Volume 91  ·   Issue 27  ·  2011

Shock is an acute and severe disease characterized by hypotension and decreased tissue perfusion. If the treatment is not timely or improper, irreversible cell damage can occur, resulting in multiple organ failure syndrome (MODS) or death. Shock can be divided into many types according to the etiology, but the principles of early rescue treatment are basically the same, mainly the treatment of primary disease, fluid resuscitation (careful in patients with heart failure) and the application of vasopressor drugs.

Objective To investigate the effects of mechanical ventilation and positive end expiratory pressure(PEEP)on central venous pressure(CVP).Methods Forty cases of respiratory failure with mechanical ventilation were enrolled.Catheter was inserted via subclavian vein in each.And then CVP was measured without mechanical ventilation and under different PEEP conditions of 0,6 and 12 cm H2O.Results Mechanical ventilation could affect the levels of CVP,Ppeak≈PS+PEEP,followed PEEP,t=3.364,P=0.006.There was significant difference was found among the three groups,F=15.293,P=0.000.And CVP increased with a rising level of PEEP.Conclusion Mechanical ventilation and PEEP affect the accuracy of CVP.

：Objective To investigatethe impact of extended focus assessed transthoracic echocardiography(eFATE)in septic shockpatients.Methods A total of 83 septic shock patients were recruited.And they were dividedinto the eFATE and routine groups.In the routine group,the patients were assesged byroutine methods.And in the eFATE group,the following parameters of central venous pressure(CVP),mean arterial pressure(MAP),cardiac index(CI),stroke volume index(SVI)andScvO2(central venous oxygen saturation)were measured routinely.The PiCCO(pulse indicatorcontinuous cardiac output)method was employed when needed.All parameters and theothers[acute physiology and chronic health evaluation II(APACHE II)& lactate]wererecorded every 6 h.At 6,24,72 h and 1 W,the fluid intake volumes were recorded.All valueswere analyzed by statistic methods.And the mortality rates of intensive care unit and Day28 were recorded.Results In the eFATE group,the 24 h targeting rate was markedly hisberthan the routine group.Yet there was no effect on the 6 h targeting rate.In the eFATEgroup,the fluid intake volumes at 6,24 h and 1 W were markedly lowered than those of thecontrol group.And the myocardial inhibition occurred earlier versus the controlgroup.There wag no difference in mortality rate between two groups.Conclusion eFATE playsan important role in the correct assessment of septic shock patients.But its prognosticimpact remains to be further defined.

Objective To review systematically the literatures regarding the effect of statins on mortality in patients with infection.Methods PUBMED,EMBASE,Web of Science and CNKI databases from 2000 to 2010 were searched.And the clinical trials on statins-related mortality in patients with infection were identified by electronic and manual searching.A systematic review of relevant data was conducted by the methods as recommended by the Cochrane Collaboration.Results Sixteen trials(11 retrospective and 5 prospective cohort studies)involving 8775 cases in statins group and 46 539 in control group were included for analysis.The mortalities of infection were 5.2%(458/8775)and 18.6%(8637/46 539)in statins and control groups respectively.In comparison with control group,statins could reduce the mortality in patients with infection[OR=0.51,(95%CI:0.36-0.71);P<0.000 01].Prospective cohort studies observed 6774 patients with infection whose survival were improved by statins[OR=0.48,(95%CI:0.24-0.94);P=0.03].It was consistent with the results of retrospective cohort studies[OR=0.66,(95%CI:0.58-0.75);P=0.002]and large sample studies[OR=0.56,(95%CI:0.50-0.63);P=0.02].Statins lowered the short-term mortality[OR:0.47,(95%CI:0.29-0.78);P=0.004],but failed to improve the outcomes of severe septic patients in Intensive Care Unit(ICU)[OR=0.69,(95%CI:0.32-1.48);P=0.34].Conclusion Statins have favorable effects on the patients with infection,but there is no effect for severe septic patients in ICU.Further randomized controlled trials of a large sample size are warranted.

Objective To review the experience of diagnosis and surgical treatment of the primary mediastinal hemangioma and lymphangioma.Methods We summarized the medical records of patients with primary mediastinal hemangioma or lymphangioma at our hospital from January 1998 to January 2009,then extracted relevant clinical data and carried out the retrospective analysis.Results There were 11 patients in the whole group.The age range was 4-78 years old(average:38.9).Six patients were symptom-free and most patients had not an accurate preoperative diagnosis.All patients underwent surgical procedures.The radical excision wag accomplished in 10 cases and incomplete excision in 1 case.Two cases of surgically related complications were observed.All the cases were diagnosed by postoperative histopathological examination.There were hemangioma(n=5),lymphangioma(n=3)and hematolymphangioma(n=3).Conclusions The operation should be performed once the diagnosis of hemangioma or lymphangioma is made.Radical excision should be performed to prevent a post-operative recurrence.

Objective To explore the clinical feasibility of thoracoabdominal incision for thoracic esophageal carcinoma by rotation position.Methods From January 2004 to December 2007,126 patients with thoracic esophageal carcinoma performed operation by rotation position.There were 75 males and 51 females aged 46 to 78 years.Tumor Was located mid-esophagus in 74 patients,whereas sub-esophagus was present in 52 patients.All patients underwent esophagectomy by rotation position(thoracoabdominal incision).Thoracic and abdominal cavity were exposed well.Results All operations were completed successful.Anastomotic stoma was located right thorax.The mean number of tow-field lymph node dissection was 25.6.There was no mortality.Postoperative complication include pulmonary complication,incision infection,recurrent laryneal nerve damage,arrhythmia.The operation time was significantly shortened by rotation position.The number of lymph node dissection was significantly increased.Conclusion The results of this study demonstrated that thoracoabdominal incision for thoracic esophageal carcinoma by rotation position exposes the operation fields clearly and make radical lymphadenectumy thoroughly.Disease-free survival is significantly improved.

Objective To determine the effects of heart rate frequency(HRF)and heart rate variability(HRV)on radiation exposure and image quality in a large cohort of patients undergoing DSCT (dual-source computed tomograph)coronary angiography with three different electrocardiogram(ECG)pulsing models,to prospectively investigate CT image quality parameters by using different protocols and to calculate the radiation dose estimates for noninvasive coronary angiography performed by DSCT.Methods Over a 1-month period,253 consecutive patients were recruited and categorized into 3 groups:Group A:low HRF (≤75 beats/min)with normal-minor heart rate variability(HRV)(mean interbeat difference(IBD),0-3),coronary CT angiography proceeding with prospective ECG-triggered flash spiral scan;Group B:intermediate-hish HRF(>75 beats/min)with normal-minor HRV(IBD,0-4),with prospective ECGtriggered sequence scan;Group C:intermediate-high HRF(>75 beats/min)with moderate-severe HRV (IBD≥5)with retrospective ECG-gated spiral scan.Results CT coronary angiography yielded excellent image quality in 87.7%of patients(222/253).No significant differences were found among three groups with different HRF and HRV in image quality and diagnostic performance.Radiation exposure was significantly higher in patients with low versus high HRF and in patients with severe versus normal HRV.Significant difference(P<0.001)was found among the effective doses of group A(mean±standard deviation,0.602±0.363 mSv),group B(1.253±0.804 mSv)and group C(9.039±5.657 mSv).Conclusion The higher temporal resolution of dual-source spiral CT coronary angiography performed with adaptive ECG pulsing results in preserved diagnostic image quality and performance independent of HRF or HRV at the cost of limited dose reduction in arrhythmic patients.

Objective To investigate the effect and safety of sequential therapy of levofloxacin in the Drevention of peri-operative infections among patients undergoing laparoscopic hysterectomy(LH),laparoscopic assisted vaginal hysterectomy(LAVH)and transvaginal hysterectomy(TVH).Methods During 2009-2010,a total of 50 patients with the indications for LH,LAVH or TVH at our hospital were recruited.Their age range was 18-65 years old.In fair general conditions,they had no severe infection of female reproductive system.Levofloxacin 500 mg was administered by an intravenous injection once daily and then orallv once dailv.Results The average duration of intravenous injection of levofloxacin was 4.3 days while and the duration of its oral administration 4.5 days.No infection was seen in 48 patients with an efficient nrevention rate of 96.0%.Only l patient showed mild gastroenterological reactions.The side reaction rate was 2.0%.Conclusion The sequential therapy of levofloxacin is both effective and safe in the preyention of peri-operative infections among patients undergoing LH,LAVH and TVH.

Objective To explore the value of bronchoalveolar lavage as an emergency treatment for systemic lupus erythematosus(SLE)patients with concurrent diffuse alveolar hemorrhage(DAH).Methods A total of 21 SLE plus DAH patients were divided randomly into 2 groups.The patients in Group A received methylprednisolone 1000 mg/d for 3 days while those in Group B methylprednisolone 1000 mg/d for 3 days in combination with a bronchoalveolar lavage.Partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SaO2)and Borg scale(BS)for quantitative evaluation of dyspnea were recorded before and after treatment.Results Except for PaCO2,all other parameters of blood gas analysis in all patients in Group A(P>0.05)were better after treatment than before(all P<0.05).After treatment,PaO2 and SaO2 in Group B were higher than those in Group A(all P<0.05),but PaCO2 was not markedly changed(P>0.05).BS decreased significantly in both groups(both P<0.01).And more decrease was observed in Group B as compared with Group A after treatment(P<0.05).Conclusion Bronchoalveolar lavage plus a high-dose implosive therapy of methylprednisolone may alleviate hyoxemia and dyspnia in acute period of SLE complicated with DAH.

Objective To study the utility of neuroendoscope-assisted surgery in the treatment of spinal dural arteriovenous fistulas.Methods From November 2008 to November 2010,8 cages of spinal dural arteriovenous fistulas underwent neuroendoscope-assisted surgical treatment by a hemilaminectomy approach.Retrospective analyses were performed for their clinical manifestations,imaging findings,surgical approaches,postoperative recovery and follow-up profiles.Results All were of single fisula.Under the assistance of neuroendoscope,the fistulas were found intra-operatively and the draining veins disconnected successfully.The results of post-operative angiography showed the disappearance of all draining veins.After a follow-up period of 3-35 months,2 cases became asymptomatic,5 cases improved obviously and 1 case had no change.Conclusion Neuroendoscope-assisted surgery is mini-invasive,safe and effective in the treatment of spinal dural arteriovenous fistulas.

Objective To observe the influences upon the degree of diaphragmatic excursion during deep cervical plexus block at the third cervical vertebra(C3)and compare the safety and anesthetic effect of modified cervical plexus block by ultrasonic guidance and blocking of cervical plexus at one point.Methods Part I:30 patients of ASA(American society of anesthesiologists)I-II scheduled for thyroid surgery wero selected for bilateral cervical plexus block at C3 and bilateral skin nerve branches via ultrasonic guidance.Diaphragmatic excursion was recorded.Part II:80 patients of ASA I-II scheduled for thyroid surgery were randomly divided into 2 groups:experimental group(Group U)and control group(Group C).In Group U.modified cervical plexus block was used to fix both sides of C3 and skin nenre branches.The anesthetic mixture with 2% lidocaine and 0.75%ropivacaine was injected.And anesthetic effects and complications were detected.In control group,traditional one-point method for blocking cervical plexus was employed.Results High-frequency Doppler sonography could clearly visualize important neck structures and precisely guide the injection of mixture to the transverse process of C3.Diaphragmatic excursion decreased significantly at 15 and 30 min pest-blocking(P<0.05).And no paralysis of diaphragmatic muscle occurred.Hoverer 3 cases had partial diaphragmatic paralysis.Both blood pressure and heart rate increased significantly post-blocking in both groups(P<0.05 or 0.01).In comparison with Group C,the range of blood pressure Was notably lower at 10 and 20 min in Group U.And heart rate was notably lower at 5,10,20 and 30 min(P<0.05 or 0.01).Furthermore the onset time of skin nerve branches was significantly shorter in Group U(P<0.01).And the anesthetic effect score was better than that in Group C(P<0.01).The incidence of complications,such as hoarseness,was significantly lower in Group U(12 cases in Group C but none in Group U,P<0.01)and Horner's syndrome(2 cases in Group C).The number of cases requiring hypotensor and heart rate control drug was significantly smaller in Group U than that in Group C (P<0.01).Conclusion The improving effect of ultrasound-guided cervical plexus block upon the degree of diaphragmatic movement is within the compensatory range of body.In comparison with the traditional onepoint blocking of cervical plexus,the modified cervical plexus block with ultrasonic guidance offers better anesthetic effects,fewer complications and convenient anesthetic localization.Thus it may be clinically applicable.

Objective Comparing the characteristics of cognitive impairment of patients with single subcortical lesion stroke of four different areas,we are to explore the cognitive function of the thalamus and basal ganglia and this is help for early identification of vascular cognitive impairment(VCI).Methods 63 patients with single subcortical lesion stroke(including 14 left thalamic stoke group,17 left basal ganglia stroke group,15 right thalamic stroke group,17 right basal ganglia stroke group)and 34 healthy subjects participated in the current study,whose age,sex and education were matched.A comprehensive neuropsychological battery was used for evaluation.Results Compared to the normal control group,there was an overall decline of cognitive functions in patients with single subcortical lesion stroke in memory,attention/executive function,language,and visuospatial ability(P<0.05).The scores of the left thalamic stroke group were worse than the other three stroke groups in language(BNT16.6±2.6),auditory verbal learning test-immediate recall(12.8±4.4),auditory verbal learning test-delayed recall(2.4±2.3),listening recognition(19.1±3.1),structure delayed recall(9.1±4.7)and symbol digit modalities testrecall(0.9±1.1)(P<0.05).However,the left basal ganglia stroke group did better in tests manipulated by the right hand[including Trial making test(part A)score(75±22),Trail making test(part B)score (204±81),Clock drawing test(23.5±4.6),Symbol digit modalities test(24±9)]than other three stroke group,as good as the normal group(P<0.05).Conclusions Single subcoaical stroke patients may have general,non-selective cognitive impairment.But,different stroke areas have their own characteristics.The scores of the left thalamic stroke group were worse than the other three stroke groups.

Objective To explore the age-related changes of blood supply and extracellular space volume in normal adult inferior rectus muscle,evaluate the microcirculation in extraocular muscle and offer important information for the diagnosis and treatment of extraocular muscle disorders.Methods A total of 250 patients undergoing nose-sinus dynamic contrast-enhanced magnetic resonance imaging were studied.Five groups were divided according to age(20-30 yr old,30-40 yr old,40-50 yr old,50-60 yr old and over 60 yr old).The technique of 3DFSPGR(3-dimensional fast spoiled gradient-recalled)was used in dynamic contrast-enhanced imaging scanning 4 minutes and 59 seconds and acquiring 12 phases.Time-intensity curves of orbital layer,global layer of inferior rectus muscle and temporal muscle ipsilaterally were drawn on post-process work station.From the curves,the values of SIpre,SImax and Slphase12 were obtained and then SIpeak(peak signal intensity),Tpeak(time of peak enhancement)and WR(washout ratio)computed.The data were analyzed statistically.Results SIpeak of orbital layer in all groups was as foaows:404.7±12.7,395.1 ±15.9,367.3±5.1,307.0±12.4 and 265.3±6.2respectively.Tpeak:(85.2±1.0)s,(93.2±8.1)s,(106.8±4.6),(122.8±8.6)s and(133.0±0.8)s respectively.WR:(9.25±0.50)%,(8.25±0.50)%,(7.50±0.58)%,(4.75±1.26)%and (3.50±1.73)%respectively.SIpeak of global layer in all groups was as follows:261.9±2.1,256.6±1.1,243.8±3.3,225.4±4.9 and 219.8±5.3 respectively.Tpeak:(157.8±1.7)s,(166.5±4.5)s,(173.2±7.2)s,(192.8±9.1)s and(200.5±2.4)s respectively.WR:(7.25±0.50)%,(6.27±0.00)%.(4.50±0.58)%,(3.75±0.50)%and(2.25±1.50)%respectively.SIpeak,Tpeak and WR of temporal muscle in all groups showed no statistical significance(P>0.05).Tpeak increased while SIpeak and WR decreased with age.Furthermore the changes of Tpeak of orbital layer were more sensitive.Conclusion Dynamic contrast-enhanced magnetic resonance imaging can non-invasively reflect the age-related changes of blood supply and extracellular space volume in normal aduh inferior rectus muscle so as to offer important information for the diagnosis and treatment of extraocular muscle disorders.

Objective To evaluate the value of peritoneoscopy via natural orifice transluminal endoscopic surgery(NOTES)in the diagnosis of patients with peritoneal carcinomatosis.Methods A total of 32 patients with peritoneal carcinomatosis were diagnosed by histological examination of biopsies at our hospital from April 2007 to October 2010.Their data of clinical manifestations,gastroscopy,colonoscopy,abdominal ultrasonography,abdominal computed tomography,magnetic resonance imaging,ascitic cytology and transgastric peritoneoscopy via NOTES were analyzed retrospectively.Results Among them,gastrointestinal cancers were diagnosed by digestive endoscopy in 9 cases(28.1%).And ovarian lesions in 8 cases(25.0%),pancreatic cancer in 2 cases(6.3%),primary liver cancer in 2 cases(6.3%)and bile duct carcinoma in 1 case(3.1%)were suspected according to imaging examinations.No peritoneal carcinomatosis was found by digestive endoscopy or imaging examinations.Ascitic cytology was positive in 6 cases(18.8%).Peritoneal carcinomatosis was diagnosed by transgastric peritoneoscopy via NOTES with histological examination of biopsies in all patients.Their findings of transgastric peritoneoscopy via NOTES were divided into 5 types,i.e.,mass type(n=3,9.4%),nodular type(n=5,15.6%),ulcerative type (n=1,3.1%),omentum-embracing type(n=1,3.1%)and mixture type(n=22,68.8%).Conclusion Transgastric peritoneoscopy via NOTES with histological examination of biopsies has important value in the pathologic diagnosis and the endoscopic typing of peritoneal carcinomatosis.

In June 2009, three miners were trapped underground at a depth of 600 meters in the Qinglong mine disaster in Guizhou Province. They maintained their lives by drinking a small amount of mine water every day. After 25 days, they were successfully treated, which created a miracle of life. In order to explore the influence of drinking water on life activities in the state of total hunger, this study summarized the treatment situation of three miners, and carried out water quality analysis and mice drinking water experiment on mine water, which are reported as follows.

A 50-year-old male was admitted to Peking Union Medical College Hospital in November 2005 due to "repeated purpura-like rash on both lower limbs for 6 years, shortness of breath and palpitations for more than 1 month". The patient had patches of purpura-like rash on the inner thigh, waist, ankle and inner upper arm since 1999. He was diagnosed as Henoch-Schonlein purpura in June 2001? The rash was relieved after treatment with prednisone 30 mg once/d and tripterygium glycosides 10 mg 3 times/d. When the dose of prednisone was reduced to 15 mg once/d, the rash appeared again. Multiple urine protein tests were positive. In July 2005, the patient felt dizzy. The urine test routine showed that urine protein was 1.0~>3.0 g/L and a large amount of occult blood; 24-h urine protein quantitation 0.4-1.6 g; Cardiac ultrasound (UCG) showed a small amount of pericardial effusion.

amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with unclear pathogenesis, mainly involving anterior horn cells of spinal cord, motor nucleus of brainstem and pyramidal tract. 5% ~10% of ALS patients have a family history, which is called familial ALA; Since the mutation of superoxide dismutase-1 (SODl) was discovered in familial ALS patients [1-2], many studies have found that abnormally expressed SODl has toxic effects on motor neurons, mainly manifested by protein oxidation, misfolding and aggregation, resulting in motor neuronal damage. This paper reviews the research progress of SODl toxic effects in the pathogenesis of ALS.

According to the latest systematic review by Cochrane researchers, quinine will no longer be the drug of choice for the treatment of severe malaria.At present, research has proved that artesunate, an antimalarial drug derived from traditional Chinese medicine, is more effective in preventing the death of patients with severe malaria.When malaria affects the function of vital organs, it is severe malaria.Rare cerebral malaria is associated with it,which can affect the brain and cause long-term disability.More than one million people die of severe malaria,mostly in sub-Saharan Africa.In 2006, the World Health Organization (WHO) recommended artesunate as the treatment of choice for severe malaria in adults,but there was insufficient evidence for recommending changes to quinine as the standard treatment for childhood malaria at that time.

A 52-year-old female was admitted to the Affiliated Hospital of Shandong Jining Medical College on December 23, 2010 due to headache for 2 months, unsteady walking and choking and coughing after drinking water for more than 10 days. Physical examination: clear mind, good spirit, fluent speech, soft neck, no sense of resistance, centered trachea, coarse breathing sound in both lungs, no dry and wet rales, uniform heart rhythm, soft abdomen, normal muscle strength and tone of limbs, left heel-knee-skin test (+), Romberg (+).

A 63-year-old female was admitted to the hospital on October 9, 2010 with cough and sputum for 1 month as the main complaint. More than a month ago, she developed cough and sputum without obvious trigger, and the sputum volume was medium, yellow in color and without bloodstreaks. Chest CT examination showed nodules in the right upper lung, which was considered to be lung cancer. Past history: 11 years ago, she underwent left upper lobectomy for left upper lung cancer in our hospital. The postoperative pathological report was left upper lung papillary adenocarcinoma grade II. After preoperative preparation, she underwent video-assisted thoracoscopic surgery (VATS) right upper lobectomy + mediastinal lymph node dissection under general anesthesia. Intraoperative ventilation of the left lower lobe was performed, and intraoperative bleeding was 150 ml. The operation time was 4 hours.

A 79-year-old male was diagnosed with prostatic hyperplasia due to frequent urination, urgency and urine drip in September 2004. After treatment, there was no significant improvement. Later, due to chest pain and dysuria, chest CT examination showed metastatic lung cancer, and rectal ultrasound prostate biopsy showed well-differentiated adenocarcinoma. Then, after 10 months of endocrine therapy with oral imnaton + flutamide, PSA decreased from 220.8 μ g/L to 10.0 μ g/L, and it was stable for 8 months.