Objective To study the effects of ephedrine and phenylepbedrine for maintenance of arterial pressure during combined spinai/epidural anesthesia (CSEA) for caesarean section. Methods Forty patients, ASA grade Ⅰ - Ⅱ, who were scheduled for caesarean section by CSEA were randomly divided into two groups, when patients were hypotension, phenylephedrine 100 μg (group P, 20 cases ) or ephedrine 10 mg (group E, 20 cases). The variety of blood pressure (Bp), heart rate (HR) and oxyhemoglobin saturation (SpO2) were monitored; recorded before anesthesia (T0), at 15 min after anesthesia (T1), fetuses were taken out of uterus (T2) and at the end of operation (T3); umbilical arterial blood gas analysis was monitored; neonatal Apgar score was investigated. Results Umbilical arterial blood gas analysis of pH,PaO2, PaCO2, HCO3-, SaO2 were normal in two groups, there were no significant difference in PaO2, PaCO2 and SaO2 between two groups, but pH and HCO3- in group P were higher than those in group E [7.38±0.07 vs7.30±0.02 and (21.5±3.4) mmol/L vs (19.3±3.3) mmol/L] (P <0.05). There were no significant difference in Apgar score and Bp between two groups. Compared with group P, the HR in group E was increased obviously at T1 and T2 (P < 0.05). Conclusion Phenylephedrine is the vasopresser that most closely meets the criteria for the best vasopressor to use in obstetric patients.

Twenty-six total intravenous anesthesia was performed in 23 ASAⅡorⅢpatients with various advanced malignancies undergoing whole body hyperthermia (WBH). Their age ranged from 32 to 67 yrs and body weight between 42 and 77 kg. The patients had no hypertension, coronary artery disease or diabetes mellitus. Anesthesia was induced with midazolam 5-10 mg, fentanyl 0.1 mg, propofol 1.5-2.5 mg?kg-1 and vecuronium 0.12 mg?kg-1 and maintained withⅣinfusion of midazolam (0.08-0.16 mg?kg-1?h-1), remifentanil (0.05-0.15?g?kg-1?h-1) and vecuronium (0.08-0.15 mg?kg-1?h-1). The patients were mechanically ventilated (VT = 8-12 ml?kg-1, RR= 10-18 bpm, FiO2 = 1.0) after tracheal intubation. PETCO2 was maintained at 35 mm Hg. ECG, MAP, HR, CVP, SpO2 , PETCO2 , peak airway pressure, VT, RR, minute ventilation (MV), urine output, core temperature (lower esophageal and naso-pharyngeal) and surface temperature were continuously monitored. Swan-Ganz catheter was placed in 15 patients. MPAP, PCWP and cardiac output (CO) were measured and Qs/Qt, cardiac index (CI) and stroke index (SI) were calculated. WBH was induced in an ultra-red radiation hyperthermic cabin (type ET-SpaceTM-1) and was divided into 3 phases:Ⅰwarming phase (lower esophageal temperature increased gradually to 41.8℃) ;Ⅱhyperthermic phase (lower esophageal temperature was maintained at 41.8℃for 1 h) andⅢcooling phase (core temperature was gradually decreased to 38.5℃without any cooling measures). Blood samples were taken from artery and Swan-Ganz catheter 15 min after induction of anesthesia (baseline), at 39℃, 40℃, 41℃and 41.8℃during warming phase, at the late hyperthermic phase and at 40℃and 38.5℃during cooling phase for blood gas analysis, determination of blood electrolytes and sugar. As the temperature was increasing, HR, CI, SI, CVP, MPAP, PCWP, Qs/Qt and peak airway pressure were gradually increased while MAP, PaO2 , pHa, BE and blood glucose and K+ were decreasing during warming phase (Ⅰ). These changes reached the peak levels at the late period of hyperthermic phase (Ⅱ) and then gradually returned to baseline during cooling phase (Ⅲ) . Vasoactive drugs and fluid infusion including crystalloid and colloid were needed to maintain hemodynamic stability in 69% patients. Acidosis had to be corrected in 54% patients. Severe hypotension and pulmonary edema occurred in 4 patients. Continuous hemodynamic monitoring, respiratory support, maintenance of circulatory stability and correction of acidosis and hypokalemia were the key factors in the management of patients during WBH.

Objective To observe the sedative effectiveness of dexmedetomidine (DEX) in digital subtraction angiography (DSA),and to investigate the optimal and safe administration dose.Methods Seventy-five patients undergoing DSA were divided into three groups by random digits table with 25 cases each group.Three groups were treated with constant infusion of DEX by micro-pump 10 min before surgery with the same dose of saline.Then group A,B,C respectively were given 0.3,0.5,0.7 μg/ (kg·h) of the maintenance infusion rate,and stop infusion 10 min before the end of the surgery.At administration (T0),10 (T1),20 (T2) and 30 (T3) min after administration,10 min after surgery (T4),the heart rate (HR),mean arterial pressure (MAP),peripheral oxygen saturation (SpO2),Ramsay score,number of cases that appeared body movement were recorded,and their forgotten degree of operating memory were compared.Results The HR,MAP in three groups at T1-T3 was significandy lower than that at T0 (P＜ 0.05),T4 levels returned to T0 (P＞ 0.05).The HR,MAP in group C at T2,T3 was significantly lower than that in group A and group B at the same time (P ＜ 0.05).The Ramsay score in three groups at T2,T3 was significantly higher than that at T0(P ＜0.05),group B and group C at T2,T3 was significantly higher than that in group A at the same time (P ＜0.05).The SpO2 in three groups at each time point compared within and among groups was no significant difference (P ＞ 0.05).Group B and group C intraoperative involuntary movement in response patients were significantly less than in group A (5,3 cases vs.10 cases).Group A and group C surgery requires intervention patients was significantly more than in group B (8,10 cases vs.3 cases).Group B and group C amnesia grade Ⅲ rate was significantly higher than that in group A [64％ (16/25),72％ (18/25) vs.40％(10/25),P ＜ 0.05].Conclusion Infusion with 0.5 μ g/(kg· h) DEX 10 min after intravenous injection with 0.5 μ g/kg can get a better sedative effect,stable vital signs and less intraoperative adverse memory,and it can also improve patients' comfortable degree,which is safe and appropriate sedative dosage in DSA.

BACKGROUND:Cortical electrical stimulation has achieved good effects in treatment of stroke through animal and clinical experiments.
OBJECTIVE:To observe the effects of a ful y implanted cortical electrical stimulation device with long time, low intensity and various frequencies stimulation protocols on the neurological function recovery in a rat model of local cerebral infarction.
METHODS:The cerebral infarction model was established through middle cerebral artery occlusion in 60 Sprague-Dawley adult male rats. Forty rats with 1-3 points by Bederson scale were detected with magnetic resonance imaging, which was used to confirm cortex infarction and to identify a location for implantation of stimulating electrode over the peri-infarct cortex. Twenty-three rats with cortex infarction were randomly divided into cortical electrical stimulation group (CES group, n=13) and no stimulation group (NS group;n=10). The device was implanted on 6 days after middle cerebral artery occlusion, and the stimulation was given for 16 days. The stimulation program consists of two sessions lasting half an hour each in the morning and in the afternoon respectively. Stimulator delivered biphasic charge balanced pulses (pulse width=200μs) with various frequencies of 50 Hz, 20 Hz and 5 Hz within 10 second blocks and then repeated. The rats of NS group were implanted with the device, but received no electrical stimulation. The behavioral tests, includingforelimb use asymmetry test and foot fault test were performed at 2 and 16 days after implantation. Final y, al of the devices were taken out to test if they were normal y working and al of the rats were sacrificed for hematoxylin-eosin staining, which can reflect the structure of peri-infarct cortex and cellmorphology.
RESULTS AND CONCLUSION:There was only one stimulator in CES group cannot normal y work, and the remaining 22 ones worked wel . The skin covered the implanted stimulator was slightly ulcerated in one rat, and the incisions of the other rats were healed wel . Hematoxylin-eosin staining showed clear and intact structure in peri-infarction cortex (i.e., electrodes were implanted at the cortex), neurons arranged in neat rows, with abundant neuronal cytoplasm and clear nucleolus. The glial cells have complete structures, and there was no edema in the intercellular spaces. Foot-fault and forelimb use asymmetry tests showed the improved neurological function in rats of CES group than that of NS group. We designed a ful-implanted cortical electrical stimulator used in cerebral ischemic rats, and established an implanted method with long time, low intensity and various frequencies pulsed electrical stimulation. The results indicated the stimulation pattern in our study is safe and effective, and it can significantly promote functional recovery in local cerebral infarction rats.

According 1o the genome sequences of α.β,e,ι toxins of Clostridium perfringens in GenBank,four pairs of primers targeting α,β,ε,ι toxin genes were designed.After the multiplex PCR reaction condition was optimized,the multiplex PCR for identification and toxintyping of C.perfringens strains was developed.The specificity test showed that the expected fragments of C.perfringens reference strains including A.B,C,D,E five toxin types were amplified successfully from genomic DNA of C.perfringens,respectively.However,a band could not be amplified from Clostidrium novyi and Clostridium septicum as negative control groups.The sensitivity test showed that the limit detection of multiplex PCR was 9.0,17.8,12.2,13.8,18.5 pg DNA of A,B,C,D,E five toxin types C.perfringens,respectively.Repetitive testing showed that the established method had a good repeatability.Nine type A strains of and 1 type C strains of C.Perfringens from 21 clinical samples of dead goat were detected by the multiplex PCR developed in this study.This study establishes the multiple PCR method which not only can detect C.perfringens rapidly but also can identify five toxin types of C.perfringens.

BACKGROUND:The microRNAs are involved in regulation of stem cel proliferation, differentiation and aging. To study the effect of Let-7c, a member of Let-7, on the neural differentiation of bone marrow mesenchymal stem cels provides new ideas for stem cel therapy. OBJECTIVE: To investigate the role of Let-7c in the neural differentiation of bone marrow mesenchymal stem cels. METHODS: The lentiviral vectors of Let-7c-up and Let-7c-inhibition were constructed and transfected into rat bone marrow mesenchymal stem cels. Optimal multiplicity of infection was screened. The cels were divided into non-transfected group, negative control group (transfected with empty virus), transfected enhancement group (transfected with LV-rno-Let-7c-up), transfected inhibition group (transfected with LV-rno-Let-7c-5p-inhibition). Bone marrow mesenchymal stem cels were treated with fasudil as an inducer for triggering the cels to differentiate into neurons. The fluorescence expressed by transfected cels was observed under inverted fluorescence microscope. The expression of neuron-specific markers, neuron-specific enolase and microtubule-associated protein 2, were measured by immunocytochemical method. The mRNA expression of microtubule-associated protein 2 was detected by RT-PCR. The cel viability was determined by MTT method. RESULTS AND CONCLUSION:Under the inverted fluorescence microscope, the cels were successfuly transfected with LV-rno-Let-7c-up and LV-rno-Let-7c-5p-inhibition. Fasudil induced bone marrow mesenchymal stem cels to differentiate into neurons. The transfection efficiency and expression levels of neuron-specific enolase and microtubule-associated protein 2 in the transfected enhancement group were significantly higher than those in the negative control group (P < 0.05), while in the transfected inhibition group, they were lower than those in the negative control group (P < 0.05). These findings indicate that the differentiation percentage of bone marrow mesenchymal stem cels is increased by fasudil after transfection with LV-rno-Let-7c-up, and Let-7c may promote the differentiation of bone marrow mesenchymal stem cels into neurons.

Objective To explore the value of percutaneous oxygen partial pressure monitoring in prognosis evaluation of patients with acute heart failure (AHF). Methods A total of 91 patients with AHF due to various reasons admitted to the emergency department of the First Affiliated Hospital of China Medical University from July 2017 to June 2018 were enrolled. Dynamic monitoring data of arterial blood gas, percutaneous oxygen partial pressure monitoring and noninvasive cardiac output monitoring (NICOM) of all of the patients at the time of diagnosis (before treatment) and 6 hours after treatment were recorded, including arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), blood lactic acid (Lac), percutaneous oxygen partial pressure (TcPO2), percutaneous carbon dioxide partial pressure (TcPCO2), cardiac output (CO) and stroke volume (SV). The 10-minute oxygen challenge test value (OCT), oxygen and carbon dioxide offsets were calculated. The patients were divided into survival group and non-survival group according to 28-day survival situation, and the differences in above parameters were compared between the two groups. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of percutaneous partial oxygen pressure monitoring for the prognosis of patients with AHF. Results All the 91 patients were enrolled in the analysis, among whom 26 died on 28 days and 65 survived, with a mortality of 28.6%. Before treatment, 10-minute OCT in the non-survival group was significantly lower than that in the survival group [mmHg (1 mmHg = 0.133 kPa):41.0±3.9 vs. 45.6±3.2, P < 0.01], and the carbon dioxide offset was significantly higher than that in the survival group [(0.51±0.11)% vs. (0.37±0.11)%, P < 0.01]. However, there was no statistically significant difference in PaO2, PaCO2, TcPO2, TcPCO2, oxygen offset, CO, SV or Lac between the two groups. After 6 hours of treatment, TcPCO2, oxygen offset and carbon dioxide offset in the non-survival group were significantly higher than those in the survival group [TcPCO2 (mmHg): 36.0±2.8 vs. 33.2±2.8, oxygen offset: (0.25±0.05)% vs. (0.22±0.06)%, carbon dioxide offset: (0.29±0.12)% vs. (0.16±0.13)%, all P < 0.05], TcPO2, 10-minute OCT, CO and SV were significantly lower than those in the survival group [TcPCO2 (mmHg): 36.0±2.8 vs. 33.2±2.8, 10-minute OCT (mmHg): 49.1±4.5 vs. 53.6±5.5, CO (L/min):4.9±0.5 vs. 5.3±0.5, SV (mL): 57.8±3.5 vs. 64.4±4.8, all P < 0.01]. However, there was no statistically significant difference in PaO2, PaCO2 or Lac between the two groups. ROC curve analysis showed that the area under the ROC curve (AUC) of 10-minute OCT onset predicting the 28-day death of patients with AHF was 0.802; when the optimal cut-off value was 43.5 mmHg, the sensitivity and specificity was 77.3% and 68.0%, respectively. The AUC of carbon dioxide offset was 0.812; when the optimal cut-off value was 0.46%, the sensitivity and specificity was 86.4% and 68.0%, respectively. Conclusions Percutaneous oxygen partial pressure monitoring can be used as a reliable indicator for prognosis evaluation of patients with AHF. Increased carbon dioxide offset and decreased 10-minute OCT suggest poor prognosis, and the prognosis of patients with AHF should be evaluated by dynamic monitoring.

OBJECTIVE: To detect the levels of Epstein-Barr virus (EBV) latent membrane protein 1 Antibodies (LMP1-Ab) in nasopharyngeal carcinoma (NPC)sera and discuss the clinical significance of this test in diagnosis, prognosis, and immune-targeted therapy of NPC. METHOD: Enzyme-linked immunosorbent assay (ELISA) and Western blot method were used to detect the LMP1-Ab levels in 61 NPC sera, 30 nasopharyngitis sera, and 55 normal sera. The relationship between the LMP1-Ab level and clinical and pathological features of NPC was analyzed. RESULT: ELISA test showed that LMP1 antibodies level was significantly higher in nasopharyngeal carcinoma group than those in nasopharyngitis group and in healthy group and there were statistical significances (all P<0.05). In SNPC group, the LMP1-Ab level was not related to the pathological grade and cervical lymph node metastases (P>0.05). Western blot test revealed that the expression of LMP1 antibodies was higher in NPC sera than in nasopharyngitis sera and in normal sera. CONCLUSION LMP1-Ab level was higher in nasopharyngeal carcinoma group than in nasopharyngitis group and in normal group. Therefore, LMP1 may be considered as a tumor correlated antigen to help the diagnosis and immune-targeted therapy of NPC.
Adolescent ; Adult ; Aged ; Antibodies, Viral ; blood ; Carcinoma ; Case-Control Studies ; Enzyme-Linked Immunosorbent Assay ; Female ; Herpesvirus 4, Human ; immunology ; Humans ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; blood ; pathology ; Viral Matrix Proteins ; immunology ; Young Adult