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 evaluate the preliminary mechanisms of endovenous laser treatment (EVLT) for lower extremity varicose vein.Methods Laser energy was endovenously administered to observe its biological effects on greater saphenous vein (GSV) segments with different conditions.Some great saphenous vein that was surgically removed after EVLT was examined by means of histopathology.Cruor status was tested after EVLT.Results Histopathologic examination found the vein wall treated by EVLT showed reddening,carbonization,or even perforation,denudation of the intima,loss of cellular contours,and fibrin deposition.Additionally,some areas showed marked vacuolization of cells or even spongiosis,swelling and waxy homogenization of collagen,focal coagulation necrosis within the intima.In saline-filled veins,EVLT-induced vessel wall injury was confined to the site of direct laser impact.In contrast,blood-filled veins exhibited thermal damage in more remote areas including the vein wall opposite to the laser impact.D-dimer was significantly changed after EVLT.Conclusions EVLT laser induced indirect local heat injury of the inner vein wall by steam bubbles originating from boiling blood is proposed as the pathophysiological mechanism of action of EVLT.Intravascular blood plays a key role for homogeneously distributed thermal damage of the inner vein wall during EVLT.No significant difference could be detected between the two laser wavelengths.Continuous emission mode is better than pulse emission mode.

Retrievable vena cava filters can be used to prevent pulmonary embolism. The advantage of the retrievable vena cava filters is that they can either be removed or be remained in the vena cava permanently if needed. This article describes the current status of retrievable vena cava filters including indications, outcomes, patient management, time of filter removal, and the management of thrombus in the filter.

Objective To study the influence of body mass index on ambulatory venous pressure of chronic venous insufficiency of lower extremity.Methods One hundred and two consecutive patients with chronic venous insufficiency of lower extremity were enrolled in this study.Ambulatory venous pressure and body mass index were assessed and compared.Normal body weight group had 28 cases,over weight group had 43 cases,obesity group had 31 cases.Resets The complication of pigmentation,eczema,skin sclerosis and ulcer were more in obesity group and over weight group than those in normal body weight group.The resting pressure (P0) in obesity group,over weight group and normal body weight group were (118.0 ± 11.5),(113.0 ± 9.7),(101.0 ± 10.6) mm Hg (1 mm Hg =0.133 kPa),the pressure after unclamp 4 s (4SP)were (75.00 ± 2.99),(71.00 ± 3.01),(65.00 ± 2.17) mm Hg,the percentage of decreased pressure(pd)were (35.0 ± 5.4)％,(39.0 ± 4.3)％,(43.0 ± 5.1)％,the time of P0 recovered 50％ (RT50) were(7 ± 1),(9 ± 2),(12 ± 3) s.The P0 and 4SP in obesity group,over weight group were significantly higher than those in normal body weight group (P ＜0.05).The Pd,RT50 in obesity group,over weight group were significantly lower than those in normal body weight group (P＜0.05).Conclusion With the increasing of body mass index,the chronic venous insufficiency of lower extremity is more severity.

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.

Objective Investigation of biological characteristics of Cdc 20AAA/+APCmin/+ mouse embryonic fibroblast(MEFs) indicate the effect of Cdc20AAA/+on growth of mouse embryonic fibroblast and the possible mechanism . Methods MEFs of Cdc20AAA/+APCmin/+, Cdc20AAA/+, APCmin/+ and WT genotype were harvested from embryos for analysis.The growth characteristics of Cdc20AAA/+APCmin/+, Cdc20AAA/+,APCmin/+and WT mouse embryonic fibroblast were analyzed through growth curve analysis and foci formation assay .Separation of sister chromatid and the presence of aneuploid were detected by karyotype analysis .Results Cell proliferation assays showed that Cdc 20AAA/+APCmin/+cells grew at an accelerated rate compared with APC min/+MEFs(P<0.01).Foci formation assay showed that the clone forming ability was significantly increased .Cdc20AAA/+APCmin/+MEFs showed a significant increase in the frequency of aneuploid compared with WT MEFs , which had a karyotype of 38 and contained prematurely separated sister chromatids .Conclusion Cdc20 carrying a null allele (Cdc20AAA/+) may accelerate the growth and proliferation of APC min/+MEFs and present the growth characteristics of the tumor cells .The possible mechanism may be associated with chromosome instability .

ObjectiveTo investigate the effects of dopamine D1 receptor (D1R) tool drugs and combined acupuncture and medicine on striatal expressions of D1R and dopamine transporters (DAT) in middle cerebral artery occlusion (MCAO)-reperfusion rats.MethodForty-seven male SD rats were randomly grouped, used to make a model and given corresponding interventions. The materials were taken and fixed six hrs later. Striatal D1R and DAT expressions were detectedby an immunohistochemical method in different groups.ResultThe neurological deficit score was significantly higher in the model group than in the blank group. Electroacupuncture treatment decreased the score significantly (P<0.05). D1R expression was significantly down-regulated in the antagonist, electroacupuncture and electroacupuncture plus antagonist groups compared with the model group (P<0.05). There was no statistically significant difference in D1R expression between the model group and the antagonist or electroacupuncture plus antagonist group (P>0.05). DAT expression was significantly down-regulated in the other groups compared with the model group (P<0.05). There was no statistically significant difference in D1R expression between all groups except the model group (P>0.05).ConclusionCerebral ischemia-reperfusion can result in high D1R and DAT expressions in rat striatum on the ischemic side. Electroacupuncture, D1R antagonists and a combination of the two can significantly down-regulate D1R expression and have a protective effect on the brain. The effects of electroacupuncture and D1R antagonists can not be added to each other. D1R signaling pathway may be one of ways by which electroacupuncture produces a protective effecton the brain.

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.

Objective: To evaluate the effect of dexmedetomidine on postoperative cognitive function in the patients with mild hyperbilirubinemia caused by choledocholithiasis. Methods: One hundred and twenty patients of both sexes with mild hyperbilirubinemia (serum total bilirubin levels 21-170 μmol/L) caused by choledocholithiasis, aged 51-63 yr, with body mass index of 20-28 kg/m², of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with preoperative Mini-Mental State Examination (MMSE) scores≥20, scheduled for elective cholecystectomy and choledocholithotomy, were divided into 3 groups (n=40 each) using a random number table method: control group (C group) and dexmedetomindine 0.4 μg·kg^-1·h^-1 group (D1 group) and dexmedetomindine 0.6 μg·kg^-1·h^-1 group (D2 group). After induction of anesthesia, dexmedetomidine was intravenously infused for 10 min in a loading dose of 0.5 μg/kg, followed by an infusion of 0.4 and 0.6 μg·kg^-1·h^-1 until the end of operation in D1 and D2 groups, respectively.The equal volume of normal saline was given instead in group C. with preoperative scores≥20, MMSE and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function at 1 day before operation (T₀) and 1, 3, 5 and 7 days after operation (T_1-4). The occurrence of cognitive dysfunction within 7 days after operation was recorded.Venous blood samples were collected at the time points mentioned above, and the plasma concentrations of β-amyloid (Aβ) 42 were determined by enzyme-linked immunosorbent assay. Results: Compared with group C, MoCA scores were significantly increased at T₁ in group D₁, and MMSE scores at T₁ and MoCA scores at T₁ and T₂ were significantly increased, and the plasma concentrations of Aβ42 were decreased at T_2-4 in group D2, and the incidence of cognitive dysfunction was significantly decreased in D1 and D2 groups (P<0.05). Compared with group D1, MoCA scores were significantly increased at T₁, and the plasma concentrations of Aβ42 were decreased at T_2-4 in group D2 (P<0.05). Conclusion Dexmedetomidine can improve postoperative cognitive function, and intravenous infusion at a rate of 0.6 μg·kg^-1 · h^-1 provides better efficacy for the patients with mild hyperbilirubinemia caused by choledocholithiasis.

In 2013,the Chinese Society of Endocrinology published the'Management ofhyperuricemia and gout:Chinese experts consensus'.In the following five years,a large number of basic researches,clinical studies,and epidemiological results had emerged and need to be popularized in order to improve the understanding and standardizing management of these conditions in general physicians.On the other hand,the methodology of developing clinical guidelines has become more and more scientific,standardized and international.Therefore,based on the 2013 version of the consensus,Chinese Society of Endocrinology decided to develop a guideline for the diagnosis and management of hyperuricemia and gout under standardized methods and procedures of evidence-based clinical practice guidelines.This article will give a review of the status of clinical practice guideline development in China and explain the methods and procedures followed when developing this guideline.We hope this work may provide some useful recommendations for other developers to draft evidence-based clinical practice guidelines.