Objective The purpose of this study was to investigate the effect of isoflurane on baroreflex sensitivity ( BRS ) during induced hypotension and to illucidate the mechanism of isoflurane-induced hypotension. Methods Fifteen female ASA I or II patients aged 13-16 yrs undergoing scoliosis surgery were studied. The patients were unpremedicated. Radial artery and internal jugular vein were cannulated for BP and CVP monitoring. EGG, BP and SpO2 were continuously monitored before and during anesthesia. Anesthesia was induced with midazolam 0.04 mg? kg-1 , fentanyl 2 ?g? kg-1 and propofol 2 mg? kg-1 . Tracheal intubation was facilitated with rocuronium 1 mg?kg-1 . Anesthesia was maintained with isoflurane inhalation and fentanyl infusion (0.4?g?kg-1?h-1). Nitroglycerin (NTG) was infused at 1 ?g?kg-1 ?min-1 at the beginning of surgery to control MAP at 55-65 mm Hg and esmolol 20 mg was given i. v. to control HR 0.8. BRS was measured before induction of anesthesia (T1), immediately after intubation (T2), when end-tidal concentration of isoflurane reached 0.7% (T3 , supine) (T4 , prone), when end-tidal concentration of isoflurane reached 1.3% (T5) , at 30 min after NTG infusion and esmolal bolus injection were stopped (T6) when end-tidal concentration of isoflurane was decreased to 0.7 % (prone, T7 ) and immediately after the patients were turned supine (T8 ) . Results When end-tidal isoflurane concentration reached 1.6%, the desired level of hypotension could be maintained without NTG infusion and esmolol injection. BRS gradually decreased with increasing end-tidal isoflurane concentration. BRS was the lowest at 30 min after termination of NTG infusion and esmolol bolus injection. Conclusion Isoflurane depresses BRS and BRS depression may be involved in the mechanism of isoflurane-induced hypotension.

Objective To explore a novel improved method of simplified fluid-supplement therapy during the diuresis stage after renal transplantation.Method We adopted an improved fluid-supplement therapy to treat 26 postoperative patients of heterologous kidney transplantation after returning Liger's liquid, 500ml of 5% glucose-salt liquid, and 500ml liger's Compound back to linical wards by means of replenishing 500ml of sodium lactate sodium chloride injection in turn for fluid supplement. In addition, the patients were given originally 10～20ml of 10% calcium glubionate within 12 hours after their operations. Results Based on the results of both blood and urine determination at the first day aftert kidney transplantation, we discovered 2 patients slightly decreased sodium in blood, one displayed hypokalemia,2 patients showed slightly hyperkalemia value than normal referance level. Meanwhile, all patients manifested blood chlorate value between 101?4. Besides, another 7 patients had slightly increased blood suger value. However, no hypernatremia, hypocalcia or hypomagnesemia were found. As a result, all specific gravity ratio value were from 1.010 to 1.015 aparting from hemobilinuria existed in some patients. Conclusion The succesessful use of the new fluid-supplement therapy could effectively avoid unnecessary repeated haemospasia analysis for mornitoring and adjusting the balance of electrolyte, which could remarkably simplify and faciliate the postoperative management of renal transplantation.

Objective To evaluate clinical features, diagnosis and treatment of anorectal malignant melanoma (ARMM).Methods The clinical data of 15 patients of ARMM in our hospital and 18 patients in the First Affiliated Hospital of China Medical University from 1990 to 2010 were reviewed.Twenty-five patients underwent curative surgical resection, 14 patients underwent abdominoperineal excision of the rectum (APR), and 11 patients underwent local excision (LE).Survival analysis was carried out.Fisher's exact test and Log-rank test was used to compare the effects of these two different surgical procedures.Results ARMM had a female predominance, the mean age was 22 -77(54.5 ± 7.6) years.The major clinical signs included hematochezia, anus pain.The misdiagnosis rate was 67% (22/33).The average tumor size was (3.5 ±1.7) cm.Thirty-one petients(94% ,31/33) had ARMM within 5 cm from anus margin.Mean survival time was (14.0 ± 6.5)months.The overall 1-,3-,and 5-year survival rates were 48% ,22% , and 10% , respectively.Local recurrence after curative LE was higher than APR (LE,64% vs APR, 21% , P = 0.049) , The overall 3-year disease-specific survival rates after curative LE was not significantly different from that of APR (LE, 28% vs APR ,31%, x2 = 0.268, P = 0.582).Conclusions Anorectal malignant melanoma has a high rate of misdiagnosis.Radical resection could not prolong the survival time significantly in anorectal malignent melanoma patients.

OBJECTIVE： To confirm the efficacy and safety of latanoprost in treating glaucoma.METHODS： In a double blind， randomized control clinical trial， we compared the efficacy and adverse drug reactions of once daily topically applied 0.005％ latanoprost with those of twice daily 0.5％ timolol for 12 weeks in patients with open angle glaucoma or ocular hypertension.RESULTS： The study included 46 patients（22 pts.randomized to latanoprost treatment， 24 pts.to timolol） ， 46 patients remained at the end of the study.Comparing with baseline diurnal intraocular pressure（IOP） ， the IOP reduction（mean±standard deviation） achieved with latanoprost（7.86±2.39） mmHg， （31.1％， P<0.001），and timolol（6.24±2.58）mmHg （24.9%，P<0.001），the difference between the two groups（1.62mmHg） being significant（P<0.01）. Two patients treated with latanoprost had foreign body sensation. No other ocular and systemic adverse reactions related to the two drugs were found. CONCLUSION: The results of this study demonstrated that 0.005% latanoprost applied once daily is well tolerated and more effective in reducing IOP than 0.5% timolol applied twice daily. Thus, latanoprost has the potential for becoming one of the ideal antiglaucoma drugs.

Background Horizontal sulcus-to-sulcus (STS) and white-to-white diameter are important parameters for designing the proper size of collamer implantable contact lens (ICL).Inappropriate size of ICL may induce the complications postoperatively.Several previous studies compare horizontal STS and white-to-white diameter in normal eyes have been reported,but seldom in high myopic eyes.Objective This study was to investigate the discrepancy of STS diameters in 4 axes and analyze the relationship between horizontal STS diameter and white-towhite diameter in high myopia eyes.Methods The STS diameters in 4 axes (45,90,135 and 180 degrees) and the white-to-white diameters were measured in 48 eyes of 26 high myopia patients using the 50 MHz ultrasound biomicroscopy (UBM),the Orbscan-Ⅱ topography system,and the IOL Master,respectively.The mean spherical was (-12.93±3.87) diopters (D) (-8 to-20 D).Statistical evaluation was performed using the one-way ANOVA for comparison of measurement.The agreement of three devices was assessed using the Bland and Altman method.Results The mean STS diameter at 45,90,135 and 180 degrees was (12.06±0.50) mm,(12.27±0.50)mm,(12.03±0.46) mm and (11.84±0.47)mm,respectively.The 90 degree STS was significantly larger than other STS diameters (all at P＜0.05).The 180 degrees STS was significantly shorter than other STS diameters (all at P＜0.05).However,there was no significant difference between 45 degree STS and 135 degree STS (P=0.817).The mean WTW was (11.56±0.40) mm with Orbscan Ⅱ z topography system and (11.98±0.41) mm with IOLMaster.The WTW measured with Orbscan Ⅱ z was significantly shorter than the 180 degrees STS (t =-4.384,P =0.000).The WTW measured with IOLMaster was significantly larger than the 180 degrees STS (t =2.368,P =0.000).Bland-Altman analysis showed not very well agreement for measurements of WTW,STS between Orbscan Ⅱz and UBM,IOLMaster and UBM,Orbscan Ⅱ z and IOLMaster,the width of 95％ confidence interval (CI) were-0.57 to 1.12 mm,-0.96 to 0.67 mm,-0.73 to-0.13 mm,respectively.Conclusions The STS diameters in 4 different axes are not identical with each other in high myopia eyes.The longest STS is in the vertical meridian,the shortest STS is in the horizontal meridian.The WTW diameter measured with both Orbscan Ⅱ z and IOLMaster are not precise for calculating the horizontal STS in high myopia eyes.Three instruments cannot be interchanged for calculating the size of ICL.

AIM: To investigate the inducing action of retinal cells of rat neonates on the adult rat bone marrow stromal cells (BMSCs).METHODS: The full marrow from adult Wistar rat were cultured and passaged repeatedly to harvest the pure BMSCs. In vitro, the BMSCs were induced by retinal cells of rat neonates in transwell.The morphological changes of the BMSCs were observed under phase contrast microscope, the specific markers of the induced cells were ~identified immunocytochemically with nestin, Map-2, neuron-specific enolase(NSE),neurofilament(NF), Thy 1.1 and glial fibrillary acidic protein(GFAP) antibodies. The mRNA of nestin, NF, NSE, Thy 1.1 and Ran were detected in the induced cells by RT-PCR.RESULTS: The BMSCs were induced by reinal cells of rat neonates into the retina-like neurons, which showed the typical neural morphology and expression of the specific retinal neural antigens.CONCLUSION: The BMSCs from the adult rat can be induced into retina-like cells by retinal cells of rat neonates. [

Objective To assess the absorbance rate of the fat after the operation of breast augmentation of the repeated injection of low volume, using ultrasonic imaging method. Methods Thirty three patients were injected with low volume of autologous fat (50-60 ml per time) to bilateral breasts for 1-5 times and breast sonographic examination was performed to evaluate the grafted fat tissues. The thickness of the retromammary fat layer before and after each injection was measured to calculate the absorbance index. Results The 264 points of breast were measured in this study. The fat was distributed in the retro-mammary fat layers at 224 points of the breast and in the pectoralis major muscle layer at 32 points of the breast, and the others distributed in the mammary gland layer.The average thickness of the retromammary fat layer increased gradually from 0.2 cm before the first operation to 1. 0 cm after the fifth operation. The average absorbance index one month after each operation was 34 %-66 %. Conclusion The present study demonstrates that breast augmentation by repeated autologous fat graft with low volume injection at each time is applicable and satisfactory and that breast ultrasound is an accurate and simple method to e-valuate the absorbance index.

Objective To assess the efficacy of stone fragmentation and clearance of this new intracorporeal ultrasound lithotripter (CQS-01) compared with currently available ultrasound units (EMS-Ⅲ/Ⅳ).Methods Twenty phantom stones composed of dental gypsum were randomly divided into four groups,and CQS-01 ultrasound lithotripter (70％ power and 70％ duty factor),EMS-Ⅲ ultrasound lithotripter (70％ power and 70％ duty factor),EMS-Ⅳ ultrasound lithotripter (type A,70％ power and 70％ duty factor) and EMS-Ⅳ ultrasound lithotripter (type B,70％ power and 100％ duty factor) were used to fragment and removepbantom stones.The mean stone breakdown time and fragment removal time and stone fragmental sizes for the standard ultrasound devices were compared to determine the completeness and efficiency of stone fragmentation and removal.Results The average time for stone breakdown was 7.4 ± 1.9 s,9.4 ± 1.6 s,82.2 ± 12.6 s and 51.4 ± 18.7 s,respectively.There was no significant difference between CQS-01 and EMS-Ⅲ (P ＞ 0.05),but there was significant difference between CQS-01 and EMS-Ⅳ (A or B) (P ＜ 0.001).The average time for stone clearance using the ultrasound devices was 387.8 ± 68.0 s,41 1.6 ± 57.6 s,568.0 ± 119.1 s and 383.6 ± 75.6 s,respectively.In addition,the average size of the largest fragments removed was the same among the groups (＜ 3 mm).Conclusion The ultrasound capabilities in a newly developed lithotriter (CQS-01) exhibited the same ability to fragment and clear phantom stones compared with standard ultrasound devices.

AIM:To characterize the effect of estradiol on proliferation,differentiation and extracellular matrix(ECM) accumulation in stromal cells through regulation of BPH-1 paracrine.METHODS:BPH-1 cells were stimulated with different concentrations of estradiol.Conditioned media(CM) were harvested and their effects on stromal cell cultures were tested.Cell proliferation was determined by MTT assay.mRNA of smoothelin,fibronectin,collagen Ⅳ and transforming growth factor ?1(TGF-?1) were analyzed by real-time RT-PCR.Western blotting was used to determine smooth muscle myosin heavy chain(SMMHC).ELISA and radioimmunoassay were respectively used to measure fibronectin,TGF-?1 and collagen Ⅳ protein expressions.RESULTS:Estrodiol stimulated the expression and secretion of TGF-?1 in BPH-1 cells.The proliferation of stromal cells increased when they were cultured with CM harvested from estrogen treated BPH-1 cells.The mRNA levels of collagen Ⅳ and smoothelin increased in stromal cells treated with CM from BPH-1 cells.The results of radioimmunoassay also showed that the collagen Ⅳ protein level up-regulated in the supernatants and cell extracts of CM-treated stromal cells.A neutralizing antibody to TGF-?1 inhibited the stimulation of collagen Ⅳ and SMMHC by BPH-1 CM.The expression of fibronectin was only marginally changed in stromal cells cultured in the presence of BPH-1 CM.CONCLUSION:The BPH-1 cells increase ECM accumulation and differentiation of stromal cells through TGF-?1.Estradiol stimulate differentiation of stromal cells by induction of TGF-?1 expression.Estradiol stimulate proliferation by influencing the factors secreted from prostatic epithelial cells.

Objective To study the mid-and long-term outcomes and prognostic risk factors of mitral valve replacement (MVR) in children.Methods Retrospectively studied the cases(＜ 14 years) receiving MVR between July 2003 and March 2014 in our hospital,and recorded the gender,age,operation related data and the results of echocardiography,electrocardiogram and chest X-ray in the out-patient department.Results A total of 48 patients were followed up.Age was 8 months 15 days-13 years 9 months and 22 days,the average was (9.5 ± 3.9) years.24 cases were original operations,others were second operations.43 mechanical valves were used,as well as 5 tissue valves.The mortality was 8.3 ％ and the incidence of complications was 25.0％ during the hospitalization or within 30 days after the operations.Follow-up time was 4.7-150.7 months,the average was(62.0 ± 42.3) months.The long-term mortality was 9.1％,and the incidence of complications was 9.4％.Follow-up of left ventricular ejection fraction was 0.30-0.77,the average was 0.61 ±0.08.There was no redo-MVR or implantation of pace maker.The survival rates of 1 year,5 years and 10 years were (89.5 ± 4.5) ％、(83.0 ± 6.1) ％、(77.8 ±7.6)％,respectively.Children younger than 5 years was the risk factor for perioperative mortality or complications (OR =8.47,95％ CI:1.36-52.61).Children with perioperative complications was the risk factor for long-term mortality or complications(OR =9.97,95％ CI:1.39-71.76).Conclusion The results of children with MVR were satisfactory.To perform MVR in children older than 5 years if possible and to reduce the incidence of perioperative complications could improve the prognosis.