Objective To observe the effect of general anesthesia combined with epidural anesthesia on postoperative cogni‐tive dysfunction(POCD) in elderly colon cancer patient underwent laparoscopic radical operation .Methods 60 cases of elderly pa‐tients underwent laparoscopic radical colon cancer operation were sellected in Qionghai People′s Hospital of Hainan Province .The patients were divided into :general anesthesia control group(n=30)and general anesthesia combined with epidural anesthesia obser‐vation group (n=30) .The cognitive function was estimated by MMSE .The expression of S‐100βprotein was determined by ELISA analysis .Results The recovery time of respiratory depression ,drowsiness and extubation and remifentanil dosage was no no signifi‐cant differences between the two groups(P>0 .05) .The propofol dosage and rate of nausea and vomitting was lower in observation group than that in control group(P< 0 .05) .Before anesthesia ,the MMSE value was no significant difference between the two groups(P>0 .05) .MMSE value was decrease after operation for 1 and 3 d(P<0 .05) .However ,MMSE value was higher in obser‐vation group than that in control group (P<0 .05) .The rate of POCD in control group was 36 .7% and 23 .3% after operation for 1 and 3 d ,which was higher than that of 20 .0% and 13 .3% in observation group(P<0 .05) .Before anesthesia ,the S‐100βexpres‐sion was no significant difference between the two groups(P>0 .05) .The S‐100βexpression was increase after operation for 1 and 3 d(P<0 .05) .However ,the S‐100βexpression was lower in observation group than that in control group (P<0 .05) .Conclusion The general anesthesia combined with epidural anesthesia can decrease POCD in elderly colon cancer patient underwent laparoscopic radical operation ,with worthy of clinical application .

Endocrine-paracrine (EP) cells, also known as APUD or neuroendocrine cells, have been known to exist in the mammalian genito-urinary system. A fairly common localization is in the prostate and urethra. In this study we demonstrated for the first time the presence of small number of EP cells in the dissociated epithelial cells of the seminal vesicles of the guinea pig. The EP cells exhibited yellow FIF, while a few green or yellow-green FIF cells can be observed after L-dopa treatment. They were stained positive by the Masson-Fontana's method but consistently negative with the Grimelius silver methods indicating that they were of argentaffin nature or other paracrine cells.

Objective To explore the time-related expressions of TGF-?1mRNA during the healing process of rat skin wounds. Method Using the method of the reverse transcriptase polymerase chain reac-tion (RT-PCR) on intra-vital rat skin incised wounds (0.5h, 1h, 3h, 6h, 48h, 72h, 96h, 168h after incision) and postmortem rat skin incised wounds (0.5h, 1h, 3h after incision) to detect the dynamics of expression Ievel of TGF-?1mRNA. The strength of the expression of TGF-?1mRNA in scanned image was using ID-Advanced software. Results The results of RT-PCR showed that TGF-?1mRNA Ievel increased at 0.5h after incision and elevated significantly after 3h. The peak of TGF-?1mRNA occurred at 48h. There was no obvious expression of TGF-?1mRNA in postmortem incised wounds. Conclusion The characteristics of the TGF-?1mRNA expression were potentially indicative for the wound aging. RT-PCR was a sensitive method for detection of the expression of cytokines in genic level.

Objective To investigate the effect of leukocyte-depleted intraoperative savaged blood on erythrocyte immunity and systemic inflammatory response during perioperative period patients.Methods Sixty patients required blood salvage were randomly divided into two groups by random digits table method with 30 cases each.The patients in control group were given routine autologous blood transfusion,while in observation group,the salvaged blood was filtered with a leukocyte depleting filter placed in the reinfusion circuit.Blood samples were collected from the central vein before anesthesia (T1),at the end of surgery(T2),and at 12 h (T3) and 36 h (T4) after operation in two groups.The rosette rates of RBC-C3b receptors (RBC-C3bRR) and RBC-immune complex (RBC-ICR) were determined.The leukocyte and neutrophil were counted.The plasma levels of interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α) and malondialdehyde (MDA) were measured.Results Compared with control group,the plasma level of IL-6,TNF-α,MDA at T2-T4 in observation group was decreased[T2:(17.8 ± 1.6) ng/L vs.(20.8 ± 1.3) ng/L,(17.4 ± 2.3) ng/L vs.(23.1 ± 2.1) ng/L,(4.31 ± 0.33) nmol/L vs.(4.64 ± 0.73) nmol/L;T3:(21.2 ± 2.0) ng/L vs.(24.3 ± 2.4) ng/L,(12.3 ±2.1) ng/L vs.(18.6 ±1.9) ng/L,(3.97 ±0.35) nmol/L vs.(4.43 ±0.64) nmol/L;T4:(22.0 ± 1.3) ng/L vs.(28.4 ± 1.5) ng/L,(10.6 ± 1.7) ng/L vs.(14.6 ± 2.2) ng/L,(3.45 ± 0.57) nmol/L vs.(3.95 ± 0.40) nmol/L],RBC-C3bRR at T3-T4 in observation group was increased [T3:(15.3 ± 1.3)/100 RBC vs.(12.8 ± 1.5)/100 RBC ;T4:(15.8 ± 1.2)/100 RBC vs.(13.0 ± 1.5)/100 RBC],and there were significant differences (P ＜0.05).There was no significant difference in RBC-ICR,the leukocyte and neutrophil between two groups (P ＞ 0.05).Conclusion Leukocyte-deleted intraoperative salvaged blood is helpful to improve the erythrocyte immunity during perioperative period in patients,and the decrease in the systemic inflammatory response may be involved in the mechanism.

Objective To investigate the inhibitory effects of intensive insulin on myocardium expression of tumor necrosis factor alpha(TNF-?)in severely burnt rats and its correlative mechanism.Methods In eighteen SD rats the right jugular vein and the left ventricle were cathetetized,and were divided into three groups randomly:(1)the sham burn group,the rats were treated by sham burn;(2)the burn group,the rats were inflicted with 30%TBSA Ⅲ degree burn,and then given fluid resuscitation routinely;(3)the intensive insulin group,the rats received intensive insulin treatment after burn,and the liquid volume given was equal to the burn group.The level of plasma glucose contents,the left ventricular systolic pressure(LVSP)and left ventricular end-diastolic pressure(LVEDP)were recorded at 1,2,3,4,5,6h after burn,and animals were sacrificed at 6 hours after burn.The level of TNF-? in myocardium tissue was assayed by ELISA,and mRNA expression was determined by real-time PCR.Western blot was used to detect I?B? phosphorylation and degradation in left ventricle tissue.Meanwhile,burn serum-challenged cardiomyocytes were also used to detect the levels of insulin and LY294002,a specific insulin activation inhibitor,on the phosphorylation of I?B?.Results The animals showed stress hyperglycemia after burns,the function of heart was damaged(LVSP degraded and LVEDP increased),the level of TNF and the expression of mRNA in the myocardium increased apparently,I?B? phosphorylation and degradation increased in left ventricle tissue and burn serum-challenged cardiomyocytes.Given the intensive insulin treatment to keep the blood glucose level between 4.5 to 5.2 mmol/L,the function of heart was significantly improved,the level of TNF-? was apparently lowered,and the I?B? phosphorylation and degradation were significantly decreased.LY294002 could abolish the inhibitory effect of insulin,and it acted on the I?B? phosphorylation on burn serum-challenged cardiomyocytes model.Conclusion Intensive insulin may decrease the activation of NF-?B through diminishing the I?B? phosphorylation and degradation,which inhibit the transcription and expression of TNF-? in myocardial cell,and improve the heart function accordingly.

Objective To evaluate the individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery.Methods From January 2009 to December 2012,80 cases of coronary heart disease patients (aged 65-80 years) undergoing gastrointestinal surgery were divided into test group and control group by random digits table with 40 cases each.Traditional fluid therapy was used in control group in the intraoperative and postoperative period.Individualized fluid therapy was used in test group in the intraoperative and postoperative transferred to the intensive care unit (ICU) during the period of 24 h:in cardiac index (CI),stroke output index,stroke variation degree,under the guidance of indicators such as capacity titration type treatment.Hemodynamic index,fluid intake,incidence of cardiac adverse events and recovery of gastrointestinal function were compared in two groups into the operating room (T1),after anesthesia induction (T2),the operation started (T3),intraoperative 1 h (T4),the end of surgery (T5),transferred to the ICU 6 h (T6),transferred to the ICU 12 h (T7) and transferred to the ICU 24 h (T8).Results Compared with T1,two groups of patients with mean arterial pressure (MAP),central venous pressure (CVP),CI and stroke volume (SV) were lower than those at T2 [test group:(68.1 ±6.1) mm Hg(1 mm Hg =0.133 kPa) vs.(84.4 ±5.2) mm Hg,(5.5 ±0.8) cm H2O(1 cm H2O =0.098 kPa) vs.(6.2 ± 1.0) cm H2O,(2.8 ± 1.6) L/(min·m2) vs.(3.3 ± 0.8) L/(min·m2),(65.7 ± 4.5) ml vs.(74.3 ± 7.5) ml;control group:(65.4 ± 7.3) mm Hg vs.(85.1 ± 6.6) mm Hg,(4.6 ± 0.8) cm H2O vs.(6.4± 1.1) cm H2O,(2.7 ±0.7) L/(min·m2) vs.(3.3 ±0.6) L/(min·m2),(60.6 ± 7.6) ml vs.(73.8 ±7.5)ml],stroke variation degree (SVV) was significantly increased [test group:(15.9 ±5.1)％ vs.(12.1 ±5.9)％; control group:(15.8 ± 9.4)％ vs.(12.6 ± 8.4)％],there was significant difference (P ＜ 0.05).Compared with the same time of control group,MAP was higher at T3,CI was higher at T4 and T5,SV was higher at T2-T7,there was significant difference (P＜ 0.05).The total transfusion amount,crystal usage and urine in intraoperative and transferred to the ICU 24 h in test group were less than those in control group,while colloid usage was more than that in control group,there was significant difference (P ＜ 0.05).The incidence of cardiac adverse events between two groups had no significant difference (P =0.232).The postoperative ICU stay time,exhaust time,defecation time,into the liquid diets time and hospital stay in test group were less than those in control group [(37 ± 13) h vs.(55 ± 25) h,(72 ± 12) h vs.(99 ± 13) h,(92 ± 16) h vs.(113 ± 16) h,(4.0 ±0.8) d vs.(4.9 ± 1.9) d,(17 ±4) d vs.(27 ±5) d],there was significant difference (P ＜ 0.05 or ＜ 0.01).Conclusion In the elderly patients with coronary heart disease undergoing gastrointestinal surgery,individualized fluid therapy can effectively decrease adverse cardiac events,improve postoperative gastrointestinal function,and reduce length of hospital stay.

OBJECTIVE To analyze the value of modified sinus CT score in olfactory function evaluation before and after functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps(CRSwNP). METHODS Fifty-four patients who underwent functional endoscopic sinus surgery for CRS with nasal polyps were enrolled in this prospective study by inclusion criteria and exclusion criteria. T&T methods and olfactory function VAS were used to analyze the subjective olfactory function and were performed preoperatively and at 6 months after surgery. In modified sinus CT score, middle turbinate and superior turbinate associated olfactory cleft areas were used to evaluate the anterior olfactory cleft score(AOCS) and posterior olfactory cleft score(POCS). Sinus CT scans Lund-Mackay scores were also collected before surgery. The correlation between the status of the olfactory cleft on CT, Lund-Mackay score and the preoperative and postoperative olfactory results were investigated.RESULTS Among 54 patients, there were 36 male and 18 female, with average age of 47.9 years old(from 24 to 67 years). There were 30 patients followed 6 months after surgery. The findings of olfactory cleft opacification and the CT Lund-Mackay scores had a positive correlation with preoperative olfactory results(P<0.001). The olfactory cleft opacification showed a stronger correlation with the preoperative olfactory results than the CT Lund-Mackay score. The AOCS was more significantly correlated with the postoperative olfactory results than the other parameters.CONCLUSION Preoperative CT findings, especially the anterior portion of the olfactory cleft had a statistically significant association with the postoperative olfactory results in patients with CRS with nasal polyps.

Objective To study the characteristics of cerebral glucose metabolism in adults with hypoxic-ischemic encephalopathy (HIE) using positron emission tomography (PET) and statistical parameter mapping (SPM), and evaluate the degree of the cerebral glucose metabolism damaged. Methods 26 HIE patients and 20 healthy controls received 18F-FDG PET imaging. The scope and degree of the brain radioactivity decrease were observed with visual analysis. The three-dimensional projection images and the KE value were obtained by SPM analysis. Results The glucose metabolic decrease in HIE was primarily bilaterally. The bilateral basal ganglia and thalamus metabolism decreased most obviously. The brain cortical lobes varied degrees of metabolic decrease according to the order from high to low was the frontal, occipital, parietal and temporal lobes. The basal ganglia and thalamus were taken as the important target area of the evaluation of damage degree, the degree of damage of HIE was divided into Level Ⅰ(mild), Level Ⅱ(moderate) and Level Ⅲ (severe) combined with cortex damage. Conclusion The basal ganglia and thalamus are the target areas of metabolic damage, the classification combined with brain cortex damage degree and scope can be used to guide the clinical treatment and prognosis evaluation.

Objective To evaluate the therapeutic effect of limb ischemic preconditioning (LIPC) by observing the changes of brain glucose metabolism using positron emission tomography (PET) and statistical parametric mapping (SPM). Methods 40 patients with severe stenotic or occlusion cerebral artery lesions were enrolled and randomized into LIPC group (n=20) and control group (n=20). Brain lesions and cerebral hemorrhagic lesions were excluded after magnetic resonance imaging. The glucose metabolism of patients was analyzed before and after treatment in two groups, respectively, using the methods of radioactivity ratio and SPM. Results There were 5 patients drop-out in the control group. Comparison of the glucose metabolism ratio of the impaired area to the opposite area: LIPC group improved better than the control group (P<0.01) while the control group aggravated heavier than LIPC group (P<0.05). Comparing the glucose metabolism of patients before and after treatment in two groups, respectively, by paired-t test, 1) Setting the glucose metabolism of patients increased after therapy: There were 9 areas activated in LIPC group, including frontal, parietal, temporal, occipital lobes, basal ganglia and thalamus, and the KE=927, while there were only 3 areas activated in the control group, including frontal, parietal and occipital lobes, and the KE=289. 2)Setting the glucose metabolism of patients decreased after therapy: There was no area activated in LIPC group, while there were 2 areas activated in the control group, including parietal and temporal lobes, and the KE=115. Conclusion The improvement of glucose metabolism was observed in cerebral cortex, basal ganglia and thalamus of the patients with severe stenotic or occlusion cerebral artery lesions after LIPC by PET and SPM.

Objective To observe the brain glucose metabolism after limb ischemic preconditioning (LIPC) for ischemic moyamoya disease with positron emission tomography (PET) and statistical parametric mapping (SPM). Methods 62 patients with ischemic moyamoya disease were enrolled and randomized into LIPC group (n=31) and control group (n=31). The glucose metabolism of patients was analyzed with PET before and after treatment in both groups, using the methods of radioactivity ratio and SPM. Results The glucose metabolism ratio improved more in the LIPC group than in the control group (P<0.01), and aggravated less than in the control group (P<0.001). As setting the glucose metabolism increased after treatment, there were 7 areas activated in LIPC group, including frontal, temporal and parietal lobes, and the KE=1121; while there were 5 areas activated in the control group, including frontal and parietal lobes, and the KE=292. As setting the glucose metabolism decreased after treatment, there was only frontal area activated in LIPC group, while there were 8 areas activated in the control group, including frontal, parietal, occipital lobes, and the KE=629. Conclusion LIPC may improve the brain glucose metabolism in patients with moyamoya disease, which can be observed with PET and SPM.