Objective Crossclamping of aorta causes a sudden increase in systemic vascular resistance. Spinal cord may suffer ischemic injury during aortic aneurysm surgery. This study was designed to evaluate the hemodynamic and and spinal cord protective effects of captopril during suprarenal aortic crossclamping in rabbits.Methods Twenty-four albino rabbits were randomly divided into three groups :sham operation group (A),control group (B) and captopril group (C). The descending aorta was crossclamped above the level of renal artery for 30 min and then declamped.In group C a bolus of captopril 2 mg?kg -1 was given intravenously 10 min before crossclamping followed by a 0.5mg?kg -1?min -1 infusion for 30 min. The same volume of normal saline was given in other 2 groups. The carotid artery pressure(BP 1) and femoral artery pressure(BP 2) were recorded before injection, 5, 20,30min after crossclamping and 5,60,180min after declamping. Spinal cord was examined at the level of T 10 and L 3 for morphological changes and MDA content 180 min after declamping.Results 1. BP 1 increased significantly after crossclamping in group B. In group C there was no significant change in BP 1 after crossclamping. In group C there was no significant change in BP 1 after crossclamping. In group B BP after declamping was significantly lower than that before crossclamping. In group C BP at 60 and 180 min after declamping was significantly higher than that at the same intervals in group B(P

Objective To evaluate the clinical effects of the artificial humeral head prosthesis in the treatment of proximal humerus bone tumors. Methods Fifteen patients with proximal humerus bone tumor had excision of bone tumor and application of artificial humeral head prosthesis were analyzed retrospectively. Among them,8 patients had osteosarcoma,4 patients had giant cell tumor of bone,2 patients had chondrosarcoma, 1 patient had fibrosarcoma. Results All cases were followed up for average (39 ± 5 ) months after the surgery.The duration time of operation were( 110 ± 10) minutes in average. The bleeding volume during operation were (600 ± 41 ) ml in average. One patient with osteosarcoma died of recurrence and metastasis 20 months after the surgery. The functions of the other 14 patients were assessed by Enneking system and the average score was 23.3 ± 3.7. The overall rate of excellent or good results was 84.6% ( 11/15 ). Conclusion Limb salvage surgery with the artificial humeral head prosthesis is an efficacious treatment for proximal humerus bone tumors,which can improve short-term clinical outcome.

Objective To investigate the impact of preoperative portal vein thrombosis (PPVT) on living donor liver transplantation (LDLT).Methods In this study,99 patients who underwent LDLT by the same surgical team of Tianjin First Centre Hospital from 2007 to 2011 were retrospectively analyzed.According to whether there was a PPVT,all the patients were divided into PPVT group (26 cases) and non-PPVT group (73 cases).The preoperative risk factors and the impact of PPVT on LDLT and outcomes were analyzed.Results Among 26 PPVT patients there were 23 cases in grade Ⅰ and 3 cases in grade Ⅱ.Splenectomy was found to be an independent risk factor for PPVT (x2 =10.211,P =0.001).PPVT prolonged the anhepatic phase (Z =-2.430,P =0.015),but the incidence of surical complications and mortality were no statistical differences between the PVT group and the non-PVT groups.Meanwhile,there was no statistical difference of 1-and 3-year survival rate between the two groups(x2 =0.505,P =0.477).Conclusions With proper intraoperative treatment and postoperative prevention,PPVT does not affect the outcomes of patients suffering from grade Ⅰ or Ⅱ PPVT.However,PPVT added to difficulties of operation,so the detailed preoperative evaluation and careful intraoperative operation is necessary.

Objective:To follow up the hepatitis B recurrence post liver transplantation using the combination of lamivu dine and high-dose intravenous/intramuscular hepatitis B immunoglobulin.Methods:Fifty-two consecutive patients who underwent liver transplantation were included in this analysis.All patients were administered lamivudine combined with hepatitis B immunoglobulin intravenous(V group)or intramuscular(M group)injection prophylaxis.Dosages of hepatitis B immunoglobulin were 4 000 U during anhepatic phase,2 000 U/d during the first six days after operation,2 000 U/week at 2-4 weeks after operation and 2 000 U/month at 2-6 months after operation.The dosages of hepatitis B immunoglobulin were decided by blood concentrations at 6 months after transplantation in both groups(HBsAb titer≥200 U/L during the 6-12 months after operation;100-200 U/L one year after operation).The negative-conversion rates of serum HBsAg,serum HBsAb levels and hepatitis B recurrence rate at the 6th month,1 year after transplantation and at the end of this study were investigated.Results:The daily average negative-conversion rate of serum HBsAg was significantly faster in V group than that of M group within the first 4 postoperative days(P ＜ 0.05).The 100% of serum HBsAg negative-conversion rate was obtained in two groups after one week of operation.No recurrence was found in two groups.And the ease of death was independent on HBV recurrent during the follow-up.Conclusion:Lamivudine combined with hepatitis B immunoglobulin intravenous/intramuscular injection prophylaxis was effective protocol for the hepatitis B recurrence after the liver transplantation.

Objective To explore the value of low resection of rectal carcinoma in pull-through anus operation and its influence factor with rectal carcinoma distant metastases along intestine wall.Method Clinical pathological and visited data of 43 patients with rectal carcinoma were analyzed prospectively.Resuits Forty--one cases were successfully accepted resection in pull-through anus (95.3%).No patient suffered from stoma leak,3 cases appeared recurrence after operation.Compared between high differentiation patients and mid differentiation patients,there was no significant difference, while the difference of comparing between high or mid differentiation patients and low differentiation patients respectively,there was significant difference.The difference of comparison among Dukes stage A,B or C was significant.Conclusions The right length of incising distant intestine tube is more than 2.0,3.0,4.0 cm respectively for rectal careinoma of high,mid and low differentiation or that of Dukes stage A,B or C.low resection of rectal carcinoma in puB-through anus should be considered as a regular operation.

Objective To explore the safety and feasibility of controlled hypotension with urapidil and nitroglycerin esmolol-three drugs combination in endoscopic surgery. Methods Forty patients who were received endoscopic surgeries were randomly divided into two groups, 20 cases in each group, urapidil-esmolol-nitroglycerin controlled hypotension group (A group) and non controlled hypotension group (B group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at the following points: before anesthesia (basal, T1), immediate before surgery (T2), 30 minutes after the start of surgery (T3), end of the operation (T4), 10 minutes after the end of surgery (T5). We recorded blood loss, operative time, transfusion volume, urine. At last the parameters were compared between the two groups. Results The difference of SBP, DBP, MAP at the points of T2, T3, T4 in the two groups was statistically significant (P < 0.05) comparing with the control group (group B). The vital signs of patients during anesthesia in A group had more stable than that of the B group , and the operation time of the A group was significantly shorter than that of the B group. Meanwhile, the blood loss in A group was significantly decreased(P < 0.05). Conclusion It has synergistic antihypertensive effect, and can reduce both side effects and the risk of anesthesia and surgery for us to use urapidil-esmolol-nitroglycerin three antihypertensive drugs in combination. It is a safe and reliable method for clinical application.

Objective To determine the key interventions transferring from the control to elimination of malaria in China so as to provide the basic information for achieving malaria elimination. Methods Based on the data collected from the document entitled of The National Annual Report on Schistosomiasis,Malaria and Echinococcosis,published by the National Institute of Parasitic Diseases of Chinese Center for Disease Control and Prevention,the malaria incidence and intervention data were se?lected only in the typical endemic provinces during the period of 2004-2010. The correlation between the incidence and interven?tions in the target provinces was analyzed based on the Panel Data Regression Model,and the key interventions were deter?mined. Results Four provinces namely Anhui,Yunnan,Hainan and Henan were targeted with 87.56%of the national malaria figures from 2004 to 2010. When Y was given as vivax malaria incidence,X1 as the log of the number of historical cases receiving radical treatment in the pre?transmission stage(RTPT)(F=14.53,P<0.01,R2=0.72),X2 as the log of risk population receiv?ing RTPR(F=15.90,P<0.01,R2=0.71)and X3 as the number of technicians trained in microscopy(F=11.53,P<0.01,R2=0.61),three space?fixed effect models were established respectively,and X1,X2,as well as X3 had negative effects on Y value. When Y was given as falciparum malaria incidence,X1 as the accumulated technicians trained in microscopy(F=11.06,P<0.01,R2=0.87),X2 as the log of technicians trained in entomology(F=15.28,P<0.01,R2=0.89),two two?way(space and time)fixed effect models were established respectively,and both X1 and X2 had negative effects on Y value. Conclusion RTPT among historical patients and at?risk populations as well as microscopy training influences the variation of vivax malaria inci? dence,while the significant interventions of microscopy training and vector control training indicate that the integrated measures with strengthened capacity in diagnosis and vector control are of importance in the control of falciparum malaria transmission.

Objective To study the effect of acute non-isovolemic hemodilution (ANIH) plus tranexamic acid on bleeding and coagulation factors. Methods Forty-two patients with brain tumor under general anesthesia were randomly divided into group N and group T with 21 patients in each group. Group N was given ANIH , while group T was given tranexamic acid and ANIH. Bleeding, transfusion, urine volume were recorded. Coagulation factors and D-dimer were detected one day before and after surgery. Hemoglobin was recorded before and after ANIH and after auto-blood was transfused. Results There was less bleeding in group T. Hemoglobin in group T was higher after transfusion. No significant difference was found in Group T and group N in terms of urine volume and transfusion rate. Both the two groups had no difference on variation of coagulation factors. Conclusion ANIH with tranexamic acid has no significant effect on coagulation but produces synergetic effect on decreasing bleeding. They can be applied in surgery of brain tumor safely.

Objective To investigate the effects of controlled hypotension (CH) combined with tranexamic acid (TA) on peri-operative blood loss and coagulation function in patients undergoing brain tumor surgery. Methods Forty patients undergoing brain tumor surgery were randomly allocated into group A and group B with 20 patients in each group. Patients in group A received CH alone, while patients in group B received CH combined with TA. Coagulation factors and d-dimer levels were measured 24 hours before and after surgery. Amount of blood loss, intravenous fluid transfused, urine output and postoperative drainage were recorded. Results D-dimer levels of 24 hours after surgery increased compared with that of 24 hours before surgery. In group B, the d-dimer level increased more than that of group A (P < 0.05). No significant difference was found in coagulation factor levels between group A and group B. Amount of blood loss, intravenous fluid transfused and postoperative drainage flows of patients in group B were lower than that in group A (P < 0.05). There were no significant changes in urine output and fluid infusion volume between two groups. Conclusion CH compared with TA can reduce perioperative blood loss in patients undergoing brain tumor surgery , with no obvious coagulant function abnormality. Collectively, it should be a safe and reliable method for clinical application.

ObjectivesTo retrospectively analyze the clinicopathological features of neuroblastoma (NB) and investigate the signiifcance of abnormality ofN-myc and anaplastic lymphoma kinase (ALK) gene copy number change as well asALKmu-tations in NB.Methods Eighty-three NB patients were collected and classiifed into different subgroups according to the clinical stage and histology. Fluorescence in situ hybridization (FISH) was performed to detect the abnormalities ofN-mycandALK genes. The extracted DNA was ampliifed by PCR and sequenced to investigate the point mutations of theALK gene. Follow-up data were collected and survival analysis was performed.ResultsFISH detection showed that the aberration ofN-mycgene copy number presented as gain and ampliifcation. The aberration ofALK gene presented as point mutation and gain. It was shown that 17 cases had the abnormality of bothN-myc andALK gene. Survival analysis showed that the prognostic factors included the clinical stage, age and abnormality ofN-myc genes.ConclusionDetection ofN-myc andALK abnormality in NB would be helpful for evaluating the prognosis and providing theoretical basis forALK target therapy.