SUMMARY A 61-year-old male patient, with the history of premier myocardial infarction and CABG surgery, experienced recurrent unstable angina. Angiography showed triple vessel disease and vein grafts obstruction. The patient underwent a re-do OPCAB + TMLR + bone marrow mononuclear cell (BM-MNCs) transplantation on Nov. 8, 2004. BM-MNCs were isolated with standard gravity gradient method and the final implanted cell number was 12.06?108. Peri-operative data were similar to those of single OPCAB or re-CABG. The patient recovered promptly without recurrence of angina or infarction. Six-minute walking distance increased significantly (366 m to 493 m). Several imaging examinations reveal improved left cardiac function (LVEF improved from 23.75% to 52% in MRI) and diminished MI area. The results reveal that bone marrow cell transplantation, combined with TMLR and OPCAB is safe and might be effective in improving heart function for patients with IHD.

Objective To compare medical students' learning curve between Macintosh laryngoscope and optical laryngoscope in endotracheal intubation and to decide which one is more suitable for novice personnel.Methods Totally 26 interns after being trained by experienced anesthesiologists were enrolled in this study.They performed intubation on 6 patients by using both Macintosh laryngoscope and optical laryngoscope ( each laryngoscope for 3 patients) under the supervision of experienced anesthesiologists.The sequence of laryngoscope was determined by computer-generated random number list.Results Totally 149 patients who were ready to receive surgery under general anesthesia were enrolled in this randomized crossover controlled study.Duration of intubation was significantly shorter in Airtraq group (78 -± 33 ) s than in Macintosh group (114 ± 32) s,P ＜ 0.001.Intubation success rate was significantly higher in Airtraq group than in Macintosh group ( 87.8％ vs.66.7％,P ＜ 0.05 ).Conclusions With the advantages of rapid learning curve,higher intubation success rate and shorter intubation duration,Airtraq laryngoscope is easier to master for novice personnel.

Objective: To observe the tolerance to ischemia-reperfusion injuries in different parts of extrahepatic bile duct during orthotopic autologous liver transplantation in rats, so as to lay a foundation for selection of anastomosis site during liver transplantation. Methods: Thirty SD rats were randomly divided into 3 groups: group I, sham operated(n=6); group II, 1 h ischemia in biliary tract followed by 1 h reperfusion (n=12); and group III, 1 h ischemia in biliary tract followed by 2 h reperfusion(n=12). TUNEL assay, pathomorphology score and ultrastructural quantitative analysis were used to analyze the epithelia of hilar bile duct, proximal, and distal common bile duct. Results: The results of TUNEL assay and pathomorphology score were not significantly different between the proximal and distal common bile ducts in group II (P>0.05), but the injury was more serious in hilar bile duct compared with those of the proximal and distal common bile ducts (P<005); the hilar bile duct had the most serious injuries as indicated by the changes of mitochondrial mean volume (V) and area density of microvilli (AMV), and the proximal common bile duct had the slightest injury (P<0.05). In group 1, the most severe injury was found in the hilar bile duct, followed by distal common bile duct and proximal common bile duct in order (P<0.05). Conclusion: The tolerance to ischemia-reperfusion is different in different parts of bile duct during liver transplantation, with the distal common duct having the best tolerance, which may be used for bile anastomosis during transplantation.

Objective To investigated the efficacy of celecoxib for postoperative analgesia after endoscopic nasal surgery. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients of both sexes aged 18-64 yr were randomly assigned to one of three groups ( n = 40 each): control group ( group C); celecoxib 200 group ( group CEL1 ) and celecoxib 400 group ( group CEL2 ). The patients took celecoxib 200 and 400 mg by mouth at 1 h before induction of anesthesia in group CEL1 and CEL2 respectively. Anesthesia was induced with midazolam,propofol, remifentanil and rocuronium and maintained with iv propofol and remifentanil infusion. VAS was used to assess postoperative pain (0 = no pain, 10 = worst pain). In PACU when VAS score ≥3, the patients were given fentany125 μg iv every 5-10 min until the VAS score ＜ 3. After being discharged from PACU, the patients received celecoxib 200 mg every 12 h for 5 days in the 2 celecoxib groups. Oxycodone 5 mg was used as rescue analgesic when VAS score ≥ 4 until the VAS score ＜ 4. The number of patients who needed fentanyl for analgesia in PACU, the number of patients who needed oxycodone within 6 h, 6-24 h and day 2-5 after operation and side effects after operation were recorded. Analgesic efficacy was assessed at day 5 after operation and the satisfactory rate of patients calculated. Blood samples were obtained at 0, 6 and 48 h after operation for determination of PGE2,6-k-PGF1α and TXB2 concentrations. TXB2/6-k-PGF1α was calculated. Results The number of patients who needed fentanyl in PACU and the number of patients who needed oxycodone within 6 h and 6-24 h after operation were less, the satisfactory rate was significantly higher, and PGE2 concentrations in blood were significantly lower at 48 h after operation in the 2 celecoxib groups than in group C ( P ＜ 0.05 or 0.01 ). There was no significant difference in each index between the 2 celecoxib groups ( P ＞ 0.05 ). There was no significant difference in TXB2/6-k-PGF1α at each time point among the three groups. Nausea and vomiting occurred in one patient after operation in group C, but side effects were not observed in the 2 celecoxib groups. Conclusion Celecoxib given before and after operation can effectively relieve postoperative pain after endoscopic nasal operation by reducing PGE2 concentrations in blood.

Objective: To establish an orthotopic autologous liver transplantation model with bile duct ischemia-reperfusion injury in rats, so as to make it easy for the operation. Methods: Eighty SD rats were used to establish the models. The method used for this model was the same as the one for orthotopic liver transplantation, except for the blood vessel anastomosis and the constant pressure perfusion of portal vein and abdominal aorta. The portal vein and the hepatic artery reperfusion were controlled by artery clamp. Results: The successful rate of the operation for establishing the model was 95%(76/80) and the anhepatic phase was (16±2) min. The periods of hot and cold ischemia and reperfusion could be accurately controlled and the effect of double constant pressure perfusion was good. There was no erythrocyte in the capillary of bile ductal wall under the light microscope after the reperfusion. Conclusion: This technique, simulating the whole process of liver transplantation, is simple and has high successful rate. Besides, it rules out the influence of immune agent on bile ducts impairment, and better reflects the pathophysiological process of bile ducts ischemia and reperfusion injury,providing a novel approach for investigation of bile ducts injury during liver transplantation.

ObjectiveTo investigate the prevention and treatment of pneumonia in patients with acute cervical spinal cord injury (CSCI).MethodsData of 278 patients with acute traumatic CSCI admitted from 1988 to 2004 were analyzed retrospectively.Results Pneumonia was the major complication following acute CSCI and discovered by radiography during the first 3—33 days after injury. The all cases were nosocomial pneumonia and G- bacilli were main pathogens, particularly pseudomonas aeruginosa. The incidence of pneumonia of patients with score ≤6 according to the criteria of American Spinal Injury Association (ASIA) was significantly higher than those with ASIA score >6 (P<0.001).ConclusionThe high incidence of pneumonia in the CSCI is associated with the level and completeness of the injury. The G- bacilli causing nosocomial infection are main pathogens.

Objective To monitor the changes of resting energy expenditure in ventilated critically ill children,to compare the results of standard equations and indirect calorimetry (IC) in predicting energy expenditure,and to investigate the possible influence factors of the metabolic status of the critically ill children.Methods From September 2012 to September 2013,56 critically ill children on assisted ventilation and fitting the requirements of IC in pediatric intensive care unit of Shanghai Children's Medical Center were enrolled in this prospective study.IC measurements were performed using metabolic cart on day 1,4,7,10 after trachea intubation.General clinical data of these children were recorded.Results 130 IC measurements were performed in the 56 children.The measured resting energy expenditure (MREE) did not exhibit significant differences among day 1,4,7,and 10 (P =0.379).Although there were no significant differences between MREE and energy expenditure predicted with Schofield and WHO equations (P =0.917,P =0.995),the agreement was poor between the measured and predicted values (R2 =0.185,R2 =0.322).The metabolic status of the children on day 1 of ventilation was only correlated with age (P =0.000) and height (P =0.027),not with severity of underlying diseases or clinical outcomes.Conclusions MREE of IC method in ventilated critically ill children did not significantly change over time in this study.A poor agreement was observed between equationpredicted energy expenditure and MREE.IC measurement of resting energy expenditure is recommended for guiding individual nutritional support among critically ill children so as to improve clinical outcome.

In recent years, premature birth rate has increased due to the development of medical technology and the change of socioeconomic environment.In order to reduce the possibilities of extrauterine growth retardation and neural development retardation among premature infants, nutrition support should be fully paid attention to in clinical settings.Currently, nutritional intervention for premature infants mainly adopts enteral or parenteral nutrition.Parenteral nutrition is prescribed according to the recommended value in China Neonatal Nutrition Support Application Guide, individualized for premature infants.Enteral nutrition commonly uses breast milk, milk supplements, premature infant formula milk, hydrolyzed protein milk and formula milk after discharge.In this review, we summarized the clinical application of nutritional intervention in premature infants.

3T3-L1 adipocytes transfected with TSH receptor (TSHR) shRNA were incubated with bovine TSH.The concentration of tumor necrosis factor (TNF)-α in culture medium was measured by enzyme linked immunosorbent asssy.Protein level of insulin receptor substrate 1 (IRS-1) was quantified by Western blotting.Tyrosine phosphorylation of IRS-1 was measured by immunoprecipitation.The results showed that 1 mIU/ml TSH significantly sitmulated TNF-α release in 3T3-L1 adipocytes [(341.85 ± 12.00 vs 522.67 ± 36.22) ng/L,P＜0.01],along with the decreases in IRS-1 protein expression and its tyrosine phosphorylation (P＜ 0.01).These effects disappeared when TSHR expression was down-regulated with RNA interference in 3T3-L1 adipocytes.In addition,WP9QY,a TNF-α antagonist,blocked TSH-decreased IRS-1 expresssion.These results suggest that TSH downregulates IRS-1 protein expression and its tyrosine phosphorylation through stimulating production of TNF-α,and thus contributes to the development of insulin resistance.

[Summary] According to the cutpoint of plasma triglycerides concentration ≥ 1.7 mmol/L,waist circumference ≥85 cm in men or ≥80 cm in women,459 patiens with type 2 diabetes mellitus were divided into four groups:normal waist circumference and triglycerides,normal waist circumference and hypertriglyceridemia,abdominal obesity and normal triglycerides,and hypertriglyceridemic-waist (HTWC) group.The results showed that body mass index,waist circumference,systolic blood pressure,triglycerides,microalbuminuria,and homeostasis model assessment insulin resistance index (HOMA-IR) in HTWC group were higher than those in non-HTWC groups (all P＜0.01),as well as higher diabetic nephropathy incidence (P＜0.05).Multiple logistic regression analysis revealed that HTWC was an independent risk factor of diabetic nephropathy (OR =2.070,95 ％ CI 1.195-3.586).