Objective To investigate the effect of sevoflurane postconditioning on the myocardial oxidative stress injury in patients undergoing heart valve replacement with cardiopulmonary bypass (CPB) . Methods Thirty ASA Ⅱ or Ⅲ and NYHA class Ⅱ or ID patients, aged 30-59 yr, weighing 42-62 kg, scheduled for cardiac valve replacement with CPB, were randomly divided into 2 groups ( n = 15 each) : control group (group C) and sevoflurane postconditioning group (group S) . Anesthesia was induced with iv injection of midazolam 0.05-0.08 mg/kg, fentanyl 3-6 μg/kg, vecuronium 0.10-0.15 mg/kg and etomidate 0.1-0.2 mg/kg. The patients were tracheal intu- bated and mechanically ventilated. Anesthesia was maintained with intermittent iv boluses of fentanyl and midazolam and continuous infusion of atracurium and propofol. In group S, 2% sevoflurane was given over 15 min via the cardiopulmonary bypass machine immediately after aortic unclamping. Blood samples from the internal jugular vein were collected immediately before skin incision (T1 ) and at 30 min, 3 h and 24 h after aortic unclamping (T2-4 ) for measurement of the plasma malondialdehyde level. Myocardial tissues were taken from the left auricle before operation and after termination of CPB for determination of α-glutathione-S-transferase expression by Western blot. Results The plasma malondialdehyde concentration was significantly lower at T2, 3, while a-glutathione-S-transferase expression in myocardial tissues higher after termination of CPB in group S than in group C ( P ＜ 0.05) . Conclusion Sevoflurane postconditioning can enhance the antioxidant capacity and attenuate the myocardial oxidative stress injury in patients undergoing cardiac valve replacement with CPB, which may be helpful to reduce myocardial ischemia-reperfusion injury.

Objective To explore the application value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) and 99Tcm-methylene diphosphonate (99 Tcm-MDP) bone scintigraphy for detecting bone destruction in multiple myeloma (MM).Methods 18 F-FDG PET/CT and 99Tcm-MDP bone scintigraphy results of 27 MM patients were analyzed retrospectively.Inspection areas checked by magnetic resonance imaging (MRI) and X-ray were the limited scopes.The location and number of bone destruction were recorded,and the maximal standardized uptake value (SUVmax) was measured simultaneously.The results were comparatively analyzed.Diagnostic certainty regarding the presence or absence of bone destruction was evaluated according to the reference standard consisting of MRI and X-ray.Results A total of 235 lesions were found according to the reference standard.Of these,227 lesions (97％) were identified by 18F-FDG PET/CT,whereas 187 lesions (80％) were identified by bone scintigraphy,with a significant statistical difference (x2 =32.43,P ＜ 0.05).SUVmax was 8.3 ± 1.7 (4.3 to 18.9).The discovery rates of bone fracture of 18F-FDG PET/CT and bone scintigraphy were 100％ (97/97) and 90％ (87/97),and there was a significant statistical difference between them (x2 =78.09,P ＜ 0.05).Conclusion 18 F-FDG PET/CT is a possible method to detect bone lesions in patients with MM,and is better than 99Tcm-MDP bone scintigraphy.

Objective To investigate the blood-saving effect of controlled low central venous pressure (CLCVP) in different types of hepatectomy.Methods Ninety ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 37-76 yr,weighing 40-75 kg,undergoing elective hepatectomy,were divided into 6 groups according to the surgical approach and whether CLCVP was used during surgery (n =15 each):CLCVP1-3 groups and nonCLCVP1-3 groups (NCLCVP1-3 groups).The standard hepatectomy,half liver resection and irregular hepatectomy were performed in CLCVP1-3 groups,respectively,with CLCVP.The standard hepatectomy,half liver resection and irregular hepatectomy were performed in NCLCVP1-3 groups,respectively,without CLCVP.In CLCVP1-3 groups,from skin incision to the end of liver resection,CVP was maintained ≤ 5 cm H2 O through adjustment of the position,fluid restriction and iv infusion of nitroglycerin,and norepinephrine was infused simultaneously to maintain mean arterial pressure ≥ 60 mm Hg.In NCLCVP1-3 groups CVP was maintained at 6-12 cm H2O.Intraoperative blood loss and blood transfusion were recorded.Results Compared with NCLCVP1-3 groups,intraoperative blood loss was significantly decreased in CLCVP1-3 groups (P ＜ 0.05).Compared with NCLCVP3 group,the amount of blood transfusion was significantly decreased,the constituent ratio of intraoperative blood loss ＜ 200 ml was increased,and the constituent ratio of intraoperative blood loss ＞ 1000 ml was decreased in group CLCVP3 (P ＜ 0.05).Conclusion CLCVP can decrease the intraoperative blood loss and blood transfusion in patients undergoing irregular hepatectomy.

Objective To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS), and compare it with contrast-enhanced CT(CECT). Methods Eighty-one focal liver lesions were evaluated with CEUS and CECT, diagnostic value of two modalities were calculated, vaseularity manifestations of two modalities in arterial phase were compared. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEUS were 96.6 %, 86.9 %, 94.9 %, 90.9 %, 93. 80%, respectively, and the diagnostic value of CECT were 98.3%, 82. 6%, 93.4%, 95.0%, 93.8%, respectively. Among all the metastasis, hypervascular manifestation lesions in arterial phase of CEUS and CECT were 72% (18/25) and 32% (8/25)( P <0.05). Conclusions The diagnostic value of CEUS and CECT in focal liver lesions are comparably satisfying,and there is no significant difference between them, the combination use of two modalities would improve the diagnosis performance. CEUS can show more hypervaseular metastasis than CECT in arterial phase.

Skeletal muscle extracellular matrix (ECM) is the microenvironment for muscle cells to survive and function. Changes in ECM components and structure directly affect the activity and function of muscle cells. Pathological remodeling occurs to skeletal muscle ECM in insulin resistance, including collagen deposition, hyaluronan accumulation, activation of membrane protein integrin signaling path-way, and the imbalance of matrix metalloproteinases and tissue inhibitors of metalloproteinases, while all those would impair the tissue insu-lin sensitivity.

TLR2 activity plays an important role in the pathogenesis of autoimmune diseases, tumor carcinogenesis and cardio-cerebrovascular diseases. To establish a TLR2 receptor-based cell screening model, NF-kappaB promoter-driven luciferase reporter plasmids were transfected into human embryonic kidney cells (HEK293) stably expressing human TLR2 and co-receptors CD14, TLR1 and TLR6. Single clones were then isolated and characterized. Using this screening system, a human TLR2-binding peptide C8 was obtained from the Ph.D.-7 Phage Display Peptide Library through biopanning and rapid analysis of selective interactive ligands (BRASIL). The binding characteristic of C8 with human TLR2 was evaluated by ELISA, flow cytometry and immunofluorescence. The NF-kappaB luciferase activity assay showed that C8 could activate the TLR2/TLR1 signaling pathway and induce the production of cytokines TNF-alpha and IL-6. In conclusion, the TLR2 receptor-based cell screening system is successfully established and a new TLR2-binding peptide is identified by using this system.

Objective To determine the risk factors for emergence agitation (EA) during the recovery period after general anesthesia.Methods One thousand and thirty-four patients of both sexes aged 18-89 yr undergoing general anesthesia were divided into EA group and non-EA group.EA occurring during recovery from general anesthesia was assessed by using Riker sedation-agitation scale.Age,sex,complication,education,medical history,ASA physical status,type and duration of anesthesia and operation,volume of blood loss,fluid replacement,urine volume,duration of stay in PACU,number of drainage tubes and so forth were recorded.Multivariate logistic regression was used to analyze the risk factors for the occurrence of EA.Results Thirty-six patients developed EA during recovery from anesthesia.The incidence of EA was 3.5 ％.Logistic regression indicated that high risk operation,premedication with diazepam,induction of anesthesia without midazolom and fluid replacement during operation were the risk factors for EA (P ＜ 0.05).Conclusion High-risk operation,premedication with diazepam,induction of anesthesia without midazolom and fluid replacement during operation are the risk factors for EA during recovery from general anesthesia.

Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCEUS) in assessing the peripancreatic vascular invasion of pancreatic carcinoma.Methods Twenty-eight patients with pancreatic cancer confirmed by postoperative pathology were examined by DCEUS preoperatively.The relationship between neoplasms and peripancreatic vessels was analyzed for assessing whether vascular invasion of pancreatic cancer had occurred.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of DCEUS in evaluating vascular involvement were calculated by using the surgical results as a gold standard.Kappa test was used for assessing the intra- and interobserver reliability of DCEUS.Results In total 28 patients,21 cases were diagnosed as vascular invasion,whereas,7 cases were noninvasive by surgical results.By DCEUS,18 cases were assessed as positive involvement of vessels,whereas,10 cases were negative.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of DCEUS in evaluating vascular involvement were 85.71 ％,100％,100 ％,70.00 ％ and 89.29 ％ respectively,and with higher reliability (Kappainter =0.75,Kappa =0.80).Conclusions DCEUS could be considered as a novel method to assess vascular invasion of pancreatic carcinoma accurately and reliably.

Objective To analyze the clinical and ultrasonographic features of intraductal papillary mucinous neoplasm (IPMN) of the pancreas and to assess the usefulness of transabdominal ultrasonography. Methods Twelve patients with IPMN underwent surgery, including 4 (33.3%)with adenoma and 8(66.7%) with adenocarcinoma. IPMN was classified into 3 categaries by the site of main duct,branch duct and combined type based on the ultrasonographic findings preoperatively. All the clinical presentations and the ultrasonographic imaging findings were analyzed and compared with the histologic diagnosis. Results Of malignant IPMNs,diabetes was presented in 5 cases,elevated CA19-9 was presented in 4 cases and steatorrhea was presented in 2 cases. But these was not presented in benigns. Transabdominal ultrasonography revealed all the cystic or cystic-solid lesions in this study. The mean diameter of the lesions with adenoma was (1.4 ± 0.8)cm (range,0.5 - 2.0 cm) and that with adenocarcinoma was (6.3 ± 6.0)cm (range, 2.0 - 20 cm). The mean diameters of the main duct for the cases with adenomas and adenocarcinomas were (1.0 ± 0.8) cm and ( 1.6 ± 1.0) cm, respectively. Among the adenomas, 3 cases were calssified as branch type and 2 were demonstrated with mural nodules and no colour signals was detected within them. Five of the malignancies were considered as main duct type and 3 were combined type. Seven cases were detected mural nodules and showed abundant colour flow signals within them. Conclusions Transabdominal ultrasonography revealed the pancreatic cystic lesions and dilated ducts of IPMN. Some characteristics should be considered for malignancy: clinical symptoms, tumor size and mural nodules with colour flow signals,which may be helpful for the diagnosis and management of IPMN.

Diagnosis, Differential ; Femur ; Fibrosarcoma ; metabolism ; pathology ; Fibrous Dysplasia of Bone ; diagnosis ; diagnostic imaging ; metabolism ; pathology ; surgery ; Follow-Up Studies ; Humans ; Leg ; Liposarcoma, Myxoid ; metabolism ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle Neoplasms ; diagnosis ; diagnostic imaging ; metabolism ; pathology ; surgery ; Myxoma ; diagnosis ; diagnostic imaging ; metabolism ; pathology ; surgery ; Neurilemmoma ; metabolism ; pathology ; Neurofibroma ; metabolism ; pathology ; Syndrome ; Tomography, X-Ray Computed ; Vimentin ; metabolism ; beta Catenin ; metabolism