Objective To investigate the effect of isoflurane preconditioning on Bcl-2 and Bax mRNA expression and the signaling pathway of nitric oxide against brain ischemia-reperfusion(I/R).Methods Seventy-five male gerbils were randomly divided into 5 groups(n=15):SHAM,I/R,ISO,AG+ISO and AG group.Global cerebral I/R was produced by occlusion of bilateral common carotid arteries for 5 minutes and confirmed by isoelectric potential on EEG.In ISO group,the animals inhaled 1.2%-1.5% isoflurane for 30 minutes followed by 30 minutes wash-out period before I/R.In AG+ISO group,30 minutes after aminoguanidine,200 mg/kg i.p.isoflurane was inhaled as ISO group,and aminoguanidine was injected 30 min before I/R in AG group.After 24 hours,the forebrains were collected,and the expression of Bcl-2 and Bax mRNA was determined by reverse transcriptase polymerase chain reaction.Results Bcl-2 mRNA expression in ISO group(1.22±0.12) was significantly higher than that in sham(0.83±0.16),I/R(0.83±0.11) and AG+ISO group(0.82±0.12)(P<0.05).Bax mRNA expression in I/R and AG group was significantly higher than that in sham group(P<0.05),and the expression in ISO group was higher than that in AG+ISO group.Conclusion Nitric oxide is involved in the signaling pathway of isoflurane preconditioning and has the protection effect on gerbil brain against I/R.

Hernia is ancient and common.With the emerging of new concepts,techniques,materials and equipments,treatment methods of hernia have undergone ever-changing changes in the 21st century.Hernia and abdominal wall surgery in China has been developing fast in the past 20 years,and has achieved remarkable progress.However,some problems still exist,such as unbalanced regional development,concept misunderstanding,classification confusions,less standardized technology,poor follow-up method,lack of innovation,and so on.Therefore,it's crucial to recognize the shortcomings of the current stagey,discuss the existing problems,sum up experiences and lessons,and clarify the direction of improvement,in order to provide a solid foundation for the sustainable development of hernia and abdominal surgery for our country.

Objective To discuss the control of ascites, timing and skill of herniorrhaphy for the treatment of umbilical hernia with ascites. Methods The management of 21 patients of umbilical hernia with ascites were retrospectively analyzed. Preoperative small amount of ascites was managed with oral diuretics, medium amount of ascites was treated with combined oral and intravenous diuretics, refractory ascites was treated with paracentensis (3000 ml each time). In the meantime, intravenous albumin, dopamine and fluid therapy were administered. In relapsing ascites, repeated paracentensis in a time interval of 2-4 days was applied. It was time for surgery when abdominal wall tension ameliorated, abdominal circumference reduced and the hernia sac shrank. In case of ascites refractory to all preoperative management an intraoperative slow extraction of the ascites to the amount below 4000 mi is mandatory. Perioperative diuretic therapy is the key for a successful herniorrhaphy. There were 21 cases in our group, 19 cases underwent selective operation, 2 cases were treated with emergency operation; 20 cases by tension-free hernia repair, 1 case by suture herniorrhaphy. Results Surgery was successful in all patients, the mean operative time was 45 min (25-90 min). During the follow-up period from 2 to 52 months (meanly 23 months), only 1 case lost and the other 19 cases healed with no recurrence. 20 patients healed well with no hernia recurrence or complications. One case who was treated with suture hemiorrhaphy suffered from incisional infection, and died of hepatic failure 3 weeks after surgery. Conclusions Umbilical hernia with ascites is not an absolute surgical contraindication. By intensive management of the ascites in perioperative period and prudent selection of the timing of surgery, tension-free herniorrhaphy is a safe and effective treatment for umbilical hernia.

Objective To evaluate the effect of lightweight polypropylene mesh in tension-free repair of inguinal hernia.Methods A total of 60 patients were divided into 2 groups to receive lightweight polypropylene mesh(experimental group)or standard polypropylene mesh(control group)repair procedures.Data collected included:operation time,postoperative highest temperature and the length of hospital stay;leucocyte count and differential count,CRP,AST,ALT,BUN,Cr at the first day preoperatively and postoperatively.Postoperative complications including wound infection,hernia recurrence,testicular swelling or atrophy,scrotal hydrocele,chronic pain and foreign body feeling were compared with each other.Data were analyzed by statistical method.Results No significant differences were found between the two groups in the operation time,postoperative highest temperature,postoperative hospital stay,and cases of elevated postoperative CRP(c-reactive protein)level.No significant differences were found in the leucocyte count,differential count,and AST,ALT,BUN,Cr level perioperatively between the two groups.During the follow up period of 12～16 months,there was no wound infection,hernia recurrence,testicular swelling or atrophy in the two groups;There were 2 cases of scrotal hydrocele and 1 case of postoperative chronic pain in experimental group,there were 3 cases of scrotal hydrocele and 3 cases of postoperative chronic pain in control group;Six patients complained of foreign body feeling in control group,but no one in experiment group,the difference was statistically significant(P＜0.05).Conclusions Lightweight polypropylene mesh in tension-free herniorrhaphy is safe and effective.It ameliorates postoperative foreign body feeling thanks to the feature of light weight,high porosity and excellent flexibility.

Objective　To explore the association between th e heparan sulfate proteoglycan gene (HSPG) polymorphism and diabetic nephropathy in Chinese.Methods　A case control study of 326 Chinese s ubjects including 136 type 2 diabetics with or without nephropathy and 190 non- diabetic control was performed.Genotype frequencies of HSPG2 polymorphism were s tudied by PCR-RFLP analysis with BamHI digestion.Results　There was no difference in genotype frequencies or allele frequencies between normal albuminuria and abnormal albuminuria patients.Moreover,there was no assoc iation between diabetic patients and non-diabetic control in allele frequencies as well,but obvious difference in genotype frequencies(0.05＞P＞0.025) was found.Conclusion　Our study showed the lack of association between HSPG polymorphism and diabetic nephropathy in Chinese type 2 diabetics. There may be association between genotype frequencies of HSPG polymorphism and d iabetes in statistics.

Currently,the number of abdominal surgery has gradually increased,accompanied by the increasing of ventral hernia and parastomal hernia patients.The main reason is abdominal incision or abdominal stoma destroying the normal abdominal muscle fascia,as well as obesity,malnutrition,ascites,diabetes,infections leading to poor wound healing.The incidence of abdominal wall incisional hernia after abdominal surgery accounts for about 80％ of ventral hernia.These incisional hernias and some other ventral hernias may easily become large ventral hernia without the standard treatment.Surgery is the only effective treatment for large ventral hernia.However,such hernia repair for surgeons is a great challenge.In clinical practice,after removing the huge sac and completely resetting the contents of the hernia sac can lead to decreasing of intraperitoneal volume and increasing of intra-abdominal pressure,or even lead to occurrence of abdominal compartment syndrome (ACS).The increasing of intra-abdominal pressure and occurrence of ACS has aroused the attention of clinicians after large ventral hernia operation.Some content reduction operation in the process of large ventral hernia surgery can effectively reduce postoperative intra-abdominal pressure,occurrence of intra-abdominal hypertension and ACS.More and more patients with large ventral hernia underwent the abdominal content reduction surgery combined with hernia repair.But there is still lack of evidencebased medical researches on large simples.Therefore,it still needs multi-center prospective clinical study on large samples to provide clinical treatment strategies for the volume reduction surgery and more base for further researches and clinical applications.

Objective To explore the application of ultrasound-guided femoral and sciatic nerve blocks combined with general anesthesia in lower limb fracture surgery.Methods Sixty four patients who received orthopaedics surgerywere randomly divided into two groups including combined group(n =32),control group (n =32).Control group was given general anesthesia alone,combined group was givengeneral anesthesia combined with ultrasound-guided femoral and sciatic nerve blocks.The intraoperative hemodynamic state at different time,anesthetic dosage,and agitation after waking upbetween two groups were compared.Results Compared with T1 moment,HR and MAP at T2 moment in both groups were significantly decreased (P ＜ 0.05),while all these indicators at T3-T5 moment had no significant difference compared with the T1 moment in combined group (P ＞ 0.05),while the difference was significant in control group (P ＜ 0.05).Compared with control group,combined group had less intraoperative propofoland fentanyl dosage during the surgery,shorter awakening timeand extubation time,and the difference had statistical significance (P ＜ 0.05).The incidence of agitation after waking up and degree of agitation was significantly decreased in combined group than that in control group (P ＜ 0.05).Conclusion Ultrasound-guided nerve blockade combined with general anesthesia for lower limb fracture surgery,canmaintain the stability of intraoperative hemodynamics,reduce the dosage of analgesic drugs,and promote early awakening and extubation.

Objective To investigate the effect of alteration of CRELD1 gene expression on the related genes in the endocardial cushion development.Methods Over-expression and silence of CRELD1 gene were realized by the construction of lentiviral vector.Afterwards,the lentiviral vectors were used to infect the human fetal lung fibroblasts (HFL)-I.All of the cells were divided into the following 5 groups:the blank control group,the negative control group of interference,the interference group,the negative control group of over-expression,and the over-expression group.Western blot and real-time fluorescent quantitative polymerase chain reaction were applied to examine the mRNA and protein expression of CRELD1,Sox9,Aggrecan,Scleraxis and Tenascin-C.Results The DNA sequences of 2 recombinant plasmids pLV3-shRNA-CRELD1 and pLV4-CRELD1 matched very well with those which were designed according to the DNA sequence analysis.HFL-I was successfully infected with lentiviral vectors and displayed fluorescent green light under inverted fluorescence microscope.The results of real-time PCR detection and Western blot test were consistent:expressions of Sox9 and Aggrecan in the interference group were significantly higher than those in the negative control group of interference,while the expressions of the 2 genes in the over-expression group were significantly lower than those in the negative control group of over-expression.Expressions of Scleraxis increased in both the interference group and the over-expression group when compared with the negative control groups respectively.Compared to the corresponding negative control groups,Tenascin-C expression decreased markedly in the interference group,whereas it increased significantly in over-expression group.Conclusions CRELD1 gene has negative effect on the expression of the related genes Sox9 and Aggrecan in the endocardial cushion development,whereas it has positive effect on the Tenascin-C expression.It serves as a theoretical framework to illustrate the effect of CRELD1 gene on the atrioventricular septal defect.

Insulin sensitivity index (SI).glucose effectiveness (SG) and insulin secretion function were assessed by modified minimal model method (MMM) with frequently sampled intravenous glucose tolerance (FSIGT) test in the controls, in patients with impaired glucose tolerance (IGT), and type II diabetes mellitus (NIDDM). There was significant correlation between modified MMM and standard MMM in evaluating SI and SG. The results indicated that SI and SG were significantly elevated in the control than in the IGT and NTDDM groups. SI diminished much more in IGT group than in NIDDM group (P

The observations on cytomorphology and cytodynamics of cultured rabbit arterial smooth muscle cells(SMC)under concentrations of glucose 5.55,11.1,16.7,33.4 and 55.5 mmol/L with or without hyperlipidemic serum(HLS)were carried out by light microscopy and transmission election microscopy. The results showed that①The extent of disruption in SMC was positively correlated with concentrations of glucose,and negatively correlated with the multipication ralte of DNA,a parameter of cytodynamics.②There was no synergistic effect between glucose and HLS in the development of atherosclerosis.③In high glucose concentration groups(glucose 16.7mmol/L)a calcifies particle of high electronic density like substance,probably the core of atherosclerosis was found in SMC. Our results suggest that to keep lower levels of blood glucose and blood lipids may delay the development of atherosclerosis.