Objective To evaluate the efficacy of different doses of ulinastatin for prevention of insulin resistance in the patients undergoing partial hepatectomy.Methods Sixty patients of both sexes,aged 33-71 yr,weighing 44-70 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for electivepartial hepatectomy,were randomly assigned into 3 groups (n =20 each) using a random number table:control group (group C),low dose of ulinastatin group (group UL) and high dose of ulinastatin group (group UH).Before induction of anesthesia and at the beginning of operation,ulinastatin 2 500 U/kg and 5 000 U/kg (in 20 ml of normal saline) were injected intravenously in UL and UH groups,respectively.The equal volume of normalsaline was given instead of ulinastatin in group C.Before skin incision,before removal of the liver,after removal of the liver,and after closure of the abdominal cavity,blood samples were taken from the right internal jugular vein for determination of plasma glucose,insulin and glucagon concentrations.Insulin sensitivity index was calculated.Results Compared with group C,insulin sensitivity index was significantly increased,and the plasma glucose and insulin concentrations were decreased in UL and UH groups.Conclusion Ulinastatin 2 500 U/kg injected intravenously before induction of anesthesia and at beginning of operation can effectively prevent insulin resistance in the patients undergoing partial hepatectomy.

Objective To investigate the effect of target-controlled infusion(TCI) of propofol on global and regional eerobral glueose metabolism in humans studied with positron emission tomography(PET).Methods Five healthy right-handed male volunteers aged 22-30yrs, weighing 58-72 kg underwent PET sean to assess glucose metabolism when they were awake and unconseions. The interval between the two PET seans was longer than 1 week. The unconseious state was induced by TCI of propofol. The initial effeet-site concentration(ESC) of propofol was set at 2.5?g?ml~(-1) and was modulated in ?0.2?g?ml~(-1) increments until OAA/S score roached 1(no response to prodding). Then the ESC was maintained during PET scanning. The dynamic scans were performed at 0-4.5 min(T_1), 4.5-9.5 min(T_2), 9.5-29.5 min(T_3), 29.5-44.5 min(T_4), 44.5-59.5min(T_5) and 59.5-74.5 min(T_6) after the end of FDG 10 mci injection. After the data were reconstructed we used the stereotactic method to select the following regions of interest(ROI): the whole brain, frontal lobe, temporal lobe, parietal lobe, occipital lobe, putamen, caudate nucleus, thalamus and cerebellum ets. The ROI data were then transformed into standard uptake value(SUV). The difference and percentage decrease in SUV of the different ROI between eonscious and unconscious state at different intervals were compared. Results The SUVs of the whole brain and all ROIs were significantly decreased in unconscious state during T_(3-6) compared with those in conscious state. In unconscious state at T_6 the percentage decrease in SUV of different ROIs was different-42.38% (occipital lobe), 35.52%(frontal lobe) and 21.40%(putamen). The percentage decrease in SUV of thalamus was similar to that of occipital lobe, temporal lobe and parietal lobe but higher than that of frontal lobe. The sequence of SUVs of cortex and subcortioal centers in conscious state during T_(4-6) and in unconscious state during T_(3-5) were the same: temporal lobe

Destruction of blood-brain barrier (BBB) is one of the important pathological changes after traumatic brain injury (TBI).Early detection of TBI evaluate and prognosis of TBI patients are of great significances. Monitoring of changes in BBB after TBI have been more and more emphasized in clinical practice. The pathophysiological changes of BBB after TBI and research progresses of MR perfusion weighted imaging (PWI) in TBI were reviewed in this article.

Objective: To investigate the nutritious effects of IGF, HGF and Gln on intestinal mucosal precursor cells in vitro.Methods: Different combinations of IGF,HGF and Gln were used to observe their effects on the expansion and development of the cultured intestinal mucosal precursor cells.Results: The combination of IGF,HGF and Gln could markedly promote the expansion of cultured intestinal mucosal precursor cells.Although IGF or HGF alone could promote the expansion of intestinal mucosal precursor cells, they had little effects on the development.On the contrary,Gln alone can promote the development of intestinal mucosal precursor cells,but it had little effects on their expansion.Conclusion: IGF,HGF or Gln alone has little effects on the expansion and development of the intestinal mucosal precursor cells.When they are used together,they can efficiently provide the essential stimuli for the expansion of the cultured intestinal mucosal precursor cells in vitro and enable the recombination of the different cells and formation of intestinal mucosa-like structure in vitro.

ObjectiveTo study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture.

METHODSWe treated 21 urethral rupture patients by endoscopic realignment with drainage via a peel-away sheath using normal saline for irrigation under the normal nephroscope or Li Xun nephroscope, followed by analysis of the clinical results.

RESULTSThe operation was successfully accomplished in 20 cases but failed in 1 and none experienced urinary extravasation. In the 14 cases of bulbar urethral rupture, the mean operation time was (5.1±1.6) min and the mean Foley catheter indwelling time was (26.0±5.1) d. Urethral stricture developed in 57.1% (8/14) of the cases after catheter removal, of which 1 was cured by internal urethrotomy and the other 7 by urethral sound dilation, with an average maximum urinary flow rate of (18.8±1.8) ml/s at 12 months after operation. In the 6 cases of posterior urethral rupture, the mean operation time was (15.8±7.5) min and the mean Foley catheter indwelling time was 8 weeks. Urethral stricture developed in all the 6 cases after catheter removal, of which 3 cases were cured by urethral dilation, 1 by internal urethrotomy, and 2 by open urethroplasty. The average maxium urinary flow rate of the 4 cases exempt from open surgery was (17.9±1.9) ml/s at 12 months after operation.

CONCLUSIONSEndoscopic realignment with drainage via a peel-away sheath can keep the operative field clear, avoid intraoperative rinse extravasation, shorten the operation time, improve the operation success rate, and achieve satisfactory early clinical outcomes in the treatment of either bulbar or posterior urethral rupture.

Device Removal ; Drainage ; Endoscopy ; Humans ; Operative Time ; Rupture ; surgery ; Treatment Outcome ; Urethra ; injuries ; Urethral Stricture ; etiology ; Urinary Catheterization

OBJECTIVETo investigate the effect of acute blood loss on postoperative cognitive function of aged spontaneously hypertensive rats (SHRs).

METHODSForty aged male SHRs were randomized into sham hemorrhage group (group A, n=13), 20% hemorrhage group (group B, n=13) and 40% hemorrhage group (group C, n=14). The rats were subjected to acute loss from the femoral artery and subsequent fluid replacement with lactated Ringer's Solution (3 folds of the blood loss volume). All the rats underwent Morris water maze test to assess the visuospatial memory and learning ability, and were then decapitated to observe the pathological changes of the hippocampus.

RESULTSThe latency of reference memory in group C was significantly prolonged after the operation (P=0.002), but the working memory and learning capacity showed no significant differences between the 3 groups. Immunochemistry did not reveal significant differences in p-CREB expressions in the hippocampal CA1 region among the groups, but volume reduction of some neurons was noted in the CA1 region in group C.

CONCLUSIONVarying degrees of acute hemorrhage can result in different effect on postoperative cognition in aged SHR. Acute hemodilutional anemia to 40% of baseline can cause reference memory impairment with cell volume reduction of the neurons in the hippocampal CA1 region but does not affect the working memory and learning capacity or p-CREB expression.

Animals ; CA1 Region, Hippocampal ; cytology ; metabolism ; Cognition ; Cyclic AMP Response Element-Binding Protein ; metabolism ; Hemorrhage ; physiopathology ; Male ; Maze Learning ; Memory ; Neurons ; pathology ; Rats ; Rats, Inbred SHR

Objective: To investigate the efficiency and safety of hypofractionated radiotherapy (HFR) combined with chemotherapy using paclitaxel for the treatment of esophageal cancer (EC) patients with post-operative tracheoesophageal groove lymph node (TGLN) metastasis. Methods: A total of fifty-three post-operative EC patients with TGLN metastasis were randomly divided into HFR group (n=25), receiving a radiation of 60 Gy/20 fractions, and conventional fractionated radiotherapy (CFR) group (n=28), receiving a radiation of 60 Gy/30 fractions combined with chemotherapy using paclitaxel with a dosage of 50 mg once per week through tossing a coin. the adverse events and the prognosis between two groups were compared. Results: The incidence of radiation esophagitis and pneumonitis (grade 3-4) between the HFR group and CFR group showed no statistically significant difference (44.0%, 25.0%, P>0.05; 16.0%, 7.1%, P>0.05). No statistical difference was noticed in the efficiency between the HFR group and the CFR group (P>0.05). The efficiency in patients with lymph node metastasis at diameters ≤2 cm was significantly higher than that with lymph node metastasis at diameters >2 cm (P<0.05). The median overall survival (OS) of the HFR group showed a significant increase compared with that of the CRF group [24.2 months (95%CI 16.2-32.1 months) vs. 11.8 months (95%CI 9.2-14.4 months)] (χ²=5.063, P<0.05). Both univariate and multivariate analysis indicated that TGLN diameter (P<0.05) and fractioned types (P<0.05) were factors that affected the prognosis. Conclusions: The combination of HFR and chemotherapy contributed to the improvement of prognosis in EC patients with TGLN metastasis and there was no obvious increase in the adverse events. Trial registration Chinese clinical trial registry, ChiCTR1800016848