Objective To determine if thiopental, propofol and ketamine can be safely used for induction of anesthesia in patients with congenital heart disease complicated by pulmonary hypertension. Methods Eighteen patients with congenital heart disease complicated by pulmonary hypertension were studied. Age ranged from 14 to 31 yr and body weight from 35 to 57 kg. The patients were premedicated with intramuscular pethidine 1 mg? kg-1 and scopolamine 0.3 mg. Swan-Ganz catheter was inserted through internal jugular vein. The patients were randomized to receive thiopental 2 mg?kg-1 , propofol 1 mg?kg-1 or ketamine 1 mg?kg-1 administered slowly via Swan-Ganz catheter for induction of anesthesia. MAP, high arterial pressure (RPA), mean pulmonary arterial pressure (MPAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO) and pulmonary vascular resistance (PVR) were measured before induction of the intravenous anesthetics. Results PVR unchanged significantly after ketamine , thiopental and propofol as compared with the baseline value. MAP was significantly decreased after injection of thiopental and propofol. Conclusion Thiopental, propofol and ketamine can be safely used for induction of anesthesia in patients with congenital heart disease complicated by pulmonary hypertension.

Objective To survey the double-preceptor system in standardized residency training of general practitioners (GPs).Methods A questionnaire survey was conducted among 48 residents,53 clinical and community preceptors during May and June 2013.Results The preceptors mostly agree with the necessity to carry out double-preceptor system.82.8％ (24/29) clinical preceptors,95.8％ (23/24) community preceptors and 89.6％ (43/48) residents considered that it was very effective.Less than half of the clinical(13/29) and community (11/24) preceptors knew very clearly about their responsibilities and obligations ; 93.1％ (27/29) clinical preceptors and 95.8 ％ (23/24) community preceptors hoped to receive corresponding training courses.72.4％ (21/29) clinical preceptors and 75.0％ (18/24) community preceptors communicated with residents frequently,75.9％ (22/29) clinical preceptors thought residents were not actively involved was the main obstacle in the implementation of double-preceptor system.The guide contents were focused on clinical skills,scientific research and how to pass assessments.The main approaches were interviews,checking the quality of medical instruments and small lecture.Only 6.9％ (2/29) clinical preceptors conducted outpatient teaching,83.3％ (40/48)residents thought tutors did not knew clearly about their responsibilities and obligations was the main obstacle in the practice of doublepreceptor system.Regarding how to evaluate the double-preceptor system,clinical and community preceptors tended to use examination results and feedback of residents.Clinical preceptors,community preceptors and residents all gave low comments about the preceptor-resident contact handbook.87.5％ (21/24) community preceptors thought lack of corresponding incentive mechanisms was the main obstacle in the practice of double-preceptor system.Conclusions Double-preceptor system has been widely recognized by both preceptors and students.In order to improve the system,we should conduct tutor training courses regularly and establish an effective mechanism to assess and evaluate tutors.

Objective To review the diagnosis and treatment of adrenal myelolipoma(ML).Methods The medical records of 21 patients with adrenal myelolipoma were reviewed.All patients were examined by B-ultrasound,CT and endocrine tests while some were also examined by MRI and 131I-MIBG.Results All patients had undergone resection of adrenal ML.The mean diameter of tumors was 6.7 cm(4.5 cm～12 cm).Pathological examination of all tumors confirmed the diagnosis of adrenal ML.No recurrence was recorded during the follow-up period(1～15years).Conclusion Adrenal ML is a kind of rare,benign tumor and is often incidentally discovered.Its prognosis is generally good.

The main reasons to doubt the validity of serum pharmacology include:①The components of medical herbs absorbed from gastrointetinal tract enter circulating plasma,not serum in vivo.②Blood coagulation involves the activation of a series of proenzymes,and the proteases induce leukocytes to release lysosomal enzymes.These enzymes may degrade some herbal components.③Thrombin can stimulate platelets and leukocytes to secrete many biologically active substances.④Fibrinolysis,complement and kinin systems are activated during blood coagulation.⑤The processes of serum preparation and inactivation always cause lose of lots of herbal components. Recently finger printing analysis using HPLC-MS and antileukemic proliferation experiments showed that the results obtained from serum pharmacological method might be incorrect. We propose that the ex vivo experiments on multiple levels are necessary to elucidate the pharmacological actions and their mechanisms of medical herbs and believe that the pharmacological method using plasma absorbed herbal components should be better than that using serum.

Phe) polymorphism and GD in Han population of Chongqing area.

BACKGROUND: Breast augmentation with polyacrylamide hydrogel injection has been used nearly for a decade in some Chinese medical therapy units. More patients need to be removing injections or a second augmentation due to complications. More attention should be paid for possibility of complications concomitant with breast malignant tumor. OBJECTIVE: Two cases of breast invasive duct carcinoma diagnosed after removing injection were analyzed retrospectively in order to increase the importance of detection rate of breast malignant tumor. METHODS: Two cases in all 41 assembled patients which were removed polyacrylamide hydrogel injections from 82 breasts were diagnosed with invasive carcinoma. The characteristics of medical history, physical diagnosis, image diagnosis and pathological examination were analyzed retrospectively. RESULTS AND CONCLUSION: The detection rate of breast malignant tumor should arise more attention in patients requiring removal of polyacrylamide hydrogel injection. The following aspects should be emphasized such as the comprehensive analysis for the results of physical diagnosis and image diagnosis, tumor-free operation with more samples from suspicious nodules and frozen pathological examination. The principles of cancer surgery should be followed in pathological diagnosed cases in case of iatrogenic metastasis and spread of breast malignant tumor.

Objective To evaluate the correlation between regional blood perfusion,metabolism and angiogenesis in breast cancer.Methods The PET/CT functional imaging technique was applied to quantitatively detect the central and marginal blood perfusion parameters including blood flow(BF),blood volume(BV)and permeability of surface(Ps),and metabolism index of standard uptake value(SUV)of the tumor in 33 breast cancer patients.The expression of CD31.CD105 and VEGF in paraffin section of breast cancer were detected by immunohistochemical method,then MVD(CD31)and MVD(CD105)were obtained.The relationship between the regional blood perfusion and metabolism and MVD(CD3 1),MVD(CD105)and the expression of VEGF were analyzed. Results There was significant correlation of MVD (CD31)with BF of marginal region(P<0.05).There were significant correlations of MVD(CD105)with BF.PS and SUV(P<0.05). Conclusions Regional blood perfusion,metabolism is correlated with angiogenesis in breast cancer tissue.PETT/CT regional blood perfusion and metabolic imaging iS a noninvasive method which can be used to estimate angiogenesis status clinically in breast cancer.

Objective To evaluate the use of PET/CT in the diagnosis of breast cancer. Methods In this study,33 patients with suspicious breast tumor underwent PET/CT imaging. The images of the breast were analyzed for qualitative assessment of increased tracer uptake and blood perfusion with PET/CT. Results Among 27 cases with pathology proved breast cancer,25 was judged as PET/CT positive,2 was false-negative. Sensitivity, specificity and accuracy of PET/CT in identifying breast cancer were 92.6%,100%,93.9%. Conclusion PET/CT is a reliable and sensitive measure in the diagnosis of breast cancer in vivo.

Objective To investigate the effect of paclitaxel drug-coated balloon (DCB) dilatation in treating coronary in-stent restenosis (ISR) occurring after drug-eluting stent (DES) implantation,and to observe the long-term changes of the target vascular lumen area in order to clarify the curative effect of paclitaxel DCB in treating ISR.Methods Four patients with ISR whose clinical condition met the DCB indication were selected.According to the standard process,sufficient pre-expansion of ISR was performed first,then paclitaxel DCB dilatation was carried out to dilate the lesion segment of ISR,and no stent was implanted.Both coronary angiography and intravascular ultrasound (IVUS) were performed immediately after the treatment as well as 9 months to measure the minimum lumen area (MLA) and cross-sectional area (SA) of the stent,and the intimal hyperplasia was also been evaluated.Results In all 4 patients,angiography performed immediately after paclitaxel DCB dilatation showed that neither dissection of the dilated segment of the target artery nor obvious residual stenosis was observed.Angiography performed 9 months after the treatment revealed that all dilated segments of the target arteries were patent,and no pronounced restenosis of stent segment was seen.IVUS examination was indicated that MLA became enlarged,SA showed an increasing trend,and intimal hyperplasia showed a tendency to be inhibited.Conclusion For the treatment of ISR,pure paclitaxel DCB dilatation can obtain long-term lumen area enlargement,thus,repeated stent implantation can be avoided,which,in turn,can reduce the risk of ISR recurrence.Paclitaxel DCB dilatation can locally release paclitaxel,which has curative effect on the coronary artery wall to inhibit the excessive proliferation of intima.

Objective To explore the clinical application value of ultrasound-guided intrahepatic biliary puncture combined with internal double biliary stenting under DSA in elderly patients with malignant hilar biliary obstruction (MHBO).Methods Totally 108 elderly MHBO patients received interventional treatment were analyzed retrospectively.Half of patients were treated with ultrasound-guided intrahepatic biliary puncture (ultrasound group),and another 54 patients were treated with DSA intrahepatic biliary puncture (DSA group).After successful puncture,the patients received percutaneous transhepatic cholangial drainage (PTCD) with 4 methods under DSA guidance,namely internal double biliary stenting,contralateral external PTCD with single biliary stenting,complete external PTCD and external PTCD on the dominant side.The recent complications of intrahepatic biliary puncture at two groups and the curative effect with four methods were observed.Results The frequency of intrahepatic biliary puncture,the dosage of contrast agent,the incidence of pain at the puncture point and hemobilia in ultrasound group were all lower than those in DSA group (all P＜0.05),the successful rate of intrahepatic biliary puncture in first time was significantly higher compared with DSA group (P＜0.05).The liver function indicators at 14 days postoperation and total bilirubin at 21 days postoperation had statistical differences between any two biliary drainage methods (all P＜ 0.05).Conclusion Ultrasound-guide intrahepatic biliary puncture combined with internal double biliary stenting under DSA can significantly benefit elderly patients with MHBO.