Objective To evaluate the efficacy of manually controlled jet ventilation with Manujet Ⅲ apparatus (VBM Co, Germany) for removal of airway foreign body in children. Methods One hundred and twenty ASA Ⅰ or Ⅱ children aged 10 months-12 yr, weighing 8-35 kg undergoing removal of airway foreign body were randomly divided into 3 groups (n=40 each) : group Ⅰ spontaneous respiration (SR) ; group Ⅱ intermittentpositive pressure ventilation through the short side tube of the rigid bronchoscope (IPPV) and group Ⅲ manually controlled jet ventilation with Manujet Ⅲ (JV). Anesthesia was induced with methylprednisolone 2 mg/kg, propofol 2 mg/kg and γ-OH 70 mg/kg in group SR (Ⅰ) and with methylprednisolone 2 mg/kg, propofol 4-5 mg/kg, fentanyl 1.5 μg/kg and succinylcholine 2 mg/kg in group IPPV and JV (Ⅱ,Ⅲ). The bronchescope insertion condition, the occurrence of hypoxia during and after operation, body movement during operation, the rate of successful removal of the foreign body, the duration of operation, anesthesia emergence time and perioperative side effects were recorded. Resulls The rate of good bronchescope insertion condition and successful removal of airway foreign body were significantly higher, the rate of hypoxia during and after operation, body movement, breath holding and restlessness were significantly lower and duration of operation and anesthesia emergence time were significantly shorter in group IPPV and JV than in group SR (P<0.05). The rate of intraoperative hypoxia was significantly lower in group JV than in group IPPV (P<0.05). Conclusion Jet ventilation with Manujet Ⅲ can reduce the occurrence of hypoxia during removal of airway foreign body in children and does not interfere with the operation.

Objective To determine the levels of monocyte chemotactic protein-3(MCP-3) and microvessel density (MVD) labeled by CD34 in skeletal muscle of patients with dermatomyositis (DM) and polymyositis (PM),so as to investigate the pathogenesis of DM/PM.Methods The expression of MCP-3 and MVD were detected in DM/PM patients and the healthy controls by using the immunohistochemical method.Results The positive expression rate of MCP-3 in DM group and PM group were higher than that in the control group (P ＜ 0.001,respectively).The microvessel marked by CD34 could be observed in muscle tissue of patients in DM group and PM group,and MVD in DM group and PM group was higher than that in the control group (P ＜ 0.001).No significant differences in the level of MCP-3 and MVD in the muscle tissue were found between the DM group and the PM group.The positive correlation between MCP-3 protein expression and MVD changes in the muscle tissue of patients inDM group and PM group was revealed (r =0.685/0.634,P ＜ 0.05).Conclusion The muscle tissue of DM/PM patients may have a new blood vessel formation,MCP-3 may be involved the process of new blood vessel formation in DM/PM.

Objective [WT5”BZ] To evaluate the preliminary clinical results of the endovascular grafts for the treatment of abdominal aortic aneurysms (AAA).[WT5”HZ]Methods [WT5”BZ] Fourteen patients with infrarenal abdominal aortic aneurysms underwent transluminal endovascular graft placement for the exclusion of AAA.[WT5”HZ]Results [WT5”BZ] Two patients received tubular and 12 patients received bifurcated endograft, the placement was successful in all cases. Aortography carried out immediatly after the procedure showed the AAA were completely excluded by endografts, and no endoleaks both on the proximal or distal connections. Myocardial infarction developing in a patient postoperatively was successfully treated by thrombolysis. Perioperative death occurred in 2 cases. Technical success at 30 days was 85 7%. 24 month follow up in 12 cases found migration of the graft in none and endoleaks in 2 cases.[WT5”HZ] Conclusion [WT5”BZ] Based on our initial results and a rather short follow up period of 24 months, the endovascular treatment of AAA with stent graft is safe and effective. Long term follow up is needed to evaluate the feasibity of this procedure.

Objective To evaluate the accuracy and value of ventricular function in conotruncal defects(CTD)by three-dimensional echocardiography(3DE).Methods Fifty-two children with CTD and forty-three children with normal hearts were examined by 3DE.The measurements of left ventricular volume and wall mass were outlined and calculated.The measurements of left ventricular volume and wall mass of 3DE in preoperative CTD were compared with those of 2D biplane Simpson-method in preoperative CTD,3DE in control group and 2D biplane Simpson-method in control group.The results of 3DE and 2DE preoperative measurements were also compared with their postoperative clinical cardiac conditions.Results From the findings of analysis of variance and Student-Newman-Keuls(SNK)test,there was no significant difference between 3DE and 2DE measurements of left ventricular function in normal children,but there was significant difference between 3DE and 2DE measurements of left ventricular function in children with CTD.2DE measurements of left ventricular volume and wall mass in the CTD group were significant underestimated and less correlated with their postoperative clinical cardiac conditions(r=0.20,P=0.2086)than 3DE measurements(r=0.39,P=0.0090).Furthermore,left ventricular function in the CTD group was poorer than that in the control group.Stroke volume and effective function were reduced due to increasing end-systolic volume.while left ventricular wall mass was increased due to the possible compensation of its ventricular muscle.With the lower end-diastolic volume,stroke volume and effective function,patients were more likely to have the occurrence of postoperative low cardiac output.Conclusions By making a precise quantitative assessment,3DE is very useful in providing more information for preoperative diagnosis in CTD and predicting such postoperative prognoses as the occurrence of postoperative low cardiac output.

Objective To investigate physicians' awareness of diagnostic criteria for irritable bowel syndrome (IBS). Methods Questionnaire was used to investigate awareness of diagnostic criteria for IBS among 782 physicians in 34 hospitals in Shanghai during August 2008. Results Overall, 82. 7 percent (647/782) of physicians surveyed thought they knew or partly knew diagnostic criteria for IBS. More than 70. 0 percent of physicians knew Rome criteria, but less than 25.0 percent knew other criteria. Awareness of current Rome criteria, whether mental symptoms included in it, and its time frame differed significantly among physicians in varied specialties (P ＜ 0. 01 ). Gastroenterologists had more knowledge about Rome criteria than other specialists, but most physicians, including gastroenterologists, did not fully understand its applicability. Conclusions Although gastroenterologists knew more about diagnostic criteria for IBS, their knowledge still needed to be perfected and updated. Awareness of diagnostic criteria for IBS was poor in nongastroenterological physicians and general practitioners knew it to certain extent.

Objective To design a questionnaire on factors that affect diagnosis of irritable bowel syndrome for physicians, and determine the retest reliability. Methods The questionnaire was completed after literature review, and 9 experts were invited to revise the questionnaire. Thirty-four physicians filled the questionnaire for pre-test and did it again for re-test 4 weeks later. Kappa value of each question of the questionnaire was calculated. Results Content validity and face validity were assured by experts. Kappa values were over 0.61 in all items, which achieved substantial level. Conclusion The questionnaire designed has fairly good reliability and validity, and can be used in investigation of irritable bowel syndrome for physicians.

Objective To analyze inpatient expenses of percutaneous coronary intervention (PCI) and factors in the department of cardiology of a hospital, in order to provide references for setting the upper expenses limit and keeping expenses within a reasonable control Methods The hospitalization expenses data were collected from inpatients having intracoronary stenting operations in a class 3 grade A hospital in Shanghai from 2004-2006. The study made multi-factor analysis on factors possibly affecting the expenses, and built a model to predict the expense per disease, and estimated the upper limit for medical insurance expense control. These figures were used in an expense appraisal for inpatients from January to June in 2007. Results For the expenses of the 1296 PCI inpatients investigated, the largest share, 84.11%, comes from operation materials. Factors affecting the expenses, as listed by their influence, were in turn the number of stents used, length of stay, age, the status at admission, and rescues made. The study found that the average hospitalization expenses of inpatients from January to June in 2007 fell below the middle control line, and 85% of them lower than the upper control line. Conclusions To lower the medical expenses for the disease, hospitals need to take measures by using less stents, less days of stay, and less medication. Control lines specified per disease can help manage and control medical treatment quality.

Objective To evaluate the importance of factors affecting efficiency of image display quality of realtime three-dimensional echocardiography (RT-3DE) and establish an optimized method for RT-3DE examination and image processing in children. Methods Based on corresponding cardiac acoustic characteristics in children, 87 healthy children (46 boys, 41 girls, mean 36.2 ± 44.2 months) were selected. Three aspects of seven factors were selected, including acquisition windows, gain, compress, post process, smoothing, frequency fusion and 3D vision for RT-3DE examination and analysis using orthogonal test design method. The principal effectiveness analysis of orthngonal test design method and its table L_(18)3~7 were used. The efficiency rate of 3D image display quality was used as the inspection index for orthogonal test. Results According to the average deviation orders of the seven factors, the maximal average deviation was gain. The aspects with maximal average deviation of each factor were at via-subcostal and via-apical acoustic windows, 90 of gain, 60 of compress, E of post process, 5 of smoothing, F3 of frequency fusion and A to B of 3D vision, respectively. Conclusions The optimized method for RT-3DE examination and image processing could be achieved by setting acquisition windows, gain, compress, post process, etc. It is helpful to promote clinical application of RT-3DE and benefits the design of multi-parameter presetting of ultrasound system to optimize RT-3DE examination in children.

Animal experiment is a primary part of medical education. At present , medical students are lack of education about laboratory animal ethics and they do not usually treat animals fol-lowing rules of laboratory animal ethics. To solve this problem, we focused on the education of labora-tory animal ethics and 3R theory (reduction, replacement, refinement) in order to help the medical students treat laboratory animals nicely. We enforced the construction of the laboratory rules and regu-lations, and improved animal experiments conditions. With these efforts, we successfully standardized and scientized our experiment classes.

Objective To investigate the longitudinal systolic ventricular function of children with single ventricle, and to appraise the feasibility and clinical value of velocity vector imaging (VVI) on assessing it. Methods The study group consisted of 30 patients with functional single ventricle. The control group consisted of 30 age- and gender-matched normal children. Using Sequoia C512 echocardiography machine,the peak velocity(V),peak displacement(D) ,strain(S) ,and strain rate(SR) were measured. Results Basel and median velocities,as well as basel and median displacements of rudimentary chamber side(RCS), were lower than those of septum[Basel velocity (1. 93 ± 0. 71)cm/s vs (3. 53 ± 1. 07)cm/s;Median velocity (1.19±0. 57)cm/s vs (2. 03 ± 0. 90) cm/s; Basel displacement (2. 53 ± 1.65) mm vs (6.21 ± 2. 12)mm;Median displacement(1. 26 ± 1. 06)mm vs (3. 21 ± 1.37)mm]. The values of strain of all the six segments of single ventricle were significantly lower than Corresponding segments of the control group [ basel nonrudimentary chamber side(NRCS) ( - 16. 17 ± 4. 37) % vs ( - 19. 66 ± 3. 47) % ; Median NRCS ( - 15. 23 +4.36)% vs (-19.64± 4. 75)%; Apical NRCS (-13.84 ± 5.79)% vs ( - 16. 7 ± 4. 15)%; Basel RCS(-10. 54±5.35)% vs (-19.49±3. 74)%;Median RCS ( - 10. 16 ± 5. 26)% vs ( -20. 83 ± 3. 82)% ;Apical RCS ( - 10. 97 ± 5. 22) % vs C - 18. 11 ± 4.43) %]. Aside from basel strain rates of NRCS, strain rates of all the other five segments of single ventricle were significantly lower than Corresponding segments of the control group [Median NRCS ( - 1. 21 ± 0. 42)s-1 vs (- 1.49 ± 0. 24)s-1 ;Apical NRCS ( - 1.10 ±0.41)s-1 vs (-1.47 ± 0.24)s-1;Basel RCS ( - 1.07 ± 0. 35) s-1 vs (- 1. 49 ± 0. 22) s-1; Median RCS (-0.97± 0.34)s-1 vs ( -1.48 ± 0. 20)s-1 (Apical RCS ( - 0. 93 ± 0. 39)s-1 vs ( - 1. 48 ± 0. 22)s-1]. Conclusions Longitudinal systolic ventricular function is impaired in children with functionally single ventricle. VVI can be used to asses ventricular systolic performance in children with functionally single ventricular.