Objective To investigate the changes in oxygenation and intrapulmonary shunt duringprolonged one-lung ventilation (OLV) and compare the effects of four different anesthetic techniques. MethodsForty ASAⅠ -Ⅱ patients (27 male, 13 female) aged 36-74 yr undergoing prolonged OLV during elective thoracicsurgery were randomly allocated to one of four groups: (1) isoflurane (GI, n = 10); (2) isoflurane + epidural(GIE, n =10); (3) propofol (GP, n = 10); (4) propofol + epidural (GPE, n = 10). Radial artery wascannulated and Swan-Ganz catheter was placed via right internal jugular vein before induction of general anesthesia.In group 2 and 4 an epidural catheter was inserted at T_(7-8) or T_(8-9) and advanced 3 .5-4.0 cm in the epidural spacecephalad. Epidural block was produced by a bolus of 0.5 % ropivacaine 7-9 ml followed by continuous infusion of0. 5 % ropivacaine at 3-5 ml?h~(-1). Anesthesia was induced with propofol 1 .0-1. 5 mg?kg~(-1), fentanyl 3?g?kg~(-1) andvecuronium 0. 1 mg?kg~(-1). A left-sided double-lumen tube was inserted and correct position was confirmed. Thepatients were mechenically ventilated. The ventilation collditions were FiO_2 = 100 %, V_T = 8-10 ml?kg~(-1), I: E =1: 5 and respiratory rate was adjusted to maintained P_(ET) CO_2 at 35-45 mm Hg during both two-lung ventilation(TLV) and OLV. Anesthesia was maintained with isoflurane inhalation in group 1 and 2 or continuous infusion ofpropofol in group 3 and 4 supplemented with intermittent i. v. boluses of fentanyl. MAP, HR, ECG, MPAP,CVP, continuous cardiac output (CCO), BIS and TOF were continuously monitored during anesthesia. BIS was maintained at 45-55. Arterial and pulmonary blood gases were analyzed before induction of anesthesia (T_1), 30min after TLV was started (T_2 ), and 5, 15, 30, 60, 120 and 180 min after OLV was started (T_(3-8)) and 30 minafter TLV was resumed (T_9 ). The Qs/Qt (shunt fraction) was calculated at T_(1-9) Results Qs/Qt was significantlyincreased after induction of general anesthesia and mechanical ventilation and increased further during OLVcompared with the baseline value (T_1) in all four groups. The calculated Qs/Qt values were highest at 15 min (T_4)or 30 min (T_5) of OLV and remained high for 30-60 min and then gradually decreasing. During OLV QS/Qt washigher in group 1 than in the other three groups (P0.05). Cardiac output was significantly higher in group 1 and 2 than thatin group 3 and 4 during OLV. Conclusion During prolonged OLV intrapulmonary shunt tends to decrease withincreasing oxygenation with time, regardless of anesthetic techniques employed. Isoflurane inhalation is associatedwith a signifficant increase in shunt fraction. Combined general and epidural anesthesia may induce greaterhemodynamic changes.

Objective To assess the influence of upper thoracic epidural anesthesia (TEA) on systemic oxygen supply-demand relationship during one-lung ventilation (OLV). Methods Twenty ASA Ⅰ-Ⅲ patients undergoing elective esophageal surgery were randomly divided into 2 groups : group Ⅰ general anesthesia (GI n = 10) and group Ⅱ combined general-epidural anesthesia (GIE n = 10). In both groups anesthesia was induced with propofol 1.5-2.0 mg?kg-1, fentanyl 3 ?g?kg-1 and vecuronium 0.1 mg?kg-1. The patients were intubated with double-lumen catheter. Correct positioning was verified by auscultation and fiberoptic bronchoscopy. Anesthesia was maintained with isoflurane (1.5-2.0% ) and intermittent i. v. boluses of fentanyl. BIS was maintained at 45-55 during operation. In GIE group epidural puncture was performed at T7-8 or T8-9. The catheter was advanced 3.5-4.0 ml in the epidural space cephalad. 0.5% ropivacaine was infused at 3-5 ml?h-1 during operation. Anesthetic block levels ranged from T2-4 to T10-12 . Radial artery was cannulated for BP monitoring and blood sampling and Swan-Ganz catheter was positioned in the pulmonary artery via right internal jugular vein. ECG, MAP, HR, CVP, continuous cardiac output index (CCI) and BIS were continuously monitored during anesthesia. Arterial and mixed venous blood samples were obtained before induction of anesthesia (T0 ), 30 min after intubation while two lungs were being ventilated (T1) at 15, 30, 60 and 120 min of OLV (T2-3) and 30 min after TLV was resumed (T6 ) . MAP, CVP, cardiac output index (CI) and arterial and mixed venous blood oxygen content were measured and oxygen supply (DO2) and consumption (VO2) were calculated at each time point. Results In GIE group MAP was significantly lower than that in GI group ( P 0.05). At 15, 30 and 60 min of OLV (T2-4) mixed venous oxygen saturation (SVO2 ) was significantly lower while VO2 significantly higher in group GIE than in group GI. Consequently DO2/ VO2 in group GIE was significantly lower than that in group GI. Conclusion Thoracic epidural anesthesia combined with general anesthesia increases oxygen consumption (VO2) and consequently decreases DO2/ VO2 during OLV.

Objective To determine the effect of of thoracic epidural block on arterial oxygenation and intrapulmonary shunt during one-lung ventilation(OLV).Methods Twenty-four ASA class I - Ⅱ patients undergoing prolonged periods of OLV during elective general thoracic surgery were divided into two groups: general anesthesia group(GA)(n=12) and general anesthesia + epidural block group(GE, n = 12). The patients were premedicated with only scopolamine 0.3mg. Radial artery was cannulated and Swan-Ganz catheter placed via right internal jugular vein under local anesthesia. Epidural block was performed at T7-8or T8-9 and a catheter was inserted and advanced in the epidural space cranially for 3.5-4 cm. General anesthesia was induced with propofol l.5mg?kg-1, fentanyl 3?g?kg-1 and vecuronium 0.1 mg?kg-1. Right or left-sided double-lumen endobronchial tube was placed blindly and the correct position was determined by a combination of unilateral clamping and unclamping and auscultation of the lungs. In GA group anesthesia was maintained with continuous infusion of propofol (150-200 ?g?kg-1?min-1 ) and intermittent IV boluses of fentanyl and vecuronium. BIS was maintained at 45-50. In GE group anesthesia was maintained with infusion of propofol(80 - 120 ?g?kg-1?min-1 ) and epidural block (a loading dose of 0.5% ropivacaine 7-9ml followed by epidural infusion of 0.5% ropivacaine 3-5 ml?h-1) .The patients were mechanically ventilated. VT = 8-10 ml?kg-1, FiO2 = 1, I: R = 1:1.5 and respiratory rate was adjusted to maintain PET CO2 at 35-45 mm Hg. During OLV the above parameters were maintained. ECG, HR, MAP, MPAP, CVP, continuous cardiac output, BIS and TOP were continuously monitored during operation. Blood samples were taken from radial artery and S-G catheter for blood gas analysis at following intervals: (1) during spontaneous breathing when the patients was a wake (baseline); (2) when the patient was placed in lateral position and the two lungs were being ventilated for 30 min(TLV 30 I) ; (3) 5,15, 30 and 60 minduring the course of OLV; (4) the two lungs were ventilated again for 30 min (TLV 30II) andQs/Qt was calculated. Results Venous admixture increased significantly after induction of anesthesia and during mechanical ventilation and increased further during OLV as compared with the baseline(P

Objective To compare the effects of isoflurane and propofol on arterial oxygenation and intrapulmonary shunt during one-lung ventilation (OLV) when combined with continuous thoracic epidural block. Methods Twenty-four ASA Ⅰ -Ⅱ patients with normal ventilatory function undergoing elective thoracic surgery were enrolled in this study. Patients with abnormal cardiac, liver or kidney function were excluded. The patients were premedicated with scopolamine 0. 3mg I. M. .Epidural block was performed at T7-8 or T8-9 . An epidural catheter was placed and its position confirmed by epidural 1% lidocaine 5 ml. General anesthesia was induced with propofol l.5mg?kg-1, fentanyl 3?g?kg-1 and vecuronium 0.lmg?kg-1 . Double-lumen catheter was inserted and its correct position was confirmed by a combination of unilateral lung ventilation and auscultation in both supine and lateral position. The patients were mechanically ventilated. Tidal volume was set at 8-10 ml?kg-1, FiO2 = 1, I:E=1:1.5, RR=10-12bpm and PETCO2 was maintained between 35-45 mm Hg. The parameters remained unchanged during one-lung ventilation. The patients were assigned to one of two groups : propofol group and isoflurane group. Anesthesia was maintained with propofol infusion in propofol group and isoflurane inhalation in isoflurane group and BIS was maintained at 45-55. A bolus of 0.5 % ropivacaine 7-9ml was given epidurally followed by 0.5% ropivacaine infusion at a rate of 3-5ml?h-1 in both groups during maintenance of anesthesia. Besides ECG, BP and BIS, continuous cardiac output(CCO Baxter) was monitored during operation. Blood samples were taken from radial artery and pulmonary artery simultaneously before anesthesia when patients were lying supine and breathing spontaneously (T0 ), in lateral position when both lungs were ventilated (T1 ), at 5,15, 30, 60 min of one-lung ventilation(T2-5 ) and when both lungs were ventilated again for 30min(T6) for blood gas analysis. Qs/Qt was calculated.Results (1) The two groups were comparable with respect to demographic data. Propofol infusion was maintained at 4-6 mg?kg-1?h-1 in propofol group and end-tidal isoflurane was maintained between 0.3%-0.5% in isoflurane group. (2) Venous admixture increased significantly at T1 and further increased after T2 and reached its peak at T3(31.1% ?4.2%) in propofol group and at T4 (33.5% ? 7.8% ) in isoflurane group. Shunt fraction was significantly lower in propofol at T4-5 than that in isoflurane group. (3) PaO2 decreased significantly during OLV in both groups, but there was no significant difference in PaO2 between the two groups. Conclusions When combined with thoracic epidural block, intravenous propofol infusion exerts less effect on intrapulmonary shunt than isoflurane inhalation during OLV but there was no significant difference in arterial oxygenation between the two groups.

Objective:To explore the role of 6-CYANO-2,3-DIHYDROXY-7-NITROQUIN OXALINE (CNQX) in different types of synapse secretion.Methods:The spontaneous mEPSCs and eEPSCs at different extracellular concentrations of CNQX in cultured cortical or hippocampal neurons were recorded respectively.Results:The half inhibitory concentration (IC50) of CNQX in evoked neurotransmitter release was significantly higher than that of spontaneous release,indicating that the spontaneous neurotransmitter release was more sensitive to CNQX.No apparent difference was observed between cortical and hippocampal cells,suggesting that the blocking effect of CNQX was similar in different brain regions.Conclusion:CNQX might have differential regulating mechanisms between excitatory spontaneous and evoked neurotransmitter release,but without brain regions specificity.

Objective:To study the effect of ultramicro-shatter technology on penetrating skin absorption of isorhamnetin-3-O-neohesperidin in Zhongtongxiao Cataplasm.Methods:To apply reformed Frans penetrating skin absorption cell marching extraorgan penetrating skin experiment.HPLC method was used to determine the content of isorhamnetin-3-Oneohesperidin in ultramicro-shatter Zhongtongxiao Cataplasm and in common Zhongtongxiao Cataplasm.Results:The Q-t equation of ultramicro-shatter Zhongtongxiao Cataplasm:Q=3.0382t+47.082,penetrating skin velocity:3.0382(?g.cm2/h);the Q-t equation of common Zhongtongxiao Cataplasm:Q=2.7967t+39.752,penetrating skin velocity:2.7967(?g.cm2/h);Extraction rate of dynamic extracting micro-powder,the ephedrina hydrochloridum,glycyrrhizic acid and glycyrrhizae glycoside were higher than the trdtional cut crude drug decocting.Conclusion:The accumulating osmolality and penetrating skin velocity of isorhamnetin-3-O-neohesperidin in ultramicro-shatter Zhongtongxiao Cataplasm were all better than those in common Zhongtongxiao Cataplasm,it explained that ultramicro-shatter technology accelerate the dissolution of medicine compsitions.

Objective To analyze the clinical and radiographic characterstics of ureteral polyps with hydronephrosis in children.Methods Thirteen patients with ureteral polyps and hydronephrosis were studied retrospectively.All patients underwent abdominal plain film,intravenous pyelogram(IVP)and ultrasound(US)examinations,contrast-enhanced CT scan was performed in 10 cases.Results Intermittent or recurrent abdominal pain with painless hematuria was presented in most cases.Hydronephrosis was demonstrated in radiographic images.IVP delineated the dilatation of the ureter and filling defects within the ureteral lumen in 5 cases.Computed tomography(CT)showed all abnormal changes of ureter and irregular intraluminal soft tissue masses in 6 cases.Moderate and low echoic structures were showed in ureters by US in 2 cases.Conclusion US and CT,as an important imaging modalities,can improve the diagnostic accuracy for ureteral polyps.

Objective To observe the effects of Chlamys farreri skirt glycosaminoglycan(SS-GAG) on the expressions of c-myc and TNF-? genes so as to explore the anti-atherosclerosis(AS) mechanism of SS-GAG.Methods The cell proliferation model of vascular smooth muscle cells(VSMC) was established by basic fibroblast growth factor(bFGF) induction.In Situ hybridization marked by non-isotope was applied to determine the effects of SS-GAG on the mRNA levels of c-myc and TNF in proliferative VSMC.Results The mRNA levels of c-myc and TNF in low dose group and high group of SS-GAG were obviously lower than that of model group(P

Objective To compare blood pressures results measured by automated sphygmomanometer and standard mercury sphygmomanometer,and to investigate the application of measurements consistency evaluation method in accurate measurement of automated sphygmomanometer.Methods Intraclass correlation coefficient was used to estimate the reliability of repeated measurements,and Bland -Altman method was adopted to evaluate the consistency between automated sphygmomanometer and standard mercury sphygmomanometer.Meanwhile,the results were compared with protocol of European Society of Hypertension.Results The tested automated sphygmomanometer did not adapt to the criteria of European Society of Hypertension.The intraclass correlation coefficient of mercury sphygmomanometer was 0.937 for systolic blood pressure,0.849 for diastolic blood pressure.The intraclass correlation coefficient of tested sphygmomanometer was 0.944 for systolic blood pressure,0.929 for diastolic blood pressure.The 95% consistency interval was(-10.20 to 16.94)mmHg for systolic blood pressure and(-6.25 to 11.69)mmHg for diastolic blood pressure.Conclusion Normally,Bland-Altman method has the same judgment result with protocol of European Society of Hypertension.

Objective To carry out the urban community residents satisfaction investigation and analyze the present situation of public service of medical institutions,to discuss under the new situation,the development of medi-cal and health innovation mechanism,thus to meet the multi -level and diverse people health services demand. Methods Random stratified sampling of Qingdao city community residents,1 430 people,adopted the method of the questionnaire about the present situation of public hospital and community health service center and the satisfaction was investigated.Results Of Qingdao city community residents,1 430 people chose to large public hospital patients (65.8%),community health service centers (37.3%).In a large public hospital from visits to the end,took at least half a day to account for 69.5%,more than a day (18.7%);Unreasonable process part (45.2%),such as hospital formalities complex,paper take inconvenient,medical guide was too little,expert outpatient service limit number,to see the doctor for a long time,adjust time was shorter,the doctor for the patient and the lack of patience,etc.The process was reasonable and convenient accounted for 40.0%.Think of large public hospital service attitude,subject to further improvement accounted for 58.2%;Think good service attitude,the very satisfied accounted for 30.7%.Think that community health service center service attitude good,very satisfied accounted for 43.2%;Think the service attitude in general,efficiency was 37.9%.96.1% of the respondents believed that society should form a public -private joint diversified do medical pattern,provided residents with various preferential policies.98.4% of the respondents expected countries to optimize the medical service resources allocation,promoted resources with high quality and the countryside in poor areas.Conclusion At present,most of the patients choose to large public hospital,process and service attitude is the key of the need to improve.Large public hospitals and community health service center should strengthen the cooperation and formation mechanism of innovation and development,and make the patients more options,so as to get better medical service quality.