Mechanical ventilation as an important treatment is widely used in clinical practice,the high inci-dence of ventilation lung injury in the course of operating it has been increasingly concerned.The basic mechanism, mechaical stress and high tidal volume machine stimulate lung cells,makes the inflammation in the cells changes,that is,it is from mechanical lung damage to biological injury.With the international and domestic in -depth researches on VILI,the application of control measures,like some medication treatment,ECMO,liquid ventilation have reduced the incidence of VILI to a certain extent,the occurrence mechanism and progress of treatment of VILI are reviewed briefly.

Objective To explore the nervous mechanism of intestinal function disorder after intestine congestion through observing the changes of acetylcholinesterase (AchE) neuron and nitric oxide synthase neuron (NOS) expression in nervous system of rat intestinal tract. Methods Sprague Dawley rats were divided into experimental groups (intestine congestion 20min and 60min group) and the control group. Then the spreading specimens of intestinal myen-teric plexus of ileums were collected and stained by AchE and nicotinamide-adenine dinucleotide phosphate-D (NADPH-d) histochemistry, to observe and compare the density of distribution and staining of AchE and NOS positive neurons. Result Compared to the control group, the number and positive expression of AchE positive neuron in intestinal myen-teric plexus of ileums in the experimental group rats decreased (P

Objective To observe the changes in enteric motor function and acetylcholine esterase(AchE)neuron and nitric oxide synthase neuron(NOS)in enteric nervous system after different abdominal operations,and to explore the mechanism of these changes.Methods Sprague Dawley rats were divided into experimental groups(laparotomy group,intestine massage group and intestinal operation group)and the control group.Rats in each group were gavaged with medicinal carbon powder,and then the transimission of carbon powder in small intestine was determined,and the spreading specimens of intestinal myenteric plexus of small intestine and large intestine were collected and stained with AchE and nicotinamide-adenine dinucleotide phosphate-D(NADPH-d)for histological study,and the density of distribution and positive stained AchE and NOS neurons were observed and compared.Results The changes in enteric motor function:the propellant rate of carbon powder was slower in enteric massage group and intestinal operation group than that in laparotomy group and control group(18.1?2.8,25.7?3.5 vs 47.4?3.6,49.8?4.5,P0.05).Compared with the control group,the number and positive expression of AchE positive neuron in intestinal myenteric plexus decreased in small intestine and large intestine in intestinal operation group and intestine massage group(small intestine 43.0?3.0,52.2?3.3 vs 65.3?3.9,P

Objective To observe the effects of CO2 pneumoperitoneum on the enteric motor function and acetylcholine esterase(AchE) neuron and nitric oxide synthase(NOS) neuron in the enteric nervous system,and explore the neuromechanism of the CO2 pneumoperitoneum on renteric motor function.Methods Thirty-six Sprague Dawley rats were randomly divided into experiment group(n=24) and control group(n=12).The experiment group was divided into two subgroups namely pneumoperitoneum 30min group and pneumoperitoneum 60min group(12 each) based on the maintenance time of pneumoperitoneum.Rats in each group were gavaged with medicinal carbon powder,and then the transmission of carbon powder in small intestine was determined.The spreading specimens of intestinal myenteric plexus of small intestine were prepared and the stained AchE and NOS neurons were observed and compared.Results The propellant velocity of carbon powder was slower in pneumoperitoneum 60min group than that in pneumoperitoneum 30min group and control group(28.55%?3.45% vs 45.90%?6.30%,48.25%?5.28%,P0.05).The number of positive expression of AchE neurons in intestinal myenteric plexus decreased in pneumoperitoneum 60min group compared with that in pneumoperitoneum 30min group and control group(48.00?3.16 vs 58.82?4.62,61.83?4.17,P0.05).The number of positive expression of NOS neurons in intestinal myenteric plexus increased in pneumoperitoneum 60min group compared with that in pneumoperitoneum 30min group and control group(42.17?4.45 vs 32.50?4.34,30.83?3.6,P0.05).Conclusions Prolonged CO2 pneumoperitoneum can affect or damage cholinergic neurons and nitroxidergic neurons in the enteric nervous system to some extent,and it may be the underlying mechanism of the intestinal motor dysfunction after operation.

Objective To investigate the clinical effect of modified anterior approach to manage fracture of the ulnar coronoid process via the space of brachial artery and vein with median nerve.Methods From June 2012 to January 2013,11 patients with ulnar coronoid fracture were fixed via the modified anterior approach.The operation time,intraoperative blood loss and postoperative complications were recorded.Flexion and rotation range of motion about the injured and normal elbow were observed during postoperative follow-up period.Function of elbow joint was evaluated by mayo elbow performance index (MEPI).Results There was approximate 8 cm in length and 5 cm in width between the brachial vessels and median nerve.Operated angle from radial to ulnar side was fifty degrees and from proximal to distal end was sixty degrees.All the patients were available for follow-up.The fracture healed,that is the elbow flexion restored [(130.7 ±5.0) °] was 96.6％ of the unaffected elbow,elbow extension restored [(7.6 ± 8.1) °] was 84.0％ of the unaffected elbow,pronation restored [(86.9 ± 3.8) °] was 98.2％ of the unaffected side,and supination restored [(85.6 ± 6.0) °] was 96.7％ of the unaffected side.MEPI of the elbow joint was over 75 points.Conclusion Modified anterior approach is relatively safe and simple in operation and results in satisfactory function recovery of the elbow joint,providing a new surgical approach for treatment of coronoid process fracture.

OBJECTIVE: To compare the hemostatic effects of local packing of Nasopore combined with hemocoagulase injection and local packing of Nasopore combined with saline injection for postoperative management of functional endoscopic sinus surgery by a double-blind, randomized control clinical trial. METHOD: Sixty-eight cases of chronic sinusitis needed functional endoscopic sinus surgery were randomly divided into the experimental group of 40 cases and control group of 28 cases, respectively. For the experimental group, 1 U of hemocoagulase dissolved in 0.5 ml saline was injected into Nasopore which was packed into the nasal cavity after operation. For the control group, 0.5 ml of saline was injected. The postoperative bleeding of the two groups were scored by visual analogue scale. RESULT: There was statistically significant difference between the bleeding VAS scores assessed 6 hours and the ones assessed 1, 2 and 3 days after the operation in the control group (P < 0.05). There was the statistically significant difference between the bleeding VAS scores of experimental group and control group assessed 6 h after the operation (P < 0.05). CONCLUSION The hemocoagulase may improve the hemostatic effect of Nasopore 6 hours after the operation by combined injection with Nasopore as nasal cavity packing.
Bandages ; Batroxobin ; administration & dosage ; Double-Blind Method ; Endoscopy ; Epistaxis ; therapy ; Female ; Humans ; Injections ; Male ; Nasal Cavity ; surgery ; Treatment Outcome

Objective To explore the clinical therapeutic effects of intravenous infusion of dihiazem in com-bination with metoprolol for treating aortic dissection. Method From June 2005 to January 2008, fourteen patients with aortic dissection (male 8, female 4) in the First Hospital of Yichang,were treated with diltiazen 1～5 μg/(kgrate 30 min,60 min, 120 min,6 h, 1 d and 7 d after treatment were recorded. All data were analyzed using self-matching t test. Results The heart rate reduced significantly 60 min after treatment. The heart rate reduced (21±5) beats/min from the baseline. The total effective rate was 100% .The blood pressure reduced significantly 30min after treatment. The systolic pressure reduced to (126.2±11.1 ) mmHg and diastolic pressure declined to (80.3±8.1) mmHg. No severe cardiac side-effect observed. Conclusions Dihiazem in combination with meto-prolol can reduce heart rate and blood pressure markedly and safely in aortic dissection patients.

Objective: To explore the relationship between myocardial ischemia and left ventricular diastolic function (LVDF) by fractional lfow reserve (FFR) evaluation in patients with coronary artery disease (CAD).
Methods: A total of 57 patients with chest pain were studied, the diagnosis of CAD was confirmed by coronary angiography, which indicated 50%-70%of coronary stenosis. All patients received FFR examination and they were divided into 2 groups:Experimental group, the patients with FFR<0.80, n=27 and Control group, the patients with FFR≥0.80, n=30. The basic condition and risk factors affecting LVDF were compared between 2 groups. Echocardiography was conducted for evaluating left ventricular end-diastolic dimension (LVEDD), left atrial dimension (LAD), left ventricular ejection fraction (LVEF) and E/e ' value in both groups.
Results: The patients’ gender, age, history of hypertension, diabetes, blood levels of cholesterol, TG, LDL-C, HDL-C and glucose were similar between 2 groups, P>0.05. Compared with Control group, the Experimental group had the increased LVEDD, LAD and E/e ' value and decreased LVEF, all P<0.05.
Conclusion: The impact of CAD on early diastolic function depends on functional myocardial ischemia in relevant patients.

Objective To explore the clinical application value of coronary angiography (CAG) combined with fractional flow re-serve(FFR) in percutaneous coronary intervention treatment of coronary artery disease (CAD) .Methods 82 cases of CAD(147 le-sions) with single hemadostenosis at least 70% -90% were randomized into the observation group and the control group .The ob-servation group(40 cases ,72 lesions) was performed the myocardial FFR detection by the pressure guide wire and the drug-eluting stents(DES) were placed in the lesions only if FFR ≤0 .80 .The patients with postoperative FFR ≤0 .80 were given the in-stent post-balloon dilatation .The control group(42 cases ,75 lesions) underwent the percutaneous coronary intervention(PCI) for conduc-ting the routine DES implantation .The general condition ,risk factors(hypertension ,diabetese ,hyperlipidemia ,smoking ,etc .) ,num-ber of lesions ,implanted stents ,hospitalization cost ,occurrence rate of major adverse cardiac events (MACE) after postoperative 6 months and the angina recurrence rate were compared between the two groups .Results The number of used stents per patient and the hospitalization cost in the observation group were significantly lower than those in the control group [(0 .88 ± 0 .88) vs .(1 .81 ± 0 .83) ,(47 200 ± 2 3000)Yuan vs .(60 000 ± 2 4100)Yuan P< 0 .05] .The two groups had no all-cause death in postoperative 6-months .The recurrent myocardial infarction rate ,revascularization rate and recurrent angina in the two groups were 2 .50% vs .0 , 2 .50% vs .2 .38% and 5 .00% vs .7 .14% respectively ,the differences had no statistical significance(P>0 .05) .Conclusion CAG combined with FFR detection can significantly reduce the number of stents and the hospitalization cost without increasing the occur-rence rates of MACE and angina within postoperative 6 months in CAD patients .

Objective To evaluate the efficacy of Disposcope endoscope(DE)-guided nasotrache-al intubation in patients with difficult airway by comparing with fiberoptic bronchoscope(FOB). Methods One hundred and twenty American Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both se-xes, with body mass index<25 kg∕m2, aged 18-64 yr, with mouth opening<3 cm, of Mallampati classifi-cation Ⅲ or Ⅳ, undergoing maxillofacial surgery requiring nasotracheal intubation were divided into DE group(n=60)and FOB group(n=60)using a random number table.Nasotracheal intubation was per-formed under the guidance of DE or FOB after induction of anesthesia.Glottis exposure was evaluated using Cormack-Lehane grade.Epistaxis during intubation, successful intubation, time and degree of glottis expo-sure, intubation time and development of tachycardia and hypertension and requirement for assisted ventila-tion with face mask during intubation were recorded.The patients were followed up postoperatively, and the development of intubation-related complications was also recorded.Results Compared with group FOB, glottis exposure time and incubation time were significantly shortened(P<0.05), and no significant change was found in Cormack-Lehane grade, rate of successful incubation, rate of successful intubation at first attempt or intubation-related complications in group DE(P>0.05). Hypertension and tachycardia were not found and no patients required assisted ventilation with face mask during intubation in the two groups.Conclusion DE-guided nasotracheal intubation provides similar efficacy to that of FOB with shorter time and is an optimal selection for the patients with difficult airway.