Objective To investigate the effects of acute hypervolemic hemodilution (AHH) on cerebral O2 supply/consumption and energy metabolism in patients undergoing elective surgery under general anesthesia combined with continuous epidural block. Methods Fourteen ASA Ⅰ or Ⅱ patients of both sexes (9 male, 5 female) aged 44-62 yrs weighing 55-70 kg undergoing elective surgery under general anesthesia combined with epidural block were enrolled in this study. Lactated Ringer's solution 6-8 ml?kg-1 was infused before anesthesia. After correct placement of epidural catheter was confirmed radial artery was cannulated for BP monitoring and blood sampling. BP, EGG, SpO2 and PET CO2 were continuously monitored during anesthesia. General anesthesia was induced with fentanyl, midazolam, propofol and rocuronium and maintained with iaoflurane and intermittent i. v. boluses of vecuronium. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 30-35 mm Hg. Epidural block was produced by a mixture of 1.33 % lidocaine + 0.167 % dicaine. Right internal jugular vein was retrogradely cannulated and advanced cephalad until jugular bulb for blood sampling. AHH was conducted by infusing 6% HES 20 ml?kg-1 at 50 ml?min-1 after induction of general anesthesia. Blood samples were taken from artery (a) and jugular venous bulb (jv) simultaneously before AHH (T0) at 15 min (T1) and 120 min (T2) after AHH was accomplished for blood gas analysis and determination of Hb, glucose and lactate concentrations. Cerebral O2 extraction rate (CERO2), glucose extraction rate (CMRglu) , arterial-jugular bulb venous O2 content difference (D a-jvO2) and arterial-jugular bulb venous lactate difference (VADL) were calculated. Results At the end of AHH Hct and Hb decreased by 20% as compared to the baseline values before AHH. S jvO2 was significantly higher, D a-jvO2 smaller and CERO2 lower at T1 than at T0. There were no significant differences in BP, HR, CMRglu and VADL at all time points. Conclusion AHH can increase cerebral O2 supply and has no significant effect on cerebral glucose metabolism during operation performed under general anesthesia combined with epidural block.

Neuronal damage is associated with the excessive stimulation of N-Methyl-D- Aspartate (NMDA) receptors by glutamate during cerebral ischemia.Because of non-selective NMDA receptor antagonist can influence all NMDA receptors and produce adverse effects,and its clinical application has been restricted significantly,an increasing attention has been paid to the selective NMDA receptor in recent years.NR2B subunit antagonists are mainly divided into piperidine derivatives,amide derivatives,amidine derivatives,and aminoquinoline derivatives,etc. The representative drugs include ifenprodil and eliprodil.These drugs can selectively act on NMDA receptor NR2B subunit,and they are expected to become safe and effective neuropro- tective agents in clinical practice.

Objective To compare oxycodone and dezocine for prevention of fentanyl-induced cough during induction of anesthesia.Methods One hundred fifty patients of both sexes, aged 25-60 yr, weighing 45-75 kg, of ASA physical status Ⅰ or Ⅱ , scheduled for elective surgery under general anesthesia, were randomly divided into 3 groups (n =50 each) using a random number table: dezocine group (group Dez), oxycodone group (group Oxy), and normal saline control group (group NS).In group Dez, dezocine 0.1 mg/kg (in 10 ml of normal saline) was injected intravenously, and 5 min later fentanyl 3 μg/kg was injected over 5 s.In group Oxy, oxycodone 0.1 mg/kg (in 10 ml of normal saline) was injected intravenously, and 5 min later fentanyl 3 μg/kg was injected over 5 s.In group NS, normal saline 10 ml was injected intravenously, and 5 min later fentanyl 3 μg/kg was injected over 5 s.The occurrence and degree of cough were observed within 2 min after administration of fentanyl.Results The incidence of cough was 2％, 4％ and 30％ in Oxy, Dez and NS groups, respectively.Compared with group NS, the incidence of cough was significantly decreased, and the degree of cough was mitigated in Oxy and Dez groups.There was no significant difference in the incidence and degree of cough between Dez group and Oxy group.Conclusion Both intravenous oxycodone and dezocine 0.1 mg/kg can significantly prevent fentanyl-induced cough during induction of anesthesia with similar efficacy.

Objective To explore the effect of combined application of Pathfile in the VDW-Mtwo nickel titanium file in the elderly narrow canals.Methods 35 teeth with 101 root canals were divided into the two groups by drawing lots.In group A,root canals were prepared with VDW-Mtwo and Pathfile.In group B,root canals were prepared with VDW-Mtwo.All root canals were filled with continuous wave thermoplasticized gutta-percha technique.The operating time for each root canal,the number of broken instruments and postoperative pain were recorded.The efficacy of reparation was analyzed with radiography.Results The root canal preparation time of group A was (5.14 ± 1.25) min,which was significantly shorter than (6.82 ± 1.76) min of group B (t =5.539,P ＜ 0.05) ; The difference was not statistically significant in step formation and just fill rate between the two groups (P =1.00,1.74) ; The instrument intact of group A was 100.00％,which was significantly higher than 79.17％ of group B (x2 =4.279,P =0.039) ;The difference was not statistically significant in pain after operation between the two groups (P =0.20).Conclusion For narrow root canals preparation in the elderly treated with Mtwo and Pathfile would be shorten the preparation time and reduce broken instruments.

Objective To discuss MRI characteristics of dysplastic gangliocytoma of the cerebellum.Methods MRI manifesta-tions of 13 cases with dysplastic gangliocytoma of the cerebellum verified by operation and pathology were analyzed retrospectively. Results All of 13 cases were located in the cerebellar hemisphere and vermis.The lesions presented striated pattern of iso-intensity signal and hypo-intensity signal on T1-weighted images.The sign of tiger stripes was the feature in dysplastic gangliocytoma on T2-weighted and FLAIR images.All of the tumors showed slightly striated enhancement after intravenous administration of contrast agent.The mass effects of dysplastic gangliocytoma of the cerebellum along with the forth ventricle and brain stem oppressed were seen in all cases.NAA was mildly reduced on magnetic resonance spectroscopy (MRS)in 7 cases of dysplastic gangliocytoma of the cerebellum.Conclusion There are distinctive manifestations in MRI images for dysplastic gangliocytoma of the cerebellum,which has crucial diagnostic value before operation.

Objective To investigate the serum superoxide dismutase( SOD) ,malondialdehyde ( MDA) , and nitric oxide( NO) level in generalized anxiety disorder ( GAD) patients for exploring the importance of oxida?tive stress in etiology of GAD. Methods 42 cases of first episode patients with GAD ( GAD group) and 42 cases of health ( control group) matched with age and gender were included . Serum levels of SOD,MDA ,and NO were tested to analyze for a control study.Results GAD patients had significantly higher levels of SOD,MAD and NO than health controls ((858.09±137.32)×102 U/L vs (745.40±119.19) ×102 U/L;(10.92±3.42)mmol/L vs (7.52±2.32)mmol/L;(74.32±12.34) μmol/L vs(65.22±14.29) μmol/L), t=4.036,5.368,3.297;P=0.000, 0.000,0.003) . A positive relationship between SOD and total score of Hamilton Anxiety Scale( HAMA ) ,psychotic anxiety factor of HAMA,or somatic anxiety factor of HAMA was found in GAD group ( r=0.331,0.370,0.318;P=0.029,0.016,0.040).The level of MAD correlated with total score or psychotic anxiety factor of HAMA( r=0.311, 0.320;P=0.042,0.039).Conclusion It is suggested that the dysfunction of oxidative stress may play a role in pathogenesis of generalized anxiety disorder.

Objective To investigate the inhibitory effect of melatonin on the proliferation activity of murine foregastic carcinomac ( MFC) cells via melatonin membrane receptors MT 2 and its relationship with the signaling pathways of mitogen-activated protein kinases ( MAPKs), phosphatidylinositol 3-kinase ( PI3K)-Akt.Methods Using siRNA technology to silence MT2 expression, we examined the ability of melatonin to inhibit the proliferation activity of MFC cells and its influence on the phosphorylation of ERK 1/2 and Akt.Results We found two interesting effects of SiRNA-mediated silencing of MT2 expression.Firstly, it significantly antagonized the inhibitory effect of melatonin on the proliferation activity of MFC cells .Secondly , it partially blocked the inhibitory effect of melatonin on the phosphorylation of ERK 1/2 and Akt.Conclusion Our results suggest that melatonin can inhibit the phosphorylation of ERK 1/2 and Akt via MT2 receptors , thereby inhibiting the proliferation of gastric cancer cells .

Objective:To investigate the calcium-phosphate metabolic condition in maintenance hemodialysis patients with chronic kidney disease (CKD), and to observe the effect of large dose calcitriol on secondary hyperparathyroidism (SHPT).
Methods:We tested and compared the serum levels of calcium, phosphate, intact parathyroid hormone (iPTH), and alkaline phosphatase (AKP) in hemodialysis patients at different hemodialysis time (Group A with hemodialysis period≤3 years and Group B with hemodialysis period>3 years). We also detected those indexes before and after treating SHPT with large dose calcitriol. Twenty SHPT patients were divided into Group I (enlargement of parathyroid gland or nodule detected by color Doppler ultrasound) and Group II (normal parathyroid gland detected by color Doppler ultrasound).
Results:In the maintenance hemodialysis patients, the serum phosphate was (2.11±0.38) mmol/L and iPTH was (581.11±487.75) pg/mL. The serum level of iPTH in Group B was higher than that in Group A [(828.13±690.39) pg/mL vs (477.94±324.73) pg/mL, P<0.001]. In Group I, the serum level of iPTH [before vs after:(2471.7±898.3) pg/mL vs (2510.4±825.7) pg/mL] and AKP [before vs after:(524.2±18.8)U/L vs (511.3±19.3)U/L] did not change after the treatment of large dose calcitriol (P>0.05). In Group II, the serum level of iPTH [before vs after:(1358.5±302.8) pg/mL vs (369.3±43.4) pg/mL, P<0.001] and AKP [before vs after:(565.9±23.9)U/L vs (234.8±21.1)U/L, P<0.001] decreased signiifcantly after the treatment of large dose calcitriol.
Conclusion:Patients with longer time of hemodialysis have a higher level of iPTH. Large dose calcitriol can improve the clinical syndrome of SHPT, and decrease the level of iPTH and AKP in SHPT patients with normal parathyroid gland.

BACKGROUND:Knowledge of retropedtoneal space communications might influence catheter placement,and understanding the normal anatomy of the retroperitoneal space is a prerequisite for predicting the distribution of inflammation or other fluid collections in this region. Until recent years,the media/ attachment of the posterior renal fascia remained controversial. The multiple detector spiral CT can show the abdominal anatomic details. So,using the multiple-detector spiral CT to study the anatomy of posterior renal fascia has clinical significance. OBJECTIVE:To describe the medial attachment of the posterior renal fascia by using multiple-detector spiral CT. DESIGN,TIME AND SETTING:A retrospective case analysis was performed at Department of Radiology,Affiliated Hospital of Weifang Medical College between June 2003 and November 2007. PARTICIPANTS:A total of 52 patients with retropedtoneal inflammatory diseases were retrospectively reviewed through analysis of their CT data. METHODS:Toshiba Akuilion 16-detector spiral CT was employed for scanning. Of the 52 patients,15 were proved by clinical and laboratory findings and 37 were proved by surgery and pathology. Among the 52 patients,17 suffered from appendicitis,1 from ureteritis,2 from abscesses in the perirenal space,3 from abscesses in the posterior pararenal space,and 29 from pancreatltis. MAIN OUTCOME MEASURES:Medial attachment of the bilateral posterior renal fascia. RESULTS:At the level of the upper pole of kidney,the posterior renal fascia fused with the fascia of the ipsilateral quadratus lumborum muscle. Forty-six patients manifested the attachment site of the left posterior renal fascia transforming from the quadratus lumborum muscle fasciae to the psoas major muscle fascia at the level of the lower pole of kidney or the infrarenal space. Fifty patients showed the attachment site of the right posterior renal fascia transforming from the quadratus lumborum muscle fascia to the psoas major muscle fascia at the level of the lower pole of kidney or the infrarenal space. CONCLUSION:The posterior renal fascia attachment site is not the same all the time. At different levels,the attachment site of the posterior renal fascia is distinct.