Objective To investigate the effects of propofol on the changes in myocardial Toll-like receptor 4 (TLR-4)and TNF-αand NF-κb protein expressions in ischemia-reperfusion injury (I/R).Methods Thirty healthy male SD rats weighing 250-320 g were randomly divided into 3 groups (n=10 for each):Group A,sham operation;Group B,I/R;and Group C,propofol + I/R.In Groups B and C myocardial I/R was induced by occlusion of the left anterior descending artery (LAD)for 30 min,followed by 120 min reperfusion.In Group C propofol was given intravenously 1 0 min before myocardial ischemia,followed by continuous infusion of propofol at 5 mg/(kg·h)until the end of 120 min reperfusion.In Groups A and B normal saline instead of propofol was given. The myocardial tissues were taken at the end of 120 min;ultrastructural changes of myocardial cells were observed under X-ray electron microscope and the expressions of TLR-4 mRNA as well as TNF-αand NF-κb protein were determined.Results Ultrastructural observation under electron microscope showed significantly worsened damage in myocardial tissue structure and mitochondria in Groups B and C compared with Group A.The myocardial expressions of TLR-4 and TNF-αand NF-κb protein were significantly higher in Groups B and C than in control Group A.The myocardial expressions of TLR-4 and TNF-αand NF-κb protein were down-regulated in Group C compared with Group B.Conclusion Intravenous injection of propofol can protect against myocardial damage.Propofol can suppress the increase in myocardial TLR-4 and TNF-αand NF-κb protein expressions induced by I/R.

Objective To evaluate the safety of a surgical appwach for transabdominal cardial carci- noma.Methods We retrospectively analyzed 326 patients undergoing transabdominal esophagastrostomy or esophagojejunostomy from 1998 to 2006 via the EEA(end-to-end anastomosis)stapler.Results By the surgi- cal approach for transabdominal cardial carcinoma,the average length of reseete esophagus above the carci- noma was about 6～8 cm realized the low average of remnant carcinoma at the margin and operation mortality and anastomotic leakage,which was lower than those in the thoraeotomy appmaeh significantly.Conclusion The transabdominal approach makes a clear operative field in posterio-inferior mediastinum,it is beneficial for radical resection of eardial carcinoma and intramediastinal esophagogastric or esophagojejunal mechanical anastomosis,and it fits to the old,the weakening and with the disease of heart and lung.

Objective To investigate the changes of glucocorticoid receptor (GR) gene expression in the hippocampus of rats following scald burn stress and the role of N methyl D aspartate (NMDA) receptor in this change. Methods Adult male Wistar rats inflicted with 30% TBSA full thickness scalding were applied as severe scalding stress model. GR mRNA levels in the hippocampus were detected with RT PCR. Results A significant decrease of GR mRNA levels was observed in the hippocampus 2 h after the scalding stress. The decrease could be inhibited when MK 801, an NMDA receptor antagonist, was administered prior to stress, and be augmented with the administration of NMDA, an NMDA receptor agonist, but not be affected by normal saline. Conclusion NMDA receptors are involved in the scalding stress induced down regulation of GR gene expression in the rat hippocampus.

Objective To evaluate the value of MSCT scores on surgery method selection and its difficulty estimation for hepatic cystic echinococcosis. Methods Based on the CT features of hepatic cystic echinococcosis ( HCE), an integral system including 7 items wasestablished. Images of preoperative CT examination performed on 71 cases of hepatic cystic echnococcosis were retrospectively analyzed by the integral system and compared with actual surgical. Total 93 cystic lesions were divided into 3 groups based on CT scores: Group A suitable for total cystectom (0 to 5 score), Group B suitable for subtotal cystectom (6 to 10 score), and Group C suitable forendocystectomy ( ≥11 scores, or4 score in one item). Spearman rank correlation was used to analyze the relationship between WHO classification of cystic echinococcosis and actual surgery methods, the relationship between operation mode forecasted by CT scores and actual surgery methods, the relationship between vessel scores of cyst and actual surgery methods, and that between biliary score of cyst and actual surgery methods. Fisher exact test and Chi-square test were used to evaluate the incidence of residual cavity in patients with different biliary scores. Results Thirty nine cysts got 0 to 5 scores, 45 cysts got 6 to 10 scores and 9 cysts got more than 10 scores. Total cystectom was performed on 30 cysts, subtotal cystectomy on 40 cysts and performed endocystectomy on 23 cysts, actually. Actual operation methods were correlated with that predicated by CT scores ( r = 0. 741, P ＜ 0. 01 ), and with vessels score and biliary score (r = 0. 587,0. 327 respectively,P ＜ 0. 01 ). The higher the biliary score, the higher the incidence of postoperative biliary tract complications. Conclusions Preoperative CT scoring was an easy and objective way to accurately predict the surgery methods and its difficulty for hepatic cystic cnechnococosis.

Objective To observe the translations of chemokine CXCL12 and its receptor CXCR4 in endometrial carcinoma tissues,and to evaluate their significance in clinical pathologic features of endometrial carcinoma.Methods From Jan.2012 to Dec.2014,52 tissue specimens of patients with endometrial carcinoma were admitted to the hospital,aged 55.6 ± 19.2 years,and 26 cases of normal endometrium as control,aged 52.3±16.5 years old.Expressions of CXCL12 and CXCR4 in the tissue specimens were detected by immunohistochemistry,and to analyze the relationship between the expressions and clini-cal pathological features,and FIGO stage,cell differentiation,lymph node metastasis and pathological type in endometrial carcinoma.Results In endometrial carcinoma,the positivity rates of CXCR4 and CXCL12 were 76.92% and 69.23% re-spectively.The positive expression rates of which were 34.62% and 30.77% in normal endometrium tissues,statistically significant (χ2 =11.826,P <0.01).The expression of CXCR4 was positively correlated with the differentiation of endome-trial carcinoma cells (P <0.05).In endometrial carcinoma,with the exception of CXCR4 expression and cell differentiation was positively related (r=0.386,P <0.05),CXCL12 and CXCR4 expression and clinical stage,pathological type and lymph node metastasis no correlation was found (P >0.05).Conclusion The results showed that the expression of CXCL12 and CXCR4 in endometrial carcinoma tissues was significantly increased,which may play an important role in the development of endometrial cancer.

Background Clinical researches showed that antimicrobial-resistance of bacterium is gradually serious.It is very important to master pathogen distribution and antimicrobial susceptibility after eye surgery.Objective This study was to investigate the distribution and drug sensitivity of pathogenic bacteria from ocular operative infection in 3-year duration to provide a reference for reasonable selection of antibiotics.Methods Sixtyfive positive specimens were obtained from 65 patients due to postoperative infection in Department of Ophthalmology of Shenzhou Hospital and Shengjing Hospital from 2009 January through 2011 December.The pathogenic bacteria were isolated and then the drug sensitivity test of conventional antibiotics was performed.Results Among the 65 ophthalmic specimens,35 strains of Gram-positive bacteria were isolated with the constituent ratio 53.8％,and 15 strains of Gram-negative bacteria accounted for 23.1％.Fungus was found in 15 cases with the constituent ratio 23.1％.Staphylococcus epidermidis accounted for 42.9％ in Gram-positive bacteria,and Pseudomonas aeruginosa accounted for 33.3％ in Gram-negative bacteria.Aspergillus was the main component of fungus,which accounted for 60.0％ of the proportion 3 strains of methicillin-resistant Staphylococcus aureus (MRSA) in 8 strains of Staphylococcus aureus,but no vancomycin-resistant Enterococcus (VRE) and vancomycin-resistant Staphylococcus (VRS) were seen.The in vitro drug sensitivity test showed that the main Gram-positive bacteria,Staphylococcus epidermidis and Staphylococcus aureus,were sensitive to linezolid,vancomycin,levofloxacin and ciprofloxacin with the sensitive rates ＞50.0％,and these bacteria were lowly sensitive to penicillin and erythromycin with the sensitive rates ≤30.0％.Pseudomonas aeruginosa appeared to be the main Gram-negative bacteria,showing a sensitive rate ≥ 80.0％ to tobramycin,amikacin,ceftazidime,cefepime,cefoperazone/sulbactam,piperacillin/tazobactam,imipenem and meropenem.Conclusions Staphylococcus epidermidis,Staphylococcus aureus,Pseudomonas aeruginosa and Aspergillus are primary pathogens in ocular infection after operation.Antibiotics such as penicillin,erythromycin,levofloxacin,cefotaxime seem to be relatively high resistant to eye infection.To choose sensitive antibiotics timely and reasonably is a key to the prevention and control of ocular infection after operation.

Objective:To discuss the clinical efficacy of minimally invasive locking plate and the traditional open reduction with internal fixation in the treatment of proximal humerus fractures.Methods:89 cases of patients with proximal humeral fractures were selected and divided into two groups according to different surgical methods.The observation group (45 cases) was given minimally invasive locking plate,while the control group (44 cases) was treated with the traditional open reduction and internal fixation.The operation time,hospitalization time,fracture healing time,intraoperative blood loss,Neer score and Constant-Murley score at 1 month after postoperatiion were compared between two groups.Results:The operation time,hospitalization,fracture healing time of observation group were significantly shorter than those of the control group,and the bleeding amount of observation group was less than that of the control group (P＜0.05).At 1 months after operation,the Constant-Murley scores of observation group were significantly better than those of the control group (P＜0.05).The For Neer scores,excellent rate of observation group (91.1％) were significantly higher than those of the control group (68.1％,P＜0.05).Conclusion:Compared with the traditional open reduction with internal fixation,minimally invasive locking plate was better,safer,faster and more effectively for promoting the recovery of shoulder function of patient with proximal humerus fractures.

Objective The purpose of this study is to determine whether the quantitative parameters of salivary gland scintigraphy are useful in the diagnosis of Sjgren's syndrome(SS).Method Forty patients with SS and 29 control subjects underwent salivary gland scintigraphy.Two indices,uptake ratio and maximum se- cretion were mearsured.The optimal cut-points of both indices were derived from receiver operative character- istic curve(ROC).The diagnostic value of the indices was assessed by the area under ROC curve(AUC~(ROC)). Results The optimal cut-point of uptake ratio was 5.5～5.7.The optimal cut-point of maximum secretion was 0.20.The sensitivities of both indices were 86.2%～89.7%.The specificity of uptake ratio was 63.4%～65.9%. The specificity of maximum secretion was 82.9%～85.4%.The AUC\+\{RoC\} of uptake ratio was 0.780/0,776.The AUC\+\{ROC\} of maximum secretion was 0.905/0,899.Conclusion The quantitative parameters of salivary gland scintigraphy may be useful in the diagnosis of Sj(?)gren syndrome.

Objective To study the clinical characteristics and curative effects of pancreatic cystade- nocarcinoma in order to improve its diagnostic and therapeutic accuracy.Methods A retrospective analysis was done on the clinical materials of 13 cases of pancreatic cystadenocarcinoma hospitalized in Shanxi Cancer Hospital from 1990 to 2006.Results The preoperative diagnosis were as follows:pancreatic cystadenocarci- noma 6 cases,pancreatic cystadenoma 2 cases,pancreatic cancer 1 case,pancreatic pseudocyst 4 cases.The misdiagnosis rate was 53.8 %.Surgical operation was done on the 13 cases,and 10 of them were treated by radical operation.A 5-year follow-up was done on 6 still alive cases,and 1 of them lived over 11 years.3 cases were treated by palliative operation,and all of them died within 3 years.Conclusion Since there is no specific clinical manifestations of pancreatic cystadenocarcinoma,it is very difficult to get an accurate preop- erative diagnosis.Radical operation is the most effective therapeutic methods.

Objective To investigate the effects of Saussurea involucrata extract pretreatment on the expression of the Toll-like receptor 4 (TLR4)/nuclear factor-κB (NF-κB) in focal cerebral ischemia/reperfusion in mice and its possible neuroprotective mechanism.Methods Seventy-two Kunming mice were randomly divided into four groups:sham operation,saline,Saussurea involucrata extract,and edaravone groups (n =18 in each group).Saussurea involucrata extract 0.8 g/kg was given intraperitoneally in the Saussurea involucrata extract group; edaravone 3 mg/kg was given in the edaravone group; and the same volume of saline was given in the saline group.A model of middle cerebral artery occlusion (MCAO) was induced after 7 days of continuous injection.Cerebral infarct volume was determined by 2,3,5-triphenyltetrazolium staining.Immunohistochemical staining was used to detect TLR4-positive cells in ischemic brain tissue.Reverse transcriptase polymerase chain reaction was used to detect the expression of TLR4/NF-κB mRNA.Results The cerebral infarct volume in mice in the saline,Saussurea involucrata extract and edaravone groups was 131.55± 28.25 mm3,84.10 ±13.92 mm3 and 65.10 ± 6.78 mm3,respectively.There were significant difference (F =10.158,P =0.012).The infarct volume in the Saussurea involucrata extract group (P =0.020) and edaravone group (P0.005) was significantly less than that in the saline group,and there was no significantly difference between the 2 groups.The numbers of cortex and TLR4 positive cells in hippocampus area at the ischemic sides in the saline group were significantly more than those in the sham operation group (all P ＜0.001).The numbers of positive cells of cortex and TLR4 in the Saussurea involucrata extract group and the edaravone group were significantly decreased compared to the saline group (all P ＜ 0.05),and there was no significant differences between the Saussurea involucrata extract group and the edaravone group.The expressions of TLR4,p50,and p65 mRNA in the saline group were significantly up-regulated compared to the sham operation group (all P =0.000).Saussurea involucrata extract could significantly down-regulate the expressions of TLR4,p50,and p65 mRNA at 24 hours after ischemia/reperfusion (all P =0.000).Edaravone could significantly down-regulate the expressions of TLR4 and p65 mRNA (all P =0.000) and it had a down-regulated trend for the expression of p50 mRNA (P =0.053); while there was no significant difference in the expressions of TLR4 and p65 mRNA between the Saussurea involucrata extract group and the edaravone group.Conclusions Saussurea involucrata extract pretreatment may significantly reduce the cerebral infarct volume,down-regulate the expressions of TLR4 and NF-κB subunit,and play a neuroprotective effect by inhibiting inflammatory response after ischemia.