Objective To investigate the effects of median effective dose (ED50 )of ropivacaine combined with sufentanil for spinal anesthesia in elderly patients.Methods Forty-eight elderly patients (ASAⅠ-Ⅲ)scheduled for elective lower limb or perineum operation under spinal anesthesia were enrolled in this study.All patients were randomly divided into two groups:control group (group C)and sufentanil group (group S).L3-4 intervertebral puncture was selected for all patients.Anesthetic solution in group C was 0.5% ropivacaine,in group S was 0.5% ropivacaine and sufentanil,which was fixed at 5.0 μg,based on the experimental results and sequential principle.The ropivacaine dose of first patient in the control group was 9.0 mg,and in sufentanil group was 8.0 mg,followed by reducing the dose of ropivacaine,each time 1.0 mg.If the patient appeared invalid standards response,the previous one was selected as the first case. ED50 was determined by Dixon??s sequential method.Results The ED50 of sufentanil combined with ropiva-caine for spinal anesthesia in elderly patients with lower extremity or perineal surgery was 6.40 mg (95%CI:5.98-6.80 mg),ED50 of only ropivacaine was 8.42 mg (95% CI:7.79-9.03 mg).Compared with pre-dose,MAP at 3,6,15 min after treated in group C were decreased,and lower than those in group S (P <0.01).Conclusion Combined with 5.0 μg sufentanil in spinal anesthesia for lower limb or perineal surgery elderly,median effective dose of ropivacaine is reduced.

Objective To investigate the effects of ulinastatin on the expression of NF-κB in lung tissues during limb ischemia-reperfusion(I/R) in rats.Methods Forty-eight male SD rats weighing 230-260 g were randomly divided into 3 groups (n=16 each):sham operation group (group S);I/R group; ulinastatin group (group U).A rat model of lung injury induced by I/R of hind limbs which was produced by occlusion of the bilateral femoral arteries for 2 h followed by reperfusion was established.The rats were sacrificed at 2 and 4 h of reperfusion(8 rats at each time point) and the lung tissues removed for determination of NF-κB expression (by immuno-histochemistry) and microscopic examination.W/D lung weight ratio was calculated.Results W/D lung weight ratio was significantly increased and NF-κB expression was up-regulated in group I/R compared with group S(P＜ 0.05). W/D lung weight ratio was significantly decreased and NF-κB expression was down-regulated in group U compared with group I/R (P＜0.05). The lung injury induced by I/R was reduced in group U compared with group I/R. Conclusion Ulinastatin can reduce the lung injury induced by limb I/R by down-regulating the expression of NF-κB in rat lung tissues.

Objective To observe the prevalence of anionic trypsinogen (PRSS2) gene G191R mutation in patients with acute pancreatitis (AP) and chronic pancreatitis (CP),and to investigate the effect of PRSS2 gene G191R mutation on susceptibility to pancreatitis.Methods The blood samples of 82 patients with acute pancreatitis,73 patients with chronic pancreatitis and 138 healthy subjects were collected,and genomic DNA was extracted.Nest PCR were performed to amplify PRSS2 gene and restriction fragment length polymorphism (RFLP) was followed by using Hpy188Ⅲ to distinguish the G191R mutation.DNA sequencing analysis was performed to confirm the mutation status.Results The size of nest PCR products was 436 bp.RFLP2 produced 309 bp and 127 bp fragments,which were resulted from PRSS2 gene G191R mutation (GGA →AGA).DNA sequencing analysis of the PCR products further confirmed the PRSS2 gene G191R mutation.Five of eighty-two(6.1％) patients with acute pancreatitis had PRSS2 gene G191R mutation (OR=0.682,95％ CI 0.231 ～ 2.010); one of seventy-three (1.4％) patients with chronic pancreatitis had the mutation (OR =0.145,95％ CI 0.019 ～ 1.145),and the corresponding value in healthy group was 8.7％ (12/138).The G191R mutation rate in patients with chronic pancreatitis was significantly lower than that in healthy group (x2 =0.432,P =0.035),but the G191R mutation rates were not significantly different between AP group and healthy group (x2 =0.487,P =0.485).Conclusions PRSS2 gene G191R mutation facilitates the degradation of anionic trypsin,and may reduce the incidence of chronic pancreatitis.

Objective To investigate the value of the dynamic susceptibility contrast enhanced MRI (DSC-MRI) in differential diagnosis of glioblastoma,solitary cerebral metastatic tumors and cerebral lymphoma.Methods Seventeen patients with glioblastoma,15 cases with solitary cerebral metastatic tumor and 17 cases with cerebral lymphoma were analyzed retrospectively.All patients underwent conventional MR imaging,contrast enhancement and DSC-MRI preoperatively.Pseudo color pictures of cerebral blood volume (CBV) and the time signal intensity curve were obtained from the raw data of DSC MRI.The relative CBV (rCBV)were measured from regions of enhanced solid parts of the tumors,peritumoral region and contralateral normal white matter regions respectively.The percentage of signal intensity recovery (PSR) of enhanced solid parts of the tumors were measured.ROC curve analysis was performed to determine optimum indicator in differential diagnosis of three types of tumors,and the sensitivity and specificity were calculated.Results Three types of tumors all showed enhancement of solid area with obvious peritumoral edema.Besides the no difference between glioblastoma and metastasis in rCBV of solid parts of the tumors,there were statistically significant differences in comparisons of two types of tumors (all P＜0.05).Besides the no difference between single brain metastases and lymphoma in rCBV of peritumoral regions,there were statistically significant differences in comparisons of two types of tumors (all P＜0.05).The PSR of the solid parts of the tumors had no difference between glioblastoma and single brain metastases,while there were statistically significant differences in comparisons of two types of tumors (all P＜0.05).ROC curve analysis showed sensitivity and specificity of the PSR values of solid parts of the tumors in differentiating lymphoma and non lymphoma were 100 ％and 81.3 ％.The rCBV of peritumoral regions was the optimum indicator for differentiating glioblastoma and solitary brain metastasis,the sensitivity and specificity were respectively 94.1％ and 86.7％.Conclusion The combination of rCBV and PSR can improve the efficiency for diagnosing the three types of brain tumors.

OBJECTIVETo study COX-2 expression in H. pylori infected gastric mucosal epithelia and its significance in the carcinogenesis of the stomach.

METHODSRapid urease test and histological examination with basic magnenta staining were used to assess the status of H. pylori infection in the stomach. COX-2 was detected immunohistochemically.

RESULTSCOX-2 immunostaining was positive in 1 out of 12 cases with H. pylori-negative gastric mucosa and also in 1 out of 10 cases with H. pylori-positive gastric mucosa without macroscopic alterations, while COX-2 expression was found to be positive in 5 out of 9 cases with H. pylori related superficial gastritis with mucosal erosions. COX-2 expression was detected in 5 out of 10 cases with H. pylori-positive mild atrophic gastritis, 8 out of 10 cases with H. pylori-positive moderate-severe atrophic gastritis and intestinal metaplasia, and 6 out of 8 cases with H. pylori-positive moderate-severe dysplasia. COX-2 expression was positive in 22 out of 32 cases of gastric cancer.

CONCLUSIONH. pylori may induce COX-2 expression of gastric mucosal epithelia in chronic superficial gastritis, which is related to the development of mucosal injury. According to gastric mucosal carcinogenesis pattern up-regulation of COX-2 expression is associated with gastric mucosal carcinogenesis, and involved in the early development of premalignant lesions.

Adult ; Aged ; Cyclooxygenase 2 ; biosynthesis ; genetics ; Female ; Gastric Mucosa ; enzymology ; Gastritis ; enzymology ; microbiology ; Helicobacter Infections ; enzymology ; Helicobacter pylori ; Humans ; Male ; Middle Aged

Objective The current study is aimed to investigate the association of single nucleotide polymorphisms and gene expression in peptidylarginine deiminase Ⅳ (PADI4) with rheumatoid arthritis (RA).Methods The gene expression of PADI4 was examined using real-time quantitative reverse transcription-polymcrase chain reaction (RT-PCR) in 70 patients with RA and 81 healthy controls. Four exonie SNPs of the PADI4 gene (PADI4_89, _90, _92, _104) were genotyped using DNA sequencing and TA cloning.Results The distribution of PADI4_89, _90, _104 SNPs in RA was different from that of healthy controls. The increased RA susceptibility was significantly associated with minor alleles. When haplotypes were construe -ted with 4 SNPs, two major haplotypes, ACCC and GTGT were found in all samples, and GTGT haplo-type (carrying only the minor alleles) was significandy associated with increased RA susceptibility (P<0.01)in comparison with the reference haplotype ACCC. There was over expression of PADI4 in RA than controls(P<0.05). C, enotypes carrying the minor alleles had higher expression level of PADI4 in RA and controls than those with the common alleles. Conclusion PADI4 SNPs and haplotypes are associated with RA susceptibility in Chinese. PADI4 is over-expressed in the blood of RA patients, and there is significant association between the haplotypes and expression level of the PADI4 gene.

Objective To investigate the efficacy and safety of autologous cryopreserved platelet transfusion in the management of thrombocytopenia after chemotherapy in hematological malignancy.Methods A total of 40 patients diagnosed as hematological malignancy with complete remission were equally assigned into study group and control group.During chemotherapy interval in the study group,when platelet counts exceeded 120 × 109/L,autologous platelets were collected with CS3000 Cell Separator and cryopreserved at-80℃ with 5％ dimethylsulfoxide.When platelet counts dropped below 15 × 109/L after chemotherapy,autologous platelets were thawed with 40℃ water bath and transfused back to each patient.In the control group,when platelet counts dropped below 15 × 109/L after chemotherapy,allogeneic fresh platelets were transfused.Median loss during the freeze-thaw-wash procedure in study group was observed,and the 1 h,24 h corrected count increments(CCI)were calculated in the both groups.The hemostatic effects and adverse reactions were also observed.Results In the control group,1hCCI and 24hCCI were (19.3 ±6.1)× 109/L and(12.2 ± 7.0)× 109/L,respectively,with the effective rate of 80％ and the transfusion reaction rate of 45％.Totally 20 collection and transfusions were finished in the study group.A total of(3.4-8.5)× 1011 platelet were obtained in each collection.Platelet recovery after freezing and thawing was(73.51 ±9.03)％(62％-83％).1hCCI was(17.4±7.6)× 109/L,24h CCI was(10.5 ±5.8)× 109/L and the effective rate was 85％.There was no significant different between the two groups (P ＞ 0.05).The transfusion reaction rate was 15 ％,which was significantly lower than that of the control group(P ＜ 0.05).Meanwhile,adverse reactions were occurred less in the study group.Conclusion This study demonstrates that autologous cryopreserved platelet transfusions can be safely administered for supporting thrombocytopenia in hematological malignancy patients undergoing chemotherapy.

Study on syndrome type should be combined with clinic closely to make clear the regularities of distribution and development of syndrome types in diseases, as well as the statues of different syndromes in the genesis and development processes of diseases. Aiming at this issue, the authors bring forward the concept of "critical syndrome types", and suggest that for resolving it, launching an epidemiologic investigation on characteristics of syndrome types is necessary.
Diagnosis, Differential ; Epidemiologic Research Design ; Humans ; Medicine, Chinese Traditional ; methods ; Syndrome

OBJECTIVEWe sought to master the clinical characteristics and prognosis of hard mental lung disease, improving this disease's diagnosis and treatment quality.

METHODSWe recruited two suspected patients with hard mental lung disease and collected their occupational history, examination results of occupational health, and past medical records. By virtue of laboratory tests, high Kv chest radiography, CT and HRCT of chest, fiberoptic bronchoscopy and ECG examination, diagnostic report was synthesized respectively by respiratory physicians and pathologist from three different agencies. Then the report was submitted to diagnosis organizations of occupational disease, and diagnostic conclusion of occupational disease was drawn after discussion by at least three diagnosticians of occupational disease.

RESULTSWe found that both of the two suspected patients were exposed to dusts of hard metal, and length of exposure service ranged from 8 to 9 years. Clinical manifestations were dominated by dry cough, wheezing after activities, and pathological manifestation was characteristic giant cell interstitial pneumonia. The prognosis and outcome of the disease were different.

CONCLUSIONAccording to exact occupational exposure history, clinical manifestations, combined with the results of high Kv chest radiography, CT of chest and pathological manifestation, it can be diagnosed with hard mental lung disease.

Alloys ; adverse effects ; Bronchoscopy ; Cobalt ; adverse effects ; Dust ; Humans ; Lung ; pathology ; Lung Diseases ; diagnosis ; etiology ; Occupational Diseases ; diagnosis ; etiology ; Occupational Exposure ; adverse effects ; Tungsten ; adverse effects

Objective To prepare the human papillomavirus (HPV) 16 peptide vaccine and explore the effect in vitro and in vivo. Methods (1) Prediction of the major histocompatibility complex (MHC) class I restricted T cell epitopes by bioinformatics target at transporter associated with antigen processing (TAP) and named by E7Pa, E7Pb, E7Pc separately. (2)In vivo, the C57BL/6 mice were divided into five groups with same amounts randomly after loading with TC-1 cells (HPV 16 positive tumor cells from C57BL/6 mouse), named as E7Pa + CpG,E7Pb + CpG,E7Pc + CpG (as experiment groups, and added 50 μg/ml E7Pa, E7Pb, E7Pc, respectively), CpG(as positive control group and added Con A with 12 mg/L final concentration) and blank control group (without any treatment). The T cell proliferation was detected by methyl thiazolyl tetrazolium (MTT) assay at different time points;the lactate dehydrogenase (LDH) delivery method was used to test the cytolytie T lymphocyte (CTL) activity of mouse splenic lymphocyte in different ratio of effector cells and target cells (E:T);the related cytokines in tumor tissue and mouse peripheral blood were evaluated by real-time PCR and enzyme-linked immunosorbent assay (ELISA), respectively. The tumor volumes were measured to contrast the therapeutic effect in different groups. Results (1) Three peptide named E7Pa, E7Pb, E7Pc were successfully preparated which had high affinity and specificity. (2) After vaccination of 24, 48, 72,96 hours, MTT results shown that the proliferation rate in E7Pa + CpG group were(131±32)%, (302±15)%, (552±28)%, (731±24)% individually, which were much higher than those in blank control [(72± 15) %, (120 ± 57) %, (176 ±41)%, (288±29)% ;P<0.01], and the other groups i. e. E7Pb + CpG,E7Pc +CpG and CpG groups all proliferated much higher than those in blank control group with statistic signification (P<0. 05), but there was no significant difference between groups(P>0.05);the LDH delivery assay showed that when the ratio of E:T was 100:1, the activity of CTL in the E7Pa + CpG group was most powerful than the other groups with statistic signification (P<0. 01). Meanwhile, the ratio of E:T was concentration-dependent. Compared E7Pb + CpG, E7Pc + CpG or CpG groups with blank control group, there were significantly difference(P<0. 05) ,while there was no significant difference between groups(P >0. 05). The mRNA levels of interferon γ (IFN-γ), interleukin-2 (IL-2) in tumor tissue and peripheral blood in E7Pa + CpG group were significantly higher than those in blank control group (P<0. 01), which was the similar results when compared E7Pb + CpG, E7Pc + CpG or CpG groups with control group (P < 0. 05), and without significant difference between groups(P > 0. 05). The tumor volumes were suppressed obviously in all the experiment groups, especially at the 60th days, the volumes in ETPa + CpG group were much smaller than that in blank control group with statistic signification (P < 0. 01),which was the similar results that E7Pb + CpG, E7Pc + CpG or CpG groups had difference than blank control group with statistic signification (P < 0. 05), and without significant difference between groups(P >0. 05). Conclusion The HPV16 E7 peptide target at TAP combination with CpG as a vaccine could treat effectively the HPV16 E7 positive tumor in experiment.