Objective To evaluate the effect of inverse ratio ventilation (I ∶ E =1 ∶ 1) on ventilatory function during pneumoperitoneum in the obese patients undergoing laparoscopic surgery.Methods Sixty patients,aged 30-64 yr,of ASA physical status Ⅰ or Ⅱ],with body mass index of 30-40 kg/m2,scheduled for elective laparoscopic radical resection of rectal carcinoma,were divided into 2 groups (n =30 each) using a random number table:I∶E =1∶1 mode of ventilation after pneumoperitoneum (group A),and I∶E =1∶2 mode of ventilation after pneumoperitoneum (group B).Anesthesia was induced with midazolam,fentanyl,propofol and vecuronium.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with infusion of propofol and remifentanil,sevoflurane inhalation,and intermittent iv boluses of vecuronium.In group A,the patients received I ∶ E =1 ∶ 1 after pneumoperitoneum.In group B,the patients received I ∶ E =1 ∶ 2.PaO2,PaCO2,peak inspiratory pressure (PIP),mean airway pressure (Pmean),dynamic compliance (Cdyn),intrapulmonary shunt (Qs/Qt),PETCO2,RR,MAP and HR were recorded immediately after intubation,and at 30,60 and 120 min of pneumoperitoneum.Results Compared with group B,PaO2,Pmean and Cdyn were significantly increased,and PIP and Qs/Qt were decreased,and no significant changes were found in RR,PET CO2,PaCO2 and hemodynamic parameters in group A.Conclusion Inverse ratio ventilation (I ∶ E =1 ∶ 1) can effectively improve ventilatory function during pneumoperitoneum in the obese patients undergoing laparoscopic surgery without exerting adverse effects on hemodynamics.

Objective To investigate the clinic technique and effect of treating lumbar disc herniation (LDH) with decompressor and ozone injection combined lumbar traction after surgery.Methods 110 contained LDH patients were randomly divided into two group:decompressor and ozone group,decompressor and ozone combined lumbar traction after surgery group.Under the guidance of CT,fifty-five patients in group A were treated by disc decompression with Decompressor through poster olateral approach,then ozone was injected into the lumbar disc or out side the lumbar disc,and the other fifty-five patients in group B were treated by lumbar traction after surgery that disc decompression and ozone injection same as the group A in once a day and one week of treatment.The theraputic effect was evaluated by comparing VAS,effective rate of therapy before and after treatment.Results The VAS score of two groups at 1,3,7 days between pre-and post-treatment had singificantly different(t =2.159,2.163,2.169,2.167,2.173,2.192,all P ＜0.05).110 case were followed up after 6 and 12 months,The good-excellent rate of therapy in B group 12 months were better than those of A group (x2 =74.23,75.11,all P ＜ 0.05).Conclusion Decompressor combined ozone injection and lumbar traction after surgery is an effective menthod for treatment of the central type mbar disc herniation.

The process in the studies on physiological effects of rare earth elements in plants and their action mechanisms were summarized in the aspects of seed germination, photosynthesis, mineral metabolism and stress resistance. And the applications of rare earth elements in traditional Chinese medicine (TCM) in recent years were also overviewed, which will provide reference for further development and application of rare earth elements in TCM.
Medicine, Chinese Traditional ; Metals, Rare Earth ; analysis ; metabolism ; Photosynthesis ; Plants, Medicinal ; chemistry ; growth & development ; metabolism ; Soil ; analysis

Objective To investigate the clinical features of bilateral medial medullary infarction (BMMI)in elderly patients.Methods Clinical and imaging data of 8 elderly BMMI patients with different morphology on diffusion-weighted magnetic resonance imaging (DWI-MR) were retrospectively analyzed.All patients were diagnosed by MRI,while 4 patients received CTA and vascular ultrasound testing,and the other 4 patients received vascular ultrasound testing.Results All 8 cases(100.0％) had acute-onset BMMI.Patients showed varying degrees of acroparalysis(7/8,87.5 ％),dizziness (5/8,62.5 ％),dysarthria(6/8,80.0 ％),dysphagia(3/8,37.5 ％),deep or superficial sensory dysfunction(5/8,62.5 ％),consciousness disorders (2/8,25.0 ％),dyspnea (2/8,25.0 ％),and tinnitus(1/8,12.5 ％).Lesions in most patients were located in the upper part of medulla oblongata(7/8,87.5 ％).In the transverse direction of DWI,the lesions as the inverted V shape were seen in 3 cases (37.5％),the V shape(12.5％)in 1 case,the Y shape(37.5％)in 3 cases,and the heart shape(12.5％) in 1 case.All 8 patients were complicated with posterior cerebral artery stenosis or occlusion,of whom patients with heart-or Y-shaped lesions showed progressive exacerbation.After treatment,4 cases (50.0 ％) recovered,3 cases (37.5 ％) improved,and 1 case (12.5 ％) unrecovered before discharge from the hospital.Conclusions Most elderly BMMI patients have concurrent posterior circulation artery stenosis,and patients with heart-or Y-shaped lesions on MR-DWI show rapid progression and have a poor prognosis.Cranial examination with MR-DWI is helpful for early clinical diagnosis of BMMI,prediction of disease progression and effective prevention of complications.

Objective To investigate the application prospect of the most extensive genome engineering pig internationally in preclinical xenotransplantation. Methods Porcine endogenous retrovirus (PERV) knockout combined with 3 major heterologous antigen gene knockouts and 9 humanized genes for inhibition of complement activation, regulation of coagulation disorders, anti-inflammatory and anti-phagocytosis were transferred into a pig (PERV-KO/3-KO/9-TG) as a donor, and the heart, liver and kidney were obtained and transplanted to 3 Rhesus macaque recipients respectively to establish a preclinical research model of pig-to-Rhesus macaque xenotransplantation. The functional status of xenografts after blood flow reconstruction was observed and the survival of recipients was summarized. The hemodynamics of xenografts were monitored. The change of hematological indexes of each recipient was compared. The histopathological manifestation of xenografts was observed. Results After the blood flow was reconstructed, all xenografts showed ruddy color, soft texture and good perfusion. The transplant heart, liver and kidney showed full arterial and venous blood flow and good perfusion at 1 d after operation. The postoperative survival time of heart, liver, and kidney transplant recipients was 7, 26, and 1 d, respectively. The levels of creatine kinase, creatine kinase isoenzyme, and lactate dehydrogenase increased in heart transplant recipient at 1 d after operation, and gradually recovered to near normal levels at 6 d after operation. All indexes increased sharply at 7 d after operation. The level of aspartate aminotransferase increased in liver transplant recipients at 2 d after operation, and the alanine aminotransferase basically returned to normal at 10 d after operation, but the total bilirubin continued to increase. Both aspartate aminotransferase and alanine aminotransferase increased at 12 d after operation, and reached a peak at 15 d after operation. The kidney transplant recipient developed mild proteinuria at 1 d after operation, and died of sudden severe arrhythmia. Histopathology showed that the tissue structure of cardiac and renal xenografts was close to normal, and liver xenografts presented with patchy necrosis, the liver tissue structure was disordered, accompanied by inflammatory damage, interstitial hemorrhage and thrombotic microangiopathy. Conclusions PERV-KO/3-KO/9-TG pig shows advantages in overcoming hyperacute rejection, mitigating humoral rejection and coagulation dysregulation. However, whether it can be used as potential donor for clinical xenotransplantation needs further evaluation.