ObjectiveTo evaluate the effects of ketamine on the minimum alveolar concentration of scvoflurane for blunting adrenergic responses to skin incision (MAC_(BAR)) in patients undergoing abdominal surgery. Methods Forty-four ASA Ⅰ or Ⅱ patients aged 30-60 yr undergoing elective abdominal surgery were randomly divided into 2 groups (n=22 each) : control group (group K_0) and ketamine group (group K_1). Anesthesia was induced with propofol 2 mg/kg and fentanyl 3 μg/kg. Tracheal intubation was facilitated with cisatracurium 0.15 mg/kg. The patients were mechanically ventilated. Anesthesia was maintained with sevoflurane inhalation (the initial end-tidal concentration 3% ). Ketamine at 14 μg·kg~(-1)·min~(-1) was infused at the same time in group K,. The patients' response to skin incision was described as positive if MAP or HR increased by≥15%. If the response was positive, the end-tidal concentration of sevoflurane for the next patient was increased by 0.5%, while if negative, decreased by 0.5% . ResultsThe MAC_(BAR) of scvoflurane was 3.25 % (95 % confidence interval 3.05%-3.45%) in group K_0, and 2.20% (95% confidence interval 1.96%-2.44%) in group K~1. The MAC_(BAR) of sevoflurane was significantly lower in group K~1 than in group K_0 (P<0.05). Conclusion Ketamine infusion at 14 μg·kg~(-1)·min~(-1) can reduce MAC_(BAR) of sevoflurane and enhance the inhibitory effect of sevoflurane on the stress response.

Objective To investigate the effect of different target plasma concentrations (Cp) of remifentanil on sedative effect of propofol. Methods Eighty adult ASA Ⅰ or Ⅱ patients aged 18-60 yr undergoing elective laparoscopic cholecystectomy were randomly assigned into 4 groups (n = 20 each). Anesthesia was induced with TCI of remifentanil (Cp = 2, 4 and 8 ng/ml in group Ⅱ-Ⅳ respectively) and propofol TCI (the initial Cp of propofol was 2 μg/ml in the 4 groups). Then the Cp of propofol increased by 0.5 μg/ml every 1 min until BIS value decreased to 50. BIS value and the Cp of propofol were recorded as the patient lost consciousness.The Cp and consumption of propofol were recorded when BIS value decreased to 50. Results BIS value was significantly increased, while the Cp of propofol was significantly decreased as the patient lost consciousness, and the Cp and consumption of propofol were significantly decreased when BIS value decreased to 50 in group Ⅲ - Ⅳ compared with group Ⅰ (P ＜ 0.05). Conclusion Remifentanil 4 ng/ml is the suitable Cp for anesthesia when combined with propofol.

Objective To investigate the role of neuroendoscope in treatment of cystic craniopharyngiomas in the third ventricle.Methods Neuroendoscope was applied to minimize the volume of the tumors,relieve obstructive hydrocephalus,canalize the intervals of the cysts,and fistulate into the third ventricle or the lateral ventricle and the cysts in 11 patients of cystic craniopharyngiomas in third ventricle accompanied with obstructive hydrocephalus,then radiotherapy followed.Results The symptoms of the intracranial hypertension disappeared and the other symptoms improved postoperatively in all 11 patients.CT imaging and MRI showed that the tumors shrunk and hydrocephalus faded.No severe complications occurred in all patients except 1 patient affected with transitory lethargy.Conclusion Neuroendoscopic technique is effective in improving curative effect and decreasing severe complications in the patients with cystic craniopharyngiomas in the third ventricle accompanied with hydrocephalus.

Objective To evaluate clinical effects of integrated traditional Chinese and western medicine therapy for epilepsy after stroke. Methods Literatures about the treatment of epilepsy after stroke with the combination of traditional Chinese medicine and western medicine which come from the database such as CNKI, VIP, WanFang and Pubmed, were studied and all the randomized controlled trials on comparing therapeutic effects of treating epilepsy between combined treatment of TCM and western medicine and western medicine were enrolled. The Cochrane Collaboration's software RevMan 5 was used for meta-analysis. Results 7 articles were included in the study, there is homogeneity among these articles(P>0.05), The fixed effect model was used for the meta analysis. the combined results were OR=5.17, 95%CI(3.02, 8.82), the overall effect of test Z=6.01, P<0.01, the difference between the treatment group and the control groups was significant, that means the overall effect of the combination of traditional Chinese medicine and Western medicine treatment was better than western medicine treatment; Funnel plot graphic displayed asymmetrically, which indicated the literatures publication bias. Conclusion The current data indicate that the curative effect of TCM and west medicine combined treatment is better than pure western medicine therapy for epilepsy after stroke, but as the literature publication bias, clinical studies need more high quality large samples to prove this conclusion.

The knowledge absence of neurosurgical regional anatomy is the major shortcoming which makes seven-year program medical students feel difficult in studying neurosurgical special course.The reasons for this phenomenon include the limited teaching time for basic medical course and the continuous progress in the field of neurological anatomy.The teacher should make good use of clinical resources to carry on the additional teaching of neurosurgical regional anatony.The detailed plans include small-class teaching and individual case analysis using the data of neuroimaging and angiography of the brain and spinal cord.All these measures are intend to let the students grasp of the basic knowledge clinical neurosurgery during the internship and make the smooth transition from interns to doctors,providing references for other department.

BACKGROUND:Previous research indicated that iron-fluorouracil-phenanthroline complex has good antitumor activity in vitro, which can inhibit the proliferation of human cancer cels. OBJECTIVE:To detect the antitumor activity and toxicity of iron-fluouracil-phenanthroline complex, [Fe(5-Fu)2(Phen)SO4],in vivo. METHODS:A total of 40 Kunming mice were randomly divided into four groups, which were intraperitoneally injected with 72, 102.9, 147, 210 mg/kg [Fe(5-Fu)2(Phen)SO4] and the half lethal dose of the complex was detected. One day after the establishment of mouse S180 sarcoma models, the model mice were randomly divided into eight groups, and administered with the intraperitoneal injection of 15 mg/kg (low dose group), 30 mg/kg (middle dose group), 60 mg/kg (high dose group) [Fe(5-Fu)2(Phen)SO4], normal saline (negative control group), cisplatin (positive control group), 5-fluorouracil, iron-salt and phenanthroline, respectively. The injection was done once a day, lasting for 7 days. The weight of sarcomas, body weight, the main organ coefficient and histopathological changes of the main organs were detected. RESULTS AND CONCLUSION: The half lethal dose of [Fe(5-Fu)2(Phen)SO4] was 103.9 mg/kg. Compared with the negative control group, high dose group, positive control group and 5-fluorouracil could significantly inhibit the growth of the tumor (P< 0.05 orP< 0.01), and the effect of high dose group was the most obvious (P < 0.01). Compared with cisplatin, 60mg/kg [Fe(5-Fu)2(Phen)SO4] had a weaker inhibitory effect on the kidney, but higher inhibitory effect on the liver, spleen and thymus, indicating the complex has a lower nephrotoxicity, but stronger immunotoxicity and hepatotoxicity than cisplatin.

BACKGROUND:Anticancer drug and organic metal complexes wil form a new structure or a change in ion concentration, thus changing both the activity and toxicity to produce a synergistic effect. OBJECTIVE:To synthesize new high-efficient and low-toxic metal-fluorouracil complexes as anticancer drugs. METHODS:Copper, zinc and iron salts and fluorouracil were used to synthesize four copper, zinc and iron-fluorouracil complexes that were [Cu(5-Fu)2Cl2], [Cu(5-Fu)2(NO3)2], [Fe(5-Fu)3]SO4 and [Zn(5-Fu)2Cl2]. Preliminary chemical structures of the four complexes were confirmed by elemental analysis and mass spectrometry. Their inhibitory activity on human cancer cells, human leukemia cellline K562 and human colon cancer cellline HCT-116, was measured by MTT colorimetric assay. RESULTS AND CONCLUSION:[Cu(5-Fu)2Cl2], [Cu(5-Fu)2(NO3)2], [Zn(5-Fu)2Cl2] and [Fe(5-Fu)3SO4] were successful y synthesized. These four complexes at a mass concentration of 0.1-100 mg/L inhibited the proliferation of K562 and HCT-116 to different extents. The IC 50 values of these four complexes on K562 and HCT-116 cells were lower than those of fluorouracil, and their cytotoxicity was 1.5-7.8 times higher than that of fluorouracil. To conclude, copper/iron/zinc-fluorouracil complexes exhibit synergic inhibitory effects on cancer cellproliferation.

Objective To evaluate the value of electrospun polymethyl methacrylate (PMMA) nanofibers with different topological structures as scaffolds for growth of Schwann cells (SCs).Methods Electrospun PMMA nanofibers with random or aligned topological structures were fabricated and measured with biocompatibility.Lentivirus-transfected green fluorescent protein was used as the reporting gene to monitor form and growth manner of SCs on different substrates and dependency of cell body and process with fiber structure,with PMMA thin films served as the control.Results Electrospun PMMA nanofibers revealed good biocompatibility and could exert contact guidance to the growth of SCs.Topological structures of the electrospun nanofibers influenced cell morphology.SCs were aligned with the orientation of substrate fibers and form longer cell process when growing on aligned nanofibers (P ＜0.01).Primary SCs preferred to follow the cue of aligned nanofibers compared to random fibers.Conclusion Aligned electrospun PMMA nanofibers have the potentiality as transplantable scaffolds for loading SCs after neural injury.

Taking microneurosurgery approach and applied surgical anatomy training as the core and combining theoretical teaching and perioperative training as the main contents , training program achieved significant effect among specialty degree neurosurgery postgraduates. In order to further improve the quality of training, it is proposed to set up micro-neurosurgery training center and more complete train-ing system based on micro-neurosurgery contents thus to improve clinical ability of specialty degree neuro-surgery postgraduates.

Objective To study the methods and effect of the surgical treatment for intrahepaticolithiasis(IHL). Methods In recent 12 years, in our hospital,230 cases of IHL were treated by different operations companied with biliary fibrescopy to remove the residnal stones of biliary tract. Results (1) Hepatolobectomy combined with Y-type hepatocholangiojejunostomy was done in 103 cases,the success rate was 91.8%.(2)Y-type hepatocholangiojejunostomy was performed on 45 cases,the success rate was 81.2%.(3)Hepaticolithotomy combined with T-tube drainage was done in 72 cases,the success rate was 69.3%. Conclusions For intrahepaticolithiasis,combination of hepatolobectomy with other operation and with biliary fibrescopy during or after the operation shoul be done, which can effectively improve the curative effect.