ve Cardiac output is traditional measured by thermodilution technique. Recent advance in catheter technique has allowed continuous monitoring of cardiac output, but it is invasive and expensive. The new transesophageal Doppler echocardiography (HemosonicTM 100) can measure aortic blood flow (ABF) and ABF is closely related to cardiac output (CO) (CO= ABF/70%). The purpose of this study was to compare cardiac output continuously measured with transesophageal Doppler echocardiography and modified Swan-Ganz catheter. Methods Forty ASA II - III patients aged 40-65 yr undergoing elective coronary artery bypass (CAB) were included in this study. Premedication consisted of intramuscular diazepam 10 mg, morphine 10 mg and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.08 mg?kg-1, fentanyl 10?g?kg-1 and pipecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation, continuous infusion of propofol and intermittent boluses of fentanyl, midazolam and pipecuronium. The sensor of transesophageal Doppler echocardiograph (TDEE) was placed in the esophagus at the level of T5-6 vertebra after induction and tracheal intubation. The sensor faced backward toward descending aorta. Swan-Ganz catheter (CCO/Sv()2) was placed via right internal jugular vein. In addition intra-arterial BP, ECG, SpO2, PET CO2 and nasal temperature were monitored.Results Continuous cardiac output measured with TDEE and Swan-Ganz catheter (CCO/SvO2) were highly correlated (R = 0.801, P

Basal Ganglia Diseases ; chemically induced ; therapy ; Child ; Humans ; Lamivudine ; adverse effects ; Male ; Palliative Care ; Reverse Transcriptase Inhibitors ; adverse effects ; Treatment Outcome

Dengue virus (DENV) is a re-emerging disease transmitted by the Aedes mosquitoes and has become a major public health problem in southern China. Currently, no antiviral drug or effective vaccine exist to control this disease. The chimeric DENV structural protein vaccine cannot elicit balanced levels of protective immunity to each of the four viral serotypes; therefore, non-structural protein components may be required to construct an effective DENV vaccine. The Dengue virus non-structural 1 (DENV NS1) protein plays a critical role in viral pathogenesis and protective immunity. Therefore, immunity to Dengue 1-4 NS1 subtypes may be crucial for the prevention of severe disease. This review attempts to provide an overview about the structure and function of DENV NS1.
Animals ; Dengue ; immunology ; prevention & control ; virology ; Dengue Vaccines ; chemistry ; genetics ; immunology ; Dengue Virus ; chemistry ; genetics ; immunology ; Humans ; Viral Nonstructural Proteins ; chemistry ; genetics ; immunology

Objective To investigate early diagnosis, clinical effect of surgical treatment and prognosis of a-cute appendicitis in elderly. Methods The clinical data of acute appendicitis in elderly undergoing surgical therapy between January 1994 and November 2008 was analyzed retrospectively, and predisposing factors, diagnostic meth-ods, therapeutic effect of operation and prognosis were studied. Results Acute appendicitis in elderly was diagnosed in 276 cases(114 female/162 male). There were 7 cases of deaths. MoRality was 2.5% (7/276). Stitches were taken out from 6 to 8 days after operation. Average stay was 8 days. 196 cases(71.0%) of wound healing at grade A, 43 cases(15.6%) at grade B ,37 cases(13.4%) at grade C. 86 cases(31.2%) with perforated acute appendici-tis, and 7 cases(2.5%) with periappendiceal abscess were confirmed after operation. 76 cases auompanied with con-comitant diseases, 87 cases auompanied with postoperative early complications, and 39 cases(14.1%) with postop-erative wound or intra-abdominal septic complications. Conclusion Key point of improvement of operative therapeu-tic effect and prognosis of acute appendicitis in elderly are early diagnosis, operation in time, and effective treatment of associated diseases and complications.

Objective To analyze etiopathogenisis, diagnosis and treatment of the aged with bowel obstruction. Methods The clinical data of 168 cases with bowel obstruction, whose age were more than 60 years,in our hospital from 1998 to 2007 were reviewed retrospectivly. Results In all the cases,32 patients' original disease were abdomenal hernia,6 patients were mesenteric vascular thrombus,75 patients were bowel tumor, 12 patients were feces,18 patients were false colonic obstruction and 25 patients were ankylenteron. 114 cases (67.68%) received operation,43 patients (25.59%) received expectant treatment and 11cases received colonofiberscope therapy. 138 cases (81.55%) were cured without any complication. 25 cases(14. 88%) had this or that kind of complication. 5 cases (2. 98%) were dead. Conclusion Firstly, the regular original disease of the aged with bowel obstruction were bowel tumor. Secondly,most elderly patients with bowie obstruct should be cured after operations. Thirdly,the aged with bowel obstruction would have higher complication rate,which should attract our enough attention.

OBJECTIVE: To observe the changes of endothelium-dependent dilation (EDD) of patients with congestive heart failure (CHF) before and after Kanli Decoction treatment. METHODS: Thirty-five CHF patients were treated with Kanli Decoction. We used color Doppler ultrasound to monitor the flow-mediated dilation (FMD), pulsatile index (PI), resistance index (RI), baseline blood flow (BF), ejection fraction (EF) before and after the treatment. RESULTS: FMD after treatment (9.26+/-3.19) were obviously higher than that before the treatment (7.06+/-2.58) (P<0.05), but BF, PI and RI were not improved. CONCLUSION: Applying color Doppler ultrasound into observation on EDD of patients suffering from CHF and treated by the Kanli Decoction shows that the CHF could be treated by traditional Chinese medicine.

Objective To assess the changes in heart geometry and function during off-pump coronary artery bypass grafting(CABG).Methods Thirty ASAⅡorⅢpatients(24 males,6 females)aged 50-78 undergoing elective off-pump CABG were studied.After induction of anesthesia and tracheal intubation a catheter which was connected to the monitor measuring continuous cardiac output(CCO),mixed venous blood oxygen saturation(S(?)O_2)and CEDV was placed via right internal jugular vein and the probe of multi-phase transesophageal echocardiograph(TEE)(Sonos HP 2500)was inserted in the esophagus.The distance between the probe and the incisors was between 34-45 cm.The hemodynamic variables and TEE parameters were recorded when epicardium was opened(T_1,baseline)when the octopus tissue stabilizer was placed during anastomosis between the graft vessel and left anterior descending artery(LAD)(T_2)left circumflex artery(LCX)(T_3)and right coronary artery(RCA)(T_4)and when the anastomoses between the vessel grafts and aorta was completed (T_5).Results At T_2 the mitral valve deceleration time(DT_1)and the blood flow through the mitral valve(Q_1) were decreased significantly as compared with the baseline(T_1);MAP was significantly decreased while HR and CVP were increased(P＜0.05).At T_3 the left and right ventricular end-diastolic diameter(LVEDD,RVEDD), tricuspid valve diameter(TVD)and the blood flow through Q_1 and tricuspid valve(Q_2)were significantly decreased as compared to the baseline values at T_1.The mitral valve E/A ratio was increased while the tricuspid valve E/A ratio was decreased(P＜0.05).The MAP,S(?)O_2,right ventricular end-systolic and end-diastolic volume(RVESV,RVEDV)and right ventricular ejection fraction were significantly decreased while HR and CVP were increased at T_3 as compared to the baseline at T_1.At T_4 LVESD,LVEDD,MVD,tricuspid valve E/A ratio and Q_1 were significantly decreased as compared to the baseline at T_1(P＜0.05).MAP,MPAP,SV,S(?)O_2, RVEF,RVESV and RVEDV were significantly decreased while HR and CVP were increased(P＜0.05).At T_5 all the TEE and hemodynamic parameters returned to the baseline valves at T_1.Conclusion During anastomoses between graft vessels and LAD,LCX and RCA,both left and right ventricles are compared to some extent and the heart function is impaired temporarily but returns to the baseline after the anastomoses are completed.

Objective To investigate the application and significance of the MS/MS method and the HPLC method for the screening and diagnosis of genetic metabolic disease phenylketonuria (PKU) .Methods The MS/MS method and the HPLC method were adopted to analyze the concentrations of phenylalanine(Phe) and tyrosine(Tyr) and its ratio in the dried blood spot specimen on filter paper and the whole blood specimen in 1 860 children aged from 3 d to 11 years old .Results The linear ranges of Phe by the MS/MS method and the HPLC method were 26 .02 - 101 .11 μmol/L and 32 .04 - 132 .50 μmol/L ,which of Tyr were 41 .50 -253 .07 μmol/L and 32 .85 - 111 .50 μmol/L ,the average recovery rates of Phe were 97 .36% and 98 .43% ,which of Tyr were 96 .71% and 98 .99% ,in‐run CV of Phe were 4 .31% and 3 .97% ,which of Tyr were 4 .09% and 4 .01% ,between‐run CV of Phe were 5 .73% and 4 .58% ,which of Tyr were 6 .01% and 5 .24% ,respectively .Conclusion Both methods can sensitively and specif‐ically detect blood Phe and Tyr concentrations and meet the requirements of screening and diagnosis of PKU .

OBJECTIVE:To provide reference for medical costs control in China. METHODS:Based on main characteristics of the United States health service system,information asymmetry,principal-agent theory and Freedman’s consumption theory were used to analyze the advantages of restrictive relationship among doctors,hospitals and health insurance institutions in control-ling medical costs and improving the quality of diagnosis and treatment. The growth rate of medical cost,the percentage of drug ex-penditure and other aspects were compared between China and the United States;the effect of restrictive relationship on medical cost control was demonstrated. RESULTS & CONCLUSIONS:In the United States,there are hierarchical medical system and two-way referral system;for-profit hospitals and non-profit hospitals are mutually complementary;different natures of health insur-ance system,different payment methods and strict“commercial bribe”monitoring system are carried out;doctors,hospitals and health insurance restrict each other. Not only there are many advantages in theory,but also in practice the growth rate of medical cost and the percentage of drug expenditure are superior to our country. Finally it controls the rapid growth of medical cost to a cer-tain extent. Combined with our national conditions,learning from the United States experience,restrictive relationship among doc-tors,hospitals and health insurance institutions is established to control the increase of medical cost in China through reducing infor-mation asymmetry and standardizing payment audit;establishing a scientific pattern of mixed payment;strengthening the indirect impact of the health insurance institutions on doctors and hospitals,etc.

BACKGROUND:Bone tissue transplantation or osteogenic material fil ing is after used for bone defect repair. To remove autologous bone tissues can lead to additional damage and secondary deformity, therefore, it is extremely urgent to search for a new osteogenic material. OBJECTIVE:To construct the porousβ-tricalcium phosphate (β-TCP)/col agen scaffold modified with human bone morphogenetic protein 2 (hBMP2) gene, and to observe its effects on differentiation of MC3T3-E1 cel lines. METHODS:The porousβ-TCP/col agen scaffold modified with hBMP2 gene was prepared. Then in vitro culture system of MC3T3-E1 cel lines with composite scaffold was established. There were scaffold and plate groups, and each group was divided into two subgroups according to the different concentrations of plasmid. Samples were col ected and observed morphological y by scanning electron microscope and light microscope after complex culture. After 1, 3, 7 and 14 days of induction, calcium nodules were observed through alizarin red staining, the cel cycle was detected by real-time PCR, and expressions ofαI-chain col agen type I gene, Osterix and bone sialoprotein were observed. RESULTS AND CONCLUSION:The number of cel s adhered, differentated and distributed on the composite scaffold was significantly higher than that of the single scaffold (P<0.05). Alizarin red staining and real-time PCR detection showed that the osteogenesis ability of MC3T3-E1 cel lines in the scaffold group was stronger than that in the plate group. To conclude, the porousβ-TCP/col agen scaffold modified with hBMP2 gene is an appropriate candidate for bone defect repair.