ObjectiveTo evaluate the safety and feasibility of the standardized management model of anesthesia for painless digestive endoscopy.MethodsData of 17 100 patients who underwent painless endoscopy were reviewed for severe adverse reaction and complications.The model included anaesthetist-directed appointment,nurse assistance during operation,and postoperative nurse observation.Eight hundred cases (200 of gastric endoscopy,intestinal endoscopy,EUS and ERCP respectively) were randomly selected and analyzed for times of endoscopic diagnosis,anesthesia,wakening and discharge,and complications.ResultsOf the 17 100 cases,severe complications occurred in 10 (0.058％ ),including 3 apnea,one respiratory obstruction due to opisthognathism and glossoptosis,five larygneal spasm and 1 reflux inspiration.There was no anesthesia or endoscopy related death.Study of 800 cases showed intraoperative MAP,HR increase or decrease over 30％ of the baseline,the incidence of SpO2 ＜ 95％ were 6.0％ ～ 25.0％,3.0％ ～8.5％,≤2.0％,respectively.The rate of lethe,good quality of sleep were 99％ ～ 100％ and 98.0％ ～100.0％,respectively.The rates of cough,body movement and myoclonic were 0.5％ ～4.5％,5.5％ ～11.5％,and 1.5％ ～ 3.5％,respectively.Rates of nausea and vomiting,excitement,restlessness and dizziness were lower than 4％.ConclusionThe standardized management model,feasible,safe and effective,is able to facilitate anesthetic efficacy and reduce complications.

Objective　To investigate the protective effect of calcium antagonist Verapamil (VP) on kidney preservation in HCA solution. Methods　After kidneys were isolated from rabbits, they were perfused and stored in HCA solution or in HCA solution with VP pre-supplement at 4℃ for 24 h respectively. The contents of mitochondrial calcium in renal cells and ATP in renal tissues were measured in every group. Results　The contents of mitochondrial calcium was remarkably higher and ATP significantly lower in the kidneys in HCA solution at 4℃ for 24 h than those just after resection. But these could be inhibited in those storing in the HCA solution with VP pre-supplement. Conclusion　Calcium antagonist VP can protect kidney function during HCA solution preservation by inhibiting calcium intaking into mitochondrium.

OBJECTIVEGlucocorticoid (GC) is the first therapeutic choice of primary nephrotic syndrome (PNS). The response to GC treatment is an important indicator for the outcome of PNS children. Children with GC-resistant PNS present with incomplete or no response to GC, and may herald the progression to end-stage renal failure. However, the detailed mechanism of GC-resistance or GC-sensitive effect in these PNS children has not been clearly elucidated. The previous study by the authors indicated that there was increased expression of GR beta in PBMCs in GC-resistant children with PNS, and the over expression of GR beta resulted in GC resistance via influencing the ability of GR alpha nuclear translocation. To elucidate the relationship between GR beta expression in renal and in PBMCs and the effect of glucocorticoid on glucocorticoid-resistance children with PNS, the expression of GR alpha and GR beta in renal tissue and in PBMCs were detected by immunohistochemistry.

METHODSForty children with PNS were divided into two groups, GC-resistant group(20) and GC-sensitive group(20), the expression of GR alpha and GR beta in renal intrinsic cells and in PBMCs were measured with the immunohistochemistry technique. A semiquantitative score was used to evaluate the injury degree of the glomeruli and tubulointerstitium.

RESULTSCompared with GC-sensitive group, the glomerular pathologic scores (6.91 +/- 1.98) and renal tubular pathologic scores (7.12 +/- 1.62) in GC- resistant group were significantly different (P < 0.01, respectively). GR alpha expressions of renal tissue and PBMCs were higher in the control group (58.3 +/- 2.6, 59.1 +/- 7.2) than those in the GC-sensitive group (40.2 +/- 7.2 and 36.6 +/- 5.1, P < 0.01, respectively) and GC-resistant group (35.0 +/- 8.2 and 36.4 +/- 6.6, P < 0.01, respectively). GR beta expressions of renal tissue and PBMCs were higher in the GC-resistant group (13.8 +/- 3.0 and 12.1 +/- 4.1) and in the GC-sensitive group (6.5 +/- 1.9 and 5.9 +/- 1.0) than that in control group (2.3 +/- 0.4 and 3.2 +/- 1.1, P < 0.01, respectively). GR beta expressions in renal tissue and PBMCs were higher in the GC-resistant group than that in the GC-sensitive group (P < 0.01). Compared with control group, GR beta expressions in PBMCs and in renal tissue were lower than those in mild renal lesion group (5.4 +/- 2.8, 6.46 +/- 2.50), midmedium renal lesion group (8.7 +/- 2.4 and 11.4 +/- 3.7) and (17.1 +/- 0.4 and 18.7 +/- 0.7) in severe renal lesion group (F = 5.8, 15.6, P < 0.01, respectively). GR beta expression of PBMCs had a positive correlation with GR beta expression of renal intrinsic cells (r = 0.651, P < 0.01). GR beta expressions by PBMCs and renal intrinsic cells were positively correlated with renal pathologic scores (r = 0.579 and 0.623, P < 0.01, respectively).

CONCLUSIONGC-resistant children with PNS were related to the increased GR beta expression in PBMCs and renal intrinsic cells. There was no correlation between the GR alpha expressions in PBMCs and in renal intrinsic cells. Increased GR beta expression might decrease the effect of GC via inhibiting the activity of GR alpha.

Adolescent ; Child ; Child, Preschool ; Drug Resistance ; Female ; Glucocorticoids ; therapeutic use ; Humans ; Kidney Glomerulus ; pathology ; Kidney Tubules ; pathology ; Male ; Nephrotic Syndrome ; drug therapy ; pathology ; Receptors, Glucocorticoid ; analysis