Objective To evaluate protective ventilation(PV) versus conventional ventilation(CV) for surgery in the prone position.Methods We searched PubMed, Embase, the Cochrane Library, WanFang Data and other Chinese databases to collect the randomized controlled trails (RCTs) on intraoperative PV in comparison with CV for surgery in the prone position.Two authors independently identified the studies, performed data extraction and assessed the risks of bias in the included studies according to the Cochrane Handbook for Systematic Reviews of Interventions.The reviewers conducted data analyses with RevMan software.Results A total of 9 RCTs involving 449 participants were included.The results showed that the incidence of postoperative pulmonary complications (RR 0.30, 95% CI 0.12~0.73, P<0.01) and peak pressure (MD-3.52, 95% CI-6.93~-0.11, P<0.05) were lower in the PV group.Intraoperative PaO2/FiO2 was higher (MD 37.28, 95% CI 22.67~51.89, P<0.001) and alveolar-arterial oxygen difference was lower (MD-45.50, 95% CI-61.35~-29.65, P<0.001) in the PV group.Conclusions Low tidal volume ventilation in combination with positive end-expiratory pressure (with or without recruitment maneuver) decreases postoperative pulmonary complications,reduces peak pressure and improves oxygenation for surgery in the prone position.

Objective To systematically review the effect of discontinuation of antiplatelet therapy for postoperative bleeding in carotid endarterectomy(CEA) patients by meta-analysis.Methods We searched the PubMed, Embase, Cochrane library, CNKI, China Biology Medicine (CBM), Wanfang Database and VIP, and collected all the randomized controlled trials (RCTs) about this topic.The quality of the included studies was evaluated using the method recommended by Cochrane Collaboration.Meta-analysis was conducted using RevMan 5.3 software.Results Four RCTs involving 514 patients were included, 256 in the control group and 258 in the intervention group.All outcome measures were not heterogeneous (P>0.1, I2<50%), fixed effect model was used to analyze the outcomes.The results of meta-analysis showed that discontinuation of preoperative antiplatelet therapy could significantly reduce the risk ratio of postoperative stroke (RR=0.30, 95%CI 0.11-0.83, P=0.02).There was no significant difference in the risk of 30 d (RR=0.23, 95%CI 0.04-1.32, P=0.1) and 1-year mortality (RR=0.49, 95%CI 0.24-1.02, P=0.06), postoperative major bleeding (RR=1.40, 95%CI 0.54-3.59, P=0.49), postoperative bleeding complications (RR=1.02, 95%CI 0.15-6.96, P=0.98) and TIA (RR=1.08, 95%CI 0.47-2.49,P=0.86) between the two groups.Conclusion Discontinuation of preoperative aspirin therapy could significantly reduce the rate of postoperative stroke without increasing bleeding risk.

Objective To investigate the expression of poly (ADP-ribose) polymerase-1 (PARP-1 ), cytokeratins (CK) 7/20, and p53 in patients with Barrett's esophagus and esophageal adenocareinoma,and to evaluate their significance. Methods Expression of PARP-1, CK7/20 and p53 were determined by immunohistochemistry in 108 patients (including 40 Barrett's esophagus, 28 esophageal adenocarcinoma and 40 cardiac mucosa). Results The expression of PARP-1 was found in Barrett's esophagus, esophageal ade-nocarcinoma and cardiac epithelium with a significantly higher level in esophageal adenocarcinoma than the other two groups (P <0. 01 ). CK7/20 was expressed in much of intestinal metaplasia, part of cardiac epi-thelium and adenocarcinoma cells. The positive expression of p53 was observed in all three groups, and it was significantly higher in adenocarcinoma group than in other two groups (P < 0. 05 ). PARP-1 expression is highly correlated with that of p53 in Barrett's esophagus ( r= 0.49, P < 0.01 ). Conclusion CK7/20 is a sensitive but less specific indicator for intestinal metaplasia. Both PARP-1 and p53 are involved in the patho-genesis of esophageal adenocarcinoma and might help to determine the risk of Barrett's esophagus developing into esophageal adenocarcinoma.

BACKGROUND: Epidemiologic studies have shown an association between higher insulin levels and coronary artery disease, and metabolic studies have associated insulin resistance and compensatory hyperinsulinemia with non-insulin-dependent diabetes mellitus, hypertension, obesity,and lipid disorders.OBJECTIVE: To investigate the relationship between insulin resistance (IR) and erythrocyte insulin receptors (EIRs) in the patients with cerebral infarction (CI).DESIGN: Case-control trial.SETTING: Department of Neurology, China-Japan Union Hospital of Jilin University.PARTICIPANTS: From January 2004 to October 2004, 40 patients with CI, who were in-patients in China-Japan Union Hospital of Jilin University,were selected for the study. Meanwhile, 30 healthy doctors or nurses were recruited as normal controls.METHODS: The levels of blood glucose and serum insulin under fasting and 2-hour after oral glucose tolerance test (OGTT) were detected in the 40 patients with CI and 30 healthy doctors or nurses. Fasting blood glucose multiplied by fasting serum insulin was insulin resistance index (IRI). The number of insulin receptors and their binding affinity on every erythrocyte were determined using modified Gambhir's method. The correlation between the number of EIRs and IRI was analyzed.MAIN OUTCOME MEASURES: Comparison of CI group with controlRESULTS: Data of 40 patients with CI and 30 controls were analyzed, and under fasting and 2-hour after OGTT: The level of serum insulin under fasting and blood glucose, serum insulin at 2-hour after OGTT in CI group were higher than those in normal group [(13.30±5.15), (9.85±4.36) mU/L,(8.27±1.65), (6.32±1.37) mmol/L, (75.21±21.12), (28.26±6.31)mU/L,P ＜ 0.01,EIRs: The number of insulin receptors with high and low affinity and maximum specific binding rate in the patients with CI were significantly less than those in normal group [20.30±4.50, 23.80±4.10; 2 223.80±509.30,2 610.10±435.10; (10.62±3.55)%, (13.21±2.94)%, P ＜ 0.01]. Multiple linear regression analysis and correlation analysis showed the numbers of two types of EIRs in the patients with CI were negatively correlated with IRI (r=-0.458, -0.439, P ＜ 0.01, both).CONCLUSION: Insulin resistance can lead to cerebral infarction. Decrease in insulin receptors may play an importance role in cerebral infarction induced by insulin resistance.

Objective To investigate the feasibility and safety of transumbilical laparoscopic single-port choledocholithotomy in the treatment of common bile duct stones. Methods The clinical data of four patients who underwent transumbilical laparoscopic single-port choledocholithotomy at Shengjing Hospital of China Medical University from January to June, 2010 were retrospectively analyzed. The operation method and postoperative effects were reviewed. Results All the operations were successfully carried out. The mean operation time was 100 minutes and the mean blood loss was 62. 5 ml. All patients were cured without the occurrence ofcomplications except for one patient who had a peritoneal infection and was cured after surgical drainage. Conclusion Transumbilical laparoscopic single-port choledocholithotomy is safe and feasible, but indications should be strictly followed.

Objective To explore the effect of xuezhikang on blood lipids,vascular endothelial function and redox balance in patients with carotid atherosclerosis.Methods A total of 108 inpatients with carotid atherosclerosis in cardiology department were randomly divided into two groups:xuezhikang group (n = 54) and cholestyramin group (n= 54).Before and after treatment,the levels of total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),nitric oxide (NO),endothelin-1 (ET-1),reduced glutathione (GSH) and oxidized glutathione (GSSG) of all patients were measured.The GSH/GSSG as redox potentials were calculated according to Nernst equation.Results After 12 weeks of treatment,the levels of blood lipids were lower than before treatment in xuezhikang group [TC:(3.94±1.36) mmol/L vs.(5.68±1.47) mmol/L;LDL-C:(2.28±1.11) mmol/L vs.(3.43±1.36) mmol/L;TG:(1.54±0.59) mmol/L vs.(1.73±0.66)mmol/L;t=3.915,4.160,2.187;P<0.01,0.01,0.05,respectively],and the levels of blood lipids also decreased in cholestyramin group [TC:(4.15 ± 1.29) mmol/L vs.(5.73 ± 1.52)mmol/L;LDLC:(2.56± 1.06) mmol/L vs.(3.37± 1.35) mmol/L;TG:(1.69±0.57) mmol/L vs.(1.72±0.67) mmol/L;t=3.760,4.035,1.893;P<0.01,0.01,>0.05,respectively].In xuezhikang group,ET-1,GSSG and GSSG/GSH ratios decreased significantly [(121.71 + 59.11) ng/L vs.(154.43±63.06) ng/L;(30.42± 1.59) μmol/L vs.(33.93±1.74) μ mol/L;-146.1±4.4vs.-142.3±4.3;t=2.168,2.325,4.168;P<0.05,0.05,0.01,respectively],and NO,NO/ET-1 ratios,GSH and GSH/GSSG increased significantly [(64.40 ± 18.86) μmol/L vs.(48.41 ±16.53) μmol/L;(0.54±0.19) vs.(0.33±0.16);(321.27±56.47) μmol/L vs.(286.11±38.23)μmol/L;(10.56±1.70) vs.(8.65±1.18);t=3.725,3.987,3.894,4.168;all P<0.01].Conclusions For patients with carotid atherosclerosis,both xuezhikang and cholestyramin could lower blood lipids efficiently,but only xuezhikang could protect vascular endothelial function partly,and makes plasma redox imbalance shift the balance.

Objective To prepare in-house calibrator of apolipoprotein A1 and apolipoprotein B with the values are traceable to the WHO-International reference materials SP1-01 and SP3-07.Methods We participated in the Northwest lipid research laboratory (NWLRL) protocol for target value transfer of WHO-IFCC apo A1 and apoB reference materials, and evaluated of comparability of the measurement.The analyses were performed on a Olympus AU 400, apo A1 and apoB were determined by immunoturbidimetric endpoint method.Results Through 3-step study, the precision and accuracy of apo A1 and apoB determination of our company met the NWLRL criteria.Correlation coefficients between obtained and assigned values of NWLRL on 40 individual serum samples were 0.983 for apo A1, 0.987 for apoB, the average absolute bias were 2.7 % for apo A1, 3.0 % for apoB, respectively.Conclusion NWLRL issued the certificate to Zhongsheng Beikong Bio-Technology and Science Inc.for the in-house apo A1 and apoB calibrator values are traceable to the WHO- International reference materials.

The daily management of medical equipment in the shelter hospital of CAPF was explored, and some measures were put forward including completing administration, determining responsibilities, improving supervising system, creating management tools, strengthening application for military and civilian uses, enhancing professional awareness and etc. The problems were solved in the discrepancies between construction and management, application and maintenance as well as training and daily service, so that the equipment was improved in efficiency, service life, metrology and stability. References may be provided for the shelter hospital or other medical units of CAPF for daily management of medical devices.

Objective To explore the mechanism of endotoxemic injury in kidneys and protective effect of dexamethasone on renal cells.Methods Fifty-four eighteen-day Wistar rats were divided into control,endotoxemic(LPS)and dexamethasone groups randomly,18 rats in every group.Rats in control group were injected intraperitoneally with the same volume(0.1 mL)of 9 g/L sodium chloride as other two groups.All rats in LPS group were injected with a single bolus of LPS(4 mg/kg).The rats in dexamethasone group received LPS(4 mg/kg)and dexamethasone(5 mg/kg).Then they were sacrificed at 6,24 and 72 hours after injection.The ultrastructure was observed by electron microscope.Results In LPS group,glomerular basement membrane became thick and foot processes had coalescent partly,mitochondrial cristae became dissolved in proximal tubular endothelial cells and microvillus of distal tubular diminished at 6,24 hours after LPS injection.The morphological changes of apoptosis were found in the proximal tubular at 72 hours after LPS injection.These changes were in dexamethasone group.Conclusion Apoptosis participates in LPS injury of kidneys and dexamethasone have protective effect on injuried renal cells.