Objective To investigate the effect of remifentanil on protein kinase C (PKC) activity during renal ischemia-reperfusion (I/R) in rats.Methods Seventy-five male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 5 groups (n=15 each) using a random number table:sham operation group (group S),I/R group,remifentanil group (group R),naloxone group (group N),and naloxone + remifentanil group (group NR).Renal ischemia was induced by clamping the bilateral renal arteries for 45 min using an atraumatic clamp followed by reperfusion.In R and NR groups,remifentanil 1.0 μg · kg-1 · min-1was infused via the caudal vein starting from 15 min before ischemia until 30 min of reperfusion.In N and NR groups,naloxone 0.3 mg/kg was injected via the caudal vein at 20 min before ischemia and 35 min of ischemia,respectively.The rats were sacrificed at 24 h of reperfusion and the kidneys were removed for determination of the ultrastructure of the renal tubular epithelial cells (using transmission electron microscope),activity of PKC in renal tissues (by ELISA),and expression of the PKC in renal tissues (by immuno-histochemistry).Results Compared with group S,the activity of PKC in renal tissues was significantly increased in the other four groups,and the expression of the PKC in renal tissues was up-regulated in group R.Compared with group I/R,the activity of PKC in renal tissues was significantlyincreased,the expression of PKC in renal tissues was up-regulated,and the pathological changes were attenuated in group R.Compared with group R,the activity of PKC in renal tissues was significantly decreased,the expression of PKC in renal tissues was down-regulated,and the pathological changes were aggravated in N and NR groups.Conclusion The mechanism by which remifentanil attenuates renal I/R injury may be related to up-regulation of PKC expression and increase in PKC activity through activating opioid receptors in rats.

Objective To compare the bispectral index score ( BIS) correlationbetween standard frontal sensor position and an alternative zygomatic position under general anesthesia with propofol combined with remifentanil during neurosurgery. Methods Twenty patients undergoing neurosurgery were enrolled. Everyone received total intravenous anesthesia by target-controlled infusion of propofol and remifentanil. Two BISTM Quatro sensors mounted on the frontal and zygomatic regions were connected to BIS VistaTM monitors on each patient during general anesthesia.Data from each position were collected and analyzed at the time of awakening ( t1 ) , intubation ( t2 ) , incision ( t3 ) , the end of surgery ( t4 ) , and extubation ( t5 ) . Results At t1 , zygomatic BIS(88.95±6.42) was significantly lower than frontal BIS (84.85±9.64,P<0.01).But during anesthesia,different of BIS value was no statistical significance between the standard frontal position and an alternative zygomatic position(P>0.05). Scatter plot analysis revealed a significant correlation between BIS of frontal positionand that of zygomatic position( R2=0.892,P=0.000) . Conclusion During the anesthesia maintenance period,the zygomatic position can be availably used as an alternative position for monitoring if the operative field renders the standard frontal position unavailable.

Objective To evaluate the effect of remifentanil on Toll-like receptor 2 (TLR2) mRNA expression during renal ischemia-reperfusion (Ⅰ/R) in rats.Methods Fifty-four male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 3 groups (n=18 each) using a random number table:sham operation group (group S),Ⅰ/R group and remifentanil group (group R).Renal Ⅰ/R injury was produced by clamping the bilateral renal arteries for 45 min followed by reperfusion in Ⅰ/R and R groups.Bilateral renal arteries were only exposed but not clamped in group S.Remifentanil 1.0 μg · kg-1 · min-1 was infused via the tail vein starting from 15 min before ischemia until 30 min of reperfusion in group R,while the equal volume of normal saline was given instead in S and Ⅰ/R groups.The animals were sacrificed at 15 min before ischemia and 6 and 24 h of reperfusion,and the renal specimens were obtained for examination of the pathological changes (with light microscope) and for determination of the contents of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) (by ELISA) and expression of TLR2 mRNA (by RT-PCR) and cell apoptosis (by double staining and flow eytometry).The apoptotic rate was calculated.Results Compared with group S,TLR2 mRNA expression was significantly up-regulated,and the contents of TNF-α and IL-6 and apoptotic rate were increased at 6 and 24 h of reperfusion in Ⅰ/R and R groups.Compared with group Ⅰ/R,TLR2 mRNA expression was significantly down-regulated,and the contents of TNF-α and IL-6 and apoptotic rate were decreased at 6 and 24 h of reperfusion in group R.The pathological changes were significantly attenuated in group R as compared with group Ⅰ/R.Conclusion The mechanism by which remifentanil reduces renal Ⅰ/R injury is related to down-regulation of TLR2 expression and decrease in TLR2 activity and inhibition of inflammatory responses in renal tissues and cell apoptosis in rats.

Objective To investigate the effects of chondroitin sulfate proteoglycans (CSPGs) degradation induced by chondroitinase ABC (ChABC) on the rat flash visual evoked potential (F-VEP) around the end of the critical period of visual development.Methods A total of 30 Long Evans rats were randomly divided into 3 groups according to their age of 14,21 and 35 d.Then in each group,5 animals served as CSPGs degradation model induced by ChABC microinjection into 5 sites of the rat cortex [750 nL (48 U/ml) for 1 site,for 2 times at a 3-day interval],and the other 5 rats served as normal control and received normal saline microinjection.Immunofluorescence microscopy and laser scanning confocal microscopy were used to determine the establishment of animal model.F-VEPs were evaluated in 7 d after first microinjection.Results In the normal rats,the latency of F-VEP main wave became shorter with the increase of their age,the number was [(63.5?10.1),(50.8?6.4),(44.9?6.3) ms,P

Objective To study the application of cervical vertebral artery CT angiography(CTA) preoperatively in the screw setting of upper cervical spine.Methods The data of 170 patients who underwent upper cervical spine surgery from January 2014 to December 2015 in our hospital were retrospectively analyzed,of whom 80 cases with typeⅡodontoid fractures,90 cases with atlantoaxial dislocation;20 cases were operated with occipitocervical fusion,150 cases treated with atlantoaxial fusion.Seventy-eight cases were examinated by cervical vertebral artery CTA before sugery(observation group) but the other 92 cases(control group).The rate of the vertebral arterial lesion between the two groups were compared.Results Six cases with vertebral artery injury in control group,the incidence of arterial injury was 7％;unilateral vertebral artery was found in 3 cases,small congenital development of left cervical vertebral artery in 5 case,abnormal branch in 5 cases.The rate of dysplasia was 17％,and the rate of vertebral artery injury was 0.The rate of vertebral artery injury in control group was higher than observation group,the difference was significant(P<0.05).Conclusion Vertebral artery CTA examination preoperatively may become a routine examination,in order to make the operator carefully evaluate the relationship between the vertebral artery with atlantoaxial vertebral,choose the accurate screw-setting and avoid the vertebral artery injury in the upper cervical spine surgery.

Objective To study the effects of TGFβ-activated kinase-1 (TAK1)mediated cell autophagy after global cerebral ischemia-reperfusion (IR ) in rats.Methods Seventy-two male Kunming rats were randomly divided into six groups:control group (group C),sham operation group (group S),ischemia-reperfusion group (group IR),TAK1 shRNA lentivirus group (group T),nega-tive lentivirus group (group Y)and normal saline group (group NS)(n = 12 each).The rats in groups T,Y and NS received cerebral ventricles injection of TAK1 shRNA lentivirus,negative lenti-virus and normal saline 10 μl two weeks before preparing animal model.Using thread embolism of the right middle cerebral artery occlusion (MCAO)to cause focal ischemia for 2 h and released for 24 h for reperfusion in groups IR,T,Y and NS.The common carotid arteries were separated but not liga-ted in group S,the rest of the procedure as the same as group IR.The rats of each group were evalua-ted by neurological severity scores (NSS)24 h after reperfusion,the cerebral infarct volume was measured with the method of TTC and the expression of TAK1,LC3Ⅱ/LC3Ⅰ,Beclin1 and p62 pro-tein in rat hippocampus were determined by using Western blot.Results The infarct volume and NSS in groups IR,T,Y and NS were significantly higher than those in group C (P <0.05).The infarct volume and NSS in group T were significantly lower than those in group IR (P <0.05).TAK1 pro-tein of hippocampus in groups IR,Y and NS was significantly higher than that in group C (P <0.05).TAK1 protein of hippocampus in group T were significantly lower than that in group IR (P <0.05).LC3Ⅱ/LC3 Ⅰand Beclin1 protein of hippocampus in groups IR,T,Y and NS were signifi-cantly higher than those in group C,and the p62 protein of hippocampus in groups IR,T,Y and NS was significantly lower than that in group C (P <0.05).The LC3 Ⅱ/LC3 Ⅰand Beclin1 in group T were significantly lower than those in group IR,and the p62 protein of hippocampus in group T was significantly higher than that in group C (P < 0.05 ).Conclusion TAK1 mediated cell autophagy takes part in the mechanism of brain ischemia-reperfusion injury in rats.

Objective To investigate the influence of 18F-FDG on the proliferation of Lewis lung cancer cell line,and to elucidate its possible mechanism.Methods Morphological changes of cells after culture for 24 h at different concentrations of 0,0.37,1.85,3.70 and 7.4 (×106) Bq/ml of 18F-FDG were observed by using inverted microscopy and electron microscopy.The apoptosis and phase distribution of cell cycle of irradiated cells were analyzed with flow cytometry.DNA synthesis of irradiated cells was assayed by 3H-TdR incorporation.Lipid peroxidation was measured by chromometry and expression of Bcl-2 and Bax protein was measured by immunohistochemical technique.Results Exposed to (0-7.40) × 106Bq/ml of 18F-FDG for 24 h,the cumulative absorbed doses delivered to cells in five groups were 0,0.11,0.55,1.10 and 2.20 Gy,respectively.Irradiated cells showed morphological changes of apoptosis.The apoptosis rate of irradiated cells was increased from (4.05 ± 0.01)% to (25.6 ± 0.28) % (t = 188,P＜0.01).3H-TdR incorporation rate was decreased from 100% to(22.0 ± 0.51)% (t =27.6,P ＜0.05).The levels of M DA in cells were augmented from (0.08 ± 0.03) to (0.67 ± 0.12) μmol/L (t =11.7,P ＜ 0.01).Cell cycle arrest was found in G2/M phase with the increasing doses from 0 to 2.20 Gy.The expression of Bcl-2 protein was decreased while that of Bax protein increased.Conclusions 18F-FDG could induce the apoptosis of cells and inhibit the proliferation of cells.

Objective:To investigate the distribution of pathogen species isolated from cerebrospinal fluid culture (CSF) in children and analyze the antibiotic-resistance of the main isolates in vitro, which provides reference for interpreting the pathogens and choosing antibiotics in empiric therapy for pediatric patients. Methods:The results of cerebrospinal fluid culture were collected by checking laboratory information system of the Children′s Hospital of Zhejiang University and the clinical characteristics of these children were analyzed retrospectively by checking electronic medical record system.Results:A total of 1 312 isolates were detected, including 1 294 isolates of bacteria and 18 isolates of fungi. A total of 497 (37.9%) isolates were pathogenic microorganisms, of which 288 (57.9%) isolates were gram-positive, 200 (40.3%) isolates were gram-negative, and 9 (1.8%) isolates were fungi. The top 5 pathogens were Escherichia coli (102 isolates, 20.5%), Streptococcus pneumoniae (64 isolates, 12.9%), Streptococcus agalactiae (52 isolates, 10.5%), Enterococcus faecium (33 isolates, 6.6%) and Staphylococcus aureus (28 isolates, 5.6%). Most of the Streptococcus pneumoniae strains were isolated from children more than 1 year old (76.6%, 49/64), while the other top 4 bacteria were mainly isolated from infants less than 1 year old, with the rate of 95.1%(97/102) for Escherichia coli, 98.1%(51/52) for Streptococcus agalactiae, 81.8%(27/33) for Enterococcus faecium and 71.4% (20/28) for Staphylococcus aureus. A total of 815 (62.1%) isolates were considered to be contaminated pathogens according to the analysis on clinical manifestations and other laboratory findings in CSF, and coagulase-negative Staphylococcus (680 isolates), Micrococcus (50 isolates), Corynebacterium (28 isolates) and Enterococcus faecium (23 isolates), which accounted for 41.1% (23/56) of the total detected Enterococcus faecium, were the top 4 contaminated bacteria. During the study period, the isolation rate of the pathogenic microorganisms increased year by year (χ2=34.84, P<0.001), while the isolation rate of the contaminated pathogens, which detected mainly in summer and autumn, decreased year by year (χ2=13.26, P<0.001). Conclusions:The predominant bacteria causing pediatric purulent meningitis were Escherichia coli, Streptococcus pneumoniae, Streptococcus agalactiae, Enterococcus faecium and Staphylococcus aureus. Coagulase-negative Staphylococcus, Micrococcus, Corynebacterium and Enterococcus faecium were common contaminated bacteria in CSF culture, therefore clinicians should interpret the results of CSF culture cautiously according to the bacterial species and clinical manifestations.

Objective To observe the short-term effect of radial head replacement for the treatment of terrible triad of the elbow.Methods In the period between June 2011 and June 2012,the radial head replacements were carried out in six patients with terrible triad of elbow.There were five acute elbow fracture-dislocation cases and one old fractnre case.All cases underwent open reduction and fixation coronoid fracture with screws or nonabsorbable sutures,radial head replacement,repair of lateral ligament complex and repair or reconstruction of annular ligament.All patients initiated the rehabilitation program under supervision within 5-7 days after surgery.The X-ray and Computed tomography of elbow was used to evaluate the posi tion of radial head prosthesis.Functional outcome of elbow was assessed by Mayo Elbow Performance Score (MEPS) and complications.Results All patients were participated in follow-up for 10-24 months and the mean duration of follow-up was 16.8 months.The MEPS was from 85 to 95 points and the mean MEPS was 91.7 points.The outcome of MEPS was excellent in 5 cases,good in 1 case.The range motion of elbow flexion was from 82 to 95 degrees and the average of elbow flexion was 87 degrees; the range motion of extension was from 15 to 32 degrees and the average of elbow extension was 21 degrees.The range motion of fore-ann pronation was from 82 to 90 degrees with 86 degrees in average.The motion range of supination was from 45 to 80 degrees with 56 degrees in average.All cases got persistent stability in elbow with painless movement.None of patient suffered traumatic arthritis and infection.The motion range of elbow was restricted due to the unfit relative position of radial head prosthesis and capi tellum in one case,characterized by decreasing radiocapitellar joint space.Two cases developed into heterotopic ossification in elbow without hampering the motion range of elbow.Conclusion The outcome of the radial head replacement on the treatment of radial head fracture in the elbow terrible triad was satisfactory.However,the longer duration of observation was essential to verify the favorable effect of radial head replacement on dealing with terrible triad in elbow.