Objective To determine perioperative changes of tumor necrosis factor alpha (TNF ?),superoxide dismutase(SOD),lipid peroxides(LPO) and creatine kinase MB (CK MB) in patients undergoing cardiopulmonary bypass (CPB) Methods Thirteen patients undergoing heart valves surgery were studied Blood samples were taken from artery and coronary sinus for measurement of plasma TNF ? and LPO concentrations, and plasma SOD and CK MB activities prior to CPB, 5min,30min after aorta declamping, at the end of operation, 6h and 18h after surgery respectively Blood gas analysis was done at various intervals and alveolar arterial oxygen gradient (P A a DO 2) was calculated The net myocardial release of TNF ? (coronary sinus plasma level minus arterial level) was recorded Results Arterial and coronary sinus TNF? levels increased significantly following aortic declamping as compared with those before CPB and were kept at the higher level till the end of operation (P

Objective To assess the influences of cardiopulmonary bypass (CPB) on energy matabolism and the effect of nicardipine pretreatment. Methods Sixteen patients with valvlar heart disease undergoing valve replacement were chosen and randomly allocated into control group (group C, n=8) and nicardipine pretreatment group (group N,n=8). In group N, nicardipine 0.5?g?kg -1?min -1 was continuously infused after induction of anesthesia and terminated before CPB. The total dose given was 0.5mg?kg -1. If the total dose was not reached before CPB, the rest dose was given immediately after the beginning of CPB. Arterial and coronary sinus blood samples were taken immediately before CPB,at 5,30min after the aortic declamping , the end of operation, 6 and 18h after operation.Blood lactate and glucose concentrations were measured. Blood gas was checked simultaneously. Then myocardial lactate extraction rate (LER) and myocardial glucose extraction rate(GER) and myocardial oxygen extraction index(MOEI) were calculated. Results In group C GER and LER decreased signficantly after aortic declamping as compared with those before CPB (P

ve To investigate the mechanism of myocardial ischemia-reperfusion injury during cardiac surgery and the protective effect of low dose nicardipine. Methods Sixteen patients undergoing valve replacement under cardiopulmonary bypass (CPB) were randomized to one of the two groups: control group (group C, n = 8) and nicardipine group (group N, n = 8) . In group N low dose nicardipine (O.5?g?kg-1 ?min-1) was infused after induction of anesthesia until beginning of CPB, a total dose of 0.05 mg?kg-1 was given. All patients were premedicated with intramuscular morphine 0.1-0.2 mg?kg-1 and scopolamine 0.3 mg 30 min before surgery. Anesthesia was induced with midazolam 0.05-0.1 mg?kg-1, fentanyl 15-20 ?g?kg-1 and pipecuronium 0.1 mg?kg-1 and maintained with intermittent boluses of midazolam 0.05 mg? kg-1, fentanyl 10-30?g?kg-1 and pipecuronium 2 mg. After induction of anesthesia Swan-Ganz catheter was placed for hemodynamic monitoring. Moderate hypothermia (26℃-28℃) was maintained and Hct was diluted to 20%-24% during CPB. Hyperkalemic cardioplegia was used for myocardial protection. Arterial blood (a) and coronary sinus (cs) blood were taken simultaneously for determination of tumor necrosis factor a (TNF-a), superoxide dismutase (SOD), lipid peroxide (LPO), creative kinase(CK-MB) before CPB and at 5 and 30 min after release of aortic cross-clamp (RACC), at the end of operation (EO) and at 6h and 18h after operation. Myocardial net release of TNF-a (TNF-anr) and LPO (LPOnr) and net consumption of SOD (SODnc) were calculated. The number of defibrillation after RACC, weaning index from CPB and dopamine requirement after CPB were recorded simultaneously. Results In group C LPOa and LPOcs increased significantly after RACC until the end of operation as compared with the baseline (P

0.05).There was remarkable low signal intensity on T2-weighed imaging and no evident artifacts for molecular probe when the concentration of Fe2+ was 20 mg/L.The least number of labeled cells detected by MR in vitro was 6?106 when the concentration of Fe2+ was 20 mg/L.Conclusion:Molecular probe,SPIO-OCT,can effectively label breast cells which express SSTR.The reasonable Fe2+ concentration of labeled cells and imaging was 20 mg/L.There is a correlation between MR signal intensity in vitro and the number of labeled cells.

Under National Health Insurance system ( NHI) , Taiwan implemented “Family Physician Integrat-ed Health care Plan” by focusing on the key functions of primary medical institutions and family physicians. This plan had continuously strengthened the family physician system and the quality of integrated health care provision. Taiwan’s achievements and experiences were valuable for Mainland China. This paper first introduced the health sys-tem and health care provision system of primary medical institutions in Taiwan from the aspects of financing, pay-ment, health care delivery system structure, and market-capture institutions. Then, we made a comprehensive intro-duction on the policy objectives, organization structures, operation system, service schemes and health insurance pay-ment system of this plan. Finally we proposed the suggestion for integrated health care provision system in Mainland China. It is of vital importance that government should design the integrated service provision system by focusing on the key functions of family physicians. It is also of equal significance that the health administrative departments should cooperate with health insurance administrative departments to gain sufficient policy and funding resources for the plan’s successful implementation.

Objective To estimate and compare the equivalent dose between the intensity modula-ted radiotherapy (IMRT) and conventional radiotherapy (CR) for patients with nasopharyngeal carcinoma (NPC). Methods The peripheral equivalent dose of NPC patients was measured by TLD during IMRT and CR. The whole-body equivalent dose was calculated. Results When prescribed tumor dose of 70 Gy was given, the mean number of accelerator output units were 25235 MU and 8575 MU, and the whole-body e-quivalent dose were 73.65 mSy and 15.28 mSy for IMRT and CR, respectively. Conclusion The equiva-lent dose in IMRT is 4.8 times higher than that in CR for patients with nasopharyngeal carcinoma.

Objective To develop a Gd-based MR probe containing arginine-glyeine-aspartic acid (RGD)motif to reveal integrin avβ3 receptor-expressed tumor.Methods Commercially available HYNICRGD conjugate with co-ligand EDDA was labeled with GdCl3,and the mixture was isolated and purified by solid phase extract(SPE)to get the entire probe Gd-EDDA-HYNIC-RGD.Human HCC cell line BEL-7402 was cultured and the cells harvested and suspended then subcutaneously inoculated into athymic nude mice for tumor growth.In vitro cell binding assay to integrin avβ3 receptor and cell viability experiments were conducted.Then in vivo,imaging of the three arms of xenografts were performed by MR scan with a dedicated animal coil at baseline and time points of 0.30,60,90 mninutes and 24 hour post-intravenous injection(P.i.) via the tail vein.Three arms of nude mice then were sacrificed for histological examination to confirm the imaging results.Results Gd-EDDA-HYNIC-RGD was successfully isolated by SPE and validity was verifled on signal enhancement througll in vitro and in vivo experiments.The T1 relaxation rate of the probe is 3.31 mmol/s:It is well tolerated to living cells when the concentration of the probe is below 0.1 μmol/ml;both BEL-7402 Hunlan Hepatocellular Carcinoma cell Iine and the tumor expressed avβ3receptor;The RGD-iigand was observed specificly binding with avβ3 receptor in vitro;The nude mice model bearing HHCC was well estabhshed.The signal intensity(SI)at the tumor site were 2247.6±39.0 at baseline and 2820.9±35.2 at 90 min p.i.respectively,the SI at 90min increased less than 25%of baseline,which is statistically different(t=-38.031,P＜0.05);while the SI at muscle site were 1824.2±32.8 and 1845.8±27.2 respectively,which is not statistically different(t=-1.424,P＞0.05);The signal to time curve for probe-administrated group is straightforward over time in the span of 0 to 90 minute p.i.while the control arms do not show such tendency.Conclusion Gd-EDDA-HYNIC-RGD has the potential to used as an MR probe detecting integrin avβ3 receptor-expressed tumor.This work may offer possibility of early detection and differentiation of specific tumors.

Objective To evaluate the effects of arterial pressure continuous output (APCO) derived from stroke volume variation (SVV)-guided fluid management in the patients undergoing supratentorial neoplasms surgery.Methods Sixty-three patients (29 males, 34 females, aged 18-65 years, ASA physical status Ⅰ or Ⅱ) undergoing elective supratentorial neoplasma surgery were randomly divided into control group (group C, CVP-guided fluid management, n=30) and GDT group (group S, SVV-guided fluid management, n=33).Before the induction of general anesthesia, the hydmxyethyl starch Voluven (130/0.4) bolus 3 ml/kg in the two groups was administered followed by infusion of crystalloid at the rate of physical requirement.Hydroxyethyl starch or vasoactive agents were administrated to achieve the goal of CVP≥8 mm Hg or MAP>80% of baseline in group C andto reach the value of SVV≤12% and MAP>70% of baselinein group S.Intraoperativecrystal, intraoperative colloids,total fluid volume, bleeding volume, volume of blood transfusion and urine volume were recorded.The radial artery and venous blood was sampled for blood gas analysis, measurement of lactate concentration and laboratory parameters at 30 min before anesthesia induction (T0), the dura mater cutted (T1), end of operation (T2) and postoperative 24 h (T3).Postoperative complications and the number of patients with complications in postoperative period, the length of ICU stay and postoperative days were assessed.Results Total infused fluid volume [(1 478±312) ml vs (1 183±294) ml] and intraoperative colloids [(775±236) ml vs (487±243) ml] were significantly higher in group S than those in group C (P<0.05).Compared with T0, the lactate concentration were decreased significantly in two groups at T1 and T2.The lactate concentration in group S was significantly lower than group C at T2 [(0.91±0.25) mmol/L vs (1.31±0.46) mmol/L](P<0.05).There was no significant difference of postoperative complications, the length of ICU stay and postoperative days between two groups.Conclusion Fluid management guided by SVV during supratentorial neoplasms surgery reduces lactate levels.

Objective:To observe the effect of "Qishen Yiqi Droplet" on serum concentrations of high sensitivity C reactive protein(hs-CRP),plasminogen activator inhibitor-1(PAI-1),endothelin-1(ET-1)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention (PCI).Methods:A total of 100 consecutive ACS patients ready to receive PCI therapy in our hospital from june 2007 to August 2008 were randomly assigned into two groups:Qishen group,n=50,with Qishen Yiqi Droplet 5.0 g three timee a day+conventional therapy after PCI;and Control group,n=50 with conventional therapy after PCI.The concentrations of hs-CRP,PAI-1 and ET-1were detected and compared 24 hours before PCI,and 24 hours,4weeks after PCI between two groups respectively.Results:There were no obvious differences of hs-CRP,PAI-1 and ET-1 24 hours after PCI in two groups.The levels of hs-CRP,PAI-1,ET-1 were lower in Qishen group than in Control group 4 weeks after PCI (0.219±0.143)ng/dl vs.(0.366±0.132)ng/dl,P<0.001,(104.252±26.038)ng/dl vs.(118.419±28.849)ng/ml,P<0.05,and (37.411±12.977)ng/dl vs.(45.755±12.305)pg/ml,P<0.01,respectively.Conclusion:Qishen Yiqi Droplet could decrease the levels of hs-CRP,PAI-1 and ET-1 in ACS patients who underwent PCI,and it might have the protective role in preventing the neointimal hyperplasia and thrombogenesis after stent implantation.

Objective To investigate the clinical implications of portal vein bloodletting immediately before reperfusion during orthotopic liver transplantation(OLT).Methods Thirty-two patients with end-stage liver diseases undergoing non veno-venous OLT were divided into bloodletting group (n=21)and control group(n=11).During anhepatic phase,we maintained mean arterial pressure ＞70 mm Hg,cardiac index＞2.5 L·min-1·m-2 by infusion,norepinephrine and dopamine.Blood samples were taken at the time when portal vein was clamped(T1),the time when portal vein was unclamped (T2),10 minutes after neohepatic phase(T3),neohepatic phase 30 minutes(T4)for electrolytes,blood gas and plasma inflammatory cytokines.Hemodynamic and ventilation parameters were also recorded.Results There was no significant difference in mortality(X2=1.12,P＞0.05)and arrhythmia incidence (X2=1.73,P＞0.05)between the two groups.Serum calcium,magnesium were both significantly lower than normal.After anhepatic phase,potassium,tumor necrosis factor alpha,interleukin-6 in radial artery didn't alter significantly;Bloodletting had no effect on lactic acid.There was no significant difference in hemodynamic and ventilation parameters among four time periods.Conclusion Bloodletting seemed to have no effect on changes of internal environment.