Aim To investigate the clinical importance of a newly designed tenodesis with polymolecular polyethlene fastener. Methods Eighty-nine patients with knee ligaments injuries were reconstructed with the technique of newly designed tenodesis. Rehabilitation program started under the instruction of the therapist from the next day of the surgery.Results The tenodesis on all patients in our study were successful. The fasteners in two patients and the transplants in three patients were blocked in the bone tunnel during the operation. One fastener was taken out from the bone tunnel under arthroscopy. The patients were followed up for 19 months averagely (from 6 months to 49 months), most of them showed a stable knee without complain, except two patients feel uncomfortable after vigorous activities; seven patients show little laxity in anterior drawer test (ADT) or posterior drawer test (PDT) and three patients had 20-degree limitation of knee flexion. Lysholm scale score were 56?8 and 89?5 before and after operation, respectively ( P

Objective To evaluate the effect of stellate ganglion block (SGB) on cerebral vasospasm in patients undergoing intracranial aneurysm surgery. Methods Forty ASA Ⅱ or Ⅲ patients aged 14-64 yr weighing 40-81 kg undergoing intracranial aneurysm clipping were randomly divided into 2 groups ( n = 20 each): group control (group C) and group SGB. Left SGB was performed with 0.25% ropivacaine 10 ml immediately after intubation. Successful block was verified by development of Homer syndrome within 15 min after block. Anesthesia was induced with midazolam, propofol, fentanyl and vecuronium and maintained with isoflurane inhalation and intermittent iv boluses of fcntanyl and vecuronium. The patients were intubated and mechanically ventilated. PETCO2 was maintained at 30-35 mm Hg. BIS was maintained at 50-60. Right internal jugular vein was cannulated and the catheter was threaded cranially until resistance was met for blood sampling. Blood samples were collected before skin incision (T1), before clipping of aneurysm (T2), at 30 min after clipping (T3 ), and at the end of surgery (T4) for determination of plasma concentrations of endothelin (ET), calcium gene-related peptide (CGRP) and S100B protein. Transcranial Doppler was used to measure the flow rate of blood in bilateral middle cerebral artery and extracranial carotid artery at 1 and 3 days after surgery. All patients were observed for incidence of brain ischemia during 1-7 days after surgery. Results Plasma ET and S100B protein concentrations were significantly decreased, while plasma CGRP concentration was significantly increased after clipping of aneurysm at T3 and T4 in group SGB as compared with group C. The incidence of cerebral vasospasm and brain ischemia was significantly lower in group SGB than in group C. Conclusion SGB performed before operation can significantly reduce the incidence of cerebral vasospasm after clipping of intracranial aneurysm by inhibiting the release of ET and promoting the release of CGRP.

Objective To evaluate the effects of isoflurane postconditioning on cerebral ischemia-reperfusion (I/R) injury in rats.Methods Thirty-two male Sprague-Dawley rats,weighing 280-320 g,were randomly divided into 4 groups (n=8 each):group sham operation (group S),group I/R,group isoflurane preconditioning (group Ⅰ-pre),and group isoflurane postconditioning (group Ⅰ-post).Global cerebral I/R was induced by 4-vessel occlusion method described by Pulsinelli.1.5％ isoflurane was inhaled for 2h before ischemia in group Ⅰ-pre.1.5％ isoflurane was inhaled for 30 min immediately after onset of reperfusion in group Ⅰ-post.Neurological function was assessed and scored at 24h of reperfusion.The rats were sacrificed at 72h of reperfusion and hippocampi were isolated for determination of neuronal apoptosis (by TUNEL),caspase-3 expression (by immuno-histochemistry),and phosphorylated c-Jun N-terminal kinase (p-JNK) protein expression (by using Western blot) in hippocampal tissues.Apoptotic rate was calculated.Results Compared with S group,the number of grid cross was decreased,twist time was prolonged,hanging time was shortened,apoptotic rate was increased,and the expression of caspase-3 and p-JNK protein was up-regulated in I/R,I-pre and Ⅰ-post groups (P ＜ 0.05).Compared in I/R group,the number of grid cross was increased,twist time was shortened,hanging time was prolonged,apoptotic rate was decreased,and the expression of caspase-3 and p-JNK protein was down-regulated in Ⅰ-pre and Ⅰ-post groups (P ＜ 0.05).Compared with I/R group,the number of grid cross was decreased,hanging time was shortened,apoptotic rate was increased,and the expression of caspase-3 was up-regulated (P ＜ 0.05),and no significant changes in the expression of p-JNK protein were found in Ⅰ-post group (P ＞ 0.05).Conclusion Isoflurane postconditioning can reduce cerebral I/R injury,the efficacy is weaker than that of preconditioning and the mechanism is related to activation of JNK signal transduction pathway and inhibition of neuronal apoptosis in hippocampus of rats.

Objective To investigate the clinical efficacy of dexmedetomidine combined with ropivacaine for ilioinguinal and iliohypogastric nerve block in elderly patients undergoing inguinal her-nia surgery.Methods Sixty elderly patients undergoing inguinal hernia surgery were randomly divided into dexmedetomidine group (group D)and control group (group C),30 patients in each group.All patients received ilioinguinal and iliohypogastric nerve block by the same anesthesiologist. 0.375% ropivacaine and dexmedetomidine 1 μg/kg 20 ml were used in ilioinguinal and iliohypogastric nerve block in group D,while 0.375% ropivacaine 20 ml were used in ilioinguinal and iliohypogastric nerve block in group C.Sensory block onset time and blockade duration were recorded.Side effects were recorded in both groups.Results Sensory block onset time in group D was significantly shorter than that in group C (10.6±4.3 min vs 14.4±5.1 min,P <0.05).Sensory block durations in group D was significantly longer than that in group C (832.7±136.6 min vs 669.8±140.1 min,P <0.05). There were two bradycardia cases in group D.No adverse reactions or anaesthesia complications oc-curred in all patients following postoperative follow-up.Conclusion Dexmedetomidine combined with ropivacaine can be used in ilioinguinal and iliohypogastric nerve block safely,and dexmedetomidine shortens the onset time and prolonged the duration of sensory block.

Objective To evaluate the effect of ORM1 genetic polymorphism on the time-course of muscle relaxation induced by rocuronium.Methods Seventy American Society of Anesthesiologists physical status [or Ⅱ patients,aged 25-55 yr,scheduled for elective gynecological laparoscopic surgery,with body mass index of 20-25 kg/m2,were enrolled in this study.Anesthesia was induced with iv midazolam and fentanyl and target-controlled infusion of propofol.After the patients lost consciousness,neuromuscular block was assessed with TOF Watch-SX using single stimulation of the ulnar nerve.When the maximal twitch depression was achieved,tracheal intubation was facilitated with rocuronium 0.6 mg/kg.The patients were mechanically ventilated.End-tidal carbon dioxide partial pressure was maintained at 35-45 mmHg.The onset time,nonresponse time,clinical duration,75％ recovery time and recovery index of rocuronium were recorded.Peripheral venous blood samples were collected before surgery for determination of concentrations of plasma alpha1 acid glycoprotein,C-reactive protein (by enzyme-linked immunosorbent assay)and albumin (by biochemical method).ORM1 genotypes were detected by polymerase chain reaction-restriction fragment length polymorphism.The patients were divided into 3 groups according to the ORM1 genotypes:wild homozygote (ORM1*F1/*F1) group (AA group),mutation heterozygote (ORM1'F1/*S)group (AG group) and mutation homozygote (ORM1*S/*S) group (GG group).Results There were 40 cases in group AA,25 cases in group AG,and 5 cases in group GG.There were no significant differences in plasma alphal acid glycoprotein,albumin and C-reactive protein concentrations between the three groups (P＞0.05).Compared with group AA,the clinical duration,75％ recovery time and recovery index of rocuronium were significantly prolonged (P＜0.05),and no significant change was found in the onset time and nonresponse time in AG and GG groups (P＞0.05).Conclusion ORM1 genetic polymorphism is one of the genetic factors which affect the time-course of muscle relaxation induced by rocuronium.

Objective:To establish an optimum preparation process for Hongteng decoction hollow suppositories. Methods:An orthogonal design was performed to screen the proportion of drug and base(A),the temperature of mold filling with drug and base(B)and stripping time(C),and the appearance and melting time were used as the indices ,the best preparation technology of the hollow suppositories was optimized. Results:The optimum preparation technology of the hollow suppositories was as follows:the proportion of drug and base was 1 ∶2,the filling temperature was 40℃,and the stripping time was 30 min. Conclusion:The optimum preparation technology of Hongteng decoction hollow suppositories is simple and feasible.

Objective To compare the occurrence of postoperative cognitive dysfunction (POCD) in elderly patients using differentanesthetic methods.Methods Ninety-three ASA Ⅱ or Ⅲ patients,aged ≥ 65 yr,weighing 45-67 kg,scheduled for artificial femoral head replacement,were randomly divided into 2 groups:general anesthesia (group G,n =47) and combined spinal-epidural anesthesia group (group S-E,n =46).In group G,anesthesia was induced with iv injection of midazolam 0.1 mg/kg,propofol 2 mg/kg,fentanyl 3-5μg/kg,and vecuronium 0.1 mg/kg,and maintained with continuous infusion of propofol 2-3 mg· kg-1 · h-1,intermittent iv boluses of fentanyl 1 μg/kg and vecuronium 0.04 mg/kg and inhalation of 1.5％-2.0％ isoflurane.In group S-E,hyperbaric 0.5 ％ ropivacaine 2 ml was injected into the subarachnoid space over 20 s,the patients were kept in the original position for 15 min,the level of anesthesia was simultaneously adjusted to below T8 on the operated side,and 0.5 ％ ropivacaine 3-5 ml was injected into the epidural space when needed during operation.Cognitive function was assessed by mini-mental state examination at 24 h before anesthesia and 24 and 72 h after operation.Venous blood samples were collected for determination of plasma amyloid-beta levels by ELISA.Results Compared with group G,the incidence of POCD at 24 h after operation and level of plasma amyloid-beta were significantly decreased in group S-E (P ＜ 0.05).Conclusion Elderly patients are more likely to develop POCD under general anesthesia than under combined spinal-epidural anesthesia.

Objective To investigate the clinical effects of TCM herbs and enema in the treatment of recurrent uterine endometriosis and control of endometriosis recurrence.Methods The recurrent endometriosis patients were randomly divided into two groups,35 cases were treated with TCM herbs and Chinese medicine enema as the observation group,35 ninhydrin treatment of patients with pregnancy-ene as the control group,two groups of patients were treated for six months,the clinical efficacy and adverse reactions were observed.Results After treatment,VRS scores compared with the corresponding group before treatment was significantly lower.VRS scores in the observation group after treatment was significantly lower than the control group.The amenorrhea rate was significantly higher than control group,the complex tidal time at the end of treatment compared with the control group was significantly shorter,the observation group,no case of adverse reactions,the control group,patients experienced adverse events,observation group 4 cases(8.57％) recurrence,in the control group of 10 cases(28.57％) relapse,the difference between the two groups were statistically significant,The patients treatment of 30 cases of lesions decreased in size,the control group,had 28 cases of lesions smaller in size,there was no significant difference.Condtusion Chinese herbal enema and topical treatment of recurrent uterine endometriosis had significant efficacy,no adverse reactions,late recurrence is low.

Objective To evaluate the role of mitochondrial ATP-sensitive potassium (mitoKATP) channel in mitigation of cerebral ischemia-reperfusion (I/R) injury by isoflurane preconditioning in rats and the relationship with c-Jun N-terminal kinase (JNK) signaling pathway.Methods Thirty-two male Sprague-Dawley rats,weighing 280-320 g,were randomly divided into 4 groups (n =8 each) using a random number table:sham operation group (group S),group I/R,isoflurane preconditioning group (group Ⅰ-pre),and 5-hydroxydecanoate (5-HD,a selective mitoKATP channel antagonist) group.Cerebral I/R was produced by modified 4-vessel technique described by Pulsinelli in anesthetized rats.In group Ⅰ-pre,the rats were exposed to 1.5％ isoflurane for 1 h everyday for 5 consecutive days before ischemia.In group 5-HD,5-HD 15 mg/kg was injected intraperitoneally at 30 min before ischemia and the other procedures were similar to those previously described in group Ⅰ-pre.Neurological behavior was evaluated at 24 h of reperfusion.The rats in each group were sacrificed at 72 h of reperfusion,and the brains were removed for determination of neuronal apoptosis (by TUNEL) and expression of caspase-3 and phosphor-JNK (p-JNK) protein (using Western blot) in hippocampal tissues.Apoptotic rate was calculated.Results Compared with group S,the number of grid cross was significantly decreased,hanging time was shortened,apoptotic rate was increased,and caspase-3 expression was up-regulated in I/R,Ⅰ-pre and 5-HD groups,the expression of p-JNK protein was up-regulated in IR and 5-HD groups,and no significant change was found in the expression of p-JNK protein in group Ⅰ-pre.Compare with group I/R,the number of grid cross was significantly increased,hanging time was prolonged,apoptotic rate was decreased,and the expression of caspase-3 and p-JNK protein was downregulated in group Ⅰ-pre,and no significant change was found in the parameters mentioned above in group 5-HD.Compared with group Ⅰ-pre,the number of grid cross was significantly decreased,hanging time was shortened,apoptotic rate was increased,and the expression of caspase-3 and p-JNK protein was up-regulated in group 5-HD.Conclusion The mitoKATP channel is involved in mitigation of cerebral I/R injury by isoflurane preconditioning through blocking the JNK signaling pathway in rats.

Objective To compare the changes in postoperative pain, complications and clinical effect between gastrodin and remifentanil for controlled hypotension in endoscopic sinus surgery.Methods Eighty patients undergoing endoscopic sinus surgery were enrolled in the study.Patients were randomized into two groups of 40 to receive gastrodin (Group G) or remifentanil (Group R) infusion.Two groups were administered with propofol of 2 mg/kg to induce anaesthesia, which was maintained using sevoflurane.Group R received a continuous infusion of remifentanil titrated between 3 and 4 ng/mL using target-controlled infusion, whereas Group G received an i.v.gastrodin bolus of 2 mg/kg followed by a 20 mg/kg continuous infusion to maintain a mean arterial pressure ( MAP) between 60 and 70 mmHg.Haemodynamic variables, surgical conditions, postoperative pain, and adverse effects, such as postoperative nausea and vomiting ( PONV) and shivering were recorded.Results Controlled hypotension was well maintained in both groups.MAP and heart rate were higher in Group R than Group G after operation(P<0.05).Surgical conditions scores were not different between two groups.Postoperative pain scores were significantly lower in Group G than Group R (P<0.05).Shivering and the use of antiemetic and analgesic drugs were also less frequent in Group G than Group R (P<0.05).Conclusions Both gastrodin and remifentanil when combined with sevoflurane provides adequate controlled hypotension and proper surgical conditions for endoscopic sinus surgery.However, patient administered gastrodin has a more favourable postoperative course with better analgesia and less shivering and PONV.