Objective: To improve the safety of anesthesia of the neonates at high risk during surgical operation. 　Methods:Before the operation, Anisodamine, Ketamine and Vecuronium bromide were injected intravenously with dosage of 0.06mg, 2mg*kg-1 and 0.08-0.1mg*kg-1, respectively. Tracheal cannula or topical anesthesia using 1% of lidocaine hydrochloride was performed. The tracheal cannulation was performed after administration of sodium hydroxybutyrate and Ketamine by injection with dosages of 50-80 mg*kg-1 and 2mg*kg-1 body weight. Anesthesia apparatus and combinative anesthesia were used. The concentrations of SpO2 were monitored during the operation. A dosage of 1-2mg*kg-1 body weight was used for resuscination of the patients after the operation. 　Results: A total of 100 cases of operation were performed using the regime of anesthetic intervention described above. A 100% of success rate was achieved and no death occurred during the operation. 　Conclusion:Significant improvement of safety in anesthesia of the neonates at high risk during surgical operation can be achieved with sufficient preoperational preparation, adequate monitoring during the operation and rational use of anesthetics as well as restrict selection of suitable anesthetical interventions.

Objective To develop the Elderly Frailty Assessment Scale and test its reliability and validity.Methods The primary item pool was formulated through literature review,compounding existing instruments measuring elderly frailty and group meeting.The items were selected by expert consultation.Totally 420 elderly adults were selected to test the reliability and validity and SPSS 20.0 was used to analyze data.Results The Elderly Frailty Assessment Scale consisted of 35 items;the exploratory factor analysis identified four principal factors which explained 72.685％ of the total variance.The item content validity index ranged from 0.824 to 1,and the scale content validity index was 0.932.The Cronbach's α coefficient of the scale was 0.952 and test-retest reliability was 0.937.Conclusion The Elderly Frailty Assessment Scale is reliable and valid,which can be used to evaluate elderly frailty.

Objective To investigate the mechanism of the permeability change in the blood brain barrier(BBB)at early stage of infectious brain edema which was pretreated with LPS.Methods PMNs were isolated and purified.The concentration of Glu was measured in the supernatant without cells.The rat BMECs were primarily isolated and cultured.The permeability of BMECs waB evaluated by measuring the passing rate of 125 I-BSA via γ ray counter.The expression of NMDAR1 on BMECs was evaluated.Results The concentration of Glu in the LPS preconditioning PMNs subgroup at 5 rain time point was highest.In each group conditioned for 240 min,the permeability index of Bake average of the LPS preconditioning PMNs extract group was highest(P＜0.01).The expression of NMDARI increased in the LPS preconditioning PMNs extract group was more than that in other groups.Conclusions The research showed for the first time that the concentration of Glu increased after LPS preconditioning and the Glu excreted by PMNs can promote the permeability of BMECs and change the function of BBB,which possibly may be related the mechanism of NMDAR1 expression increased in BMECs.

Objective To evaluate effect of construction with dual plates via olecranon osteotomy approach in treatment of type C distal humeral fractures.Methods The study involved 19 patients with type C distal humeral fractures treated by olecranon osteotomy and double plate fixation between July 2008 and April 2010,including 11 males and 8 females at a mean age of 49.2 years (range,27-71 years).Fractures were causes by traffic accidents in 10 patients,tumble in seven and fall from height in two.According to Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification,there were nine patients with type C2 and 10 with type C3 fractures.Besides,two patients were complicated by ulnar nerve injuries and one by radial nerve injury.Results Primary wound healing was achieved in all patients after operation.All patients were followed up for average 15.9 months (range,12-20 months).X-ray films revealed that both fracture and olecranon osteotomy sites were healed in average 12 weeks (range,8-18 weeks).No fixation failure,myositis ossificans,malunion,delayed union or disunion occurred during the follow-up.Average Mayo elbow performance score (MEPS) was 94.8 points (range,75-100 points) at the last follow-up,which showed excellent results in 14 patients,good in three,and fair in two,with excellence rate of 90％.Conclusions Double plate fixation via olecranon osteotomy gains advantages of solid fixation and early functional exercise in treatment of comminuted intercondylar fractures of humerus.Moreover,postoperative outcome is satisfactory.

BackgroundRevascularization and statin therapy are routinely used in the management of stable coronary artery disease. However, it is unclear whether the estimated high-density lipoprotein (HDL) particle size (eHDL-S), the ratio of HDL cholesterol (HDL-C) to apoprotein A-I (apoA-I), is associated with the clinical outcomes of diabetic patients with stablecoronary artery disease (CAD).MethodsWe per-formed a prospective cohort study of 328 patients diagnosed with stable CAD by coronary angiography. Patients were followed up for a mean duration of 12 months. The patients were divided into three groups by the tertiles of eHDL-S: low eHDL-S (< 0.71,n= 118); interme-diate eHDL-S (0.71-0.79,n= 111); and high eHDL-S (> 0.79,n= 99). The associations between the baseline eHDL-S and short-term out-comes were evaluated using the Kaplan-Meier method and Cox proportional regression.Results The low eHDL-S group had higher trig-lyceride, hemoglobin A1c, uric acid, and leukocyte count than the other groups. During the follow-up period, 47/328 patients experienced a pre-specified outcome. According to the Kaplan-Meier analysis, the incidence of pre-specified outcomes was lower in the high eHDL-S group (P = 0.04). However, eHDL-S was not independently associated with adverse outcomes in Cox proportional hazards regression (haz-ard ratio (HR): 0.23, 95% confidence interval (95% CI): 0.01-11.24,P = 0.493).ConclusionAlthough the eHDL-S was associated with inflammatory biomarkers, it was not independently associated with the short-term prognosis of diabetic patients with stable CAD in the era of revascularization and potent statin therapy.

Objective To evaluate and compare the cellular immune response induced by live at-tenuated and inactivated hepatitis A vaccines. Methods A total of 18 healthy volunteers were enrolled in this study. They were divided randomly into 2 groups and injected by inactivated hepatitis A vaccine and at-tenuated hepatitis A vaccine, respectively. All volunteers' heparinized venous blood was separately collected for testing anti-HAV antibody and the responses of PBMC. The level of IFN-γsecreted by effect T cell was tested by ELISPOT. The percentage of lymphocytes secreting IFN-γ from CD+ and CD8+ T cell was tested by intracellular cytokine staining (ICS) technique. The concentrations of IFN-γ, IL-2, IL-10 and IL-4 in the culture supernatants(grown in the presence or absence of HAV) of the in vitro HAV-primed PBMC were determined by Luminex. Results These two types of vaccines can elicit specific anti-HAY antibodies and no statistical significance between them were observed. At the early stage after inoculation, T cell-mediated immune responses with the secretion of IFN-γ were detected in vaccines inoculated with either type of vac-cines. There was a tendency that the cellular immune responses level induced by inactivated hepatitis A vac-cine was higher than that by live attenuated hepatitis A vaccine during 1 to 3 weeks post-injection. The booster inoculation could significantly increase the level of cellular immune responses induced by the inacti-vated vaccine. Conclusion Both live attenuated and inactivated HAV vaccines can elicit an earlier specific humoral and cellular immune responses, and booster inoculation of inactivated HAV vaccine can rapidly and intensively evoke memory immune responses.

Objective To observe the role of chronic inflammation in the development of atherosclerosis (AS) by analyzing the expression of TLR4 and NF-κB in artery endothelium. Methods To construct the atherosclerotic animal model, the balloon catheter was used to injure common carotid artery and rabbits were fed the high cholesterol diet. All the rabbits were divided into three groups: control group with the normal diet, high cholesterol diet-fed group and model group (balloon-injured common carotid artery and the high cholesterol diet fed rabbits). The rabbits were sacrificed after 8 weeks and their tissues were collected. Then morphological changes of rabbit common carotid artery were observed by light microscope. The expression of TLR4 and NF-κB in endarterium was displayed using immunochemistry method. Results Both hyperlipidemia and exterior inflammatory stimulation promoted the expression of TLR4 and NF-κB in vascular endothelium (P ＜ 0.01 ). And when both of them were present, the level of TLR4 and NF-κB expression would get higher even than that affected by one of them( P ＜ 0.01 ). Conclusion Both hyperlipidemia and chronic inflammatory process can improve the expression of TLR4 and NF- κB in vascular endothelium in different degree; the inflammatory stimulation would promote the atherosclerosis to some extent; TLR4/ NF-κB would play a role as a bridge between the internal environment changes and the arterial morphological changes.

Objective To investigate the relationships and clinicopathologic features of the expressions of cytochrome P450 2E1 (CYP2E1) and PC cell-derived growth factor (PCDGF) in esophageal squamous cell carcinoma (ESCC),and to determine the role of CYP2E1 and PCDGF in angiogenesis.Methods The expression levels of CYP2E1 and PCDGF in 42 surgical cancer specimens and 20 adjacent normal esophageal mucosa specimens from patients with ESCC were detected by immunohistochemistry.Results The positive expression rates of CYP2E1 and PCDGF in ESCC were 83.3 ％ (35/42) and 88.1％ (37/42),respectively,which were obviously higher than those of normal mucosa (P ＜ 0.05).Expression of PCDGF was correlated with the degree of histological differentiation (r =0.444,P ＜ 0.05),depth of tumor invasion (r =0.332,P ＜ 0.05),lymph node metastasis (r =0.476,P ＜ 0.05),and TNM classification (r =0.450,P ＜ 0.05).The expression of CYP2E1 was negatively correlated with tumor tissue differentiation (r =-0.518,P ＜ 0.05),and positively correlated with depth of invasion in ESCC (r =0.388,P ＜ 0.05).The expression of CYP2E1 was related to that of PCDGF in the tumor (r =0.483,P ＜ 0.05).Conclusion The expressions of CYP2E1 and PCDGF are synergistically involved in tumor growth,infiltration andmetastasis.Overexpression of CYP2E1 and PCDGF can be used as the important predictors for evaluating the biological behavior of ESCC and predicting prognosis of patients.

Objective To assess the efficacy of ganciclovir to prevent and cure cytomegalovirus (CMV) infection after renal transplantation. Methods We searched PubMed, EMBASE, Cochrane Library, SCI, China Academic Journals Full-text Databases, Chinese Biomedical Literature Database, Chinese Scientific Journals Databases and Chinese Medical Association Journals to collect randomized controlled trials of ganciclovir to prevent and cure CMV infection after renal transplantation (up to June, 2009). Two reviewers extracted data independently using a designed extraction form. The quality of included trials was evaluated according to the Cochrane Handbook. RevMan 5.0 software was used for data analysis. Results Twelve randomized controlled trials were included. The results of meta-analysis showed that: ①Compared with no receive antiviral agents, ganciclovir couldn't lower CMV infection rate and disease rate in 3 months and 6 months after renal transplantation, but could lower CMV disease rate in 12 months. The delay between transplantation and CMV infection was significantly longer. ②Either valaciclovir or ganciclovir could lower CMV infection rate and disease rate after renal transplantation, without statistical difference. ③Compared with acyclovir, ganciclovir could lower CMV disease rate in 6 months after renal transplantation. ④Compared with CMV-IgG and valganciclovir, ganciclovir didn't have statistical difference in decreasing CMV disease rate (P=0.93;P=0.14). Conclusions Longer prophylaxis by ganciclovior may prevent CMV infection after renal transplantation. Its curative effect is similar to valaciclovir, CMV-IgG and valganciclovir, but better than acyclovir.

Objective To evaluate the value of flow cytometry ( FCM) for the differential diagnosis between myelodysplasia (MDS) subtype refractory cytopenia with multiple dysplasia (RCMD) and aplastic anemia (AA). Methods The flow cytometric data of bone marrow samples from 168 cases of RCMD and 77 cases of AA were analyzed retrospectively in blind, and its results were compared with gold standard to evaluate its diagnosis values. Results The specificity of abnormal of single immunophenotype in the surface of granulocytes and myeloblasts was high (range 75.3% -100% ) , but the sensitivity was very low (range 5.4%-50% ). In parallel tests, the sensitivity and specificity of the combination of CD+34 cells≥1% , myeloblasts ≥3% , abnormal expression of CD117 in granulocytes and loss of CD13 in myeloblasts or increased intensity of CD33 in granulocytes were higher than other combinations. The sensitivity and specificity of above combination were more than 62% and 92% , respectively. In the scoring method,different score was given to 8 markers according to different diagnostic value, which were CD+34 cells ≥1 % ,myeloblasts≥3% , abnormal expression of CD117 in granulocytes, loss of CD13 in myeloblasts, increased intensity of CD33 in granulocytes, loss of CD13 in granulocytes, loss of CD10 in granulocytes, and decreased SSC in granulocytes. The sensitivity and specificity were both high if we defined that the total score ≥1.5 was RCMD and the score < 1. 5 was AA. Conclusions The value of abnormal of single immunophenotype for differential diagnosis between RCMD and AA is low. Parallel tests can increase the diagnostic sensitivity obviously and not decrease the specificity. CD+34 cells≥1% , myeloblasts≥3% and abnormal expression of CO117 in granulocytes were the most important markers. The scoring method is precise to distinguish RCMD from AA.