Objective To evaluate the effects of 6% hydroxyethyl starch (HES)130/0.4 and 6% HES 200/0.5 on blood coagulation in patients undergoing major operation under general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing major operation under general anesthesia during which the blood loss was expected to be＞20%of blood volume were allocated randomly into 3 groups(n=20 each):Ⅰ control group(C);Ⅱ6% HES200/0.5 group (H) and Ⅲ HES130/0.4 group (V).In group H and V the patients Arterial blood samples were taken before(T1),immediately(T2)and 1 h after the end of fluid infusion(T3)for determination of hematocrit(Hct),platelet count(PLT)and prothrombin time(PT),platelet maximum aggregation test induced by 5 μmol/L ADP,and Sonoclot coagulation and platelet function analysis(gbACT,CR,PF,TP).Activated partial thromboplastin time(Am),coagulation factor Ⅷ (FⅧ)activity and von Willebrand factor(vWF)were measured only in group H and V.Results (1) PT and APTT were significantly prolonged after fluid infusion at T2 and T3 as compared with the baseline values at T1 in group H and V.(2)FⅧ activity and platelet maximum aggregation induced by ADP were significantly decreased at the end of fluid infusion at T2 as compared with the baseline at T1 but increased again at T3 in group H and V.(3)There was no significant change in Sonoclot coagulation parameters after fluid infusion as compared with the baseline except clot formation rate (CR)in group H and V.Conclusion Acute hypervolemic hemodilution with 6% HES130/0.4 or 200/0.5 has minimal effect on blood coagulation and there is no significant difference in blood coagulation changes induced by 6%HES130/0.4 and 200/0.5.

Objective To determine intra-operative changes in blood coagulation and the applicability of SCA in liver transplantation. Methods Twenty-four patients with end-stage liver disease undergoing or-thotopic Liver transplantation (OLT) were studied. Arterial blood samples were drawn for determination of celite-activated TEG, glass bead-activated SCA and RCT at 6 intervals: before anesthesia induction (T0), 60 min after operation was started (T1), 30 miu in anhepatic phase (T2), 30 min in neohepatic phase (T3) ,120 min in neohepatic phase (T4) and the end of the operation (T5) ; the variables of TEG includ-ed: reaction time(R) ,coagulation time(K), alpha angles (α) and maximal amplitude (MA) ; the variables of SCA included: activated clotting time (ACT), clot rate (CR) and platelet function(PF) ;RCT included: Plt, PT, INR, APTT, Fbg. Results The Kappa values of SCA and TEG diagnosing the deficiency of blood coagulation factors, the gel formation speed of fibrin and the function of platelet were respectively 0.371 (P < 0.05) ,0. 363 (P < 0.05) ,0.438 (P < 0.05). gbACT and R, CR and α, PF and MA were positive-ly correlative (r = 0. 790, P < 0.05 ; r = 0. 766, P < 0. 05 ; r = 0. 502, P < 0.05 ; respectively) ; CR and K were negatively correlative(r = -0. 588,P <0.05). Compared with T0, PT, INR, gbACT and R were pro-longed, FBG, CR, α and MA were decreased at T3-5 (P < 0.05). APTT was prolonged at T1 ～ T5 (P < 0.05). K was prolonged at T3 (P < 0.05) and PF was decreased at T2 ～ T4. Conclusion SCA can exactly monitor changes of blood coagulation in liver transplantation.

Bacterial resistance to antibiotics is currently a serious health concern.According to the data from the surveil-lance of bacterial resistance in China ( CHINET) ,the isolation rates of gram-negative bacteria have been rising annually. Among the gram-negative organisms, the isolation rate of Carbapenem-resistant enterobacteriaceae, especially extensive drug-resistant strains,has been increasing rapidly.The isolation rate of extensive drug-resistant or pandrug-resistant non-fermenting bacteria,es-pecially Acinetobacter baumanii,is still relatively high.These extensive drug-resistant gram-negative bacteria cause high mortality, which has drawn great attention in clinical settings.On the part of multidrug-assistant gram-positive bacteria,the isolation rate of vancomycin-resistant enterococci remains stable but rates of methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci are still high.Staphylococcal strains have not yet been found resistant to vancomycin in China.Understanding the epi-demiology of local drug-resistant bacteria facilitates the development of appropriate antibiotic strategies. The mortality of patients with severe infection may be improved by early use of antibiotics and appropriate de-escalation therapy.Rational use of antibiotics and recognition of the influence factors,such as antibiotic-induced endotoxin release,may maximize the efficacy of antibiotics and minimize the adverse reactions.

Objective To investigate the effects of statins on coronary artery disease in patients with coro-nary heart disease and lipid regulating effect on curative effect .Methods 126 cases of patients with coronary heart disease were randomly divided into the control group of 60 cases and 66 cases in the treatment group ,the control group was given routine treatment of coronary heart disease ,the treatment group was treated with routine treatment with simv-astatin bedtime,before treatment and after 3,12 months when the determination of lipids ,liver function and renal func-tion index,and compared between the two groups of cardiovascular events .Results 3 months after treatment , TG, TC,LDL-C of the treatment group decreased significantly ,while the control group in 3,12 months after treatment,TC, TG,LDL-C had the rise of certain level(t=5.43,5.21,4.85,all P<0.05).The two groups after treatment in 3, 12 months in TC,TG,LDL-C had significant differences(t=5.32,5.78,5.64,6.15,6.41,6.06,all P<0.05).Dur-ing follow-up,patients in the treatment group 33 cases of cardiovascular events ,the control group of 81 cases,two groups of cardiovascular event rate had a significant difference (χ2 =13.42,P<0.01).Conclusion Statins can re-duce blood lipids in patients with coronary artery disease ,thereby reducing the patients appear related to cardiovascu-lar accidents,improve the treatment effect of coronary heart disease .

11?-hydroxylase deficiency is one of the main causes of congenital adrenal hyperplasia (CAH),which is caused by the mutation of CYP11B1 gene that encodes the enzyme.Researches have shown that mutations of CYP11B1 gene would result in decreased activity or inactivation of the enzyme in classical 11?- hydroxylase deficiency,and their relationship between genotype and phenotype of 11?-hydroxylase deficiency is not clear.

Objective To evaluate the reliability and accuracy of the fully automated erythrocyte sedimentation rate (ESR) analy‐ser Monitor‐100 for determining ESR .Methods 146 outpatients and inpatinets were selected and detected ESR by the fully automa‐ted ESR analyser 1 h ,30 min and the Westergren method .Then these three kinds of method were compared and the repeatability test was performed .Results (1)The ESR values determined by the analyser 1 h ,analyser 30 min and Westergren method were 37 . 8 ± 34 .1 ,38 .1 ± 33 .7 ,36 .4 ± 32 .9 respectively ,there were no statistical significance between any two methods (P>0 .05) .(2)The detection rates of the positive results by the analyser 1 h ,analyser 30 min and Westergren method were 43 .2% ,44 .5% and 45 .2%respectively ,no statistical difference between them was found (P>0 .05) .(3)The Kapper values between the analyser 30 min with the analyser1h ,between the analyser 30 min with the Westergren method and between the analyzer 1h with the Westergren method were 0 .944 ,0 .875 and 0 .903 .4 respectively .(4)The CV values in the repeatability test were very lower and within the acceptable limits .Conclusion Compared with the Westergren method ,the fully automated ESR analyser Monitor‐100 has lower false positive rate and lower false negative rate ,moreover its consistency and repeatability are excellent ,it is convenient ,fast ,safe and should be largely promoted in clinic .

Adult ; Histiocytosis, Sinus ; Humans ; Male ; Nasal Cavity ; Paranasal Sinuses

BACKGROUND: Panax notoginseng saponins (PNS) could significantly improve the learning and memory ability of rats, but its influence to peripheral nervous system still needs further investigation.OBJECTIVE: To observe the effects of PNS on the fast-excitatory postsynaptic potential (f-EPSP) in stellate ganglion (SG) of rats.DESIGN: Observation and controlled trial.SETTING: Pharmacological Laboratory of Guangxi Medical University.MATERIALS: The experiment was carried out at the Pharmacological Laboratory of the Experimental Center of Guangxi Medical University from January 2005 to February 2006. Thirty healthy male SD rats of clean grade and (220±20) g, provided by the Experimental Animal Center of Guangxi Medical University; SEN-7203 digital three track strip stimulator, microelectrode amplifier (MEZ8301, Japan NIHON KOHDEN COMPANY); glass microelectrode puller, and microelectrode manipulator, both the products of Narishige Company, Japan; PNS, provided by Kunming Jacobson Pharmaceutical Co., Ltd, and acetylchloride chline (Ach), the product of Sigma, U.S.A.METHODS: After the animals were executed acutely, their chest wall was opened to isolate SG rapidly under microscope, which was transferred to the perfusion chamber, and fixed with wire needles after peeling the connective tissue membrane. The ganglia were perfused continuously with the mixture of volume fraction 0.95 O2 and 0.05 CO2 plus Krebs solution with pH (7.4±0.05). Meanwhile, 0.08-0.16 g/L PNS was employed to perfuse and culture SG.①The glass microelectrode filled with 3 mmol/L KCI was used to puncture the isolated SG and record the amplitude and duration of depolarizing reaction of postsynaptic membrane.②PNS with the maximum concentration of 0.16 g/L, which could inhibit the f-EPSPs, was perfused to observe the effect of PNS on the amplitude and duration of depolarizing reaction of postsynaptic membrane induced by exogenous Ach (1 mmol/L, 1 minute).③PNS with the maximum concentration of 0.16 g/L, which could inhibit the f-EPSPs, was perfused to observe the effect of PNS on membrane resistance and membrane potential.MAIN OUTCOME MEASURES:①Amplitude of depolarizing reaction of postsynaptic membrane; ②Effect of PNS on the amplitude and duration of depolarizing reaction of postsynaptic membrane induced by exogenous Ach, and membrane resistance and membrane potential.RESULTS: Thirty rats were involved in the result analysis. ①PNS ranged 0.08 to 0.16 g/L could reversibly depress the f-EPSPs amplitude of, or change the forward active potential into f-EPSP; the higher the concentration of PNS, the more obvious the inhibition was. The depression appeared in 3-10 minutes after PNS perfusion, and the effect reached the peak at 0.16 g/L; f-EPSP was decreased evidently in 3 to 4 minutes. The inhibition nearly recovered to the control level after washing the ganglia with Krebs solution for 15 to 20 minutes. ②Effect of PNS on exogenous ACh-induced depolarization: The amplitude and duration of the Ach-induced depolarization did not significantly change before and 5 minutes after 0.16 g/L PNS perfusion [before: (15.5±2.4) mV, (256.1±21.5) seconds; after: (14.3±1.9) mV, (228.6±24.5) seconds, P＞0.05].③Effects of PNS on membrane potential and membrane resistance: The mean membrane potential and membrane resistance were not significantly changed after PNS perfusion [before:-(55.5±12.1) mV, (53.9±5.1) MΩ; after: -(54.3±10.4) mV, (55.1±4.8)MΩ, P＞0.05].CONCLUSION: PNS could reversibly depress the fast-excitatory postsynaptic potential in stellate ganglion of rats by presynaptic mechanism.

Objective To approach the hemodynamic effects of combined spinal-epidural anesthesia in 65 years or older patients. Methods In a prospective study, 60 American Society of Anesthesiologists Ⅱ～Ⅲ patients (aged 65 yr or older), undergoing elective TKR surgery were randomLy assigned to either CSE an-esthesia (CSEA, n=30) or epidurai anesthesia alone (CEA, n=30). The age, sex, duration of surgery, blood loss, fluid infusion during the surgery and main complications were recorded. Hemodynamic measure-ments included invasive or non-invasive mean arterial blood pressure (MAP), heart rate (HR) before an-aesthesiaufe, 15 wins after anaesthesia and the end of surgery. Our primary endpoint (outcome) was the number of hypotension and bradycardic episodes (defined as MAP<70 mmHg and HR<50 beats per mi-nute). Cases of blood bandage were also recorded. Results There was no significant difference between two groups in the age, sex, duration of surgery, blood loss, fluid infusion and main complications. Using univariate analysis, we found no significant differences between the groups in regards to MAP, HR during the perioperative period. The incidence of hypotension was similar in both groups (7 patients in CSEA and 6 in CEA group, P=0.704), as of bradycardia (3 patients in CSE, 5 in epidural, P=0.754). The inci-dance of blood bandage pain of CSE group was higher than CSEA group. Conclusion Combined spinal-epi-dural anesthesia and epidural anesthesia alone during TKB surgery are associated with the same incidence of hypotension with statistically and clinically similar hemodynamic responses.

Objective To investigate the changes of extravaacular lung water during the perioperative period of orthotopic liver trans-plantation. Methods 24 consecutive patients with end-stage fiver disease undergoing orthotopie liver transplantation (OLT) were studied. In all patients a 5 French fiberoptic catheter with a thermistor was placed in the brachial artery and connected to the PiCCO system. Extravascular lung water (EVLW) and intrathoracic blood volume (ITBV) were monitored. After induction of anesthesia and achievement of stable hemodynamic and respiratory conditions, the baseline values of hemedynamic data, ITBV and EVLW were recorded. The patients were studied during the anhepatic stage, the Ist hour and 2nd hours after reperfusion of the graft. Final measurements of all the values were immediately determined after operation. Results EVLW remained statistically unchanged during the whole study period in all patients though all of them were increased, compared to normal values. EVWL was positively correlated with ITBV (r = 0. 822, P < 0. 05). Conclusion The changes of EVLW during perioperative period of orthotopic fiver transplantation were very little. Circulative volume overload may be perhaps the most important cause of the increase of EVLW.