Objective To explore the effects of dexmedetomidine(DEX) on the changes of patient' s cognitive function after undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods Sixty patients to selectively receive cardiac valve replacement with CPB were randomly divided into two groups:DEX group(n =30) and normal saline group(NS group,n =30).DEX (0.5 μ.g/kg bolus and infusion at a rate of 0.5 μg · kg-1 · h-1) was administered to the patients of DEX group,and the patients of NS group were given with equivalent normal saline at the same time.Aortic clamped time,CPB time,duration of anesthesia and PaO2 at 10 min before CPB were recorded.Heart rate(HR),mean arterial pressure(MAP),jugular venous oxygen saturation(SJvO2) and jugular venous oxygen partial pressure(PJvO2) of anesthesia induction(T0),10 min after induction(T1),CPB re-warmed to 36℃ (T2),and 1 h(T3),6 h(T4),24 h (T5),48 h (T6),72 h (T7) after CPB were performed.MMSE were performed 3 days after surgery,the incidence of POCD was calculated.Results There was no statistical significance in aortic clamped time,duration of CPB,anesthesia time and PaO2 at 10 min before CPB (P ＞ 0.05) between both of groups.Compared to TO,SJvO2 and PJvO2 of NS group from T1 to T2,T4 to T7 and DEX group at T1,T4 to T7 were decreased(P＜0.05,P＜0.01).Compared to NS group,SJvO2 and PJvO2 of DEX group from T2 to T3 were increased(P ＜ 0.01).MMSE evaluation and the incidence of POCD of DEX group were better than those of NS group 3 days af ter surgery(P ＜0.05,P ＜ 0.01).Conclusion Cardiac valve replacement with CPB can lead to cognitive impairment in pa tients,dexmedetomidine can ameliorate cognitive function by decreasing oxygen consumption in brain tissue.

Objective To evaluate the effects of Shenmai injection on intrapulmonary shunt during one-lung ventilation in patients undergoing thoracic surgery.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 40-60 yr,with body mass index of 18-25 kg/m2,scheduled for elective thoracic surgery,were randomly divided into 2 groups (n =30 each) using a random number table:control group (group C) and Shenmai injection group (group SM).Anesthesia was induced with midazolam,sufentanil,rocuronium,and etomidate.Starting from the end of induction of anesthesia until the time point immediately before one-lung ventilation,Shenmai injection 0.6 ml/kg (in 250 ml normal saline) was infused intravenously in SM group,and the equal volume of normal saline was given instead in C group.Immediately before one-lung ventilation,at 10 and 60 min of one-lung ventilation and at 10 min of two-lung ventilation,arterial and venous blood samples were collected for blood gas analysis and PaO2 was recorded.Intrapulmonary shunt (Qs/Qt) and alveolar-arterial oxygen pressure difference (P(A-a)DO2) were calculated.Results Compared with group C,PaO2 was significantly increased at 10 and 60 min of one-lung ventilation,and Qs/Qt and P(A-a)DO2 were decreased in group SM.Conclusion Shenmai injection 0.6 ml/kg infused intravenously before one-lung ventilation can reduce the intrapulmonary shunt during one-lung ventilation in patients undergoing thoracic surgery.

Forkhead Box m1 ( Foxm1) is a component of the Fox transcription factor family. It is only detected in proliferating cells, but disappears when cells enter into their terminal differentiation phase. Foxml is closely related to cellular growth mainly through inhibiting cyclin-dependent kinase(cdk) inhibitors to influence cell proliferation. It also participates in growth hormone mediated cell multiplication. The overexpression of Foxml has been observed in many tumor cell lines and malignant tumors, indicating that Foxml might be an essential proto-oncogene in carcinoaenesis. Upregulation of Foxml is sufficient to induce genomic instability due to loss of heterozygosity and variation of copy numbers. Foxml-induced genomic instability was significantly enhanced and accumulated with increasing cell passages. Foxml might become a new potential target for the treatment human cancer based on future investigations.

Objective: Our purpose was to study the effect of L-arginine (L-Arg) on the kidneys of rats with obstructive jaundice and the underlying mechanism. Methods: Forty male Sprague-Dowley rats, weighting 200 to 230 g, were randomly assigned to four groups (n=10): sham-operation group, control group, L-Arg group, L-NG-nitroarginine methyl (L-NAME) group.Except the sham-operation group,the other groups rendered jaundiced by doubly ligating the common bile duct. Fourteen days later,we administrated L-Arg to L-Arg group,and L-NAME to L-NAME group for 7 days.On the 21st day after bile duct ligation, we measured the amount of nitric oxide (NO), malondrialdehyde (MDA), and superoxide dismutase (SOD) in the kidneys, and assessed the changes of the renal function.We also observed the morphological changes of the kidneys. Results: In the control group,the amount of NO and MDA increased while that of SOD decreased (P<0.01, P<0.01and P<0.01), and the renal function and the nephric tissue were impaired on the 21st day after bile duct ligation compared with the sham-operation group.In the L-Arg group, the amount of NO and SOD increased significantly (P<0.01, P<0.01), whereas that of MDA decreased (P<0.05), and the damage in the nephric tissue and renal function was alleviated,as compared with the control group.On the contrary, the amount of NO in the L-NAME group decreased significantly (P<0.05) compared with the control group.Although there was no significant difference in the levels of SOD, MDA, and the parameters of the renal function between the L-NAME group and control group,those indexes in the L-NAME group tended to be aggravated. Moreover, the damage in the nephric tissue of the L-NAME group was not alleviated. Conclusion: L-arginine may protect the kidney from impairment in rats with obstructive jaundice through L-Arg-NO pathway.

Objective:To study the neuroprotective effect of nobiletin on the symptoms of postoperative cognitive impairment (POCD) induced by sevoflurane inhalation.Methods:Twenty-four aged SD rats (12 female mice and 12 male mice) were divided into three groups randomly: control group ( n=8), surgery group ( n=8) and surgery + nobiletin group ( n=8), with 4 females and 4 males in each group.The rats in surgery group and surgery+ nobiletin group were given normal saline(0.1 ml/10 g, once a day) and nobiletin(100 mg/kg, once a day) intragastrically for 6 weeks.Then the rats were anesthetized by sevoflurane and treated by abdominal exploration surgery, and then continued gavage for 1 week.The rats in control group were given normal saline(0.1 ml/10 g, once a day) intragastrically for 7 weeks without anesthesia or surgery.Sevoflurane inhalation anesthesia and abbreviated laparotomy were not done for control group.Morris water maze and open field experiment were used to measure the memory and cognitive ability and the independent exploration ability respectively.The changes of α-band electroencephalogram (EEG) were recorded by multi-channel physiological signal acquisition and processing system.The concentration of S100β, a marker of neurological impairment was detected by ELISA.Western blot was used to detect the expression level of IBA-1 in microglia.SPSS 20.0 software was used to analyze the data. Results:There were no significant differences in Morris water maze, positioning cruise test and open field test among the groups before operation (all P>0.05). The differences were statistically significant among the groups 7 days after operation (all P<0.05). Compared with the control group (the escape latency, path length and cross platform times were ((20.37±1.11)s, (552.37±14.19)cm, (6.75±0.43)times respectively), the escape latency ((40.87±2.03)s) and path length ((1 258.62±19.53)cm) of rats in surgery group were significantly longer (both P<0.01), and the cross platform times ((2.12±0.33)times) significantly reduced ( P<0.01). The differences between surgery + nobiletin group ((22.37±1.11)s, (584.50±10.90)cm, (6.62±0.48)times) and control group were not significant (all P>0.05). The open field experiment showed that the movement distance, the crossed square number, and activity times in surgery group ((1.78±0.55) m, (4.75±0.50), (14.87±0.33) times) decreased significantly compared with those in control group ((3.73±0.07) m, (11.10±0.78), (51.12±0.78) times, all P<0.01). No significant difference was found between surgery + nobiletin group ((3.76±0.07)m, (10.75±0.66), (50.75±0.43)times) and control group(all P>0.05). Before anesthesia, there was no significant difference in the power ratio of α-band among the three groups ( P>0.05), but the differences during anesthesia and operation were significant ( F=72.58, 101.50, P<0.01). During anesthesia and operation, the power ratio of α-band in anesthesia and in surgery group (2.51±0.04, 2.14±0.03) were significantly lower (both P<0.01) than those in control group (3.49±0.03, 3.49±0.03), while there was no obvious changes (both P>0.05) in the surgery + nobiletin group (3.50±0.04, 3.51±0.04). There were significant differences in Bcl-2 protein expression and caspase 3/7 protein activity among the three groups ( F=5.21, 7.84, P<0.01). Compared with control group (1.00±0.02, 1 557.46±3.63), Bcl-2 of rats in the surgery group(0.40±0.05) were significantly lower and Caspase3/7 expression of surgery group (3 689.58±10.46) was significantly higher (both P<0.01), while the rats in the surgery + nobiletin group had no significant difference in both Bcl-2 level (1.03±0.06) and caspase 3/7 activities (1 805.28±6.17, both P>0.05). The difference of S100 β protein expression was significant among the three groups ( F=490.80, P<0.01). Compared with the control group ((0.18±0.01)μg/L), the concentration of S100β protein in the surgery group ((2.13±0.02)μg/L) decreased ( P<0.01), while there was no significant difference in the surgery + nobiletin group ((0.16±0.01) μg/L, P>0.05). The expression levels of IBA-1 protein ( F=10.83) and TNF-α, IL-1, IL-1β and IL-6 ( F=996.20, 221.40, 73.02, 174.13) were significantly different among the three groups (all P<0.01). The expression level of the neuroglial marker IBA-1 in the surgery group(1.36±0.02) was significantly higher than that in the control group (1.00±0.01, P<0.01), while the surgery + nobiletin group (1.03±0.01) had no significant different compared with control group ( P>0.05). The levels of inflammatory factors, including TNF-α, IL-1, IL-1β and IL-6, in the brain of rats treated with nobiletin ((49.06±3.63)pg/mg, (2.09±0.43)pg/mg, (16.27±0.80)pg/mg, (2.11±0.19)pg/mg) were significantly lower than those in the surgery group((145.10±6.46)pg/mg, (5.67±0.43)pg/mg, (27.88±3.43)pg/mg, (4.74±0.32)pg/mg, all P<0.01). Conclusion:Nobiletin can obviously alleviate POCD symptoms caused by sevoflurane inhalation anesthesia.

Objective To evaluate the safety and feasibility of totally thoracoscopic anatomic pulmonary segmentectomy (TTAS) for the treatment of the peripheral stage ⅠA non small cell lung cancer(NSCLC).Methods The study involved 50 consecutive patients undergoing totally thoracoscopic anatomic segmentectomy (TTAS) from September 2010 to November 2012 in the First People's Hospital affiliatied to Nanjing Medical University.The diameter of the tumors were less than 2 cm [(mean diameter(1.35 ±0.48) cm].All lymph node sampling of N1 and N2 were neglive,All patients received symtematic lymph node dissection.The pulmonary vessels were individually ligated,and the bronchi were closed using an endoscopic stapler.The intersegmental plane was identified using the demarcation between the resected(inflated) and preserved(collapsed) lungs.Staplers were used for intersegmental dissection.Results The mean operative time and intraoperative bleeding were (191.5 ± 50.4) min and (49.2 ± 54.6) ml respectively.The chest tube drainage duration was (3 ± 1) days.The number of stapler cartridges used for intersegmental division was 3.9 ±0.8.The mean number of lymph nodes and nodal stations dissected were 12.6 ± 2.8 and 6.0 ± 1.5 respectively.No mortality and complications were observed 30 days after the surgery.Further,no local recurrence or metastases were observed during follow-up.Conclusion Totally thoracoscopic anatomic segmentectomy(TTAS) is a feasible and safe technique.With systematic lymph node dissection,TTAS can be a reasonable therapeutic option for stage ⅠA NSCLC.

Objective To analyze the normal anatomy and variation of arteries around ankles in Chinese adults in and around Shaanxi province. Methods Aged 18-82 (48±15) years, 522 males and 557 females who came to Xijing Hospital for medical treatment or for a healthy check were randomly recruited to participate in this study. Their arteries around ankles were assessed by high-frequency color Doppler ultrasound. Then the anatomy and variation of the arteries were analyzed. Results There were totally 213 arterial variations in 175 subjects, including variations at single ankle in 137 subjects and variations at both sides in 38 subjects. The rate of arterial variation at ankle in persons was 16.2%(175/1 079) and was higher in females than that in males (21.5%, 120/557,χ2=24.028, P=0.000). The rate of arterial variation at ankle in limbs was 9.9%(213/2 158). There was no signiifcant difference for the rate of arterial variation between the left (5.1%, 109/2 158) and right (4.8%, 104/2 158) ankles (χ2=0.129, P=0.701). In variations of arteries at ankles, there were 131 cases with small posterior tibial arteries and peroneal arteries extending to the bottoms of feet, i.e., posterior tibial arteries substituted by peroneal arteries (typeⅠ, 6.1%, 131/2 158), 69 cases with small anterior tibial arteries and peroneal arteries extending to the dorsums of feet, i.e., anterior tibial arteries substituted by peroneal arteries (typeⅡ, 3.2%, 69/2 158), and 13 cases with both small anterior and posterior tibial arteries, and peroneal arteries extending to both the dorsums and bottoms of feet, i.e., both anterior and posterior tibial arteries substituted by peroneal arteries (typeⅢ, 0.6%, 13/2 158). There was no signiifcant difference in each type of variation rates between left and right sides. The rates of typeⅠvariation were 6.0%(65/1 079) and 6.1%(66/1 079) at the left and right ankles respectively (χ2=0.010, P=0.928);the rates of typeⅡvariation were 3.6%(39/1 079) and 2.8%(30/1 079) at the left and right ankles respectively (χ2=1.213, P=0.271);the rates of typeⅢvariation were 0.5%(5/1 079) and 0.7%(8/1 079) at the left and right ankles respectively (χ2=0.697, P=0.404). Conclusions Ultrasound can be used to depict anatomy and variation arteries around ankles. There is a high prevalence of anatomic variation of ankle arteries in population in and around Shaanxi province. Therefore it will be helpful for diagnosis vascular abnormalities with the knowledge of characteristics of normal anatomy and variation of ankle arteries.

BACKGROUND:Brain natriuretic peptide, an important serum marker for diagnosis of cardiovascular diseases, is crucial for risk factor analysis of cardiovascular diseases.
OBJECTIVE: To analyze the relationship between brain natriuretic peptide and hemodynamic parameters before and after coronary artery bypass grafting.
METHODS:Thirty patients with coronary heart disease undergoing coronary artery bypass grafting were selected, including 13 patients with left ventricular ejection fraction≥ 50% (normal heart function) and 17 patients with left ventricular ejection fraction < 50% (cardiac insufficiency). Levels of plasma brain natriuretic peptides were detected at 1 day before transplantation, 7 hours, 1, 3, 5, 7 days after transplantation, and then the correlation between plasma brain natriuretic peptide levels and hemodynamic parameters was analyzed before and after coronary artery bypass grafting.
RESULTS AND CONCLUSION: Preoperative and postoperative levels of plasma brain natriuretic peptides were significantly lower in the patients with left ventricular ejection fraction≥ 50% than those with left ventricular ejection fraction < 50%; while in each group, the level of brain natriuretic peptides was remarkably increased after coronary artery bypass grafting (P < 0.05 orP< 0.001). Preoperative brain natriuretic peptide levels were positively correlated with New York Heart Association classification grading, left atrial diameter and left ventricular diameter (r=0.61;r=0.34;r=0.67), but negatively correlated with echocardiographic left ventricular ejection fraction and cardiac output (r=-0.75;r=-0.70). The postoperative peak level of brain natriuretic peptides was positively correlated with New York Heart Association classification grading, echocardiographic left ventricular end diastolic diameter and pulmonary artery pressure (r=0.72;r=0.70;r=0.45). These findings indicate that the plasma level of brain natriuretic peptides before coronary artery bypass grafting shows a good correlation with left ventricular ejection fraction and left ventricular end diastolic diameter, which accurately reflect the state of cardiac function before coronary artery bypass grafting.

BACKGROUND:Although drug treatment.physics-behavior therapy,and postoperative therapy have been commonly used to treat stress urinary incontinence(SUI),there is still no satisfactory treatment at present.OBJECTlVE:To build a stable animal model simulating stress urinary incontinence(SUI)by bilateral transaction of pudendal nerve and nerves innervating pelvic floor muscles,including iliococcygeous muscle and pubococcygeous muscle.METHODS:A total of 18 6-week-old female SD rats weighing(1 99.44±8.41)g were randomly divided into 3 groups:normal,model,and sham-surgery groups,with 6 rats in each group.Rats in the model group underwent bilateral transaction of pudendal nerves and nerves innervating iliococcygeous/pubococcygeous muscles,while rats in the sham-surgery group had same procedures except nerve transaction.The normal group did not undergo any operation.Each rat was subjected to measure leak point pressure(LPP)at 2 weeks after the operation.After the measurement of LPP,cross sections of connection area of bladder and urethra were sent to histology.RESULTS AND CONCLUSION:One rat in the sham-surgery group died at 1 week after the operation.The LPP of model group decreased significantly by approximately 33%compared with the normal group(P＜0 05):however,there was no significant difference in LPP between sham-surgery and normal groups(P＞0.05).The results of histology showed loosely arrangement and atrophy of urethral sttriated muscle fibers in rats of the model group.Bilateral transaction of pudendal nerves and nerves innervating to iliococcygeous/pubococcygeous muscles resulted in SUI in rats stably.

Objective To evaluate the clinical application of CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules (SPNs) before video-assisted thoracoscopic resection.Methods CTguided localization the SPNs before resection in 56 patients and 60 nodules,then underwent video-assisted thoracic surgery (VATS) resection.Among 56 patients,19 males and 37 females,aged from 35 to 81 years,mean age was (61.1 ±8.9)years.Results SPNs diameter (6.80 ±4.12) mm,distance from the parietal pleura (15.38 ±4.63) mm.CT-guided localization success rate was 100％,positioning time (10.76 ± 8.17) min,8.9％ (5/56) had micro pneumothorax aftet positioning,7.1％ (4/56) occurrence of needle tract bleeding,no conservative treatment.VATS resection rate was 100％.The pathology of 60 lesions were shown:Bronchiolo-alveolar carcinoma(BAC) were 33 lesions(55.0％),BAC and adenocarcinoma were 11 lesions(18.3％),Atypicaladenomatous hyperplasia (AAH) were 7 lesions (11.8％),Inflammation were 4 lesions (6.7％),Harmatoma were 3 lesions(5.0％),Tuberculoses were 2 lesions(3.3％).Conclusion CT-guided localization with combination of methylene blue and a Hookwire system before video-assisted thoracoscopic resection is a promising technique for small solitary pulmonary nodules.It could play an important role in accurate localization of small pulmonary nodules,and it is a safe technique with clinical application.