Objective To evaluate the efficacy and safety of dexmedetomidine combined with propofol for gastroscopy in elderly patients.Methods Ninety ASA physical status Ⅰ-Ⅲ patients,aged 65-80 yr,weighing 45-80 kg,scheduled for elective gastroscopy,were randomized to receive either dexmedetomidine combined with propofol (group DP,n =45) or propofol (group P,n =45).In group DP,dexmedetomidine 0.4 μg/kg was infused over 5 min and propofol 1.0 mg/kg was injected intravenously 25 min later.Propofol 2.0 mg/kg was injected intravenously in group P.When body movement occurred during operation,additional propofol 0.2 mg/kg was given intermittently.Mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation (SpO2) and Narcotrend index were monitored during the whole procedures.The consumption of propofol and vasoactive agents,adverse cardiovascular events,and respiratory depression were recorded.Results Compared with group P,the consumption of propofol,incidences of respiratory depression and tachycardia,and degree of body movement were significantly decreased (P ＜ 0.05),Narcotrend index was increased during operation (P ＜ 0.01),and no significant change in the incidence of circulatory depression was found in group DP (P ＞ 0.05).Conclusion Small dose of dexmedetomidine 0.4 μg/kg combined with small dose of propofol 1.0 mg/kg provides good efficacy and safety for gastroscopy in elderly patients.

Objective To investigate the analgesic effect of intrathecal(IT)human bone marrow mesenchymal stem cells(hMSC)genetically modified with human proenkephalin gene(PENK)in a rat model of neuropathic pain.Methods Forty male SD rats weighing 160-180 g in which IT catheters were successfully implanted without complication were randomly divided into 4 gorups(n = 10 each): group A normal control;group B neuropathic pain(NP);group C NP + hMSC-pBABE and group D NP + hMSC-PENK.Neuropathic pain was induced with chronic constrictive injury(CCI).Four loose ligatures were placed on the main stem of sciatic nerve with 4-0 chronic catgut.IT normal saline 10 μl,hMSC-pBABE cell suspension 10 μl(2 × 108-3 × 108/μl)and hMSCPENK cell suspension 10 μl(2 × 108-3 × 108/μl)were injected in group B,C and D respectively on the 3rd day after operation.Paw-withdrawal latency(PWL)to noxious thermal stimulation was measured before(baseline)and at 3,5,7,9 and 14 d after operation.The animals were killed on the 14th day after last PWL measurement.RNA was extracted from the spinal cord for determination of proenkephalin mRNA expression.Results PWL was significantly decreased after operation as compared with the baseline values before operation in group B,C and D.PWL was significantly longer at 7,9,14 d after operation in group D than in group B and C but there was no significant difference in PWL after operation between group B and C.PENK mRNA expression was significantly lower in group B and C than in group A,but was significantly higher in group D than in group B and C.There was no significant difference in PENK mRNA expression between group B and C.Conclusion Intratheccal human bone marrow mesenchymal stem cells genetically modified with human proenkephalin gene can relieve neuropathic pain in rats.

AIM: To evaluate the clinical curative effect of Qiangli Tianma Duzhong Capsule in the treatment of acute cerebral infarctions. METHODS: 72 patients were randomly divided into two groups:the treatment group and contrast group.The treatment group on the basis of the regular treatment was assigned to 28 days of treatment with Qiangli Tianma Duzhong Capsule.The contrast group on the same regular treatment was assigned to 28 days of treatment with Fufang Danshen Injection.The European Stroke Score(ESS) and clinical curative effect were evaluated in the treatment group and control group on the 28~(th) day. RESULTS: After 28 days,the European Stroke Score(ESS) of the treatment group(6.02?4.81) decreased significantly in the control group(7.88?4.85)(P

Focal adhesion kinase is a non-receptor protein tyrosine kinase with molecular weight 125 ku and regarded as the foundmental molecule of integrin-dependent signal transduction pathway. Active focal adhesion kinase regulates cell adhesion, migration, proliferation and differentiation by interacting with Src family kinase, phosphatidylinositol-3 kinase, cytoskeletal proteins, Graf and adoptor proteins through the phosphorylated tyrosines and the proline-rich sequences.

Objective To assess the clinical outcomes in patients who underwent laparoscopic primary closure of common bile duct (CBD) with or without transcystic cholangiography and transcystic biliary drainage.Methods From June 2013 to March 2016,we operated on 46 patients who underwent primary closure of common bile duct after laparoscopic choledochotomy (group A).The results were compared with 51 patients who underwent primary closure of common bile duct after laparoscopic choledochotomy together with transcystic biliary drainage (group B) during the same study period.Results There was a significant difference in the incidence of postoperative bile leakage between the two groups.The risk in group A was sig nificantly higher than group B (8.7％ vs 0％,P ＜0.05).The duration of operation in group A was significantly shorter than in group B [(125.3 ± 28.3) min vs (131.3 ± 20.5) min].There were no significant differences in the duration of hospital stay between the two groups [(7.3 ± 2.4) days vs (7.8 ± 1.9) days,P ＞ 0.05].All patients were followed up (range 3 months to 29 months,average 8.4 months).B-ultrasound examination showed no residual bile duct stones and the liver functions were normal.Conclusions Laparoscopic primary closure of common bile duct was possible after choledochotomy.Transcystic cholangiography and transcystic biliary drainage after primary closure of common bile duct were safer and more reli able.

early lithagogue rate.

Objective To construct h n bone marrow mesenchymal stem cell line genetically modified with human proenkephalin gene. Methods The packaging cell line Phoenix-293T was transfected with the recombinant pBABE-PENK vector to aquire virus. The recombinant virus was then collected and used to infect hMSCs. Stable expression of proenkephalin gene and leucine enkephalin protein and the concentration of leucine enkephalin protein were detected by RT-PCR, immunofluorescence and ELISA respectively. Results The expression of proenkephalin gene and leucine enkephalin protein were significantly up-regulated in the hMSC-PENK cells, and the concentration of leucine enkephalin protein was also increased in the culture medium. Conclusion A human mesenchymal stem cell line that expresses proenkephalin gene and secrets enkephalin was successfully established.

BACKGROUND: The number of patients undergoing total knee replacement due to severe gouty arthritis is increasing rapidly in recent years, and the ages of patients also present younger and younger. However, its clinical efficacy remains controversial, and it is lack of retrospective systematic analysis. OBJECTIVE: To assess the clinical efficacy of total knee replacement for severe gouty knee arthritis from several aspects, such as pain, function, quality of life and complications. METHODS: From January 2006 to January 2015, 17 patients (20 knees) with severe knee gouty arthritis received total knee replacement in Department of Orthopedics of Nanjing General Hospital of Nanjing Military Region of Chinese PLA. They underwent knee joint surface replacement with posterior cruciate ligament, and patel a was not replaced. Posterior stabilized prosthesis was used. Al patients were successful y fol owed up postoperatively. The Hospital for SpecialSurgery Knee Score, range of motion of the knee, Visual Analogue Scale score and SF-36 scale scores were determined before and after replacement and during final fol ow-up. RESULTS AND CONCLUSION: Patients were fol owed up for 1-9 years. No serious complications occurred during and after replacement. The Hospital for Special Surgery Knee Score, range of motion of the knee, Visual Analogue Scale score and SF-36 scale scores were significantly higher after replacement and during final fol ow-up than those before replacement (P < 0.001). X-ray films showed good prosthesis position, satisfactory limb alignment without radiolucent lines or loosing. These findings verified that total knee replacement was considered as the final way to treat the severe gouty knee arthritis; its short-term clinical effect is significant, but systematic anti-uric acid, prevention and treatment of complications, pain control, function exercising, and healthy mood maintenance were needed to get a better long-term clinical efficacy.

Recent in vitro and in vivo experiments have revealed that ellagic acid and its metabolites can inhibit the growth of digestive system malignant tumor cells by inhibiting tumor cell proliferation,inducing apoptosis,breaking DNA binding to carcinogens,blocking virus infection,disturbing inflammation,angiogenesis and drug-resistance processes required for tumor metastasis.Ellagic acid and its metabolites are potential chemoprevention and therapeutic drugs against human cancers.

Objective To evaluate bile duct drainage with ureteral catheter through cystic duct in laparoscopic common bile duct exploration followed by primary duct closure (LCBDEPDC) and posto laparoscopic endoscopic stone extraction treatment of extrahepatic bile duct stones.Methods The clinical data of 116 cases of extrahepatic bile duct stones were retrospectively analyzed.Patients were divided into 2 groups: 57 patients with dilated common bile duct were in group A treated with laparoscopic common bile duct exploration followed by primary duct closure and via cystic duct ureteral catheter biliary drainage.While in group B (59 patients) with normal calibre of the common bile duct, the procedures was laparoscopic cholecystectomy + via cystic duct ureteral catheter biliary drainage and postoperative endoscopic stone extraction.Results Procedures were successful in both the two groups.There was no postoperative pancreatitis and biliary leakage complications.The catheter was withdrawn in 6-9 d in group A postoperative hospitalization time was (8.5 ± 2) d.The catheter was withdrawn in 2-8 d in group B after endoscopic stone extraction.Postoperative hospitalization time was (7.6 ± 3) d.No complications occurred in both two groups relating extubation.Conclusions Bile duct drainage using the ureteral catheter via cyst duct after LCBDEPDC and endoscopic stone extraction treatment of extrahepatic bile duct stones effectively prevent postoperative pancreatitis, biliary leakage and bile duct stricture.