Objective To compare the cerebral blood flow (CBF) and intracranial pressure (ICP) during laparoscopic gynecologic surgery performed under propofol and sevoflurane combined anesthesia.Methods Forty ASAⅠ orⅡ patients aged 20-59 yr weighing 44-69 kg were randomly divided into 2 groups(n=20 each):propofol group (group P) and sevoflurane group (group S).Anesthesia was induced with TCI of propofol (Ce 4μg/ml) in group P or 8% sevoflurane in group S combined with TCI of remifentanil (Ce 6 ng/ml).Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of propofol or sevoflurane.inhalation combined with TCI of remifentanil.BIS value was maintained at 45-50 by adjusting Ce of propofol or concentration of sevoflurane.Intraabdominal pressure (IAP) was maintained at 12-14 mm Hg.Transcranial Doppler monitoring wag used.Cerebral blood flow velocity (CBFV) and pulsatility index (PI) were recorded at 5 min after supine position(T1)and 5 min after supine lithotomy position before induction(T2),while tracheal tube was being inserted(T3),5 min after tracheal intubation(T4),immediately and 15 min after abdominal CO2 iusnfflation in trendelenburglithotomy position (T5,T6) and at 10 min after deflation of abdomen(T7).Results CBFV was significandy decreased at T3,T4 and T7 in group P and at T4 and T7 in group S as compared with the baseline at T1.CBFV at T3 was significantly lower in group P than in group S.PI at T3,T4 was significantly decreased in group P as compared with the baseline at T1 and was significantly lower than in group S.PI at T5,6 was significantly increased as compared with the baseline in both groups but was not significantly different between the 2 groups.Conclusion When combined with remifentanil.propofol could decrease CBF and ICP while sevoflurane has no significant effect on CBF and ICP after induction.CBF and ICP are significantly increased in both groups after abdominal CO2 insufflation.

Objective To investigate the expressions of regulatory T cell (Treg) and interleukin-35 (IL-35) in patients with cholangiocarcinoma and to explore their clinical significance.Methods Flow-cytometry,PCR,Enzyme-linked immunosorbent assay (Elisa) and immunohistochemistry were used to detect the levels of Treg and IL-35 in peripheral blood and cholangiocarcinoma tissues in 42 patients with cholangiocarcinoma.Healthy volunteers were used as a control group.Result The percentage of Treg cells to CD4 + T cells in patients with cholangiocarcinoma was (5.6 ± 1.7) ％,while that in the normal control group was (2.9 ± 0.8) ％.There was a significant difference between the two groups (P ＜ 0.05).The plasma levels of IL-35 in patients with cholangiocarcinoma was (198.4 ± 81.4) pg/ml,while that in the normal control group was (33.7 ± 18.0) pg/ml.Again,a significant difference was observed between the two groups (P ＜ 0.05).In peripheral blood mononuclear cell,the IL-35 mRNA level was positively correlated with the plasma IL-35 level (p35,R =0.795,P ＜0.05;EBI3,R =0.812,P ＜ 0.05).Immunohistochemical studies showed that FOXP3 + tumor cells and Treg cells increased significantly in tumor tissues.Conclusion Overexpressions of Treg and IL-35 in peripheral blood and tumor tissues of patients with cholangiocarcinoma suggested that they may play important roles in the development of cholangiocarcinoma.

Objective To study and correlate serum bilirubin and regulatory T cell (Treg) levels in patients with bile duct stone.Methods Flow-cytometry and Enzyme-linked immunosorbent assay (Elisa) were used to study the peripheral blood expression level of Tregs and the bilirubin level in 27 patients with bile duct stones and jaundice.The changes in the expression level of Tregs and the bilirubin level were studied and correlated before and after treatment.Results After treatment,both the peripheral blood bilirubin level,the Tregs expression level and the cell cytokines decreased significantly.The total bilirubin level decreased from (102.8 ± 33.1) mmol/L to (15.3 ± 5.7) mmol/L (P ＜ 0.05),the direct bilirubin level decreased from (38.1 ± 12.8) mmol/L to (5.0 ± 1.6) mmol/L (P ＜0.05);the percentages of CD4+ CD25 +Foxp3 + T cells in CD4+ T decreased from (4.2 ± 2.0) ％ to (2.4 ± 1.0) ％ (P ＜ 0.05).Before treatment,the levels of IL-10 and TGF-β were 171.4 ± 13.7 and 2016 ±657 pg/ml but after treatment,the two cytokines decreased to 92.1 ± 7.4 and 1 686 ± 168 pg/ml,respectively (P ＜ 0.05).Conclusions Patients with bile duct stones and jaundice presented with high expressions of bilirubin and Tregs level.These expressions returned to normal after effective treatment.The Tregs expression level was positively correlated with the bilirubin level.

Eukaryotic translation initiation factor eIF2B, the guanine nucleotide exchange factor (GEF) for eIF2, catalyzes conversion of eIF2·GDP to eIF2·GTP. The eIF2B is composed of five subunits, α, β, γ, δ and ɛ, within which the ɛ subunit is responsible for catalyzing the guanine exchange reaction. Here we present the crystal structure of the C-terminal domain of human eIF2Bɛ (eIF2Bɛ-CTD) at 2.0-Å resolution. The structure resembles a HEAT motif and three charge-rich areas on its surface can be identified. When compared to yeast eIF2Bɛ-CTD, one area involves highly conserved AA boxes while the other two are only partially conserved. In addition, the previously reported mutations in human eIF2Bɛ-CTD, which are related to the loss of the GEF activity and human VWM disease, have been discussed. Based on the structure, most of such mutations tend to destabilize the HEAT motif.
Amino Acid Motifs ; Amino Acid Sequence ; Catalytic Domain ; Crystallography, X-Ray ; Eukaryotic Initiation Factor-2B ; biosynthesis ; chemistry ; Humans ; Molecular Sequence Data ; Protein Structure, Tertiary ; Protein Subunits ; biosynthesis ; chemistry ; Recombinant Proteins ; biosynthesis ; chemistry ; Sequence Alignment ; Structural Homology, Protein ; Surface Properties

Objective:To investigate the perioperative impact of closure of mesenteric fissure in laparoscopic right hemicolectomy.Methods:The prospective randomized controlled trial was conducted. The clinical data of 320 patients who underwent laparoscopic right hemicolectomy in 11 medical centers, including The First Affiliated Hospital of China Medical University et al, from November 2022 to August 2023 were selected. Based on block randomization, patients were alloca-ted into the mesenteric fissure non-closure group and the mesenteric fissure closure group. Observa-tion indicators: (1) grouping of the enrolled patients; (2) intraoperative conditions; (3) postopera-tive conditions. Measurement data with skewed distribution were represented as M( Q1, Q3) and com-parison between groups was conducted using the Mann-Whitney U test. Count data were represen-ted as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher's exact probability. Comparison of ordinal data was conducted using the rank sum test. Comparison of visual analog scores was analyzed using generalized estimating equations. Results:(1) Grouping of the enrolled patients. A total of 320 patients with colon cancer were screened for eligibility, including 156 males and 164 females, aged 68(59,73)years. All the 320 patients were allocated into the mesenteric fissure non-closure group with 164 cases and the mesenteric fissure closure group with 156 cases. There was no significant difference in the age, body mass index, American Society of Anesthesiologist score, maximum tumor diameter, anastomosis location, anastomosis method, surgical approach, range of lymph node dissection, tumor staging between the two groups ( P>0.05) and there was a significant difference in the sex between them ( P<0.05). (2) Intraoperative conditions. There was no significant difference between the mesenteric fissure closure group and the mesenteric fissure non-closure group in the volume of intraoperative blood loss, operation time, conversion to laparotomy, intraoperative complication ( P>0.05). Three patients in the mesenteric fissure non-closure group were converted to laparotomy. One patient in the mesenteric fissure closure group was converted to laparotomy, and 2 cases with intraoperative complication were mesenteric hematoma. (3) Postoperative conditions. There was no significant difference between the mesenteric fissure non-closure group and the mesenteric fissure closure group in the overall postoperative complications ( χ2=0.28, P>0.05). There was no significant difference in the occurrence of postoperative intestinal obstruction, abdominal distension, ascites, pleural effusion, gastric paralysis, anastomotic bleeding, anastomotic leakage, or surgical wound infection between the two groups ( P>0.05). There was no significant difference between the two groups in the reoperation, postoperative gastric tube replacement. There was no significant differ-ence in time to postoperative first flatus, time to postoperative initial liquid food intake, time to post-operative resumption of bowel movements, duration of postoperative hospital stay, total hospital expenses between the two groups ( Z=-0.01, 0.43, 1.04, -0.54, -0.36, P>0.05). One patient in the mesenteric fissure non-closure group received reoperation. No perioperative internal hernia or death occurred in either group. The visual analog score decreased with time in both groups. There was no significant difference in the visual analog score between the mesenteric fissure closure group and the mesenteric fissure non-closure group [ β=-0.20(-0.53,0.13), P>0.05]. Conclusion:Compared with closure of mesenteric fissure, non-closure of mesenteric fissure during laparoscopic right hemi-colectomy dose not increase perioperative complications or postoperative management risk.