OBJECTIVETo observe the effect of transcutaneous acupoint electric stimulation on the postoperative nausea and vomiting (PONV) and explore its mechanism.

METHODSNinety cases of elective cesarean section of I to II grade in American Society of Anesthesiologists (ASA) were collected and randomized into a transcutaneous acupoint electric stimulation group (group A), a sham-acupoint group (group B) and a blank control group (group C), 30 cases in each one. In the group A, 30 min before operation, the transcutaneous electric stimulation was applied to bilateral Neiguan (PC 6) and Zusanli (ST 36). The stimulation lasted during operation and 1 h after operation. In the group B, the same electric stimulation was given at the sites 3 cm lateral to the medial sides of Neiguan (PC 6) and Zusanli (ST 36). In the group C, the electric plaster was attached to bilateral Neiguan (PC 6) and Zusanli (ST 36), without any electric stimulation. The lumbar epidural combined anesthesia and the postoperative analgesia were same in each group. The mean arterial pressure (MAP), heart rate (HR) , oxygen saturation of blood (SpO2) and the VAS (visual analogue scale) score of nausea and vomiting were recorded before acupoint stimulation (T0), at skin incision (T1), fetal delivery (T2), abdominal exploration (T3) and 1 h after operation (T4) as well as bleeding and application of oxytocin, ephedrine and atropine during operation separately. The changes of plasma 5-hydroxytryptamine (5-HT) concentration were observed at T0 and 30 min after electric stimulation.

RESULTSThe differences were not significant in MAP, HP and SpO2 at each time point of the three groups (all P> 0.05). The differences were not significant in bleeding and application of oxytocin, ephedrine and atropine during operation (all P > 0.05). The scores of nausea and vomiting in the group A during T1 to T4 were lower than those in the group B and group C (all P < 0.05). In the group A, 30 min after transcutaneous acupoint electric stimulation, plasma 5-HT concentration was lower than those in the group B and group C (both P < 0.01).

CONCLUSIONThe transcutaneous acupoint electric stimulation apparently relieves nausea and vomiting during and after cesarean section and the mechanism is relevant with the decrease of plasma 5-HT concentration.

Acupuncture Points ; Adult ; Cesarean Section ; adverse effects ; Electric Stimulation ; Female ; Humans ; Postoperative Nausea and Vomiting ; blood ; etiology ; therapy ; Pregnancy ; Serotonin ; blood ; Young Adult

Objective To study the effect of transcutaneous electrical acupoint stimulation(TEAS) on endtidal concentration of sevoflurane in upper abdominal operation.Methods The use of prospective,randomized,blinded principles.A total of 50 patients underwent selective epigastric operations with ASA Ⅰ - Ⅱ were randomly divided into group A(25 cases) and B(25 cases).In group A,TEAS was performed and sevoflurane was inhaled during operation.In group B,only sevoflurane was inhaled and TEAS was not performed during operation.Electrical stimulation on Nei-guan,He-gu and Zu-sanli was performed for 30min before induction of anesthesia in group A and meanwhile patients in group B were waiting for 30min in operating room.After intubation,in group A,TEAS was performed persistently and sevoflurane was inhaled,meanwhile remifentanil was infused persistently during operation.In group B,only sevoflurane was inhaled and remifentanil was infused persistently during operation.At time points:before TEAS( T0 ),skin incision( T1 ),exploratory laparotomy( T2 ),30min after exploratory laparotomy ( T3 ),60min after exploratory laparotomy( T4 ),blood glucose and angiotensin Ⅱ were measured,recorded 10min after the start of surgery,once for each end-tidal sevoflurane concentration.Results End-tidal concentration of sevoflurane of group A ( 1.4 ± 0.2 ) ％,was significantly lower than group B( 1.9 ± 0.4 ) ％ ( t =3.147,P ＜ 0.01 ).Cortisol and angiotensin Ⅱ were increased at T1 and T2 compared with T0 in both groups(F =2.256,2.432,2.132,2.334,all P＜0.05).Cortisol and angiotensin Ⅱwere decreased in group A compared with in group B at T1 ～T4(t =2.159,2.232,2.453,2.602,al1 P ＜0.05).Conclusion TEAS can decrease end-tidal concentration of sevoflurane and stress response.TEAS combined with sevoflurane has synergistic effect on general anesthesia.

Objective: To study the correlation between serum resistin (SR) level and blood pressure in patients with type 2 diabetes mellitus (T2DM) complicated hypertension. Methods: A total of 124 patients with T2DM complicated hypertension (T2DM + hypertension group), 85 patients with pure T2DM (pure DM group) and 71 normal subjects (normal control group) were enrolled. According to blood pressure level, T2DM + hypertension group was further divided into stage 1 subgroup (n=34), stage 2 subgroup (n=43) and stage 3 subgroup (n=47). Peripheral venous blood was taken to measure levels of SR and other indexes in three groups. Logistic multi-factor regression analysis was used to analyze the risk factors affecting blood pressure level. Kendall’s tau-b correlation analysis was used to analyze the correlation among SR, fasting insulin, quantitative insulin sensitivity check index, homeostasis model-insulin resistance index and blood pressure level. Results: Compared with normal control group, there were significant rise in SR levels [(7.21±2.65) ng/ml vs. (19.87±3.67) ng/ml vs. (31.32±3.89) ng/ml] in pure DM group and T2DM + hypertension group, and that of T2DM + hypertension group was significantly higher than that of pure DM group, P<0.01 all. Logistic multi-factor regression analysis indicated that SR level was an independent risk factor influencing blood pressure level of patients (R2=0.087, P<0.05). Kendall’ s tau-b correlation analysis indicated that SR level was significantly positively correlated with blood pressure level of patients with hypertension (r=0.202, P=0.001); after other influencing factors were controlled, the significant positive correlation still existed between them (r=0.233, P=0.022). Conclusion: Serum resistin level rise is a risk factor of patients with type 2 diabetes mellitus complicated hypertension, and it is significantly positively correlated with their blood pressure level.

Objective To study the safety and efficacy of transpedicular osteotomy en bloc lamina resection to treat thoracic spinal stenosis.Methods A retrospective study of 23 consecutive patients underwent transpedicular osteotomy en bloc lamina resection from June 2004 to December 2008,including 12 males and 11 females,with a mean age of 46 years(range,38-62 years)was conducted.The courses of diseases were 1.5 to 20 months with an average of 6.5 months.There were 18 cases caused by thoracic ossification of ligamentum flavum(OLF),4 cases caused by ossification of posterior longitudinal ligament(OPLL)and 1 case caused chondroma.Preoperative CT and MRI examinations showed that all patients got spinal cord compression.Preoperative ASIA Grade was A for 1 case,B for 3 cases,C for 7 cases and D for 13 cases.Postoperative neurological status was evaluated by ASIA grade system.Results The postoperative follow-up duration ranged from 16 to 58 months(mean 30 months).The operation time varied from 90 to 210 min,with the average of 163 min.Blood loss varied from 600 to 3200 ml,with the average of 2150 ml.Pedicle screws were used in 10 cases with T9-T12 stenosis,and dura excisions were repaired by lumbodorsal fascia in 5 cases.Cerebrospinal fluid leakage occurred in 2 cases.Postoperative ASIA grade showed that there was A for 1 case,B for 2 cases,C for 2 cases,D for 5 cases and E for 13 cases.Conclusion Transpedicular osteotomy is a good approach,which avoid sclerotic cortex and ossified ligamentum flavum,to resect en bloc lamina with with shorter operative time and less blood loss.

Objective To analyze the differences of biochemical and immunological indicators in gender or Lee′s classification of IgA nephropathy ( IgAN) to provide laboratory evidence for clinical diagnosis and treatment of IgAN.Methods Retrospective cohort study.The information of biochemical and immunological indicators of 213 in-hospital patients which were admitted in Chinese PLA General Hospital in June to December, 2012.The data were collected and analyzed with t-test, non-parameter analysis, Pearson correlation analysis, ROC curves analysis and Logistic regression analysis according to gender or Lee′s classification ( Lee′s≤3 group and Lee′s>3 group).Results In this study, the average age and sex ratio of patients with IgAN was ( 35.0 ±10.6 ) years old and 2.04∶1.00.T-test and non-parameter analysis indicated homocysteine(HCY), immunoglobulin E (IgE), immunoglobulin M (IgM), prealbumin (PA), ceruloplasmin ( CP) ,α1-acidoglycoprotein(α1-AGP) , albumin ( Alb) ,α2-globulin(α2-G) andγ-globulin (γ-G) had significant difference in gender (P<0.05).And cystantin-C (CYS-C), HCY, complement 4 (C4),β2-microglobulin(β2-MG), PA, α1-AGP, α1-globulin(α1-G), immunoglobulin G (IgG), IgM and transferrin ( TF ) had significantly different in Lee′s classification ( P<0.05 ).ROC curves analysis showed that the areas under curves of CYS-C andβ2-MG were 0.891 and 0.839 respectively;the sensitivity was 90.2%and specificity was 75.3% when cutoff value of CYS-C was 1.56 mg/L; the sensitivity was 80.3%and specificity was 78.8% when cutoff value of β2-MG was 0.275 mg/dl.Logistic regression analysis showed that CYS-C ( OR: 31.380, 95% CI: 10.808 -91.113, P=0.000 ) and HCY ( OR:1.035, 95%CI:1.002-1.069, P=0.040) were introduced into the model after twice variable selections.ROC curve of CYS-C combined with HCY for classifying Lee′s classification showed that the sensitivity, specificity, Jorden index and AUC were 0.843, 0.862, 0.705 and 0.894 ( P=0.000 ) , respectively.Conclusions CYS-C,β2-MG, PA and HCY were valuable indicators for Lee′s classification.CYS-C andβ2-MG had high correlation with Lee′s classification, which indicated that these two tests were related to the severity of IgAN.CYS-C combined with HCY could improve the diagnostic efficiency of IgAN Lee′s classification.Combination of biochemical and immunological indicators could improve the accuracy of Lee′s classification and provide effective laboratory evidence for clinical treatment of IgAN.

Objective To investigate the methods, feasibility, outcome and indications of atlantoaxial pedicle screw system in the treatment of upper cervical injury. Methods Thirteen patients with upper cervical injury were treated by atlantoaxial pedicle screw system. There were four patients with old odontoid fractures, two with new odontoid fractures (Aderson ⅡC), three with rapture of the transverse ligament of C1 and four with C1 fracture. Results A total of 26 pedicle screws and 26 pedicle screws were implanted. The mean operation time and perioperative blood loss were 2.6 hours and 470 ml, respectively. No injury to the vertebral artery and spinal cord was observed. All patients were followed up for 4-25 months (mean 13 months). The clinical symptoms were improved to some extent according to Japanese Orthopedic Association scoring system, with improvement rate of 72%-91% (mean 81%). The screws were verified to be fixed in a proper position, and no hardware broken or loosening was observed except for one C1 screw penetrating the medial superior cortex of lateral mass for 3 mm without affecting occipito-aflantal motions. All patients had a solid bony fusion 3-6 months later. Conclusion The atlantoaxial pedicle screw system is feasible in the treatment of upper cervical injury with the advantages of better outcomes and wider indications.

Objective To investigate the clinical features and prognosis of recurrent gastric cancer. Methods The clinical data of 147 patients with recurrent gastric cancer was reviewed. Risk factors correlated with tumor recurrence and recurrent intervals were studied by logistic regression analysis. Survival analyses and comparisons were performed using Kaplan-Meier plots, the log rank test and the Cox proportional hazards model. Results Patients were divided into an early recurrence group consisting of 86 patients (recurred within one year after surgery) and a late recurrence group of 61 patients (recurred one year or more after surgery). There were significant difference in size of primary tumor, Borrmann stage, type of gastrectomy, T stage, N stage, TNM stage between the two groups(P ＜0.05). Multivariate analysis showed that the TNM stage and N stage independently influenced the recurrent time ( P ＜ 0. 05 ). In univariate survival analysis, post-gastrectomy chemotherapy(P ＜0. 05) , T stage (P ＜0. 05) , N stage(P ＜0.01) , TNM stage ( P ＜ 0. 01) , recurrence-free interval (P ＜ 0. 01) and reoperation (P ＜ 0.01) were significantly correlated with the prognosis. In multivariable analysis, TNM stage(P ＜0. 01) , recurrence-free interval ( P ＜ 0. 05 ) and reoperation ( P ＜ 0. 05 ) were independent factors predicting recurrence. Conclusions The TNM stage and N stage were the important factors predicting the time of recurrence after curative resection for gastric cancer. Patients with recurrent gastric cancer have poor prognosis and reoperation was associated with an improved survival in patients with recurrent gastric cancer.

Objective To investigate the changes in the expression of hippocampal occludin and claudin-5 after operation in aged rats.Methods Eighty-one healthy male Wistar rats, aged 16-18 months, weighing 400-500 g, were randomly assigned into 3 groups (n =27 each) using a random number table: normal control group (group C), skin incision group (group I) and splenectomy group (group S).Splenectomy was performed in group S.Only skin incision and closing were performed in group I.Morris water maze test was performed before operation and on 1, 3 and 7 days after operation.The escape latency and the percentage of time spent at the target platform quadrant were recorded.Nine rats randomly selected from each group were sacrificed after the end of the test, and the hippocampi were isolated to detect the expression of occludin and claudin-5 by Western blot.Results Compared with group C, the escape latency was significantly prolonged, the percentage of time spent at the target platform quadrant was decreased, the expression of hyperphosphorylated occludin and claudin-5 was down-regulated, and the expression of hypophosphorylated occludin was up-regulated on 1 and 3 days after operation in group S (P＜0.05).Conclusion The mechanism of postoperative cognitive dysfunction is related to the downregulated expression of hippocampal hyperphosphorylated occludin and claudin-5 in aged rats.

Objective To evaluate the accuracy of cerebrospinal fluid (CSF) amyloid beta 42 (Aβ-42) to tau level ratio (Aβ-42/tau) in predicting postoperative cognitive dysfunction (POCD) in elderly patients.Methods Eighty ASA physical status Ⅱ or Ⅲ patients of both sexes,aged 65-85 yr,undergoing elective total hip or knee replacement under combined spinal-epidural anesthesia,were enrolled in the study.Epidural catheter was placed at T3,4 interspace,and after a catheter was successfully placed into the subarachnoid space,CSF 2 ml was obtained to measure Aβ-42 and tau levels (units:pg/ml),and the ratio between them was calculated.Neuropsychological tests were performed at 1 day before surgery and 1 week after surgery.The Z score was used to identity POCD.The cut-off value for POCD and nonPOCD patients was determined by using ROC curve.Results Thirty-two patients were diagnosed with POCD,and the incidence was 40％.The Aβ-42/tau was 2.6±0.3 and 1.7±0.4 in non-POCD and POCD groups,respectively,and the ratio was significantly lower in POCD group than in non-POCD group.The sensitivity of CSF Aβ-42/tau in predicting POCD was 91.7％,the specificity was 81.2％,and Youden index was 0.7.ROC curves revealed that the cut-off value for POCD and non-POCD patients was 2.0.Conclusion CSF Aβ-42/tau can accurately predict the occurrence of POCD in elderly patients.

Objective To evaluate the inhibitory effects of shRNAs targeting genes encoding viral capsomeres VP1-VP4 on enterovirus 71 (EV71) replication when used alone or in combination.Methods Short hairpin RNAs (shRNAs) targeting genes encoding VP1-VP4 protein of EV71 were designed and then respectively inserted into lentiviral vector pLKD-CMV-GFP-U6 to construct the recombinant plasmids.The expression plasmids together with psPAX2 and pMD2.G were transfected into 293T cells to induce the expression of recombinant lentiviruses,which were collected on the third day after transfection.The titers of recombined lentiviruses were determined by real-time PCR.The effects of shRNAs used alone or in combination on the expression of EV71 at mRNA and protein levels were respectively detected by real-time PCR and Western blot.Results The inhibitory effects of shRNAs on EV71 replication showed no significant differences among various strains (isolated from fatal cases,severe cases,mild cases and FY0805) (P＞0.05).Their inhibition rates were 51.6％ (sh-VP1-1),85.1％ (sh-VP1-2),76.4％ (sh-VP1-3),57.5％ (sh-VP2-1),81.4％ (sh-VP2-2),79.5％ (sh-VP2-3),68.9％ (sh-VP3) and 56.7％ (sh-VP4) respectively,and they were in a dosage dependent manner.sh-VP1-2 in combination with sh-VP2-2 showed the highest inhibition rate reaching up to 96.6％.Moreover,shRNAs used in combination showed better effects than any one used alone even at double dosage.Conclusion All shRNAs targeting viral capsid VP1-VP4 genes showed inhibitory effects on EV71 replication with inhibition rates over 50％ and the effects could be strengthened when using shRNAs in combination.