喉显微术麻醉中较小气管导管对气道控制和手术视野的影响

目的研究喉显微术麻醉中采用较小管径的气管导管对气道控制和手术视野的影响。方法全麻观察组56例,局麻对照组44例,观察组在快速诱导后气管插入较常规小ID值1～1.5的导管,控制呼吸14次/分,Vt12～14ml/kg,对照组则以1%的丁卡因作舌、咽喉表麻后手术。观察气道控制对手术视野的影响和可能的问题以及两组病人生命体征的变化。结果观察组手术视野暴露优者比例为87%,差为0,对照组优比例为57%,差为9%,观察组手术视野暴露明显优于对照组(P<0.05),而术中生命体征变化与术前比较对照组有显著差异(P<0.05),观察组则趋平稳。观察组术中SPO2达98.76±0.87%,PetCO2维持在38～42mmHg,无缺氧和CO2潴留问题。结论全麻下较小导管插管行喉显微术既能有效的控制呼吸道,又有利于手术视野的暴露。

氟比洛芬酯与帕瑞昔布在开胸术后镇痛效果比较及术后慢性疼痛高危因素分析

开胸手术后患者经历的疼痛是最剧烈的手术后疼痛之一,患者以对疼痛的恐惧而不敢用力呼吸及咳嗽咳痰,致使呼吸道内的分泌物无法及时排出,可阻塞细小气管,导致肺不张,肺炎,术后低氧血症等并发症的发生,不仅增加了患者的痛苦,也是致死率提高的重要原因。术后急性疼痛如未及时干预,还可导致慢性疼痛综合征的发展,术后慢性疼痛的发生率明显提高,对患者的躯体机能和活动力造成不利影响[1-2]。

昆虫之间怎样交流信息

早期的人类靠面对面交谈、面部表情、肢体动作进行交流的.昆虫不会说话,也不会写字,它们是怎样交流的呢?……

创意设计

Inkling,首款离线数位笔设计师人手一支数位笔已经不稀奇了,然而它还是无法替代用笔和纸张进行创作时的那种真实触感,大部分人仍乐于坚持用笔和纸创作。但在必要时仍不免要将图像扫描进电脑进行后期修改、传输。Wacom因此推出一款结合传统墨水笔最佳特性的离线数位笔——

Multiple metastases to the small bowel from large cell bronchial carcinomas

AIM: Metastases from lung cancer to gastrointestinal tract are not rare at postmortem studies but the development of clinically significant symptoms from the gastrointestinal metastases is very unusual. METHODS: Formalin-fixed, paraffin-embedded tissues were cut into 5 urn thick sections and routinely stained with hematoxylin and eosin. Some slides were also stained with Alcian-PAS. Antibodies used were primary antibodies to pancytokeratin, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, vimentin, smooth muscle actin and CD-117. RESULTS: We observed three patients who presented with multiple metastases from large cell bronchial carcinoma to small intestine. Two of them had abdominal symptoms (sudden onset of abdominal pain, constipation and vomiting) and in one case the tumor was incidentally found during autopsy. Microscopically, all tumors showed a same histological pattern and consisted almost exclusively of strands and sheets of poorly cohesive, polymorphic giant cells with scanty, delicate stromas. Few smaller polygonal anaplastic cells dispersed between polymorphic giant cells, were also observed. Immunohistochemistry showed positive staining of the tumor cells with cytokeratin and vimentin. Microscopically and immunohistochemically all metastases had a similar pattern to primary anaplastic carcinoma of the small intestine. CONCLUSION: In patients with small intestine tumors showing anaplastic features, especially with multiple tumors, metastases from large cell bronchial carcinoma should be first excluded, because it seems that they are more common than expected.

Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients

AIM: To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions. METHODS: In 37 post-surgical patients, a stepwise approach was performed to reach normal papilla or enteral anastomoses of the biliary tract/pancreas. When conventional endoscopy failed, DBE-based ERCP was performed and standard parameters for DBE, ERCP and interventions were recorded. RESULTS: Push-enteroscopy (overall, 16 procedures) reached enteral anastomoses only in six out of 37 post-surgical patients (16.2%). DBE achieved a high rate of luminal access to the biliary tract in 23 of the remaining 31 patients (74.1%) and to the pancreatic duct (three patients). Among all DBE-based ERCPs (86 procedures), 21/23 patients (91.3%) were successfully treated. Interventions included ostium incision or papillotomy in 6/23 (26%) and 7/23 patients (30.4%), respectively. Biliary endoprosthesis insertion and regular exchange was achieved in 17/23 (73.9%) and 7/23 patients (30.4%), respectively. Furthermore, bile duct stone extraction as well as ostium and papillary dilation were performed in 5/23 (21.7%) and 3/23 patients (13.0%), respectively. Complications during DBE-based procedures were bleeding (1.1%), perforation (2.3%) and pancreatitis (2.3%), and minor complications occurred in up to 19.1%. CONCLUSION: The appropriate use of DBE yields a high rate of luminal access to papilla or enteral anastomoses in more than two-thirds of post-surgical patients, allowing important successful endoscopic therapeutic interventions.

Lipopolysaccharide Challenge Induces Long Pentraxin 3 Expression in Mice Independently from Acute Lung Injury

Objective To determine whether the onset of acute lung injury （ALl） induces the up-regulation of pentraxin 3 （PTX3） expression in mice and whether PTX3 concentration in the biofluid can help recognizing sepsis-induced ALI. Methods Wild-type C57BL/6 mice （12-14 weeks old） were randomly divided into 3 groups. Mice in the group 1 （n=12） and group 2 （n=12） were instilled with lipopolysaccharide via intratracheal or intraperitoneal routes, respectively. Mice in the group 3 （n=8） were taken as blank controls. Pulmonary morphological and functional alterations were measured to determine the presence of experimental ALl. PTX3 expression in the lung was quantified at both protein and mRNA levels. PTX3 protein concentration in blood and bronchoalveolar lavage fluid was measured to evaluate its ability to diagnose sepsis-induced ALI by computing area under receiver operator characteristic curve （AUROCC）. Results ALl was commonly confirmed in the group 1 but never in the other groups. PTX3 expression was up-regulated indiscriminately among lipopolysaccharide-challenged mice. PTX3 protein concentration in the biofluid was unable to diagnose sepsis-induced ALl evidenced by its small AUROCC. PTX3 concentration in bronchoalveolar lavage fluid did not correlate with that in serum. Conclusions Lipopolysaccharide challenges induced PTX3 expression in mice regardless of the presence ofALI. PTX3 may act as an indicator of inflammatory response instead of organ injury per se.

EFFECT OF FK224 ON THE BRONCHOCONSTRIC TIONINDUCED BY ISOCAPNIC HYPERPNEA IN GUINEA PIGS

Objective To evaluate effect of Neurokinin receptor antagonist on the prevention from hyper-pnea-induced bronchoconstriction using a dual Neurokinin receptor antagonist FK224. Methods 12 pathogen-free Hartley guinea pigs were divided into two groups randomly-. Dimethyl sulfoxide (DMSO) control group (n =6)and FK224 group (n =6). Guinea pigs were anesthetized with pentobarbital sodium. A cervical tracheostomy wasperformed and a polyethylene tube was inserted into the trachea. After measuring baseline value of the lung resist-ance (RL) and dynamic compliance of respiratory system (Cdyn), DMSO (0.3 ml/kg) and FK224 (1mg/kg) wereadministered by injection through jugular vein respectively. A rodent respirator with dry 5% CO2-95% O2 mixture atroom temperature provided mechanical ventilation ( VT 8ml/animal, 100breaths/min) for 5min. RL and Cdyn of 2groups were measured after isocapnic hyperpnea challenge. Results In DMSO control group, isocapnic hyper-pnea of dry gas elicited a marked increase in RL and decrease in Cdyn. RL and Cdyn of FK224 group did not changesignificantly. Conclusion FK224 can inhibit the increase in RL and decrease in Cdyn caused by isocapnic hy-perpnea in guinea pigs. And antagonists of tachykinins receptors might have effect on prophylaxis and treatment inexercise-induced asthma.

Lipocalin-2 Test in Distinguishing Acute Lung Injury Cases from Septic Mice Without Acute Lung Injury

Objective To explore whether the amount of lipocalin-2 in the biofluid could reflect the onset of sepsis-induced acute lung injury(ALI) in mice. Methods Lipopolysaccharide(LPS, 10 mg/kg) injection or cecal ligation and puncture(CLP) was performed to induce severe sepsis and ALI in C57 BL/6 male mice randomly divided into 5 groups(n=10 in each group): group A(intraperitoneal LPS injection), group B(intravenous LPS injection via tail vein), group C(CLP with 25% of the cecum ligated), group D(CLP with 75% of the cecum ligated), and the control group(6 sham-operation controls plus 4 saline controls). All the mice received volume resuscitation. Measurements of pulmonary morphological and functional alterations were used to identify the presence of experimental ALI. The expressions of lipocalin-2 and interleukin(IL)-6 in serum, bronchoalveolar lavage fluid(BALF), and lung tissue were quantified at both protein and mRNA levels. The overall abilities of lipocalin-2 and IL-6 tests to diagnose sepsis-induced ALI were evaluated by generating receiver operator characteristic curves(ROC) and computing area under curve(AUC). Results In both group B and group D, most of the "main features" of experimental ALI were reproduced in mice, while group A and group C showed septic syndrome without definite evidence for the presence of ALI. Compared with septic mice without ALI(group A+group C), lipocalin-2 protein expression in septic mice with ALI(group B+group D) was significantly up-regulated in BALF(P<0.01) and in serum(P<0.01), and mRNA expression boosted in lung tissues(all P<0.05). Lipocalin-2 tests performed better than IL-6 tests in recognizing sepsis-induced ALI cases, evidenced by the larger AUC of the former(BALF tests, 0.8800 versus 0.6625; serum tests, 0.8500 versus 0.7000). Using a dual cutoff system to diagnose sepsis-induced ALI, BALF lipocalin-2 test exhibited the highest positive likelihood ratio(13.000) and the lowest negative likelihood ratio(0.077) among the tests of lipocalin-2 and IL-6 in blood and BALF. A statistically significant correlation was found between lipocalin-2 concentration in BALF and that in serum(Spearman r=0.8803,P<0.0001). Conclusions Lipocalin-2 expression is significantly up-regulated in septic ALI mice compared with those without ALI. Lipocalin-2 tests with a dual cutoff system could be an effective tool in distinguishing experimental ALI cases.

Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography

AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth Ⅱ gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing,selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96% success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96%), Billroth Ⅱ reconstruction (94%), or pancreatoduodenectomy (100%), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89%). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88 %), Billroth Ⅱ reconstruction (89%), or pancreatoduodenectomy (100%), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100%) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting knife using a guidewire. The mean total duration of the procedure was 93.6 ± 6.8 min and the mean time required to reach the papilla was 30.5 ± 3.7 min. The mean time required to reach the papilla tended to be shorter in Billroth Ⅱ reconstruction (20.9 ± 5.8 min) than that in Roux-en-Y total gastrectomy (37.1 ± 4.9 min) but there was no significant difference (P = 0.09). A major complication occurred in one patient (3.5%); perforation of the long limb in a patient with Billroth Ⅱ anastomosis.CONCLUSION: Short-type DBE combined with several technical innovations enabled us to perform ERCP in most patients with altered gastrointestinal anatomy.

“Passive-bending colonoscope”significantly improves cecal intubation in difficult cases

Colonoscopy sometimes causes pain during insertion,especially in difficult cases.Over-insufflation of air causes elongation or acute angulations of the colon,making passage of the scope difficult and causing pain.We previously reported a sedative-risk-free colonoscopy insertion technique,namely,"Water Navigation Colonoscopy".Complete air suction after water infusion not only improves the vision,but also makes water flow down to the descending colon,while the sigmoid colon collapses and shortens.While non-sedative colonoscopy can be carried out without pain in most cases,some patients do complain of pain.Most of these patients have abnormal colon morphology,and the pain is caused while negotiating the "hairpin" bends of the colon.The "hairpin" bends of the colon should be negotiated by gently pushing the full-angled colonoscope.The proximal 10-20 cm from the angulated part of the conventional colonoscope is stiff,with a wide turning radius,therefore,a conventional colonoscope cannot be negotiated through the "hairpin" bends of the colon without stretching them and causing pain.The "passive-bending colonoscope" has a flexible tip with a narrow turning radius,so that the scope can be negotiated through the "hairpin" bends of the colon with a minimum turning radius and minimal discomfort.Therefore,the intubation and pain-reducing performance of the "passive-bending colonoscope" was assessed in difficult cases.

Effect of grain boundary on electric performance of ZnO nanowire transistor with wrap-around gate

A novel grain boundary(GB) model characterized with different angles and positions in the nanowire was set up.By means of device simulator,the effects of grain boundary angle and location on the electrical performance of ZnO nanowire FET(Nanowire Field-Effect Transistor) with a wrap-around gate configuration,were explored.With the increase of the grain boundary angle,the electrical performance degrades gradually.When a grain boundary with a smaller angle,such as 5° GB,is located close to the source or drain electrode,the grain boundary is partially depleted by an electric field peak,which leads to the decrease of electron concentration and the degradation of transistor characteristics.When the 90° GB is located at the center of the nanowire,the action of the electric field is balanced out,so the electrical performance of transistor is better than that of the 90° GB located at the other positions.

TEMPORAL EXPRESSION OF NOTCH RECEPTORS DURING LUNG DEVELOPMENT IN RAT

Objective To investigate the temporal expression of Notch receptors in developing lungs of rats and to explore the regulating role of Notch in lung development. Methods We studied the expression of Notch1,2,3 isforms in embryonic days 18,20,21 and postnatal days 1,4,7,14, 21 rat lungs. Six rats of each group were used to assess lung histologic changes by HE staining and expression of Notch in lungs by immunohistochemistry. Total RNA was extracted by Trizol reagent from the frozen lung tissues. mRNA levels of Notch were measured by reverse transcription polymerase chain reaction (RT-PCR). Results It is showed that Notch_ 1-3 mainly localized in the airway surface epithelium、alveolar epithelium during the psdueoglandular stage, and reached the peaks at canalicular period. The expression patterns of Notch_ 1-3 were changed with the fetal age. Conclusion These results support multiple roles for Notch1,2,and 3 receptor activation during lung development, probably not only modulating the process of branching morphogenesis but also involved in determining the cell differentiation fate in fetal alveolar epithelium.

自主呼吸时辅助呼气能补偿气管导管阻力

背景尽管辅助吸气在插管的自主呼吸病人很常见，但辅助呼气却少见报道。在自主呼吸时有效的呼气支持（expiratorysupport，ES）可用于抵消气管导管（endotrachealtube，ETT）的阻力。在这个研究中，我们测试了一个新系统的性能，这个系统用于在自主呼吸中既提供吸气支持（inspiratorysupport，IS）又提供呼气支持以减少气管导管的有效阻力。方法这个ES系统由一个通气阀门和一个电脑控制的气缸活塞组成，用于在呼气相把气体从呼吸回路抽出。这个活塞的运动与自主呼吸同步。我们在9例健康成年男性志愿者身上，比较在自主呼吸时，5mmID和8mmID两种导管的尖端和呼吸回路内的压力。通气模式设定在维持持续气道压在0cmH2O。比较用5mmIDETT通气时3种通气设置（无支持，单纯吸气支持，吸气支持＋呼气支持）。结果我们监测了呼吸回路压力（Paw），导管尖端压力（Ptip），呼吸气流。在无呼吸支持的5mmIDETT，Ptip在吸气时呈大幅度的负偏移而呼气时呈大幅度的正偏移。单纯的IS并不改善小气管导管的呼吸模式。但是Is＋ES却能使只。在呼气呈负压吸气呈正压，使5mmIDE]rr的只，。压力特征与8mmIDETT的相似。而且Is＋ES使5mmIDETT的呼吸模式与8mmIDETT的相似。结论通过这项对健康志愿者的研究表明，IS＋ES抵消通过5mmIDETT强加的气道阻力，产生与8mmIDETT相似的Ptip改变。

一粒花生米 送掉女儿命——谈谈小儿气管异物的防治

有这样一个真实的事例:三岁的欢欢哭着要抱,妈妈心烦了,顺手把一粒花生米塞进孩子嘴里.突然,欢欢剧烈的呛咳起来,脸色憋得青紫,呼吸困难,妈妈慌了手脚,赶忙抱着欢欢上医院.

昆虫怎样交流?

大家都知道,早期的人类靠面对面交谈、面部表情、肢体动作进行交流,随着社会不断进步,我们还可以通过电话和上网进行交流。昆虫不会说话,也不会写字,更不能使用现代化设备,那么,它们是怎样交流的呢? 其实,昆虫的交流方式也是很多的,

客机上的新鲜空气从哪里来

凡搭乘过民航客机的乘客都有这样的体会,当客机在万米高空穿行时,清新的空气迎面阵阵扑来,让人感到分外舒适。一些人不禁有些疑惑：客机上的新鲜空气从何而来？混合气体一般人想不到的是,民航客机上的新鲜空气是从隐蔽在行李舱内的出气口流出来的。沿着机舱圆弧形两侧壁,分布着许多像毛细血管一般的小气管,它们纵向均匀延伸到座舱地板,与粗大的主气管相连。

萤火虫发光的秘密

在夏天的晚上,我们能看到一盏盏幽绿色的"小灯笼"——萤火虫。萤火虫为什么能发光呢?萤火虫的尾部有发光器官,这个发光器官由发光细胞、