Objective To study the sedation efficacy of propofol combined with midazolam and /or fentanyl in fibreoptic choledochoscope. Methods Ninty outpatients were randomly divided into three groups. Group PF (n=31)was given fentanyl 0. 05 m.g plus propofol 1 mg/kg intravenously, group PM (n=29) midazolam 2 mg plus propofol 1 mg/kg, and group PMF(n=30) fentanyl 0. 05 mg, midazolam 2 mg and propofol 1 mg/kg. Propofol 20 mg was used when needed. HR,MAP,SpO_2,sedation scores and amnesia were recorded. Results All patients were awakened in 20 minutes after procedures. The recovery time was shorter in group PF than that in the other two groups. There were 21(67. 70%) patients in group PF, who were aware of surgery. Fifteen(48. 4%) patients were satisfied in group PF. Conclusion Propofol combined with midazolam and /or fentanyl in fibreoptic choledochoscope has better sedation without any obvious side effects.

Objective To investigate the changes in cerebral cAMP and PKA levels during development of acute opioid tolerance induced by remifentanil and to determine whether post-receptor cAMP/PKA signaling pathway is involved in the process. Methods Fifty-six male Kunming mice weighing 25-35 g were randomly divided into 5 groups: group Ⅰ control (C) (n=8); group Ⅱ received morphine infused intraperitoneally (IP) at 0.6 μg'kg-1·min-1 for 120min(M) (n=8); group Ⅲ,Ⅳ,Ⅴ received remifentnil infused IP at 0.4, 0.8 and 1.6 μg·kg-1·min-1 for 120 min(R1=8, R2n=8; R3 n=24).Control group received IP infusion of normal saline. Tail-flick test was performed td measure the response of animals to a thermal nociceptive stimulus before IP infusion, at 30, 60, 90 and 120 min after beginning of IP infusion and at 15, 30, 45 and 60 min after termination of IP infusion. Eight animals were decapitated at 60 min after termination of IP infusion in all 5 groups and the other 16 animals in group R3 were decapitated at 30 and 45 min after termination of IP infusion (n=8 each) for determination of intracellular contents of cAMP and activities of PKA in cerebral cortex and inferior colliculus-striatum by ELISA or radioactive isotope [32p,] ATP-catalyzing assay. Results The tail-flick latency was significantly prolonged during IP infusion as compared with the baseline before infusion in group M, R1 , R2 and R3 but became significantly shorter at 30 and 45 min after infusion than the baseline values in group R1, R2 and R3indicating hyperalgesia after remifentauil infusion. The cerebral contents of cAMP and PKA activities at 60 min after termination of infusion were comparable or decreased in group M, R1, R2 and R3 as compared with group C. There was no significant difference in cerebral cAMP contents and PKA activities at 30, 60 and 45 min after IP remifentanil infusion in group R3. Conclusion Remifentanil can induce acute hyperalgesic effect on mice, and there is no up-regulation of post-receptor cAMP/PKA signaling pathway in the acute opioid tolerance, which is not similar to that chronic opioid tolerance.

Objective: To study the effects of the different doses of midazolam in fibreoptic gastroscopy on sedation, respiratory and circulatory function. Method: One hundred and four outpatients undergoing fibreoptic gastroscopy were randomly divided into four groups. The control group(N)was not given drugs, the other groups were intravenously given midazolam 0.07mg/kg(MS),0.05mg/kg(M),diazepam 10mg(D)respectively. The sedative scores, symptom, amnesia,HR,MAP and blood gases were observed. Result: The sedative scores of MS,M and D groups were much better than that of control group. There were significant differences in sedative scores,amnesia and sedative period between MS group and D group or M group. MAP decreased one minute after administering the drugs in MS,D and M groups significantly. The results of blood gases analysis of all groups were in normal ranges. Conclusion: Midazolam 0.07mg/kg can produce safe and effective sedation for fibreoptic gastroscopy.

Laparoscopic anatomical hepatectomy of segment 7 is recognized as one of the most difficult hepatectomies. Because of its location and anatomic characteristics, the resection of hepatic segment 7 has the difficulties of poor surgical view, instrumental accessibility, hepatic pedicle anatomy, confirmation of dividing line and secure hemostasis. When performing laparoscopic anatomical hepatectomy of segment 7, the authors routinely put patient at left semi-decubitus position, set all trocars at the right upper quadrant of the abdomen, and select proper approach for hepatic pedicle anatomy according to the results of individualized preoperative three-dimensional reconstruction. The authors use to transect the liver parenchyma at the plane between hepatic segment 6 and segment 7, with the direction perpendicular to the right hepatic vein, and then finish parenchymal dissection using right hepatic vein as the intrahepatic landmark. According to the authors experiences, choosing appropriate tactics can effectively reduce the difficulty of laparoscopic anatomical hepatectomy of segment 7, improve the safety and controllability of operation, and ensure the oncological radical effects.

Objective To evaluate the therapeutic effect of Yin-Huang pills combined with Banlangen granule therapy on upper respiratory infection.Methods 120 cases of acute upper respiratory infection were randomly separated into an experiment group and a control group.The experiment group was treated by Yin-Huang pills combined with Banlangen granule;while the control group was treated by Yin-Huang pills.Results There was significant difference of cure rate between the experiment group(75%)and the control group(51.6%),with P＜0.01.There was no significant difference of total effective rate between the experiment group(96.6%)and the control group(88.3%),with P＞0.05.Conclusion Yin-Huang pills combined with Banlangen granule therapy was more effective in controlling acute upper respiratory infection,and this therapy caused few adverse effects.

Objective To evaluate the correlation between the dynamic enhanced CT signs of hepatocellual carcinoma(HCC),MVD and VEGF expressions in hepatocellular carcinoma.Methods The MVD and VEGF expression were examined by means of SP immunohistochemical technique in 45 cases of HCC proved by pathology.All patients were examined by plain and contrast-enhanced CT.Results(1)The relation of pathologic grade,MVD and VEGF:the MVD in HCC of grade Ⅰ,Ⅱ,Ⅲ,Ⅳ were 22.9 ± 12.6,36.7 ±16.2,51.1±17.3,67.8±21.4,VEGF positive rates in HCC of grade Ⅰ,Ⅱ,Ⅲ and Ⅳ were 28.6%(2/7),53.3%(8/15),90.9%(10/11)and 100.0%(12/12).The pathologic grading of HCC was positively correlated with MVD and VEGF expression,in grade Ⅰ and grade Ⅲ～Ⅳ,Ⅱ and grade Ⅳ(P＜0.05).There were no statistical correlation between Ⅰ and Ⅱ,Ⅱ and Ⅲ or between Ⅲ and Ⅳ(P＞0.05).(2)There were three blood supply types in HCC at contrast-enhanced CT,the MVD ad VEGF positive rates were 70.6±22.9 and 85.l%(23/27)in tumors with arterial blood,65.7±21.6 and 63.6%(7/11)in those with double blood supply,and 25.1±13.5 and 28.6%(2/7)in those with poor blood supply.There was statistical difference(P＞0.05)in VEGF expression between the tumors with arterial blood,arterial combining with double blood supply and poorly blood supply.In HCC with arterial and double blood supply,MVD expression level was higher than that with poor blood supplies(P＜0.01).Conclusion MVD and VEGF expression can reflect the tumor's cell differentiation of HCC in a certain degree.

Objective To investigate the effect of operation timing on patients with rheumatic mitral stenosis underwent valve replacement during perioperative period.Methods Retrospective analysis were performed on 122 cases diagnosed as rheumatic mitral stenosis (mitral stenosis,MS) underwent valve replacement,during January 2012 through December 2013 in the Department of Cardiovascular Surgery,General Hospital of Shenyang military region.According to the mitral valve area (mitral valve area,MVA) measured by echocardiography before operation,patients were respectively divided into three groups,mild stenosis (＞ 1.5 cm2),moderate stenosis (1.0 ～ 1.5 cm2),and severe stenosis (＜ 1.0 cm2).Through the single factor and multi-factor logistic regression analysis on all clinical data collected from patients,the effects of operation timing on patients were confirmed in perioperative period in each group.Results The results were satisfied in the group.Heart function was significantly raised compared to that before surgery,and the life quality of the patients was improved.Two cases died during hospitalization,New York Heart Association Functional Class (NYHA) reached between Ⅰ ～ Ⅱ,Ⅱ,perhaps Ⅰ for survival.Single factor analysis showed that the pulmonary arterial systolic pressure (pulmonary arterial systolic pressure,PASP),left ventricular end diastolic volume,mitral valve area,cardiothoracic ratio,intensive care unit (ICU) staying,ventilator-assistant during hospitalization were influence factors on surgical opportunity of patients with rheumatic mitral stenosis and perioperative outcomes.Multivariate logistic regression analysis showed that pulmonary artery pressure and mitral valve orifice area were the independent influence factors on surgical timing by collecting perioperative outcomes in the groups.Conclusions Mitral valve replacement (mitral valve replacement,MVR) is an effective method in the treatment of rheumatic mitral stenosis.Timely operation can improve the prognosis of patients in the perioperative period,and help to improve the quality of life.Early treatment should be an important factor affecting the perioperative prognosis.Timely operation,early treatment may improve the patient's survival during perioperative period.

Objective To investigate the effects of isoflurane (Iso) on the water-maze performances in scopolamine (Sco) treated rats.Methods Fifty-five male SD rats weighing 150-200 g were randomly divided into 8 groups :group I control (Con)/1 d ( n = 6); group II Iso/1 d ( n = 7);group III Sco/1 d ( n = 9);group IV Iso + Sco/1 d ( n = 9) ; group V Con/7 d ( n = 6); group VI Iso/7 d ( n = 6); group VII Sco/7 d ( n = 6) and group VIII Iso + Sco/7 d ( n = 6) . In Iso and Iso + Sco groups the animals inhaled 1.5% isoflurane 2 h per day for four consecutive days. The Morris water-maze (MWM) test was performed for 3 consecutive days starting from the first day (group I -IV ) or the 7th day (group V -VII) after the 4 day isoflurane inhalation. Scopolamine 0.8 mg.kg-1 was given ip 20 min before the beginning of the MWM test in Sco and Iso + Sco groups. Results In group I - IV , (1) the latency period and swimming distance were significantly longer in Sco and Iso + Sco group than those in Con and Iso group ( P

Objective To explore the application of left posterior lateral thoracotomy in the reoperation of mitral vavle. Methods Between April 1995 and April 2003, 11 cases of postoperative recurred mitral valve diseases received reoperation through a left posterior lateral thoracotomy under cardiopulmonary bypass via descending aorta for artery line and main pulmonary artery cannulation for venous line. Results There were no operative and post-operative deaths. The mean CPB time was 138 min. Blood loss of postoperation was less than 300ml in each patient. Conclusion Left posterior lateral thoracotomy in the reoperation of postoperative recurred mitral valve diseases had a minimal adhesiotomy. Extracorporeal circulation via descending aorta and main pulmonary artery cannulation proved easy to do and reliable. This operative approach was simple and safe.

Objective To sum up the diagnosis and treatment of airway complication after heart-lung transplantation. Methods One patient who occurred dyspnea, cough and wheeze at the 200th day after heart-lung transplantation, was diagnosed suffering from anastomosis stenosis. Comprehensive multimodality approach such as rigid bronchoscopic debridement and laser photoresection were performed. Eventually, this case was surgically managed with sleeve resection of stenotic bronchial segment. Results Surgical operation by sleeve resection of stenotic segment was successful, and the patient's symptoms disappeared. Till now the patient has been living more than 14 months after transplant, and CT scanning and fibrous bronchoscopy examination showed that the anastomasis healed well. Conclusion Airway complication's early recognition and proper management could improve the patients symptoms and survival rate.