Objective To determine the median effective dose of remifentanil for maintaining the tolerance to ProSeal laryngeal mask airway in awake and spontaneously breathing patients.Methods Sixty ASA Ⅰ orⅡpatients aged 20-55 years old were recruited.Sixty patients was randomized into six groups with 10 case each Remifentanil was infused in a dose of 0.061,0.048,0.039,0.03,0.025 or 0.02μg·kg~(-1) 5 minutes after inserting PLMA.Single dose of remifentanil 0.25/μg/kg was given before continuous intravenous infusion.Respiratory response subscore of comfort scale(CSRR)and Ramsay sedation scale(RSS)were recorded after 25 minutes.ED50 was calculated.Results The ED50 of remifentanil for ProSeal laryngeal mask airway tolerance was 0.027μg·kg~(-1)(95%CI:0.023-0.030μg·kg~(-1)·min~(-1)in awake and spontaneously breathing patients.Conclusion The patients tolerate stimulus of laryngeal mask with a low dose continuous intravenous infusion of remifentanil in awake.and can maintain the hemodynamics stable.

Objective To study the clinicopathological characteristics and prognosis of asymptomatie IgA nephropathy (IgAN) children with pmteinuria and/or microscope haematuria .Methods Clinical and pathological characteristics of 54 children with IgA nephropathy confirmed by renal biopsy were analyzed . These children with IgAN were divided into two groups according to their clinical characteristics at the first onset: asymptomatic IgAN group (AsIgAN) and symptomatic IgAN group (SIgAN) . Histologic changes were classified by Lee SM and Katafuchi semiquantitative scoring system . Results Eighteen children were in AslgAN group and 36 children were in SIgAN group . The degree of proteinuria in SIgAN group [(2 .3±2 .2) g/d] was higher than that in AslgAN group [(0 .4±0 .3) g/d] at the time of biopsy (P＜0 .05) . Although asymptomatic IgAN children were mainly of Lee's type Ⅰ ～Ⅱ, 2 children (11%) were of Lee's type Ⅳ～Ⅴ and 5 cases (27%) presented interstitial injury . Symptomatic IgAN children were mainly of Lee's type Ⅱ ～Ⅲ, there was no significant difference between two groups (P＞0 .05) . Urine micrealbumin was increased in 87% children presented with microscope haematuria . After an average of (26 .9±8 .8)months follow-up, only one case of Lee's Ⅴ progressed into renal failure and the others maintained normal renal function . Conclusions Although children with asymptomatic IgAN have minor clinical symptoms, severe renal pathological lesion and poor prognosis also occur . Urine screening helps to detect renal diseases and renal biopsy should be performed in the patients with increased urine microalbumin .

Objective To investigate the influencing factors of successfully switching to sequential ventilation in patients with prolonged weaning due to acute respiratory failure (ARF) after thoracolaparotomy based on the initial rapid shallow breathing index (RSBI) at 60 min after spontaneous breathing trial (SBT), namely, the f/VT optimal value range of 80-120 times/ (min · L), thus providing the basis for determining the ideal timing of weaning in clinical practice.Methods A prospective observational study of sequential ventilation [RSBI during the initial SBT (60 min), 80-120 breaths/ (min · L)] was carried out in 42 patients on mechanical ventilation (≥ 48 h) due to post-thoracolaparotomy ARF in the ICUs.According to the duration of the mechanical ventilation, the patients were divided into 2 groups : successfully prolonged weaning group (≥ 7 days, n =24) and refractory weaning group (＜ 7 days, n =18).The patients with cardiac failure, aged less 18 or over 80, with hepatic dysfunction, or those needing gastrointestinal decompression after esophageal surgery or upper abdomen surgery were excluded.The demographics, APACHE Ⅱ scores and duration of mechanical ventilation of both groups were recorded, and the respiratory work and oxygen metabolism variables before the switch to sequential ventilation (within 24 hours after admission to ICU) and at the time of switching (24 hours in the ICU after admission) were recorded, respectively: clinical puhnonary infection score (CPIS), assessment of cough severity, pH, PaO2, PaCO2 and PaO2/FiO2;hemodynamic and microcirculation-related variables: HR, MAP, fluid balance, BNP and Lac;endocrine and metabolism variables : Hb, ALB and random serum cortisol (COR).The clinical features and the changes of the above-mentioned variables before and at the time of switching were compared between both groups.The independent sample t test was used for the single factor comparison and Mann-Whitney U test was applied to the non-normal distributions.The Fisher exact probability test was used for the single factor comparison of ranked data such as categorical variables.Results There were no significant differences in age, gender and severity of disease between two groups (P ＞ 0.05);the successfully prolonged weaning group had longer duration of invasive mechanical ventilation and ICU stay compared with the refractory weaning group (P ＜ 0.05).There were significant differences in cough severity, PaCO2, pH, HR and fluid balance between two groups before switching (P ＜ 0.05).Compared with those before switching, in the refractory weaning group there were marked decrease in Lac (P ＜ 0.05), obvious increase in cough severity, pH, Hb and ALB (P ＜ 0.05), but there was no significant difference in COR (P ＞ 0.05);while in the successfully delayed weaning group, there were significant decrease in CPIS, PaCO2, HR, MAP, BNP, fluid balance and Lac (P ＜ 0.05), and cough severity, pH, ALB and COR showed an upward trend (P ＜ 0.05).Conclusions The key of successful sequential ventilation is within the values of RSBI ranging from 80 to 120 times/ (min · L) during the initial SBT (60 min) selected as the switching point in patients with prolonged weaning after thoracolaparotomy.The major influencing factors for determining the ideal timing of switching include the matching status between respiratory endurance and respiratory work, the balance between myocardial strength and both cardiac preload and afterload, the severe disease associated with adrenal insufficiency, and malnutrition.

Objective To explore the different concentrations of glycyrrhizin on hepatic stellate cell proliferation and its regulation mechanism.MethodsHepatic stellate cell proliferation rate of three different concentrations of glycyrrhizin was detected by MTT assay.The expression of cyclin E was detected by immunocytochemistry.ResultsMTT assay was used to detect the cell proliferation inhabitation in different concentration groups,from control group 0.8 mg/L glycyrrhizin group to 1.2 mg/L glycyrrhizin group and 1.6 mg/L glycyrrhizin group.The cell proliferation inhibited rates were 0,2.73%,14.75 % and 25.96%.The difference was significant (P＜0.05).The numbers of Cyclin E positive cells in different concentrations of glycyrrhizin group were significantly different compared with control group,and it was concentration dependently decreased (P＜0.01).ConclusionsGlycyrrhizin concentration dependently inhibited rat hepatic stellate cells proliferation and it could reduce the expression of cyclin E and inhibit the proliferation of rat hepatic stellate cells.

Objective To detect the change and clinical significance of homocysteine (Hcy),hypersensitivity C response protein (hs-CRP) and hypersensitivity troponin I (hs-TnI) in patients with acute myocardial infarction (AMI).Methods Ninety-six cases of AMI were selected as the research group and 60 cases of coronary heart disease without AMI were enrolled in the control group.Blood samples were collected to measure the contents of serum Hcy,hs-CRP and hs-TnI.ROC curve was drawn and Logistic regression model was established to analyze the role of each index alone and combined detection in the diagnosis of AMI.Results The levels of Hcy,hs-CRP and hs-TnI in the research group were significantly higher than those in the control group (Hcy: (29.29±7.65) mol/L vs.(17.23±4.68) mol/L;hs-CRP: (15.47±5.01) mg/L vs.(9.21±3.15) mg/L;hs-TnI: (40.88±9.18) ng/mL vs.(7.34±2.12) ng/mL,t=2.78,8.66,34.36,P<0.05).The area under the ROC curve of Hcy,hs-CRP,hs-TnI were 0.802 (95%CI(0.729~0.874)),0.71(95%CI(0.62~0.792)),0.929 (95%CI(0.891~0.967)),respectively.The area under the combine detection curve was 0.971 (95%CI,0.950~0.992).The sensitivity of Hcy,hs-CRP and hs-TnI in the diagnosis of AMI were 79%,57%,87%,respectively,the specificity of the three groups were 72%,70%,90%,the sensitivity and specificity of combined detection were 96% and 88%.Conclusion Combined detection of Hcy,hs-CRP and hs-TnI plays a better role in the diagnosis of AMI than that of Hcy,hs-CRP,hs-TnI alone and has a high specificity and sensitivity in the diagnosis of AMI.

Objective To investigate the influence of benzopyrene on extracellular matrix(ECM) protein deposition of human airway smooth muscle cells(HASMC) and the related pathway mechanism.Methods HASMC were primarily cultured and the 2-6 generations cells were applied in this experiment.The expression amount of ECM gene and protein was detected by real time PCR and Western Blot the phosphorylation level was analyzed by using the Western Blot method.Results Benzopyrene could to increase the expression of HASMC collagen Ⅰ α1 protein (P＜0.01) and ECM protein (including collagen Ⅰ α1,versican,fibronectin,laminin α2) mRNA(P＜0.05).Benzopyrene could induce the rapid increase of ERK1/2 phosphorylation level (P＜0.01).Furthermore,the ERK pathway inhibitor PD98059 could significantly inhibit the increase of benzopyrene-induced collagen Ⅰ α1 (P＜0.01)and ECM protein(including collagen Ⅰ α1,versican,fibronectin,laminin α2) mRNA expression(P＜0.01).Conclusion Benzopyrene induces the ECM protein deposition of HASMC by activating the ERK1/2 pathway,blocking the ERK1/2 signal pathway can inhibit the benzopyrene-induced airway remodeling.

Objective To observe the affection of smoking on atherosclerosis. Methods The research objects were divided into two groups,smoking group and control group in 60 cases. intima-media thickness and the numbers of plaques were measured in both sides of common carotid arteries by gray-scale imaging.Results There was significant difference between smoking group and control group(P

Objective To study the effect of rhu-IFN-? on immune state and vertical transmission in pregnant mice infected with Toxoplasma gondii. Methods Sixty pregnant BALB/c mice were randomly divided into three groups: a control group,infected group and treatment group. In the infected group and treatment group,each mouse was injected with T.gondii tachyzoites peritoneally on the day 8 of gestation. In the treatment group,each mouse was treated with 1 000 U rhu-IFN-? on the day 7,8,9 of gestation. Blood was collected from the tail veins of all the mice on the day 10,12 of gestation. The levels of blood CD4+ and CD8+ T cells were detected by flow cytometry. Meanwhile,on the day 12 of gestation,all mice were anatomized to observe live embryo rate and the infection status in fetal brain tissue. Results Compared with the control group,the levels of CD4+ T cells in the infected group and treatment group were low,and the levels of CD8+ T cells high on the day 10,12 of gestation,so the ratio of CD4+/CD8+ was inversed. However,compared with the infected group,the levels of CD4+ T cells in the treatment group were high and the levels of CD8+ T cells low on the day 10,12 of gestation,so the ratios of CD4+/CD8+ were high on the day 10,12 of gestation. Meanwhile,the live embryo rate was high and the infection rate of intrauterine embryonic low. Conclusion A proper dose of rhu-IFN-? could improve the function of immunity system and reduce the vertical transmission probability in pregnant mice infected with T.gondii.

Objective To study the association between serum free fatty acid (FFA) and ankylosing spondylitis (AS).Methods According to the classification criteria,a total of 90 newly diagnosed AS patients,223 healthy individuals and 82 patients with non-inflammatory diseases were divided into three groups,and biochemistry and immunology biomarks were measured in all individuals.One-Way analysis of variance (ANOVA) test was used to compare the difference between the three groups in the serum indexes,and Logistic regression analysis was used to identify AS risk factors associated with AS.Results There were no significant differences in gender,age,body mass index (BMI),white blood cells (WBC),high-level data link control (HDL-C),low-density lipoprotein control (LDL-C),lipoproteins [Lp (a)],alkaline phosphatase (ALP) and TG in the three groups,and our results showed that serum FFA was statistical different between the three groups (F=24.191,P＜0.01),the serum level of FFA in patients with AS was higher compared with patients with noninflammatory diseases and healthy controls [(0.48 ±0.18) mmol/L,(0.28 ±0.09) mmol/L,(0.29±0.16) mmol/L;t=-5.969,P＜0.01;t=5.106,P＜0.01].Seral IgA,IgG,IgM levels,ESR and CRP were statistically different between the three groups (F=14.870,P＜0.01;F=16.464,P＜0.01;F=4.124,P=0.018;F=97.002,P＜0.01;F=22.069,P＜0.01).Gender,age,BMI,serum IgA,IgM,ALP,HDL-C,LDL-C,Lp(a) and TG levels were not associated with AS by logistic regression analysis.However,serum IgG level,ESR and CRP were associated with AS [OR05％CI):1.659(1.032,2.660),P=0.037;OR05％CI):1.340(1.005,1.787),P=0.046;OR05％CI):1.820 (1.025,3.232),P=0.041],and there is an association between FFA and AS was observed in logistic regression analysis (OR=1.132,95％CI:1.014-1.421,P=0.033).Conclusion We suggest that incre-ased FFA is closely associated with AS,and may be an underlying risk factor for AS.

Objective To differentiate proteinuria due to non-diabetic renal diseases(NDRD)from that of diabetic nephropathy(DN)in type 2 diabetic patients,and to evaluate the prevalence of NDRD.Methods A retrospective analysis was performed on diabetic patients who had undergone renal biopsy between Jan 1,2003 and Dec 3 1,2006.The data including history of diabetes,cardiac color ultrasound,color Doppler ultrasound of the carotid artery,retinal changes,examination of ocular fundus,giomerular filtration rate,hepatic and renal function,lipid profile,blood glucose,HbA1c,and urine protein were collected.Results Among 46 patients,22 cases (47.8%)were distinctly diagnosed as diabetic nephropathy(DN),while the other 24(52.2%)as NDRD.Focal segmental glomeruloselerosis Was the most common lesion found in patients with NDRD.In DN group,the fasting blood glucose was higher than that of NDRD group,as well as ejection fraction,carotid plaque,and intimamedia thickness(IMT)showed significant differences between 2 groups.Patients with NDRD were less frequently associated with diabetic retinopathy.Diabetic retinopathy showed hiigh sensitivity(72.7%)and specificity (91.7%)in diagnosing DN.Conclusions Blood glucose,ejection fraction,carotid plaques and IMT,and retinopathy may be helpful in differential diagnosis of diabetic patients with overt proteinuria.Renal biopsy is an important step lo establish the diagnosis.