Objective To observe the changes of TNF‐α,interleukin IL‐6 ,IL‐10 and gas analysis though one lung ventilationone with two different pattern to study the effects lung injury and values of oxygenation on patients undergoing esophageal surgery . Methods 60 patients with esophageal cancer were randomly divided into two groups of A and B with 30 cases each .A term :contin‐ual one lungventilation and 4 cm H2 O peep until the end operate ,B term :intermittent one lung ventilation each 45 min with two lung ventilation 5 min .Blood gas analysis were determined immediately before one lung ventilation ,30 min following OLV ,60 min following OLV ,90 min following OLV ,120 min following OLV ,the end of the OLV ,after operate 24 h observe the MAP ,HR ,P , R ,SpO2 .PETCO2 and airway peak were recorded during operate .Results (1)SpO2 in group A was decreased at T3 and reached lest level at T5 ,which was higher than that in group B at T3 ,T5(P<0 .05) .(2)the levels of IL‐6 ,TNF‐α and IL‐10 in the two groups began to rise at T3(P<0 .01) ,reached peak level at T6 ,and decreased gradually at T7 ,which were still higher than those at T1(P<0 .05) .(3) The levels of TNF‐αand IL‐6 were lower in group A than those in g roup B at T3-T6(P<0 .05) ,T1 ,T2 ,T7 (P>0 .05) .The levels of IL‐10 was higher in group A than those in group B at T3-T7(P<0 .05) .Conclusion Compared with A term ,B term without VT has more lung injury although it increases values of oxygenation .

Objective　To investigate the effect of cardiopulmonary bypass (CPB) on vascular endothelial cell injury and plasma endothelin-1 and nitric oxide equilibrium in patients undergoing cardiovascular operation with CPB. Methods　A total of 20 patients with congenital heart disease (Group Ⅰ) and 20 with valvular problem (group Ⅱ) were operated on under CPB respectively. Blood samples were collected from central vein before skin incision, before CPB, 30 min after CPB, at the end of CPB, and end of operation, the first morning and third morning after operation. The levels of plasma thrombomodulin(TM), endothelin-1(ET-1) and nitric oxide(NO) were measured. Results　The plasma TM level was significantly elevated during CPB (P<0.01, P<0.05) and 1 d after operation, reached its peak as (4.88±1.12) ng/ml in Group Ⅰand (8.34±1.84) ng/ml in group Ⅱ at the end of surgery and came back to the level as before operation. The plasma level of ET-1 was also increased significantly after CPB and reached peak as (129.04±22.29) in Group Ⅰ and (156.62±29.66) in Group Ⅱ at the end of operation. And the level was still higher than before operation in 2 groups 3 d after operation. No change was found on the level of NO in 2 groups. Conclusion　CPB may cause extensive acute endothelial cells damage for about 24-48 h and recovered about 72 h and it may also cause an imbalance of ET-1 and NO.

Objective To study vascular endothelial cell injury/activation associated with CPB in order to understand the pathophysiology of the complications of patients undergoing cardiovascular operationsMethods Twenty-six patients scheduled for cardiac operations with CPB, were divided into two grourps, group Ⅰ: 14 patients with acyanotic congenital heart diseases undergoing corrective surgical procedures; group Ⅱ: 12 patients undergoing selective cardiac operation for valvular replacement Blood samples were withdrawn from central vein before skin incision,before CPB, 30 min following CPB, at end of CPB, at end of operation, on the first postoperative day and the third postoperative day to measure the levels of circulating endothelial cells(CEC), thrombomodulin(TM) and von Willebrand Factor(vWF).Results The levels of CEC,TM and vWF significantly elevated during CPB and on the first postoperative day in the two groups,as compared with those before operation (P

Objecfive To evaluate the effects of cilostazol on the prevention of microvascular complications in diabetic patients.Methods 60 diabetic patients with microvascular complications were orally given cilostazol for 1 month.Changes of Mean platelet volume (MPV),plateletcrit (PCT),platelet distribution width (PDW) and platelet count (PLT) were studied.Results With administration of cilostazol,MPV and PDW decreased significantly. Conclusion Cilostazol improves platelet parameters,suggesting that it could prevent the progression of microvascular diseases.

Objective To observe the changes of the endothelium-dependent vasodilatation(EDF)and serum vascular endothelial growth factor(VEGF)in the patients with impaired glucose tolerance(IGT)and type 2 diabetes mellitus(DM).Methods 30 IGT patients,30 type 2 DM patients and 33 normal subjects were divided into3 groups. Fasting glucose(FPG),fasting insulin(FINS),serum superoxide dismutase(SOD),maleie. dialdehyde(MDA)and VEGF were measured after 12 hours overnight fast. Oral 75g glucose tolerance test(OGTT)was performed. The inner diameter of braehial artery was assessed by a high resolution ultrasound system before and after reactive hyperemia. EDF was calculated as the percent change in brachial artery diameter 1 minute after reactive hyperemia compared with baseline. Results In the IGT group and DM group, EDF was significantly lower than that in NGT group(both P＜0.01),and EDF in the DM group was significantly lower than that in the IGT group(P＜0.01).SOD in the IGT group and DM group were significantly lower than that in the NGT group(both P＜0.01),but MDA in reverse(both P＜0.01).Compared with the IGT group, SOD in DM group was significantly lower(P＜0.01),but MDA was significantly higher(P＜0.01).VEGF was progressively increased in the NGT,IGT, DM groups. The difference between the two groups was significant(both P＜0.01).Stepwise regression analysis showed that EDF was positively related to SOD(r=0.418,P＜0.01,n=93),and negatively related to HOMA-IR and VEGF(r=-0.553,-0.221,both P＜0.01,n=93).VEGF was negatively related to SOD(r=-0.552,P＜0.01,n=93).Conclusion EDF is impaired in IGT patients while the impairment in DM patients becomes more marked. Insulin resistance, VEGF,SOD and MDA are closely related to the impairment of EDF in IGT and type 2 DM.

Objective To compare the effect of occupy effects of tumor in situ before surgery(OETS) and after neurosurgery (ANS) on neuroendocrine dysfunction and grading of neuroendocrine function in children with craniopharyngioma. Methods The grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma were drew up according to references and the endocrine feedback principle. Based on these grading evaluation criteria, the clinical date of 227 cases of children with craniopharyngioma who underwent neurosurgical treatment were retrospectively studied. These children were divided into pre-pubertal group (167 cases) and pubertal group (60 cases). The neuroendocrine impairment status before and after the surgery were evaluated separately. Results Among 227 children with craniopharyngioma, after the surgery, the incidence of the hypothalamus-pituitary-thyroid dysfunction increased from 16.74%(38/227) to 67.40%(153/227), the incidence of the hypothalamus-pituitary-adrenal gland dysfunction increased from 14.54%(33/227) to 44.49%(101/227), and the the incidence of pituitary function impairment increased from 17.62%(40/227) to 21.15%(48/227). Meanwhile, the incidence of body temperature dysregulation, sleeping disorder, personality abnormality and cognitive abnormality all increased after the surgery. The scoring and grading on neuroendocrine dysfunction in pre-pubertal group were increased after the surgery (Z=-5.20, P<0.01; Z=-4.94, P<0.01,). The scoring and grading on neuroendocrine dysfunction in pubertal group were increased after the surgery( Z=-4.10, P<0.01;Z=-4.25, P<0.01). Conclusions Both the mass effect of tumor in situ of craniopharyngioma and the neurosurgical treatment can be harmful to the neuroendocrine function. Even though the surgery can remove the mass effect of tumor in situ in the saddle area, it can increase the level of grading of neuroendocrine dysfunction. The status of neuroendocrine dysfunction can be evaluated by the grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma, which then provides an effective evaluation tool for the reconstruction and rehabilitation of neuroendocrine function.

BACKGROUND:In perioperative period of total knee replacement in elderly patients, it is crucial to maintain the normal function of blood coagulation. However, many factors may influence coagulation function of patients in perioperative period. Of them, anesthesia is an important factor. Different anesthesia methods wil produce different effects on blood coagulation. Appropriate anesthesia methods should be selected in the clinic to maintain the stability of coagulation function. OBJECTIVE:To explore the effect of application of general anesthesia and epidural anesthesia in elderly knee replacement and the effects on the function of blood coagulation. METHODS:A retrospective analysis was performed on clinical data of 135 elderly patients after total knee replacement in Dongying Hospital of Shandong Provincial Hospital Group from September 2012 to September 2013. Al patients were divided into control group (67 cases;general anesthesia) and observation group (68 cases;epidural anesthesia) according to the mode of anesthesia. Coagulation indexes and D-dimer levels were observed before anesthesia, 6 hours after anesthesia, and 1 day after replacement in both groups. The incidence of deep venous thrombosis was measured and compared between the two groups in 12-month fol ow-up.
RESULTS AND CONCLUSION:Through the statistics and comparison, no significant difference was detected in blood coagulation indexes at different time points in the two groups (al P>0.05). However, significant differences in D-dimer levels were detectable between the two groups at 6 hours after anesthesia and in the morning at 1 day after replacement. D-dimer levels were significantly lower in the observation group than in the control group (al P<0.05). The incidences of deep venous thrombosis were 3%and 21%in the observation and control groups, respectively, showing significant differences (P<0.05). These results suggest that epidural anesthesia during elderly totak knee replacement obtained good effects, and could maintain stable coagulation function.

Objective Colour ultrasound was used to detect the hemodynamic changes in patients with internal carotid artery kingking,in order to investigate the relationship between the carotid distortion angle and blood flow changes and to explore the assessment of severe internal carotid artery twist operation indications.Methods Forty-five patients with carotid artery kingking hospitalized in the Brain Hospital of Liaocheng were performed colour ultrasound to detect systolic blood flow velocity (PSV), end-diastolic velocity EDV) and to measure the angle of carotid artery kingking.Results According Metz classification, of the 45 patients, Ⅰ level 17 cases, Ⅱ level 17 cases, Ⅲ level 11 cases.With the decrease of carotid distortion angle,the influence on hemodynamics was more and more obvious, especially while the angle less than 30 degrees, the carotid artery blood flow was severely affected.The difference of PSV before and after Kinking was statistically significant in patientes of Metz Ⅲ level (Z=-2.934,P=0.003) and Metz Ⅱ level (Z=-3.053,P=0.002), but was statistically no significant in patientes of Metz Ⅰ level (Z=-0.382, P=0.702).There was a negative correlation between the ratio of the twist angle and PSV before kinking/PSV after kinking (rz =-0.842, P ＜0.05),that was, with the decrease of the twist angle, PSV before kinking/ PSV after kinking increase accordingly.Conclusion Kinking seriously affect the carotid artery blood flow dynamics.Ultrasound can accurately detect distortions arterial hemodynamics

First aid skills are very important in the process of disaster medical rescue methods. Some first aid skills is rarely applied in clinical work at ordinary times, resulting in relevant medical personnel grasp of these skills being not enough skilled. This training method combined with the sim-ulator, has the characteristics and advantages of being close to the real, operational and repeatable. The main training program consists of 6 basic skills such as ventilation, hemostasis, bandaging, fixing, handling, basic life support. By simulating the real disaster scenario and simulation cases, we have targeted a single first aid skills training and multiple comprehensive ability training of first aid skills to trainees. To evaluate the training effect we have examined the individual skills of our trainees, with excellent performance as the goal, and in the comprehensive skills ability assessment we have paid attention to the emergency team's team cooperation ability. By the application of comprehensive simu-lation training and evaluation, the trainees can master all kinds of first aid skills in a short period of time.

Objective To analyse the effect of dual-antiplatelet drugs on S100β,IL-1β, adiponectin(ADPN)and NIHSS score in patients with acute cerebral infarction.Methods 58 patients diagnosed with acute cerebral infarction in first hospital of Qinhuangdao.All patients were collected and randomly divided into experimental group and control group according to random number table , 29 cases in each group.Both group were given the treatrnent of improvng the cerebral vascular circulation, protect brain cells, control blood pressure, blood glucose, oxygen when necessary.On the basis of conventional treatment, control group was treated with aspirin 200 mg, one time per day,orally.And experimental group was treated with clopidogrel 75 mg/d on the basis of control group,one time per day,orally.After treatment, the serum levels of S100β, IL-1β, ADPN and NIHSS score were detected in all patients.ResuIts After treatment, compared with control group,the serum S100βprotein level was significantly lower in the experimental group (P<0.05); the serum IL-1βlevel in experimental group was significantly lower (P<0.05);ADPN level in experimental group was significantly higher (P<0.05); NIHSS score of patients in experimental group was significantly lower (P<0.05).ConcIusions Dual antiplatelet drugs can reduce serum S100βprotein,IL-1βin serum of patients with acute cerebral infarction, increase the level of serum adiponectin, decrease NIHSS score, can effectively improre neurological function in patients with acute cerebral infarction.