Objective To analyze the causes of dual damage during lumbar disc surgery and to probe the prevention and treatment of cerebrospinal fluid leakage after surgery.Methods Clinical materials of 19 cases suffered from cerebrospinal fluid leakage after surgery from March 1997 to October 2001 were retrospectively analyzed.Result Eighteen out of 19 patients were cured by conservative measurements while one was reoperatived for repairing dura mater.Conclusions The rate of cerebrospinal fluid leakage can be decreased by detailed preoperative preparation and strict operation; repairing dura mater in operation and regular conservative treatment after operation can cure most of cerebrospinal fluid leakage. Few cases failing to conservative treatment need reoperation for repairing dura mater.

Objective To investigate the effect of target-controlled infusion(TCI) of propofol on global and regional eerobral glueose metabolism in humans studied with positron emission tomography(PET).Methods Five healthy right-handed male volunteers aged 22-30yrs, weighing 58-72 kg underwent PET sean to assess glucose metabolism when they were awake and unconseions. The interval between the two PET seans was longer than 1 week. The unconseious state was induced by TCI of propofol. The initial effeet-site concentration(ESC) of propofol was set at 2.5?g?ml~(-1) and was modulated in ?0.2?g?ml~(-1) increments until OAA/S score roached 1(no response to prodding). Then the ESC was maintained during PET scanning. The dynamic scans were performed at 0-4.5 min(T_1), 4.5-9.5 min(T_2), 9.5-29.5 min(T_3), 29.5-44.5 min(T_4), 44.5-59.5min(T_5) and 59.5-74.5 min(T_6) after the end of FDG 10 mci injection. After the data were reconstructed we used the stereotactic method to select the following regions of interest(ROI): the whole brain, frontal lobe, temporal lobe, parietal lobe, occipital lobe, putamen, caudate nucleus, thalamus and cerebellum ets. The ROI data were then transformed into standard uptake value(SUV). The difference and percentage decrease in SUV of the different ROI between eonscious and unconscious state at different intervals were compared. Results The SUVs of the whole brain and all ROIs were significantly decreased in unconscious state during T_(3-6) compared with those in conscious state. In unconscious state at T_6 the percentage decrease in SUV of different ROIs was different-42.38% (occipital lobe), 35.52%(frontal lobe) and 21.40%(putamen). The percentage decrease in SUV of thalamus was similar to that of occipital lobe, temporal lobe and parietal lobe but higher than that of frontal lobe. The sequence of SUVs of cortex and subcortioal centers in conscious state during T_(4-6) and in unconscious state during T_(3-5) were the same: temporal lobe

Objective To study the rate and time-course of the cerebral uptake of propofol during the intravenous continued infusion at a constant rate.Methods Fourteen adult patients were randomly assigned to receive a propofol infusion at a constant of 6 mg?kg -1?h -1(group A) or 12 mg?kg -1?h -1 (group B) for 30-35 min. Blood samples were taken simultaneously from radial artery and jugular venous bulb for measurement of propofol concentrations by high performance liquid chromatography.Results The arterial propofol concentrations(C a) increased progressively during the first 15min after the start of propofol infusion and became stable 15min later.Jugular bulb venous blood propofol concentrations(C ijbv) were increased progressively during the first 30min after the start of propofol infusion in group A and the first 20min in group B, but they were lower than C a at the corresponding interval. 30min after the start of propofol infusion in group A and 20min in group B C ijbv became stable and close to C a. There was significant difference in the accumulated area between the arterial and jugular bulb venous concentration-time curves at the different interval between the two groups before the equilibrium of cerebral uptake was achieved.Conclusions Cerebral propofol uptake is rate- and time-dependent when administered at a constant infusion rate, and there is a hysteresis between the arterial blood concentration and equilibrium of cerebral uptake. Propofol is not metabolized in human brain.

0.05), but there were significant differences in the mean induction time(697 and 313 s, P

Objective To evaluate the influence and safety of topical ketamine on postoperative sore throat following endotracheal intubation. Methods The clinical literatures concerning topical application of ketamine for the prevention of postoperative sore throat (POST) were searched from online databases. Randomized controlled trials were selected by the inclusive and exclusive criteria. Meta-analysis was conducted to assess the risk ratio(RR) of the incidence of POST and software Stata 12.0 was used in this analysis. Results Seven randomized trials involving 490 patients were included in this meta-analysis. The results of meta-analysis showed that the incidence of POST was significantly reduced in the ketamine group,with RR 0.61(95%CI 0.47~0.79,P<0.001) at 0~1 h,0.55(95%CI 0.43~0.71, P<0.001) at 4 h and 0.48 (95%CI 0.34 to 0.66, P<0.001) at 24 h after surgery. No major complications related to topical ketamine were observed. Conclusions For the patients receiving general anesthesia and endotracheal intubation, topical prophylactic application of ketamine can significantly reduce the incidence of POST without major complications.

Objective:To determine the derivative chromosome 9 by the method of detecting the ASS gene,and to explore the relationship between the deletion of derivative chromosome 9 and the efficacy and prognosis of the chronic myeloid leukemia (CML)patients. Methods:The materials of 34 CML patients with positive BCR-ABL fusion gene whose ASS genes were detected were retrospectively analyzed. All patients were treated with Extra-signal (ES)probe to detect the derivative chromosome 9.All patients were divided into two groups according to whether they carried the derivative chromosome 9.The blastic phase or the accelerated phase rates in two groups were compared by using Fisher exact probability. Results:All patients were detected by FISH (BCR-ABL ES probe),and all the BCR-ABL fusion signals were positive.6 of 34 patients were found the deletion of ASS gene, among them 1 case blonged to chronic phase,and 5 cases developed into blastic phase or accelerated phase. In the patients without ASS gene deletion,there were 22 cases in chronic phase,and 6 cases in plastic phase or accelerate phase,there was significant difference of blastic phase rate/accelated phase rate between them (P<0.05).A total of 26 patients were treated with tyrosine kinase inhibitors (TKI).5 of 26 patients belonged to the ASS gene deletion group,1 of 5 patients treated with TKI got molecular remission,4 of 5 patients developed into blastic phase or accelerated phase.21 of 26 patients belonged to the group without ASS gene deletion,and among them,19 cases got molecular remission,2 cases developed into plastic phase or accelerated phase after treatment of TKI,there was significant difference between them (P < 0.05 ). 6 patients were treated with traditional chemotherapy (hydroxyurea,interferon);1 of 6 patients belonged to the ASS gene deletion group,finally developed into the blastic phase or accelerated phase;5 of 6 patients belonged to the group without ASS gene deletion,2 cases got the hematological remission,and 3 patients developed into blastic phase or accelerated phase after treatment,and there was no significant difference of blastic phase rate/ accelerated phase rate between them (P > 0.05 ). Conclusion:The CML patients with derivative chromosome 9 (ASS gene deletion)prone to get disease progression, and have a higher proportion in the blastic phase or accelerated phase patients.Derivative chromosome 9 is related to the bad treatment efficacy of TKI and the poor prognosis of CML.

Objective To investigate whether abnormalities can be detected in normal-appearing white matter(NAWM)and normal-appearing white matter(NAGM)in patients with clinically isolated syndrome(CIS)and comparing them to the abnormalities in relapsing-remitting multiple sclerosis(RRMS)by using diffusion tensor imaging(DTI)histogram.To detect the potential relationship between DTI indices of NAWM,NAGM and patient's clinical condition.Methods Nineteen patients with CIS,19 clinically diagnosed RRMS patients and 19 sex-and age-matched healthy volunteers were included in this study.Conventional MRI and DTI images were obtained using Siemens 1.5 T Magnetom sonata scanner.DTI histograms of NAWM and NAGM were obtained after post-processing.The mean value,peak height,peak location of the histogram were used for analysis.All data was statistically processed with SPSS for Windows.Results NAWM average MD was higher and FA was lower in RRMS[MD(0.83±0.04)×10-3mm2/s,FA 0.36±0.03]when compared to CIS[MD(0.79±0.02)×10-3mm2/s,FA 0.40±0.02]and control[MD(0.78±0.02)×10-3mm2/s,FA 0.41±0.01](P＜0.01).But no statistically significant difference was found between CIS and control.The peak height of NAWM average MD histogram was significantly lower in CIS than control(P＜0.05),while the peak location of average FA histogram shifted to the left(P＜0.01).Patients with CIS[(1.08±0.06)×10-3mm2/s]showed significantly higher NAGM average MD than control[(1.03±0.05)×10-3mm2/s](P＜0.05),but,lower than RRMS[(1.18±0.12)×10-3mm2/s](P＞0.01).There were no correlation between DTI indices and EDSS scores in patients with CIS.Moderate correlation between NAGM average MD(r=0.568,P＜0.05)and EDSS scores were found in patient with RRMS.Conclusion NAWM and NAGM abnormalities do occur in CIS which can be detected by DTI.The underlying pathological changes in NAWM and NAGM in CIS may be milder than RRMS as demonstrated by DTI histogram.

Objective To investigate the effect of ulinastatin on postoperative clinical outcomes in pa-tients undergoing elective laparoscopic colectomy. Methods 454 patients underwent elective laparoscopic colecto-my from January 2015 to September 2017 were included in this retrospective study. Patients were divided into 2 groups:ulinastatin group and control group. Propensity score matching was applied to balance the preoperative baseline differences between 2 groups. 155 patients in each group were successfully matched. Mixed linear model was used to exam the effect of ulinastatin on various clinical indicators within 3 days after the surgery,including in-flammation indicators(white blood cell counts,C reactive protein),liver function indicators(alanine transami-nase,aspartate transaminase,total bilirubin),renal function indicators(serum creatinine,blood urea nitrogen). Postoperative hospital length of stay was compared between 2 groups using student's t-test. Results Ulinastatin group showed significantly reduced postoperative white blood cell count and ? reactive protein level (P = 0.036 and 0.025)compared with the control group. The average mean inhibitory effects were 1.04×109/L and 23.93 mg/L respectively,which was 11.1% and 29.9% lower than that of the control group. Procalcitonin,transaminases,total bilirubin,serum creatinine,blood urea nitrogen levels and postoperative hospital length of stay showed no signifi-cant difference between the two groups(P > 0.05). Conclusion Ulinastatin can significantly reduce the level of inflammation response after laparoscopic colectomy,which is beneficial to the fast recovery.

OBJECTIVETo investigate the effects of different doses of propofol on pulmonary metastasis of intravenous injected MADB106 tumor cells and the expression of E-cadherin and β-catenin in the metastatic tumor tissue in rats.

METHODSForty Fischer 344 male rats were randomly divided into 4 groups (n=10) for intravenous administration of normal saline, intralipid, or propofol at 30 or 50 mg/kg via the femoral vein. One hour after the infusion, MADB106 tumor cells (2×10(5)) were injected intravenously in the rats. Three weeks later, pulmonary metastasis tumor foci and metastatic inhibitory rate were observed and the expression of E-cadherin and β-catenin in the metastatic tumor tissue were detected by immunohistochemistry.

RESULTSCompared with the normal saline group, intralipid group showed no significant differences in the number of metastatic tumor foci in the lungs or E-cadherin and β-catenin expressions (P>0.05), which were all significantly lowered in the two propofol groups (P<0.05 or 0.01). The dose of propofol was inversely correlated with the number of metastasis tumor foci (r=-0.879) and expressions of E-cadherin (r=-0.755) and β-catenin (r=-0.693) (P<0.01).

CONCLUSIONPropofol can dose-dependently suppress pulmonary metastasis of intravenous injected MADB106 tumor cells by inhibiting the Wnt/β-catenin pathway and down-regulating E-cadherin and β-catenin expressions in the metastatic tumor tissue.

Animals ; Cadherins ; metabolism ; Dose-Response Relationship, Drug ; Down-Regulation ; Immunohistochemistry ; Injections, Intravenous ; Lung Neoplasms ; drug therapy ; Male ; Neoplasm Metastasis ; drug therapy ; Neoplasm Transplantation ; Propofol ; pharmacology ; Rats ; Rats, Inbred F344 ; beta Catenin ; metabolism

OBJECTIVETo investigate the expressions of gamma aminobutyric acid transporter 1 (GAT-1) and glutamate decarboxylase 65 (GAD65) mRNA in different brain regions at brain propofol uptake equilibrium in dogs.

METHODSEighteen 12- to 18-month-old healthy hybrid dogs were randomized equally into control group (group C), low dose group (group L), and high dose group (group H). In groups L and H, anesthesia was administered by intravenous injection of 5.5 and 7.0 mg/kg propofol followed by propofol infusion at a constant rate of 55 and 70 mg·kg(-1)·h(-1) for 50 min, respectively. Blood samples were taken from the internal carotid artery and jugular vein to measure plasma propofol concentrations, and the brain tissues of the hypothalamus, sub thalamus, dorsal thalamus, hippocampus, pons, parietal lobe and frontal lobe were examined for GAT-1 and GAD65 mRNA expressions using quantitative real-time PCR.

RESULTSIn groups L and H, propofol infusion at a constant rate for 50 min resulted in comparable plasma propofol concentrations between the internal carotid artery and jugular vein (P>0.05), but the concentrations differed significantly between the two groups (P<0.01). GAT-1 mRNA levels in the hypothalamus and hippocampus were significantly higher in groups L and H than in group C (P<0.05 and P<0.01), but comparable between the former two groups. The variations of GAT-1 mRNA levels between the hypothalamus and hippocampus were similar in both group L [(61.26∓7.17)% and (79.34∓39.95)%, P>0.05] and group H [(74.64∓19.63)% and (97.12∓32.31)%, P>0.05]. GAT-1 mRNA levels in other brain regions showed no significant difference among the 3 groups. GAD65 mRNA levels were similar between group L and group H, but both significantly higher than that in group C (P<0.01). GAD65 mRNA in other brain regions had no significant difference among the 3 groups.

CONCLUSIONGAT-1 mRNA in the hypothalamus and hippocampus and GAD65 mRNA in the dorsal thalamus are upregulated when propofol uptake reaches an equilibrium in the brain of dogs.

Animals ; Brain ; drug effects ; metabolism ; Dogs ; GABA Plasma Membrane Transport Proteins ; genetics ; metabolism ; Glutamate Decarboxylase ; genetics ; metabolism ; Hippocampus ; drug effects ; metabolism ; Hypothalamus ; drug effects ; metabolism ; Propofol ; pharmacology ; RNA, Messenger ; genetics ; Thalamus ; drug effects ; metabolism