45.0?5.4)was higher than those who underwent omnidistance tourniquet technology.The incidence rate of hematoma and venous thrombus of lower extremity had no obvious difference.[Conclusion]The postoperative blood loss can be reduced and early postoperative clinical effect and affected limb function can be improved by halfway tourniquet technology for patients who underwent TKA.

[Objective]To explore the "acute angle" of femur,and evaluate the bone tunnel technique in posterior cruciate ligament reconstruction.[Method]Using the porcine flexor digitorum tendon as graft,the author reconstructed posterior cruciate ligament.The bone tunnel was established with the angle of 80?,90?and 100?comparison the tunnel and intercondylar fossa of femur side wall,and press sensitive film was set between the edge of tunnel and graft.The pressure between was used to represent abrasion.The bigger the pressure was,the larger the abrasion was.The difference of pressure between bone tunnel technique group and the control group was compared.[Result]The pressure of angle 100?was lowest(3.55?0.21 MPa).And the pressure of burnishing group(3.29?0.19 MPa)was lower than that of the control group(3.55?0.21 MPa).[Conclusion]The bone tunnel technique can reduce the femoral;"acute angle" of femur in posterior cruciate ligament reconstruction.

Objective To discuss the advantage of hispectral index(BIS) monitoring used in gastrointestinal endoscopy,and to observe elinical effects of target-controlled infusion(TCI) propofol combined with remifentanyl in elderly patients.Methods 120 patients aged from 65 to 78 with ASA physical status Ⅰ ～ Ⅱ were randomly divided into two groups,i,e.Group A (propofol with fentanyl ),Group B ( TCI propofol and remifentanyl with BIS).The amount of propofol was adjusted by consciousness and hemodynamics in Group A,while by BIS value in Group B.BIS was controlled at 55 ～60.The total amount of propofol and the time of wake-up,the incidence of complicatiors in each group were recorded.Results Compared with Group A,the changes of MAP and HR at T1 and T2 were smaller in Group B(P ＜ 0.05 ) ; Compared with Group A,the total amount of propofol and the time of wake-up were less in Group B ( P ＜ 0.05 ) ;Compared with Group A,the incidence of intraoperative respiratory depression and bradycardia were increased in Group B( P ＜ 0.05 ),there were no differences in the rest between the two groups.Conclusion Under BIS monitoring,TCl propofol and remifentanyl in elderly patients undewent gastrointestinal endoscopy may reduce propofol,and reach rapid recovery from anesthesia,but it needs additional management of respiration and circulation.

ObjectiveTo observe the changes of HR,MAP,BIS and Narcotrend induced by different doses of propofol in elderly patients. MethodsOne hundred elder patients(60 ～ 85 years old), AS A class Ⅰ or Ⅱ, scheduled for selective surgeries,were divided equally into 5 different doses of propofol( constant intravenous injection for 1min) groups of 0.5mg/kg( Ⅰ ) ,0. 75mg/kg( Ⅱ ) ,1.0mg/kg(Ⅲ) ,1.25mg/kg( Ⅳ)and 1.5mg/kg(Ⅴ). HR,MAP,BIS and Narcotrend were monitored before propofol injection and at 1 and 5 min after propofol injection. ResultsHR of 5 group s as similar. At 1 min after pmpofol injection, MAP decreased remarkably compared with at before in all 5 groups( t =2. 17,2.84,2.49,5.63,7.10, all p ＜ 0.05 ), which in group Ⅳ and Ⅴ decreased significantly compared with at in group Ⅰ, Ⅱ and Ⅲ(t =4.67,2.77,2.45,5.49,4.57,2. 18,all P＜0.05).At 1 min after propofol injection,BIS and NI values decreased compared with at before in all 5 groups(t =7.74,11.74,28.18,30.34,45.28, 6. 65,10.52,17.27,26.28,30. 14,allP ＜0.05) ,which in groupⅢ, Ⅳ and Ⅴ were significantly lower than those in group Ⅰ and Ⅱ (t =12.59,11.08,16.72,15.12,17.67,15.64,allP＜0.05).Dose of propofol was negatively correlated with BIS and NI value ( r =-0. 898/0. 930, P ＜ 0.01 ). ConclusionPropofol 1.0mg/kg constant injection should meet the sedation and hypnosis demand of general anesthesia in elderly patients and could not inhibit circulatory system; Bispectral Index and Narcotrend could accuratly monitor depth of anesthesia in elderly patients.

BACKGROUND: Schwann cells are the seed cells of neural repair, and it is a key to harvest a large number of Schwann cells with high purity and activity. OBJECTIVE: To compare the in vitro culture, purification, and morphology of Schwann cells between neonatal and adult rats, and investigate a simple and feasible culture method to harvest high-purity Schwann cells. METHODS: Totally 30 Sprague-Dawley rats, comprising 20 neonatal (1-3 days after birth, neonatal group) and 10 adult (weighing 150-200 g, adult group) rats, were included. Following double-enzyme digestion and two incubations, Schwann cells were isolated and purified by differential attachment. Cell morphology and attaching speed were determined through the use of inverted microscope. Cells were counted and cell purity was calculated. Cell proliferative ability was detected by MTT microcolorimetry. Curves of cell proliferation in each group were depicted to determine proliferative speed. Schwann cells were identified by S-100 immunochemistry.RESULTS AND CONCLUSION: Compared with fibroblasts, neonatal rat Schwann cells exhibited faster, while adult rat Schwann cells showed slower, attaching speed. Both neonatal and adult groups yielded over 96% cell purity. MTT microcolorimetry results revealed that Schwann cells proliferated actively in neonatal and adult groups. Cell proliferative curves show that neonatal rat Schwann cells proliferated faster than adult rat Schwann cells (P < 0.05). S-100 immunochemistry results showed positive results in both groups. All these findings suggest that double-enzyme digestion and two incubations followed by differential attachment is a satisfactory method to harvest considerable Schwann cells with high purity and activity. Neonatal rat Schwann cells show stronger proliferative, attaching capacities than adult rat Schwann cells.

Background and purpose: The overall survival time of extensive-stage small cell lung cancer is not satisfactory. No chemotherapy schemes more effective than etoposide combined with cisplatin, and other optimum combinations should be under evaluation. The aim of this study was to investigate the survival advantage of IEP followed by EP chemotherapy in the treatment of extensive-stage small cell lung cancer compared with EP chemotherapy alone. Methods: From Jan 2004 to Sep 2007, 68 extensive-stage small cell lung cancer patients were enrolled in this project and were randomly divided into research group and control group in the ratio of 1:1. In the research group, 34 patients accepted IEP chemotherapy at least two times followed by EP chemotherapy maintenance therapy. 34 patients as control group accepted EP chemotherapy only. Statistical significance was defined as P<0.05. Results: The median overall survival time of the research group was 15.32 months and the control group was 9.30 months. There were no significant differences between the two groups (P=0.0787). The median time to progression of the research group was 7.83 months and 6.92 months for the control group, respectively. There were no significant differences between the two groups (P=0.0164). It is suggested that IEP followed by EP chemotherapy in treatment of extensive-stage small cell lung cancer could get a better progression free survival, but the overall survival time has not been improved. Conclusion: We conclude that those patients with extensive-stage small cell lung cancer could get better progression free survival by accepting IEP chemotherapy.

Objective To investigate the role of rotational alignment reference landmarks of the proximal tibia in total knee arthroplasty.Methods Fifteen healthy adult volunteers were enrolled in this study,including 10 males and 5 females,aged from 21 to 38 years (average,28.1±6.0).CT scans of 26 knees were taken as the knees were placed in full extension.Two anteroposterior axes were drawn on the CT images:one line connected the middle of the posterior cruciate ligament insertion site and the medial edge of the patellar tendon,and another line connected the middle of the posterior cruciate ligament insertion site and the middle-medial 1/3 of the patellar tendon.The surgical epicondylar axis was also drawn on the CT images.Angles were measured between a line perpendicular to the surgical epicondylar axis and the two anteroposterior axes,and the angles were compared with the ideal tibial rotational alignment reference axis (0°).Results Angles between the line perpendicular to the surgical epicondylar axis and the line connecting the middle of the posterior cruciate ligament insertion site and the medial edge of the patellar tendon averaged 0.7°±2.8° (range,-5.1°-5.8°),there was no significant difference compared with 0°.Angles between the line perpendicular to the surgical epicondylar axis and the line connecting the middle of the posterior cruciate ligament insertion site and the middle-medial 1/3 of the patellar tendon averaged 6.9°±5.3° (range,-3.4°-14.1°),there was significant difference compared with 0°.Significant difference existed in angles between the two anteroposterior axes and the line perpendicular to the surgical epicondylar axis.Conclusion The line connecting the middle of the posterior cruciate ligament insertion site and the medial edge of the patellar tendon is a more reliable reference axis for the tibial component rotational alignment,which makes the femoral and tibial components in a more matching rotational position.

Objective To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) in intrathoracic tuberculosis(TB).Methods We retrospectively analyzed patients underwent EBUS-TBNA with a final diagnosis of intrathoracic TB at Shanghai Chest Hospital from October 2009 to March 2013 and observed that the diagnostic efficacy by pathology and microbiology and safety of EBUS-TBNA for intrathoracic TB.Results 75 patients were diagnosed with pulmonary TB or intrathoracic tuberculous lymphadenitis,and accuracy was 80％ (60/75) by EBUS TBNA.A total of 60 patients had pathology,acid-fast bacilli(AFB) staining and mycobacterial culture test results,of whom 52 (86.67％)were diagnosed.Pathological findings were consistent with TB in 77.33％ patients (58/75),in 20.31％ (13/64) the smear were positive for AFB and in 46.67％ (28/60) were positive for cuhure.One hundred and twenty-nine mediastinal or hilar lymph nodes and 10 intrapulmonary lesions were biopsied in 75 patients,the average target number of per patient were 1.85.Pathological findings were consistent with TB in 66.19％ samples(92/139),in 13.91％ (16/115) were positive for AFB and in 38.32％ (41/107) were positive for culture.Multivariate regression revealed that short-axis diameter was an independent risk factor associated with positive pathology,smear and euhure.Additionally,more aspiration times cause higher pathology positive rate,pathology showing necrosis and positive smear were independent risk factors associated with positive cuhure.There were two patients occurred complications during operation.Conclusion EBUS-TBNA was a safe and effective method for the diagnosis of intrathoracic tuberculosis.

BACKGROUND:The establishment of a safe, reliable and easily repeatable mouse model of nonalcoholic fatty liver disease is the prerequisite for the study of the diagnosis and treatment of the disease.
OBJECTIVE:To establish a C57BL/6 mouse model of nonalcoholic fatty liver disease and observe changes of biochemical indicators, which can provide a theoretical basis for its pathogenesis and drug treatment.
METHODS:Sixty healthy male C57BL/6 mice were randomly divided into a control group of 30 cases (normal diet), and a model group of 30 cases (high fat diet). Models of nonalcoholic fatty liver were established. At 8 weeks, body mass, liver index, and homogenate superoxide dismutase activity in the liver were detected. Changes in serum alanine aminotransferase, aspartate aminotransferase, triglyceride glycerol, cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were observed. Pathological examination was performed.
RESULTS AND CONCLUSION:(1) Pathological sections showed that large droplets and smal lipid droplets in the mouse liver and spread the whole liver. Swel ing of the liver cel s, visible cytoplasmic vacuoles and obviously inflammatory changes in liver cel s were observed in the model group. (2) Body weight and liver index were significantly higher in the model group than in the control group (P<0.05). Superoxide dismutase activity was significantly reduced in the liver (P<0.05). (3) Triglycerides, cholesterol, and low-density lipoprotein cholesterol levels were significantly higher, but high-density lipoprotein cholesterol levels were significantly lower in the model group than in the control group (P<0.05). (4) Nonalcoholic fatty liver mouse model is ideal for high-fat diet-induced animal model. The method is simple, repetitive, and can provide a stable animal model for the study on the mechanism of nonalcoholic fatty liver disease and drug treatment.

Objective To determine if stimulation of cholinergic anti-inflammatory pathway mediated by vagus can protect liver against sepsis.Methods Male SD rats weighing 250-300 g were anesthetized with intraperitoneal methane 1g?kg~(-1).Left common carotid artery,was cannulated for MAP monitoring and blood sampling.Sepsis was produced by ligation of cecum which was punctured twice at an interspace of 3 mm with a 9G needle(CLP).Bilateral vagus nerves were isolated,ligated with 4-0 silk and cut(VGX).The distal end of the vagus nerve was stimulated with direct current(5V,2 ms,1 Hz)continuously for 20 min(STM).Forty animals were randomly divided into 4 groups(n=10 each):group Ⅰ sham operation;group Ⅱ CLP;group Ⅲ CLP + VGX and group Ⅳ CLP+VGX+STM.Arterial blood samples were obtained at 0,1,2 and 4 h after operation for determination of plasma TNF-? concentration and serum ALT and AST activities.The animals were then killed and the livers removed for ultrastructure examination with electron microscope.Results Electrical stimulation of the distal end of vagus nerve significantly attenuated the significant decrease in MAP and increase in plasma TNF-? concentration and serum AST and ALT activities and the damage to the organelle in the liver cell induced by sepsis.Conclusion Our results show that electrical stimulation of vagus nerve can protect liver from sepsis to some extent through cholinergic anti-inflammatory pathway.