0.999). The characteristic masses and detection limits achieved were as follows,as for As,21 pg and 0.13 ?g/L,as for Se,32 pg and 0.33 ?g/L. The recoveries were 96.0%-103.6% for As,98.3%-104.7% for Se and the RSDs were 0.6%-1.7% for As,0.6%-2.8% for Se. Conclusion This method was accurate, simple and sensitive,it is applicable to the determination of trace As and Se in water.

Objective To determine if the cardiac index (CI) measured by transesophageal echocardiography (TEE) through the mitral valve (MV) agrees with that measured by transesophageal echocardiography through the ascending aorta (AA).Methods Sixteen ASA Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ),aged 18-70 kg,weighing 46-72 kg,undergoing mitral valve replacement under cardiopulmonary bypass (CPB),were studied.Total intravenous anesthesia was used for induction and maintenance of anesthesia.After tracheal intubation,the TEE probe was placed in the esophagus.CI was measured by transesophageal echocardiography through the MV (CIMV)and AA (CIAA) at 15,30 and 60 min after termination of CPB and recorded.All the data were compared by Bland-Altman analysis.Results CIMV values were significantly lower at each time point than CIAA values (P ＜0.01).The results of Bland-Altman comparison:CIMV 1.29-5.52 L· min-1 · m-2,mean was (2.6 ± 0.9)L·min-1·m-2,and CIAA 2.7-8.8 L·min-1·m-2,mean was (4.9± 1.7) L·min-1 ·m-2,bias was-2.3 L·min-1 ·m-2,and limit of agreement was-5.62-1.03 L· min-1 · m-2 resulting in r =-0.577,P ＜ 0.01.Conclusion CI values obtained through the MV agrees well with that measured through the AA using TEE in patients undergoing mitral valve replacement,but CIAA values are significantly higher than CIMV values,there is a large difference between them for clinical use,and both methods for CI measurement cannot replace each other.

Objective To evaluate the effect of dexmedetomidine on left ventricular function in patients undergoing coronary artery bypass grafting (CABG) by transesophageal echocardiography (TEE).Methods The study was a prospective,randomized and placebo-control clinical trial.Eighty patients undergoing CABG with cardiopulmonary bypass (CPB) were divided into dexmedetomidine group (group D)and control group (group C) by random digits table method with 40 cases each.A loading dose of dexmedetomidine 0.5 μg/kg was injected intravenously 10 min after induction followed by infusion at 0.4 μ g/(kg· h) until the end of operation in group D,while equal volume of normal saline was given in group C.Left ventricular function was assessed by transesophageal echocardiography before the infusion of dexmedetomidine (T1),at the end of the infusion of loading dose (T2),before CPB (T3) and at the end of the operation (T4).Results Compared with those at T1,left ventricular ejection fraction and fractional area change decreased significantly [(58.0 ± 12.0)％,(60.0 ± 9.6)％ vs.(63.0 ± 8.6)％ and (46.0 ± 9.3)％,(48.0 ± 8.4)％ vs.(51.0 ± 6.7)％] (P ＜ 0.05 or ＜ 0.01),E/A ratio increased significantly (1.05 ± 0.27,1.07 ±0.31 vs.0.98 ±0.19)(P ＜0.05 or ＜0.01) and myocardial performance index (MPI) decreased significantly (0.46 ± 0.14,0.45 ± 0.12 vs.0.51 ± 0.14) (P ＜ 0.05) at T2 and T3 in group D,while stroke volume was not significantly changed (P＞ 0.05).Compared with that in group C,E/A ratio and rapid filling fraction in group D was significantly higher [1.06 ± 0.18 vs.0.97 ± 0.18,(62.0 ± 7.1)％ vs.(58.0 ± 7.3)％],and S/D ratio and MPI was significantly lower at T4(1.17 ± 0.21 vs.1.29 ± 0.22,0.43 ± 0.15 vs.0.50 ± 0.15),and there were significant differences (P ＜ 0.05).There was no difference in the parameters indicating left ventricular systolic function (P ＞ 0.05).Conclusions Dexmedetomidine restrains left ventricular systolic function in the patients undergoing CABG,but does not decrease the cardiac output,and improve relaxation dysfunction of left ventricular diastolic function.Global left ventricular function is improved by dexmedetomidine after CABG.

Objective To evaluate the effect of sevoflurane anesthesia on left ventricular synchroni?zation in patients undergoing coronary artery bypass grafting ( CABG ) . Methods Twenty?six patients of both sexes, aged 45-75 yr, with body mass index of 19-30 kg∕m2 and body surface area 1.4-2.0 m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ and New York Heart Association class ⅡorⅢ, undergoing elective CABG with cardiopulmonary bypass, were divided into 2 groups using a random number table: control group ( group C, n=11) and sevoflurane group ( group S, n=15) . After induction of general anesthesia, the patients were endotracheally intubated and mechanically ventilated. Anesthesia was maintained with iv infusion of propofol 4-6 mg·kg-1 ·h-1 , remifentanil 0. 2-0. 3 μg·kg-1 ·min-1 and cisatracurium 0.10-0.15 mg·kg-1·h-1, and intermittent iv boluses of fentanyl 0.5 μg∕kg, and bis?pectral index value was maintained at 40-60. In group S, sevoflurane ( end?tidal concentration: 2.05% for 45-49 yr, 1.80% for 50-59 yr, 1.60% for 60-75 yr) was inhaled for 30 min starting from 15 min after termination of cardiopulmonary bypass, followed by 30 min washout. The parameters of cardiac function
were monitored using transesophageal echocardiography. After induction and before sternotomy, immediate?ly before sevoflurane inhalation, at 30 min of sevoflurane inhalation, and at 30 min of washout, heart rate, mean arterial pressure, central venous pressure, pulmonary artery occlusion pressure, cardiac output, left ventricular ejection fraction, standardized standard deviation of time to peak systolic longitudinal strain of R?R interval ( Tssl?SD) of 17 left ventricular segment, and standardized standard deviation of time to peak systolic circumferential strain of R?R interval ( Tssc?SD) of 16 left ventricular segment were recorded. Re?sults Cardiac output and left ventricular ejection fraction were within in the normal ranges in the two groups. Compared with group C, heart rate was significantly decreased at 30 min of sevoflurane inhalation and 30 min of washout, and mean arterial pressure, cardiac output and left ventricular ejection fraction were significantly decreased at 30 min of sevoflurane inhalation in group S (P<0.05 or 0.01). There were no significant differences in standardized Tssl?SD and standardized Tssc?SD between group S and group C ( P>0.05) . Conclusion Sevoflurane anesthesia has no marked effect on the left ventricular synchronization in patients undergoing CABG.

Objective To explore the biological effects of the luteinizing hormone receptor (LHR) and vascular endothelial growth factor (VEGF) on the ovary of mice during peri-implantation. Methods The immunohistochemistry SABC method and image analysis were used to study the distribution and changes of the LHR and VEGF in Kunming mouse( n =28) ovary during estrous,pregnancy of day 1, day 4 and day 6 stage. Results The expression of LHR-immunoreactive substance and that of VEGF-immunoreactive substance had the same distribution and changes. Compared with other groups,the level of LHR-immunoreactive substance and that of VEGF-immunoreactive substance increased highly on the stroma cells around largergrowing follicles in estrous group ( P <0.05). Along with the pregnancy, the positive immunostaining for LHR and VEGF increased gradually on the granulosa lutein cells, and reached the highest level on day 6 of pregnancy. Positive immunostaining for LHR or VEGF on some endothelia and blood cells were observed in day 1 of pregnancy or estrous group respectively. Form day 1 of pregnancy, the theca cells had positive immunostaining for LHR. Conclusion The expression of LHR and VEGF is closely related with the process of follicle growing, ovulation and corpus luteum formation.

Tumor cells leads to enhanced glucose uptake and the conversion of a larger fraction of pyruvate into lactate even under the circumstance of abundant oxygen. This phenomenon of aerobic glycolysis is known as the Warburg effect. Lactic acid, as an important tool for tumor cells to modify the tumor microenvironment, promotes the process of tumor invasion and metastasis, and contributes to tumor development by inducing and recruiting immunosuppression-related cells and molecules. Lactic acid could efflux out of the cancer cells via the monocarboxylate transporters to prevent intracellular acidification. Lactate can inhibit the cytolytic activity of T cells and natural killer (NK) cells, promoting the differentiation of tolerogenic interleukin 10 (IL-10)-producing dendritic cells. Moreover, the lactate-derived lactylation of histone lysine residues can promote macrophage polarization toward the M2-like phenotype, suppressing the immune response within the tumor microenvironment. In this review, we discuss the role of lactate as an immunosuppressor molecule that contributes to tumor evasion from the aspects of lactic acid metabolism and its effect on immune cells. And we explore the possibility of targeting potential targets in lactate metabolism for tumor treatment. At last, we proposed a tumor immunotherapy strategy by inhibiting the pathway of aerobic glycolysis and proteins associated with the production and transport of lactic acid.

To observe the effects of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and postoperative cognitive dysfunction (POCD) of elderly patients, we collected 80 elderly patients undergoing selective coronary artery bypass graft under cardiopulmonary bypass. The Mini Mental State Examination (MMSE) was applied to test the cognitive function. The SjvO2, Da-jvO2 and CEO2 were used for the analysis of the cerebral oxygen metabolism. We found that POCD was related to disequilibrium of cerebral oxygen metabolism. Ultrasound-guided SGB before surgery reduced the incidence of POCD because of the improvement of cerebral oxygen metabolism.
Aged ; Autonomic Nerve Block ; Cardiopulmonary Bypass ; Cognition Disorders ; prevention & control ; Coronary Artery Bypass ; Humans ; Neuropsychological Tests ; Oxygen Consumption ; Postoperative Complications ; Stellate Ganglion ; diagnostic imaging ; Ultrasonography

BACKGROUNDMedical consortium is a specific vertical integration model of regional medical resources. To improve medical resources utilization and control the health insurance costs by fee-for-service plans (FFS), capitation fee and diagnosis-related groups (DRGs), it is important to explore the attitudes of doctors towards the different health insurance payment in the medical consortium in Shanghai.

METHODSA questionnaire survey was carried out randomly on 50 doctors respectively in 3 different levels medical institutes.

RESULTSThe statistical results showed that 90% of doctors in tertiary hospitals had the tendency towards FFS, whereas 78% in secondary hospitals towards DRGs and 84% in community health centers towards capitation fee.

CONCLUSIONSThere are some obvious differences on doctors' attitudes towards health insurance payment in 3 different levels hospitals. Thus, it is feasible that health insurance payment should be supposed to the doctors' attitudes using the bundled payments along with the third-party payment as a supervisor within consortium.

Objective To observe the effect of acupuncture on ghrelin,estradiol (E2) and bone mineral density (BMD) in postmenopausal osteoporosis rats.Methods According to the random number table method,60 female Sprague-Dawley rats aged 3 months,were randomly divided into surgery group (40 rats) and sham group (20 rats).The osteoporosis model was established by bilateral ovariectomy.Three months after the operation,a significant decrease in BMD of lumbar vertebrae and femur of the model rats as measured by dual energy X-ray absorptionmetry against the sham group indicated successful establishment of the osteoporosis model.Then surgery group was randomly divided into a model subgroup,a acupuncture subgroup and an estrogen subgroup,with 10 rats in each subgroup.The acupuncture subgroup was treated with electroacupuncture,estrogen subgroup with subcutaneous injection of estradiol benzoate,sham group and model subgroup without any treatment.After 3 months of intervention all the rats were sacrificed,BMD of the lumbar vertebrae and femur was measured,ghrelin and E2 were determined.Results Serum ghrelin in acupuncture subgroup (399 pg/ml) and estrogen subgroup (276 pg/ml) were significantly lower (P ＜ 0.01) than that in model subgroup (546 pg/ml); serum E2 in acupuncture subgroup (128.02 pg/ml) and estrogen subgroup (182.89 pg/ml) increased significantly (P ＜ 0.05) than that in model subgroup (72.10 pg/ml) ;lumbar vertebrae BMD in acupuncture subgroup (0.212 g/cm2) and estrogen subgroup (0.231 g/cm2) increased significantly (P ＜ 0.05) than that in model subgroup (0.191 g/cm2),but in acupuncture subgroup the effect on improving the level of E2,ghrelin and lumbar vertebrae BMD was less than that in estrogen subgroup (P ＜ 0.05).Conclusions Acupuncture intervention can improve lumbar vertebrae BMD and serum E2 level of postmenopausal osteoporosis rat model,down regulate serum ghrelin level,but the overall effect of acupuncture is less than estrogen.

Objective To evaluate the effect of sevoflurane preconditioning on the left ventricular function in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods Thirty ASA physical status Ⅱ or Ⅲ patients,aged 42-70 yr,with body height 152-181 cm,weighing 43-78 kg,scheduled for elective CABG under CPB,were randomly divided into 2 groups (n =15 each) using a random number table:control group (group C) and sevoflurane preconditioning group (group SP).Group SP inhaled sevoflurane with the end-tidal concentration corresponding to 1 MAC for 30 min after endotracheal intubation.Before sevoflurane preconditioning (T0) and at 60 min after termination of CPB (T1),mean arterial pressure (MAP),stroke volume index (SVI),pulmonary artery obstruction pressure and the TEE variables including left ventricular ejection fraction (LVEF),peak E wave velocity (E),systolic wave velocity (S),and diastolic wave velocity (D),and low propagation velocity (Vp) were recorded.S/D ratio and E/Vp ratio were calculated.Extubation time and duration of ICU stay were also recorded.Results Compared with the baseline value at T0,HR was significantly increased at T1 (P ＜ 0.05 or 0.01),and no significant change was found in the other parameters of the left ventricle function in the two groups (P ＞ 0.05).There was no significant difference in the parameters of the left ventricle function,extubation time and duration of ICU stay between SP group and C group (P ＞ 0.05).Conclusion Preconditioning with inhalation of sevoflurane with the end-tidal concentration corresponding to 1 MAC before CPB does not produce myocardial protection in terms of the left ventricular function or exerts little effect on the short-term outcomes.