Objective To evaluate the feasibility and safety of using continuous spinal anesthesia (CSA) in high risk elderly patients undergoing lower abdominal or lower extremity surgery. Methods Sixty-four ASA III or IV patients aged 70-101 yr weighing 38-55 kg undergoing lower abdominal or lower extremity surgery were randomized to receive epidural anesthesia (EA) (n = 32) or CSA ( n = 32). The patients were complicated with cerebral embolism and/or hypertension, coronary artery disease and/or COPD and/or diabetes mellitus. The patients were unpremedicated. EA was performed at I2.3 or L1.2. A test dose of 2 ml of 2% lidocaine was given. When no signs of spinal block was observed, 1 % ropivacaine was given in small increments until the block height reached T6-8 . CSA was performed at L3,4 using Spinocath (B. Braun). A 2-cm catheter segment was left in subarachnoid space. 0.5% bupivacaine was given in 0.5 ml increments every 3 min until satisfactory block level was reached. The onset time of anesthesia was recorded. The degree of motor block was assessed using modified Bromage scale. Arterial blood samples were obtained before anesthesia (T0 , baseline), when satisfactory block level was reached ( T1), 1 h after skin incision (T2) and at the end of operation (T3) for determination of lactate concentration. The amount of ephedrine and innovar ( droperidol-fentanyl mixture) used during operation and the recovery of motor function of lower extremities were also recorded. Results The demographic data including sex, age, height, body weight, ASA physical status and types of operation were not significantly different between the two groups. BP and HR were significantly decreased after anesthesia as compared to the baseline values at T0 in group EA, whereas in CSA group there were no significant changes in BP and HR after anesthesia. Significantly more patients received ephedrine in EA group (98% ) than in CSA group (15%) and the mean dose of ephedrine was significantly higher in EA group [(34.5?3.1) mg] than in CSA group [(4.3?0.5) mg ]. The onset of block was significantly faster in CSA group than in EA group. Motor blockade was less intense in EA group as assessed by modified Bromage scale. Analgesia was more satisfactory in CSA group and less patients received innovar during operation in CSA group (20% ) than in EA group (51% ). The recovery of motor function of lower extremities was faster in CSA group than in EA group. Blood lactate was significantly higher at T1 , T2 , T3 in EA group than in CSA group. No late complications related to CSA was observed. Conclusion CSA is safe and effective and provides better analgesia with better hemodynamic stability and faster onset of block than EA in elderly patients.

Objective It has been shown that strong acute stress or long-term chronic stress significantly affects learning and memory. The aim of this study was to investigate the effects of chronic pain on learning and memory and morphological structure of hippocampus in neonatal rats.Methods Sixty SD rats aged 7 days were randomly divided into two groups : (A) chronic pain group ( n = 30) in which 0.5% formalin 0.1 ml was injected subcutaneously into plantar region of hind paw every day for two weeks and (B) control group (n = 30) in which the plantar region of hind paw was touched with cotton-tipped swab every day for 2 weeks instead of subcutaneous injection of formalin. Morris water maze performance was used to test learning and memory. The number of granule neurons in dentate gyrus and pyramidal neurons in CA3 were counted. Results The mean latency period in the Morris water maze intelligence test was significantly longer in chronic pain group than that in control group ( P

ObjectiveTo investigate the effects of isoflurane anesthesia on the expression of brain-derived neurotrophic factor (BDNF) and phosphorylated extracellular signal-regulated kinase (p-ERK) in neonatal rat hippocampus.MethodsForty-eight SD rats of both sexes,aged 7 days,weighing 12-17 g,were randomly divided into 2 groups ( n =24 each):control group (group C) and isoflurane anesthesia group (group Ⅰ).In group Ⅰ,the rats were exposed to2.5％ isotlurane for 3 min and then 1.5％ isoflurane was inhaled for 4 h,while in group C the rats were exposed to air for4 h.Arterial blood samples were collected immediately after anesthesia for blood gas analysis and for determination of the blood glucose concentration.Five rats in each group were sacrificed at 0,6,24 and 48 h after anesthesia (T1-4) and hippocanpi were removed for determination of the expression of potassiumchloride cotransporter 2 (KCC2),potassium-chloride cotrmsporter 1 (NKCC1),BDNF and p-ERK by Western blot.NKCC1/KCC2 ratio was calculated.ResultsAcid-base imbalance,hypoxemia and glycopenia were not found immediately after anesthesia in both groups.Compared with group C,KCC2 expression was significantly down-regulated and NKCC1/KCC2 ratio was increased at T3 and T4,and the expression of BDNF and p-ERK was dewn-regnlated at T1 and T2 in group Ⅰ (P＜0.05).There was no significant difference in NKCCI expression at each time point between groups Ⅰ and C ( P ＞ 0.05 )、ConclusionIsoflurane anesthesia delays the neuronal development in neonatal rat hippocampus through down-regulating the expression of BDNF and p-ERK.

Objective To investigate the effects of isoflurane anesthesia on proliferation and differentiation of neural stem cells (NSCs) in the dentate gyrus of neonatal rats.Methods Ten SD rats,aged 7 days,weighing 16-20 g,were randomly divided into 2 groups ( n =5 each):control group (group C) and isoflurane group (group 1) .The rats in group Ⅰ inhaled 2.5％ isoflurane for 3 min for induction and then anesthesia was maintained with 1.5 ％ isoflurane for 4 h,while the rats in group C only breathed the room air for 4 h.Bromodeoxyuridine (BrdU) 100 mg/kg was injected intraperitoneally right before the induction and after the end of administration to label NSCs and their progeny in the dentate gyrus.At 24 h after the 2nd administration of BrdU,double immunofluorescence for BrdU and NeuroD (a marker of neuroblasts and immature neurons) was used to assess NSC proliferation and neuronal differentiation.Results Compared with group C,the number of BrdU+ cells in group Ⅰ was significantly decreased,whereas the fraction of NeuroD+/BrdU+ differentiated cells was increased in the dentate gyrus( P ＜ 0.05 or 0.01 ).Conclusion Isoflurane anesthesia suppresses the proliferation of NSCs and induces neuronal differentiation of NSCs in the dentate gyrus of neonatal rats.

Objective To study the role of three-dimensional conformal radiation therapy(3DCRT) in the treatment of elderly non-small cell lung cancer(NSCLC) patients.Methods From 2000 to 2004,39 elderly NSCLC patients(range 70-87 years) were treated by 3DCRT.Their Karnovsky performance score was 50-60 in 20 patients and those of the other 19 patients were not less than 70.Prescription dose were 40-60?Gy,with a median of 50?Gy.Results Thirty-six(92%) patients'symptoms were relieved at the end of treatment,with the other three patients' symptoms steady.Complete response and partial response was achieved in 19 and 17 patients respectively.The 1-year survival rate was 60%,with a median survival time of 10 months.Conclusions Three dimensional conformal radiotherapy is effective for elderly NSCLC patients in terms of symptom relief.For treatment choice of these senior NSCLC patients,the balance between tumor control and quality of life should be carefully considered.

Objective To research the structure and principle of Helical Tomotherapy, and study the clinical application value of the equipment system. Methods As the first helical radiotherapy system in the mainland of China, its constructions, structure and principle were analyzed and discussed. Results Helical Tomotherapy is a new kind of radiotherapy equipment. The Hi-Art treatment system is a combination of a LINAC and a CT scanner capable of having the function of both systems. It was approved to achieve the best intensity modulated radiation therapy (IMRT), used for adjusting the setup position of the patient with MVCT and as the basis for dose reconstruction and other adaptive radiotherapy processes. It is the first integrated planning, delivery and verification system for IMRT. Conclusion Image-guided radiation therapy (IGRT) and IMRT have introduced a new era in radiation oncology which will better fight cancer and simultaneously improve the patients' quality of life. Having been designed from the ground up for IGRT and IMRT, the tomotherapy system is in the forefront of technical advancements for efficacy and processes to make it efficiently.

Objective To investigate the effect of precondition with Toll-like receptor 4 monoclonal antibody (TLR4mAb) on lipopolysaccharide (LPS) -induced acute lung injury in mice.Methods A total of 45 male BALB/c mice were randomly divided into 3 groups:the control group ( group C),the sepsis group (group S) and the pretreatment group (group P).Mice in the group P and group S were injected intraperitoneally with LPS ( 10 mg/kg) to produce acute lung injury models.Mice in the group P was injected intraperitoneally with TLR4mAb (5 μg/g) 1 h before the injection of LPS.Expression of TLR4mRNA in lung tissue,expression of TNF-α and IL-6 in serum,water content of lung,and the pathomorphologic changes of lung were detected after 6 h,12 h and 24 h.One-way ANOVA was used for inter-group comparison and two-way ANOVA was used for intra-group comparison.Results Compared to group C,water content significantly increased at 12 h and 24 h in group S and group P; compared to group S,water content significantly decreased in group P at 12 h and 24 h.Compared to group C,the expression of IL-6 and TNF-α significantly increased in group S and group P at 6 h,12 h and 24 h; compared to group S,the expression of IL-6 and TNF-α significantly decreased at 6 h,12 h and 24 h in group P.Compared to group C,the expression of TLR4 mRNA increased significantly in group S and group P at 6 h,12 h and 24 h; compared to group S,the expression of TLR4 mRNA decreased significantly in group P at6 h,12 h and 24 h.Compared to group S,pathological damage of the lung was improved significantly in group P.Conclusions Precondition with TLR4mAb can attenuate LPS-induced acute lung injury,suppress the expression of inflammatory factors.Regulation of TLR4 pathway may be a promising therapeutic strategy for ALI.

Objective To investigate the effects of different concentrations of isoflurane on the caspase-3 expression in the hippocampus and S100β level of plasma in fetal rats. Methods 18 pregnant rats at gestational day 21 were divided into control group, 1. 3% isoflurane group,3% isoflurane group. Rats in the control group spontaneously breathed 100% oxygen for 1 h. Rats in the treatment groups breathed 1.3% or 3% isoflurane in 100% oxygen through an endotracheal tube, with mechanical ventilation for 1 h. Rat pups were delivered by cesarean section 6 h after treatment, and fetal blood was sampled from the left ventricle of each fetal heart and evaluated for S100β. Fetal brains were then evaluated for apoptosis, using caspase-3 immunohistochemistry in the CA1 region of the hippocampus. Results Compared to the control group ((1. 48 ± 0. 08) μg/L) and the 1. 3% isoflurane group( (1.53 ±0. 12)μg/L) ,the 3% isoflurane group showed significantly higher level of S100β( (3. 12 ±0. 15) μg/L, P＜0.05) . There was no differences in densities of caspase-3-positive cells between the control ((33 ±4) cell/mm ) and 1.3% isoflurane groups((31 ±5)cell/mm2). Compared to 1.3% isoflurane,isoflurane at a concentration of 3%((75 ± 7) cell/mm2, P＜0.05) for lh increased neurodegeneration in the hippocampal CA1 area in the developing brain of fetal rats. Conclusion Isoflurane can dose-dependently induce brain damage. Isoflurane at a concentration of 3% for lh can induce apoptosis in the hippocampal CA1 area and increase S100β levels of fetal rats.

Objective To observe the pain behavioral performance of rats that different sensory nerve fibers were transected,and examine the expression of brain-derived neurotrophic factor(BDNF) in these models.Methods Twenty-four rats were divided into three groups according to random number table method:SUR group,GS group and SHAM group, which received sural nerve transection, gastrocnemius-soleus nerve transection or sham operation respectively.There were 8 rats in every group.The expression of BDNF in the lumbar 5 DRG and spinal dorsal horn were detected,and the types of damaged cells were also observed.Results In GS group, 50% paw-withdrawal thresholds were significantly decreased on the ipsilateral hind paw compared with baseline and with those in SHAM group,and the paw-withdrawal durations in response to the thermal stimulus increased significantly (P＜0.01 ＝.In contrast, no change was found in SUR group(P＞0.05 ).The expression of BDNF in the lumbar 5 DRG ( (37.87 ± 4.23 ) % ) and spinal dorsal horn ( (21.9 ± 3.1 ) % ) was significantly higher in GS group than in SHAM group( ( 17.31 ± 2.12 ) %, ( 12.6 ± 1.3 ) % ), and no significant difference was found between SUR and SHAM groups(P＞0.05 ).FG opposite cells which also expressed BDNF in GS group were more than those in SUR group ( (47.7 ± 1.8) % and (26.7 ± 2.3 ) % ) (P ＜ 0.01 ＝.The percentage in N200 and FG double positive cells to N200 positive cells in GS group was significantly increased in GS group than those in SUR group ( (47.7 ±1.8 ) %, (26.7 ± 2.3 ) % ) (P ＜ 0.01 ＝.Conclusion The data suggest that injury of the sensory nerve innervating skin does not produce hyperalgesia, but injury of the sensory nerve innervating muscle does.Different kinds of neuron were damaged and the differences of BDNF expression is essential for this difference.