Objective To investigate the pharmacodynamics of remifentanil required to prevent laryngeal mask airway (LMA) insertion response in patients anesthetized with propofol by TCI. Methods Thirty-six ASA Ⅰor Ⅱ patients aged 18-59 yr with body mass index ＜ 30 kg/m2 undergoing elective breast operation were enrolled in the study. Propofol was administered by TCI at an effect-site concentration of 4.0 μg/ml. When the patients lost conciousness, TCI of remifentanil was started. The initial target plasma concentration of remifentanil was set at 2.9 ng/ml, and the ratio of two consecutive effect-site concentrations was 1.2. LMA was inserted at 3 min after the target effect-site concentration and the plasma concentration achieved the balance. Criteria of successful insertion were defined as Muzi score≤2 and the increase in MAP and HR≤ 15% of the baseline values within 3 min after insertion. EC50 was determined by modified Dixon's up-and-down sequential trial and the 95 % confidence interval was calculated. Results The EC50 of remifentanil was 2.75 ng/ml. The 95% confidence interval was 2.51-3.01 ng/ml. Conclusion The EC50 of remifentanil for suppression of cardiovascular response to LMA insertion is 2.75 ng/ml in patients anesthetized with propofol by TCI.

Objective To summarize the clinical experiences of total cavopulmonary connection (TCPC), investigate the applications and short and mid term effects. Methods From 1999 to 2007,31 patients with complex congenital heart disease underwent TCPC. All patients were divided into child group(≤16 years old ,n =21 ) and a-dult group( n = 10 ), including 15 cases of functional univentricle, 8 cases of complete atrioventricular septal defect with double outlet of right ventricle, 3 cases of transposition with double outlet right ventricle, 3 cases of tricuspid atresia, 1 case of double outlet of right ventricle with hypoplastic left heart. 1 case of corrected transposition of the great arteries with TOF. Among them, 1 patient had cortriatriatum, 10 patients had left superior vena cave, moderate or severe mitral valve insufficiency occurred in 1, moderate atrioventricular valve insufficiency occurred in 3.28 pa-tients underwent TCPC with cardiopulmonary bypass ( CPB ) and 3 patients without CPB ;Of them, 21 patients were treated with extracardiac conduit and 10 cases with intratrial lateral tunnel. Results There was no early death,post-operative death or large quantities of pleural effusion in child group;but two deaths and three patients with large quantities of pleural effusion in adult group. One case caught up in inferior venous stasis and was cured. Follow- up was carded out from 6 months to 6 years. 26 patients were in NYHA class Ⅰ ,2 patients in NYHA class Ⅱ and only one patient in NYHA class Ⅲ. Conclusions TCPC is effectively used for complex congenital heart disease which can not be corrected in anatomy;serious postoperative complications often occur in adults. Atrioventricular valve in-sufficiency decisively affects the short and midterm effects, even the long-term effects.

Objective To assess the effectiveness and safety of vitamin D in preventing and treating bone loss in renal transplant patients.Methods Methods recommended by the Cochrane Collaboration were used.MEDLINE,EMBase,Cochrane Library and CNKI were searched from Jan.1990 to Nov.2009 to locate all the randomized controlled trials (RCT) concerning preventing and treating bone loss by vitamin D in renal transplant patients.The qualities of included trials were evaluated by two independent reviewers.Trails consistent with criteria wereanalyzed by Revman 4.2 software.Results Nine RCTs involving 658 post transplant patients were included.The qualities of included trials were graded as grade A in 4,grade B in 2 and grade C in 3.Meta-analysis showed that after being treated with vitamin D for one year,the difference of BMD,Z-score and T-score between the two groups was statistically significant (P＜ 0.05); the difference of PTH concentration was also statistically significant (P＜0.01),but there was no significant difference in concentrations of serum calcium and phosphorus,and the incidence of hypercalcemia (P＞0.05).Conclusion Current available evidence demonstrates that vitamin D is effective and safe in preventing and treating bone loss in renal transplant patients.

Objective To explore the mechanism of the gut microbiota metabolite trimethylamine-N-oxide （TMAO） acting on high mobility group box 1 （HMGB1）/NOD-like receptor protein 3 （NLRP3） to regulate inflammatory response after cerebral ischemia/reperfusion （I/R） injury in mice. Methods A mouse atherosclerosis model was established by feeding on TMAO and high-fat diet.A mouse model of middle cerebral artery occlusion （MCAO） was prepared using the suture method.Mice were randomly divided into sham group，2-week-TMAO-feeding group，and 6-week-TMAO-feeding group.After I/R injury，we measured the protein levels of NLRP3，HMGB1，cleaved interleukin-1β （Cle-IL-1β），and zonula occludens-1 （ZO-1） by Western blotting.After six weeks of TMAO feeding，mice were randomly divided into sham group，I/R group，TMAO+I/R group，and TMAO+DMB+I/R group.For each group，we scored neurological function，determined NLRP3，HMGB1，Cle-IL-1β，and ZO-1 protein expression by Western blot，measured brain infarct volume with TTC staining，and measured the water content of brain tissue. Results Compared with those of the sham group，NLRP3，HMGB1，and Cle-IL-1β protein expression increased significantly and ZO-1 decreased significantly with the length of TMAO feeding （all P<0.05）.Compared with the I/R group，the TMAO+I/R group showed a significant decline in neurological scores，significantly increased NLRP3，HMGB1，and Cle-IL-1β expression，significantly decreased ZO-1 expression，a significant increase in brain infarct volume，and a significant decrease in the water content of brain tissue （all P<0.05）.With DMB lowering TMAO，the TMAO+DMB+I/R group had significantly better neurological scores，significantly lower NLRP3，HMGB1，and Cle-IL-1β levels，a significantly increased ZO-1 level，and significantly reduced brain infarct volume and brain tissue water content，as compared with the TMAO+I/R group （all P<0.05）. Conclusion The gut microbiota metabolite TMAO can upregulate HMGB1/NLRP3-mediated inflammatory response in mice with cerebral I/R injury，worsening the breakdown of the blood-brain barrier to exacerbate brain tissue damage.

BACKGROUND: The high incidence of urinary fistula following renal transplantation not only influence on wound healing, but also result in local or systemic infection, even renal allograft loss or death. Therefore, it is necessary to establish a standard for diagnosing and treating of urinary fistula. OBJECTIVE: To retrospectively analyze the diagnosis and treatment of urinary fistula following renal transplantation in 95 cases. METHODS: In 95 cases, there were 59 males and 36 females, aged from 19 to 61 years, urinary fistula occurred at days 1-40 after renal transplantation, including 74 simple fistulas and 21 complex fistulas. Besides of our clinical experiences and routine methods, the "five-step procedure protocol" for diagnosis and treatment of urinary fistula reported by Li Qian-sheng was also referred. RESULTS AND CONCLUSION: Totally 56 cases were managed by conservative treatment, 45 of whom were cured. 50 cases (including 11 cases those failed to cure by conservative treatment) were managed by surgical treatment, 45 of whom were cured. Of the remaining 5 cases, 2 grafts were removed because of graft rupture and massive hemorrhage caused by uncontrolled acute rejection, and 3 recipients died of severe pneumonia shortly after transplantation. 71 of the 90 cases were received long-term follow up, ranging 2 to 11 years. Of the simple urinary fistula cases, 56 were on regular follow up; 41 kept a normal graft function, 10 were diagnosed of chronic allograft nephropathy, 4 returned to hemodialysis and 1 died of lung cancer. Of the complicated ones, 15 were on regular follow up. 8 kept a normal graft function, 4 were diagnosed of chronic allograft nephropathy, and 3 returned to hemodialysis. The design of "five-step procedure protocol" makes urinary fistula diagnosis and treatment more ordered and standard, which can obtain excellent therapeutic efficiency.

Objective To analyze setup errors for irradiation of pelvic carcinoma by online conebeam CT (CBCT) scanning and to calculate the external margins from clinical target volume (CTV) to planning target volume (PTV) in treatment planning. Methods Twelve patients with rectal or prostate cancer were enrolled in this study. Translational errors (x,y,z) and rotational errors (u,v,w) were obtained by using CBCT in radiotherapy. Results The set-up errors were gathered from 229 sets of CBCT in 12patients. The systemic ± random errors on x,y,z, u,v and w axes were (0.49 ± 1.18) mm, (-0. 11 ±3.45) mm, (-2. 00 ± 1.59) mm, 1.14°±0. 67°, 0. 42°±O. 94°and -0. 32°±±0. 68°, respectively. Setup errors in the left-right, anterior-posterior, and superior-inferior directions were 4. 6 mm, 12. 5 mm, and 6. 2 mm, respectively. Conclusions Set-up errors were unavoidable in pelvic carcinoma irradiation. To minimize the influence of set-up errors, we suggest a PTV margin of 5 mm, 15 mm and 10 mm in the leftright, anterior-posterior and superior-inferior directions, respectively.

Objective To study the brain protection of sequential double-sided antegrade cerebral perfusion to central nervous system in arotie arch surgery. Methods 24 patients received aortic arch replacement under deep hyperthermic circulatory arrest (DHCA) ,with fight-sided, and following double-sided, and left-sided,if necessary, antagrade cerebral perfnsion through right axillary arterial cannula or right femoral arterial eannula homeochronously. Post-operation recovery and the central nervous complications (CNC) were recorded and analyzed. Results 2 cases died, one of whom died of refractory low cardiac output syndrome and the other died of late massive gastrointestinal tract hemorrhage. No patient suffered severe CNC. Conclusion Sequential double-sided antegrade cerebral perfusion combined with DHCA can provide good brain protection in arotic arch replacement.

This study was aimed to examine the effect of TREK-1 silencing on the function of astrocytes. Three 21-nucleotide small interfering RNA (siRNA) duplexes (siT1, siT2, siT3) targeting TREK-1 were constructed. Cy3-labeled dsRNA oligmers were used to determine the transfection efficiency in cultured astrocytes. TREK-1-specific siRNA duplexes (siT1, siT2, siT3) at the optimal concentration were transfected into cultured astrocytes, and the most efficient siRNA was identified by the method of immunocytochemical staining and Western blotting. The proliferation of astrocytes tranfected with TREK-1-targeting siRNA under hypoxia condition was measured by fluorescence-activated cell sorting (FACS). The results showed that TREK-1 was expressed in cultured astrocytes. The dsRNA oligmers targeting TREK-1 could be transfected efficiently in cultured astrocytes and down-regulate the expression of TREK-1 in astrocytes. Moreover, the down-regulation of TREK-1 in astrocytes contributed to the proliferation of astrocytes under hypoxia condition as determined by cell cycle analysis. It was concluded that siRNA is a powerful technique that can be used to knockdown the expression of TREK-1 in astrocytes, which helps further investigate the function of TREK-1 channel in astrocytes under physicological and pathological condition.

Objective To evaluate the efficacy of dexmedetomidine and dezocine used to supplement awake tracheal intubation assisted by fiberoptic bronchoscope (FOB) in elderly patients.Methods Sixty elderly patients aged 65-77 yr,of ASA physical status Ⅱ or Ⅲ (Mallampati grade Ⅰ or Ⅱ),scheduled for elective surgery under general anesthesia,were randomly divided into 3 groups (n =20 each) using a random number table:dezocine group (group DEZ),dexmedetomidine group (group DEX) and dezocine combined with dexmedetomidine group (group DEZ+DEX).Dezocine 0.1 mg/kg was injected intravenously in group DEZ.Dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min in group DEX.In group DEZ+DEX,dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min,and dezocine 0.1 mg/kg was injected simultaneously.Laryngeal mucous membrane was sprayed with 2％ lidocaine for topical anesthesia during infusion in all the three groups.In addition,1％ tetracaine 3 ml was injected into trachea through cricothyroid membrane.Awake tracheal intubation was performed and assisted by FOB after the end of administration in all the three groups.Cardiovascular response (MAP or HR＞30％ of baseline values) and respiratory depression (SpO2＜90％ and RR＜8 bpm) were recorded during the period between induction of anesthesia and 3 min after intubation was completed.The intubation time was recorded.The tolerance of tracheal tube was assessed in the patients.At the time of topical anesthesia,when epiglottis came into view,immediately after tracheal tube was successfully inserted into trachea,and at 3 min after successful intubation,perfusion index and Ramsay sedation score,and patients' satisfaction with the sedation (Ramsay sedation score 2-4) were recorded.Results Compared with group DEZ or DEX,the tolerance of tracheal tube was significantly enhanced,intubation time was shortened,the rate of satisfactory sedation was increased,perfusion index and the incidence of cardiovascular response were decreased in DEZ+DEX group.There was no significant difference in respiratory depression among the three groups.Conclusion Dexmedetomidine and dezocine can provide better condition for awake tracheal intubation assisted by FOB than dexmedetomidine or dezocine alone in elderly patients.

Aim To investigate the role of Wnt/β-cate-nin signaling pathway on the baicalin-induced osteo-genic differentiation in rat bone marrow derived mesen-chymal stem cells ( rBMSC ) . Methods rBMSC was isolated and cultured by adherence screening method. Alkaline phosphatase ( ALP) amount, CFU-FALP and mineralized nodules were compared between each ba-icalin group and vehicle control group at different time points. Real time q-PCR was employed to evaluate the mRNA level of Wnt signaling-related marker ( Wnt10a, GSK-3β,β-catenin and LEF1) after baica-lin treatment. Protein expression of β-catenin and Runx2 was measured by Western blot. Results Ba-icalin significantly increased ALP activities from day 3 to day 7 . The formation of CFU-FALP and mineralized nodules remarkably increased after rBMSC was treated with1, 10, 50 μmol · L-1 baicalin. mRNA levels of Wnt10a, β-catenin, GSK-3β, LEF1and osteocalcin were enhanced significantly in baicalin-treated group compared to control group. Protein expression of β-catenin and Runx2 was also elevated. Conclusion Baicalin ( 0. 1 to 50 μmol · L-1 ) promotes the osteo-genic differentiation and maturation of rBMSC, in which Wnt/β-catenin signaling pathway might be in-volved.