of rete ridges in all the 88 cases, basal cells arranged in a cordike or radial pattern in 9 cases, and bright reflective structures in the basal layer and dermis in 6 cases. CLSM imaging of Bowen′s disease lesions revealed disorderly arrangement of large, irregularly shaped atypical cells in some areas in the middle and lower epidermis, and infiltration of scattered mononuclear cells in the superficial dermis. Conclusion CLSM images of seborrheic keratosis are different from those of Bowen′s disease, and CLSM may be helpful for their differential diagnosis.

Using the method of stratified random cluster sampling,8 996 elderly hypertensive patients in community were selected in the study.Patients entered the community-based hypertension program receiving stratified management,individualized treatment and health education.After 3 years of intervention,the disease awareness rate,treatment compliance rate and hypertensive control rate were increased from 68.30％,55.40％ and 38.60％ to 98.90％,86.70％ and 77.80％,respectively (P ＜0.05).The systolic and diastolic pressure,body mass index,triglyceride levels and other hypertensionrelated indicators were improved significantly,the number of individuals with obesity/overweight,smoking and drinking were decreased and those with regular exercise increased (all P ＜ 0.05).The results indicate that community-based comprehensive hypertension management is effective for hypertension control for elderly patients in community.

Objective From October 2010 to explore the current situation of hypertension control and its influencing factors among geriatric patients in Hangzhou,Jiaxing and Shaoxing in Zhejiang province.Methods To April 2011,10 644 geriatric patients aged 60 years and over were included,and related questionnaire survey,physical examination and laboratory examination were carried out.The situation of hypertension control and influencing factors were analyzed.Results The control rate of hypertension was 38.6％,and its standardized rate was 27.6％.It showed that female,inhabited city,high level of education degree and regular exercise were positively correlated with hypertension control,while age,smoking,high salt diet and abdominal obesity were negatively correlated with hypertension control,and standardized treatment had a close relationship with hypertension control.Conclusions The situations of hypertensive control among geriatric patients in Hangzhou,Jiaxing,Shaoxing in Zhejiang province are still unsatisfactory.Strengthening standardization management measures for improving the control rate of hypertension is needed and has actual value.

BACKGROUND:Studies on basic research of magnetic treatment of limb ischemic disease are not much, because poor compliance of animals and the stability of the magnetic field strength are difficult to control, resulting in big experimental error and decreased credibility of the results. For this kind of problem, experimental study on low-frequency electromagnetic magnetic cages for treatment of ischemic limbs was conducted, thus overcoming the two major issues of poor compliance of animals and difficult control of the stability of magnetic field strength.
OBJECTIVE:To investigate the effects of self-made low-frequency magnetic fields of rabbit cages on neovascular growth-promoting factor of rabbits with limb ischemia.
METHODS:A total of 96 rabbit models of atherosclerosis were constructed, numbered and randomly divided into ischemia group and non-ischemia group (12 treatment combination in each group). Experiments in each group were performed four times according to the requirement of factorial design. Electromagnetic field intensity factor A (0, 3, 6, 12 mT) and the time factor B (3, 5, 7 days) were set.
RESULTS AND CONCLUSION:Low-frequency magnetic field could apparently promote hypoxia inducible factor-1α, vascular endothelial growth factor and CD34 expression in ischemic limb of rabbits. Electromagnetic field intensity factor A was a key factor for contributing to the expression of hypoxia inducible factor-1α, vascular endothelial growth factor and CD34, and the time factor B was secondary factor. Low-frequency magnetic field also promoted hypoxia inducible factor-1αexpression in non-ischemia limb, but did not promote vascular endothelial growth factor and CD34 expression. Thus, the expression of vascular endothelial growth factor and CD34 was regulated by hypoxia inducible factor-1α, as wel as other factors, in the ischemic state.

Objective To study the effects of rehabilitation training on learning and memory ability and the expression of growth-associated protein-43(GAP-43)in rats with vascular dementia.Methods Forty-four female Sprague-Dawley rats were randomly assigned to a rehabilitation group(n=20),an immobilization group(n=20),and a sham-operation group(n=4).The rats in the former 2 groups were operated on to establish the experimental vascular dementia model by repeatedly ischemia/reperfusion injury of brain induced by ligation of bilateral common carotid arteries and lowering of blood pressure induced by intraabdominal injection of sodium nitroprusside.The rats in rehabilitation group were administered with rotating bar and rolling cage exercises for 1 hour once daily,while those in the immobilization group were immobilized and without any exercise:the rats in sham-operation group could move freely in cage.Learning and memory tests were preformed by using step-down avoidance test at the 27th and 28th days after operation.Immunohistochemical staining was used to detect GAP-43 expression in hippocampus CA1 area at different time points after operation. Results The rats in rehabilitation group demonstrated better learning and memory ability than those in immobilization group(P<0.01),and more GAP-43 expression in hippocampus CA1 ar-ea than those in immobilization group and sham-operation(P<0.01).Conclusion Rehabilitation training can im-prove the learning and memory ability of rats with experimental vascular dementia,and the mechanism is probably re-lated to the increase of GAP-43 in hippocampus CA1 area.

Objective To investigate the effect of rehabilitation training on learning and memory ability and the expression of neural cell adhesion molecule(NCAM)in rats modeling vascular dementia.Methods Foay-five female Sprague-Dawley rats were randomly assigned to a rehabilitation group(20 rats),an immobilization group(20 rats),or a sham-operation group(5 rats).The experimental vascular dementia model was established by repeatedly clipping the common carotid artery to induce repetitive isehemia-reperfusion,and by reducing blood pressure with intra-abdominal injection of sodium nitroprusside.The rats' learning and memory were tested on the 27th and 28th days after the operation using a water-maze step-down avoidance test.A RT-PCR technique was used to detect NCAM expression around the hippocampal area at different times after the operation.Results The rehabilitation group rats showed significantly better learning and memory ability than those in the immobilization group.NCAM was also more strongly expressed in their hippocampi than in those of the immobilization group and sham-operation group.Conclusion Rehabilitation can accelerate recovery of learning and memory ability in rats,and the mechanism possibly is related to the increase of NCAM expression in the hippocampus.

Objective To evaluate the MR perfusion imaging in measuring the hemodynamics of liver.MethodsCT and MR perfusion imaging were performed in livers of 13 pigs.The hepatic artery perfusion(HAP),portal vein perfusion(PVP),total hepatic blood flow(THBF),portal vein perfusion index(PVI),distribution volume(DV)and mean transit time(MTT)were calculated and compared respectively.Hemodynamics of the liver from two kinds of imaging was compared by paked t-test,and the relativity was analyzed by Pearson correlation analysis.ResultsIn CT and MR perfusion imaging of the 13 pigs:the hepatic artery perfusion(HAP)were(37.7±7.38)and(35.80±7.31)ml-min-1·100ml-1.the portal vein perfusion(PVP)were(123.16 35.89)and(121.40±36.81)ml·min-1·100 ml-1.the total hepatic blood flow(THBF)were(160.88±37.05)and(157.21±38.71)ml·min-1·100 ml-1.the portal vein perfusion index(PVI)were(75.95±5.21)%and(76.63±5.24)%,the distilbution volume(DV)were(35.10±11.17)%and(41.03±10.06)%。The mean transit time(MTT)were(14.08±1.40)and(14.94±1.32)s.There were no statistical differences for HAP,PVP,THBF and PVI between CT and MR perfusion imaging(t=1.263,0.926,1.225,-1.115,P＞0.05).There were no statistical differences for DV and MTT(t=-3.345,-3.200,P＜0.01).Analysis of these two kinds of imaging showed the correlation coefficient of PVP,THBF and PVI were hishly related(r＞0.85,P＜0.01).Correlation coefficient of HAP,DV and M1T were moderately related(r＞0.70,P＜0.01).ConclusionsMR perfusion Call quantify the blood flow parameters of liver accurately.It is close to that of the CT perfusion imaging.