An experimental study on the effect of different mechanical ventilation levels on right ventricular function in acute respiratory distress syndrome animals / 中华急诊医学杂志

Objective:To explore the relationship between respiratory mechanics and right heart function during ARDS mechanical ventilation through the establishment of Beagle dogs acute respiratory distress syndrome (ARDS) animal model and the application of different levels of mechanical ventilation, which will provide theoretical basis for right heart protective ventilation strategy of ARDS.Methods:Beagle dogs were anesthetized successfully and then pulmonary artery floating catheter, esophageal manometric catheter and femoral artery catheter were inserted. Under the pressure control mode, the driving pressure was fixed. After adjustment, PEEP gradually increased from 2 cmH 2O to 14 cmH 2O. The changes of respiratory mechanics, hemodynamics and right heart function were observed. ARDS model was established by injecting oleic acid into central vein, and mechanical ventilation with the same parameters was given after the model was established successfully. In contrast to itself, the changes of respiratory mechanics, hemodynamics and right heart function indexes of experimental dogs before and after modeling were analyzed. In the group, the indexes of different PEEP were compared by ANOVA, and then compared by Student-Newman-Keuls. The difference was statistically significant at a P value <0.05. Results:Before modeling, the peak airway pressure (P peak) and plateau pressure (P plat) increased with the increase of PEEP ( F=232.733,196.33, P<0.05). However, P trans-I, P trans-E, C stat and Vt decreased significantly ( F=4.524, 6.499, 64.803, 2.31, P<0.05). The area of change of right ventricle (FAC) became smaller ( F=3.09, P<0.05); SV first increased and then decreased ( F=3.24, P<0.05), and CVP and MPAP increased ( F=19.07,14.81, P<0.05). There was no significant difference in TAPSE, MAP, HR and SpO 2 ( P>0.05). After modeling, as PEEP increased, P peak, P plat, P ES-I and P ES-E increased significantly ( F=24.829, 41.95, 9.78, 87.86, P<0.05). Vt, P trans-I, P trans-E, C stat and Vt first increased and then decreased ( F=2.91, 4.29, 5.84, 48.890, P<0.05). TAPSE and SV first increased and then decreased ( F=6.22,6.54, P<0.05). CVP and MPAP increased ( F=5.23, 19.24, P<0.05). MAP increased first and then decreased ( F=5.02, P<0.05). SpO 2 increased ( F=2.77, P<0.05). FAC and HR had no statistical significance ( P>0.05). Conclusions:Trans pulmonary pressure and lung compliance can reflect the effectiveness of ARDS lung recruitment, and have good synergy; with the increase of PEEP, the right ventricular systolic function TAPSE is first affected, and SV compensatory increase, but with the increase of PEEP, TAPSE and SV decrease; pulmonary blood flow distribution is more important in improving alveolar oxygenation. Therefore, real-time monitoring of trans pulmonary pressure, TAPSE and intrapulmonary blood flow should be performed in ARDS treatment.

Quantitative EEG and event-related potential P300 analysis oxiracetam injection curative effect in the treatment of delayed encephalopathy after acutecarbon monoxide poisoning / 中华劳动卫生职业病杂志

Objective@#oevaluateclinical curative effect of oxiracetam injection in the treatment of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) .@*Methods@#Methods 52 patients with DEACMP were randomly divided into the observation group and the control group, 27 cases in the observation group and 25 cases in the control group. The 2 groups were adopted the treatment to improve the cerebral microcirculation and other symptomatic, the observation group on the basis of treatment for the treatment of oxiracetam Injection. Quantitative electroencephalogram (QEEG) and event-related potential P300 were used to evaluate the therapeutic effects of the 2 groups before and after treatment.@*Results@#After treatment, QEEG value and event related potential P300 in observation group were decreased with statistically significant, respectively (P<0.05) , compared with the control group after treatment, the observation group excepted the occipital lobe, left parietal lobe, left around central and other indicators, QEEG and P300 oflatent period was shortened while the bank widens with statistical significance (P<0.05) .@*Conclusion@#Olathe injection of DEACMP patients recovery have certain curative effect.

The efficacy of supine half-sitting lithotomy position in the treatment of upper ureteral calculi by surgery of ureteroscopic Holmium laser lithotripsy / 中华泌尿外科杂志

Objective To evaluate the efficacy and economic results in the treatment of upper ureteral calculi by surgery of ureteroscopic Holmium laser lithotripsy under the supine half-sitting lithotomy position.Methods To analyze the clinical data of upper ureter calculi patients who underwent ureteroscopy Holmium laser lithotripsy retrospectively.Patients in traditional lithotomy position with assistance of stone basket during the surgery were in group A.Those in traditional position surgery without stone basket were in group B.Those in supine,half-sitting,lithotomy position and without the assistance of stone basket were in group C.There were 62,31 and 75 patients in group A,B and C respectively.In group A,there were 32 males and 30 females;37 cases in left side,25 in right side,with degree of hydronephrosis of (2.9 ±0.6) cm and stone size of (1.7 ±0.4) cm.In group B,there were 18 males and 13 females;14 cases in left side,17 in right side,with degree of hydronephrosis of (2.8 ± 0.6) cm and stone size of (1.6 ±0.5) cm.In group C,there were 44 males and 31 females;36 cases in left side,39 in right side,with degree of hydronephrosis of (2.8 ± 0.7) cm and stone size of (1.7 ± 0.5) cm.There was no significant difference in aspects of age,degree of hydronephrosis and stone maximum diameter.Statistical analysis was performed regarding operation time,fee for hospitalization and stone free rate among the three groups.Results Ittook (71.8±9.6) min,(62.2±ll.4) min and (65.4±6.8) min in group A,BandC respectively,and there was significant difference among three groups.When comparing two groups respectively,the operation time in group A was more than group B and C significantly,while group B and C shared no difference.As for fees in hospitalization,they were (27.2 ± 4.0),(22.4 ± 5.0) and (22.4 ±3.8) thousand Yuan in three groups,and significant difference was found.By comparing two groups,we found that the fees in group A were more than group B and C significantly,while group B and C had no difference.Finally,stone free rate was compared among three groups,they were 90.3％,64.5％,96％ respectively,and there was significant difference as well.By further study,we found that stone free rate in group C was the highest,followed by A and B group.Conclusions There were higher stone free rates,less operation time and expense to perform ureteroscopic Holmium laser lithotripsy in supine half-sitting lithotomy position.

Effect observation of a novel pressure controlled water jet in transurethral resection of bladder tumor / 肿瘤研究与临床

Objective To observe the effect of a novel pressure controlled water jet used in transurethral resection of bladder tumor. Methods Clinical data of 12 patients who underwent a transurethral resection of bladder tumor by using a novel water jet was retrospectively analyzed. Results All 12 cases were successfully operated. Estimated blood loss during operation was less than 5 ml. Operation time was 20-45 minutes (median was 28 min), time of water injection was 8-15 minutes (median was 12 min). There were no significant complications. All patients were followed up for 4-10 months, and tumor recurrence or progression was not found by cystoscopic examination. Conclusion Transurethral resection of bladder tumor by using a novel pressure controlled water jet is advantageous with favorable safety and feasibility.

Left Ventricular Systolic Function in Patients with Chronic Renal Insufficiency Using Three-dimensional Speckle Tracking Imaging / 中国医学影像学杂志

Purpose To evaluate changes of left ventricular systolic function in patients with different-stage chronic renal insufficiency using three-dimensional speckle tracking imaging (3D-STI).Materials and Methods Twenty-six patients with mild chronic renal insufficiency (CKD2-3 group),20 patients with moderate-severe chronic renal insufficiency (CKD4-5 group),who accepted treatment in the West Coast Medical Center,Qingdao University Affiliated Hospital from June 2015 to June 2016,and 20 healthy volunteers (control group) were enrolled.Routine two-dimensional echocardiography was carried out,and the indicators were compared,including inter-ventricular septum end-diastolic thickness (IVSTd) and left ventricular posterior wall end-diastolic thickness (LVPWTd).In addition,3D-STI analysis was conducted,and the indicators were compared,including left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),three-dimensional left ventricular ejection fraction (3D-LVEF),left ventricular global longitudinal strain (GLS),global radial strain (GRS) and global circumferential strain (GCS).The efficacy of GLS,GCS and GRS in the diagnosis of left ventricular systolic dysfunction in patients with chronic renal insufficiency was compared by ROC curve analysis.Results Compared with the control group,serum creatinine and triglyceride increased (t=22.152 and 2.655),glomerular filtration rate (GFR) and hemoglobin content decreased (t=-36.527 and-19.610),IVSTd increased (t=6.035),and 3D-LVEF,GLS,GRS and GCS decreased (t=-2.958,-5.336,-9.552 and-4.384) in CKD2-3 group.Compared with the control group,systolic blood pressure,serum creatinine,total cholesterol and triglyceride increased (t=15.060,29.461,8.210 and 6.512),GFR and hemoglobin content decreased (t=-67.557 and-28.071),IVSTd increased (t=10.959),and 3D-LVEF,GLS,GRS and GCS decreased (t=-7.315,-7.460,-17.99 and-6.052) in CKD4-5 group.Compared with CKD2-3 group,systolic blood pressure,serum creatinine and total cholesterol increased (t=14.551,28.902 and 8.555),GFR and hemoglobin content decreased (t=-18.455 and-16.832),IVSTd increased (t=7.331),and 3D-LVEF,GRS,GCS and GLS decreased (t=-4.977,-3.847,-4.929 and-2.553) in CKD4-5 group.All the above differences were statistically significant (P＜0.05).ROC curve showed that determining left ventricular systolic dysfunction in patients with chronic renal insufficiency using GLS,GCS and GRS,when the cutoff value of GLS was 17.80％,the sensitivity was the highest (88.89％),and the Youden index was 0.673;however,when the cutoff value of GCS was 14.70％,the specificity was the highest (89.47％),and the Youden index was 0.561.Conclusion In patients with chronic renal insufficiency,left ventricular systolic function reduces,and with the progress of the disease,the cardiac function also gradually reduces.3D-STI can accurately assess changes of left ventricular systolic function in patients with different-stage chronic renal insufficiency.

A novel complete retroperitoneal laparoscopic nephroureterectomy via modified three ports approach / 中华泌尿外科杂志

Objective To assess the clinical efficacy of a modified complete retroperitoneal laparoscopic nephroureterectomy via 3 port approach.Methods From August 2013 to February 2016,23 patients with complete retroperitoneal laparoscopic renal and ureteral sleeve resection were treated with modified three port approach,including 15 males and 8 females.The average age was 67 years old (ranging 44-83 years old).All patients had complained about the hematuria before operation and urine exfoliated cells showed moderate to severe nuclear atypia.All patients accepted the abdominal CT and urography CTU examination,pre-operatively.All of them was diagnosed localized upper urinary tract malignant tumors based on those images,including 13 cases in the pelvis,and 10 cases in the upper segment of the ureter.No chemotherapy,radiotherapy or immunotherapy was performed before surgery.No patients have the history of severe basic disease or upper urinary procedure.The operations were performed under general anesthesia,patients take the contralateral back 30 degrees slope,low elevation head foot,waist bridge,side waist stretch.In the anterior superior iliac spine perpendicular to the line 2 cm parallel to the lower intersection of the rib border were disposed into the 12 mm trocar.Above the anterior superior iliac spine two cross finger level with the intersection of the anterior axillary node,we placed into the 10 mm trocar placement lens.Laparoscopic placement of third casing form an isosceles triangle with the first two casing.The renal fascia was incised with an ultrasonic knife from the renal dorsal side,and the renal hilum was isolated from the kidney by suction aspirator.The renal artery and vein were separated and closed by hem-o-lok.Along the psoas muscle surface to ureter,ureteral clipping by hem-o-lok but not to cut off the free distal ureteral,the lens is composed of first casing into,using ultrasonic knife to free ureter to the bladder wall segment,with 30 mm endoscopic stapler ureter and bladder wall cut off part.Operation time,blood loss and postoperative recovery were recorded in 23 cases.Results All 23 cases were successfully operated without related the operative complication.The operative duration ranged from 3.5 to 6.1 h (mean 4.8 h),the blood loss was 30-880 ml (mean 304 ml),and the postoperative stay was 8-30 d (mean 17.8 d).There are 3 cases of positive lymph node by postoperative pathological reports.Within 2 to 30 months following up,2 patients died of tumor progression in 6 months after surgery.4 patients were diagnosed with bladder cancer in 15 months,15 months,21 months,24 months after surgery,respectively.And the transurethral resection of bladder tumor was performed.Conclusion The modified complete retroperitoneal laparoscopic nephroureterectomy via three ports is safe and reliable.

Evaluation on the lesion in theleft thalamusin patients with subcortical vascular congnitive impairment us-ing 1H magnetic resonance spectroscopy and diffusion tensor imaging / 中国神经精神疾病杂志

Objective To investigate the lesionsin theleft thalamus and to explore their correlation with executive functionin patients with subcortical ischemic vascular disease(SIVD)by using 1H magnetic resonance spectroscopy (1H-MRS) and diffusion tensor imaging (DTI). Methods Fourteen patients with vascular dementia (VaD), 14 patients with vas-cular cognitive impairment without dementia(VCIND)and 14 normal controls (NC) were recruited. The quantitative analy-sis of N-acetylaspartate (NAA), Choline (Cho), myoinositol (MI) and Creatine (Cr) resonance signals in region of interests (ROI) in the left thalamus were measured. Fractional anisotropy (FA) and mean diffusivity (MD) values in the same region were examined by using DTI. The relationship were analyzedamong the MRS, DTI ratios and cognitive impairment reflect-ed in MMSE and trail making test(TMT). Results The NAA/Cr ratio showed a gradual decrease in the left thalamus of VaD andVCIND patients compared with controls(F=3.656, P=0.038). There was no significant difference in NAA/Cr ra- tiobetween VaD and VCIND patients.Compared with controls, patients with VaD and VCIND demonstrated increased MD value in the left thalamus(F=3.882, P=0.030).There was no significant difference in MD value between VaD and VCIND patients (P>0.05). There were no correlations between NAA/Cr, MI/Cr, Cho/Cr value and DTI parameters in the ROI (P>0.05). TMTb time was positively associated with Cho/Cr(r=0.520,P=0.001 ) and with MD value in the left thalamus (r=0.305, P=0.044). Conclusions Combination of 1H-MRS with DTI can provide the valuable informationon the potential lesions in the thalamus in patients with SIVD. The Cho/Cr and MD values in the leftthalamus may be correlated with ex-ecutive function.

The relationship of Aβ40 ,Aβ42 in CSF and apolipoprotein E genotype in patients with Alzheimer's disease / 中国综合临床

Objective To test amyloid beta protein(Aβ)40 and Aβ42 levels in CSF and apolipoprotein E (ApoE) genotype in patients with Alzheimer's disease(AD) and study whether or not the Aβ is related to the severity of dementia and the genotypes of ApoE.Methods 48 AD patients including 27 cases of mild type and 21 cases of serious type and 35 normal controls were selected.Aβ40 and Aβ42 in CSF and ApoE genotype were analyzed.Results Aβ40 levels were ( 12.3 ±4.6) μg/L,( 11.7 ±4.1 ) μg/L,( 12.6 ±4.9) μg/L and ( 11.0 ±3.7) μg/L(t = 1.377,0.705 and 1.385 ,all the p values were greater than 0.05) and Aβ42 levels were ( 105.3 ±25.4) ng/L,(110.7 ±21.7) ng/L,(96.9 ±23.9) ng/L and (123.5 ±29.6) ng/L(t=3.006,2.832,and 3.488,all the p values less than 0.01 ),in AD group,mild AD group,moderate to serious AD group and normal controls,respectively.Aβ40 levels were (11.9 ± 5.2) μg/L vs.(10.5 ± 3.8) μg/L in AD and controls with ApoEε4(t=0.696,P＞0.05) and (12.6 ±4.5) μg/L vs.(11.4 ±3.4) μg/L without ApoEε4(t = 1.008,P＞0.05).Aβ42 levels were (99.7 ± 23.8) ng/L vs.( 129.6 ± 31.0) ng/L in AD and controls with ApoEε4( t =1.632,P ＞ 0.05 ) and ( 110.4 ± 28.4) ng/L vs.( 129.6 ± 31.0) ng/L in those without ApoEε4 ( t = 2.110,P ＜0.05 ).Conclusions The CSF level of Aβ is abnormal in AD,and it is related to the severity of the disease and the ApoE genotypes.

Pregnantal ultrasonography on fetus' complicate congenital heart diseases / 中华超声影像学杂志

Objective To discuss the value of pregnantal ultrasonography(US) on fetus' complicate congenital heart diseases(CHD). Methods The uhrasonographic fetures of fetus complicate CHD were analyzed and compared with the pathological diagnosis. Resells Twenty fetus' complicate CHD were diagnosed by pregnantal US. Four cases with single ventricle, two eases with transposition of great arteries,two eases with double outlet right ventricle,two cases with truncus arteriosus,three cases with hypoplastic left heart syndrome, three cases with endocardial cushion defect, two cases with hypoplastic right heart syndrome,one case with tetralogy of Fallot and one case with pulmonary atresia were included. The diagnosing according rate was 100%. Conclusions Pregnantal US can fully evaluate the fetus' complicate CHD.

Level of Fasting Plasma Glucose, True Insulin, C-peptide and Amyloid Beta-protein in Patients with Alzheimer Disease / 中国康复理论与实践

@#Objective To investigate the level of insulin and amyloid beta-protein (Aβ) in patients with Alzheimer disease(AD). Methods The levels of fasting plasma glucose, true insulin, C-peptide, Aβ40 and Aβ42 in 70 healthy age-matched adults and 55 patients with AD were measured and analyzed. Results No differences were observed for the levels of fasting plasma glucose between AD groups and normal group (P>0.05). The level of the true insulin and C-peptide of the moderate/severe AD group were significantly higher than that of the normal control group(P<0.05), as well aw that of the Aβ40 (P<0.05). The level of Aβ42 of the mild AD group waw significantly higher than that of the normal control group(P<0.01). Conclusion Plasma insulin and Aβ are abnormal in AD, and they are related to severity of dementia.

Study of rat osteoblasts transfected by transforming growth factor beta 1 gene / 华中科技大学学报（医学）（英德文版）

In order to investigate the effect of TGF beta 1 gene transfer on the biological characteristics, the effects of gene transfer and supernatant of transfected osteoblasts on the proliferation and ALP activity of osteoblasts were detected by 3H-TdR and MTT. Our results showed that TGF beta 1 gene transfer had no effect on the biological characteristics and the activated supernatant of transfected osteoblasts stimulated proliferation and inhibited ALP activity of osteoblasts. TGF beta 1 gene transfer could promote the expression of TGF beta 1 and the biological characteristics of transfected osteoblasts were stable, which might be helpful for gene therapy of bone defects in vivo.

Clinical Value of 16-slice Spiral CTA for the Diagnosis of Lower Extremity Arterial Disease / 中国微创外科杂志

Objective To evaluate the clinical value of 16-slice spiral CTA for the diagnosis of lower extremity arterial disease.Methods A total of 103 patients with arterial disease at the lower extremities were submitted to 16-slice spiral CTA.A scanner with a slice thickness of 5 mm,pitch 1.15 mm,increment 1.0 mm,and overlapping 30% was used.Totally 90-100 ml of contrast agent was injected at a rate of 3 ml/s.The scanning was started with a Smartprep auto-trigger and persisted for 20-30 s.The reconstructed images were reformed by means of maximum intensity projection,volume rendering technique,and multiplanar reformation.Results The reconstructed images of the 103 cases were clearly demonstrated by CTA,which showed arteriosclerotic occlusion in 64 patients,arteriostenosis in 32,aneurysm in 4,and normal vessels in 3.Among the 103 patients,40 received surgical treatment,which confirmed the results of CTA.Conclusion Lesions in the lower extremity arteries can be well demonstrated by 16-slice spiral CTA,which can serve as a pre-surgery screening and evaluation.