Objective To compare the severity of hepatic ischemidreperfusion(I/R)injury caused by partial hepatectomy performed under propofol-remifentanil and isoflurane-fentanyl anesthesia.Methods Thirty ASA Ⅰ or Ⅱ patients aged 41-64 yr weighing 58-86 kg undergoing elective partial hepatectomy were randomly divided into 2 groups(n=15 each):propefol-remifentanil group(PR)and isoflurane-fentanyl group(IF).Anesthesia was induced with midazolam,fentanyl,etomidate and vecuronium.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with TCI of propofol(Cp=3.5μg/ml)and remifentanil(Cp=4.2 ng/ml)in group PR or 1.5%-2.5% isoflurane and intermittent iv boluses of fentanyl in group IF.Muscle relaxation was maintained with intermittent iv boluses of vecuronium in both groups.Blood samples were taken before occlusion of hepatic portal(T1)immediately(T2)and 30,60 min after release of portal occlusion(T3,4)and 1 d after operation(T5),for determination of sernm levels of ALT,AST,γ-GGT,LDH,TBIL,T-SOD and MDA.Specimens were obtained from the liver left intact after partial hepatectomy for ultrastructural examination with electron microscope.ResultsSerum levels of ALT at T5,γ-GGT at T3,4,and MDA at T4,5 were significandy lower while T-SOD at T5 were significantly higher in group PR than in group IF.Electron microscopic examination showed that tissue damages were significantly aRenuated in PR group as compared with IF group.Conclusion Propofol-remifentanil anesthesia can to some extent pmtect the liver against I/R injury during partial hepatectomy by reducing oxygen free radicals.

Objective To compare the efficacy of different doses of intrathecal administration of morphine and fentanyl before operation for postoperative analgesia in patients undergoing abdominal hysterectomy.Methods Forty ASA Ⅰ or Ⅱ patients,aged 19-60 yr,undergoing abdominal hysterectomy under combined spinal-epidural anesthesia,were randomly divided into Ⅰ and Ⅱ groups (n =20 each).Morphine 0.5 mg+ fentanyl 15 μg and morphine 0.2 mg+ fentanyl 25 μg were injected intrathecally in groups Ⅰ and Ⅱ respectively.VAS score ≤2was considered as effective analgesia.When VAS score≥ 3,morphine 0.05 mg/kg was given intravenously as rescue analgesic.The incidence of nausea and vomiting and pruritus was recorded after operation.Results Compared with group Ⅰ,no significant change was found in the percentage of patients requiring rescue morphine after operation (P ＞ 0.05),the incidence of nausea and vomiting and pruritus was significantly decreased after operation and the time when the patients passed the flatus was significantly shortened after operation in group Ⅱ (P ＜ 0.05).Conclusion Intrathecal administration of morphine 0.2 mg and fentanyl 25.μg before operation is safer and more helpful to recovery of gastrointestinal function than intrathecal administration of morphine 0.5 mg and fentanyl 15 μg before operation if they can provide the equivalent postoperative analgesia.

Background and Objective Previous study showed tenecteplase and alteplaxe were equovalent for 30-day mortality in the treatment of acute myocardial infarction. The purpose of this open-label, randomized, multi-center, angiographic trial was to assess the efficacy and safety of tenecteplase compared with alteplase in Chinese patients with acute myocardial infarction. Methods We recruited patients with acute ST-elevation myocardial infarction presenting within 6 hours of symptom onset from October, 2002 to March,2004, in 5 hospitals in Beijing. After giving informed consent, patients were randomly assigned a single-bolus injection of tenecteplase (30-50 mg according to body weight) or front loaded alteplase (100 mg), and underwent coronary angiography at 90 min after starting the study drug. All patients received aspirin and heparin (target activated partial thromboplastin time 50-70 s). The primary efficacy end point was the rate of TIMI grade 3 flow at 90 minutes. Other efficacy end points included TIMI grade 2/3 flow at 90 minutes. Safety end points included all stroke, intracranial hemorrhage (ICH), moderate/severe hemorrhage (except for ICH), all-cause mortality at 30-days, and major non-fatal cardiac events at 30 days. Results Overall 110 patients were eligible for statistical analysis, with 58 patients assigned to receive tenecteplase and 52 patients to alteplase. Tenecteplase produced a rate of TIMI grade 3 flow at 90 minutes after the start of thrombolysis(68.4%) similar to that of alteplase (66.7%, P=1.0); the rates of TIMI grade 2 or 3 were similar for patients treated with tenecteplase versus alteplase (89.5% versus 80.4%, respectively, P=0.278). At 30 days, rates for all strokes were similar for the two groups (5.17% for tenecteplase and 1.92% for alteplase, P=0.62); rates of ICH were 3.45% and 1.92% (tenecteplase and rt-PA,P=1.00) respectively. The rate of moderate/severe hemorrhage was 8.62% with tenecteplase and 5.77% with alteplase (P=0.72); total mortality was almost identical in the two groups (13.8% versus 9.6%, respectively, P=0.565) while the rates of non-fatal cardiac complications were 10.35% and 11.54% (tenecteplase and alteplase, P=1.0). Conclusions The efficacy of a single-bolus, weightadjusted tenecteplase fibrinolytic regimen is equivalent to front-loaded alteplase in terms of the rates of TIMI grade 3 flow, and TIMI 2 or 3 flow, but the 30-day mortality and ICH in both groups was so high that the use of tenecteplase is not permitted in China. These negative safety results might be due to the high rate of percutaneous coronary intervention (PCI) and high dose of bolus heparin and suboptimal concomitant medical therapy during hospitalization, so further studies are needed to confirm the safety for tenecteplase in Chinese patients.

The UL49.5 gene of most herpesviruses is conserved and encodes glycoprotein N. However, the UL49.5 protein of duck enteritis virus (DEV) (pUL49.5) has not been reported. In the current study, the DEV pUL49.5 gene was first subjected to molecular characterization. To verify the predicted intracellular localization of gene expression, the recombinant plasmid pEGFP-C1/pUL49.5 was constructed and used to transfect duck embryo fibroblasts. Next, the recombinant plasmid pDsRed1-N1/glycoprotein M (gM) was produced and used for co-transfection with the pEGFP-C1/pUL49.5 plasmid to determine whether DEV pUL49.5 and gM (a conserved protein in herpesviruses) colocalize. DEV pUL49.5 was thought to be an envelope glycoprotein with a signal peptide and two transmembrane domains. This protein was also predicted to localize in the cytoplasm and endoplasmic reticulum with a probability of 66.7%. Images taken by a fluorescence microscope at different time points revealed that the DEV pUL49.5 and gM proteins were both expressed in the cytoplasm. Overlap of the two different fluorescence signals appeared 12 h after transfection and continued to persist until the end of the experiment. These data indicate a possible interaction between DEV pUL49.5 and gM.
Animals ; Ducks/virology ; Genes, Viral/genetics ; Mardivirus/*genetics ; Membrane Glycoproteins/*genetics ; Microscopy, Fluorescence ; Phylogeny ; Polymerase Chain Reaction/veterinary ; Viral Envelope Proteins/*genetics

Objective To observe the aortic calcification level in patients with rheumatoid arthritis (RA),and to analyze the relationships between aortic calcification and some RA disease related presentations.Methods RA patients (RA group) were all in-patients consecutively recruited from the Department of Rheumatology in one single tertiary hospital,and healthy subjects (control group) were individuals for check-up from the same hospital at the same time.Subjects with long-term smoking and drinking history,diabetes,hypertension,coronary heart disease,cancer,active or chronic infection,other autoimmune diseases and liver or kidney dysfunction were excluded in both groups.The aortic calcification scores (including ascending aorta,arcus aorta and aorta thoracica) were obtained automatically by 256-slice spiral CT scanner using the Heart Beat-CS program.Statistical package from Soci-science (SPSS) 17.0 software was used for data analysis.Student's t test,Mann-Whitney U test,Spearman test and x2 test were used.Results One hundred RA patients and 60 healthy subjects were selected,and there were no differences of age [(53±10) vs (51 ±8),t=1.031,P=0.304) and gender compositions [male 40(40％) vs 25(41％),x2=0.430,P=0.869) between the two groups.The aortic calcification score in the RA group was higher than that in the control group [19.4(3.3,190.0) vs 2.1 (1.9,18.0),U=1 579.5,P＜0.01].In RA group,the calcification score was positively correlated with age (r=0.729,P＜0.01),course of disease (r=0.227,P=0.023),C-reactive protein (CRP) (r=0.229,P=0.022),total cholesterol (TC) (r=0.220,P=0.028) and low density lipoprotein cholesterol (LDL-C) (r=0.224,P=0.014),but not related with treatment duration,number of tender joints and swollen joints,erythrocyte sedimentation rate,rheumatoid factor,anti-CCP antibody,DAS-28 (CRP),DAS-28 (ESR),triglyceride (TG) and high density lipoprotein cholesterol (HDL-C).The aortic calcification was also positively correlated with age in control group (r=0.465,P＜0.01),but not related with TC,TG,HDL-C,LDL-C.Conclusion RA patients have more severe aortic calcification than the matched general population.Aortic calcification degree is related to disease course,CRP,TC and LDL-C,which indicates that chronic systemic inflammation is essential to aortic calcification in RA.