Objective To investigate the clinical effects differences of two kinds of D2 lymphadenectomy in the treatment of patients with advanced gastric cancer including open operation and laparoscopy operation.Methods 90 patients with advanced gastric cancer were chosen in recent years in our hospital and were randomly divided into both group including group A (45 patients)with D2 lymphadenectomy by open operation and group B (45 patients) with D2 lymphadenectomy by laparoscopy operation;and the clinical indicators in peri-operation period,the dissec-tion number of lymph node,survival rate in 1 year with follow-up and postoperative complication incidence of both groups were compared.Results The clinical indicators in peri-operation period of group B was significantly better than that of group A (t=2.13,2.56,1.98,1.96,1.94,2.05,2.10,all P<0.05).The N2 dissection number of lymph node of group B was significantly fewer than that of group A (t=2.15,P<0.05).The survival rate in 1 year with follow-up of group A and group B were separately 88.89%and 91.11%,there was no significant difference in survival rate in 1 year with follow-up between the two groups(χ2 =1.67,P>0.05).The postoperative complication incidence of group A and group B were separately 20.00% and 8.89%,the postoperative complication incidence of group B was significantly lower than that of group A (χ2 =9.44,P<0.05).Conclusion Compared with D2 lymph-adenectomy by open operation,D2 lymphadenectomy by laparoscopy operation in treatment of patients with advanced gastric cancer can efficiently decrease the degree of surgical trauma,accelerate the process of recovering after opera-tion,and be helpful to reduce the risk of postoperative complications.

Objective To analyze the magnetic resonance imaging(MRI) appearance and pathological changes of pig thigh of soft tissues after been shot by rifle,so as to offer a theoretical foundation for wound management in early stage of gunshot injuries.Methods Seventeen adult pigs were intravenously anesthetized and suspended in supine position,the pigs were shot in 10 meters away by domestic-made rifle of 95 type.The wound limb were undergone 1.5T MRI scans and histological observation at 2h,6h,12h,24h,48h,9day,and 18day after shot injury.Results The wounded tissues included four areas of different pathological changes:primary ballistic cavity,coagulative necrosis area,tissue disruption area and tissue distortion area.The thickness of coagulative necrosis area was about 1 to 3 millimeters,which showed double-hypointense signal phenomenon in both T2 weighted image and enhanced T1 weighted image.The tissue disruption area and part of tissue distortion area showed double-hyperintense signal phenomenon in both T2 weight image and enhanced T1 weighted image.Conclusion Penetrating gunshot wound in soft tissues of hind limb can be divided into four areas:primary ballistic cavity,coagulative necrosis area,tissue disruption area and tissue distortion area.MRI can clearly show primary ballistic cavity and coagulative necrosis area.Tissue disruption area and tissue distortion area are hyperintense signal areas on the outside of the primary ballistic cavity,which can be distinguished clearly by pathalogical observation,but tissue disruption area and part of tissue distortion area are undistinguishable by MRI.

Objective To investigate outcomes of different surgical approaches for treating cases of fracture and dislocation of the lower cervical spine.Methods The study involved 26 cases of fracture and dislocation of the lower cervical spine treated surgically from December 2002 to January 2012,including 19 males and 7 females with age ranging from 27 to 62 years (average 39 years).According to the AO classification,there were 12 cases of type B3.1,three of type B3.2,two of type C2.1,three of type C3.1,and six of type C3.2.Preoperative spinal cord function graded by Frankel criteria was six cases of grade A,five of grade B,seven of grade C,six of grade D,and two of grade E.Conventional skull traction was done for all patients before operation.Vertebral cannal decompression and interbody fusion through anterior,posterior or anterior-posterior approaches were determined according to type of fracture dislocation and severity of spinal cord injury.Radiography was performed regularly after operation to review the correction of dislocation,restoration of vertebral height,and interbody fusion.Spinal cord function was also evaluated postoperatively.Results No large blood vessel injury or aggravation of spinal cord injury occurred intraoperatively.There were no complications of incision infection,leakage of cerebrospinal fluid,herniation of bone graft or implant breakage postoperatively.All cases obtained successful correction of fracture and dislocation of the lower cervical spine as well as the recovery of cervical sequence,physiological curvature,and vertebral height in the 12 to 24 months of follow-up (average 16 months).Bony fusion was obtained for all cases at postoperative 3-6 months (average 3.5 months).Spinal function evaluated by Frankel criteria at the latest follow-up showed was grade A in six cases,grade B in three,grade C in five,grade D in five and grade E in seven,with different degree of improvement for all cases.Conclusions Operative approaches should be selected according to the specific status of fracture and dislocation of the lower cervical spine.Anterior approach can be performed for vertebral or intervertebral disc injury straightly and the procedure handles cervical instability immediately.Posterior surgical approach can be used to settle dislocation and interlocking of the articular process directly,but the intervertebral disc injury should be ruled out simultaneously in order to avoid further injury of spinal cord during the reduction process.Combined anterior and posterior surgical approach can be applied to treat fracture and dislocation of lower cervical spine and intervertebral disc injury concurrently but has high risk and large operation wound.

AIM To elucidate the possible antiarrhythmic mechanism of matrine. METHODS Whole-cell patch-clamp technique was used to record ionic currents in ventricular myocytes. RESULTS In guinea pig ventricular myocytes, matrine 100 μmol·L-1 prolonged 90% action potential duration (APD90) by 40% at a stimulation of 0.1 Hz in a frequency-independent manner, inhibited IK1 by 47% at the test potential of -120 mV, reduced IKr,tail by 50% and had no effect on IKs,tail. CONCLUSION Matrine prolonged APD through blockade of multiple potassium currents, which may relate to its antiarrhythmic efficacy.

Objective To investigate whether sulfonylurea ( SU) increases the risk of stroke in patients with type 2 diabetes mellitus(T2DM). Methods A systemic meta-analysis including 17 random control trails(RCT) was performed to compare the risk of stroke between type 2 diabetic patients treated with SUs and comparators. Results 1 612 articles were retrieved, and finally 17 articles were included. Patients receiving SUs treatment had a higher relative risk of stroke (RR 1. 35, 95% CI 1. 13-1. 60) than those who received comparators. The I2 statistic for heterogeneity between 17 trails was 0. 0%(P=0. 687). No major asymmetry appeared in the funnel plot and Begg′adjusted rank correlation test(kendall′s score=22, P=0. 387). Conclusion The use of SUs may raise the risk of stroke which is already high in patients with T2DM.

Aim To investigate the effects of cholecys-tokinin octapeptide(CCK-8)on the withdrawal symp-toms of morphinistic rats by the observation of praxiology,and change of expression of proto-oncogene c-jun in caudate nucleus(Cd) after CCK-8 injected by immunohistochemistry.Methods Animal praxiology evaluation and immunohistochemistry were used.The influence of CCK-8(10 mg?L-1,1 ?l) on the withdrawal symptoms and the expression of c-jun of morphinistic rats was observed.Results Morphinistic rats had obvious praxiological changes in the withdrawal symptoms compared with normal saline rats;the scores of withdrawal symptoms decreased most obviously at withdrawal 40 h after Cd injection of CCK-8;the expression of c-jun protein in Cd decreased in morphinistic rats,but increased after Cd injection of CCK-8.Conclusions Models of morphinomania rats were successfully built.The Cd injection of CCK-8 could decrease the withdrawal symptoms of morphinomania rats.The CCK-8 could increase the expression of c-jun protein in Cd.These findings suggested that CCK-8 could regulate the production of withdrawal symptoms and the expression of c-jun protein in Cd of morphinomania rats.

Objective To investigate the methods and effects of different flaps for repair of high energy injury-induced soft tissue wound of the heel.Methods From January 2002 to June 2012,the patients including 12 males and 9 females aged 18-57 years (mean,32 years) underwent heel soft tissue defect reconstruction.Causes of injury were traffic injury in 11 case and mechanical injury in 10 cases.Dimension of soft tissue defect ranged from 5 cm × 3 cm to 8 cm × 6 cm.Soft-tissue defect was repaired with sural neurovascular flaps at the posterolateral heel in 9 cases (Group A),with posterior tibial artery flaps at the posterolateral heel in 5 cases (Group B),and with medial plantar flaps at the loading area of heel in 7 cases (Group C).Sensory recovery and two point discrimination motion of the ankle joint were observed and compared among groups 12 month after operation.Heel pain was observed during weight bearing and joint activity was evaluated using the visual analogue scale (VAS).Results All the flaps survived,except for one with epidermal necrosis over the distal part,which healed after partial changing medication.Duration of follow-up was 12-24 months.There were no differences in the appearance,texture and contour between the flaps and recipient sites.Flaps showed no ulcer in the weight-bearing area and recovered their protective sense.Patients could walk normally after surgery.At postoperative 1 year,sensory recovery rate of the flaps in Groups A,B and C was 0,20％ and 100％ respectively (P ＜0.01).Appearance of the heel in all groups recovered to almost normal.Cases that could start nil weight-bearing exercise without pain accounted for 8 (89％) in Group A,4 (80％) in Group B,and 6 (86％) in Group C (P ＞ 0.05).While heel pain existed in weight-bearing exercise.Difference in VAS was significant among the three groups (P ＜ 0.05),but ankle range of motion was not (P ＞0.05).Conclusion Medial plantar flaps are suitable for tissue defect of 5-8 cm in length but sural neurovascular flaps and posterior tibial artery flaps should be considered for over 8 cm defect in order to elevate survival rate of the flaps and reconstruct limb function.

Objective To evaluate the effects of dexmedetomidine pretreatment on extracellular sig?nal?regulated kinase ( ERK) pathway during acute lung injury in a rat model of liver transplantation. Meth?ods Sixty male Sprague?Dawley rats, weighing 235-250 g, were divided into 4 groups ( n=15 each) u?sing a random number table: sham operation group (group S), liver transplantation group (group LT), low?dose dexmedetomidine pretreatment group ( group LD ) and high?dose dexmedetomidine pretreatment group ( group HD) . In LT, LD and HD groups, the model of orthotopic liver transplantation was estab?lished, and the operation time was about 4 h. Dexmedetomidine 2?5 and 5?0μg·kg-1 ·h-1 were intrave?nously infused for 1 h starting from 1 h prior to clipping the hepatic artery and portal vein in LD and HD groups, respectively. The rats were sacrificed after the end of operation, and the lungs were removed for determination of wet to dry weight ratio ( W∕D ratio) , cell apoptosis and expression of ERK mRNA, ERK, phosphorylated ERK ( p?ERK) , Bcl?2 and Bax in lung tissues and for examination of the pathological chan?ges ( with light microscope) and ultrastructure of lung tissues ( with transmission electron microscope) . The
injured alveolus rate ( IAR) , apoptosis index ( AI) and ratio of Bcl?2 to Bax expression ( Bcl?2∕Bax ratio) were calculated. Results Compared to group S, the W∕D ratio, IAR, AI, expression of ERK?1 mRNA, ERK?2 mRNA, p?ERK, Bcl?2 and Bax and Bcl?2∕Bax ratio were significantly increased in LT, LD and HD groups ( P<0?05) . Compared to group LT, the W∕D ratio, IAR and AI were significantly decreased, the expression of ERK?1 mRNA, ERK?2 mRNA, p?ERK and Bcl?2 and Bcl?2∕Bax ratio were significantly increased, and the expression of Bax was significantly down?regulated in LD and HD groups (P<0?05). Compared to group LD, the W∕D ratio, IAR and AI were significantly decreased, the expression of ERK?1 mRNA, ERK?2 mRNA, p?ERK and Bcl?2 and Bcl?2∕Bax ratio were significantly increased, and the ex?pression of Bax was significantly down?regulated in group HD ( P<0?05) . The pathological changes of lung tissues were significantly attenuated in LD and HD groups as compared with group LT, and in group HD as compared with group LD. Conclusion The mechanism by which dexmedetomidine pretreatment mitigates cell apoptosis during acute lung injury is related to activation of ERK pathway in a rat model of liver trans?plantation.

Objective To evaluate the effect of penehyclidine hydrochloride on the damage to the non-ventilated lung in the pediatric patients undergoing one-lung ventilation (OLV).Methods One hundred and twenty pediatric patients of both sexes,aged 2-6 yr,with body mass index of 17-24 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or lⅡ and New York Heart Association class Ⅰ or Ⅱ,undergoing elective lobectomy performed via video-assisted thoracoscope,were randomly divided into 2 groups (n=60 each) using a random number table:control group (group C) and penehyclidine hydrochloride group (group P).At 10 rmin before anesthesia induction,penehyclidine hydrochloride 0.05 mg/kg was injected intravenously in group P,and the equal volume of normal saline was given in group C.At 5 min after drug intervention (T0),immediately after onset of OLV (T1),at 60 min of OLV (T2),immediately after the end of OLV (T3),at the end of surgery (T4),and at 24 h after surgery (T5),venous blood samples were collected for determination of serum tumor necrosis factor-alpha (TNF-o),interleukin-6 (IL-6) and IL-8 concentrations by enzyme-linked immunosorbent assay.The specimens of normal lung tissues around the lung lobe to be resected were obtained at T1 and T3 for determination of the injured alveolus count (with a light microscope) and cell apoptosis (using TUNEL) and for examination of the ultrastructure of epithelial cells (with a transmission electron microscope).The injured alveolus rate (IAR) and apoptosis index (AI) were calculated.Results Compared to the value at T0,the IAR and AI were significantly increased at T3,the serum TNF-α,IL-6 and IL-8 concentrations were significantly increased at T2-5 (P＜0.05),and the pathological changes were obvious in the two groups.Compared to group C,the IAR and AI were significantly decreased at T3,the serum TNF-α,IL-6 and IL-8 concentrations were significantly decreased at T2-5 (P＜0.05),and the pathological changes were significantly reduced in group P.Conclusion Penehyclidine hydrochloride can attenuate the damage to the non-ventilated lung in the pediatric patients undergoing OLV,and the mechanism is probably related to inhibition of systemic inflammatory responses and cell apoptosis in lung tissues.

Aim To observe the protective effect of quercetin on rat cardiomyocyte apoptosis induced by adriamycin and explore its possible mechanism.Methods Cultured neonatal rat cardiomyocytes were randomly divided into six groups:normal control group, adriamycin group,quercetin control group, adriamycin+quercetin(25,50,100 ?mol?L-1)groups. The activity of LDH was detected by chromatometry, the cardiomyocyte viability was measured by MTT, the ultrastructure of cardiomyocyte was observed by electron microscope, the expression of protein Bcl-2 and Bax was analyzed by immunocytochemical, and the mRNA and protein of caspase-3 were detected by RT-PCR and Western blot respectively.Results Compared with the control group, the activity of LDH was increased but the viability of cardiomyocyte was decreased; the expression of Bax and caspase-3 was up-regulated while Bcl-2 was down-regulated in ADR group.Compared with ADR group, the above changes were lightened in adriamycin+quercetin groups. But the quercetin control group, in which cultured myocardial cells only exposed to quercetin without ADR, had no obvious changes.Conclusions Quercetin significantly inhibits the apoptosis induced by ADR in the cultured myocardial cells. Its mechanism is involved in the apoptosis-related pathways, including caspase-3, Bax and Bcl-2.