Objective To evaluate the accuracy of stroke volume variation(SVV)in blood volume monitoring during induction in patients undergo?ing coronary artery bypass grafting(CABG). Methods Thirty ASAⅡorⅢpatients,aged 53?74 year,BMI 21?27,NYHA classⅡorⅢ,scheduled for CABG were enrolled in this study. MAP,HR,CVP,SVV,cardiac output(CO),cardiac index(CI),stroke volume index(SVI)and systemic vascular resistance index(SVRI)were continuously measured by Vigileo/FloTrac system and recorded simultaneously at the following time points:T1(baseline level)and T2(after induction and before intubation). Calculate the changes of SVV,CVP and CI(△SVV、△CVP and△CI). Pa?tients whose△CI≥15%were defined as the responders to the insufficiency of blood volume. The receiver operating characteristic(ROC)curve for SVV and CVP were plotted,and the area under the curve were calculated. Results Compared with T1,significant decrease in CO,CI and SVI was observed at T2 . Meanwhile,SVV increased from 8%±5%to 17%±12%(P=0.012). Twenty?four patients were responders to intravascular volume insufficiency due to induction. SVV were significantly higher in responders than in non?responders(20%±13%vs 9%±4%,P=0.036). A threshold SVV value of 10.5%allowed discrimination between responders and non?responders to blood volume insufficiency,with a sensitivity of 75%and a specificity of 80%. The area under the curve for SVV was 0.875,and the 95%confidence interval was 0.689 to 1.000. Conclusion SVV exhibited reliable sensitivity and specificity in monitoring blood volume changes during induction in patients undergoing CABG.

Objective To observe the improvement effects of astragaloside Ⅳ (AS-Ⅳ)on the myocardial focal ischemia-reperfusion (I/R)injury and its influence in PI3K/Akt/mTOR pathway,and to clarify the protective effect of AS-Ⅳ on myocardial I/R inj ury and the possible mechanisms.Methods The left main coronary arteries of 60 Sprague-Dawley rats were occluded for 30 min followed by a 120-min reperfusion to induce I/R model.The rats with I/R inj ury were randomly divided into model group (normal saline), AS-Ⅳ group (intravenous inj ection of 10 mg·kg-1 AS-Ⅳ 5 min before reperfusion),PI3K inhibitor Wortmannin (WOR)group (intravenous injection of 0.6 mg·kg-1 WOR 10 min before reperfusion)and AS-Ⅳ+WOR group (intravenous injection of 10 mg·kg-1 AS-Ⅳ and 0.6 mg·kg-1 WOR 5 and 10 min before reperfusion,respectively).15 age-matched SD rats were chosen as control group.The heart mass,degrees of infarction and ischemia and cardiac function ,including left ventricular systolic mean pressure (LVSP),end-diastolic pressure (LVEDP),fractional shortening (FS)and ej ection fraction (EF),of the rats in all groups were analyzed. Western blotting method was used to measure the phosphorylation levels of Akt and mTOR(p-Akt and p-mTOR).The specific fluorescent probe DHE staining was employed to detect the myocardial reactive oxygen species levels. Results Compared with control group, the degrees of infarction and ischemia, LVEDP, myocardial levels of p-Akt/Akt, p-mTOR/mTOR and reactive oxygen species levels of the rats were increased (P<0.05).and the levels of LVSP,FS and EF were decreased in model group (P<0.05). Compared with the model group,the degrees of infarction and ischemia,LVEDP and reactive oxygen species level were decreased (P<0.05),while the levels of p-Akt/Akt,p-mTOR/mTOR LVSP, FS and EF of all rats in AS-Ⅳ group were increased (P<0.05).Compared with AS-Ⅳ group,the degrees of infarction and ischemia,LVEDP and reactive oxygen species levels of the rats in WOR group and AS-Ⅳ+WOR group were increased (P<0.05 ), and the myocardial p-Akt/Akt, p-mTOR/mTOR and LVSP, FS, EF were decreased (P<0.05).Conclusion AS-Ⅳ has improvement effect on myocardial I/R injury.AS-Ⅳ can reduce the extent of myocardial infarction and oxidative stress and improve the heart function,and its possible mechanism may be related to activating PI3K/Akt/mTOR signaling pathway.

Objective To investigate the effect of propofol on the expression of bone morphogenetic protein-7 ( BMP-7 ) mRNA in heart during ischemia-reperfusion ( I/R) in rats. Methods Thirty Wistar rats weighing 280-300 g were randomly divided into three groups of 10 animals : (1) control group; (2) I/R group and (3) propofol group. In control group sham operation was performed. Chest was opened and closed. In I/R group the anterior descending branch of the left coronary artery was reversibly blocked with a 3-0 thread. Ischemia of the myocardium was confirmed by the color of apex turning from bright to dark red. The block was maintained for 10 min, then relieved for reperfusion. In propofol group propofol 1mg?kg-1?min-1 was continuously infused iv during 10 min of myocardial ischemia. The animals were saclificed at the end of 4h reperfusion. Specimen was obtained from apex of heart for determination of expression of BMP-7 mRNA using RT-PCR. Results The expression of BMP-7 mRNA was 1.14 ?0.08 in control group, significantly higher than that in I/R group (0.9 ? 0.05) and propofol group (1 .00 ? 0.08) (P

Reduced responsiveness to reward stimuli is a central feature of major depressive disorder (MDD). Study on the changes of neural substrates and behavior contributes to understand the mechanism of MDD. Functional magnetic resonance imaging (fMRI) has the unique advantage of investigating reward processing, which is of importance in the brain imaging study. The progresses of event-related fMRI (ER-fMRI) in field of rewarding stimuli in major depressive disorder were reviewed in this article.

The rapid dlevelopment of life science,specially the coning technique,has made science and society,ethics and law become very complicated life science involved the stem cell of blood in the umbilical cord how to be transplanted and gene research.These problems have already ouched upon a series of law cond ethics.The paper stated the lawful and ethical problems about the blood in the umbilical cord from its belongs,management and privator rights.

Objective To analyze the risk factors of mortality in hospitalized patients with peptic ulcer bleeding (PUB).Methods From January 2003 to December 2012,1 210 patients with PUB were collected.Among them,1 170 patients were cured (cured group) and 40 patients died (dead group).The general information and clinical data of patients were collected,which included gender,age,smoking history,non-steroidal anti-inflammatory drugs intake,haematemesis,shock,blood infusion and rebleeding.The information of patients combined with other diseases was also collected.The lab findings and gastroendoscopy findings were also collected,including hemoglobin,platelets,serum albumin,blood urea nitrogen,serum creatinine levels,coagulation,location of ulcer and Forrest classification.Chi-square test was performed for comparison between groups of count data.The t-test was used for comparison between groups of measurement data and normally distributed,and Mann-Whitney rank sum test was used for non-normal distribution.The risk factors of mortality of patients with PUB were analyzed by univariate and multivariate Logistic regression analysis.Results The rates of age over 65,combined with other diseases,shock,rebleeding,abnormal coagulation,Forrest classification above Ⅱ b,medicine spraying to stop bleeding under gastroendoscope,gastroendoscopic hemostasis with titanium clip and operation of dead group (57.5％,23/40; 27.5％,11/40; 25.0％,10/40; 42.5％,17/40; 25.0％,10/40; 35.0％,14/40; 15.0％,6/40; 12.5％,5/40 and 17.5％,7/40) were all higher than those of cured group (25.0％,293/1 170; 7.4％,86/1 170; 12.5％,146/1 170; 13.1％,153/1 170; 5.1％,60/1 170; 20.9％,244/1 170; 4.8％,56/1 170; 4.1％,48/1 170 and 6.5％,76/1 170).The differences were statistically significant (x2 =21.117,18.651,5.400,27.728,9.203,4.613,6.332,4.661 and 5.710,all P＜0.05).The serum albumin level of dead group ((28.71±7.13) g/L) was lower than that of cured group ((32.82±7.55) g/L) and the difference was statistically significant (t=2.215,P＜0.05).Between the groups,there were no significant differences in gender distribution,rate of patients smoking,rate of patients taking non-steroidal anti-inflammatory drugs,rate of patients with haematemesis,volume of blood infusion,location of ulcer,dosage of proton pump inhibitor (PPI),average hemoglobin level,blood urea nitrogen level,serum creatinine and platelet count (all P＞0.01).Age over 65,combined with other diseases and rebleeding were the independent risk factors of mortality of patients with PUB during hospitalization (OR=4.821,12.959 and9.627,all P＜0.01).Conclusion Age over 65,combined with other diseases and rebleeding are the independent risk factors of mortality of patients with PUB during hospitalization.

Organic phosphorus pesticide poisoning is a common disease in emergency.Compared with other clinical disease teaching,the basic concepts and theories of this unit are relatively less and more fixed,which is conducive to the case-based learning(CBL).The CBL teaching curriculum of organic phosphorus pesticide poisoning includes three aspects:pre-class teaching design,classroom teaching,after-class teaching evaluation and feedback.Pre-class teaching requires teachers to carefully read the syllabus,choose the teaching content,and design typical cases and problems.Classroom teaching emphasizes a lively and relaxed atmosphere,Teachers should guide students to think about questions and find answers themselves,and cultivated the correct clinic ideation through the combination of their theoretical knowledge and clinical practice in a classroom environment.Teaching evaluation and feedback help teachers to summarize what they are teaching and promote the teaching,which benefits both the teachers and students.

Objective To investigate the clinic effect of the Salvia miltiorrhiza combined with dextran to prevent veno-occlusive disease after hematopoietic stem cell transplantation. Methods In the process of the pretreatment of the hematopoietic stem cell transplantation, patients were treated with salvia miltiorrhiza (20 ml/d), dextran(250 ml, twice a day) by venous transfusion and the drugs to protect the liver cell was used in the same time. When the count of platelet dropped to 30×109/L, salvia miltiorrhiza and dextranware stopped applying forever. Results Veno-occlusive disease and hemorrhage has not occurred during 85 times of the hematopoietic stem cell transplantation treated with salvia miltiorrhiza and dextran. Conclusion We conclude that the combined treatment with salvia miltiorrhiza and dextran is safe and effective to prevent veno-occlusive disease after hematopoietic stem cell transplantation.

Objective To investigate the protective effect of heat shock protein (HSP) 70 on the acute lung injury (ALI) of rats with heat stroke.Methods Sixty four rats were randomly (by employing a random number table) assigned into a sham-heated group (Sham group),heat stress group (HS group),and HS plus gluttamine treatment group (HS+GLN group) and HS plus quercet in treatment group (HS+QU group),16 each.All rats were housed in a artificial climate chamber,with the rats in the sham groups exposed to a temperature of 23 ℃ and humidity of 55％ ± 5％,while the rats of HS,HS+GLN and HS+QU groups to an ambient temperature of 39 ℃ and humidity of 65％.During heat stress or sham heating,rectal temperature (Tr),systolic blood pressure (SBP) and pulse rate (PR) were monitored to observe the difference in heat stress response among the groups.The time point at which the SBP started to drop from the peak level was taken as the point of HS onset.At the onset of HS,heat exposure was terminated,then the rats were immediately removed from the chamber,and returned to room temperature.The rats were scarified 0h and 6h after HS onset respectively.After bronchoalveolar lavage fluid (BALF) was collected,the lungs of all animals were harvested for pathological examination of lung injury.The concentrations of IL-1β,TNF-α and IL-6 in BALF and HSP70 in lung homogenate were measured by using an enzyme linked immunosorbent assay kit.Results Compared with HS and HS+QU groups,the rats in HS+GLN group required significantly greater heat load to induce HS (P＜0.001),and had longer survival time span after HS onset.Compared with Sham group,the concentration of HSP70 in lung homogenate in HS group increased in a time-dependent manner (P＜0.001).In comparison with HS group,the concentration of HSP70 in lung homogenate from HS+GLN group was significantly elevated at each time point (P＜0.001),while the treatment with QU significantly inhibited the expression of HSP70 (P＜0.001).The concentration of IL-1β,TNF-α and IL-6 in BALF significantly decreased in HS+GLN group compared with those in HS group and HS+QU group (P＜0.001).The pathological results showed that the lung injury was milder in HS+GLN group,while the opposite in HS+QU group.Conclusion HSP70 could protect HS rats against ALI by enhancing their thermo-tolerance and inhibiting inflammatory response.

Objective To investigate the role of oxidative stress in acute liver injury in a heat stroke model of conscious rats,and to explore its underlying mechanism.Methods Thirty-two rats were randomly (by using a random number table) assigned into a sham-heated control group (Sham group,n=8),a sham-heated group treated with NAC (Sham-NAC group,n=8),a heat stroke group (HS group,n=8) and a heat stoke group treated with NAC (HS-NAC,n=8).Rats were prepared with pre-warm chamber to initiate heat stoke.The change of rectum temperature (Tr),heart rate (HR) and systolic blood pressure (SBP) were monitored,and the time point of HS onset was recorded.Rats were sacrificed 12h after HS onset.ALT,serum TBIL,IL-6,IL-1β,TNF-α,MDA,T-SOD and GSH in the liver homogenates were measured.Liver tissues were harvested for determining the concentration of reactive oxygen species (ROS),neutrophil infiltration and the histological changes.Results During HS onset,no significant differences were observed in Tr,HR,SBP and heat exposure time between HS group and HS-NAC group (P＞0.05).However,the survival time was significantly longer in HS-NAC group than in HS group (P=0.039).12 hours after HS onset,the concentrations of ROS and MDA in the liver homogenates were significantly higher in HS group than in the other groups (P=0.000),while the concentrations of T-SOD and GSH were much lower than in the other groups (P=0.000).The serum concentrations of ALT and TBIL were significantly higher in HS group than in the other groups (P=0.000).Compare with HS group,the pathological injury was alleviated in HS-NAC group (P=0.000).The neutrophil infiltration level and the concentrations of IL-6,IL-1 β and TNF-α in liver tissue were significantly higher in HS group than in HS-NAC group (P=0.000).Conclusion Oxidative stress may play an important role in the pathogenesis of HS liver injury through its cytotoxic effect and by inducing inflammatory responses.