Objective To study the effects of propofol on the expressions of tumor necrosis factor(TNF)-α, interleukin-10 (IL-10) and nuclear factor-κB(NF-κB) in rat cerebrum undergoing ischemia and reperfusion. Methods Thirty rats were randomly divided into five groups with 6 rats each. The rats in group S accepted sharm operation as the controls, in group IR focal cerebral ischemia Concentrations of TNF-α and IL-10 in the cerebrum were measured by enzyme-linked immunosorbance assay(ELISA). An isotope([32P]-ATP) technique was applied for detecting nuclear factor-κB(NF-κB) in rat cerebral cortex. Electrophoretic mobility shift assay (EMSA) was performed in nuclear extracts from cerebral tissues. Results Compared with group S,TNF-α of group IR increased [(2.57±0.19) pg/g vs. (1.60±0.15) pg/g](P<0.05),so did the IL-10 [(11.59±1.32) pg/g vs. (7.97±1.96) pg/g](P<0.05). Compaered with group IR,TNF-α of group PP decreased [(1.88±0.26) pg/g vs. (2. 57±0. 9) pg/g](P<0.05) ,so did the IL-10 [(8.35±1.00) pg/g vs. (11.59±1.32) pg/g](P< 0.05),with decreased activity of NF-κB. There was no significant difference in the levels of TNF-α, IL-10 and NF-κB between group IR and group PA. The changes of IL-10 and NF-κB activity were parallel to that of TNF-α. Conclusion Pre-treatment with propofol can prevent the elevation of inflammatory factors in the cerebrum undergoing ischemia and reperfusion, which was not when used after cerebral ischemia. The effect of propofol on reduction of TNF-α production in ischemic cerebrum may be through inhibiting transduction pathway of NF-κB.

OBJECTIVE:To observe clinical efficacy and safety of mosapride combined with flupentixol melitracen in the treat-ment of elderly functional heartburn. METHODS:106 elderly patients with functional heartburn in accordance with Rome IIIstan-dard were randomly divided into control group(52 cases)and treatment group(54 cases). The control group was treated with Mo-sapride dispersible tablets 5mg,tid,orally;the treatment group was additionally given Flupentixol melitracen tablets(containing flu-pentixol 0.5 mg and melitracen 10 mg),qd,on the basis of control group. Therapeutic efficacy of 2 groups were observed after 4 weeks. Hamilton anxiety scale(HAMA),Hamilton depressive scale(HAMD) and symptom score were conducted before and after treatment. RESULTS:The total effective rate of treatment group and control group were 87.0%and 53.8%;with statistical signifi-cance(P<0.05);there was statistical significance in symptom score,HAMA score and HAMD score between 2 groups after treatment (P<0.01). No severe ADR was found in 2 groups. CONCLUSIONS:Mosapride combined with flupentixol melitracen is safe and ef-fective in the treatment of elderly functional heartburn.

BACKGROUND:The artificial heart valve used in clinical application can be divided into stented and stentless. Stented valve is convenient for operations, with a low possibility of incompetency after transplantation. However stented valve cannot stimulate natural valve. OBJECTIVE:To reduce valve implantation time and improve valve properties, this study was designed to develop a new stentless porcine aortic valve for single-layer suture and implantation based on the design of valve in pig aortic root geometry optimization, and to further evaluate its performance by in vitro test. METHODS:(1) Stentless porcine aortic valve for single-layer suture was prepared. (2) The in vitro valve implantation experiment was performed with monolayer suture method. (3) The valve was detected by in vitro fluid mechanics test and fatigue test. RESULTS AND CONCLUSION:Stentless valve for single-layer suture has removed the valve hard, which contributes to reduce the damaged caused by blood flow on the valve leaflet, at the same time removal of the hard valve ring can widen the diameter of implanted valve and improve hemodynamics, even the implantation time of valve is shorter than traditional double-layer suture. The in vitro fluid mechanics test and fatigue test results are satisfactory. The future research lies in a complete elucidation of long operation time, postoperative long-term clinical efficacy and durability of stentless valve implantation.

Objective To investigate the surgical management of scoliosis in neurofibromatosis Ⅰ type. Methods Since 1983, the results of surgical intervention of 31 consecutive patients for scoliosis in neurofibromatosis were reviewed. There were 19 males and 12 females. The mean age of the patients was 15.4 years (range, 5 to 25 years). The type of curve in scoliosis included thoracic curve in 23 patients, lumbar curve in 3 and thoracolumbar curve in 5. There were 6 cases of thoracic curves associated with kyphosis. The mean Cobb angle of scoliosis was 85.9? ranging from 45? to 145?, and the mean Cobb angle of kyphosis was 81.3? ranging from 43? to 120? before operation. The surgical methods included posterior operation in 17 patients, anterior operation in 2, and combination of anterior and posterior in 12. The instrumentation used for internal fixation included Harrington rod in 7 patients,Luque rod in 3, combination of Harrington and Luque rod in 5 patients, CD in 4 patients, CDH in 3 patients,TSRH in 7, and PRSS in 2, 10 cases of whom only single rod fixation were used. Results The patients were followed up for an average of 9.4 years (range, 1-18 years). The correction rate of Cobb angle in scoliosis was 33.4% in scoliosis, and 39.6% in kyphosis postoperatively. The complications of the group consisted of Luque rod breakage in 1 patient, Harrington rod breakage in 1, Harrington rod and Luque wire breakage in 1,nonunion of bone graft and pseudarthrosis in 4, curve aggravation in 1. One patient underwent revision for three times because of recurrent hook dislodgement. Conclusion Scoliosis in neurofibromatosis should be operated early, sufficient bone graft and the solid instrumentation for internal fixation are required.

Objective The study was to probe into the causes and strategies of decompensation after operation in adolescent idiopathic scoliosis in order to reduce the operative mistakes and be aware of pitfalls in scoliosis surgery.Methods From July1997to December2001,174patients underwent the operation of three-dimensional correction of adolescent idiopathic scoliosis,ten of them developed postoperative decom-pensation.Other four patients with postoperative decompensation were referred to our hospital,who received the primary operation for idiopathic scoliosis at the local hospital.In all,fourteen patients with decompensa-tion were retrospectively reviewed including3male and11female cases aging from12to23years(range,15.7years).The criteria of postoperative decompensation was defined as trunk shift more than2mm,shoul-der tilting,aggravated distal lumbar rotation in coronal plane,the plumb line of center of C 7 deviating the from the posterior edge of S 1 and kyphosis of thoracic-lumbar junction more than10degree in sagittal plane.Results The analysis was made depending on preoperative and postoperative X-ray films,the causes of de-compensation after surgery included classification error,inappropriate fusion level,over correction for tho-racic curve and insufficient knowledge of lumbosacral hemicurve in this group.According to the patientssubjective symptoms and decompensation conditions,ten of the patients were treated surgically,which in-cluded re-fusion and fixation for3patients,fusion level extension for6patients and fusion of the upper tho-racic curve after removing major thoracic curve instrumentation for one patient.The other four patients re-ceived conservative therapy with brace.The patients were followed up from1to3years(average,18.9months),except one case followed up to6months.Twelve patients regained spinal balance;two patients re-mained more than20mm trunk shift.Conclusion Although operative treatment is frequently used for idio-pathic scoliosis,it is important to recognize the necessity for operative intervention,indication for surgery.The adolescent idiopathic scoliosis should be operated according to the curve type and flexibility,the appro-priate fusion level and operative procedures can contribute to lessen the postoperative decompensation.If postoperative decompensation occurs,therapeutic decision should be made according to subjective symptoms and the decompensation type of the patients.

Objective To observe the expression of the transforming growth factor beta 1, the basic fibroblast growth factor and the core protein of proteoglycan on the convex and concave sides of apex and end vertebral cartilagnous endplate in adolescent idiopathic scoliosis. Methods There were 12 cases in the study group. There were 4 males and 8 females. The age of patients at the surgery ranged from 12 to 20 years(with an average of 14.9 years). The Cobb angle ranged 43? to 102? (mean, 65.1?) preoperatively. The diagnosis of idiopathic scolisis was made based on radiography, CTM and/or MRI to rule out congenital, neuromyeputhic and other scolisis. All patients underwent anterior correction procedures. The sections of the convex and concave side of the resected apex and end vertebral cartilage endplate were examined with S-P immunohistochemistry and the results were analyzed with image analysis system. Results The transforming growth factor beta 1, the basic fibroblast growth factor and the core protein of proteoglycan were all expressed in the cytoplasm of chondrocytes in the cartilaginous endplate. With non-parameter Wilcoxon rank test, the area density and quantity density of the transforming growth factor beta 1, the basic fibroblast growth factor on the concave curve of the apex and end vertebrae are expressed in a significantly higher level than those of the convex curve at the apex and end vertebrae(P0.05). Conclusion There was a significantly higher expression of TGF?1 and bFGF, while a lower expression of the core protein on the concave side, which suggest a possible aetiological factor or a secondary change in the development of AIS.

BACKGROUND:Abnormal stress is an important factor causing intervertebral disc degeneration. To establish an ideal in vivoanimal model of intervertebral disc degeneration is of great significance for in-depth study on the related pathogenesis. OBJECTIVE:To develop anin vivo rabbit intervertebral disc model and to investigate the relationship between continuous tensile load and intervertebral disc degeneration. METHODS:Twenty-five New Zealand white rabbits aged 6 months old were randomly divided into three groups: blank control (n=5), sham (n=10) and experimental (n=10) groups. The blank control group received no intervention, and the L4/5 segments were removed at the 1st day. The intervertebral disc assistor was used to fix the L4 and L5 vertebral bodies in the experimental and sham groups, the L4/5 segments in the experimental group were loaded 1 MPa axial tensile force, and the L4/5 segments in both two groups were then removed at 14 and 28 days. The changes of L4/5 intervetebral space height and surrounding bone substance were observed by X-ray examination, the morphological changes of the intervertebral disc were observed by hematoxylin-eosin staining, the cell survival was detected by nitro blue tetrazolium staining and mRNA expression levels of aggrecan, collagen type Ⅱ and SOX9 in the intervertebral disc tissues were assessed by RT-PCR at each time point. RESULTS AND CONCLUSION:The radiological manifestations, histological changes, cell survival and mRNA expression levels of aggrecan, collagen type Ⅱ and Sox9 showed no significant difference between the blank control and sham groups. Comparied with the blank control group, in the experimental group, the L4/5 intervertebral space was narrowed with time, the articular surface was coarse, and the upper and lower corpus vertebrae edge appeared to have lip-shaped hyperplasia; the intervertebral disc cells distributed irregularly; the nucleus pulposus was in dehydration and deflation, annulus fibrosus arranged irregularly, and the vacuoles in notochord cells tended to disappear; the expression levels of aggrecan, collagen type Ⅱ and SOX9 were markedly downregulated. These findings suggest that the in vivo rabbit model of intervertebral disc is successfully established, in which continuous mechanical tensile load is further proved to directly cause intervertebral disc degeneration.

Objective To observe the morphologic changes of of vascular buds in vertebral cartilage endplate in age-specific rabbits and also to investigate the correlation between the changes of vascular buds and interverbral disc degeneration. Methods There were 15 New Zealand white rabbits in our study,which include three groups, 2-week-old rabbits, 1-year-old rabbits and 3-year-old rabbits, and each groups had five rabbits. The X-ray radiograph, histology and scanning electron microscope were used to observe the changes of vertebral cartilage endplate. According to Miyamoto standard, the interverbral disc was graded 1-5, and scored 1-5 respectively. Results The changes of micro-vascular structure of vertebral cartilage endplate were observed during aging. Under the scanning electron microscope, the vascular structure degenerated gradually, and disappeared in the end. The blood vessels in the central region of the vertebral cartilage endplate reduced more obviously than those in periphery region. The severe degeneration was found in vertebral endplate, compared with intervertebral disc. The changes of vascular buds in rabbits vertebral cartilage endplate had positive correlation with the vertebral endplate calcification and the interbertebral disc degeneration. Conclusion Changes of vascular buds in vertebral endplate may accelerate intervertebral disc degeneration.

Objective To research the 50% effective anesthetic volume ( EAV50) of 0.5% ropivacaine in nerve stimulator-guided vertical infraclavicular brachial plexus block. Methods Thirty patients scheduled for forearm or hand surgery were blocked using 0. 5% ropivacaine in nerve stimulator-guided vertical infraclavicular brachial plexus block. The EAV50, which is the anesthetic volume corresponding to 50% success and 50% failure was determined by up-and-down sequential test. The starting dose of 0. 5% ropivacaine was 0. 55ml/kg. Block failure resulted in a dose increase 110% , and block success in a reduction 110%. The sensory and motor blockade were accessed at 5- min intervals (up to 60 min). Results In nerve stimulator-guided vertical infraclavicular brachial plexus block, EAV50 for 0.5% ropivacaine was 0.417ml/kg. In up-and-down sequential test, there were significantly different in the block success rates of lateral, medial and posterior cord ( P <0.01). Conclusion In nerve stimulator-guided vertical infraclavicular brachial plexus block, enough anesthetic volume must be given to increase block success rates of all the cords of brachial plexus, and EAV50 for 0. 5% ropivacaine was 0.417ml/kg.

Objective　 To investigate the efficacy and security of the treatment for the with visual function in neovascular glaucoma with Ahmed glaucoma value(AGV ).Methods　Twenty-six cases (26 eyes) with visual function in neovascular glaucoma underwent AGV implantation. Results　After surgery，the follow-up periods lasted for 4 to 26 months (mean 8 months ),the visual acuity of 22 eyes (86.4%) was improved or remained the same，no case of the blindness was found. The mean intraocular pressure was between 0.8～2.8kPa in 17 eyes，and the Yate of control reaches to 65.4% , the postoperative complication included transicent hyphema, Early hypotony, obstruction of the tube tip and drop out of the plate.Conclusion　The AGV implantation treating those with visual function in neovascular glaucoma is an effective and safe method.