Objective To explore the feasibility of laparoscopical left hepatectomy with the method of Glis-son pedicle transsection.Methods Clinical data of anatomical left hepatectomy patients with the method of Glisson pedicle transsection from February 2012 to April 2012 in our hospital were retrospectively analyzed.Results All patients were completely suffered laparoscopical left hepatectomy with the method of Glisson pedicle transsection. Operation time form 2-4 hours,postoperative hospitalization for 6-7 days,all these patients were cured and discharged, without any complication of bile leakage, hemorrhage, peritonitis, intestinal obstruction, postoperative liver function recovered rapidly.There was no death case.Conclusion It is safe and feasible of laparoscopical left hepatectomy with the method of Glisson pedicle transsection and should be worth to popularize.

HDL or apolipoprotein A-Ⅰ,the major protein of HDL particles,protect host against vascular endothelial dysfunction.HDL binding to scavenger receptor-BI activates eNOS for increasing NO.SR-BI and Endothelial lipase(EL) play a critical role in the regulation of plasma HDL.Incubation of HDL with vascular endothelial cells promotes prostacyclin synthesis.Some proteins such as paraoxonase that cotransport with HDL in plasma,have antioxidant properties.HDL inhibits TNF-? dependent expression of adhesion molecules in vascular endothelial cells and interferes with apoptosis,proliferation and migration of vascular endothelial cells.

Objective To investigate the influence of intrahepatic cholestasis of pregnancy (ICP) on the pulmonary morphologic changes of fetal rats.Methods Twenty pregnant SD rats at 15 days of gestations were randomly divided into ICP and control group.Rats in the ICP group were subcutaneously injected with 17-α-ethinylestradiol and progesterone for 5 consecutive days to establish the rat ICP model, and those of the control group received subcutaneous injection of sirasimeyu also for 5 days.The levels of serum alanine aminotransferases (ALT), aspartate transamlnase (AST), and total bile salt (TBA) were measured before and after the treatment, respectively.Maternal rats were sacrificed on 21 days of gestations and hysterotomies were performed immediately.Histopathologic changes of mammal rats' livers and fetal lungs were observed under light and electron microscopes.Results (1) The maternal serum levels of ALT, AST, and TBA showed no significant difference between the ICP and control group [ALT: (55 ± 15) vs (49 ±12) U/L; AST:(146±16)vs (145±20) U/L; TBA: (13±4) vs (14 ±4) μmol/L, P>0.05, respectively]before the ICP models were established, but higher levels were shown in the ICP group after [ALT: (94±12) vs (59±17) U/L; AST: (245±26) vs (163±27) U/L; TBA: (44±16) vs (17± 3) μmol/L, P <0.05, respectively].(2) The livers of maternal rats' in the ICP group were gloomy with blurred margins, however those of the control group were normal.Microscopic observed swollen and degenerated hepatocytes with narrowed hepatic sinusoid, dilated bile duct and necrosis of hepatocytes occasionally in the ICP group, while the morphology of hepatocytes and structures of lobuli hepatis in the control group were normal.(3) The fetal pulmonary tissues in the ICP group were dark, and normal in the control group.Histopathologic examination showed matured fetal pulmonary tissues with dilated and congested interstitial lung capillaries, thickened alveolar septum, mild focal inflammatory exudation and focal hemorrhage in alveolus.Furthermore, reduced microvilli, mitochondrion vacuolization, cytoplasm disintegration and increased lamellar body evacuation were observed in type Ⅱ pneumonocytes in ICP group under light and electron microscopes.While fetal pulmonary tissues of the control group did not show any significant lesions.Conclusions Rat model of ICP can be established with the combination of estrogen and progestin.Hyperbileacidemia in ICP rat may lead to pathological changes in fetal pulmonary tissues.

Objective To examine the differences in the level of sedation and adverse effects produced by equivalent analgesic doses of remifentanil,sufentanil and fentanyl.Methods Eighty ASA Ⅰ female patients aged 18-39 yr with BMI of 18-25 kg/m2 scheduled for laparoscopic surgery under general anesthesia were randomly divided into 4 groups ( n =20 each):group control (group C) ; group remifentanil ( group R) ; group sufentanil (group S) and group fentanyl (group F).Remifentanil 2 μg/kg,sufentanil 0.2 μg/kg and fentanyl 2 μg/kg in normal saline 10 ml were infused iv over 2 min in groups R,S and F respectively.Depth of sedation was assessed and scored using OAA/S scale (5 =alert,1 =no response to prodding) and wavele index (WLI),before (baseline) and at 2,4,6,8 and 10 min after drug administration.Besides RR,pulse oxygen saturation,BP,HR were also monitored.The incidences of apnea,muscle rigidity,nausea and vomiting,pruritus,vertigo,bradycardia,profuse sweating and skin rash were measured and calculated.Results The 4 groups were comparable with respect to age,BMI and height.The lowest values of OAA/S scores,WLI and RR were significantly lower in groups R,S and F than in group C.Sufentanil produced the deepest sedation among the 3 opioids.Remifentanil produced strongest respiratory depression and nausea and vomiting.Conclusion The equivalent analgesic dose of sufentanil produces deeper sedation than that of remifentanil and fentanyl while remifentanil has the greatest impact on RR.

Objective:To investigate the cardiac magnetic resonance technique in the diagnosis and treatment of unstable angina application value. Methods:The hospital diagnosed patients with unstable angina as research subjects, were given coronary angiography in patients (CAG) examination, ECG, echocardiography and cardiac MRI examination, recording the results and statistical analysis. Results:Cardiac MRI for>90%stenos is detected heart rate, and coronary angiography (CAG) showed no significant difference (x2=3.257, P>0.05), for<90%stenos is detection rate, and coronary angiography (CAG) was statistically significant between test results (x2=17.267, x2=25.714;P<0.05);cardiac magnetic resonance for the degree of stenos is of myocardial ischemia in patients with high detection rate and electrocardiogram detection rates were significantly different(x2=4.65, P<0.05), but the total no significant difference between the detection rate(x2=0.251, P>0.05);cardiac MRI for cardiac function and cardiac structure determination is better than conventional echocardiography. Conclusion: Cardiac MRI technology to more accurately reflect changes in cardiac structure and function of the stenos is and effort ischemia detection rate with conventional inspection methods have better consistency.

Objective To explore the clinical effect of pulmonary infection control window for sequence ven-tilation on treatment of severe pneumonia with respiratory failure,and to observe and analyze the prognosis.Methods 102 severe pneumonia patients complicated with respiratory failure were selected.They were divided into the observation group and the control group by the random number table method.The patients of the observation group were treated with pulmonary infection control window for sequence ventilation treatment,the control group were treated with conven-tional sequence ventilation treatment.The change of blood oxygen partial pressure(PaO2 ),carbon dioxide partial pres-sure(PaCO2 )and blood oxygen saturation (SaO2 )before and after ventilation,and the treatment time and symptoms improve time and the complications such as ventilator associated pneumonia(VAP)of the two groups were observed. Results PaO2 and SaO2 of the observation group after the ventilation were (75.60 ±2.89)mmHg and (0.78 ± 0.09),which were higher than control group after the ventilation (70.48 ±3.16)mmHg and (0.71 ±0.11),and data of two groups after ventilation were higher than those before the treatment,differences were statistically significant (t =11.30,10.92,13.26,14.08,all P <0.05).PaCO2 of the observation group after the ventilation was 49.21 ±3.22 mmHg, which was lower than that of control group after the ventilation of 54.35 ±3.82 mmHg,and data of two groups after treatment was lower than before treatment,the differences were statistically significant(t =12.44,11.85,14.16, 13.42,all P <0.05).The total mechanical ventilation time of the observation group,respiratory difficulty relief time, lung then disappear time and hospital stay time were (5.24 ±1.83)d,(38.13 ±2.91 )h,(6.72 ±0.40)d and (15.33 ±3.18)d,which were lower than those of control group,the differences were statistically significant (t =9.87,10.21,10.46,11.08,all P <0.05).The general adverse reaction and the death rate of the observation group was 9.80% (5 /51),which was lower than 19.61% of the control group(χ2 =9.85,P <0.05).Conclusion There was effect of pulmonary infection control window for sequence ventilation treatment of severe pneumonia with respirato-ry failure,and it could improve effectively lung function and the prognosis and reduce the incidence of complications.

Objective To systematically evaluate the effectiveness of using gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU.Methods The randomized controlled trials (RCTs) on the application of gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU were collected through the databases such as the China National Knowledge Infrastructure (CNKI),China Scientific Journal Database by VIP (VIP) and Wanfang Database.The quality of studies was critically appraised and data were extracted by two reviewers independently.Meta-analysis was conducted for the included studies.Results Eleven RCTs involving 1 337 patients were included.Meta-analysis showed that the application of gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU could reduce ventilator-associated pneumonia (VAP) incidence rate[RR=0.54,95％CI(0.44-0.65),P ＜ 0.01],shorten the duration of mechanical ventilation [mean differences(MD)=-2.38,95％CI(-2.69--2.07),P ＜ 0.01] and length of ICU [MD=-3.66,95％CI (-5.45--1.87),P ＜ 0.01],but the mortality rate was not statistically significant [RR=0.37,95％CI (0.11-1.26),P ＞ 0.05].Conclusions The application of gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU is safe and effective.

Objective To observe the relation between functions of vessels of lower extremities and TCM syndromes differentiation in diabetes patients. Methods Totally 168 diabetics of Type II were differentiated into 5 syndromes, i.e. 29 cases of yin deficiency with excessive heat, 41 cases of qi and yin deficiency, 30 cases of yin and yang deficiency, 37 cases of blood stasis in channels, and 31 cases of damp heat affecting the spleen, and 26 healthy people were involved in the control group. The peripheral vessel diagnostic system was adopted to get the toe photoplethysmogram (PPG) and ankle brachial index (ABI) to observe the blood perfusion of limb terminals and the functional state of lower limb arteries. The relation between function of vessels of lower extremities and TCM syndrome was analyzed. Results All the diabetic groups were related with the arterial blood supply of toe terminals. Diabetes was the main risk factor in affecting the terminal blood supply (P

Objective:To investigate the value of magnetic resonance imaging, CT and X ray radiography on preoperative diagnosis of osteoporotic vertebral compression fracture and post-operation follow up of percutaneous kyphoplasty.Methods: A retrospectively analysis was adopted for 41 patients of osteoporotic vertebral compression fracture, who were detected by X ray, MRI examination and CT analyze, respectively. And the values of 3 methods for preoperative diagnosis of osteoporotic vertebral fractures and X-ray in postoperative follow-up were analyzed. Results: For preoperative diagnosis of osteoporotic vertebral compression fractures, the accuracy rate of MRI, X-ray and CT were 100%(41/41), 65.85%(27/41) and 92.85%(13/14), respectively. Both of the accuracy rates of MRI and CT were higher than X-ray, and the differences were statistical significant (x2=16.882,x2=3.837;P<0.05); the difference of accuracy rate between MRI and CT was not significant (x2=2.983,P>0.05). After the third day of post-operative and during last follow up, anterior vertebral height and middle vertebral height were significantly higher than before operation (F=17.094,F=15.526,P<0.05); and the Cobb angle and the VAS score of lumbar back pain were lower than before operation, the difference was statistical significant (F=41.085,F=107.338;P<0.05).Conclusion: For preoperative diagnosis of osteoporotic vertebral compression fractures, the accuracy rate of MRI is the highest and X-ray is lowest. X-ray can be used to evaluate surgery effect during postoperative follow-up.

Studying of atherosclerosis is more than a hundred year.There are many theories about this disease,but now most of us seems to agree with the stress-reponse theory.Heat shock proteins are the products produced at the first stage of atherosclerosis.And someone think that it may have something to do with atherosclerosis.This paper discussed the heat shock proteins and atherosclerosis respectively,and emphasized the relationship between them.