Lung ultrasound(LUS)has gained increasing popularity among intensivists in recent dec-ades.Although limited by the presence of air,LUS has proved to be useful in the evaluation of a number of different acute and chronic conditions,such as pneumonia,pneumothorax,acute lung injury,alveolar-intersti-tial syndrome,pleural effusion,etc,and showed a relatively higher sensitivity,specificity and diagnostic accu-racy compared to routine radiographic imaging.It is also critical in improving the safety of pleural interven-tional procedures.The most common signs for diagnosing and differential diagnosing include the pleural line, lung sliding,the A-line,the quad sign,the sinusoid sign,the fractal,and tissue-like sign,the B-line,lung rock-ets,abolished lung sliding with the barcode sign,the lung point,the dynamic air bronchogram,etc.The BLUE-protocol allows differential diagnosis of acute respiratory failure.LUS is a feasible technique that can be used routinely and integrated into clinical practice in the fields of intensive care,emergency care,respirato-ry and general medicine.

Objective To investigate the effect of dexmedetomidine on the renal function and the expression of tight junction protein ZO-1 and occluding in the kidney of rats with septicopyemia induced by lipopolysaccharide.Methods Thirty adult male SD rats were randomly divided into 3 groups ( n=10 each):control group( group C) , LPS group ( group M) , and dexmedetomidine group ( group Dex ) .In the groups Dex and LPS, the rats were infused with saline and lipopolysaccharide (5 mg/kg, i.v.) respectively.In the Dex group, after intravenous injection of lipopolysaccharide (5 mg/kg) , the rats were firstly infused the loaded dose of dexmedetomidine (7μg/kg) for 15 minutes, and then changed to 5 μg/kg· min for 30 minutes.Blood samples were collected at 24 h later for measuring TNF-α, IL-1β, Scr and BUN.The kidney tissues were examined by histopathology.The expression of ZO-1 and occludin was detected by Western blot. Results Compared with the group C, the kidney tissue of group M was extensively damaged with tubular dilatation and inflammation, while reduced in the group Dex.Compared with the group C, the expressions of Scr, BUN, IL-1βand TNF-αwere all enhanced in the groups M and Dex ( P <0.05 ) , while the inflammatory factors in the group Dex were significantly lower than those of the group M ( P <0.05 ) .The Results The Western blot analysis showed that the expressions of protein ZO-1 and occludin in the group Dex were significantly higher than those of the group M (P<0.05). Conclusions Dexmedetomidine can improve the renal function of rats with septicopyemia, inhibit the acute renal injury and inflammation, increase the expression of protein ZO-1, and exert certain protective effect on the kidneys.

Adolescent ; Female ; Heart Septal Defects, Atrial ; complications ; therapy ; Humans ; Male ; Pulmonary Veins ; abnormalities ; Young Adult

Objective To study the mechanism of sacral plexus injury resulting from anteroposteri- or compression zone-Ⅱsacral fractures.Methods Six short-term(within one year)embalmed pelves were obtained from Anatomic Department of Hebei Medical University.The preserved sacral plexus and re- sected pubic symphysis were used to make the models of anteropesterior compression zone-Ⅱsacral frac- tures.Quantitative analysis for fracture displacement was carried out to observe the characteristics and mechanism of sacral plexus injury.The removed sacral plexus was replaced by proportional diameter silica gel pips filled with contrast medium.The experimental procedure was repeated under X-ray.The experi- mental data were analyzed by SPSS 10.0 statistic software to obtain result.Results In anteropostefior compression sacral fracture,sacral nerve canal was gradually opened and its volume raised.No sacral nerve was opressed in nerve canal.However ilium external rotation prolonged sacral nerves,especially S_1,S_4 and the more the pubic symphsis was separated the more the sacral plexus nerves were prolonged.At the same time,the sharp border of fracture segment stabbed the nerves,especially L_5(6 cases),S_1(5 cases)and S_2 (3 eases).Conclsions Sacral plexus is tightly connected with the wall of pelvic cavity and fixed. When zone-Ⅱsacral fractures happen sacral plexus is easily damaged.In anteroposterior compression sacral fracture,nerves S_1 and S_4 are likely to be damaged by dragment,and nerve compression injury is attributed to stabbing by fracture segment border,with L_5 and S_1.more hackneyed.

Objective To investigate the clinical application of ultrasound biomicroscopy in the treatment of congenital corneal opacities.Methods Medical records of 20 eyes (15 patients) with congenital corneal opacity treated at our hospital from July 2004 to November 2011 were retrospectively reviewed.Best corrected visual acuity testing,intraocular pressure testing,slit-lamp anterior segment examination,fundus examination,slit-lamp microscopic photography,B scan examination,and ultrasound biomicroscopy were performed for analysis of complications of congenital corneal opacity and selection of surgical approaches.Results The ultrasound biomicroscopic examination showed that 5 eyes had no Descemet's membrane and corneal endothelium,20 eyes had anterior synechia,5 eyes had aniridia,3 eyes had loss of lens cortex,13 eyes had cataract,14 eyes had closed angle,and 3 eyes had pupillary membrane.14 of 20 eyes received surgical treatment,including penetrating keratoplasty combined with cataract extraction and trabeculectomy (5 eyes),penetrating keratoplasty combined with pupil angioplasty (3 eyes),penetrating keratoplasty combined with cataract extraction (3 eyes),penetrating keratoplasty combined with trabeculectomy (2 eyes),and lamellar keratoplasty (1 eye).Conclusions Ultrasound biomicroscopy is important to guide the diagnosis and treatment of congenital corneal opacity.

Lactose tolerance test with ethanol(LTTE)described by Arola was performed in 41 healthy children and lactose malabsorption(LM)could be diagnosed if blood galactose(B-gal)was less than 0.3 mmol/L or urine galactose less than 2 mmol/L.Then 138 healthy infants and children and 95 children with acute diarrhea were examined for LM or lactose intolerance(LI)with the urine samples of LTTE and symptom-response score(SRS).It was found that LTTE was reliable in the diagnosis of LM ;the incidence of LM or LI increased with the increase of age in children)and RV enteritis was liable to be complicated with LM or Li.

Objective To explore the total treatment effect,layered diagnostic treatment effect,the relationship between effect and site of infection and common side effects of commonly used antifungal agents such as itraconazole,Voriconazole,caspofungin and amphotericin B liposome in invasive fungal infection with hematologic malignancies.Methods The clinical data of 117 cases of patients with hematologic malignancies combining with invasive fungal infection hospitalized in our department from Jan,2005 to Aug,2008 were retrospectively analyzed.Results The total effect rates of itraconazole,Voriconazole,caspofungin and amphotericin B liposome were 69.0%(40/58),77.4%(24/31),64.7%(11/17)and 63.6%(7/11)respectivley(P=0.726).In patients with pulmonary infection,the effect rates of the agents were 63.0%(17/27),85.7%(12/14),50.0%(4/8)and 62.5%(5/8)respectively(P=0.283),which itraconazole group was higher than that of the other agents.The effect rates of the 4 groups have similar rates in patients with liver and spleen candidiasis,fungemia and infections with unknown origin.The rates of 6 weeks survival were 86.2%,87.1%,70.6% and 72.7% respectively.The common side effects of itraconazole and Voriconazole were mainly gastrointestinal reaction and mild hypokalemia.There were few patients showed gastrointestinal reaction(12.1%) and hypokalemia(20.7%)in the former.Some individual showed visual abnormity(9.7%)and external vertebral body symptoms(6.4%).caspofungin showed mild toxic and side effects,which was only gastrointestinal reaction(15.4%),while they were common in amphotericin B liposome group,which were Chill and fever(81.8%),hypokalemia(100%),gastrointestinal reaction(18.2%)and liver damage(9.1%).Conclusion The total effect,layered diagnostic effect and 6 weeks survival rates were similar in itraconazole,Voriconazole,caspofungin and amphotericin B liposome in patients with hematologic malignancies combining with invasive fungal infection.

Objective To approach the feasibility of the development and routinely carrying out of gynecological analgesia. Methods A total of 286 pregnant women, 58 were primiparae with full-term fetus and 228 were for mid-term delivery or induced abortion, were enrolled in present study. The combined lumbar-epidural analgesia (CLEA) and the patient-controlled epidural analgesia (PCEA) were given to the primiparae and the ones for mid-term delivery, and the intravenous anesthesia was given to those for induced abortion. Results Among the primiparae and the ones for mid-term delivery, VAS scores were rapidly reduced from 87.7?12.5 and 51.1?14.1 to 8.7?8.8 and 10.6?6.2, respectively, within 3 minutes by CLEA, the effective rates of analgesia were 94% and 100%, respectively. For all of them the Bromage evaluation was in 0 degree. After the induction of labor, no algesia memory existed in the women for induced abortion, the operative time was 15.28?2.57 minutes, the dosage of propoful was 162.9?39.8 mg (about 3mg/kg), and the dosage of fentanyl was 0.05 mg. The incidence of hypotension after intravenous anesthesia was 5.8%. Conclusions Intravenous anesthesia with propoful may remit the panic and fearful sense of pregnant women to induced abortion, and reduce the pain during operation. It is suggested to develop widely and carry out routinely the intravenous anesthesia as an effective and safe technique in gynecological analgesia.

Objective To evaluate the effect of telmisartan on serum adiponectin and urine microalbumin(mAlb) level by administrating it to mice with simple obesity, so as to explore new therapies for obesity-related kidney diseases.Method A total of 24 8-week-old male OB mice and 8 8-week-old male C57 mice were selected for this study.The genetic background of OB mouse was C57 mouse, but the lepin gene was deleted in OB mouse.OB mice were randomly divided into 3 groups by body weight and fed with high-fat diet for 12 weeks: model group (M group), telmisartan group (T1 group) and losartan group (T2 group).C57 mice acted as control and were fed with general diet for 12 weeks.Serum adiponectin and blood glucose levels were measured before and after treatment.24 h urine was collected to measure urine mAlb.Quantitative real-time PCR (qRT-PCR) was used to measure the expression level of peroxisome proliferators-activated receptors gamma mRNA(PPARγ mRNA).HE stain was used to observe the morphological changes of kidney and measure the glomerular diameter.Body weight, serum adiponectin level, blood glucose level, urine mAlb level, expression level of kidney PPARγ mRNA, kidney wet weight and glomerular diameter of 4 groups were compared and a correlation analysis was carried out by Person correlation coefficient.Results Compared with C group, the urine mAlb level in M group increased (P＜0.01), serum adiponectin level and the expression level of kidney PPARγ mRNA in M group decreased (P ＜ 0.01);The urine mAlb level was negatively correlated with serum adiponectin level and expression of kidney PPARγmRNA (r=-0.773,P ＜ 0.01;r=-0.469, P ＜ 0.01).The urine mAlb level in T1 group was lower than M group (P ＜ 0.05),serum adiponectin level and expression of kidney PPARγmRNA in T1 group were higher than M group (P ＜ 0.05).Compared with T2 group, the urine mAlb level in T1 group decreased, serum adiponectin level and expression of kidney PPARγ mRNA in T1 group increased (P ＜ 0.05);Compared with M group, the urine mAlb level in T2 group decreased (P=0.01).The morphological changes of kidney:glomerular volume increase and focal segmental sclerosis were found in some mice in M group and T2 group.No glomerular volume increase and focal segmental sclerosis were observed in T1 group.Conclusions Telmisartan can reduce urine microalbumin, whose mechanism might be that telmisartan can active the PPARγand promote the level of serum adiponectin.