Objective To explore the difference between pressure-regulated volume controlled ventilation (PRVCV) and volume controlled ventilation (VCV) during videothoracoscopic bhb excision.Methods Consecutive 20 patients scheduled to undergo videothoracoscopic bleb excision were enrolled into the study.After induction, endotracheal blocker was advanced into endotracheal tube to establish one-lung ventilation,each patient was randomly assigned to receive successively PRVCV and VCV for 20 minutes.Ventilatory variables were kept constantly(tide volume 6 ml/kg, respiratory rate 15 breaths/min and I: E ratio 1: 2).Heart rate,blood pressure,peak airway pressure and blood gas parameters were compared.Results Peak airway pressure was significantly lower with PRVCV than that with VCV [(12.7±3.6 ) cmH_2O(1 cm H_2O =0.098 kPa) vs (18.2±4.3) cm H_2O,P < 0.01].However,there was no significant difference in arterial oxygen tension,arterlal partial pressure of carbon dioxide,heart rate and blood pressure between PRVCV and VCV.Conclusion During one-lung ventilation in videothoracoscopic bleb excision, PRVCV offers lower peak inspiratory airway pressures while maintaining equal oxygenation compared with VCV.

Objective To study the effect of endotracheal tube's resistance on the respiratory systolic variation test(RSVT).Methods The RSVT,a test to predict fluid responsiveness was performed in 20 patients.The test consisted of the delivery of three congecutive pressure-controlled breaths with incremental peak inspiratory pressures of 10,20 and 30 cm H2O(1 cm H2O=0.098 kPa).The minimal values of the systolic arterial pressure following each of these three breaths were measured and plotted against their respective airway pressures,producing the RSVT slope.RSVT slope were compared between normal airway resistance and increased resistance circumstances,and the latter was simulated by advancing a Cooperdech bronchial blocker into endotracheal tube.Results Under normal resistance,RSVT slope was(0.39±0.21) volumes were(461.5±95.9),(891.5±149.8)and(1207.5±159.1)ml,when peak inspiratory pressures of 10,20 and 30 cm H2O were dehvered.When bronchial blocker was advanced into endotrecheal tube, (0.27±0.17)mm Hg,cm H2O significantly(P<0.01),and tidal volumes decreased to(434.5±92.8), (796.5±96.6)and(1097.5±68.4)ml(P<0.05 or<0.01).Conclusion Changes in endotraeheal tube's resistance can distort the RSVT slope.

ve To assess the protective effect of L-arginine on vascular endothelial cell during cardiopulmonary bypass(CPB). Methods 12 adult healthy mongrel dogs of either sex weighing 10-15kg, were divided into L-arginine group (group L, n=6) and control group (group C, n=6) . Femoral artery and vein were cannulated for monitoring of MAP and CVP. Right internal jugular vein was cannulated with Swan-Ganz catheter for hemodynamic monitoring. L-arginine 100 mg?kg-1 was administered intravenously before CPB followed by continuous intravenous infusion at 10mg?kg-1.min-1 to the end of CPB in group L. Control group was treated as group L except the administration of L-arginine. Venous blood samples were taken before CPB, 5min after CPB was started, 15, 45min after aortic cross-clamping and 15, 30min after release of aortic cross-clamp for determination of the plasma levels of metabolites of nitric oxide (NO2- and NO3-), malondialdehyde (MDA) and von Willebrand Factor(vWF). Hemodynamic parameters were measured before CPB, 15 and 30min after release of aortic clamp. Specimens of tissue from femoral artery and descending aorta were taken for microscopic examination at 15,45 min after aortic cross-clamping and 30min after release of aortic cross-clamp.Results There was little difference in plasma NO2- and NO3-concentrations before CPB between the two groups. NO2- and NO3- levels increased significantly after CPB in both groups but were significantly higher in group L than those in group C (P

Objective:To study the technical operation of self-developed investment (FUS-invest) for titanium crown and bridge. Methods:Orthogonal design was done. Four factors were taken into account, i.e. water/powder ratio, adhesive/hardener ratio, fine powder proportion in refractory and agitation time. And each factor was ranked into three levels. Slurry fluidity, initial setting time and setting time of every experiment group were studied. Grain size graduation of the best group was measured.Results:Fluidity, initial setting time and setting time were most greatly affected by water/powder ratio and secondly by fine powder proportion in refractory. When water/powder ratio was 7.5∶1 and the content of fine powder was 35%, slurry fluidity was better and initial setting time and setting time were appropriate. When the content of fine powder of AFS fineness number 300 was 31.31%, fineness number 100 was (40.09%), fineness number 70 was 18.05% and adhesive/hardness ratio was 200∶1, the perfect titanium castings could be fabricated. Conclution:The best rules of technical operation for perfect titanium castings are water/powder ratio (7.5)∶1, the content of fine powder 35% and adhesive/hardener ratio 200∶1.

Objective To discuss the spiral CT features of lymph node metastasis in advanced gastric cancer, and to investigate the correlation between spiral CT features and pathologic results. Methods Spiral CT scan and triphasic enhancement spiral CT scan were performed in 59 patients with advanced gastric cancer before operation. Results ①The pathologic metastatic rate of lymph node in gastric cancer was high when the lymph nodes were nubby-mixed, prominently enhanced, unsymmetrical enhanced and ≥9 mm in diameter on spiral CT (P<0.05). ②The detection rate of lymph node metastasis with spiral CT was high when carcinoma tissues were poorly differentiated, Borrmann Ⅲ+Ⅳ, T3-4 staging and TNM Ⅲ+Ⅳ staging. Conclusion The spiral CT features of lymph node (distributing type, size, enhanced degree, enhanced mode and staging) can reflect the pathologic characteristics of lymph node metastasis in gastric carcinoma. Pathologic characteristic of gastric tumor determines the detection rate of lymph node metastasis on spiral CT. The accuracy of CT to diagnose lymph nodes metastasis will be improved by integrating the spiral CT features of both gastric tumor and lymph node.

BACKGROUND:Silk fibroin/mesoporous glass ceramic composites have been reported to exert satisfactory repair outcomes in bone defects and hold good biocompatibility. However, the biosafety and preparation methods are rarely reported. OBJECTIVE:To investigate the preparation method and treatment outcomes of silk fibroin/mesoporous bioactive glass ceramic in skul repair. METHODS:Thirty-two Sprague-Dawley rats were enrol ed to establish the skul defect models and were thenrandomized into two groups:fibroin/mesoporous glass ceramic materials and silk fibroin were respectively implanted into the defect region in experimental and control groups. At 4 and 8 weeks after implantation, the CT examination and histological observation were performed. RESULTS AND CONCLUSION:CT examination showed that at 4 weeks after implantation, the defect area in the experimental group diminished in size, showing more dense new bones. The defect area of the control group was reduced, and a smal amount of new bones were observed. At 8 weeks after implantation, bone defect repair was completed in the experimental group, but not in the control group. The bone volume in the experimental group was significantly larger than that in the control group at different time points after implantation (P<0.05). Hematoxylin-eosin staining found that at 4 weeks after implantation, in the experimental group, there was new bone between the implant and the bone, which did not cause inflammation;there were few new bones and fibrous tissues in the control group. At 8 weeks after implantation, many new bones formed in the experimental group, with similar morphology to the host bone and the scaffold was degraded completely. Conversely, the implant material stil existed in the control group. In conclusion, the silk fibroin/mesoporous glass ceramic composite can promote bone repair.

ObjectiveTo study the effect of low molecular weight heparin sodium (LMWHS) therapy for exertional heat stroke (EHS) patients with pre-disseminated intravascular coagulation (pre-DIC).Methods A prospective randomized controlled trial (RCT) was conducted. Thirty-six patients with EHS with pre-DIC admitted to Department of Critical Care Medicine of 180th Hospital of Chinese PLA from April 2012 to November 2014 were divided into heparin sodium group (n = 20) and LMWHS group (n = 16) in accordance with the random number table. All patients received bundle treatment after being admitted to the hospital, including rapid cooling, fluid resuscitation, organ support (mechanical ventilation, hemopurification if necessary), supplement of pro-coagulation factors, etc. The patients in heparin sodium group were treated with continuous heparin sodium 12 500 U throughout 24 hours with intravenous pump for 5 days, and the patients in LMWHS group were given LMWHS 2 500 U subcutaneously, twice a day for 5 days.The incidence of DIC, incidence of bleeding and mortality of two groups were compared.The platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and D-dimer of each patient between pre and post treatment times were compared.Results No significant difference was found in the incidence of DIC and mortality between LMWHS group and heparin sodium group (31.2% vs. 30.0%,χ2 =0.007,P = 0.936; 6.2% vs. 5.0%,χ2 = 0.026,P = 0.871). Incidence of bleeding during treatment in LMWHS group was significantly lower than that in heparin sodium group (12.5% vs. 45.0%,χ2 = 4.425,P = 0.035). After treatment,PLT in both LMWHS group and heparin sodium group was significantly increased compared with that before treatment (×109/L: 140.5±17.5 vs. 110.5±16.5, 152.6±21.5 vs. 120.0±20.0, bothP< 0.05) and D-dimer was significantly decreased (mg/L: 0.5±0.1 vs. 3.2±1.2, 0.6±0.2 vs. 4.4±1.8, bothP< 0.05). APTT after treatment in heparin sodium group was significantly prolonged compared with that before treatment (s: 75.3±10.6 vs. 44.1±8.2,P< 0.05) while no change in APTT was found in LMWHS group (s: 38.6±5.5 vs. 42.1±8.4,P> 0.05). No significant difference was found in PT and Fib between pre and post treatment in all the patients.Conclusion When LMWHS was applied in EHS patients in pre-DIC stage, it could not only prevent DIC as efficiently as heparin sodium, but also results in lower incidence of bleeding. So LMWHS is safer.

Objective:To detect the existence of IFNGR in the stellate ganglion in female goats .Methods:The stellate ganglia were taken from female goats .The expression of IFNGR was detected by PCR method and immunohistochemical SP staining .Results:The results showed that:IFNGR immunoreactive substances were distributed in neurons , supporting cells and passing fiber , and mainly in the cytomembrane and nuclei of neurons .The relative expression of IFNGR was very significantly higher than that of non-neuronal cells (P<0.01).The sequence of IFNGR1 gene amplified by PCR method contained 376 bp, and IFNGR1 gene of goats exhibited the highest homology with sheep(98%),followed by cattle(97%).Conclusion:The results suggested that the IFNGR in the Stellate Gan-glion of female goats mainly expressed and located in sympathetic postganglionic neurons which were provided with the conditions for the role of IFN-γ, which implied that the Stellate Ganglion may act as the critical point to concert the immune regulation of IFN -γand neu-roregulation of autonomic nerve on cardiovascular system .

Objective In order to explore whether neurons in the cervicothoracic ganglion of female goat were equipped with the condition for the role of progesterone .Methods Immunohistochemical SP method was used to detect the expression of progesteron receptor ( PR) in cervicothoracic ganglion of female goats .Results The result indicated that PR-immunoreactive-products were mainly present in the cell bodies of neurons , and satellite cells , Schwann cells , neurapophysis and nerve fiber also had weaker staining .The cell membrane and cytoplasm of neurons represented brown as strong positive ,but the nucleus of neurons showed the presence of heterogeneity , 85.10% neurons ’ nucleus was strong positive,of which 31.91%nucleolus being clear vacuoles were negative;14.90%nucleus displaying vacuolization had no shaining, of which 7.45%nucleolus was strong positive .There were weak positive and flaxen PR-immunoreactive-products in satellite cells, Schwann cells, neurapophysis and nerve fiber .Image analysis shows that PR of neurons was extremely significant compared with other non-nerve cells ( P <0.01 ) . Conclusion The result proved that the sympathetic postganglionic neurons in cervicothoracic ganglion of female goat were the one of main target cells of progesterone ,suggesting that progesterone may be involving in the neuroregulation of cardiac functional activities through affectinng the activities of neurons in the cervicothoracic ganglion of female goat ,and PR in the cervicothoracic ganglion may act as a network node to coordinate endocrine regulation of progesterone and neuroregulation of autonomic nerve on the cardiac functional activities .

Objective To investigate the surgical management of Crohn's disease complicated with duodenal fistula.Methods The clinical data of 1 012 patients with Crohn's disease who were admitted to the Nanjing General Hospital of Nanjing Military Connnand from January 2002 to January 2014 were retrospectively analyzed.Of the 1 012 patients,22 were complicated with duodenal fistula,including 12 with ileocolonic anastomosis-duodenal fistula,7 with colo-duodenal fistula,2 with sigmoido-duodenal fistula and 1 with duodeno-enteric fistula.All patients received duodenal fistula repair + resection of diseased intestine.Patients were followed up via out-patient examination,phone call and email till May 2014.The condition of patients before and after enteral nutrition support was compared using the t test.Non-normal data were analyzed using the Mann-Whitney u test.Results Two patients with abdominal infection and 1 with gastrointestinal bleeding received emergent operation,and the other 19 patients received enteral nutrition support prior to operation.Three patients received emergent colostomy.Two patients had fistula at the duodenal anastomosis,and 1 patient was cured by enteral nutrition support + drainage for 12 days and the other 1 received reoperation.The energies provided by enteral nutrition and enteral + parenteral nutrition were (25.3 ± 2.1) cal/g and (28.5 ± 3.2) cal/g,respectively,and the time for nutrition support was (31 ± 5)days.The level of C-reaction protein and Crohn's disease activity index were decreased from 25 mg/L and 207 ± 111 before treatment to 2 mg/L and 117 ± 71 after treatment,with significant difference (u =53.000,t =0.942,P ＜ 0.05).The levels of body mass index,albumin and blood sedimentation rate were (17.0 ± 2.1) kg/m2,(35 ± 5) g/L and 26 mm/h before treatment,and (17.9 ± 2.8) kg/m2,(38 ± 5) g/L and 23 mm/h after treatment,with no significant differences (t =0.482,1.170,u =67.500,P ＞ 0.05).One patient was cured by enternal nutrition.Five patients received intestinal stoma and the other 13 patients received intestinal anastomosis.Twenty-two patients were followed up with the median time of 13.4 months (range,4.0-37.0 months).One patient had recurrence of ileocolonic anastomosis-duodenal fistula and received reoperation,and complications were not observed in the other 21 patients.Conclusions Selective operation is recommended for patients with Crohn's disease complicated with duodenal fistula.Enteral nutrition support is the first choice during the interoperative management.Resection of diseased intestine combined with repair of duodenal fistula after alleviation of Crohn's disease and malnutrition could achieve satisfactorv effect.