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 explore the application of Allostatic Load (AL) in evaluation the effect of management for patients with type 2 diabetes.Methods:According to the control objectives of each indicator in the Guidelines for the Prevention and Treatment of Type 2 Diabetes in China, the P75 and P80 of the subjects before intervention, AL was calculated, which were AL1-1, AL1-2 and AL1-3 respectively. On the basis of the above three indicators, the number of complications was taken as the numerical sum to obtain AL2-1, AL2-2 and AL2-3. Study participants were from a one-year randomized controlled intervention trial in patients with type 2 diabetes. Patients in the control group were treated with the integrated diabetes management mode used bg the tier-three medical institutions, while the intervention group added the intervention based on " Your Doctor" App on the basis of the above strategy. The changes of 6 types of AL and HbA 1C in the two groups before and after intervention were compared. Two groups of patients were treated with propensity score matching method to ensure the balanced distribution of covariates between groups. Multiple regression analysis was used to explore the factors influencing the effect of AL intervention. Two independent samples t-test, paired t-test and chi-square test were used to analyze the efficacy of the intervention. Results:After propensity score matching, the control group and the intervention group each included 483 patients. Among the six types of AL, the score of AL2-1 was the highest, while the score of AL1-3 was the lowest. Compared with baseline, all other indicators in the two groups decreased after intervention except ALL-3 in control group ( P<0.05).Patients who were residing in rural areas, having less co-habitants and more diabetic complications, and lower annual household income, shown higher AL ( P<0.05). The number of complications and the situation of urban or rural areas were the factors influencing the effect of AL intervention. Conclusions:More research is needed on AL as an early evaluation index of the effect of comprehensive management of diabetes.

OBJECTIVETo evaluate the effectiveness of hypnotic and musical relaxation therapy and psychological consultation for parents of children with cleft lip and/or palate (CLP) and to provide a scientific basis of clinical-psychological treatment options.

METHODSSixty-six subjects with children with CLP participated in this study. The subjects were randomly assigned to a test group (n = 33) and a control group (n = 33). The test group was treated with hypnotic and musical relaxation therapy; the control group were subjected to psychological consultation. Anxiety and depression states were evaluated by using a self-rating anxiety scale (SAS) and a self-rating depression scale (SDS) before and after treatment was administered.

RESULTS1) The test group demonstrated a significant decrease in SAS and SDS scores (t = 2.855, P < 0.01; t = 2.777, P < 0.01). The control group showed a significant decrease in the SAS score (t = 1.831, P < 0.05) but failed to show a significant change in the depression score (t = 0.909, P > 0.05). 2) The test group yielded a higher percentage of remission indicated by the SDS scores than the control group (test group = 75.76%; control group = 60.61%; P < 0.05). The test group also displayed a higher percentage of remission indicated by the SAS scores than the control group (test group = 78.79%, test group = 69.70%; P < 0.05).

CONCLUSIONHypnotic and musical relaxation therapy can more effectively reduce the scores of the anxiety and depression states of the parents of patients with cleft lip and/or palate than psychological consultation.

Anxiety ; psychology ; therapy ; Child ; Cleft Lip ; psychology ; Cleft Palate ; psychology ; Depression ; psychology ; therapy ; Humans ; Hypnosis ; Music ; Parents ; psychology ; Relaxation Therapy ; methods ; Self-Assessment

BACKGROUND: Studies have showed that Chengzai pill is of distinct significance in the treatment of steroid-induced osteonecrosis of femoral head through increasing bone mineral density, bone weight, bone strength and rigidity, it also reverses the low levels of estrogen. OBJECTIVE: To explore the effect of Chengzai pill on the genes of cell adhesion molecules on bone cells of steroid-induced ostaonecrotic rats, and to understand the role to resume normal blood transport in femoral head of steroid-induced osteonecrosis. DESIGN, TIME AND SETTING: Grouping controlled observation was performed in the Pharmacological Laboratory of Wangjing Hospital of China Academy of Chinese Medical Sciences and laboratory of CapitalBio Corporation between March and August in 2006. MATERIALS: Six male SD rats of 6 months old and weighing (280:1:20) g were used in this study. Chengzai pill was consisted of 22 Chinese medicines, such as Chinese Angelica, Eucommia Bark, Milkvetch Root, Barbary Wolfberry Fruit, Degelatined Deer-hom, Desertliving Cistanche, Eupolyphaga seu Steleophaga, Leech, Danshen Root and Himalayan Teasel Root, which were offered by Beijing Boran Pharmaceutical Co., Ltd. METHODS: The lipopolysaccharide and methylprednisolone were applied to prepare a rat model of steroid-induced osteonecrosis of femoral head. Six rats were divided into model group and Chengzai pill group at random with 3 rats in each group. The rats in the Chengzai pill group were administrated with methylprednisolone for the first time and then 1.5 g/kg Chengzai pill solution, once a day, totally for 6 weeks. The total RNA was extracted from femoral head in all rata 6 weeks later and then gene expression profiling was analyzed. MAIN OUTCOME MEASURES: Gene action pathway of cell adhesion molecules in gene expression profile. RESULTS: Compared with model rats, there were totally 8 downregulated genes of cell adhesion molecules which changed by a minimum of 1.5 folds in cell adhesion molecules pathway of Chengzai pill group, three rats were present with 633 genes (506 down-regulated and 127 up-regulated), 883 genes (640 down-regulated and 243 up-regulated) and 593 genes (408 down-regulated and 185 up-regulated), respectively. MAS software classification analysis showed 79 action pathways were involved in 297 genes.CONCLUSION: Following Chengzai pill administration, those downregulated genes recover the cognitive functions of macrophage and target cell in rats, also renew the normal survival condition of epithelial cells including vascular endothelial cells. Cell adhesion molecules action pathway returns to normal levels. This is the key to resume normal blood transport in femoral head of steroid-induced osteonecrosis.

Objective To assay the protective effect of endothelial progenitor cells (EPCs) on acute lung injury (ALI) in rabbits.Methods Forty male New Zealand rabbits were divided into EPCs low-dose group,EPCs mid-dose group,EPCs high-dose group,ALI group,and control group according to the random number table,with 8 rabbits per group.Emulsified oleic acid was used to induce ALl.Instead,saline emulsion was injected to rabbits in control group.PBS containing 1 × 105,1 × 106,and 1 ×107 EPCs were respectively administered to rabbits in EPCs low-dose,mid-dose,and high-dose groups; on the contrary,blank PBS was injected to rabbits in ALI and control groups.Lung weight to dry ratio (W/D) and pulmonary permeability index (PPI) were detected before and after operation; protein expressions of TNF-α and IL-1 βby western blot,and mRNA expression of NF-κB by RT-PCR.Results PPI and W/D value lowered in EPCs low-dose group (15.0 ± 1.1,5.04 ± 0.11),mid-dose group (13.8 ± 0.7,4.80 ± 0.13),and high-dose group (13.7 ± 0.7,4.87 ± 0.08) when compared to 17.1 ± 1.5 and 5.21 ±0.05 in ALI group (P ＜0.05).EPCs low-dose,mid-dose,and high-dose groups showed decreased levels in NF-κB (0.75 ± 0.04,0.41 ± 0.05,0.42 ± 0.03),TNF-α (0.364 ± 0.020,0.312 ±0.015,0.310 ±0.013),and IL-1β (0.230 ±0.017,0.206 ±0.010,0.210 ±0.018) compared to ALI group (0.87 ±0.11,0.387 ±0.018,0.262 ±0.019,P ＜0.05).Moreover,all indicators were lowered significantly in EPCs mid-dose and high-dose groups when compared to EPCs low-dose (P ＜0.05),but the two groups themselves revealed no statistical difference.Conclusion EPCs protect ALI via improving pulmonary edema,pulmonary permeability,and inflammatory response in a dose-dependent correlation with EPCs,but ceiling effect is observed as well.

Objective To explore a method for earlier evaluating death toll based on a function relationship ( an increasing hour-increasing death index ( K value) followed with time (T) changing after catastrophic earthquake. Methods Information data of 10 typical occurrences of catastrophic earthquake obtained from China International Search and Rescue Team (CISAR) were analyzed. Total deaths were estimated according to the simulation function made by hour-increasing death index (K value) followed with time (T) changing. Expected value of the simulation function was assessed by statistical software SPSS version 17.0 to establish the model of simulation function.Results The length of time (T) to reach K maximum (Kmmax) was ( 12.94 ± 8.18) h and then the K value was gradually decreased. Kmax was symmetrically scattered within 2 T time.Estimated death toll (W) within 2 T was obtained from calculating the integration summation of the function to get a formula as W =∫∞ kf(t) dt.This Estimated death toll(W) numbers was correlated approximately with the death toll (M) from authoritative report (P ＜ 0.01 ).According to the regression analysis of model simulation curve,the predictive function of death toll within 2 T was M =W1.23 ×0.194.A determinant coefficient of this power function R2 was 0.88. Conclusions Earlier estimating death toll within about 12 h should be carried out by using the data of real-time information report system.

With the continuously exploration,in recent years,further understanding of anatomical characteristics of the cervical pedicle brings great breakthrough in cervical pedicle screw implantation.In addition,pedicle screw implantation in cervical spine is considered as a technique with high safety and reliability,which can be widely used in cervical trauma fracture,cervical instability,degenerative,inflammatory,benign or malignant tumor,deformity and other neck diseases.Because of the tremendous differences between upper cervical spine (C1,C2) and lower cervical spine (C3-7) in anatomical morphology,cervical pedicle screw implantation in C1 and C2 differs from in lower cervical spine.Due to the similar structure of C3-7,pedicle screw implantation methods are based on the same principle and sharing a few points in common.The pedicle screw technique can be classified in two groups according to the practice methods:navigation technology and manual placement of cervical pedicle screw.Navigation nailing is considered as reliable,easy handing,and with clear operative vision,however,with disadvantages as complex procedures,highly cost operation equipment,and risk in navigation draft.Therefore,manual placement of pedicle screw is more reasonable and practical comparing with the former.In this study,it analyzed anatomical characteristics of lower cervical pedicle and the measurement of pedicle structure,discussed technique of manual placement of pedicle screw in lower cervical spine and biomechanical study of pedicle screw,and summed up the comparison of the advantages and disadvantages of current representative manual placement technology.

Objective To investigate the clinical efficacy of sequential nasal flow ventilation after extubation in patients with acute respiratory failure (referred to as respiratory failure).First of all,before and after extubation in HFNCO group,the respiratory parameters (PaO2,PaCO2,pH,lactic acid value,oxygenation index,HR,RR and LVEF) were compared with each other.The circulatory parameters (PaO2,PaCO2,pH,lactate,oxygenation index,HR,RR),clinical outcomes at the end of treatment / comorbidities (delirium,diarrhea,reintubation,ICU stay after extubation).Methods PaO2,PaCO2,pH value,lactate value at 1 h,6 h,12 h and 24 h after extubation in HFNCO group were not significantly different from those before extubation (all P＞ 0.05) (P ＜0.05).The LVEF of patients after extubation was slightly higher than that before extubation (0.59 ± 0.09 vs.0.60 ± 0.09),and the difference was not statistically significant Significance (P＞ 0.05).PaO2,PaCO2,pH and lactate value in HFNCO group and NIV group at 1 h,6 h,12 h and 24 h after extubation showed no significant difference (all P＞ 0.05).The effect of HFNCO on improving the oxygenation index after extubation was better than that of NPV group (P ＜0.05).HR and RR before extubation were higher or higher in HFNCO group than those in NPV group lower HR,RR better (P ＜0.05).The incidence of diarrhea (33.33％ vs.38.89％) and reintubation rate (6.1％ vs 13.9％) in HFNCO group were lower than those in NIV group (38.89％),but the difference was not statistically significant (all P＞ 0.05).The incidence of delirium in HFNCO group (18.18％ vs.41.67％) and ICU stay time after extubation (2.00 to 3.50) were statistically significant (all P ＜0.05).Results There were no significant differences in the arterial blood gas analysis (PaO2,PaCO2,pH,lactate value),PaO2,PaCO2,pH value,lactate value and LVEF at 1 h,6 h,12 h and 24 h before and after extubation in HFNCO group (all P＞ 0.05) Slightly higher than before extubation (0.59 ± 0.09 vs.0.60 ± 0.09),the difference was not statistically significant (P＞ 0.05).PaO2,PaCO2,pH and lactate value in HFNCO group and NIV group at 1 h,6 h,12 h and 24 h after extubation showed no significant difference (all P＞ 0.05).The incidence of diarrhea (33.33％ vs.38.89％) and reintubation rate (6.1％ vs.13.9％) in HFNCO group were lower than those in NIV group (38.89％),but the difference was not statistically significant (all P＞ 0.05).The incidence of delirium (18.18％ vs.41.67％),and ICU stay time (2.00 to 3.50) in HFNCO group were significantly lower than those in NIV group (all P＜0.05).Conclusions For acute respiratory failure patients after mechanical ventilation extubation,sequential administration of HFNCO and NIV can provide stable and effective oxygen therapy support;relative to the NIV,HFNCO can effectively improve patients oxygenation index,improve patient comfort and reduce the incidence of delirium And ICU stay time.

Objective To investigate the effect of trunk control on the biomechanical characteristics of lower limb movements during Asian squats(AS)and Western squats(WS)in young adults to provide empirical support for the application and promotion of deep squat training.Methods Twenty-four healthy young male collegiate students performed AS and WS with and without bar control,and their lower limb kinematic and kinetic characteristics were collected using an infrared light-point motion capture system and a three-dimensional(3D)dynamometer.The 3D angles of the lower limbs were obtained using Cortex-642.6.2 software,based on the calculation of Euler angles,and the 3D moments were obtained by applying the inverse dynamics method.The effects of trunk control and deep squatting posture on the lower limb kinematic characteristics were examined using a two-factor analysis of variance with a 2×2 repeated design.Results There was no significant interaction between trunk control and the deep squatting posture for either kinematic or kinetic parameters(P>0.05).The WS group had a large knee flexion angle,peak patellofemoral contact force,and ratio of peak hip and knee extension moments,and small ankle dorsiflexion and hip flexion angles(P<0.05).The deep squat with a bar had a large ankle dorsiflexion angle,peak patellofemoral contact force,and hip flexion angle as well as a small knee flexion angle and ratio of peak hip and knee extension moments(P<0.05).Conclusions WS is helpful for training hip extension muscle groups,whereas AS is helpful for training knee extension muscle strength.The peak patellofemoral joint contact force of the WS is significantly greater than that of the AS;therefore,it is recommended that patients with patellofemoral joint pain use the AS.A squat with a bar can compensate for the body's balance;thus,people with limited ankle dorsiflexion range of motion or anterior tibial muscle weakness may consider trunk control training,such as a deep squat with a bar.This may help improve lower limb stability during squats.

Objective To evaluate the efficacy of one stage anterior debridement combined with posterior pedicle screw fixation in the treatment of cervical intervertebral space infection.Methods From June 2010 to June 2016,28 cases were fixed by anterior debridement combined with the posterior vertebral pedicle screws for the cervical intervertebral space infection,19 males and 9 females.The average age was 45-74 years (58±14.5 years old).21 cases (75％) were spontaneous infection,of which 6 cases were diabetes mellitus,15 cases were over 60 years old.The remaining 7 cases (25％) were intervertebral space infection after radiofrequency ablation of the cervical spine.All patients were excluded from tuberculosis and Brucella infection.All patients underwent hematological examination,with emphasis on WBC,ESP and CRP.All patients received JOA score before operation,applied antibiotic according to blood culture and drug sensitive test.All patients underwent one stage anterior debridement combined with posterior pedicle screw fixation,and the operative time and bleeding volume were recorded.After the operation,intravenous antibiotic therapy was continued,and the application of antibiotics was guided according to the results of ESP and CRP,and the time for the application of antibiotics was recorded.Follow up was performed at 3 months,6 months and 1 years after operation respectively.The JOA score and postoperative cervical lordosis Cobb angle were recorded.Results All operations were successfully completed in this group.The operation time was 130-225 min,with an average of 145.5±12.7 min.The intraoperative blood loss was 40-100 ml,with an average of 67±35.2 ml.The incision was healed in one stage.The time of application of antibiotics in 28 patients was 21-87 days,with an average of 30.8±8.7 days.The longest application time of antibiotics was 87 days,and no relapse was found during follow-up.The postoperative JOA score increased from 11.3± 1.2 to three months 14.9 ± 1.96 postoperatively and 6 months 15.1 ± 1.55 and 1 years 16.5±0.48 after operation.The JOA score was significantly higher than that before operation.No significant loss and change of the Cobb angle in the cervical spine surgery were found.All cases had good bone graft fusion at 1 years.Conclusion One stage anterior debridement combined with posterior pedicle screw fixation is a safe and effective method for the treatment of cervical vertebra instability and nerve function injury caused by cervical intervertebral space infection.It provides a new way for the treatment of cervical intervertebral space infection.