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 observe the effects of propofol or sevoflurane combined with remifentanil on cerebral blood flow (CBF) and cerebral autoregulation in patients undergoing gynecologic laparoscopic surgery. Methods Forty patients were randomly divided into two groups: the propofol group (group P, n=20) and the sevoflurane group (group S, n=20). Anaesthesia was induced with target-controlled infusion (TCI) of propofol and remifentanil in group P, with an inhaled induction of sevoflurane and TCI of remifentanil in group S, respectively. The depth of anesthesia was regulated according to bispectral index (BIS). The pressure of end-tidal carbon dioxide (P_(ET)CO_2) was kept at 35-40 mmHg by mechanical ventilation. The mean arterial pressure (MAP), heart rate (HR), pressure of arterial carbon dioxide (PaCO_2), P_(ET)CO_2, time-averaged peak flow velocity (TAP) and the transient hyperaemic response ratio (THRR) were recorded at 7 different time points: supine position (T_1) and supine lithotomy position before induction (T_2), the instant and 5 min after tracheal intubation (T_3,T_4), the instant and 15 min after abdominal CO_2 insufflation and trendelenburg-lithotomy position (T_5,T_6), and 10 min after the deflation abdomen (T_7), respectively. Results Compared with the baseline values at T_1, TAP was not significantly changed at T_2, T_5, or T_6 in group P, but was markedly decreased at T_3, T_4 and T_7. TAP in group S only decreased at T_4 and T_7, while it was much higher than that in group P at T_3. In group S, THRR was markedly lowered at T_3 compared with that at T_1; but in group P, it showed a significant increase at T_3. Conclusions Combined with remifentanil, propofol decreased CBF, but has no effect on the brain self-regulation. When inhaled in high concentrations, sevoflurane significantly reduces the brain self-regulation. Intraoperation pneumoperitoneum and postural factor significantly increase CBF, playing a stronger role than the narcotic drugs in clinical dosage (propofol, sevoflurane), without any influence on the brain self-regulation.

ObjectiveTo know urban-rural differences of reference factors for the identification of students from poor families in order to provide references for identifying index system.Methods Questionnaires were used among 708 students from poor families.ResultsThere were 78.9％ urban and 89.1％ rural families whose average earnings were lower than 410 RMB per month.The number of majority urban and rural family (58.8％,75.4％ ) was 4 - 6 ; 77.0％ ( 86.3％ ) urban and 97.3％ (97.9％) rural fathers' ( mothers' ) education levels were high school or below; 8.6％ ( 23.1％ ) urban and 82.3 ％ ( 85.1％ ) rural fathers ( mothers ) were farmers.The proportion of students having computers was 87.2％ (urban) and 7 1.9 ％ (rural) ; 54.9％ urban and 63.9％ rural students' life was not frugal; 85.2％ urban and 79.1％ rural students thought campus cards shouldn't be monitored.ConclusionsThere are significant urban-rural differences of reference factors for the idenffication and family residence is the key indicator which should have higher weights.

ObjectiveTo analyze the underlying causes of postoperative gastrointestinal (CI)bleeding after pancreaticoduodenectomy and to discuss the strategies in diagnosis,prevention and management.MethodsThe clinical data of 331 patients who were admitted to the Surgical Department of the First Hospital,Peking University from Jan. 1998 to Jan. 2010 was retrospectively analyzed.ResultsThe overall postoperative morbidity was 37.2 ％,with a bleeding complication rate of 6.7 ％,and a GI bleeding rate of 1.5％.For postoperative GI bleeding,the main bleeding sites were from the pancreaticointestinal anastomosis (40.0％) and the gastrointestinal anastomosis (20.0％). Embolotherapy using vascular intervention alone (20.0％),open abdominal operation following vascular interventional therapy (40.0 ％ ) and open abdominal operation alone (40.0 ％ ) were used to control GIbleeding.ConclusionsThe common bleeding sites in the GI tract were at the pancreaticointestinal anastomosis and the gastrointestinal anastomosis. The main procedures used to control bleeding were embolization using vascular interventional therapy,endoscopic therapy and open abdominal therapy.

Objective To know the problems of reference factors,and then provide evidences for scientific and specific identifying index system for students from poor families.Methods Questionnaires were used among 719 students from poor families.Results There were 86.0％ families whose earnings were lower than 410 RMB per month.57.2％ families depended on agriculture.70.1％ students were from the rural areas.Family member number was 4～6 for the majority ( 70.7％ ).91.2％ ( 94.5％ ) fathers'( mothers' ) education levels were under high middle school.64.0％ ( 67.3％ )fathers ( mothers ) were farmers.The proportion of students having computers was 76.1％.61.2％ students' life was not frugal.There were 80.9％ students who thought campus cards shouldn't be monitored.Conclusion Family economic situation should be the key indicator.Most of the basic family information could be reference factors.Basic situation of students at school was inappropriate to be reference factors.

Objective To investigate tbe pharmacodynamics of different local anesthetics administered intrathecally for caesarean section. Methods Ninety-six parturients with singleton term pregnancies undergoing caesarean section under combined spinal-epidural anesthesia were enrolled in this study. The patients were randomly divided into 3 groups ( n = 32 each ) and received intrathecal (IT) 0.5 % bupivacaine, 0.5 %levobupivacaine and 0.5% ropivacaine respectively. The initial doses was 9 mg in all 3 groups. The ratio of two successive doses was 0.9. If the upper sensory block reached T7 or above and there was no need for additional dose in the 45 min after the initial dose, the IT analgesia was considered to be effective. The median effective dose ( ED50 ), the 95 % effective dose( ED95) and 95 % confidence interval (95 % CI )were calculated by Dixon. Results The ED50 and ED95 and 95%CI of bupivacaine were 6.15 (95%CI 5.48-6.68) mg and 7.62 (95%CI 6.91-11.82) mg; of levobupivacaine were 8.06 (95%CI 7.46-8.62) mg and 9.59 (95%CI 8.86-13.42) mg;of ropivacaine were 10.55 (95%CI 9.73-11.49) mg and 12.80 (95%CI 11.66-21.42) mg. The relative potency potency ratio between bupivacaine, levobupivacaine and rupivacaine is 1.00:0.76:0.58.

Objective: To investigate the effect of a long-term CpG-ODN stimulation on the maturation of murine bone-marrow derived dendritic cells (BMDCs). Methods: Murine bone-marrow cells were cultured in GM-CSF alone or with CpG-ODN for 7 d or for last 36 h (days 6, 7). Cell phenotypes and antigens uptake by BMDCs were analyzed by flow cytometry. Cytokines released by BMDCs were detected by ELISA. The antigen presenting capability by BMDCs was evaluated by mixed lymphocyte responses.Results:Compared to those of the short-term CpG-ODN stimulation group, the expression of MHCⅡ, CD86, CD40, and secretion of IL-12(p70) by BMDCs in long-term stimulation group were not increased. The phagocytosis of FITC-OVA by BMDCs in long-term CpG-ODN stimulation group was strengthened, but the activation of allogenic and homogenic lymphocyte cells proliferation was impaired. Conclusion:Long-term CpG-ODN stimulation can suppress the maturation of DCs, which may explain the low adaptive immunity in sepsis patients.

Objective To observe the Leu72Met single nucleotide polymorphism (SNP)of ghrelin gene and the relationship with essential hypertension (EH).Methods Polymerase chain reaction -restriction fragment length polymorphism (PCR -RFLP)was used to detect the Leu72Met SNP of ghrelin gene in 210 EH patients and 220 healthy controls.The plasma ghrelin was detected by radioimmunoassay method collected from all subjects. Results There were three types of polymorphism of ghrelin gene at the base site Leu72Met.There were significant differences in the genotypes (CC,CA,AA)and alleles (C,A)between the EH patients and the controls (χ2 =6.054,P =0.048;χ2 =5.866,P =0.015).In EH group,the plasma ghrelin level in subjects who were homozygous CC without mutant was not only significantly lower than those who were heterozygous CA,but also lower than those who were nucleotide homozygous mutant AA (t =-8.738,P =0.000;t =-5.103,P =0.000).The patients with CC genotype had higher SBP (t =4.298,P =0.000;t =2.236,P =0.019)and lower HDL -C (t =-11.682,P =0.000;t =-7.872,P =0.000).The patients with A allele had lower plasma ghrelin (t =-16.264,P =0.000), HDL -C (t =-15.332,P =0.000)and higher SBP(t =3.800,P =0.000),DBP(t =11.895,P =0.000),and LDL -C (t =38.401,P =0.000).Conclusion The Leu72Met SNP of ghrelin gene is significantly related to the susceptibility of EH.Base mutation C to A reduced the incidence of EH.The Leu72Met polymorphism of ghrelin gene is related to the plasma ghrelin,blood pressure and blood lipid metabolism.Base mutation C to A elevated plasma ghrelin,and lowered blood pressure and blood lipid.

[ ABSTRACT] AIM: To observe the effect of microRNA-19a ( miR-19a) on the lipid catabolism of hepatocyte LO2, and to explore the potential mechanism.METHODS: miR-19a was over-expressed or silenced by transfection of miR-19a mimics or miR-19a inhibitor into LO2 cells, then the mRNA level of miR-19a was detected by real-time PCR.The potential target of miR-19a was found by the method of bioinformatics through internet website.The effect of miR-19a on the 3’ UTR of peroxisome proliferator-activated receptorα(PPARα) was measured by dual luciferase reporter assay, and the protein level of PPARαand its 2 major downstream rate-limiting enzymes involved in lipid catabolism, acyl-coenzyme a dehydrogenase (ACADM) and carnitine palmitoyltransferase 1A ( CPT1A), were detected by Western blotting.Mean-while, the effect of miR-19a on the generation of ketone body was measured by beta-hydroxybutyric acid (β-OHB) detec-tion assay.RESULTS:The mRNA level of miR-19a was dramatically elevated by the transfection of miR-19a mimics, and sharply decreased by the transfection of miR-19a inhibitor (P<0.05).PPARαwas found as a potential target of miR-19a, and dual luciferase reporter assay and Western blotting confirmed the regulatory effect of miR-19a on the expression of PPARα, with the protein level changes of ACADM and CPT1A.miR-19a mimics down-regulated, while miR-19a inhibitor up-regulated the concentration ofβ-OHB in LO2 cells (P<0.05).CONCLUSION:miR-19a regulates the lipid catabo-lism of hepatocytes by targeting the PPARαand its 2 downstream rate-limiting enzymes.

Objective: To study the expression and activity changes of methionine adenosyltransferase (MAT) in human peripheral T lymphocytes. Methods: The expression of MAT mRNA was detected by RT-PCR and the activity of MAT was measured. Results: After stimulated by IL-2, PHA and anti-CD3 antibody, MAT-Ⅱ gene expression increased by (8.9? 2.1), (7.7?1.9) and (8.0?1.8) times, respectively, and the expression peak was at 8, 4 and 8 h,respectively; MAT activity continuously increased in 48 h. S-adenosylmethioinie (SAM) moderately induced IL-2 and IFN secretion by human T cells. SAM(0.1 mg/ml) downregulated the expression and activity of MAT-Ⅱ and the secretion of IL-2 and IFN induced by PHA or anti-CD3 antibody in human T cells. Conclusion:MAT is involved in the activation of T lymphocytes, and high dose of SAM may also inhibit its activation through PHA and anti-CD3 antibody.