Objective To evaluate the hemodynamic effects of rocuronium in patients with rheumatic heart disease during induction of anesthesia.Methods Twenty patients of either sex (ASA classes Ⅲ -Ⅳ ;NYHA classes Ⅱ -Ⅲ) scheduled for valve replacement were included in this double blinded study. Their ages ranged from 34 to 62 yr and weights from 48 to 70 kg. The patients were premedicated with intramuscular morphine 0.2 mg?kg-1 and scopolamine 0.3mg. Radial artery was cannukted for direct BP monitoring and Swan-Ganz catheter was placed via right internal jugular vein for hemodynamic monitoring before induction of anesthesia.TOF,BIS,ECG and SpO2 were also monitored throughout anesthesia. Anesthesia was induced with midazolam 0.05-0.1 mg?g-1 and fentanyl 10-15?g?kg-1. The patients were randomized to receive either rocuronium 0.6 mg?kg-1 (group Ⅰ,n=10) or vecuronium 0.1 mg?kg-1(group Ⅱ,n=10) to facilitate tracheal intubation when BIS value dropped to 60%.The patients were mechanically ventilated (VT 8-10 ml?kg-1 ,RR 10-12 bpm).Systolic arterial pressure (SAP),MAP,HR,cardiac output (CO), PCWP, CVP, mixed venous blood O2 saturation (SvO2), BIS and TOF were recorded and stroke volume (SV), stroke index (SI), LVSWI and rate-pressure product (RPP) were calculated before anesthesia (To), 1 min after administration of muscle relaxant (T1), when TOF reached 0 (T2) and 1,2,3,4,5,7,10,15,20,25,30 min after tracheal intubation (T3-13).Results The demographic data including age, sex and body weight were comparable between the two groups. In rocuronium group HR increased by 17.43% -7.54%,SAP increased by 16.94% - 12.3% and RPP increased by 13.96% - 22.67% respectively during 1-7 min after intubation (T3-8) as compared with the baseline values (To), significantly higher than those in vecuronium group (P

Objective To evaluate the effects of hypothermic cardiopulmouary bypass(CPB) on depth of anesthesia measured by BIS and auditory evoked potential index(AEPI) monitoring and cerebral O_2 and glucose metabolism. Methods Twenty-eight ASA Ⅱ-Ⅲ patients of both sexes(15 males, 13 females) aged 29-55 yrs undergoing elective cardiac valve replacement under hypothemic CPB were studied. Patients were excluded from the study if they had hearing disturbance, hepato-renal dysfunction, diabetes melhtus, hypertension, cerehro-vascular or mental diseases. The patients were premedicated with intramuscular morphine 0.15 mg?kg~(-1) and scopolamine 0.3mg. Anesthesia was induced with midazulam 0.05-0.1 mg?kg~(-1), fentanyl 10 ug?kg~(-1) and pancuronium 0.1 mg?kg~(-1) and maintained with intermittent ⅰ.ⅴ. boluses of fentanyl, diazepam and pancuronium. Radial artery was cannulated for BP monitoring and blood sampling. A CVP catheter was inserted into right internal jugular vein and advanced in a cephalad direction until jugular bulb for blood sampling. BP, HR, T℃(naso-pharyngeal), BIS and AEPI were continuously monitored during operation. Arterial and jugular bulb blood samples were obtained before CPB(T_1), T℃ was lowered to 33℃(T_2)during stable hypothermia(T_3) during rewarming at 33℃(T_4) and 30 min after termination of CPB(T_5) for blood gas analysis and determination of glucose and lactate concentrations. Cerebral oxygen extraction rate(O_2 ER) cerebral glucose extraction rate(GER), arterial-jugular bulb venous lactate difference(DLa-jv) and arterial-jugular bulb venous O_2 content difference (Ca-jvO_2) were calculated. Results Blood glucose and lactate concentrations were significantly increased, while arterial blood pH and DLa-jv did not change significantly during CPB. Cerebral oxygen extraction rate(O_2ER), cerebral glucose extraction rate(GER) and arterial-jugular bulb venous O_2 content difference (Ca-jvO_2) decreased while jugular bulb venous oxygen saturation (SjvO_2) increased with decreasing body temperature. BIS and AEPI values decreased with decreasing T℃ and both were well correlated with T℃. AEPI was positively correlated with O_2 ER and negatively correlated with Ca-jvO_2 whereas BIS was positively correlated with PaO_2. Conclusion Cerebral metabolism is decreased during hypothermic CPB which also deepens anesthetic depth measured by BIS and AEPI monitoring.

BACKGROUND: Nucleus raphe magnus(NRM) is an important nucleus located in the median raphe of ventral medulla. Many studies have been focused on the crucial role which plays in acupuncture analgesia, cardiovascular regulation, respiratory regulation and other aspects of health. However,little attention has been paid to its role in the regulation of digestive system heretofore.OBJECTIVE: To investigate the effect of NRM on gastric movement and gastric electric activity in rabbits.DESIGN: Comparative study based on the experimental animals.SETTING: A laboratory of functional medicine in a traditional Chinese medical university. PARTICIPANTS: From September 2002 to April 2004, the study was conducted in the functional medicine laboratory of Heilongjiang University of Chinese Medicine(Provincial Key Laboratory). Seventy healthy New Zealand white rabbits were used including male and female, which weighed 2 - 2. 5 kg on average, supplied by the Laboratory Animal Center of Heilongjiang University of Chinese Medicine(Class I) . The rabbits were randomly divided into 7 groups: saline group, 5-hydroxytryptamine(5-HT)group, cyproheptadine group, substance P group, substance pantagonist group, morphine group and noradrenaline group.METHODS: Through cannula, microinjection of 5-HT, cyproheptadine, substance P, substance P antagonist, morphine and noradrenaline were given into NRM. Synchronously, gastric movement and changes in the amplitude and frequency of gastric electric slow wave in rabbits were recorded.MAIN OUTCOME MEASUREMENTS: Gastric movement and gastric electric activity were observed after microinjection of 5-HT, cyproheptadine,substance P, substance P antagonist, morphine and noradrenaline into NRM.RESULTS: After microinjection of 5-HT and substance P into NRM,gastric movement and gastric electric slow waves in rabbits were inhibited ( P ＜ 0. 05, P ＜ 0. 01 ). After microinjection of cyproheptadine, substance P antagonist, gastric movement and gastric electric slow waves in rabbits were increased( P ＜ 0.05, P ＜ 0.01) . Meanwhile, it turned out that microinjection of morphine and noradrenaline into NRM had no effect on gastric movement and gastric electric slow waves in rabbits ( P ＞ 0.05).CONCLUSION: 5-HT and substance P in NRM contribute to the regulation of gastric movement and gastric electric slow wave in rabbits by NRM, while morphine and noradrenaline presumably have no relation with the regulation.

Objective To investigate the clinical effect of ureteroscopic holmium laser lithotripsy for the treatment of ureteral calculus.Methods A total of 72 cases of ureteral calculus was treated with stone fragmentation from April to November 2004,by using the Lumenis VersaPulse PowerSuite 100W Holmium Laser system and the Circon ACMI Micro Ureteroscope.Under ureteroscopic visualization,the laser lithotrite was introduced to the stones,and holmium laser intraluminal stone fragmentation was carried out. Results The operation time was 14~83 min(mean,28 min).Three cases of fragmentation failure were due to upper ureteral stones migrating to the renal pelvis.The success rate of fragmentation on one session was 95.8%(69/72),which was 92.1%(35/38) for upper segment calculi and 100%(34/34) for middle-to-lower segment calculi.Intraoperative complications included 3 cases of ureteral perforation(4.2%),9 cases of stone migration(12.5%),and 72 cases of hematuria(100%).Postoperative complications included 45 cases of lumbago(62.5%),72 cases of hematuria(100%),and 5 cases of urinary tract infection(6.9%), without ureteral stricture.The kidney,ureter,and bladder(KUB) X-ray radiograph on the first postoperative day showed a stone-free rate of 86.1%(62/72),and the remaining residual stones were thoroughly expelled within following 2 weeks.The length of postoperative hospital stay was 2~5 d(mean,3 d).Re-examinations with B-ultrasonography or intravenous urography(IVU) at 3 months after operation in 46 cases revealed no ureteral stricture.Hydronephrosis subsided by 1.4?0.5 cm in 28 cases and completely disappeared in 21 cases.Conclusions Ureteroscopic holmium laser lithotripsy for treating ureteral calculus offers satisfactory clinical effects and low complication rates.

5-lipoxygenase (5LO) is the key enzyme in the synthesis of leukotrienes, which are potent biological mediators of inflammation and anaphylaxis.After lock out of the 5LO gene by homologous recombination in embryonic stem cells, 5LO deficient-mice can develop normally and stay healthy, with a selective opposition to certain inflammatory insults. The cellular distribution of 5LO in unstimulated cells among different cell types is different; it can present in the cytosol, the nucleus, or both. 5LO was also found capable of shuttling in and out of the nucleus under certain conditions. It is suggested that 5LO might have other functions besides its traditional catalytic role.

Objective To explore the clinical characteristics, surgical methods and outcome of recurrent retinal detachment in silicone oil-filled eyes after vitreoretinal surgery. Design Retrospective, observational case series. Participants 55 patients (55 eyes) diagnosed as recurrent retinal detachment with silicone oil-filled eyes. Methods To analyze the clinical manifestations of recurrent retinal detachments and adopt different methods to make retina reattach including vitreoretinal surgery with or without silicone oil removal and scleral buckle revision alone. Patients were followed up for 3 months. Main Outcome Measures Clinical manifestations, retinal re-attachment and visual acuity. Results The characteristics of recurrent retinal detachment in silicone oil-filled eyes were inferior location mainly, less than 2 quadrants, with proliferation and hole. Fifty of the 55 patients underwent repeat surgical repair. Surgical methods included re-vitreoretinal surgery in 39 eyes with silicone oil removal, re-vitreoretinal surgery in 9 eyes without silicone oil removal and scleral buckle revision alone in 2 eyes. After a follow-up of 3 months, retina re-attached in 41 eyes, partially attached in 7 eyes, and detached in 2 eyes. Conclusions Repair of recurrent retinal detachment in silicone oil filled eye is challenging. Favorable anatomic outcome may be achieved in selected patients with proper surgical measures according to the characteristics of recurrent retinal detachment.

Since Reich completed the first laparoscopic hepatectomy (LH) in 1991,LH has been developed rapidly with the continuous improvement of surgeons' technique and the technological changes in devices and related processes.This article elaborates on the safety and efficacy of LH,the value of 3D visualization,3D printing technology,and 3D laparoscopic technology in guiding precise hepatectomy,control of hemorrhage during LH,and safety and efficacy of robotic hepatectomy.

Objective To investigate the value of Helicobacter pylori (HP),blood carcinoembryonic antigen (CEA),carbohydrate antigens 72-4 (CA72-4) and CA24-2 in the screening of gastric cancer.Methods The contents of HP,blood CEA,CA72-4 and CA24-2 in 50 healthy controls,45 patients with benign gastric lesions mnd 70 patients with gastric cancer were detected.According to the number of positive cases,the positive rate of single detection and the positive rate of combined detection were calculated.Sensitivity,specificity,and accuracy of serum tumor markers were calculated according to HP single and combined detection.Results The positive rate of each individual detection and 4 joint detection in gastric cancer group was significantly different from that in the benign lesion group and the normal control group (P ＜0.01).The positive rate of 4 joint detection in gastric cancer group was 89.25％,and the difference was statistically significant (P ＜0.01).There was no significant difference in the positive rate of the single test and the 4 joint detection in benign stomach group and normal control group (P ＞ 0.05).The sensitivity,specificity and accuracy of HP,blood CEA,CA72-4,CA24-2 joint detection were significantly higher than single detection (P ＜ 0.05).Conclusions Joint detection was significandy better than single detection,and can significantly improve the detection rate of gastric cancer.

Objective To investigate the clinical and pathological features of colonic polyp canceration and related risk factors of colon polyps,and explore clinicopathologic features and major risk factors of the canceration of polyps of colon polyps.Methods Totally 80 patients with colon polyps including 6 cases of cancerations and 20 patients with colon cancers were selected from Xuzhou Tumor Hospital Admissions.Those patients were divided into 74 cases of non cancer group and 26 cases of cancer group.The clinical data,the detection index and the statistical analysis were performed.Results The clinical features of patients included 51 cases of multiple polyps,30 cases of fatty liver,13 cases of fecal occult blood positive,and 30 patients with colonoscopy.There were 218 polyps,191 data intact,and 6 cases showed cancer (3.14％).Inflammatory polyps mainly occurred in rectum,cecum,and significant risk other than the colon.Tubular adenoma occurred mainly in the transverse colon.Sigmoid colon cancer colon polyps of the highest risk showed OR =2.30 (P ＜ 0.05).The cancer risk from high to low was from tubular villous adenoma to villous adenoma hair (P ＜0.01),and no difference in tubular adenoma cancer risk (P ＞0.05).There was no difference between the indexes of the canceration group and the non cancerous group (P ＞ 0.05).The single factor analysis showed pathological type,and the lesion were the main risk factors of malignant colonic polyps (P ＜ 0.05).Multi-factor regression analysis showed WBC,pathological type,and the lesion were the main risk factors of malignant colonic polyps (P ＜ 0.05).Conclusions The colonic polyps in male have higher incidence with fatty liver,hypertension and other pathological features,and are mainly tubular adenomas,inflammatory and hyperplastic polyps,with different lesions,pathological types occur and different cancer risk.

With the development of imaging technology,the reports of spontaneous isolated superior mesenteric artery dissection become more frequently,but there is no consensus on the therapeutic plans which consist of conservative therapy,endovascular treatment and surgical treatment.Therefore,the related questions of the spontaneous isolated superior mesenteric artery dissection will be discussed in order to improve the diagnosis and treatment of vascular diseases of digestive tract with a review of literatures.