Objective To compare the efficacy and safety of topical anesthesia,conscious sedation and intravenous anesthesia during endoscopic varices ligation(EVL).Methods Patients underwent EVL were divided into 3 groups to receive different anesthetic methods,namely topical anesthesia,conscious sedation and intravenous anesthesia,with 50 subjects in each group.The changes of vital signs,the tolerance to stimulation of the procedure,the time of operation,the rate of complication were recorded and compared between 3 groups.Results The procedure of EVL were completed in all patients.In topical anesthesia group,40(80%)patients had nausea and vomiting,9 cases(1 8%)tried to pull out the endoscopy.The mucosa at the entrance of the esophagus were injured in 10 cases(20%).Massive bleeding occurred in 4 patients(8%)during operation because of nausea and vomiting.In conscious sedation group,only 7 patients(14%)had mild nausea and vomiting,and no complication of variceal bleeding occurred.The mucosa at the entrance of the esophagus was injured in 5 cases(10%).In intravenous anesthesia group,no patient had nausea or vomiting.The respiratory rate,heart rate and mean artery pressure decreased during the procedure,but without significant difference(P＞0.05).The operation time in intravenous anesthesia group WaS shorter than that in other two groups,but without significant difference(P＞0.05).Conclusion EVL can be completed under 3 different anesthetic methods,while EVL under conscious sedation is more effective and safe.

Objective To evaluate the efficacy of narrow-band imaging (NBI) in diagnosis of color-ectal neoplasm. Methods A total of 96 colorectal neoplasm from 78 patients were observed under NBI, and the findings were compared with those from magnifying chromo-endoscopy and pathologic examinations. Re-suits The sensitivity of conventional colonoscopy in diagnosis of polyps was 78. 7%, which was increased to 99% (P < 0. 05) under NBI, with the clear identification of the shape and boundary of the lesions. Magnif-ying NBI colonoscopy provided images of pit patterns similar to those from chromo-endoscopy in diagnosis of type Ⅱ , ⅢL, Ⅳ and ⅤN, which showed better recognition than conventional colonoscopy, but less sensitiv-ity than chromo-endoscopy. Superficial vascular morphologic features could be better classified with NBI, with sensitivity of 100% and specificity at 87. 8%, which was superior to conventional colonoscopy but infe-rior to chromo-endoscopy. Conclusion Both chromo-endoscopy and NBI colonoscopy have better sensitivity and specificity in detection of colon polyps, while chromo-endoscopy reveals clear superficial structure of le-sion and pit pattern, and NBI demenstrates capillary morphology, which can distinguish neoplasm from non-neoplasm colorectal lesions. NBI, easy and convenient to switch, is an effective technique to make early di-agnosis of colorectal neoplasm.

In order to study the relationship between Staphylococcal nuclease(SNase) and diabetes mellitus,genetic engineering bacteria E.coli BL21/pET28a-His-SNase was constructed,the expression of soluble extracellular protein SNase was induced and the a preliminary research was made on it.An expression vector pET28a-His-SNase plasmid containing the His-SNase gene was constructed and transformed into E.coli BL21 (DE3) competent cells.The protein was induced by lactose and purified by ultrasound destruction and Ni-affinity chromatography,respectively.It was then analyzed by SDS-PAGE and Western blot.The enzymatic properties for SNase has been preliminary studied as well.Results indicated that the purity of the correctly expressed fusion protein HisSNase was over 85％.SNase showed good activity within a wide range of pH and good heat resistance.This experiment might be a foundation work for the further study on the relationship between SNase and with diabetes.

Objective To investigate the proper anesthetic administration schemes in pediatric patients undergoing surgery of transcatheter ventricular septal defect closure .Methods A total of 120 pediatric patients with congenital heart diseases of ventricu-lar septal defect ,aged 3-9 years old with ASA physiological status Ⅰ or Ⅱ ,undergoing surgery of transcatheter ventricular septal defect closure were randomly divided into 4 groups with 30 each :ketamine group( K group) ,propofol group( P group) ,ketamine associate with propofol ( KP group) ,sevoflurane group( S group) .Spontaneous respiration were maintained in K ,P ,PK groups ,but mechanical ventilation was adopted after endotracheal tube intubation in S group .The values of MAP ,HR ,SpO2 ,RR were recorded at the following time points :before anesthesia ,incision immediate ,procedure in heart ,completion of operation ,and 30min after oper-ation .awaking time and adverse reactions were recorded .Results Anesthesia and operation were carried out successfully in all pa-tients .Awaking time in P group and KP group markedly shorter than K group (P<0 .01) .The incidence rate of adverse reactions such as cough ,asphyxia and body motion in pediatric patients by mechanical ventilation and sevoflurane inhaled markedly less than other groups(P<0 .01) .Conclusion It is safe that pediatric patients received mechanical ventilation and sevoflurane inhaled after endotracheal intubation undergoing surgery of transcatheter ventricular septal defect closure .

Objective To observe the changes on the neurogenic inflammation-related factors in the dura mater of the rat model of migraine and investigate the possible mechanism of the pain of migraine.Methods SD rats were randomly divided into stimulation group ( n = 32 ) and sham group ( n = 32 ).Unilateral trigeminal ganglion was stimulated to induce migraine for rats in the stimulation group. Rats in the sham group were subjected to sham surgery. The levels of calcitonin gene-related peptide (CGRP) in the blood of jugular vein in the stimulation side were measured by radioimmunoassay. The levels of histamine in peripheral blood and prostaglandin E2 (PGE2 ) in the dura mater were determined by enzyme-linked immunosorbent assay (ELISA). The number of mast cells and percentage of their degranulation in the dura mater were determined under a microscope after toluidine blue staining. Cyclooxygenase 2 (COX-2)expression in the dura mater was evaluated by immunohistochemical staining and western blot analysis. Results In the stimulation group, the level of CGRP in the ipsilateral jugular vein was (82. 84 ± 16. 24)pg/ml and in the sham group was (59. 20 ±11.66) pg/ml (t = -3.34, P ＜ 0. 05 ). The level of histamine in the ipsilateral jugular vein was ( 11.59 ± 1.20) ng/ml and in the sham group was (9. 87 ±0. 88) ng/ml (t = - 3. 27, P ＜ 0. 05). The number of mast cells in the dura mater decreased from 15.46 ± 2. 40 in the stimulation group to 11.63 ± 1.67 in the sham group ( t = 3.71, P ＜ 0. 05 ). Degranulation of mast cells in the dura mater significantly increased from 14. 09% ±4. 53% in the sham group to 29. 10% ±9. 39% in the stimulation group (t = - 4. 07, P ＜ 0. 05 ). The level of PGE2 in the stimulation group was ( 382. 30 ±20. 90) pg/ml and in the sham group was (80. 70 ± 10. 60) pg/ml (t = - 16. 674, P ＜0. 05). The number of COX-2 positive cells significantly increased from 42. 00 ± 18.40 in the sham group to 139.00 ±20. 50 in the stimulation group (t = -7. 994, P ＜0. 05). Also the COX-2 protein level was elevated from 19. 50 ±9. 20 in the sham group to 359. 20 ±21.90 in the stimulation group (t = -5. 190, P ＜0. 05). Conclusions Electrical stimulation on the unilateral trigeminal ganglion induces neurogenic inflammation in the dura mater. Changes on the neurogenic inflammation-related factors are probably the essential pathophysiological mechanism underlying the pain in migraine.

Objective To explore the treatment of multifocal lower extremity arteriosclerosis oblitera-tions. Methods From March 2014 to September 2014, combined procedures were performed on 30 lower limbs in 30 patients with multifocal lower extremity arteriosclerosis obliterations for revascularization. All the patients underwent endovascular , 20 of whom received endarterectomy , 10 received artery emboloctomy , and 8 received profundaplasty. The rates of technical success and clinical success were observed. The patients were followed up for 6-12 months to observe the total patency rate and rate of limb reservation. Results The technical success rate was 100%. The perioperative complication rate was 30% (9/30). 29 limbs gained improvement with differ-ent degree and the clinical success rate was 96.67% (29/30). The ankle-brachial index elevated 0.37 ± 0.19 on average (P < 0.001). Primary patency rate was 90% and 73% at 6 and 12 months, and 12-month limb reserva-tion rate was 97.67%. Conclusions The combined procedures for complex lower extremity arteriosclerosis oblit-erations have a higher short- to mid-term patency rate and limb reservation rate.

This study was aimed to improve the transfer rate of sinomenine in the intermediate product of Caulis Sinomenii in order to optimize the purification process of intermediate product ofCaulis Sinomenii fromTong-An (TA) injection. The transfer rate of sinomenine and the stability of fingerprints in the intermediate product of Caulis Sinomenii were used as indexes for the investigation on the impact from different pH ofCaulis Sinomenii extract before extraction. The transfer rate of sinomenine was used as an index for the investigation on the impact by different pH of hydrochloric acid created to dry extract solution. The transfer rate of sinomenine was used as an index for the investigation of four separation ways, which included the vacuum filtration, plate and frame filters, high-speed tube separator, and flat direct centrifuge, on the liquid separation of sinomenium acutum acid. The results showed that the pH ofCaulis Sinomenii extract before extraction was 10-11; the transfer rate of sinomenine was the highest in the extraction process and the fingerprints of TA injection was stable. The pH of hydrochloric acid was 2.0-2.5; and the highest transfer rate of sinomenine in acid dissolution process was 92.94%. The high-speed tube separator had the best separation to sinomenium acutum acid-dissolving liquid. The highest transfer rate of sinomenine was 93.34%. It was concluded that the optimized process can effectively improve the transfer rate of sinomenine in the intermediate product ofCaulis Sinomenii. Meanwhile, fingerprints of the product were stable. The process was simple with good repeatability.

Objective To analyse the risk factors for lymph node metastasis of early colorectal cancer and the therapeutic indication for endoscopy.Methods The clinical data of the 269 early colorectal cancer patients who underwent surgical treatments between January 2009 and December 2013 in the West China hospital of Sichuan University were analyzed retrospectively.Pathologic features were compared between different histological types and investigated by univariate and multivariate analysis of their possible risk factors for lymph node metastasis.Results Univariate analysis showed that tumor size (P =0.029),depth of tumor invasion (P =0.006),histological type (P =0.000) and lymphatic involvement (P =0.035) were correlated with lymph node metastasis.Multivariate analysis revealed that tumor size (OR =5.385,95％ CI:1.156-25.075,P =0.032)and histological type (OR =5.145,95％ CI:1.553-17.053,P =0.007) were independent risk factorsfor lymph node metastasis.Comprehensive analysis showed that lymph node metastasis could not be found in patients with tumor invading the mucous layer.However,lymph node metastasis occurred if the tumor invaded the submucous layer.The larger and less differentiated tumor was,the higher occurrence of lymph node matastasis would be (P ＜ 0.05).Conclusion Endoscopic resection is recommended for those with early colorectal cancer localized in the mucous layer and without lymph node metastasis.It is recommended that patients with submucosal carcinomas undergo a preoperative endoscopic ultrasonography or pathological screening for the most appropriate surgical treatment,as the larger and the lower differentiated the tumor is,the higher chance the lymphatic metastasis is.

Objective To Btudy effect of standardized acupuncture combined with rehabilitation therapy (function training)on improvement of comprehensive function among patients with stroke in communities,Changning District of Shanghai.Methods One hundred and seventy-six stroke patients were divided into rehabilitation therapy group(88 cases)and control group(88 cages)with block randomization.Patients in rehabilitation therapy group were treated with standardized acupuncture combined with function training in addition to regular medical treatment,and patients in control group regular medical treatment only.All the patients were evaluated with functional comprehensive assessment(FCA)scale by the end of 2-and 5-month of treatment,respectively.Results By the end of 5-month of treatment,scores of FCA in both groups increased significantly (P＜0.01),as compared to those before treatment,more in rehabilitation therapy group than that in control group(P＜0.05).Conclusions Effect of standardized acupuncture combined with rehabilitation therapy Can obviously improve their comprehensive function among stroke patients in communities.

Objective To study the impact of blood transfusion on postoperative complications of pancreaticoduodenectomy.Methods The medical data of 356 patients who underwent pancreaticoduodenectomy from January 2005 to December 2011 were retrospectively analyzed.242 patients in the transfusion group received blood transfusion while the remaining patients in the non transfusion group received no blood transfusion.Results The rates of pancreatic fistula and pulmonary infection,mean operative time,intraoperative blood loss,and hospital stay were 17.8％,16.5％,6.4 h,920.0 ml and 29.1 d in the transfusion group compared with 8.8％,6.1％,5.4 h,150.0 ml and 25.9 d in the non-transfusion group,respectively (P＜0.05).However,there were no significant differences between the two groups in the rates of biliary fistula,gastrointestinal and intraabdominal bleeding,delayed gastric emptying and death.Conclusions Patients undergoing pancreaticoduodenectomy in the non-transfusion group had significantly lower rates of pancreatic fistula and pulmonary infection,shorter operative time and hospital stay,and less intraoperative blood loss.This study suggested that a reduction in intraoperative blood loss by advanced instruments and techniques,with operations carried out by experienced pancreatic surgeons in specialized pancreatic center,could result in a significantly lower postoperative complication rate.