Objective To compare the clinical effect of remifentanil and dexmedetomidine on controlled hypotension during endoscopic sinus surgery. Methods Forty patients undergoing endoscopic sinus surgery were randomly divided into group R and group D, 20 in each group. All patients received controlled hypotension when the surgeons began to sterilize the nasal cavity for the purpose of maintaining the MAP at 60 ~ 70 mmHg. Group R received remifentanil 1μg/kg over 1 minute, followed by 0.2 to 0.4μg/kg per minute infusion during maintenance, whereas group D received dexmedetomidine 1μg/kg over 10 minutes, followed by 0.2 to 0.7μg/kg per hour during maintenance. At the moment of pre-induction(T0), incision(T1), 30 min(T2) and 60 min(T3) after incision and 10 min(T4) after end of controlled hypotension, MAP and HR were measured. Quality of the surgical field, blood loss and extubation time were recorded. Sedation and postoperative pain were assessed on arrival at the PACU. Results The goals for the MAP level were achieved and the surgical field quality was ideal in both groups. The MAP and HR values at T1~ T3 were significantly lower than those at T0 in both groups (P < 0.05). There were no significant differences in the MAP or HR values between the groups at each time point (P>0.05). No significant difference was founded between the groups in the Fromme operative field score and blood loss (P > 0.05). The extubation time was significantly shorter in group R than in group D(P<0.05). The sedation score in the PACU was significantly lower in group R than in group D(P<0.05), while there were no significant differences in postoperative pain between the groups(P<0.05). Conclusion Both remifentanil and dexmedetomidine are safe agents for controlled hypotension and are effective in providing satisfactory surgical fields during endoscopic sinus surgery. However , remifentanil is advantageous in time for extubation and complete consciousness from anesthesia and therefore it may have the advantage of fast track anesthesia.

Endovascular treatment is becoming a novel technique in the treatment of carotid stenosis. Since this technique is in its infancy, there are many controversies on this technique and theory now. This paper briefly reviews the most recent advances in endovascular treatment of carotid stenosis.

Objective: To observe the effect of Baihe Zhimu Decoction on serum sex hormone and uterus index of ovariectomized rats with kidney-yin deficiency. Methods: 3-month years old femal SD rats which were ovariectomized were divided randomLy into 6 groups: ovariectomized, Baihe Zhimu DecoctionⅠ, Baihe Zhimu DecoctionⅡ, Baihe Zhimu Decoction Ⅲ, Baihe Zhimu Decoction Ⅳ, then the normal group was set. The rats were induced to kidney-yin deficiency by using etraiodothyronine, then ig Baihe Zhimu Decoction for 4 weeks. The levels of sex hormone E2, FSH, LH in serum were detected and the indexes of uterus were caculated to observe the effect of Baihe Zhimu Decoction on sexual hormone and sexual organ in ovariectomized rats with kidney-yin deficiency. Results: Compared with normal group, the index of uterus and E2 level declined, and the level of FSH and LH increased (P

Objective To observe the effect of Aitongping on c-fos gene expression and substance P(SP) content in spinal dorsal horn of rats with formalin-induced pain.Methods Fifty SD rats were randomized into 5 groups: blank control group,model group,tramadol group(0.06g/kg),high-and low-dose Aitongping groups(36 and 18g/kg respectively).Rats model of pain was induced by subcutaneous injection of formalin into the plantar surface of the left hind paw of rats.The fos gene expression and SP content were observed in superficial lamella of spinal dorsal horn of spinal section from the lumbar vertebrae L3 to L5 by immunohistochemical method.Results The number of neurons with fos gene expression positive and the optical density(D value) of reactants with SP expression positive were increased in the model group(P

Objective To investigate the relationship between serum levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) and Suzuki' s grading system in adult moyamoya disease (MMD).Methods Fifty-two adult patients with MMD,who were diagnosed in Jinling hospital between April 2009 and January 2010,were retrieved from the Nanjing Stroke Registry Program (NSRP).Sixteen sex- and age-matched healthy individuals with MMD patients consisted of the control group.Using enzyme-linked immunosorbent assay,serum concentrations of VEGF and MMP-9 were compared between adult MMD patients and healthy individuals.By Suzuki' s six-grading system,patients were divided into different subgroups,and the correlation of serum levels of VEGF and MMP-9 corresponding to different subgroup and Suzuki's grading was respectively analyzed.In addition,the correlation of serum levels of VEGF and MMP-9 was also evaluated.Results Serum VEGF concentrations in ischemic and hemorrhagic MMD patients was respectively ( 289.4 + 69.2 ) pg/ml and ( 324.3 ± 95.6 ) pg/ml and were significantly higher compared to those in healthy controls ( ( 63.5 ± 7.6 ) pg/ml; F =69.43,P ＜ 0.01 ).Similar findings were observed for MMP-9 ( ( 499.4 ± 76.2 ) ng/ml and ( 531.2 + 100.2 ) ng/ml versus (257.1 ±30.7) ng/ml; F =66.023,P ＜0.01 ).With the increase of Suzuki' s grading,serum levels of VEGF and MMP-9 respectively showed a high trend ( r =0.879,P ＜ 0.01:r =0.838,P ＜ 0.01 ).In addition,a positive correlation between serum levels of VEGF and MMP-9 was found in the MMD group( r =0.590,P ＜0.01 ).Conclusion The results show that serum levels of VEGF and MMP-9 in adult MMD are higher than those in healthy controls,which may play a role in neovascularization in MMD,and moreover,serum levels of VEGF and MMP-9 show a high trend with the progression of MMD,which suggest that serum levels of VEGF and MMP-9 can reflect the severity of MMD.

Objective To investigate the changes in high voltage-activated (HVA) calcium current in dorsal root ganglion (DRG) neurons isolated from rats with neuropathic pain. Methods Pathogen-free male SD rats aged 4-6 weeks weighing 180-220 g were used in this study. The animals were anesthetized with intraperitoneal pentobarbital sodium 50 mg/kg. Neuropathic pain was induced by ligation of L5 spinal nerve between DRG and sciatic nerve. The nerve was transected distal to the ligature. The animals which showed positive signs of neuropathic pain were decapitated on the 14th postoperative day. L5 and L4 DRGs were isolated and the neurons in the ganglia were enzymatically dissociated (group L5 and L4). The control group received no surgery (group C). The HVA Ca2+ current was recorded using whole-cell patch clamp technique. Results Peak calcium current density was significantly lower in group L5 and L4 than in group C, and was significantly lower in group L5 than in group L4 . Halfactivation value (Va 1/2) was also significantly lower in group L5 than in group C and L4 (P ＜ 0.05). The relative contribution of N-type to the total HVA Ca2+ current was significantly greater in group L5 than in group C and L4(P ＜ 0.05). There was no significant difference in the steady-state inactivation curves among the 3 groups. Conclusion In rats with neuropathic pain, the HVA Ca2+ current in the injured DRG neurons may play a key role in the induction of neuropathic pain.

Objective To evaluate the diagnostic accuracy of contrast-enhanced harmonic EUS (CH-EUS)for pancreatic cancer.Methods Patients with pancreatic occupying lesion underwent CH-EUS with ultrasonic contrast medium Sonovue.Pathological diagnoses by EUS-FNA or surgery and the follow-up results were made as the final diagnosis to evaluate the accuracy of CH-EUS for pancreatic cancer.Character-istics of CH-EUS in different pancreatic tumors were analysed.Results A total of 76 patients were en-rolled,with an average age of 53. 1 ±14. 2.Thirty-five were finally diagnosed as having pancreatic cancer, 21 local mass-type pancreatitis,10 pancreatic neuroendocrine tumor,6 cystadenoma,4 intraductal papillary mucinous neoplasm.Tumor diameter was 3. 4 ±1. 4 cm and there were 18 less than 2 cm.The sensitivity and specificity,positive and negative predictive value of CH-EUS for pancreatic cancer was 97. 1%, 92. 9%,91. 7% and 97. 5% respectively.The sensitivity was 100% combined with FNA.Conclusion CH-EUS is safe,convenient for pancreatic cancer with high accuracy and can be used as an additional diag-nostic method to EUS-FNA.

Objective To investigate the relationship between p53,COX-2,Bax,c-myc genes and colorectal carcinoma complicated with chronic schistosomiasis. Methods One hundred and sixty patients with colorectal carcinoma were selected and divided into two groups;a schistosomiasis group(colorectal carcinoma complicated with chronic schistosomiasis,n=80)and a non-schistosomiasis group(colorectal carcinoma uncomplicated with chronic schistosomiasis,n=80). The tissue microarray tech-niques and immunohistochemistry method were used in all the patients to detect the expressions of p53,COX-2,Bax and c-myc proteins. Results The positive rate and level of p53 protein expression in the schistosomiasis group were lower than those in the non-schistosomiasis group,but there were no significant differences between the two groups(both P>0.05). The COX-2 protein in both groups was positive,but the positive expression level of COX-2 in the schistosomiasis group was higher than that in the non-schistosomiasis group,and there was a significant difference between the two groups(P<0.01). The positive rate and level of Bax protein expression were not significantly different between the two groups(both P>0.05). The positive rate of c-myc expression in the schistosomiasis group was higher than that in the non-schistosomiasis group,with a significant difference(P<0.01),but the positive expression level was lower than that in the non-schistosomiasis group,and there was a significant difference between the two groups(P<0.01). Conclusions Schistosome infection may impact on the deficiency of p53 of human colorectal cancer cells. It may promote the excessive expression of COX-2 protein,which is an indirect carcinogenic factor. The expression of Bax gene has no correlation with schistosome infection. The schistosome chronic infection may cause a persistent low level expression of c-myc gene.

Objective To investigate the dynamic changes of hippocampal insulin like growth factor-1(IGF-1)/IGF-1 receptor (1GF-1 R) signaling pathway and learning and memory function and to investigate the possible mechanisms of vascular dementia (VaD).Methods A rat chronic cerebral hypoperfusion model was induced by using permanent bilateral common carotid artery ligation.At day 3,1 and 2 weeks,1,2 and 4months after modeling,Morris water maze test was used to evaluate the changes of learning and memory function in rats.HE staining was used to observe the morphological changes of hippocampal neurons.Enzymelinked immunosorbent assay was used to detect the dynamic changes of IGF-1,IGF-1R,Akt and p-Akt in hippocampal tissue.Results One month after modeling,the rats of a model group began to appear significant learning and memory dysfunction.The numbers of crossing the platform were significant lower than those in a sham operation group (1.91 ±0.45 times vs.3.95 ± 1.64 times; t =17.251,P =0.000).With the extension of ischemia time,the degree of injury of pyramidal cells in hippocampal CA1 region aggravated gradually in the model group.The levels of IGF-1 and p-Akt in hippocampal tissue increased early after modeling in the model group,and then they declined gradually to the normal levels.The levels of IGF-1 (0.09 ± 0.05 ng/mg vs.0.20 ±0.03 ng/mg; t =-5.263,P =0.003) and p-Akt (12.50± 1.40 pg/mg vs.17.13 ± 0.87 pg/mg; t =- 5.651,P =0.000) at 1 month were significantly lower than those in the sham operation group and continued to 4 months.There were no significant changes in the levels of IGF-1R and Akt.Conclusions The down-regulation of IGF-1/IGF-1R signaling pathway may be one of the pathogeneses of VaD.

Objective To investigate the value of hyperintense vessel signs (HVS) on fluidattenuated inversion recovery (FLAIR) sequence for assessing the patterns of collateral blood flow in adult moyamoya disease (MMD).Methods Forty-one adult patients with non-hemorrhagic MMD retrieved from Nanjing Stroke Registry Program between August 2008 and January 2011 were identified by digital cerebral angiography and performed the examination of FLAIR sequence in Jinling hospital.According to the different sites of HVS located in the territory of the middle cerebral artery,the patterns of HVS were classified into grades 0-3: Grade 0,absence of HVS ; Grade 1,HVS limited in the cerebral sulci of temporal lobe and Sylvian fissure ; Grade 2,HVS in the cerebral sulci of frontal and parietal lobe regions and Sylvian fissure;and Grade 3,HVS in the combined territories of Grade 1 and Grade 2.According to the intracerebral collateral blood flow,steno-occlusions of the arteries were classified into three types: Type 1,residual antegrade flow across steno-occlusive lesions; Type 2,retrograde flow via leptomeningeal vessels; Type 3,the combined collateral blood flow of Type 1 and Type 2.The relationship between the patterns of intracerebral collateral blood flow and the location of HVS was analyzed.Results Of 41 adult patients with non-hemorrhagic MMD,there were 3 patients presented with unilateral vascular lesions and 38 with bilateral vascular lesions,so the total number of vascular lesions of the cerebral hemispheres was 79.Because three patients showed the absence of HVS in bilateral hemispheres,the total number of the presence of HVS of the cerebral hemispheres was 73.Therefore,the percentage of the presence of HVS was 92.4％ (73/79) in vascular lesions of the cerebral hemispheres.Importantly,the patterns of slow collateral blood flow corresponding to Grade 1 HVS were all antegrade (7/7) ; the collateral patterns corresponding to Grade 2 HVS were mainly retrograde leptomeningeal flow (95.0％,19/20) ; and the patterns corresponding to Grade 3 HVS were mainly slow combined collateral blood flow(84.8％,39/46).Furthermore,with the changing sites of HVS from the cerebral sulci of temporal lobe to the cerebral sulci of frontal and parietal lobe regions,the directions of collateral flow changed with a shift from antegrade to retrograde,which was statistically significant.Conclusion The different locations of HVS can reflect the different patterns of collateral blood flow,and the locations of HVS may predict the directions of intracerebral collateral blood flow in adult MMD patients.