Mechanical ventilation as an important treatment is widely used in clinical practice,the high inci-dence of ventilation lung injury in the course of operating it has been increasingly concerned.The basic mechanism, mechaical stress and high tidal volume machine stimulate lung cells,makes the inflammation in the cells changes,that is,it is from mechanical lung damage to biological injury.With the international and domestic in -depth researches on VILI,the application of control measures,like some medication treatment,ECMO,liquid ventilation have reduced the incidence of VILI to a certain extent,the occurrence mechanism and progress of treatment of VILI are reviewed briefly.

Objective:To detect the mucin gene (MUC2,MUC5AC,MUC5B,MUC18 and MUC19)expression in the nasal polyps, allergic rhinitis (AR)and the normal nasal mucosa in human. To investigate the role and clinical significance of mucin gene in the pathogenesis of nasal polyps and AR patients .Method:We obtained samples from 35 cases of nasal polyps,18 cases of AR inferior turbinate and 18 cases of simple nasal septum deviation inferior turbinate. Specimens were analyzed with RT-PCR and Real-time FQ-RT-PCR.Result:The results of RT-PCR and FQ-RT-PCR showed that the expression of MUC5AC,MUC5B in nasal polyps and AR patients was significantly higher than that in normal mucosa(P<0.05). The expression of MUC5AC,MUC5B in nasal polyps was not significantly different from that in AR patients(P>0.05). The expression of MUC2, MUC18 in nasal polyps and AR was not significantly different from that in normal mucosa(P>0.05). And the results of RT-PCR for MUC19 expression in AR was higher than that in nasal polyps group and normal group(P<0.05 or P<0.01).Conclusion:MUC5AC and MUC5B are highly expressed in epithelium of human nasal polyps and AR, and they take part in mucus over-secretion in nasal polyps and AR.The expression of MUC19 in AR was higher than that in nasal polyps group and normal group. It indicates that the secretion of MUC19 in allergic rhinitis was on high level. There was no difference of the expression of MUC2 and MUC18 in nasal polyps group, AR group and in normal group.

Objective: To observe the effects of mild moxibustion on angiogenesis and microcirculation in wound repair after operation of anal fistula, and to explore the mechanism of action. Methods: Seventy-two SD male rats were made to bear an "acute, open, bleeding, infected" wound surface and were divided randomly into mild moxibustion group, microwave group and control group (24 rats per group). The wound surfaces of the treatment groups were treated for 15 min with mild moxibustion or microwave medical instrument from the first day after operation, and the control group was not given any treatment. At the first, third, seventh and fourteenth days after operation (1, 3, 7 and 14 days of treatment), six rats in each group were sacrificed after examining the blood flow of the wound surface, and the samples of granulation tissues were collected. The numbers of CD34 and positive expression of vascular endothelial growth factor (VEGF) in granulation tissues were detected. Results: In the early and middle stages of wound healing, mild moxibustion could obviously increase the expression of VEGF, the number of CD34, and the blood flow of the wound surface. And the expression of VEGF, the number of CD34, and the blood flow of the wound surface began to increase at the third day, and reached the peak level at the seventh day, and then began to decrease. In the late stage of wound healing (day 14), mild moxibustion could decrease the expression of VEGF, the number of CD34, and decrease the blood flow of the wound surface. There were significant differences between the mild moxibustion group and the control group in the blood flow of the wound surface, the expression of VEGF and the numbers of CD34 in granulation tissues (P<0.05) after treatment, and except the number of CD34 at 14-day treatment, there were also differences between the mild moxibustion group and the microwave group. Conclusion: Mild moxibustion has better regulative actions on blood flow of the wound surface and the number of CD34 and positive expression of VEGF in granulation tissues, and can regulate microcirculation in wound surface and promote the wound healing.

Objective To evaluate the effectiveness of cryosurgery by using fiber optic bronchoscope for the treatment of middle or late stage central lung cancer.Methods Cryosurgery was performed on 31 patients with middle or late stage central lung cancer,who could not received open surgery,with liquid CO2 by using fiber optic bronchoscope.The effectiveness was monitored.Via the bronchoscope,a cryo-probe was inserted to the center or margin of the tumor.The cryotherapy was persisted for 30 to 120 seconds at-50 to-70 ℃.And then,the tumor was removed before the ice-ball on the point of the probe thawed.The procedure was repeated for several times till the airway was reopened.Results After 1 to 6 times therapies(2.5 times on average),the improve rates of cough,hemoptysis,dyspnea,and chest pain were 74%(23/31),87%(27/31),87%(27/31),and 58%(18/31),respectively.The rates of "markedly effective"and "effective" were 61%(19/31)and 39%(12/31)respectively.The pulmonary function of the patients was also improved:the FEV1 rose from(1.21?0.22)L to(1.72?0.35)L(t=21.843,P=0.001),and the FVC was increased from(1.86?0.31)L to(2.26?0.43)L(t=33.703,P=0.001).Conclusions Cryosurgery by using a fiber optic bronchoscope is an effective and minimally invasive method to reopen the airway,control the obstructive pneumonia,and improve dyspnea and hemoptysis.

Objective To investigate the effect of propofol pretreatment on hippocampal monocyte chemotactic protein-1 ( MCP-1 ) and CC-chemokine receptor type 2 (CCR2) expression following forebrain ischemiarepcrfusion (I/R) in rats. Methods Twenty-four male SD rats weighing 250-300 g were randomly divided into 3 groups ( n = 8 each): group Ⅰ control; group Ⅱ I/R and group Ⅲ propofol pretreatment. Cerebral I/R was induced by clamping bilateral common carotid arteries for 10 min combined with hypotension ( MAP was maintained at 35-45 mm Hg) induced by exsanguinations in group Ⅱ and Ⅲ. In group Ⅲ propofol 50 mg/kg was injected into femoral vein immediately before cerebral ischemia. The animals were sacrificed at 6 h of reperfusion. Hippocampal tissue was obtained for detection of MCP-1 mRNA and CCR2 mRNA and their protein expression by RT-PCR and Western blot technique. Results I/R significantly increased the expression of MCP-1 and CCR2 in hippoeampal tissue as compared with control group. Propofol pretreatment significantly attenuated cerebral I/R induced increase in MCP-1 and CCR2 expression. Conclusion Propofol pretreatment can significantly inhibit forebrain I/R-induced hippocampal MCP-1 and CCP2 expression.

Objective To compare cardiac output continuously measured by transesophageal echocardiograph (TEE)with Flotrac /Vigileo system.Methods Thirty -six patients,aged 30 -60years,of American Society of Anesthesiologists physical status ⅠorⅡscheduled for laparoscopic hysterectomy (LH )were included in this study.The radial artery puncture on the left connecting the Flotrac /Vigileo system monitoring was established before anesthesia and ultrasonic probe was inserted into the esophagus after anesthesia induction.The depth of the probe was located at the middle esophagus with monitoring of transesophageal echocardiography(tee).At the same time the value of CO after anesthesia,before and after pneumoperitoneum were recorded and the application of SPSS 13.0 software package for statistical analysis was made.Monadic linear correlation and regression analysis were both used in measured CO. Results Each point,the determination of transesophageal echocardiography(tee)between the CO and the determination of the Flotrac /Vigileo CO,had high correlation(r =0.850,P =0.002).The CO at the time of T2 monitored by TEE group and Flotrac /Vigileo group were (3.3 ±0.2)L/min,(3.2 ±0.2)L/min,which were significantly lower than (5.6 ±0.3)L/min,(5.4 ±0.3)L/min(t =2.248,2.178,P =0.032,0.029).But there were no statistically significant differences at other time respectively(tT =0.102,0.199,0.201,0.124,0.198,PT =0.918,0.887,0.894, 0.908,0.898;tF =0.098,0.189,0.214,0.119,0.112,PF =0.953,0.874,0.898,0.913,0.932).Conclusion The correlation of CO monitored by transesophageal echocardiography(tee)and Flotrac /Vigileo was good,which can be safely and efficiently used in intraoperative monitoring of patients.

Objective To investigate the effects of edaranvone on lung injury induced by myocardial ischemia-reperfusion (I/R) in rats. Methods Twenty-four male Wistar rats weighing 250-300 g were randomly assigned to one of 4 groups ( n = 6 each): group Ⅰ sham operation (group S); group Ⅱ myocardial I/R and group Ⅲ and Ⅳ different doses of edaravone ( group E1, E2 ). The animals were anesthetized, intubated and mechanically ventilated. In group Ⅱ-Ⅳ myocardial I/R was induced by occlusion of left anterior descending coronary artery for 45 min followed by 3 h reperfusion. In group Ⅲ and Ⅳ edavarone 3 and 10 mg/kg was administered via right femoral vein at 1 min before reperfusion respectively. The animals were sacrificed by exsanguination at the end of 3 h reperfusion. Blood was collected for determination of serum CK-MB activity and total protein content. The left lung was lavaged and the broncho-alveolar lavage fluid (BALF) was colleted for determination of protein content. Pulmonary permeability index (PPI) was calculated. The lung tissue was obtained for determination of BD-2 mRNA and protein and TNF-α expression. Results The serum CK-MB activity, PPI,BD-2 mRNA and protein and TNF-α expression were significantly higher in group I/R, E1 and E2 than in group S,but significantly lower in group E1 and E2 than in group I/R and in group E2 than in group E1. Conclusion Edaravone can reduce myocardial I/R-induced lung injury by scavenging oxygen free radicals and inhibiting inflammatory response of lung tissues in rats.

BACKGROUND: Amfetamine, one of the levarterenols, can improve the recovery of motor function of animals after cerebral ischemia. Chlorimipramine can inhibit the re-intake of 5-serotonin and levarterenol and improve the level of them in brain. OBJECTIVE: To observe the effect of chlorimipramine on motor function of rats with focal cerebral ischemic injury.DESIGN: Randomized grouping and controlled animal study. SETTING: Neuropsychiatry Team of Aerial Clinical Medical Department of the Fourth Military Medical University of Chinese PLA. MATERIALS: The experiment was completed in the Morphological Laboratory of Aerial Aerospace Medical Department of the Fourth Military Medical University of Chinese PLA. All the 24 SD rats were divided into sham operation group, ischemia group and ischemic medication group with 8 in each group. Rats in ischemic medication group were perfused with 10 mg/kg chlorimipramine solution (2.5 g/L) once a day through mouth 24 hours after ischemia, and rats in sham operation group and ischemia group were perfused with the same volume of distilled water through mouth. METHODS: Middle cerebral artery (MCA) models of ischemia/reperfusion rats were established with inserted lining method. After modeling, the operations were performed as followed: ① holding test of net screen: Net screen was put horizontally, and then rats were put on it. One side of the screen was raised gradually; then it was turned over 125° within 2 s, and maintained at this placement. Time of holding rats on net screen was recorded. ② Test of struggling to tear off rubberized cloth: 0.5 cm2 medical rubberized cloth was adhered to the ventral of anterior claws of rats, and then rats were sent to the observing box to record the time of tearing off rubberized cloth. 1, 3, 7, 14 and 28 days after operation were the observing time points. MAIN OUTCOME MEASURES: Times of holding rats on the net screen and tearing off the rubberized cloth of rats with focal cerebral is chemia.RESULTS: ① Time of muscular strength test of rats in ischemia group and ischemic medication group was shorter than that of rats in sham operation group, and there was significant difference [3 days after operation:(54±4), (20±5) and (21±4) s in sham operation group, ischemia group and ischemic medication group respectively, P ＜ 0.01]. Holding time was longer in ischemic medication group than that in ischemia group, and there was significant difference [28 days after operation: (51±5) and (54±5) s in ischemia group and ischemic medication group respectively, P ＜ 0.05]. ②Time of tearing off the rubberized cloth was longer in ischemia group and ischemic medication group than that in sham operation group, and there was significant difference [3 days after operation: (47±9), (188±20) and (172±22) s in sham operation group, ischemia group and ischemic medication group respectively, P ＜ 0.01]. The time in ischemic medication group was shorter than that in ischemia group, and there was no significant difference (P ＞ 0.05).CONCLUSION: Chlorimipramine has great effect on the recovery of muscular strength after focal cerebral ischemia, but has poor effect on sense and refined motor function, which is in coincidence with the poor recovery of refined motor function of limbs after hemiplegia.

Objective To analyze risk factors for soft-tissue defects after surgery on leg trauma,to discuss methods for prevention of soft-tissue defects and its treatment.Methods A retrospective analysis was conducted on 217 cases of soft-tissue defects with bone exposure and / or internal fixation exposure after surgery on leg trauma from January,1999 to December,2012.Soft-tissue defects with various flaps were used in 201 cases,including neurocutaneous flap(89 cases),random flap(21 cases),free flap(75 cases),cross-leg flap(16 cases),and by skin grafting in 16 cases.For the 117 internal plate-fixated fractures,96 removed the plate and 21 cases did not remove the plate.For the 13 intramedullary nail fixations,4 cases of intramedullary nails were removed,9 cases were not removed.For the 56 cases of external fixation of the fractures,39 patients had unadjusted external fixation,17 cases re-adjusted external fixations.Results Of the 217 cases of soft-tissue defect after surgery on legs,201 cases were conducted flap surgery.The flap was completely necrosis in one case,and partial distal necrosis were in 14 cases,of which 6 cases healed after changing the dressing,5 underwent debridement and skin grafting,3 cases underwent flap surgery again.In cases of fracture patients,177 cases healed within 1 year,delayed union 23 cases,nonunion eight cases.Nonunion healing after bone grafting and re-fixation surgery.In 9 cases of uncontrollable osteomyelitis,6 patients underwent bone removal and bone transport surgery,3 patients underwent amputation.Conclusion Soft-tissue defects after surgery on leg trauma is a serious complication whose prevalence is associated,in a certain degree,with incorrect surgical time and methods.It is crucial for early repair of soft-tissue defects by using various kinds of proper flaps whenever soft-tissue complication occurs.In patients with early stage internal fixation,flap surgery without internal fixation removing is feasible if little soft-tissue defect,little exposed internal fixation and mild infection,otherwise it is necessary to remove internal fixation and re-fix by external fixation before flap surgery.