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

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 static closure functional characteristics of lower urinary tract in continence in late pregnancy of primigravida through perineal ultrasound and urodynamieal measurement. Methods From January of 2003 to December of 2005,83 primigravida undergoing antenatal health care in Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital were randomly enrolled in the study, while 28 nulliparous women were recruited as control.The perineal ultrasound and urodynamical measurement were performed at the gestation age of 36-40 weeks,in both groups.We analysed the parameters of lower urinary tract function in late pregnancy compared with nullipara,such as maximal urethral closure pressure(MUCP),functional urethral length(FUL),maximal urethral pressure(MUP), valsalva leak point pressure(VLPP),postvoid residual bladder volume(PVRBV)and volume of first desire to voiding(VFDV).Results The average weight of 83 neonates was(3504?404)g.In all of 83 primigravida PVRBV was less than l0 ml.MUP(110 + 22)cm H_2O(1 cm H_2O=0.098 kPa),MUCP (96?22)cm H_2O and FUL(44?9)mm were significantly increased in the third trimester compared with nullipara(P0.05). There were 33 pregnant women suffering from urinary leakage throughout the terms.The data showed that MUCP was significantly lower in the pregnant women with symptoms of leaking than without leaking. Conclusion The static closure function increased significantly compared with nulliparous women.The VLPP was decreased and had relationship with symptoms of leakage.The results suggest that the function of lower urinary tract in continence in late pregnancy of primigravida is complex.

Objective To investigate the effects of warming-needle acupuncture on the levels of matrix metalloproteinase-1 (MMP-1) and interleukin-1β (IL-1β) in the articular cartilage in knee osteoarthritis induced by immobilization in rabbits.MethodsA total of 30 adult male Japanese white rabbits were randomly assigned into three groups by random number table method: a normal group, a model group and a treatment group, with 10 rabbits in each group. Knee osteoarthritis was induced by 6 weeks of immobilization. The rabbits in the treatment group received warming-needle acupuncture after modeling at points of “Neixiyan” (EX-LE4), “Dubi” (ST35), “Zusanli” (ST36) and “Yanglingquan” (GB34) for 4 weeks. The level of MMP-1 and IL-1β in the articular cartilage of the knee were determined with radioimmunological assay.ResultsThere were significant difference in the levels of MMP-1(0.16 ± 0.02 ng/mg, 0.37 ± 0.02 ng/mg, and 0.28 ± 0.03 ng/mg;F=258.251) and IL-1β (0.21 ± 0.01 pg/mg, 0.34 ± 0.02pg/mg, and 0.31 ± 0.04 pg/mg;F=127.112) among the normal group, model group and treatment group. The levels of MMP-1 and IL-1β both in the model group and treatment group were significant higher than those in the normal group (allP<0.01), while the levels of MMP-1 and IL-1β in the treatment group were significant lower than those in the model group (allP<0.01).ConclusionWarming-needle acupuncture can effectively reduced the levels of MMP-1 and IL-1β in the articular cartilage in knee osteoarthritis induced by immobilization in rabbits.

Objective To study the expression of multidrug resistance associated protein 1 (MRP1) and MRP2 in the peripheral blood mononuclear cells of children with intractable epilepsy (IE).Methods During Nov.2010 to Oct.2013,50 children with I E were collected as the experimental group,simultaneously 50 children with epilepsy controlled by the anti-epileptic drugs (AEDs) and 50 healthy children without epilepsy were collected as the control group from the outpatient or inpatient of Xuzhou Children's Hospital.The expressions of MRP1 and MRP2 in the peripheral blood mononuclear cells of children were detected by reverse transcriptase polymerase chain reaction and Western blot.Results 1.The mean relative expression of MRP1 and MRP2 mRNA in the peripheral blood mononuclear cells of children with IE (0.795 ± 0.042,0.804 ± 0.023) were higher than those in epilepsy controlled by AEDs (0.682 ± 0.030,0.675 ± 0.021) and healthy children without epilepsy (0.665 ± 0.031,0.654 ± 0.029) (all P ＜0.001).2.The mean relative expression of MRP1 and MRP2 protein in the peripheral blood mononuclear cells of children with IE (2.027 ±0.034,1.902 ±0.021) were higher than those in epilepsy controlled by AEDs(1.131 ±0.042,1.086 ± 0.027) and healthy children without epilepsy (1.093 ± 0.023,1.045 ± 0.018) (all P ＜ 0.001).3.There was no difference in the expression of MRP1,MRP2 mRNA and proteins between the children with epilepsy controlled by AEDs and healthy children without epilepsy (all P ＞ 0.05).Conclusions MRP1 and MRP2 over-expression in the peripheral blood mononuclear cells of children with IE may be associated with drug-resistance mechanism for medically intractable epilepsy.

Objective Clinical parenteral nutrition( PN) support still lacks in standards on some degree .This paper was to analyze the clinical application of PN support in our hospital in order to provide the basis for clinical rational drug use . Methods Random weighting method was applied to collect 5% hospitalized patients′information from each patient unit each month from April 2012 to March 2013 in Nanjing Gerneral Hospital of Nanjing Military Region .NRS-2002 nutrition risk screening was applied to eval-uate whether the patient needed PN support .Statistical analysis were carried out on patients supported with parenteral nutrition from department distribution, PN detailed components and distribution intervals of aII in one admixture non-protein calorie and nitrogen ra-tio. Results According to the survey, 393 patients had received PN support, including 217 cases′NRS score <3 and 176 cases′NRS score ≥3.General surgery department ranked the first in the cases of usingall in oneadmixture support.Among 133 cases receiving all in one admixture support, the course of 37 cases(27.82%) <7 d.The aII in one admixture non-protein calorie and ni-trogen ratio(100~150∶1) only took up 28.57%. Conclusion Although PN has got wide application in clinical departments, the rationality of prescription should be strengthened .Pharmacists should help doctors set up appropriate prescription from the aspect of pharmacy.

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.

Authors described the patterns,core measures and mechanisms of coordinated care delivery in the localities and analyzed initial outcomes of this practice.It is found that such practice has optimized distribution of regional healthcare resources,implemented first visit to primary institutions, and the care delivery to separate emergency from outpatient service.In addition,the paper analyzed problems found in localities in terms of policy,public hospitals and primary institutions,and proposed elements required for coordinated care delivery system to succeed,such as enhanced policy support, enhanced multi-departmental coordination,and public hospital reform to explore feasible approaches.

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.