Objective To investigate the accuracy of end-tidal carbon dioxide (PETCO2) in reflecting arterial carbon dioxide (PaCO2) during mechanical ventilation via laryngeal mask airway (LMA) in children. Methods Fifty-two ASA Ⅰ patients, aged 2-9 yr, weighing 10-30 kg, undergoing orthopaedic surgery under general anesthesia, were randomized into 2 groups (n = 26 each) : LMA group and endotracheal tube (ETT) group. After anesthesia was induced with fentanyl, propofol and succinycholine, LMA or ETT was inserted and the children were mechanically ventilated. After the hemodynamics was stable, arterial blood samples were obtained to detect PaCO2, and PETCO2 was recorded simultaneously. Results There was no significant difference in PaCO2 and PCT CO, between groups LMA and ETT ( P ＞ 0.05) . There was no significant difference between PaCO2 and PETCO2 in LMA group (P ＞ 0.05). Conclusion When mechanical ventilation is performed via LMA in children, PETCO2 can reliably reflect PaCO2 and guide the regulation of ventilatory parameters.

Objective To investigate the effect of propofol on LPS-induced TLR4 expression in rat alveolar type Ⅱ epithelial cells. Methods The primarily cultured alveolar type Ⅱ epithelial cells isolated from male rats were randomly assigned to one of 5 groups: group Ⅰ cells were incubated for 3 h without any additive (control) ; group Ⅱ cells were incubated with LPS 1 μg/ml for 3 h (LPS) ; group Ⅲ , Ⅳ , Ⅴ cells were incubated with LPS 1 μg/ml + propofol 25, 50 and 100 μmol/L respectively for 3 b (P1-3). TLR4 mRNA and TLR4 protein expression was detected by real time PCR and Western blot. TNF-α release amount was measured using ELISA. Results LPS significantly' increased TLR4 mRNA and protein expression in alveolar type Ⅱ epithelial cells as well as TNF-α release amount. Propefol at 50 and 100 μmol/L significantly inhibited LPS-imluced increase in TLR4 mRNA and protein expression and TNF-α release amount. Conclusion Propofol can dose-dependently inhibit LPS-induced inflammation in alveolar type Ⅱ epithelial ceils, through down-regnlation of TLR4 gene and protein expression.

Objective To summarize our experience in the diagnosis and management of popliteal artery entrapment syndrome (PAES). Methods This is a retrospective study on 10 patients (13 limbs)who were admitted for symptoms of claudication and the diagnosis of popliteal entrapment was established either with angiography,computed tomographic angiography,magnetic resonance angiogram or during the operation in recent 7 years (2002-2009).All patients were treated surgically. Results The mean age at the time of presentation was (25 ±7) years old (range,17-41 years).Claudication was the most frequent presenting symptom (12 limbs).The surgical procedures consisted of simple musculotendinous dissociation in 1 limb,thrombectomy with balloon angioplasty in 1 limb,musculotendinous dissociation plus thromboendarterectomy with autogenous saphenous vein (ASV)patch angioplasty in 2 limbs,ASV graft interposition or bypass in 6 limbs and graft interposition or bypass in 3 limbs.At a median follow-up of (35 ±27) months (range,2 months-7 years),there were no intraoperative or long-term postoperative complications and all the patients were cured. Conclusions PAES is an unusual but important cause of peripheral vascular insufficiency especially in young patients.A combined approach is necessary for diagnosis.Popliteal artery release alone or with vein bypass or reconstruction is the treatment of choice.

Objective To compare the safety of dopamine ( DA) and norepinephrine ( NE) in hypovolemic shock , and the impact on the stability of blood pressure and haemodynamics .Methods Eighty two patients with hypovolemic shock were given fluid resuscitation . All the patients were divided into two groups including DA group (n=41) and NE group(n=41).Recovery of blood pressure, hemody-namic parameters were observed at different time point , and the complications and mortality of two groups were recorded .Results Blood pressure of all the patients returned to normal in 15min after the medication, and became stable after 30min.There was no significant difference in the blood pressure in both groups except that of 15min.Compared with T0, There were higher in the numerous of CVP , CI, ELWI, ITBI.The ELWL at T2 in DA group was higher than that of NE group , while there was no significant difference in the other time points between the two groups(P>0.05).After treatment for 24 h, blood oxygen saturation, urine volume in two groups were significantly increased, blood lactic acid markedly reduced , but lactic acid in NE group was obviously lower than that in DA group (P<0.05).Com-pared with DA group, the incidence of arrhythmia cordis , 2-week mortality in NE group were significantly reduced (P<0.05), while the acute kidney injury in two group was not statistically different (P>0.05).Conclusion The effect of NE and DA in maintaining the stability of blood pressure and hemodynamic are equivalent , and NE did not increase the risk of acute kidney injury , but can effectively improve tissue perfusion , reduce arrhythmia and case fatality rate , improve clinical outcomes .

Aim To establish a new simple, easy and economical PCR method for determining cyp2d6~*10 allele and studying its distributive frequencies in Chinese population. Methods The new PCR are established and compared with the classical PCR-RFLP. The 224 samples have been determined with the new PCR.Results the results of the two methods go on the way. The allele distribution frequencies of cyp2d6~*10 resembles the reports. Conclusion the new method is proved to be accurate and convenient. It provides a genetics basis for the drug therapy with individuals in clinics.

Objective To study the change of the content of collagen typeⅠand collagen type Ⅲ (C-Ⅰ, C-Ⅲ) in liver and spleen of patients with advanced schistosomiasis japonica. Methods Sirius red staining was used to examine pathologically the liver and spleen biopsy materials from 55 patients at the advanced stage of schistosomiasis and 5 healthy persons as control. The stained slides were observed under polarizing microscope and results were interpreted by computer imaging analysis system. (Results) The content of C-Ⅰand C-Ⅲ in liver tissue and hepatic sinusoids increased significantly in the patients than that of the control (P

Objective To observe the change of liver sinusoid in BALB/c mice infected with Schistosoma japonicum and explore its relationship between the degree of hepatic fibrosis and liver function. Methods A model was established in BALB/c mice infected with cercariae of Schistosoma japonicum. The liver specimens of mice were used for pathological examination with routine and picric acid-sirius red staining to know the degree of hepatic fibrosis by semi-quantity. The expressions of C-IV and vWF in liver sinusoid were assayed through the immuhistochemistry staining. The serum ALT and AST were detected by the automatic biochemistry analyzer, and the ultramicrostructure of the liver tissue was observed by a transmission electron microscope. Results The number and diameter of fenestrations in SEC reduced 4 weeks after the infection. The fenestrations were disappeared and the base membrane established 8 weeks after the infection. The expressions of C-IV and vWF in liver sinusoid and the degree of hepatic fibrosis increased with the time after infection. The levels of serum ALT and AST were not correlated with the infection time. Conclusions The phenotype alteration of the hepatic sinusoidal endothelium may be a vital issue triggering the liver fibrosis induced by Schistosoma japoncium.

By using distraction osteogenesis technique, 3 cases of mandibular hypoplasia were treated by home-made and German-made jaw distractors: including one patient suffered from bilateral ankylosis of temporo-mandibular joint and 2 patients from deficiency of mandible. The duration of distraction osteogenesis was one month. The bone distractor was removed 3 months after operation. Satisfactory results were obtained in all 3 cases. Distraction osteogenesis can successfully be used in mandibular functional reconstruction and has much more advantages than traditional technique.
Ankylosis/etiology ; Ankylosis/surgery ; Bone Transplantation ; Mandible/*abnormalities ; Mandible/*surgery ; Oral Surgical Procedures ; *Osteogenesis, Distraction ; Temporomandibular Joint

To treat large facial defect (more than 6 cm x 4 cm in diameter) or a wound with bone exposure to atmosphere by less-traumatic, easier-healing reconstruction method, a pedicle flap including facial, neck, posterior auricle and occipital skin flap was designed and transferred, one by one, to repair facial defect as well as other flap donor sites, but occipital skin flap was only used to cover posterior auricle area. After 2-3 years follow-up, well-healed skin flaps with good color, elasticity and sensation were observed in all 16 patients. It is concluded that this method is effective and practical.
Carcinoma, Basal Cell/surgery ; Cicatrix/*surgery ; Face ; Neck ; Orbital Neoplasms/*surgery ; Parotid Neoplasms/*surgery ; Reconstructive Surgical Procedures/methods ; Scalp ; *Surgical Flaps

BACKGROUND :Although the conventional 20 G pars plana vitrectomy can improve the prognosis of vitreous-retina diseases,but it would also cause serious operation related injury and much complications.OBJECTIVE:To evaluate the practicability and safety of 25-gauge transconjunctival sutureless vitrectomy system (TSV25G) in the macular surgery, so as to elicit the preliminary clinical experience of mimimally invasive vitrectomy system.DESIGN:Case analysisSETTING: Department of Ophthalmology, General Hospital of Chinese People's Armed Police Force; Department of Ophthalmology, Beijing Sino Japen Friendship Hospital; Department of Ophthalmology and Visual Science, Chinese University of Hong Kong; Department of Ophthalmology,Prince of Wales Hospital, Hong Kong PARTICIPANTS: From July 2003 to July 2004, 16 patients with macular diseases were admitted to the Department of Ophthalmology in the General Hospital of Chinese People's Armed Police Force and taken as subjects (n=16), they were confirmed as epiretinal membrane in 9 eyes, idiopathic macular hole in 3 eyes, traumatic macular hole in 2 eyes and vitreo-macu lar tractional syndrome in 2 eyes. The course of disease ranged from 3 to 36 months with eyesight varied between 0.06 and 0.4.METHODS: 16 eyes underwent preoperative ophthalmic evaluation in cluding visual acuity measurement, Amsler chart test, slit lamp microscopy,.indirect ophthalmoscopy tonometry and optical coherence tomography (OCT). For the macular hole patients OCT was performed. 25-gauge Transconjunctival Sutureless Vitrectomy System (TSV25G) was used to carry on minimally invasive surgery under anesthesia state, the surgical parameter was set as: high speed cutter with rate of 1500 cuts per minute,BSS bottle was hang at height of 40-50 cm, the maximum aspiration of TSV25G was 550 mm Hg with the intraocular pressure remained at around 29-35 mmHg during the operation. Three-beveled trocar were used to make three-transeonjunctival incision on sclera of about 0.5 mm long respectively in the infratemporal, superotemporal, and supraotemporal quan drants, meanwhile a transconjunctival cannula was placed. One end of the infusion tube was inserted into the infratemporal cannula to establish infusion with the other two cannulas used for the intraocular operation with 25-gauge vitreous cutter and other instruments, such as vitreoectomy and membrane dislocation. The surgery was terminated by removing the cannula except for ceaseless leak, the conjunctival and scleral incision were not sutured. Patients received follow-up examination for 1-12 months postoperatively.MAIN OUTCOME MEASURES:①The operative time and the time for the establishment of three access. ② Changes of intraocular pressure after operation. ③ The effusion from the puncture after the intraocular perfor mance. ④ The postoperative vision, operative complication and the sealing of the holes.RESULTS:All of the 16 patients completed the vitrectomy; and entered the data analysis.①16 patients complete the vitrectomy with the operative time of 28-56 minutes (the mean of 37 minutes). The average time for the establishment of three access and closing was 84 s and 32 s respectively.②The average preoperative intraocular pressure was 16.4 mm Hg,comparing with 13.5,15.5,17.9 mm Hg at postoperative 1 day, 1 w and 1 m. ③Water leakage were found in 4 wounds of three patients after operation, 3 wounds were sealed after injecting 1-2 mL disinfected air into the eyes, the other one sutured with 6-0 absorbable suture. ④The mean time of inpatients were 5 days postoperatively. The visual acuity improved in 14 patients by the average of three lines, amongst which visual acuity was found improved to above 0.8 in 5 patients and the visual distortion disappeared in 8 eyes and attenuated in 3 eyes. But still there were 2 cases without improvement.No surgical complications were noted and macular hole gained clinical sealing in totally 5 eyes.CONCLUSION: TSV25G system can simplify the surgical procedure with many other advantages such as decreasing the operation related injury and complications, as well as shortening operative time, which benefits the rapid rehabilitation.