Radiofrequency ablation (RFA) is one of the most important methods for the treatment of liver cancer and has the advantages of small trauma,simple operation,and repeatability.However,for tumors in high-risk locations within 5 mm of the first and second branches of the hepatic portal vein,near the hepatic vein,the inferior vena cava,or the gallbladder,within 5 mm of the intestinal tract,under the Glisson's capsule,and in the diaphragm,RFA has the issues of a low complete ablation rate,a high local recurrence rate,and serious complications.This article introduces the complications of RFA for liver cancer in high-risk locations and their prevention and points out that with the promotion of individualized and standardized RFA,liver cancer in these high-risk locations is no longer a contradiction for RFA.

Objective To investigate the role of endogenous cystathionine beta synthase (CBS)/hydrogen sulfide (H2S) and heme oxygenase-1 (HO-1)/carbon monoxide (CO) during global cerebral ischemia-reperfusion (I/R).Methods Thirty male Wistar rats weighing 180-220g were anesthetized with intraperitoneal (IP) 3% pentobarbiral 40 mg?kg-1. Global cerebral I/R was produced by 4-vessel occlusion. Bilateral vertebral arteries were cauterized and bilateral common carotid arteries were occluded with atraumatic clamps for 20 min. The clamps were then released to allow reperfusion. The animals were randomly divided into 5 groups (n=6 each) : group Ⅰ sham operation(C); groupⅡ I/R; in group Ⅲ (Z+I/R),Ⅳ(H+I/R) andⅤ(Z + H + I/R) zinc protoporphyrin (HO-1 inhibitor) 45 ?mol?kg-1 or/and 1 ml of 5 mmol?L-1 hydroxylamine (CBS inhibitor) were given IP 30 min before I/R. The animals were killed at 6h of reperfusion. Brains were removed immediately for determination of H2S, CO, GSH, MDA level and SOD activity and expression of CBS mRNA and HO-1 mRNA in hippocampus and histologic examination with electron microscope. Results H2S, CO, MDA content and CBS mRNA and HO-1 mRNA expression were significantly higher while GSH content and SOD activity were significantly lower in I/R group than in control group (sham operation) . CO content and HO-1 mRNA expression were significantly lower while H2S, GSH content and CBS mRNA expression were significantly higher in Z + I/R group than in I/R group. H2S, GSH content and CBS mRNA expression were significantly lower and CO content and HO-1 mRNA expression were significantly higher in H + I/R group than in I/R group. In Z + H + I/R group H2S, CO, GSH content, SOD activity and expression of HO-1 mRNA and CBS mRNA were significantly decreased whereas MDA content was significantly increased as compared with I/R group. Mitochondria in hippocampal neurons were severely damaged in group Ⅱ-Ⅴ and the damage was worst in group Z + H + I/R. Conclusion CBS/H2S and HO-1/CO systems can protect brain against I/R injury.

Aim To investigate the effect of sevoflurane pretreatment on the nuclear factor kappa B(NF-?B)-DNA binding activity of leukocyte in peripheral blood of the patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty patients undergoing cardiac valve replacement under CPB were divided randomly into two groups:control group(group C)and sevoflurane pretreatment group(group S).All patients were induced with midazolam 0.08~0.12 mg?kg-1,fentanyl 5~10 ?g?kg-1 and vecuronium 0.1 mg?kg-1.After endotracheal intubation,mechanical ventilation was conducted with 100% oxygen.Anesthesia in group C was maintained with intermittent intravenous fentanyl and midazolam,while in group S maintained with 2MAC sevoflurane besides fentanyl and midazolam intermittently before CPB.The anesthesia depth was kept to maintain the systolic pressure within 90~120 mmHg in both groups.Sevoflurane was discontinued at the initiation of CPB,and the following anesthetic regimen was the same as that in group C.To examine the NF-?B-DNA binding activity,the arterial blood samples were withdrawn at the following time point:after endotracheal intubation and before inhaling sevoflurane(T0),30 min(T1),1 h(T2),2 h(T3),6 h(T4)after aortic de-clamping.Electrophoretic mobility shift assay(EMSA)was used to measure the NF-?B-DNA binding activity of leukocyte.The dosage of fentanyl,midazolam,dopamine,sodium nitroprusside and the rate of spontaneous heart resuscitation in both groups were recorded.Results The NF-?B-DNA binding activity in group C was increased significantly after aortic de-clamping,and it reached to maximum at T1,but it was not changed significantly in group S from T0 to T4.The value of EMSA at all time points was lower in group S except T0 than that in group C(P

Aim To investigate the effects of Isofluraneon function,metabolism,ATPase activity and free radicals in isolated ischemia /reperfusion(I/R) rat hearts.Methods 56 SD rats were randomly divided into 7 small groups(n=7),or 2 big groups according to given drug.In a normal thermal isolated Langendorff rat heart model,Myocardial Adenosine triphosphate(ATP),Malodialdehyde(MDA),Activity of Ca2+-ATPase,Na+,K+-ATPase and Superoxide Dismutase(SOD)were determined.Results In isoflurane group,LVDP and dp/dt decreased,CF and ATP increased while the activity of Na+,K+-ATPase remained unchanged.The myocardial ATP content decreased slowly in isoflurane group.At the end of reperfusion,ventricular function,CF,myocardial ATP content and the activity of Ca2+-ATPase and SOD in isoflurane group were significantly higher while myocardial MDA was significantly lower than those in control group.Conclusion Isoflurane can depress myocardial systolic function and activity of Ca+-ATPase in normal myocardium,improve the recovery of function and metabolism,and increase CF and the activity of Ca2+-ATPase and Na+,K+-ATPase.

Objective To evaluate the effect of transcutaneous electrical acupoint stimulation(TEAS)on emergence agitation in children under?went general anesthesia with sevoflurane. Methods Sixty children aged 3?6 years underwent adenoidectomy and tonsillectomy were selected and randomly divided into two groups:TEAS(group T,n=30)and control(group C,n=30). After venous induction,the general anesthesia was main?tained with sevoflurane. Group T received continuous TEAS at point hegu and neiguan after anesthesia induction till the end of operation. Control group were not given TEAS. The change of the blood flow dynamics in the process of anesthesia,the time of extubation,awaking time and the time in PACU were recorded. The emergence agitation,postoperative nausea and vomitting and respiratory depression were observed. Results There were no significant differences in gender,age,weight,anesthesia time,and operative time between the two groups (P>0.05 ). There was no significant difference in extubation time,awaking time and time in PACU between the two groups(P>0.05). The mean arterial pressure and heart rate in group T were lower than those in group C at the time of extubation and in PACU(P<0.05). The emergence agitation scale in group T was lower than in group C(P<0.01). There was no significant difference in incidence rate of PONV and respiratory depression between two groups. Conclusion TEAS can reduce emergence agitation in children with sevoflurane?induced general anesthesia,but not prolong extubation time,awaking time and time in PACU. In addition,it does not increase the incidence of respiratory depression.

Objective To compare the effects of tracheal intubation (TI) and laryngeal mask (LM) during general anesthesia (GA) induction on the α 1-band of quantitative pharmaco-electroencephalography (QPEEG).Methods Fortypatients undergoing GA were randomly divided into two groups:group T included 20 patients who received TI and group L included 20 who received a LM.Parameters like heart rate (HR),mean arterial pressure (MAP),and QPEEG were recorded before anesthesia induction (T0),after induction (T1),and after intubating the cannula or LM (T2).Using power-spectrum analysis,we calculated the power percentage of the α 1-band of QPEEG.Results The HR,MAP,and power percentage of the α 1-band in most areas of the brain were lower at T1 than at T0 (P ＜ 0.05) in both groups.Moreover,the HR,MAP,and α 1-band power percentage were higher at T2 than at T1 (P ＜ 0.05) in group T,whereas they showed no significant change at T2 (P ＞ 0.05) in group L.Conclusion TI is stronger than LM for stimulating the circulatory system.Moreover,TI may cause an increase in the power percentage of the α 1-band of QPEEG.This finding suggests that the α1-band power percentage of QPEEG can be an effective means of monitoring stimulation.

Objective To observe the effect of transcutanous acupoint electrical stimulation(TAES)and dexmedetomidine on postoperative cogni?tive dysfunction in female patients underwent laparoscopic surgery. Methods Nighty patients scheduled for laparoscopic surgery were recruited in this study and randomly divided into control group(group C,n=30),TAES group(group T,n=30)and dexmedetomidine group(group D,n=30). In group T,patients received TAES treatment 30 min before the anesthesia until the end of the surgery at Neiguan(PC 6)and Zusanli(ST 36). The frequency was 2/100 Hz. In group D,patients were intravenously administrated with dexmedetomidine(0.5μg/kg)before the induction. All the patients were given routine general anesthesia. Drugs induced were sulfentanyl,etomidate and cisatracurium. Sevoflurane was given to main?tain the bispectral index(BIS)between 40 and 55. The time of extubation and in PACU was recorded. The serum S100βlevel was assessed at pre?operation(T0),the end of operation(T1)and 24 h after operation(T2). Mini?mental state examination(MMSE)was adopted to evaluate and re?cord the changes in cognitive function 1 day before operation and 24 h after operation. Results The incidence rate of POCD in group T and group D were lower than that in group C(all P<0.05). The level of S100βin group T and group D was lower than those in group C at T1 and T2 separately (all P<0.05). The time of extubation and time in PACU in group D were longer than those in group C and group T(all P<0.05),and the incidence of bradycadia in group D was higher than that in the other groups(all P<0.05). Conclusion TAES and dexmedetomidine reduce the incidence of cognitive dysfunction,decrease the release of S100βprotein. However,dexmedetomidine increases bradycadia,and prolongs extubation time and stay time in PACU. Hence,TAES deserve to be recommended practically.

BACKGROUND:Intracerebral administration of selective drugsviathe carotid artery is currently one of the effective methods to enhance the drug concentration in the brain and reduce the influence of drugs on other system functions. OBJECTIVE:To establish the muscle-relaxation rabbit models by infusing propofol continuously in the internal carotid artery and analyze the variations of propofol concentration. METHODS: The muscle-relaxation rabbit models were established by continuously infusing propofol at a constant speedviacatheterization in the internal carotid artery. The pharmacokinetic characteristics could be analyzed by the methods of obtaining arterial and venous blood on both sides of neck and samples of brain tissue on both sides in different points, detecting drug concentration using high pressure liquid assay, and then mathematicaly conversing the resulting data for fitting processing and statistical regression. RESULTS AND CONCLUSION:The method of determining the concentration of propofol using high pressure liquid assay is feasible, stable and reliable. Through investigating the concentration of propofol infused via the carotid artery at different time points, we discovered that the growth rate distribution of propofol concentration and data distribution are in log-normal distribution profile which belong to non-exponential kinetics model,i.e., modified log-normal distribution model,??)(ln x μ 2 1 fx ()=e 2σ2 , whereσ is the range of drug concentration growth indicating stability xk 2πσ of concentration changes, which is an integrated variable related to various factors, such as brain tissue uptake of drugs and brain circulation. The pharmacokinetic model of continuously infusing propofol in the internal carotid artery belongs to log-normal distribution function, i.e., a non-exponential function kinetics model. The brain concentration variations on both sides changing over time folow log-normal distribution function law.

Objective To observe the effect of Shengji corium elephatis mastic in treating chronic refractory skin ulcer, and analyze its preliminary mechanism. Methods Totally 62 patients with chronic refractory skin ulcer in granulation stage were randomly divided into two groups, 32 cases of treatment group were treated with Shengji corium elephatis mastic, and 30 cases of control group were treated with Vaseline gauze. All patients were treated for 4 weeks. The rate of wound healing, wound reduction ratio and wound secretion level of VEGF were observed. Results The cure rate and the total effective rate between the two groups had significant difference (P<0.05). After 2 weeks treatment, the mean wound reduction area of treatment group and control group was 82.31%and 66.32%respectively. After 4 weeks treatment, the mean wound reduction area of treatment group and control group was 90.35%and 78.7%respectively, the difference was statistically significant (P<0.05). After 1, 2 and 3 weeks treatment, the treatment group had significant difference with the control group in wound secretion VEGF level (P<0.05). Conclusion Shengji corium elephatis mastic can promote wound healing of chronic refractory skin ulcer. The possible mechanism is that Shengji corium elephatis mastic promotes the generation of VEGF in wound thus promotes wound repair.

Objective To compare the effects of different doses of sufentanil on theα1?band of quantitative pharmaco?electroencephalography (QPEEG)during the induction of general anesthesia by tracheal intubation(TI). Methods Forty selected patients under general anesthesia were randomly divided into two groups,with 20 patients per group. Patients in group Ⅰ were administered 0.2μg/kg sufentanil,whereas patients in group Ⅱ were administered 0.3μg/kg sufentanil. Subsequently,the patients were administered 2 mg/kg propofol and 0.15 mg/kg cisatracurium. HR,MAP,and QPEEG were recorded before induction(T0),after induction(T1),and after insertion of the cannula(T2). Using the method of power spectrum analysis,theα1?band power percentage of QPEEG was calculated. Results In comparison with T0,the values of HR,MAP,andα1?band power percentage in most areas of the brain were both decreased at T1(P<0.05). Furthermore,in comparison with T1,the parameters were increased in group Ⅰ at T2(P<0.05),but no significant changes were observed in group Ⅱ (P>0.05). Conclusion The administration of 0.3μg/kg sufentanil during anesthesia induction can effectively depress the cardiovascular response to TI and stabilize theα1?band power per?centage. This suggests that theα1?band power percentage of QPEEG can be an effective means to monitor the depth of sedation.