Objective To investigate the effects of mechanicl ventilation with lower tidal volume and positive end-expiratory pressure (PEEP) on pulmonary function during laparoscopic surgery in patients with chronic obstructive pulmonary disease (COPD).Methods Forty patients with COPD,aged 60-82 yr,with body mass index of 16-29 kg/m2,undergoing elective laparoscopic surgery,were randomly divided into 2 groups (n =20 each) using a random number table:conventional ventilation group (group Ⅰ) and mechanical ventilation with lower tidal volume and PEEP group (group Ⅱ).Anesthesia was induced with midazolam,sufentanil,cisatracurium and propofol and maintained with iv infusion of propofol,cisawacurium and remifentanil.The patients were endotracheally ventilated and mechanically ventilated.In group Ⅰ,fresh gas flow was set at 2 L/min,VT at 10 ml/kg,and I∶E at 1∶2 during ventilation.In group Ⅱ,fresh gas flow was set at 2 L/min,VT at 6 ml/kg,I∶E at 1∶2 and PEEP at 6 cm H2O during ventilation.PErCO2 was maintained at 35-45 mm Hg in both groups.Airway peak pressure (Pp~),airway plateau pressure (Pplat),airway resistance (Raw) and dynamic lung compliance (Cdyn) were measured at 5 min after intubation (T1),45 min of pneumoperitoneum (T2),and 15 min after the end of pneumoperitoneum (T3).Arterial blood samples were obtained at T1,T2 and T3 for blood gas analysis.Alveolar-arterial oxygen gradiant (A-aDO2),oxygenation index (PaO2/FiO2),respiratory index (RI) and physiologic dead space fraction (VD/VT) were calculated.The extubation time and development of complications were recorded within 48 h after operation.Results Compared with group Ⅰ,Ppeak and Plat at T2 and Raw at T1,2 were significantly decreased,Cdyn at T2 and PaO2/FiO2 at T1-3 were significantly increased,RI,VD/VT and A-aDO2 were significantly decreased at T1-3,and the incidence of hyoxemia,atelectasis and rales was decreased within 48 h after operation in group Ⅱ (P ＜ 0.05).There was no significant difference in the extubation time between the two groups (P ＞ 0.05).Conclusion Mechanical ventilation with lower tidal volume (6 nl/kg) and PEEP (6 cm H2O) can improve the pulmonary function during laparoscopic surgery in patients with COPD.

ATP binding cassette C4(ABCC4,MRP4)plays an important role in transshipment physio-logic,endogenous or exogenous substances. The over expression of ABCC4 gene has been found in many kinds of solid tumors and hematological malignancies. The target gene also influences metastasis and recurrence process. ABCC4 can reduce the intracellular concentration and the sensitivity of various chemotherapy drugs, which is bad for prognosis.

Objective To evaluate the effect of penehyclidine hydrochloride pretreatment on pulmonary function during mechanical ventilation in the patients with chronic obstructive pulmonary disease (COPD) undergoing non-thoracotomy.Methods Sixty patients with COPD,aged 58-82 yr,weighing 45-76 kg,of ASA physical status Ⅱ or Ⅲ,scheduled for elective non-thoracotomy under general anesthesia,were randomly divided into Ⅰ,Ⅱ and Ⅲ groups (n =20 each) using a random number table.Anesthesia was induced with iv midazolam,sufentanil,cisatracurium and propofol.The patients were endotracheally intubated and mechanically ventilated.At 30 min before endotracheal intubation,normal saline 5 ml (group Ⅰ),penehyclidine hydrochloride 0.01 mg/kg (group Ⅱ) or penehyclidine hydrochloride 0.02 mg/kg (group Ⅲ) was injected intravenously.At 30,60 and 120 min of ventilation,airway peak pressure (Ppeak),airway plateau pressure (Pplat),airway resistance (Raw) and dynamic lung compliance (Cdyn) were recorded.At 120 min of ventilation,arterial blood samples were obtained for blood gas analysis and oxygenation index (OI),respiratory index (RI),physiologic dead space fraction (VD/VT) and alveolar-arterial oxygen gradient (A-aDO2) were calculated.At 30 min before ventilation and 120 min of ventilation,blood samples were drawn from the radial artery for determination of the serum concentrations of TNF-α,IL-8 and IL-10 by ELISA.The extubation time and pulmonary complications within 72 h after operation were recorded.Results Compared with group Ⅰ,Ppeak,Pplat,Raw,RI,VD/VT and A-aDO2 were significantly decreased,Cdyn and OI were increased,the serum TNF-α,IL-8 and IL-10 concentrations and incidence of pulmonary complications were decreased,and no significant change was found in the extubation time in Ⅱ and Ⅲ groups.There were no significant differences in the parameters mentioned above between group Ⅱ and group Ⅲ.Conclusion Penehyclidine hydrochloride pretreatment can reduce the inflammatory responses during mechanical ventilation,improve pulmonary function,and decrease postoperative pulmonary complications and is helpful for prognosis in the patients with COPD undergoing non-thoracotomy.

To analyze the genetic characterization of epidemic mumps virus strains in Liaoning Province and provide the basis for mumps control. A total of 32 mumps viruses strains were isolated during 2008-2104. The fragment of SH genes and HN genes were amplified by RT-PCR, the PCR products were sequenced and analyzed. Basing on the 316 nucleotides of SH gene, The phylogenetic analyses were processed with the data of WHO mumps reference strains downloaded from GenBank and 32 mumps viruses strains. It showed that the 31 mumps virus strains belong to F genotype except MuVi/Liaoning. CHN/16.11 which was G genotype . Comparing to the A reference strains (Jeryl-Lynn and S-79), F genotype MuV were mutated on 12 amino acids sites and 27 amino acids siteson on HN gene. F genotype MuV added one N-glycosylation site in 464th-466th amino acids. The antigenic sites on HN were mutated on 121th, 123th, 279th, 287th, 336th, 356th and 442th. Maybe, it will influence the MuV antigenic.
Base Sequence ; China ; Genotype ; HN Protein ; chemistry ; genetics ; Humans ; Molecular Sequence Data ; Mumps ; virology ; Mumps virus ; chemistry ; classification ; genetics ; isolation & purification ; Phylogeny ; Sequence Alignment ; Viral Proteins ; chemistry ; genetics

To wished to characterize the hemagglutinin (H) gene of the measles virus epidemic strain H1a in Liaoning Province (China) from 1997-2014 to provide a basis for the control and elimination of measles. All 63 measles virus strains were the H1a genotype. Fragments of the H gene (1854 nucleotides) and nucleoprotein (N) gene (450 nucleotides) were amplified by reverse transcription-polymerase chain reaction (RT-PCR) and the PCR products sequenced and analyzed. Phylogenetic-trees were constructed with reference strains of the genotype-H measles virus downloaded from GenBank, including Chinese measles virus strains isolated in 1993-1994 and the vaccine reference strains S-191 and C-47. Sixty-three strains of the measles virus in 1997-2014 belonged to genotype H1a. The mean evolutionary rate for gene N-450 was higher than that for the H gene. All 63 strains of the measles virus were mutated from: serine (Ser S) to asparagine (Asn N) in the 240th amino acid; arginine (Arg R) to glycine (Gly G) in the 243th; and tyrosine (Tyr Y) to Asn N in the 481th amino acid. All measles virus strains in cluster 2 were mutated from proline (Pro P) to leucine (Leu L) in the 397th amino acid. The other neutralization sites showed no apparent difference when comparing the nucleotides/amino acids of the H gene of S191 vaccine strains.
Amino Acid Sequence ; China ; epidemiology ; Databases, Genetic ; Epidemics ; Evolution, Molecular ; Genotype ; Hemagglutinins, Viral ; chemistry ; genetics ; Measles ; epidemiology ; Measles virus ; genetics ; physiology ; Molecular Sequence Data ; Mutation ; Phylogeny

Objective To investigate the epidemiologic features of rotavirus (RV)diarrhea among children in Dongguan area. Methods The stool specimens were collected from the children outpatients with acute diarrhea in the enterology clinic of our hospi-tal from June 2012 to May 2013.The cluster A RV antigen was detected in the stool specimens by the qualitative technique of col-loidal gold and immunochromatographic double antibody sandwich assay.The sex,age of onset and seasons distribution were ana-lyzed.Results Among 4 967 cases of diarrhea,1 555 cases (33.8%)were positive for rotavirus antigen.The ratio of infected boys and girls was 1 .9∶1 .Most infected children (93%)were under the age of three.The cases of RV diarrhea were observed through-out the year;and it was found that there were two peaks of detection rate appearing in November (49.8%)and February (43.3%), and it was lowest in June and October (16.0%).Conclusion Children aged under 3 years in Dongguan area are the susceptible pop-ulation for cluster A RV.RV diarrhea occurs throughout the year with two peaks in spring and autumn-winter.Timely RV vaccina-tion for children based on the epidemiologic features is effective for reducing the incidence of RV diarrhea.

Objective To evaluate the accuracy of auditory evoked potential index (AAI) in monitoring the depth of sevoflurane anesthesia in infants.Methods Fifty ASA Ⅰ or Ⅱ pediatric patients,aged 1-3 yr,scheduled for elective surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with propofol,cisatracurium and remifentanil.The patients were tracheal intubated and mechanically ventilated.PET CO2 was maintained at 35-45 mm Hg.Anesthesia was maintained with inhalation of sevoflurane.Fresh gas flow was first set at 6 L/min for 15 min and then reduced to 3 L/min.The end-tidal sevoflurane concentration (CETSev) was maintained at 2.5%,2.8%,3.0%,3.5%,3.7% and 4.0%.Each CETSev was maintained for 3 min.AAI was continuously monitored before induction of anesthesia,after induction,immediately before sevoflurane inhalation,and at the 6 CET Sev.Results AAI was negatively correlated with CET Sev (r =-0.872,P ＜ 0.01).Conclusion AAI can accurately reflect the depth of sevoflurane anesthesia in infants.

Objective To evaluate the usefulness of serum galactemannan(GM) for the diagnosis of invasive pulmonary aspergillosis (IPA) in critically ill patients. Methods Study was conducted between February 2007 and July 2008. Included patients on admission ICU who suffer from suspected IPA. GM test and culture were collected 2 weekly. Chnical feature, mycological evidence and optical density index (ODI) were noted. Clinically invasive fungal infection(IFI) were defined proven, probable and possible. The patients were classified into neutropenia, non-neutropenia and treated with immunosuppressive agents, non-neutropenia and non-immunosuppressive agents. To compared of the sensitivity and specificity of GM in different patients. Results 94 patients were included, 4 patients were proven, 29 patients were probable, 34 patients were possible IFI, 27 patients were non-IPA. The positive rate of the GM was 31.9% (30/94). The sensitivity and specificity of GM in proven cases and probable cases are 66.7% and 92.6%. GM assay tended to become positive earlier than the culture 2-10(5.33±2.17)d. We found that differences in patient diagnosis and selection might account for the disparities seen for positive rate for the GM test. There was positive in three of the four patients with proven, the positive rate of GM was 65.5% for probable cases, for possible cases was 17.6%, for non-IPA cases was 7.4% (P=0.001). For patient with neutropenia , treated with immunosuppressive agents and without immunosuppressive agents, the positive rate of GM was 52.9%vs 41.7% vs 34. 6% (P=0.015) ;the sensitivity was 80.0% vs 70. 0% vs 53.8% (P=0.011), the ODI was 1.365 (0.582-6.736) vs 1. 123 (0. 623-6.868) vs 0.554 (0.522-0.823), P=0. 005, respectively. Conclusion These results show that GM test is useful for early diagnosis IPA in critically ill patients. Differences in patient selection and diagnosis might account for the disparities seen for positive rate and sensitivity for the GM test. It has been higher sensitivity and ODI in the patient treated by immunosuppressive agents.

Objective To investigate the clinical role of central venous pressure(CVP) to evaluate fluid responsiveness in septic shock patients. Methods 66 septic shock patients were studied, every patient was administered a volume challenge, before and after it, CVP, intrathoracic blood volume index (ITBVI),global end-diastolic volume index(GEDVI), cardiac index(CI), stroke volume index(SVI) were measured by PiCCO method. All the obtained values were analyzed by statistics method. Results Initial CVP in responders is significantly different from that in nonresponders; △ITBVI, △GEDVI, △CI, △SVI, △HR (△:changes) before and after volume challenge in responders were significantly different from those in nonresponders; the significance of △ITBVI, AGEDVI to predict volume responsiveness was strong indicated by high values of areas under the receiver operating characteristic curves (0.674 and 0.700, respectively).If patients were regrouped by CVP≤11 mm Hg(1 mm Hg=0.133 kPa) and CVP > 11 mm Hg, initial ITBVI and GEDVI in responders were not significantly different from that in nonresponders; △ITBVI,△GEDVI, △CI, △SVI before and after volume challenge in responders were significantly different from those in nom'esponders. Conclusion In septic shock patients, CVP play a guidance role to predict and evaluate volume responsiveness and when CVP was > 11 nun Hg, a positive response will be less likely. Initial volumetric parameters(intrathoracic blood volume and global end-diastolic volume) play a questionable role in predicting and evaluating volume responsiveness, changes before and after volume challenge maybe helpful.

Objectlve To research and analyze the hemod)rnamic status of refractory septic shock associated cardiac dysfunction.Methods 70 refractory septic shock patients were studied.In the duration of pulmonary artery catheter(PAC)-directed hemodynamic optimization,the patients were divided into a cardiac dysfunction group and a control group.Hemodynamic parameters,arterial blood lactate concentration and APACHE II scores were obtained instantly after the placement of a PAC,then lactate clearance in 24 hours was surveyed and calculated.Subsequently the two groups of patients were regrouped by nonsurvivor and survivors respectively.All the obtained values were analyzed with statistic methods.Results 37% of the refractory septic shock patients was complicated with cardiac dysfunction.The age of the patients complicated with cardiac dysfunction was significantly higher than that of the patients of the control group.Central venous pressure(CVP),pulmonary artery obstruction pressure(PAOP),pulmonary artery pressure (PAP),systemic vascular resistance index(SVRI),pulmonary vascular resistance index(PVRI)and oxygen extraction ratio(O2ext)in the cardiac dysfunction group were significantly different from those in the control group.Cardiac output(CO),cardiac index(CI),oxygen delivery index(DO2I)and mixed venous oxygensaturation(S-v O2)were significantly lower than those of the patients in the control group.S -v O2 had a strong correlation witIl CI.If the patients were regrouped by nonsurvivors and survivors.in the patients complicated with cardiac dysfunction APACHE II scores were significantly higher in the nonsurvivors than survivors:the lactate clearance in 24 hours(median-25%)of the nonsurvivors was significantly lower than that of nonresponders(median 22%),P＜0.05.Conclusion (1)In refractory septic shock patients,cardiac dysfunction maybe the main reason leading to bad outcome.(2)Higher CVP and PAOP and lower S -v O2 indicate the onset of cardiac dysfunction.(3)The patients with significantly high initial arterial blood lactate level and the low lactate clearance in 24 hours had bad outcome.