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Objective To discuss the advantage of hispectral index(BIS) monitoring used in gastrointestinal endoscopy,and to observe elinical effects of target-controlled infusion(TCI) propofol combined with remifentanyl in elderly patients.Methods 120 patients aged from 65 to 78 with ASA physical status Ⅰ ～ Ⅱ were randomly divided into two groups,i,e.Group A (propofol with fentanyl ),Group B ( TCI propofol and remifentanyl with BIS).The amount of propofol was adjusted by consciousness and hemodynamics in Group A,while by BIS value in Group B.BIS was controlled at 55 ～60.The total amount of propofol and the time of wake-up,the incidence of complicatiors in each group were recorded.Results Compared with Group A,the changes of MAP and HR at T1 and T2 were smaller in Group B(P ＜ 0.05 ) ; Compared with Group A,the total amount of propofol and the time of wake-up were less in Group B ( P ＜ 0.05 ) ;Compared with Group A,the incidence of intraoperative respiratory depression and bradycardia were increased in Group B( P ＜ 0.05 ),there were no differences in the rest between the two groups.Conclusion Under BIS monitoring,TCl propofol and remifentanyl in elderly patients undewent gastrointestinal endoscopy may reduce propofol,and reach rapid recovery from anesthesia,but it needs additional management of respiration and circulation.

ObjectiveTo observe the changes of HR,MAP,BIS and Narcotrend induced by different doses of propofol in elderly patients. MethodsOne hundred elder patients(60 ～ 85 years old), AS A class Ⅰ or Ⅱ, scheduled for selective surgeries,were divided equally into 5 different doses of propofol( constant intravenous injection for 1min) groups of 0.5mg/kg( Ⅰ ) ,0. 75mg/kg( Ⅱ ) ,1.0mg/kg(Ⅲ) ,1.25mg/kg( Ⅳ)and 1.5mg/kg(Ⅴ). HR,MAP,BIS and Narcotrend were monitored before propofol injection and at 1 and 5 min after propofol injection. ResultsHR of 5 group s as similar. At 1 min after pmpofol injection, MAP decreased remarkably compared with at before in all 5 groups( t =2. 17,2.84,2.49,5.63,7.10, all p ＜ 0.05 ), which in group Ⅳ and Ⅴ decreased significantly compared with at in group Ⅰ, Ⅱ and Ⅲ(t =4.67,2.77,2.45,5.49,4.57,2. 18,all P＜0.05).At 1 min after propofol injection,BIS and NI values decreased compared with at before in all 5 groups(t =7.74,11.74,28.18,30.34,45.28, 6. 65,10.52,17.27,26.28,30. 14,allP ＜0.05) ,which in groupⅢ, Ⅳ and Ⅴ were significantly lower than those in group Ⅰ and Ⅱ (t =12.59,11.08,16.72,15.12,17.67,15.64,allP＜0.05).Dose of propofol was negatively correlated with BIS and NI value ( r =-0. 898/0. 930, P ＜ 0.01 ). ConclusionPropofol 1.0mg/kg constant injection should meet the sedation and hypnosis demand of general anesthesia in elderly patients and could not inhibit circulatory system; Bispectral Index and Narcotrend could accuratly monitor depth of anesthesia in elderly patients.

ObjectiveTo study the expressions of p75NTR,Bax and Bcl-2 and cell apoptosis in rat cortical neurons following mechanical injury and discuss the mechanism and mutual action way during the apoptosis of rat neurons after mechanical injury.Methods Cortical neuron cultures were prepared from the brain tissues of day 17 rat embryos and were exposed to mechanical injury seven days after seeding.After the traumatic neuron injury models were created,the apoptosis ratio of neurons was tested at several time points.The models were divided into the minor,moderate,severe injury groups according to the injury severity and the control group.The expressions of Bax and Bcl-2 in each group were detected by immunohistochemistry method and that of p75NTR by Western-blot.Combining with cellular apoptosis ratio in each group shown after FCM analysis,the correlation between the expressions of p75NTR,Bax and Bcl-2 and the apoptosis in rat neurons after mechanical injury could be analyzed.ResultsThe apoptosis ratio of the neurons in all the injury groups was obviously higher than that in the control group,with significantly higher apoptosis ratio of the neurons in the severe injury group than the minor and moderate injury groups (P ＜0.05).P75NTR,Bax and Bcl-2 were all expressed in all the injury groups,with statistical differences between groups.The expression of Bax in the severe injury group was significantly higher than that in the minor and moderate injury groups(P ＜ 0.05 ). Conclusions p75NTR expression and Bax/Bcl-2 ratio are closely correlated with neuron apoptosis.The early expression of p75NTR may be one of mechnisms for neuronal apoptosis after neuron injury,when Bax and Bcl-2 may be involved.

Objective To study the CT manifestation of testicular endodermal sinus tumor in childhood.Methods Clinical and CT data in sixteen cases of testicular endodermal sinus tumor in children were retrospectively reviewed.Results The tumors appeared as solid masses on plain CT scan,the density of the tumor was homogeneous in 14 cases and heterogeneous in 2 cases.The masses were obviously heterogeneous enhancement after administration of contrast material in 12 cases.Serum ?-fetoprotein(AFP)level was elevated to more than 1000?g/L(normal:less than 20?g/L).Conclusion CT is a valuable in diagnosis of testicular endodermal sinus tumor in children.CT combined with serum AFP can improve the diagnosis of the disease.

Objective To investigate the clinical efficacy and prognosis of transcatheter arterial chemoembo-lization(TACE)combined with radiofrequency ablation(RFA)in treatment of liver cancer.Methods 64 patients of liver cancer were selected as the research subjects,and they were divided into two groups by randomized single blind method.32 cases in the control group adopted the TACE treatment,while 32 cases in the observation group were given TACE combined with RFA.The tumor shrinkage,complete necrosis rate,local recurrence rate,AFP levels and adverse reactions of the two groups were compared.The patients were followed up for 3 years to record survival.Results After treatment,the tumor shrinkage rate and complete necrosis rate of the observation group were 90.63% and 75.00%, which were significantly higher than 68.75% and 50.00% of the control group,the differences were statistically significant (χ2 =8.453,8.203,all P <0.05).The local recurrence rate of the observation group was 21.88%,which was significantly lower than 43.75% of the control group,the difference was statistically significant(χ2 =7.887,P <0.05).After treatment,the AFP level of the observation group was (70.11 ±6.45 )ng/L,which was significantly lower than (157.76 ±10.42)ng/L in the control group,the difference was statistically significant (t =7.433,P <0.05).The survival rates of 1 year,2 years and 3 years in the observation group were 84.38%,71.88%,56.25%, which were significantly higher than 65.63%,53.13%,31.25% in the control group (χ2 =8.677,8.203,8.985,all P <0.05).The incidence rate of postoperative adverse reaction had no significant difference between the two groups (χ2 =1.337,P >0.05 ).Conclusion TACE combined with RFA in treatment of liver cancer can significantly improve the effect of tumor necrosis rate,reduce the local recurrence rate and prolong the survival time of the patients, and it had less adverse reaction,higher safety,and which should be applied in clinical.

ObjectⅣe To investigate the nephroprotectⅣe effect of mycophenolate mofetil (MMF) on 5/6 nephrectomized rats and explore its mechanism. Methods The 5/6 nephrectomized SD rats were used. After the operation, 15 mg/kg MMF, 25 mg/kg fosinopril (F) and 15 mg/kg MMF+25 mg/kg fosinopril were respectⅣely delⅣered daily by gavage for 8 weeks. Urinary protein, BUN, serum creatinine were measured at the end of the study. Renal pathological changes were evaluated and immunohistochemistry was used to examine the expression of fibronectin (FN), collagen Ⅳ, macrophage chemoattractant protein 1 (MCP-1) and proliferating cell nuclear antigen(PCNA) . RT-PCR was used to examine the TGF-?1 mRNA and TIMP-1 mRNA in the cortex of the kidney. Results Compared with the untreated 5 /6 nephrectomized group (NX group), urinary albumin excretion of MMF, MMF + F or F treated rats were substantially decreased [MMF: (116. 1?12. 5) mg/24 h, F: (95. 3?13. 8) mg/24 h, MMF + F: (73. 2?16. 3) mg/24 h vs. NX: (205. 6?16. 8) mg/24 h. P

Objective:To determine whether ox-LDL (oxdized low-density lipoprotein) is highly deposited on the uremic vessel wall and its influence on the vascular remodeling. Methods: Segments of radial arteries were obtained from 21 uremic subjects during the operation of A-V fistula prior to hemodialysis. Segments of internal thoracic arteries of similar diameter were obtained from patients with benign chest tumors as control.The vascular lesions and ox-LDL, CD68,MCP-1, eNOS,ET-1, PCNA,FN on the vessel wall were determined by means of H-E stain and immunohistochemistry. Results： With H-E stain,atherosclerotic plaques were found in the radial arteries of 4 uremic patients. The middle layer of the arteries in uremic patients were obviously thickened, and the T/D　(thickness of the wall/external diameter) ratio was significantly higher than those in control group(P<0.01). ox-LDL,CD68,MCP-1, ET-1, PCNA,FN on the vessel wall in uremic patients were much higher than those in control group (P<0.01). Moreover, ox-LDL on the vessel wall was positively related to the expression of other above mentioned substances on the vessel wall (P<0.01). Whereas the expression of eNOS on the vessel wall was lower than control group (P<0.01),and was negatively related to ox-LDL on the vessel wall(P<0.01). Conclusion: ox-LDL is an important factor contributing to uremic vascular remodeling by increasing the migration,adhesion and infiltration of monocyte,the proliferation of vascular smooth muscle cell and dysfunction of endothelia.

Objective To investigate the injury of podocyte and its association with proteinuria in IgA nephropathy (IgAN). Method Thirty-five patients of IgA nephropathy with proteinuria more than 1.0 g/24 h were enrolled in the study, and eight cases of renal harmatomaeetomy or renal cancinomaectomy were as controls. Cell cycle regulatory proteins (p21, p27), podocyte-associated molecules (integrin-β1, nephrin, α-actinin 4, nestin), foot process width (FPW) and the amount of podocyte were examined by immunohistochemistry and real-time PCR, respectively. Patients were divided into two groups according to podocyte number per volume (Nv): podocytopenia group (n=15, Nv<52.49×106/μm3) and normal number group (n=20, Nv≥52.49× 106/μm3). Proteinuria was followed up for eighteen months. Results Compared with the controls, podocyte p21 was re-expressed, while the expression of p27 was decreased (0.71±0.12 vs 0.91±0.07, P<0.05) in IgAN. The nestin protein level was markedly decreased in IgAN (13.4%± 0.04% vs 17.6%±0.04%, P<0.05). The mRNA expression of integrin-β1 was significantly increased (12.54±5.20 vs 1.02±0.30, P<0.05), while the amount of nephrin, α-actinin4 remained unchanged. Effacement of foot processes and podocyte detachment from the glomerulax basement membrane were observed in some cases. Nv was significantly less than that of controls (161.27± 225.92 vs 323.22±138.12, P<0.05), which was associated with the Lee's grade of IgA nephropathy. The integrin-β1 mRNA expression and Nv were negatively correlated with baseline proteinuria by univariate analysis (r=-0.840, P=0.034; r =-0.4483, P=0.014, respectively). Proteinuria in podocytopenia group was decreased more slowly than that in normal number group. Conclusions Podocyte injury exsists in IgAN with proteinuria, which manifests alterations in cell cycle regulatory protein and some podocyte-associated molecules, as well as foot process effacement and loss of pedocyte. Podocyte injury may be involved in proteinuria by affecting the progression of proteinuria in IgAN.