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 investigate risk factors of nocturnal hypoglycemia in patients with type 2 diabetes mellitus,to seek quantitative indicators for early warning,and to evaluate the effects of intervention.Methods 24-h blood glucose of 1147 patients with type 2 diabetes mellitus with well-controlled hyperglycemia were determined by continuous glucose monitoring system (CGMS).Incidences of hypoglycemia were compared between groups with different 3 h postprandial blood glucose levels after supper.Results The rates of hypoglycemia,asymptomatic hypoglycemia,and nocturnal hypoglycemia were respectively 37.23％,22.75％,and 18.31％.Nocturnal hypoglycemia set in most frequently by 22:00-2:00 (RR =1.72,x2 =31.667,P＜0.01).The hypoglycemia incidence was reduced in intervention group than that in control group (9.67％ vs 16.76％,x2 =8.79,P ＜0.01).Conclusions Nocturnal hypoglycemia happens commonly in patients with type 2 diabetes.It usually sets in by 22:00-2:00.Appropriate intervention may prevent the hypoglycemic events.

Objective To evaluate the efficacy of pressure support ventilation ( PSV ) in the infants undergoing laparoscopic hernia repair under sevoflurane anesthesia. Methods Thirty ASA physical statusⅠpediatric children, aged 9 months-1 yr, weighing 8.0-11.5 kg, undergoing elective laparoscopic hernia repair, were randomly assigned into 3 groups ( n=10 each) using a random number table: pressure control ventilation ( PCV) used for muscle relaxants in combination with low?concentration sevoflurane group ( group PCV1 ) , PCV used for high?concentration sevoflurane group ( group PCV2 ) , and PSV used for low?concentration sevoflurane group ( group PSV) . Anesthesia was induced with inhalation of 4%-6%sevoflurane and iv fentanyl 2 μg∕kg and succinylcholine 1.5 mg∕kg. The pediatric children were endotracheally intubated and mechanically ventilated. In PCV1 and PCV2 groups, PCV was used during operation. In group PSV, PCV was used first after intubation, and then PSV was applied after spontaneous breathing recovered. Anesthesia was maintained as follows: in group PCV1 , the end?tidal concentration of sevoflurane was maintained at 2.5% - 3.0%, and cisatracurium besylate 0.1 mg∕kg was injected intermittently as required; in group PCV1 , the end?tidal concentration of sevoflurane was maintained at 3.5%-4.0%; in group PSV, the end?tidal concentration of sevoflurane was maintained at 2.5%-3.0%, and succinylcholine 1.0 mg∕kg was injected intravenously before pneumoperitoneum. Narcotrend index value was maintained at 50-60 in PCV1 and PSV groups, or at 37-45 in PCV2 group. Heart rate ( HR) and mean arterial pressure (MAP) were recorded before induction of anesthesia (baseline), at the beginning of pneumoperitoneum, at 5 and 10 min of pneumoperitoneum, at the end of pneumoperitoneum, at the end of operation and immediately after extubation. The time interval from the end of surgery to extubation was recorded. Results Pulse oxygen saturation was 100% during anesthesia, and>95% during recovery from anesthesia in the three groups. Compared with the baseline value, HR was significantly faster, and MAP was increased during extubation in PCV1 and PCV2 groups, and no significant change was found in HR and MAP at each time point in group PSV. The time interval from the end of surgery to extubation was 30.3± 5.4, 18.4±4.3 and (4.1±1.2) min in PCV1, PCV2 and PSV groups, respectively. Compared with PCV1 and PCV2 groups, the time interval from the end of surgery to extubation was significantly shortened in group PSV. Conclusion When PSV is applied in the infants undergoing laparoscopic hernia repair under sevoflurane anesthesia, it can provide adequate ventilation, recovery from anesthesia is rapid, and no cardiovascular responses occur during extubation.

BACKGROUND:In recent years, studies on the application of traditional Chinese medicine in bone tissue engineering are stil at the initial stage in China. Reports about psoralen antibiotic biphasic ceramic bone have not been seen in bone tissue engineering research. OBJECTIVE:To fabricate the psoralen antibiotic biphasic ceramic bone by vacuum evaporator and to observe the physicochemical properties, antibiotic activity and biocompatibility of the material. METHODS:Biphasic ceramic bone was prepared by twice low-temperature calcining pig vertebrae combined with sodium pyrophosphate, and then the ceramic bone was immersed in chitosan/psoralen compound solution to prepare psoralen antibiotic biphasic ceramic bone. The surface morphology was observed by scanning electron microscope, and the compressive strength was tested. Antibiotic activity of the psoralen antibiotic biphasic ceramic bone on Escherichia coli and Staphylococcus aureus was tested by microbiological methods. Mouse osteoblasts MC3T3-E1 were co-cultured with the psoralen antibiotic biphasic ceramic bone for 4 and 8 days, and the cel adhesion and proliferation on the scaffold surface were observed under the scanning electron microscope. RESULTS AND CONCLUSION:Psoralen antibiotic biphasic ceramic bone had natural pore structure with the trabecular bone, trabecular space and lumen system and exerted great antibiotic effect on Escherichia coli and Staphylococcus aureus. The compressive strength was (4.69±0.50) MPa. Mouse osteoblasts MC3T3-E1M could be adherent to the psoralen antibiotic biphasic ceramic bone and proliferate rapidly, suggesting the psoralen antibiotic biphasic ceramic bone has good cytocompatibility.

The variation of blood glucose in 1 147 patients with type 2 diabetes mellitus was monitored by continuous glucose monitoring system(CGMS). The results showed that the peak hours of nocturnal hypoglycemia occurred during 22 : 00-2 : 00. The incidence of nocturnal hypoglycemia was negatively correlated with mean blood glucose and blood glucose at three hours after supper. The probability of hypoglycemia was up to 50% when blood glucose level had been as low as 4. 7 mmol/L at 3 h after supper.

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 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.