Objective To investigate the effects of remifentanil-indueed controlled hypoteusion (CH) on the cerebral oxygen metabolism in patients undergoing radical operation for gastric cancer. MethodsForty-two ASA Ⅰ or Ⅱ patients (26 male, 16 female) aged 30-64 yr with body nuts index < 30 kg/m2 undergoing elective radical operation for gastric cancer were randomly divided into 3 groups (n = 14 each): group R remifentanil-induced controlled hypotension; group N sodium nitroprusside-induced CH and group C normal BP. Radial artery was cannulated for continuous BP monitoring and blood sampling. A catheter was inserted into right internal jugular vein and advanced cephalad until jugular bulb for blood sampling. MAP, HR, ECG and SpO2were continuously monitored. Anesthesia was induced with midazolam 0.1 mg/kg, fentanyl 5 μg/kg, propofol 2 mg/kg and vecuronium 0.08 mg/kg and maintained with isoflurane (end-tidal concentration 1. 1% ), iv infusion of propofol (50-100 μg·kg-1·min-1 ) and remifentanil (0.1 μg·kg-1·min-1) and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8-10 ml/kg, RR 12 bpm, I: E 1:1.5) after tracheal intubation. End-tidal CO2was maintained at 30-35 mm Hg. CH was started after abdomen was opened. In group R the remifentanil infusion rate was increased from 0.1 μg·kg-1·min-1 in 0.05 μg·kg-1·min-1 increment every minute until the1 μg·kg-1min-1 in 0.5 μg·kg-1·min-1 increment every minute until the desired BP was achieved. MAP was reduced to 70% of the baseline value but never below 50 mm Hg. CH induction time and BP recovery time were recorded. Arterial and jugular bulb venous blood samples were obtained before induction of anesthesia (T0), immediately before induction of CH (T1), at 10 and 30 min of CH (T2,3) and 20 min after termination of CH (T4). The arterial and jugular bulb venous O2content difference (Da-jvO2) and cerebral O2extraction rate ( CERO2) were calculated. The difference between arterial and jugular bulb venous blood lactic acid concentration (Da-jvL) was also calculated. Results The CH induction time and BP recovery time were significantly longer in group R than in group N, but BP was stabler during CH in group R than in group N. Compared with group C, Da-jvO2, CERO2and Da-jvL were significantly decreased in group R, while CERO2and Da-jvL were significantly increased in group N. Conclusion Remifentanil can effectively induce CH and reduce cerebral O2consumption in patients undergoing radical operation for gastric cancer.

Objective To observe the influences of Yangxinshi pill on ET, NO, CRP in patients with angina pectoris belonging to manifestation of Qi-deficiency and blood stagnation. Methods 78 patients with angina pectoris were randomly divided into two groups. 40 patients in treatment group were treated with Yangxinshi pill, 4 pills once, three times a day 8 weeks. 38 patients in control group were treated with isosorbide mononitrate 8 weeks. The symptoms and the ET, NO, CRP level before and after treatment were recorded. Results Obvious drop of ET, NO, CRP were observed after treatment in the treatment group. The level of ET was reduced from (67.47?15.72)pg/mL to (37.97?7.82) pg/mL. The level of NO was increased from (78.24?13.81)?mol/mL to (96.25?12.72)?mol/mL. The level of CRP was reduced from (5.31? 2.02)mg/L to (3.42?2.17) mg/L. There was a significant difference between the two drugs (P 0.05). The total efficacy rate in improving symptom was 95%. There was a significant difference between the two drugs (P

Compared with CT scan results of OSAS patients and normal adults to explore the value of CT diagnosis of upper airway stricture in patients with OSAS, 35 patients with OSAS and 35 normal adults were included in the study. 22, 19, 12, 8 cases had obstruction at palate, uvula, lingua and epiglottis region respectively, the awaked CT scan results of 61 obstructive sites were compared with those of normal adults. Obvious difference was found between patients and normal adults in area, left right dimension and coronal dimension. difference was also found in thickness of lateral pharyngeal tissue of palate, uvula and lingua region and retropharyngeal tissue of palate and uvula. The normal extent was determined by unilateral 95% confidence interval in normal adult group. And 43 sites had abnormal CT scan results, the positive ratio was 72 13%. The results sugget that there are obvious differences between the patients with OSAS and normal adults, the CT scan measure can show the upper airway obstructive site of patients with OSAS.

Objective To discuss the efficacy of a modified single posterior fixation of complicated acetabular fractures with a percutaneous cannulated screw and a reconstruction plate in comparison with traditional bilateral approaches (ilioinguinal and Kocher-Langerbeek). Methods From April 2004 to May 2007, 48 cases of complicated acetabular fracture were treated surgically. By Letoumel classification, 22 were transverse and posterior wall fractures, 16 fractures of both columns, 3 fractures of anterior column and posterior wall, 3 T shape fractures and 4 anterior column and posterior hemi-transverse fractures. Of them, 22 cases were treated through the bilateral approaches and 26 cases through the modified single posterior approach by which a percutuneous cannulated screw was applied, going askew through skin and ischial tuberosity, to fix the anterior column and a reconstruction plate to fix the posterior column. Results Forty patients were followed up for 6 to 37 months(average, 18 months) . There was no statistical difference between the 2 groups as fax as the following factors were concerned: anatomic reduction rate and functional good-to-excellent rate. But there were significant differences in operation time and volume of hemorrhage during operation. Conclusion In treatment of complicated acetabular fractures, the modified singl eposterior approach simplifies traditional bilateral approaches so that surgery procedures, perioperative bleeding and postoperative complications can be reduced without sacrificing the treatment efficacy.

OBJECTIVE To summarize and evaluate the therapeutic studies on obstructive sleep apnea-hypopnea syndrome(OSAHS)in our country. METHODS Articles of therapeutic studies on OSAHS published in major journals of our country from Jan. 1995 to Dec. 2004 were evaluated retrospectively. RESULTS A total of 201 articles were recruited. The number of articles published every year was increased with time and most of the articles were retrospective study. There were no standard criteria for evaluating the curative effect,and the cure rate of UPPP were obviously different according to different evaluation criteria. In same evaluation criteria,the short- term outcome were better than long-term outcome,and the patients underwent multiple levels surgery had better outcome than single UPPP. CONCLUSION Multi-center,large sampled and prospective random comparison therapeutic study based on evaluative criteria constituted by Chinese Medical Association should be carried out in the future study. The impersonal methods and criteria for evaluation the upper airway anatomic structure and pharyngeal wall resilience should be established. Individuality therapy should be done. And finally, bring on therapeutic effect of OSAHS to a higher level in our country.

Objective To study the efficacy of chitosan on rehabilitation treatment after sinuses open surgery .Methods Fifty-six cases patients after sinuses open surgery were collected during June 2013 to October 2014 and divided into experimental group and control group by random sampling method, 28 cases in each group.The experimental group were smeared with chitosan on surface after cleaning by normal saline, while control group cleaned by normal saline alone.The efficacy, adhesion of nasal mucosa and time of mucosa complete epithelialization in two groups at three and six months were analysed while out-patient review.ResuIts After three and six months, the total effective rate of experimental group was significantly higher than that of control group[85.71% vs.60.71%(χ2 =4.46,P<0.05);92.86% vs.67.86%(χ2 =5.54,P<0.05)].The time of mucosa complete epithelialization in experimental group was (50.4 ±6.5)d, which was shorter than (62.3 ±7.5)d of control group (t=6.34,P<0.05).After three and six months, the nasal mucosa without adhesion in experimental group was better than that in control group (χ2 =5.60, χ2 =5.49;P<0.05). ConcIusion Chitosan can promote nasal mucosa epithelialization, reduce adhesion of nasal mucosa, improve the postoperative curative effect of chronic nasal-sinusitis.

The bFGF plays an important role in embryonic development of tendons and ligaments and in the healing of injuried tendons and ligaments. The eukaryotic expression plasmid of rat basic fibroblast growth factor (bFGF) gene was constructed in order to further investigate the bFGF function in molecular regulatory mechanism in the repair of tendons and ligaments and to provide the foundation for the clinical application. The cDNA fragments of bFGF were cloned from the skin of rats by RT-PCR, and recombinated to the pMD18-T vector. The cDNA encoding bFGF was cloned from the pMD18-T vector by RT-PCR, digested with restriction enzyme EcoR I Pst I and bound to eukaryotic expression plasmid pIRES2-EGFP to construct eukaryotic expression plasmid pIRES2-EGFP-bFGF. The pIRES2-EGFP-bFGF was transfected into the tenocytes by lipid-mediated ransfection technique. MTT test was used to detect the biological activity of bFGF in supernatants after the transfection. The expression of type I and III collagen genes was detected by using RT-PCR. It was verified that the pIRES2-EGFP-bFGF was successfully constructed, and its transfection into tenocytes could significantly enhance the biological activity of bFGF, and increase the expression of type I and III collagen mRNA, suggesting that pIRES2-EGFP-mediated bFGF gene therapy was beneficial to the repair of tendons and ligaments.

Objective To discuss the effects and influence of preoperative and postoperative adjunctive intravitreal conbercept in 23G vitrectomy for proliferative diabetic retinopathy (PDR).Methods A retrospective research was performed on 42 PDR eyes from January 2015 to February 2016 in the Second Affiliated Hospital of Nanchang University,who received either intravitreal 0.05 mL conbercept injection 7 days before 23G vitrectomy (group A,n =22) or intravitreal 0.05 mL conbercept injection at the end of 23 G vitrectomy (group B,n =20).The operative time,postoperative vitreous hemorrhage (VH),intraoperative and postoperative other differences of clinical indicators and postoperative best-corrected visual acuity (BCVA) between the two groups were compared.Results The average operation time,intraoperative electric coagulation hemostasis rate,iatrogenic hiatal incidence and intraoperative hemorrhage rate of group A were lower than those of group B (all P ＜ 0.05).BCVA at 6 months after surgery did not differ significantly between two groups (P ＞ 0.05),but the difference was statistically significant between pre-operation and post-operation (P ＜ 0.05).The incidences of early (≤ 1 month) postoperative VH were 18.2％ (4 eyes) and 15.0％ (3 eyes) in group A and B,respectively (P ＞ 0.05).The incidences of later (＞ 1 month) postoperative VH were 27.3％ (6 eyes) and 0 in group A and B,respectively,the difference was statistically significant (P ＜0.05).The percentages of reoperation were 13.6％ (3eyes with postoperative VH) and 10.0％ (2 eyes with traction retinal detachment) respectively in group A and B.The average times of supplementary laser photocoagulation were (2.3 ± 1.0) times and (1.4 ±0.6) times in group A and B,respectively in follow-up period (P ＜ 0.05).Conclusion The adjunctive use of intraoperative intravitreal injection of conbercept can prevent effectively postoperative VH and decrease conveniently the time of supplementary laser photocoagulation in 23G vitrectomy for PDR,as well as the preoperative adjunctive use can decrease the operation time,intraoperative complications and incidences of early postoperative VH.

Purpose To explore the feasibility of optimizing monochromatic images in reducing iodinated contrast dose in CT pulmonary angiography (CTPA). Materials and Methods Sixty-eight patients undergoing CTPA were randomly divided into two groups, with half in research group and half in conventional group to evaluate image quality. Research group underwent spectral CT imaging with the injection of 30 ml Omnipaque (300 mgI/ml) and optimal monochromatic images were postprocessed using the software of GSI viewer. Conventional group underwent conventional CTPA with the injection of 80 ml Ultravist (370 mgI/ml). The CT values were measured respectively in the main pulmonary artery, left pulmonary trunk, right pulmonary trunk, left lobe artery and right lobe artery. The contrast noise ratio (CNR) in two groups were calculated, and image quality were subjectively assessed. Results The total iodine intake in research group (9000 mg) was significantly lower than that of conventional group (29 600 mg). CNR in the main pulmonary artery, left pulmonary trunk, right pulmonary trunk, left lobe artery and right lobe artery in research group was significantly higher than that of conventional group (t=2.07-2.71, P<0.05). Subjective image quality scores in research group were also higher than that of conventional group but had no statistical difference (Z=-0.944, P>0.05), while there was a good agreement between the two readers (Kappa=0.8, P<0.05). Conclusion It is possible to reduce iodinated contrast dose using spectral CT imaging and improve the image quality of CTPA.

Objective To evaluate the value of low concentration of isotonic contrast agent combined with 80 kV and adaptive statistical itera-tive reconstruction (ASiR)technique for bronchial artery with CT angiography (CTA).Methods 40 patients (18.5 kg/m2 ≤ body mass index(BMI)≤25 kg/m2 )with lung cancer were randomly divided into two groups and performed enhanced chest CT examina-tion.20 patients (low concentration group)were scanned with Visipaque 270mg I/mL,scanning protocol of (80 kV,260 mA)and other 20 patients (high concentration group)were scanned with Ultravist 370 mg I/mL,scanning protocol of (120 kV,1 50 mA). The CT value,signal noise (SD),signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR)and effective dose (ED)of the two groups were compared and analyzed statistically.Differences between the two groups were determined with t test(P <0.05).Results The mean CT value of the low concentration group (31 7.33 HU±70.44 HU)was higher than that of the high concentration group (256.39 HU±37.38 HU)(P <0.05).SD,ED and dose length product (DLP)of the low concentration group (SD:7.55 ±1.51 HU;ED:1.74±0.14 mSv;DLP:124.94±9.9 mGy/cm)were lower than those of the high concentration group (SD:9.36±1.26 HU;ED:3.20±0.35 mSv;DLP:228.82±25.13 mGy/cm)(P <0.05).CNR and SNR of the low concentration group (CNR:59.71± 17.36;SNR:44.01±14.71)were higher than those of the high concentration group (CNR:37.61±6.16;SNR:27.75±4.72)(P <0.05).The subjective scores of the two groups were (3.73±0.66)and (3.81±0.59),respectively,with no statistical difference.Conclusion For the patients with normal body mass index ,it can reduce 47% radiation dose and 27% iodine dosage using low concentration of isotonic contrast agent combined with 80kV and ASiR technique for bronchial artery CTA,while maintaining similar excellent image quality.