Objective To evaluate the right ventricular function using volumetric pulmonary artery catheter (VPAC) in patients undergoing off-pump coronary artery bypass grafting (CABG) .Methods Thirty-two patients (18 males, 14 females) aged 45-63 yrs weighing 58-74 kg undergoing CABG were studied. Their cardiac functions were graded according to NYHA classification as Ⅰ or Ⅱ. Radial artery was cannulated before induction of anesthesia for BP monitoring. Anesthesia was induced with midazolam 0.03-0.05 mg?kg-1, fentanyl 10-15 ?g?kg-1 and pipecuronium 0.1-0.15 mg?kg-1 and maintained with 1.0-1.5% isoflurane. The probe (7 MHz) of the transesophageal echocardiography (TEE, Sonos 2500, HP) was placed in esophagus after tracheal intubation for measurement of both right and left ventricular end-diastolic, end-systolic volume and ejection fraction (LVEDV, LVESV, LVEF, RVEDV, RVESV, RVEF). VPAC (type 774HF75, Edwards Life Science Co) was placed via right internal jugular vein for measurement of RVEDV, RVESV and RVEF. 6% HAES 10 ml?kg-1 was infused over 10 min. The cardiovascular parameters mentioned above were measured before and immediately after 6% HAES infusion using both TEE and VPAC, and compared.Results The RVEDV and RVESV (measured by TEE and VPAC) and LVEDV, LVESV (by TEE) were significantly increased after HAES infusion as compared with the baseline values (P

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Objective To assess the changes in heart geometry and function during off-pump coronary artery bypass grafting(CABG).Methods Thirty ASAⅡorⅢpatients(24 males,6 females)aged 50-78 undergoing elective off-pump CABG were studied.After induction of anesthesia and tracheal intubation a catheter which was connected to the monitor measuring continuous cardiac output(CCO),mixed venous blood oxygen saturation(S(?)O_2)and CEDV was placed via right internal jugular vein and the probe of multi-phase transesophageal echocardiograph(TEE)(Sonos HP 2500)was inserted in the esophagus.The distance between the probe and the incisors was between 34-45 cm.The hemodynamic variables and TEE parameters were recorded when epicardium was opened(T_1,baseline)when the octopus tissue stabilizer was placed during anastomosis between the graft vessel and left anterior descending artery(LAD)(T_2)left circumflex artery(LCX)(T_3)and right coronary artery(RCA)(T_4)and when the anastomoses between the vessel grafts and aorta was completed (T_5).Results At T_2 the mitral valve deceleration time(DT_1)and the blood flow through the mitral valve(Q_1) were decreased significantly as compared with the baseline(T_1);MAP was significantly decreased while HR and CVP were increased(P＜0.05).At T_3 the left and right ventricular end-diastolic diameter(LVEDD,RVEDD), tricuspid valve diameter(TVD)and the blood flow through Q_1 and tricuspid valve(Q_2)were significantly decreased as compared to the baseline values at T_1.The mitral valve E/A ratio was increased while the tricuspid valve E/A ratio was decreased(P＜0.05).The MAP,S(?)O_2,right ventricular end-systolic and end-diastolic volume(RVESV,RVEDV)and right ventricular ejection fraction were significantly decreased while HR and CVP were increased at T_3 as compared to the baseline at T_1.At T_4 LVESD,LVEDD,MVD,tricuspid valve E/A ratio and Q_1 were significantly decreased as compared to the baseline at T_1(P＜0.05).MAP,MPAP,SV,S(?)O_2, RVEF,RVESV and RVEDV were significantly decreased while HR and CVP were increased(P＜0.05).At T_5 all the TEE and hemodynamic parameters returned to the baseline valves at T_1.Conclusion During anastomoses between graft vessels and LAD,LCX and RCA,both left and right ventricles are compared to some extent and the heart function is impaired temporarily but returns to the baseline after the anastomoses are completed.

Objective To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE MRA) in infrapopliteal occlusive diseases of diabetic patients.Methods A total of 105 patients with known diabetes and peripheral vascular occlusive disease who underwent both CE MRA and DSA examnations were included in this study.They had no obvious stenosis or with stenosis of less than 75％ in iliac,femoral,and popliteal arteries.Every infra-popliteal artery was anatomically divided into 9 vascular segments as tibiofibular trunk artery,proximal and distal anterior tibial artery,proximal and distal posterior tibial artery,proximal and distal peroneal artery,plantar and dorsalis pedis artery.There were 945 segments.The arterial stenosis was accessed with CE MRA and DSA respectively.The segments were scored in 5 categories as＜30％,≥30％ and＜50％,≥50％ and＜75％,≥75％ and＜100％,and 100％ according to stenostic degrees.The Kappa test was used to compare the diagnostic consistency of CE MRA and DSA.Taken DSA as a gold standard for reference,ROC curve was drawn to calculate the diagnostic accuracy of CE MRA in diagnosis of lower limb arterial disease.Results The ratio of statistically valid segments for both CE MRA and DSA were 97.7％ (923/945) in 945 vessel segments of 105 patients,and 390 of 923 arterial segments were both indicated as occlusion by CE MRA and DSA.The diagnostic consistency for the segments was listed in the decreasing order as follows:proximal peroneal artery,proximal posterior tibial artery,distal posterior tibial artery,proximal anterior tibial artery,distal anterior tibial artery,tibiofibular trunk artery,dorsalis pedis artery,plantar artery,distal peroneal artery,and corresponding Kappa values were 0.88,0.86,0.84,0.84,0.81,0.77,0.75,0.75 and 0.73,P＜ 0.05.The AUC(area under ROC curve) of CE MRA was 0.893 with 95％ confidence interval of 0.882 to 0.904.Conclusion CE MRA is an accurate imaging modality in the diagnosis of infrapopliteal occlusive disease s for diabetes.

This study was aimed to discuss the relations between relieving depression and benefit findings for advanced cancer patients.A total of 80 advanced cancer patients with the anxiety / depression assessment of more than 7 points and less than 15 points,were randomly divided into the intervention group and the control group,in comprehensive hospitals.Finally,76 cases were included with 39 cases in the intervention group,and 37 cases in the control group.The progressive muscle relaxation training (PMRT) was used in the control group.Traditional Chinese medicine (TCM) special technique (i.e.,TCM five-element musicotherapy plus PMRT) was used in the intervention group.The reduced fraction of the Benefit Finding Scale (BFS) and the Hospital Anxiety and Depression Scale (HADS) were used in the effect evaluation after 8-week intervention.The results showed that after 8-week treatment,the reduced fractions of BFS and HADS in the intervention group were obviously higher than the control group with statistical significance.The variation tendencies of BFS and HADS in the intervention group were obviously higher than the control group with statistical significance.There were 8 individual values in BFS of the intervention group were higher than the control group with statistical significance.It was concluded that the benefit findings for advanced cancer patients were related to the application of TCM special techniques,can improve the levels of benefit findings among advanced cancer patients.It enriched and perfected the depression regulation plan of cancer patients by TCM special techniques.

Objective To evaluate the effect of pretreatment with botulinum toxin A injected intrath?ecally or locally at the incision site on the neurokinin?1 ( NK?1) receptor internalization in the spinal dorsal horn in a rat model of incisional pain. Methods Male Sprague?Dawley rats, weighing 280-300 g, aged 6-8 weeks, were used in the study. The experiment was performed in two parts. ExperimentⅠ Twenty?seven rats with no sign of nerve injury at day 7 after successful catheterization were selected and divided into 3 groups (n=9 each) using a random number table: control group (C1 group), incisional pain group (IP1 group) and intrathecal botulinum toxin A group (BoNT∕A1 group). At 24 h before operation, botulinum tox?in A 0.5 U ( in 10μl of normal saline) was injected intrathecally in group BoNT∕A1, and normal saline 10μl was injected intrathecally in group IP1. ExperimentⅡ Twenty?seven rats were selected and divided into 3 groups (n=9 each) using a random number table: control group (group C2), incisional pain group (IP2 group) and locally injected botulinum toxin A at the incision site group (BoNT∕A2 group). At 24 h before op?eration, botulinum toxin A 2 U ( in 0.4 ml of normal saline) was injected subcutaneously at the incision site and into the plantar surface, and normal saline 0.4 ml was injected subcutaneously at the incision site and into the plantar surface in group IP2. Six rats in each group were selected, and the cumulative pain score (CPS) was recorded, and the mechanical paw withdrawal threshold ( MWT) in the right hindpaw was measured be?fore administration, before operation, and at 3 h and 1, 3, 5 and 7 days after operation. At 3 h after opera?tion, 3 rats in each group were selected and sacrificed, and the lumbar segment ( L4,5 ) of the spinal cord was removed for determination of the expression of NK?1 receptors in the spinal dorsal horn by immunofluores?cence. Results ExperimentⅠ Compared with group C1, the CPS was significantly increased at 3 h and 1, 3, 5 and 7 days after operation, the MWT was significantly decreased at 3 h and 1 and 3 days after opera?tion, and the expression of NK?1 receptors in the spinal dorsal horn was significantly up?regulated in group IP1, and the CPS was significantly increased at 3 h and 1, 3 and 5 days after operation, the MWT was sig?nificantly decreased at 3 h after operation ( P<0.05) , and no significant change was found in the expression of NK?1 receptors in the spinal dorsal horn in group BoNT∕A1 (P>0.05). Compared with group IP1, the CPS was significantly decreased, and the MWT was significantly increased at 3 h and 1, 3, and 5 days after oper?ation, and the expression of NK?1 receptors in the spinal dorsal horn was significantly down?regulated in group BoNT∕A1 (P<0.05). ExperimentⅡ Compared with group C2, the CPS was significantly increased at 3 h and 1, 3, 5 and 7 days after operation, the MWT was significantly decreased at 3 h and 1, 3, 5 and 7 days after operation, and the expression of NK?1 receptors in the spinal dorsal horn was significantly up?regu?lated in group IP2, and the CPS was significantly increased at 3 h and 1, 3, 5 and 7 days after operation, the MWT was significantly decreased at 3 h after operation ( P<0.05) , and no significant change was found in the expression of NK?1 receptors in the spinal dorsal horn in group BoNT∕A2 ( P>0.05) . Compared with group IP2, the CPS was significantly decreased at 3 h and 1, 3, and 5 days after operation, the MWT was signifi?cantly increased at 3 h and 1 and 3 days after operation, and the expression of NK?1 receptors in the spinal dorsal horn was significantly down?regulated in group BoNT∕A2 (P<0.05). Conclusion Pretreatment with botulinum toxin A injected intrathecally or locally at the incision site can inhibit the internalization of NK?1 re?ceptors in the spinal dorsal horn in a rat model of incisional pain.

OBJECTIVETo study the consistency between DR and high-kV chest radiographs in diagnosis of pneumoconiosis and to explore the feasibility of DR chest radiograph in the diagnosis of pneumoconiosis.

METHODSTwenty five coal miners were examined with DR and high-kV chest radiographs at the same time. Image post-processing parameters (density, contrast, etc.) were set to ensure the quality of DR chest radiograph in Philips Essenta DR machine. In order to avoid the repetitive numbers, 50 chest radiographs were numbered at random. Pneumoconiosis diagnosis was conducted by six independent certified occupational physicians of pneumoconiosis by blind method. The consistency between 2 kinds of chest films was assessed.

RESULTSAll chest radiographs (25 cases, 50 chest films) were excellent. The diagnosis results of six readers on the 15 pairs of DR and high-kV chest radiographies were summarized. For high-kV chest radiographs, the consistency of pneumoconiosis classification for 12 pairs of readers was more than 68%, the consistency of total density for 11 pairs of readers was more than 68%. For DR chest radiographs, the consistency of pneumoconiosis classification for 13 pairs of readers was more than 60%, the consistency of total density for 14 pairs of readers was more than 60%. The consistency of pneumoconiosis classification between two chest radiographs was 72% (value: 0.69, 95% CI: 0.46-0.92), the consistency of total density between two chest radiographs was 80% (value: 0.78, 95% CI: 0.61-0.95).

CONCLUSIONWhen the chest radiograph quality was good and the difference of reading films was low, there was a good consistency of pneumoconiosis diagnosis between DR chest radiographs and high-kV chest radiographs.

Objective To assess the number of peripheral blood Th17 cells and mRNA expressions of IL-17A and IL-23R and their correlations with disease severity in patients with psoriasis vulgaris (PV).Methods Tissue specimens were resected from the lesions of 25 patients with PV and normal skin of 10 human controls,and venous blood samples were obtained from 20 of the patients and all of the normal human controls.Reverse transcription PCR and flow cytometry were carried out to measure the mRNA levels of IL-17A and IL-23R in these tissue specimens and quantify the number of peripheral blood CD4+IL-17+ T lymphocytes.Psoriasis area and severity index (PASI) was calculated for these patients.Results A significant increase was observed in the IL-17A and IL-23R mRNA levels in the patients compared with the controls (0.996 ± 0.231vs.0.437 ± 0.096,t =10.572,P ＜ 0.05; 1.006 ± 0.339 vs.0.491 ± 0.196,t =6.015,P ＜ 0.05).The levels of both IL-17A mRNA and IL-23R mRNA were positively correlated with PASI (r,=0.67,0.70,respectively,both P ＜ 0.05).The number of CD4+IL-1 7+ T lymphocytes in peripheral blood showed no significant differences between the patients and controls.No statistical correlation was observed between the counts of CD4+IL-17+ T lymphocytes and expression levels of IL-17A or IL-23R mRNA in psoriatic lesions.Conclusions In patients with PV,there is an increase in the expressions of IL-17A and IL-23R mRNA in lesions,which are correlated with disease severity,while no significant change is observed in the number of peripheral blood CD4+IL-17+ T cells.

Objective To study the correlation between cognitive dysfunction and cholinergic neuron changes in basal forebrain(BFB)and brainstem reticular formation(BSRF)areas after brain con- cussion(BC)in rats.Methods Eighty-four Spragne-Dawley rats weighing 250-310g were used.The BC rat models were reproduced by a self-made simple pendulum impact device,then the rats were ran- domized into one control group and six experimental groups(1 day,2 day,4 day,8 day,16 day,and 24 day groups;n=12 in each group).A Morris Water Maze(MWM)test was used to assess learning and memory function of the rats.Cholinergic neurons in the BFB and BSRF were identified with choline acetyltransferase(CHAT)antibody and quantitated.Results Compared with the control group,the la- tency to find the platform in MWM was much longer on days 1-3 after BC,but there was no statistical difference on days 4-21 after BC.The cell number and the ChAT expression activity of cholinergic neu- rons in the BFB were obviously decreased after BC,and reached the lowest level at 8 days after BC,then increased gradually and nearly reached the normal level at 24 days.The ChAT expression activity in BSRF declined on the first 2 days after BC,then went up gradually,and reached the peak at the 24th day.Conclusion The spatial cognition deficit of BC rats can be detected by MWM in the early period (1-3 days after BC).There are significant changes in the number and ChAT expression activity in BFB and BSRF after BC.The change of cholinergic neurons may be correlated with cognitive deficits in BC rats.