Objective To discuss the influence on cerebral oxygen balance and metabolism of propofol target controlled infusion induced tracheal intubation in patients with laparoscopic surgery.Methods A total of 96 patients with gynecologic laparoscopic surgery were selected from January 2012 to October 2013.All patients were in propofol target controlled infusion anesthesia induction downward internal jugular vein retrograde through jugular vein ball tube,radial artery catheter.According to propofol target controlled infusion target concentrations,96 patients were divided into A group (32 cases,3 μ g/ml),B group (33 cases,5 μμg/ml) and C group (31 cases,7 μg/ml).Hemodynamic and Nacotrend index (NI) change were monitored in the process of surgery patients,with internal jugular vein and radial artery blood at pre-induction (To),intubation (T1),30 min after intubation (T2) and the end of the operation (T3) were detected and arterial blood oxygen saturation (PaO2),arterial oxygen content (CaO2),internal jugular vein ball blood oxygen saturation (SjvO2),internal jugular vein ball blood oxygen partial pressure (PjvO2) at different time points were compared among three groups.Artery-internal jugular vein ball low blood oxygen of components (Da-jvO2),brain oxygen uptake rate (CEO2),poor lactic acid content (Da-jvL) were calculated.Results The systolic blood pressure,heart rate and NI at T1,T2 was lower than that at To in three groups,and there was significant difference (P ＜ 0.05),but there was significant difference in NI at T1,T2 among three groups (P ＜ 0.05).Compared with T0,PaO2,PjvO2,SjvO2 and CaO2 at T1-T3 in three groups were increased significantly (P ＜ 0.05),and the highest was C group,and then B group and A group.In the process of propofol target controlled infusion,Da-jvO2,CEO2 and Da-jvL showed a trend of gradual decline,Da-jvL decline highest significantly (P ＜ 0.05).Conclusions Propofol target controlled infusion induced endotracheal intubation can decrease the laparoscopic surgery in patients with cerebral oxygen metabolism and the brain tissue of ischemia hypoxia tolerance,but will not lead to cerebral oxygen supply and demand imbalance,and 7 μ g/ml concentration of propofol anesthesia effect is the best.

Aim To establish an ideal hyperlipidemia animal model by a new way.Methods 30 mice were randomly divided into control group, positive control group and model group.The mice of control group were only fed with a standard diet.Those of positive control group were fed with high fat diet.Those of model group were fed with a standard diet and enough milk.After 30 days the TG, TC, HDL-C and LDL-C of serum and hepatic and LI were detected and pathological changes in the liver of mice were observed microscopically.Results Compared with the control group, the mice of model group developed hyperlipidemia with LI and the serum and the hepatic TG, TC, LDL-C elevated significantly, while HDL-C were significantly lower.The histopathological research showed hepatocellular macrovesicular steatosis and hepatitis in the model group.Conclusion An ideal model of hyperlipidemia is successfully established with standard diet and milk fed to mice for 30 days.

BACKGROUND:Mesenchymal stem cel s are multipotent progenitor cel s that can be isolated from the bone marrow, adipose tissue, umbilical cord blood and so on. Mesenchymal stem cel s possess strong immunosuppressive effects on both innate and adaptive immunity.
OBJECTIVE:To summarize the immunomodulatory properties of mesenchymal stem cel s for T lymphocytes, B lymphocytes, natural kil er cel s and dentritic cel s and prospect its therapeutic implication.
METHODS:PubMed and CNKI databases were searched for relevant literatures published from 2000 to 2015. The key words were“mesenchymal stem cel s, immunomodulator, T cel s, B cel s, NK cel s, dendriticc cel s”in Chinese and English, respectively. Then, 61 papers were included and further analyzed.
RESULTS AND CONCLUSION:The immunomodulatory effects of MSCs on lymphocytes, B lymphocytes, natural kil er cel s and dentritic cel s were elicited by cel-cel contact and soluble cytokines. But mesenchymal stem cel s from different sources hold different immunomodulatory effect on immune cel s. When we use mesenchymal stem cel s in clinic, some important factors, such as isolation methods, cel sources, colonization sites, should be taken into account. In order to ensure the clinical safety and effectiveness, there are stil many problems to be further studied before mesenchymal stem cel s can be widely used in clinic.

Objective To discuss causes and corresponding prevention for groin pain occurred early after total hip arthroplasty(THA).Methods A retrospective study was done on 189 cases(193 hips)treated with THA including unilateral procedures in 185 hips and bilateral procedures in eight hips to analyze common causes for early groin pain.Results Groin pain was found in 9.3% hips(18/ 193)during hospital stay,including 1.6%(3 cases)with deep infection,1.6%(3 cases)with incision infection,1%(2 cases)with posterior dislocation,4.1%(8 cases)with leg lengthening and 1%(2 cases)with hematoma.Conclusions Despite of the numerous diagnostic alternatives available to the orthopedic surgeon,detailed history,careful physical examination,necessary laboratory and imaging stud- ies can contribute to a correct determination of causes for groin pain.Meanwhile,appropriate indication, accurate preoperative radiographic measurement,intraoperative standardized surgical procedures and per- fect rehabilitation are necessary to avoid complications.

Objective To explore the impact of different doses of dexmedetomidine on the anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy.Methods 90 patients with uterine fibroids with ASA class Ⅰ or Ⅱ who were going to undergoing general intravenous anesthesia laparoscopic hysterectomy were selected and they were divided into group A (dexmedetomidine 0.4μg·kg-1·h-1,n=30) and group B (dexmedetomidine 0.2μg·kg-1·h-1,n=30) and group C (no dexmedetomidine,n=30) by digital random method.The analgesia effect (VAS score) of group A,group B and group C preoperation and postoperative 1h,12h and 24h,and the sedation (Ramsay sedation score) were compared.General information,postoperative blood pressure,heart rate,pulse oxygen saturation,postoperative patients'' satisfaction on analgesic effect and the sedation effect and adverse reactions of the three groups were also compared.Results Age,body mass index and other basic information of three groups had no statistically significant differences (all P＞0.05).The preoperative VAS score of the three groups also had no statistically significant difference (F=0.625,P＞0.05).Postoperative 12h,24h,the VAS scores of group A and group B were lower than those of C group,which of group A were lower than group B (F=11.250,P＜0.05,F=21.181,P＜0.05).The Ramsay sedation score was higher than that of C group[(3.67±0.18) vs.(2.13±0.11)].The satisfaction of group A was significantly higher than group B and group C (96.67％ vs.73.33％,46.67％,χ2=25.953).The Ramsay sedation score and satisfaction were higher than those of group B (all P＜0.05).There were no significant differences in blood pressure (F=0.362,P＞0.05),pulse oxygen saturation (F=0.978,P＞0.05) and heart rate among the three groups before and after operation (F=1.268,P＞0.05).There was no obvious adverse reaction in the three groups.Conclusion Dexmedetomidine can promote anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy,and the dose 0.4μg·kg-1·h-1 of dexmedetomidine has better effect,feasibility and safety,it is worthy of clinical promotion.

BACKGROUND: At present, the commercial artificial small vascular grafts (diameter < 6 mm) are still unsatisfactory, due to poor blocompatibility and low long-term patency rate. Therefore, finding a vascular substitute with normal biological function and studying construction and function of tissue-engineered blood vessel have become hot topics recently.OBJECTIVE: To construct a novel tissue-engineered blood vessel by rabbit bone marrow mesenchymal stem cells (MSCs) and vascular acellular matrix, and to investigate the biocompatibility and patency rate of tissue-engineered blood vessels.DESIGN, TIME AND SETTING: An in vitro randomized controlled study at level of cytology and histopathology was performed at the Laboratory of Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2006 to June 2008.MATERIALS: The decellularized vascular acellular matrix was obtained by a detergent-enzymatic procedure. MSCs from rabbits were isolated using density gradient centrifugation method and cultured in culture flasks coated with fibronectin. Subsequently, the expanded MSCs were seeded on the decellularized scaffolds, and then co-cultured in the self-made bioreactor to construct the tissue-engineered blood vessels.METHODS: Sixty rabbits were randomly divided into three groups. A1.0-cm abdominal aorta was sheared, and a tissue-engineered blood vessel was transplanted on the abdominal aorta using 8/0 polypropylene thread. Tissue-engineered blood vessel group: Tissue-engineered blood vessel was considered as the transplanted vessel; vascular acellular matrix group:Xenoma artery treated by vascular acellular matrix was considered as the transplanted vessel; xenoma artery group: Fresh xenoma artery was considered as the transplanted vessel.MAIN OUTCOME MEASURES: Immunocytochemical staining was used to identify the cultured MSCs. After 3 months of transplantation, the grafts were retrieved for digital subtraction angiography, pathological test and scanning electron microscope examination.RESULTS: Rabbits MSCs presented a whirlpool-like appearance at 8 days after culture. The immunocytochemistry results were consistent with the phenotype of MSCs. After high proliferation, MSCs were seeded onto the vascular acellular matrix for 12 days,and seed cells attached to well in the lumen of blood vessels. Three months after implantation, the patency rate was 90% of tissue-engineered blood vessel group and 80% of vascular acellular matrix group, which was superior to xenoma artery group (25%). At three months after transplantation, HE staining and scanning electron microscope demonstrated that internal, middle,and external membrane were clearly observed in the tissue-engineered blood vessel group, and the membrane morphology was similar to normal artery. The endothelial cells were covered completely. However, the endothelial cells were not covered completely in the vascular acellular matrix group, while mural thrombosis, mild proliferation of intima, and inflammatory cell infiltration were observed. The intima was thick and necrotic in the xenoma artery group, while lumens were stenotic and accompanied with a certain degree of thrombus organization.CONCLUSION: This study provides a new strategy to develop a tissue-engineered blood vessel with excellent biocompatibility and high patency rate constructed by rabbit MSCs and vascular acellular matrix.

Objective To discuss the experience in the diagnosis, treatment, complications and follow up of carotid body tumor. Methods All the 25 cases were diagnosised by DSA and CTA. The tumor was resected under carotid adventitial plane in 18 cases, with external carotid artery resection in 4cases, and in 3 cases, internal carotid artery (ICA) and external carotid artery (ECA) were resected simultaneously in which internal carotid artery was reconstructed in two cases including using self vein bypass in one and anastomosis between ICA and ECA in the other. ICA was ligated in the third case. Results No cases died perioperatively. ALL CBTs were treated successfully. Horner syndrome and trachyphonia were relieved after operation. Postoperative trachyphonia, bucking and lingual paralysis developed in 3 cases, and in one case with vagus resection caused dyspnea tracheotomy was performed. The rate of nerves injuries was 12% but no semiplegia and aphasia occurred. Follow up period was from 4 to 90 months (average 44 ±6 months) for 21 cases. The trachyphonia and bucking were improved during follow up but the lingual paralysis persists, and tumor recurred in two cases with one dying. Conclusions CBT treatment should include active surgery, sufficient preoperative preparation and avoiding the postoperative nervous complications.

Objective To investigate the technical details and therapeutic effect in treating StarIdford B aortic dissection by endovaseular aortic repair(EVAR). Methods We retrospectively review 115 type B aortic dissection cases undergoing the procedure of mini-traumatic EVAR from November 1998 to February 2009.There were 71 male patients and 44 female patients with a mean age of55.7 years and follow up period from 7 to 83 months for 75 cases. Results The procedure Was technically successful in 113 cases and 122 stent grafts were placed with hybrid surgery being carried out in 3 cases of carotid artery bypass.Severe perioperative complications included subclavian steal syndrome in 4 eases,pulmonaryinfections in 3 cases.arterial embolism in 2 cases,acute cerebral infarction in 2 cases,kidney tailure in 2 cases.alimentary tract hemorrhage,graft infection,acute intestinal ischemia and type A dissection occurred in one each case respectively.Five cases died perioperatively.Among the 75 cases that were fouowed up,there were 9 eases with type I endoleak and at last 5 cases redid endovaacular repmr.2 cases with secondary type A dissection accepted graft replacement.There were 6 deaths during the follow-up period,4 dying of acute myocardial infarction(2 cases),cerebral hemorrhage(1 case),type A dlssection (1 case)respectively,the causes of other2 deaths were not confirmed. Conclusion EVAR was effective for Standford B aortic dissection as shown by midterm follow up.

OBJECTIVETo study the effects of electroacupuncture (EA) on the changes of behavior after ketamine anesthesia, and changes of serum antibodies against beta-amyloid (Abeta) and Abeta protein in the hippocampus of aged rats, thus exploring the effects of EA on the cognitive dysfunction.

METHODSThirty 14-month old SD rats were randomly divided into 3 groups, i. e. , the control group (Group A), the ketamine anesthesia group (Group B), and the EA+ketamine anesthesia group (Group C), 10 in each group. 50 mg/kg katemine was intraperitoneally injected to rats in Group B and Group C, once daily for 7 successive days. EA was performed to rats in Group C from the 1st day of the experiment after rats awoke completely from anesthesia, twice daily for 7 successive days. Changes of the ratio of the swim time in the original platform quadrant to the total swim time and the escape latency phase were observed by Morris water maze. The peripheral blood was withdrawn by the end of the experiment. Serum anti-Abeta antibody contents were detected using enzyme-linked immunosorbent assay (ELISA). The expressions of Abeta in the hippocampus were detected using Westen blot.

RESULTSLong-term application of ketamine could lower aged rats' cognitive function. In the navigation test, the escape latency phase of rats in Group B was significantly prolonged ( P < 0.01) . On the 7th day of the experiment, the serum level of anti-Abeta antibodies was lower in Group B than in Group A (P < 0.05), while the serum level of anti-Abeta antibodies was significantly higher in Group C than in Group B (P < 0.01). On the 7th day of the experiment, the expression of Abeta in the hippocampus was higher in Group B than in Group A (P < 0.05).

CONCLUSIONEA could increase the contents of anti-Abeta antibodies in aged rats with ketamine anesthesia, decrease the expression of Abeta in the hippocampus, alleviate the deposition of Abeta, thus improving rats' cognitive dysfunction.

Amyloid beta-Peptides ; immunology ; Anesthesia ; adverse effects ; Animals ; Antibodies ; blood ; Cognitive Dysfunction ; therapy ; Electroacupuncture ; Female ; Hippocampus ; metabolism ; Ketamine ; adverse effects ; Male ; Maze Learning ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the expression of focal adhesion kinase (FAK) in breast carcinoma tissues and its association with microvessel density (MVD), and explore the relationship between FAK-mediated cell signaling and angiogenesis in breast carcinoma.

METHODSFAK and CD34 expressions were examined by immunohistochemistry with SP method in 88 breast carcinoma tissues and 30 tissues of benign breast disease. The correlations of FAK protein expression with MVD marked with CD34 and clinicopathological parameters were analyzed in breast carcinoma.

RESULTSIn the 88 breast carcinomas, the positivity rate of FAK was 68.2% (60/88) with MVD of (34.52-/+13.11) /HPE, showing significant differences from those of the benign disease group (P<0.01). FAK expression and MVD in breast carcinoma tissues were positively related to tumor size, axillary lymph node metastasis and clinical stage (P<0.05), but not to the patients' age or histopathological grade of the tumors (P>0.05). In breast carcinoma, the expression of FAK was positively related to MVD (P<0.01).

CONCLUSIONSFAK protein expression and MVD are closely correlated with the invasion and metastasis of breast carcinoma. FAK expression can promote angiogenesis of breast carcinoma.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; genetics ; metabolism ; pathology ; physiopathology ; Cytoplasm ; metabolism ; Female ; Focal Adhesion Protein-Tyrosine Kinases ; metabolism ; Gene Expression Regulation, Neoplastic ; Humans ; Immunohistochemistry ; Middle Aged ; Neoplasm Invasiveness ; genetics ; Neovascularization, Pathologic ; metabolism