Objective To investigate the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine mixed with sufentanil on the sleep quality after spinal surgery.Methods Eighty patients of both sexes, aged 21-72 yr, weighing 48-100 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective spinal surgery, were randomly assigned into sufentanil group (group S) and dexmedetomidine mixed with sufentanil group (group DS) with 40 cases in each group.In group S, PCIA solution contained sufentanil 2 μg/kg and tropisetron 6 mg in 100 ml of normal saline.In group DS, PCIA solution contained sufentanil 2 μg/kg, dexmedetomidine 3 μg/kg and tropisetron 6 mg in 100 ml of normal saline.The PCA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h.Sufentanil 5 μg injected intravenously and celecoxib 200 mg given orally were used as rescue analgesics, and numeric rating scale (NRS) score at rest was maintained ≤4 within 48 h after surgery.Ramsay sedation scores were recorded at 1, 2, 6, 12, 24 and 48 h after surgery.Sleep quality was evaluated using the Medical Outcomes Study Sleep Scale (MOS-SS), and the average time of daily sleep and Sleep Problems Index (SPI) were recorded at week 1 before and after surgery.Patient's satisfaction with sleep was assessed on the night of surgery and 1st day after surgery.The requirement for rescue analgesics was recorded.Results There was no significant difference in the requirement for rescue analgesics between group S and group DS (P＞0.05).Compared with the value before surgery, the average time of daily sleep was significantly shortened, and SPI was increased at week 1 after surgery in group S (P＜0.05 or 0.01), and no significant change was found in group DS (P＞0.05).Compared with group S, the Ramsay sedation scores were significantly increased at 1, 2, and 6 h after surgery, the average time of daily sleep was prolonged at week 1 after surgery, the SPI was decreased at week 1 after surgery, and the degree of satisfaction with sleep was increased on 1st day after surgery in group DS (P＜0.05 or 0.01).Conclusion PCIA with dexmedetomidine mixed with sufentanil is helpful in improving the sleep quality after spinal surgery in the patients.

Objective To investigate the impact of squamous cell carcinoma antigen(SCCAg)in patients with recurrent squamous cell carcinoma of the uterine cervix.Methods Totally 72 patients with recurrent squamous cell carcinoma of the uterine cervix treated at the Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,between 1999 and 2005 were retrospectively analyzed to investigate the impact of SCCAg on diagnosis and prognosis by univariate and multivariate analysis.Results This study included 30 patients with recurrent disease after primary radical surgery and 42 patients with recurrent cervical cancer after radio-chemotherapy.Sixty one patients(85%)had serum SCCAg elevated (≥1.5 pg/L),and 20 of these(28%)had an increase of SCCAg before clinical manifestation of relapse.The median leading time was 3 months(range:1-13 months).Forty five patients had no symptoms with only SCCAg elevation,and 15 patients experienced leg edema and(or)sciatic pain,7 patients suffered from irregular bleeding and 5 patients had symptoms resulting from distant metastasis.Thirty three patients were diagnosed by histology biopsy and (or) cytology,39 patients were diagnosed with SCCAg elevation and clinical and radiological examinations,29 of these patients were diagnosed only by SCCAg elevation and CT or MRI.Fourteen patients recurred limited to the cervix or to the cervix and adjacent tissues(central recurrence),31 cases recurred at pelvis,and 20 patients with distant metastasis and 7 patients suffered from Pelvic recurrence and distant metastasis.Twenty three cases received salvage therapy including surgery for patients recurring after definitive radiotherapy and radiotherapy and or conform radiotherapy for patients after primary radical surgery,46 patients were given palliative chemotherapy and or radiotherapy,and 3 patients refused any treatment.The median and mean survival time were 11 months and 23 months respectively(2-62 months).The 3-year,5-year overall survival rate were 25%and 19%respectively.Univariate analysis showed SCCAg elevation before primary treatment,grade,recurrent site,treatment method,SCCAg≥10pg/L,SCCAg elevation during treatment,and SCCAg not within normal after treatment were correlated with 3-year survival rate.Twenty patients had an increase of SCCAg before clinical manifestation of relapse compared with other patients who did not,and the 3-year survival rate was not significantly different (22% vs 27%). Multivariate analysis revealed that only grade and treatment methods were independent risk factors. Conclusion The impact of the SCCAg in recurrent squamous cell carcinoma of the uterine cervix needs further study.

Objective To study the effects of bone marrow mesenchymal stem cells transplantation on functional recovery of the injured rats spinal cord.Methods MSCs labeled with Brdu were transplanted into rats model of spinal cord half-transection injury.The open-field BBB scoring system was employed to evaluate behavioral changes.MSCs' survival after transplantation was identified by BrdU immunohisto chemistry.We observed the reconstruction of neuronal circuits by HRP coloration.The recovery of transduction function after spinal injury was examined by cortex somatosensory evoked potential (CSEP).Results Treated rats generally showed better functional recovery than control rats after operation.BrdU-positive cells could be found in the spinal cord injury site one week after transplantation.At two months after transplantation, HRP-positive cells could be found at rostral of the spinal cord injury site of treated rats, but not be found in control.CSEP could be evoked at treated rats from two months after transplantation,but not in controls.Conclusion MSCs may survive in the spinal cord injury site via local injection immediately after spinal cord injury, and may promote regeneration of the injured axons.

Objective To observe the effect of the injection of myoblast carrying human insulin-like growth factor-1(hIGF-1) on the expression of endogenous IGF-1 mRNA and IGF-1 level in mice skeletal muscle following injury.Methods Seventy two male C3H mice(20~30g,7~11w)were randomly divided into three groups(24 mice in each group) with four mice normal controls.Applied a falling hit from certain height at the medial calf of right lower limbs in three groups,the injured skeletal muscle model was successfully simulated.Three days following injury,the mice in group A and B were injected with 1?106 myoblasts either carried with or without hIGF-1 gene respectively and the mice in group C were injected with 100?l saline at the injured muscle.Three mice in each group were sacrificed randomly at day 2,5,10,15,20,30 after contusion.The expression level of mIGF-1 was assessed by immunohistochemical staining and real time PCR.Results mIGF-1 mRNA expression and mIGF-1 factor secretion were observed in all three groups;the amount of mIGF-1 mRNA expression and mIGF-1 secretion in group A were significant higher than that in group B and C.Conclusion Myoblast carrying hIGF-1 transplantation could promote endogenous IGF-1 secretion in injured skeletal muscle.

Objective To observe the survival of myoblasts carrying hIGF-1 gene transplanted into the mice, and the expression of hIGF-1 in the transplanted mice. Methods Eighty four male C3H mice(20～30g,7～11w)were divided into four groups: group A, B, C and D (20 mice each group), and the remaining four mice were used as normal control. At the middle of the right gastrocnemius muscle, the mice in group A and B were injected with 1?10~6 myoblasts either carried with or without hIGF-1 gene. Muscle contusion at the middle of the right gastrocnemius muscle of the mice in group C and D was produced. At day 3 following injury, they were injected with 1?10~6 myoblasts either carried with hIGF-1 gene (group C) or without hIGF-1 gene (group D). At the day 2, 5, 10, 20, 30 after injection, four mice of each group were sacrificed randomly. BrdU staining in all mice were performed to evaluate cells surviving, and the expression level of hIGF-1 in group A and C was assessed by immunohistochemical staining and real-time-PCR. Results The BrdU staining in both normal and injured mice transplanted with myoblast carried with or without hIGF-1 were positive. hIGF-1 was expressed and secreted in both group A and C. Conclusion The myoblast carrying hIGF-1 gene transplanted into normal or injured mice can survive for a certain period of time, and can secrete hIGF-1.

Objective To probe into the advantages and disadvantages of intravenous chemotherapy and intraperitoneal chemotherapy for advanced epithelial ovarian cancer.Methods All of the 226 patients with advanced epithelial ovarian cancer were treated by maximum cytoreductive surgery or non-effective cytoreductive surgery and received 6-8 courses of postoperative regular chemotherapy(chemotherapy regimens,TP:taxol and cis-platinum or carboplatinum;PC:cis-platinum and cyclophosphamide;PAC:cis platinum and adriamycin and cyclophosphamide)during Jan 1998-Jan 2006.We systematically compared the characteristics of patients in intraperitoneal chemotherapy(IPC)group and intravenous chemotherapy(IVC)group.We measured the incidence rate of the response,side-effects,the recurrence time of intraperitoneal tumor and survival time of the two groups respectively.ResultsFor the first phase after operation(three courses of treatment),the response rate of two groups were 75.8％and 52.8％respectively.For the response rate of IPC was higher than that of IVC(P＜0.01).The second phase after operation(all courses finished),the response rate of two groups were 93.9％and 87.7％,respectively(P＞0.05).After maximum cytoreductive surgery,the recurrence rate of IPC and IVC were 47.0％and 59.4％,respectively(P＞0.05).After non-effective cytoreductive surgery of IPC and IVC groups,the recurrence rates were 84.8％and 86.2％,respectively(P＞0.05).The recurrence time of intraperitoneal tumor of IPC and IVC groups were 24 and 18 months,respectively(P=0.001).The overall survival time ofgroups IPC and IVC were 32 and 30 months(P=0.188).There were some differences in the side-effect between IPC and IVC.The rates of chemotherapeutic phlebitis of IPC and IVC were 34.0％and 10.8％ respectively(P＜0.01).The rates of serious gastrointestinal reaction of IPC and IVC were 33.8％and 25.8％,respectively(P=0.236).There was no significant difference in bone marrow depression,intestinal adhesion and intestinal obstruction.ConclusionsIPC can extend the disease progression free survival than IVC,without increasing overall survival period.IPC can also reduce the side-effect of chemotherapeutic phlebitis.However,IPC is used limitedly,and can not substitute for IVC.Combination of IPC with IVC may enhance their effectiveness and reduce the side-effects.

Foam Cells ; pathology ; Gastrointestinal Neoplasms ; pathology ; Humans

BACKGROUND:Different methods and biomaterials have been applied in animal experiments and clinical practice to prevent the formation of epidural scars,Biodegradable and sticky semi-fluid gels are the most often used material.Salvia miltforrhiza radix (SMR) and carbomer have been clinically confirmed to be the safe and effective drugs and gel agents. OBJECTIVE:To observe the effect of SMR-gel on preventing epidural adhesion after laminectomy.DESIGN:A complete randomized grouping design, a controlled experiment. SETTING:Department of Orthopaedics,Shenzhen People's Hospital (Second Clinical College of Jinan University). MATERIALS:Thirty-six healthy pure New Zealand rabbits were used,either male of female,clean degree,2-3 years of age. They were randomly divided into four groups with 9 rabbits in each group:blank control group,gel contro group, HA group and SMR-gel group. Carbomer934 powder (Shanghai People's Pharmaceutical Factory, batch number: 20000510) , hyaluronic acid (HA) [Shandong Bausch & Lomb Freda Pharaceutical, Co., Ltd.,No.H10960136,2 mL (20 mg)].METHODS:The experiments were carried out in the animal laboratory of Shenzhen People's Hospital from April 2002 to August 2003.①Preparing SMR-gel:SMR was prepared into extract powder.Carbomer934 powder was added by water for dissolving and swelling and stayed overnight,then SMR-gel was prepared by dipping with triethanolamine,adding with SMR extract powder (2 g),then adding with purified water till 100.0 g and stirring uniformly.②The rabbits were anesthetized. and the lamina of vertebra was totally resected at L3 and L6 (reserving superior and Inferior articular processes).then defects of 10 mm×5 mm were made to expose the dura mater.The vertebral defects were added with 1 mL carbomer gel, 1 mL HA (20 g/L) and 1 mL SMR-gel in the gel control group,HA group and SMR-gel group respectively.whereas nothing was added in the blank control group.③Gross samples:Three rabbits were killed 4,6 and 8 weeks postoperatively in each group.vertebraI ventral fascia were stripped to remove the spinal segments (L3,L6) for operation completely,and totally 24 samples for each time.One sample was selected in each group 4 weeks postoperatively. and the samples were observed under H-600 transmission electron microscope (Hitachi). ④The adhesion compactness of scar tissue with dura mater was evaluated in the 24 samples of the 4 groups at 8 weeks postoperatively:There were 4 grades:No obvious adhesion between dural sac and scar tissue for grade O:Extensive and compact adhesion between dural sac and scar tissue. impossible blunt dissection between dural sac and scar tissue.incomplete dural sac after sharp dissection for grade Ⅲ.Each spinal segment was cut into 4 parts equally,and all were prepared into sections and stained,then the thickness of epidural scar was determined with Tiger2000 image analyzer. ⑤The rank sum test was used in the scar adhesion compactness grading evaluated with naked eyes,whereas analysis of variance.and two-two comparison were used in analyzing the thickness of epidural scar.P＜0.05 was considered as significant difference.MAIN OUTCOME MEASURES:①Results of gross scar adhesion compactness grading at 8 weeks and comparison of the thickness of epidural scar at 4.6 and 8 weeks;②Results of gross observation,histological examination and ultrastructure.RESULTS: All the 36 rabbits were involved in the analysis of results. ①Results of gross observation and pathohistological examination:There was compact adhesion at each time point in the blank control group,part adhesion in the gel control group and HA group, and no obvious adhesion in the SMR-gel group.②Results of quantitative analysis:The rabbits with lower scores of scar adhesion compactness grading In the blank control group,gel control group and HA group were obviously fewer than those in the SMR-gel group (W=45-52,P＜0.05-0.01).The scar thickness at 4 and 8 weeks in the SMR-gel group was obviously less than that in the other 3 groups(F=128.657,152.246,80.891,P＜0.01).③Results of observation under transmission electron microscope:The proliferation of fibroblasts at 4 week was active in the blank control group,gel control group and HA group,but inactive in the SMR-gel group.CONCLUSION:①SMR can inhibit the fibroblasts to proliferate,differentiate and synthetize into secretory collagens,and then inhibit the formation of epidural scar adhesion.②HA can be absorbed by organs very early,which reduces its role in preventing adhesion.Whereas carbomer gel can stay longer, and it plays a role in inhibiting and blocking adhesion in the whole process of wound repairing.

ObjectiveTo investigate the correlation between electro-acupunctured point Houxi(SI3)and activated brain function areas, contrast the images produced with electroacupuncture at left and right points Houxi and make a comparison with electroacupuncture at point Hegu(LI4)in patients with peripheral facial paralysis.MethodPatients with peripheral facial paralysis, six on the left side and six on the right side, were enrolled as subjects. A scan of the whole brain was taken using fMRI during electroacupuncture stimulation. The images were processed using SPM software. An analysis using at-test (P<0.01) showed differences in brain functional images produced with electroacupuncture at different points.ResultElectroacupuncture at left point Houxi increased the signals of brain regions: rightcaudate nucleus, right cingulate gyrus, right parahippocampal gyrus, right superior temporal gyrus, the brainstem and the cerebellar vermis. Electroacupuncture at right point Houxi increased the signals of brain regions: right medial frontal gyrus, left middle frontal gyrus, left anterior cingulate gyrus, rightcingulate gyrus and right superior temporal gyrus.ConclusionThere is a difference in the image between electroacupuncture at point Houxi and at point Hegu or Dicang(ST4). There is also a larger difference in the image between bilateral points Houxi. The brain regions with high-frequency or low-frequency signals are not consistent. The results further prove the scientificalness of “Point Hegu is indicated for diseasesin the face and mouth” and also show that the cognominal acupoints on the two sides ofthe human body may have some differences, e.g. the conduction pathways are not completely the same and the therapeutic effects are not completely consistent.

Objective To evaluate the endoscopic and pathologic characteristics and etiological ex-amination of viral esophagitis. Methods The data of 16 patients with viral esophagitis, including endoscop-ic, pathological and immunohistochemical findings were retrospectively studied. Results Endoscopic find-ings of viral esophagitis were characterized by single or multiple round and oval ulcers, located at the upper and middle esophagus. The surface of the ulcer was clean, and the boundary was distinct. Pathologic findings included degeneration and necrosis in squamons epithelium, accompanied by ulcer, infiltration of neutrophils and lymphocytes, hyperplasia of capillaries and basal cells and formation of granulation tissues, Immunocyto-chemical examination showed HSV-1 was positive in biopses, while CMV, EBV, HHV8 were negetive. Con-dusion Viral esophagtitis exhibited distinctive endosoopic and pathological features, and etiology can be confirmed by immunohistochemical examinations.