0 05); when concentration of H.pylori ≥1 6?10 8 CFU/L,apoptosis rate increased in a concentration-dependent manner ( P

Objective To evaluate the feasibility of the cerebrospinal fluid (CSF) flow measurement by cine phase contrast MRI. Methods Evaluation of intracranial and intraspinal CSF flow was accomplished by the use of periphery gated cine phase contrast MRI technique. Normal patterns of pulsatile flow within the ventricles, cisterns and cervical subarachnoid space were established by this technique. Results CSF flow within ventricle, cistern and subarachnoid space could be clearly displayed, and the relationships between the cardiac cycle and the CSF pulsations were demonstrated on both magnitude reconstruction and phase reconstruction MR images. Conclusions Cine phase contrast MRI is capable of demonstrating intracranial and intraspinal CSF flow. As a new noninvasive technique, it is really superior than other modalities in studying the flow pattern and direction of CSF.

The instrument monitors respiratory rhythm of serious dangerous patients by temperatrature senser in nostril and electronic detective technique.The Principle is to input breath signal through temperature senser,which is attached to nasal cavity,and monitor will automaitcally give a alarm when frequencys of breath is under or over threshold.

Objective With the improvement of technology and strategy , reduced field-of-view diffusion weighted imaging ( rFOV DWI) has provided more robust imaging .This article was intended to compare the clinical utility between rFOV DWI and con-ventional DWI in the diagnosis of prostate cancer . Methods Retrospective analysis was made on 58 prostate cancer patients under-going verification of biopsy or surgery after 3.0 T MRI rFOV DWI and regular DWI examinations in Nanjing General Hospital of Nan-jing Military Command from August 2014 to September 2015 , among whom prostate cancer and benign prostatic hyperplasia were 31 cases and 27 cases respectively .Independent grading was made by 2 radiol-ogists who were unaware of any clinical data and sequences in the as-pects of distortion on DW images , lesion conspicuity on DWI ( b=1000 ) and ADC images according to a 4-point Likert scale .rFOV and conventional DWI sequences were acquired using b =400,1000,0s/mm2.The IVIM double exponential model software was applied to generate ACD value, slow dispersive coefficient(D value) and parameterized image of volume fraction of fast dispersion (f value).Se-quence analysis was made in suspected peripheral tumor regions of prostate cancer patients and and healthy peripheral zones of patients with benign prostatic hyperplasia respectively to get ACD , D and f values .The ratio values rADC , rD and rf were attained compared with obturator internus .ROC analysis was made on the efficacy of different parameters of two sequences in prostate cancer . Results Image qualities of rFOV DWI were rated superior to conventional DWI (P<0.001,Wilcoxon Signed-Rank Test).Compared with con-ventional DWI, ADC value (0.728 ±0.094 vs 0.789 ±0.116, P<0.05)and D value(0.622 ±0.077 vs 0.651 ±0.099, P<0.05)of peripheral tumor regions in rFOV DWI were lower and the difference was statistically significant , whereas no significant difference was found in f value(P=0.932).No difference was found in area under ROC curve of f value between rFOV DWI and traditional DWI (0.853 vs 0.767, P=0.283). Conclusion The rFOV DWI sequence yielded can efficiently improve image quality , which is of important value to the clinical diagnosis of prostate cancer .

Objective To evaluate the role of nuclear factor erythroid 2-related factor 2/antioxidant responsive element (Nrt2/ARE) signaling pathway inthe reduction of myocardial ischemia-reperfusion (I/R) injury by propofol in rats.Methods Sixty adult male Sprague-Dawley rats,weighing 200-240 g,were randomly divided into 5 groups (n =12 each) using a random number table:sham operation group (S group),I/R group,propofol group (P group),propofol + Nrf2 vehicle-plasmid group (PNV group) and propofol + Nrf2 siRNA plasmid group (PNS group).The animals were anesthetized with inhalation of 2％ isoflurane,tracheally intubated and mechanically ventilated.Myocardial I/R was produced by 5 min occlusion of left anterior descending branch of coronary artery followed by 60 min reperfusion.In P,PNV and PNS groups,isoflurane inhalation was stopped after successful intubation and propofol was infused via the caudal vein at 6 mg· kg-1 · h-1 until 30 of reperfusion.At 30 min of propofol infusion,Nrf2 vehicle-plasmid 10 μg (100 μl) was injected intramyocardially before myocardial ischemia in group PNV,and Nrf2 siRNA 10 μg (100 μl) was injected intramyocardially before myocardial ischemia in group PNS.The animals were sacrificed at 60 min of reperfusion and myocardial specimens were taken for determination of the infarct size,apoptosis index,and the expression of Nrf2 and heme oxygenase-1 (HO-1).Results Compared with group S,the infarct size and apoptosis index were significantly increased,and the expression of Nrf2 and HO-1 was up-regulated in I/R and P groups.Compared with group I/R,the infarct size and apoptosis index were significantly decreased,and the expression of Nrf2 and HO-1 was up-regulated in group P.Compared with group P,no significant changes were found in the infarct size,apoptosis index and expression of Nrf2 and HO-1 in group PNV,and the infarct size and apoptosis index were significantly increased,and the expression of Nrf2 and HO-1 was down-regulated in group PNS.Conclusion Nrf2/ARE signaling pathway is involved in the reduction of myocardial I/R injury by propofol in rats.

Objective To investigate the value of the bedside index for severity in acute pancreatitis (BISAP),Ranson's,APACHE Ⅱ and computed tomography severity index (CTSI) scoring system in evaluating the severity of acute pancreatitis.Methods The clinical data of 385 patients with acute pancreatitis who were admitted to the Zhongnan Hospital of Wuhan University from 2005 to 2011 were retrospectively analyzed.The values of 4 scoring systems including BISAP,Ranson's,APACHE Ⅱ and CTSI in predicting the incidences of severe acute pancreatitis,local complications and death were investigated by Chi-square test and receiver operating characteristic curv e.Odds ratio (OR) was calculated.The differences of areas under the curves (AUC) were analyzed using the Z test.Results The incidences of severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥ 3 were 64.4％ (56/87),16.1％ (14/87) and 8.0％ (7/87),which were significantly higher than 13.4％ (40/298),6.4％ (19/298) and 0.3 ％ (1/298) of patients with BISAP score ≤ 2 (x2 =93.4,8.1,19.7,P ＜ 0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with Ranson's score≥3 were 52.7％ (48/91),22.0％ (20/91) and 7.7％ (7/91),which were significantly higher than 16.3％ (48/294),4.4％ (13/294) and 0.3％ (1/294) of patients with Ranson's score ≤2 (x2 =49.2,27.3,18.5,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with APACHE Ⅱ score ≥ 8 were 46.6％ (27/58),20.7％ (12/58) and 8.6％ (5/58),which were significantly higher than 21.1％ (69/327),6.4％ (21/327) and 0.9％ (3/327) of patients with APACHE Ⅱ score≤7 (x2 =17.0,12.8,14.4,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with CTSI score ≥4 were 51.4％ (19/37),51.4％ (19/37),16.2％ (6/37),which were significantly higher than 22.2％ (77/347),4.0％ (14/347),0.6％ (2/347) of patients with CTSI score≤3 (x2 =15.1,95.3,40.1,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 58％,89％,64％,86％,respectively,and the AUC was 0.848,which were significantly higher than the other 3 systems (Z =2.02,4.22,4.78,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of CTSI were 58％,95％,51％ and 96％,respectively,and the AUC was 0.926,which was significantly higher than the other 3 systems (Z =3.99,3.24,4.06,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 88％,79％,8％ and 100％,respectively,and the AUC was 0.855,with no significant difference compared with the other 3 systems (Z =0.81,0.03,0.14,P ＞ 0.05).Conclusions The accurate rate of BISAP in predicting the severe acute pancreatitis is higher than Ranson's,APACHE Ⅱ and CTSI.The accurate rate of CTSI in predicting the incidence of local complications is higher than the other 3 systems.There is no significant difference of the 4 systems in predicting the mortality.The BISAP scoring system is helpful in early diagnosis of severe acute pancreatitis,and making the individualized treatment plan,thus improving the prognosis of patients.

Objective To evaluate the effect of OPRM1A118G genetic polymorphism on postoperative analgesia with fentanyl in the patients undergoing radical resection of lung cancer.Methods One hundred and seventy-four patients(native of He′nan province), aged 40-64 yr, weighing 40-70 kg, with American Society of Anesthesiologists physical status Ⅰor Ⅱ, undergoing elective radical resection of lung cancer under general anesthesia, were enrolled in this study.OPRM1A118G genetic polymorphic sites were analyzed by using polymerase chain reaction technique and ABI 3130 Genetic Analyzer.The patients were divided into wild homozygote group,heterozygote group and mutation homozygote group according to their genotypes.The analgesia pump was connected at the end of operation.Patient-controlled intravenous analgesia solution contained fentanyl 30 μg/kg and ondansetron 8 mg in 200 ml of normal saline.The analgesia pump was programmed to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at a rate of 2 ml/h, maintaining the visual analogue scale score ≤3 points.The amount of fentanyl consumed within 24 and 48 h after operation was recorded, and the occurrence of adverse reactions was recorded within 48 h after operation.Results Compared with wild homozygote group, the amount of fentanyl consumed within 24 and 48 h after operation was significantly increased in mutation homozygote group(P<0.05), and no significant change was found in the amount of fentanyl consumed within 24 and 48 h after operation in heterozygote group(P>0.05).There was no significant difference in the incidence of postoperative adverse reactions between the three groups(P>0.05).Conclusion OPRM1A118G genetic polymorphism is one of the genetic factors contributing to individual variation in fentanyl pharmacodynamics in the patients undergoing radical resection of lung cancer.

Objective To evaluate the effects of OPRM1All8G and CYP3A4*18B genetic polymorphism and the interaction on postoperative analgesia with fentanyl in the patients undergoing radical resection of lung cancer.Methods One hundred and thirty-nine patients (native of Henan province),aged 40-64 yr,weighing 40-70 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical resection of lung cancer under general anesthesia,were enrolled in this study.The polymorphic sites of the OPRM1All8G and CYP3A4*18B allele were analyzed by using polymerase chain reaction technique and ABI 3130 Genetic Analyzer.The patients were divided into wild homozygote group (group AA,group *1/*1),heterozygote group (group AG,group * 1/*18B) and mutation homozygote group (group GG,group *18B/*1SB) according to their genotypes.The patients were divided into 7 groups according to the interaction between the two genes:AA plus *1/*1 group (group Ⅰ),AA plus *1/*18B group (group Ⅱ),AG plus *1/*1 group (group Ⅲ),AG plus *1/*18B group (group Ⅳ),GG plus * 1/*1 group (group Ⅴ),GG plus *1/*18B group (group Ⅵ) and *18B/*18B group (group Ⅶ).Patientcontrolled intravenous analgesia with fentanyl was started at the end of surgery to maintain the visual analogue scale ≤ 3 points.The amount of fentanyl used within 24 and 48 h after surgery was recorded,and the occurrence of adverse reactions within 48 h after surgery was observed.Results The amount of fentanyl used within 24 and 48 h after surgery was significantly higher in group GG than in group AA (P＜0.05).The amount of fentanyl used within 48 h after surgery was significantly lower in group *18B/*18B than in group *1/*1 (P＜0.05).The amount of fentanyl used within 48 h after surgery was significantly higher in Ⅱ and Ⅳ groups than in group Ⅰ,in group Ⅲ than in group Ⅱ,in group Ⅴ than in Ⅰ-Ⅳ groups,and in group Ⅵ than in Ⅱ and Ⅳ groups,and was significantly lower in group Ⅶ than in Ⅰ-Ⅵ groups (P＜ 0.05).There was no significant difference in the incidence of adverse reactions within 48 h after surgery between groups (P＞0.05).Conclusion OPRM1A1l8G and CYP3A4*18B genetic polymorphism and the interaction are the genetic factors contributing to individual variation in fentanyl pharmacodynamics in the patients undergoing radical resection of lung cancer.

Objective:To evaluate the efficacy of sugammadex for the reversal of residual neuromuscular blockade after laparoscopic radical gastrectomy in elderly patients.Methods:Sixty patients of both sexes, aged 65-85 yr, with body mass index of 20-26 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic radical gastrectomy under general anesthesia, were divided into 2 groups ( n=30 each) by a random number table method: sugammadex group (S group) and neostigmine group (N group). Rocuronium 0.3-0.6 mg·kg -1·h -1 was intravenously infused during operation, and the muscle relaxation was monitored by a Veryark-TOF monitor, maintaining TOF ratio=0 and counting 1 or 2 after tonic stimulation.Rocuronium was discontinued when the peritoneum was closed.The patients were admitted to the PACU after operation.When the muscle relaxation monitoring T 2 appeared, sugammadex 2 mg/kg was intravenously injected in S group, and neostigmine 0.03 mg/kg plus atropine 0.015 mg/kg was intravenously injected in N group.The tracheal tube was removed after the patient′s consciousness and spontaneous breathing recovered.Before anesthesia (T 1) and 5 and 30 min after tracheal extubation (T 2, 3), arterial blood samples were collected for blood gas analysis, PaO 2 and PaCO 2 were recorded, and ultrasound was used to measure the diaphragm end-inspiratory thickness, end-expiratory thickness and mobility of diaphragm muscle at the above time points.The diaphragm thickening fraction was calculated.The time of T 2 appeared, time of extubation, time of postanesthesia care unit (PACU) stay, postoperative hospital stay, and residual neuromuscular blockade (TOF ratio <0.9) and hypoxemia occurred within 30 min after extubation were recorded.The pulmonary complications within 7 days after operation were recorded. Results:Compared with group N, PaO 2 was significantly increased and PaCO 2 was decreased at T 2, 3, the mobility of diaphragm muscle and diaphragm thickening fraction were increased at T 2, the tracheal extubation time, time of PACU stay and postoperative hospital stay were shortened, the residual neuromuscular blockade and hypoxemia occurred after extubation and incidence of pulmonary complications after operation were decreased ( P<0.05), and no significant change was found in the time of T 2 appeared in group S ( P>0.05). Conclusion:Sugammadex can quickly and effectively reverse the residual neuromuscular blockade after laparoscopic radical gastrectomy, which is helpful for early postoperative recovery in elderly patients.

BACKGROUND: Ureteral obstruction is mainly caused by surgical technic, ischemic, and peripheral lesion compression as well as rejection; in particular, the surgical technic factor is the most important. How to effectively reduce ureteral complications following renal transplantation is significant for prompt diagnosis and clinical treatment.OBJECTIVE: To retrospectively analyze the diagnosis of 23 cases with ureteral complications following renal transplantation, and to summarize pathogeny and preventing management.METHODS: The retrospective analysis was conducted on 23 (1.98%) out of 1 160 cases with ureteral complications following renal transplantation who were selected from General Hospital of Jinan Military Area Command of Chinese PLA from January 1998 to December 2008. In 924 cases of renal transplantation with cadaver kidneys, ureteral stenosis occurred in 18 cases (1.95%), while in 236 cases with relative kidneys, ureteral stenosis occurred in 5 cases (2.12%). A total of 17 cases were performed with ureterovesicostomy; 2 with uretero-autoallergic anastomosis of ureter; 1 with cutaneous ureterostomy; 1 with ureteral liberation, resetting ureteric branch stand; 1 with saccule dilation; 1 with retrograde ureteric branch stand under cystoscope. Type-B ultrasonic examination was re-checked to determine pyeloureterectasis following treating ureteral complications.RESULTS AND CONCLUSION: Of the 23 cases, stenosis of ureterovesical junction occurred in 19 cases, necrosis of the ureter on 2 cases, and twisting of ureter graft on 2 cases. Following up was performed after treatment for 3-98 months. In 20 cases, renal pelvis and urinary bladder of transplanted kidney were smooth, and function was recovered remarkably. At 4 days after surgery, serum creatinine level was decreased, and no recurrence was rechecked postoperatively. One patient had skin stoma for 8 years at least postoperatively, and the renal function was still normal. The skin stoma was replaced regularly. Therapeutic effect was poor in a patient with distension and 1 with detaining ureteric branch stand, and patients still had stricture of ureter,which was treated by a surgery. The results demonstrated that the etiology of ureteral obstruction after kidney transplantation was complex, and stenosis of ureterovesical junction was most common. Most of obstruction request surgical management. The graft function and the long-term graft survival were not affected by a correctly treated ureteral obstruction.