Objective To observe the effects of general anesthesia combined with epidural anesthesia on the short-term cognitive function in the elderly patients after orthopedics surgery.Methods 185 elderly patients undergoing orthopedics surgery were treated in our hospital from Jan.2011 to Jan.2014.The patients were divided into observation group (with general anesthesia combined with epidural anesthesia,n=94) and control group (with general anesthesia,n=91).The short term cognitive function,mean arterial pressure and heart rate were compared at 30 min before,during and at the end of the operation between the two groups.Results There were no statistically significant differences in awakening time,extubation time and response time between the two groups [(28.7±7.8) min vs.(30.9±8.1) min,(29.2±8.1) min vs.(32.2±8.4) min,(30.4±7.9) min vs.(33.1±8.6) min,t=1.881,2.472,1.943,respectively,P=0.031,0.007,0.027].The minimental state examination (MMSE) scores were higher in observation group than in control group at 6,12 and 24 hours after surgery [(26.1±1.4) vs.(24.9±1.5),(25.0±1.5) vs.(24.1±1.4),(27.9 ±1.4) vs.(26.3±1.3),t=5.627,3.279,8.049,all P＜0.001].The incidence of cognitive dysfunction was less in observation group than in control group at 6 and 12 hours after surgery (7.5％ vs.17.6％,8.5％ vs.19.8％,x2=4.363,4.862,respectively,P=0.037,0.027).Conclusions Compared with general anesthesia,the general anesthesia combined with epidural anesthesia can reduce the effects of anesthesia on cognitive dysfunction,and has a good effect of anesthesia.It is more suitable for the elderly patients with anesthesia for surgery.

Objective To investigate the effects of cerebral hemodynamics and oxygen metabolism of dexmedetomidine on patients with intracranial aneurysm surgery.Methods Sixty-four patients with intracranial aneurysm surgery were collected and randomly divided into study group and control group (32 cases for each group).Patients in the study group before induction of anesthesia were given dexmedetomidine and patients in the control group were given saline but anesthesia.Mean arterial pressure (MAP),heart rate (HR),cerebral metabolic rate of oxygen(CMRO2) in different time points were observed and time in intubation and intracranial aneurysm clamp before anesthesia were rescored.Cerebral blood flow (CBF),intracranial pressure (ICP) were observed and the recovery situation.Results At the intubation,MAP and HR in the study group after 15 min of intubation,time in intracranial aneurysm clamp and extubation were significantly lower than those of the control group(P ＜ 0.05).CMRO2 in study group at the intubation and intracranial aneurysm clamp were (34.2 ± 5.0) ％ and (27.1 ± 4.2),significantly higher than that of the control group ((33.9 ± 4.3) ％,(26.5 ±3.6) ％; P ＜ 0.05).CBF in study group at the intubation and intracranial aneurysm clamp were (53.5 ±8.8) ml/(100 g · min) and (56.8 ±9.2) ml/(100 g · min),significantly lower than that of control group ((67.3±11.2) ml/(100 g· min),(67.3 ±11.2) ml) (100 g· min); P＜0.05) ; The same trend was seen in terms of ICP.Spontaneous breathing recovery time and extubation time in study group were (7.35 ± 1.12) h and(12.98 ± 3.76),significantly earlier than those of the control group((9.27 ± 1.45) h and (14.89 ±4.88) h; t =10.92,9.23,P ＜0.01).Steward scores in study group was (5.12 ±0.33),significantly higher than control group ((3.98 ± 0.28) ; t =5.55,P ＜ 0.05).Conclusion Dexmedetomidine can certainly keep hemodynamic stability in patients with intracranial aneurysm surgery,improve rate of cerebral oxygen uptake and recovery performance,which is worthy of clinical application and promotion.

Objective To compare the effects of Dexmedetomidine and Midazolam for sedation in elderly patient with upper cervical spine fracture in awake tracheal intubation.Methods A total of 68 patients with upper cervical spine fracture undergoing awake tracheal intubation who treated in our hospital from Jan.2010 to Jan.2015 were considered as the objects,who was randomly divided into group A and group B.34 cases in group A were treated with Dexmedetomidine for sedation,and the other 34 cases in group B were treated with Midazolam for sedation.The Heart rate (HR),mean arterial pressure (MAP) and BIS value on the before anesthesia (T1),immediately before intubation (T2),immediately after intubation (T3),PaCO2 in before and after intubation,and the adverse reactions were compared between the two groups.Results There was no difference in HR,MAP and BIS at time of T1 between the two groups (P＞0.05).The HR,MAP and BIS were lower in group A than in group B at time of T2 and T3 (P＜0.01).The PaCO2 had no difference between the two groups at before and after intubation (P＞ 0.05).The rate of adverse effects had no difference between the two groups (x2 =1.308,P =0.253).Conclusions Compared with Midazolam,Dexmedetomidine can stable HR,MAP and BIS effectively and has a good safety in the treatment of elderly upper cervical spine fracture in awake tracheal intubation,which is worthy of clinical application.

Objective To construct a prokaryotic expression system of human ferritin L which could be overexpressed in E.coli, and then prepare quality control materials of rFL and evaluate the homogeneity, stability, precision and application value of the rFL.Methods RT-PCR was used to clone ferritin L gene with total RNA from peripheral blood.Ferritin L gene was inserted into plasmid pGM-T to construct subclone plasmid pGM-T/ferritin L, which was identified by sequencing.The recombinant plasmid pET-30a/ferritin L was transformed into E.coli BL21 (DE3) and efficiently expressed under IPTG induction.rFL was identified by SDS-PAGE, and its antigenicity was examined by WB.The concentration of rFL was measured by ACCESS immunoassay system.Fifteen control samples were randomly selected using random number table.The homogeneity and stability of rFL were evaluated by one-way analysis of variance (ANOVA) and a linear regression model, respectively.The uncertainties of homogeneity, stability and the precision were evaluated.Results A prokaryotic expression system of ferritin L was successfully constructed.Sequence analysis showed that the ferritin L gene inserted was identical with the one from GenBank(NM_000146.3).The PCR products were 527 bp long, in complete agreement with length of ferritin L gene.The molecular weight of rFL highly expressed in E.coli induced by IPTG was 19 000 Da.The WB analysis indicated that this rFL protein had good antigenicity.The concentration of rFL(1 000 times dilution) measured by ACCESS immunoassay system was (1115.84±38.38) ng/ml.Homogeneity evaluation of low-concentration QC sample and high-concentration QC sample of rFL showed that there were no statistical significances in the within-groups and between-groups (for high-concentration F=2.336, P>0.05 and for low-concentration F=0.730, P>0.05).A linear regression based on the stability test indicated that there was no statistically significant trend of instability in five and a half months (F=1.755, P>0.05). Precision analysis showed the within-run CV, the between-run CV, the between-day CV and the total CV of high-concentration QC sample were 2.06%, 2.12%, 0% and 2.96% respectively; the within-run CV, the between-run CV, the between-day CV and the total CV of low-concentration QC sample 2.03%, 2.08%, 0% and 2.90%, respectively.Conclusion This rFL for quality control materials with independent intellectual property rights could meet the clinical requirement of homogeneity, stability and precision, and could provide raw materials for preparation of mixed ferritin for quality control.

Objective To study the method which was used to prepare naproxen microcapsule with alginate-chitosan by means of a complex coacervation method in an emulsion system.MethodsThe orthogonal experimental design using the standard of drug encapsulation was applied to optimize the preparation procedure of the microcapsules.Results The optimal preparation condition was as follows: r=500r?min-1,pH=4.0,C(chitosan)=3%,T=50℃.Conclusion This method was reproducible,and the results of the experiment in vitro indicated that the microcapsule obtained under these conditions may sustained release of drugs.

Objective To evaluate the clinical features and various diagnostic methods for sarcoidosis.Methods The data of 28 cases with sarcoidosis confirmed by pathology were reviewed and analized,and different diagnostic methods were compared.The disease was evaluated by regular serological tests,chest X ray film,chest high resolution computed topography(HRCT),bronchofibroscopy,and pulmonary function test.Results These patients shared a typical clinical presentation,consisting of dyspnea,cough,subskin nodes,enlargement of peripheral lymphnodes and splenomegaly.Laboratory test revealed elevated serum blood sedimentation,alkali phosphatase,Angiotensin-converting,and urine calcium.The saricoidosis was confirmed by pathological biopsy for bronchial mucosa,lung tissues,peripheral lymphnodes,subskin nodes biopsies and spleen.HRCT showed its superiority to traditional X ray film examination in fingding early staging chest sarcoidosis.Conclusions Chest HRCT and bronchopulmonary biopsy through bronchofibroscopy possess significant clinical value for sarcoidosis diagnosing and staging.And extropulmonary lessions biopsy also plays a complementary role to some extent.

Objective To study the mechanism of adaptive immunity against Rhizopus arrihizus (R. arrihizus) infections. Methods Bone marrow derived dendritic cells (BMDCs) were separated from C57BL/6 mice and Card9-/- mice and then were cultured in vitro. Resting spores and swollen spores of R. arrihizus were in vitro co-cultured with BMDCs with or without Syk inhibition. Secretion of cytokines ( IL-23, IL-1βand IL-12) was analyzed by ELISA after 24 hours of culture. Na?ve T cells derived from C57BL/6 mice were in vitro co-cultured with spore-stimulated BMDCs for four days. Levels of IL-17A and IFN-γ in supernatants of cell culture were analyzed by ELISA. Flow cytometry was performed to analyze T cell differ-entiation. Confocal microscopy was used to observe the images of stained β-glucan on the surface of resting and swollen spores. Swollen spores were co-cultured with Dectin-1, Dectin-2, TLR2 and mannose receptor ( MMR) , and the binding results were analyzed by flow cytometry. Results Swollen spores but resting spores could induce the maturation of BMDCs and promote the secretion of cytokines (IL-23, IL-1βand IL-12). Co-culturing T cells with swollen spore-stimulated BMDCs enhanced their differentiation to Th17 and Th1. In addition, swollen spores promoted the secretion of Th1-related cytokine ( IFN-γ) and Th17-related cytokine (IL-17A). Adding Syk inhibitor to Card9-/-BMDCs or wild type BMDCs significantly inhibited the secretion of cytokines and T cell differentiation, especially in the Card9-/- group. β-glucan was overserved on the surface of swollen spores, but not on resting spores. On the surface of swollen spores existed pathogen associated molecular patterns ( PAMPs) that could bind with Dectin-1 and TLR2. Conclusion Swollen spores of R. arrihizus could active BMDCs to secrete cytokines of IL-23, IL-1β and IL-12 and trigger T cell responses in vitro. The possible mechanism might be associated with β-glucan exposed on the surface of swollen spores that binds with Dectin-1. The responses between BMDCs and R. arrihizus are Syk-Card9-dependent.

Objective To compare the effects of remifentanil infused at different rates on median effective target plasma concentration (EC50) of propofol inhibiting responses to laryngeal mask airway (LMA) insertion and determine the optimum infusion rate of remifentanil when used for fiberoptic bronchoscopy in pediatric patients.Methods Eighty-four ASA Ⅰ or Ⅱ pediatric patients,aged 7 months-3 years,scheduled for elective fiberoptic bronchoscopy,were randomly assigned into 3 groups (n =28 each):normal saline group (group C),remifentanil infused at 3 ng· kg-1 ·min-1 group (group R1) and remifentanil infused at 5 ng· kg-1 · min-1 group (group R2).Responses to LMA insertion were defined as body movement and/or bucking during insertion.The initial target plasma concentrations of propofol were 5.2,4.8 and 4.4 μg/ml in groups C,R1 and R2,respectively.The target plasma concentration of propofol was determined by up-and-down sequential allocation.Each time the target plasma concentration increased/decreased by 0.2μg/ml.EC50 and 95 ％ confidence interval of propofol blunting responses to LMA insertion were determined by probit method.Results EC50 (95 ％ confidence interval) of propofol was 5.03 (4.92-5.12) μg/ml,4.71 (4.58-4.84) μg/rnl and 4.46 (4.20-4.94) μg/ml in groups C,R1 and R2,respectively.There was no significant difference in EC50 of propofol between groups R1 and C (P ＞ 0.05).EC50 of propofol was significantly lower in group R2 than in groups C and R1 (P ＜ 0.05).Conclusion The infusion rate of remifentanil should not be lower than 5 ng· kg-1· min-1 when combined with propofol in pediatric patients undergoing fiberoptic bronchoscopy.

Objective Acute necrotizing pancreatitis (ANP) may cause lung injury.This study explores two factors that are associated with lung damage from ANP,the expression of tumor suppressor factor CYLD and nuclear factor-kappa B (NF-κB).Methods 72 adult Sprague-Dawley rats were randomly divided into 3 groups:sham operation,ANP,and GdCl3 treatment groups (n=24 for each group).A retrograde injection of 5％ sodium taurocholate into the biliopancreeatic duct of rats induced ANP,and the animals were killed 1,3,6,and 12 hours after the ANP induction.AMs were harvested by bronchoalveolar lavage technique,and TNF-a and IL-1β levels in bronchoalveolar lavage fluid (BALF) were evaluated.Lung tissue was checked with histological examinations,and the activity of NF-κB and CYLD in AM were measured by western blot.Results TNF-α and IL-1β secreted by AM were gradually elevated,peaked on the sixth hour,had maximums of (491.3 ±20.3)ng/L and (178.83±11.32)ng/L respectively,and decreased on the twelfth hour.The levels of TNF-α and IL-1β in the ANP group were significantly higher than the sham operation group (P＜0.05),and the GdC13 group levels were obviously lower than ANP group.In the sham operation group,the expression of NF-κB was low and CYLD was high.In the ANP group,when compared to the sham operation group,the expression of NF-κB rose after 3 hours and continued to rise with time progression (P＜0.05).In contrast,CYLD protein expression in the ANP group dropped after 3 hours and continued to gradually decrease (P＜0.05).The CYLD and NF-κB protein expression in GdCl3 groups had similar trends as the ANP group.GdCl3 group CYLD levels began to rise at 6 hours (P＜0.05),and NF κB levels began to fall at 1 hour (P＜0.05).The expression of NF-κB and CYLD possessed a negative correlation in both the ANP and GdCl3 groups (r =-0.918,r=-0.723,P＜ 0.01).Conclusions Therefore,in acute lung injury associated with acute pancreatitis,CYLD expression decreased with evident phases,such as a decrease in levels after 3 hours,and NF κB expression increased.Also,GdCl3 may be responsible for upregulation of CYLD expression and downregulation of NF-κB expression,and confirmed that CYLD had a negative effect on NF-κB.Perhaps GdCl3 could be used in the future to ameliorate the lung injury associated with ANP.

BACKGROUND: Bone marrow mesenchymal stem cells (BMMSCs) can be induced differentiating into osteoblasts and chondroblasts, DNA methylate depressant 5-azacytidine can induce BMMSCs expressing myogenic regulating factors: Myf5 and myopoietin, which involving in the differentiation of BMMSCs into myoblasts.OBJECTIVE: Muscular traumatic fluid containing the highest protein content was screened out and co-cultured with BMMSCs,in order to explore the inductive effect on the proliferation and myogeneis of BMMSCs.DESIGN : Standardized comparative study.SETTING .:At State Key Laboratory of Trauma, Bums and Combined Injury,Institute of Combined Injury, Medical College of Preventive Medicine, Third Military Medical University of Chinese PLA.MATERIALS: Muscular traumatic model was established on 18 Balb/C pure rats for the extraction of muscular traumatic fluid, the inductive effect of the fluid on BMMSC was then compared with 5-azacytidine.METHODS:This study was carried out at State Key Laboratory of Trauma,Burns and Combined Injury, Institute of Combined Injury, College of Preventive Medicine, Third Military Medical University of Chinese PLA from April 2001 and September 2003. Bradford colorimetric was used to detect the protein content in the muscular traumatic fluid, and the fluid with the highest protein was used to co-culture with BMMSC, whose effect on the proliferation of BMMSC was measured with MTT methods at day 0, 3, 6, 9, 12, 15.RT-PCR technique was used to detect the expression of myopoietin at day 6,with its myogenic effect compared with that of 5-azacytidine.fluid on BMMSC.eration of BMMSC: the proloferative activity of BMMSC in traumatic fluid genic effect of traumatic fluid on BMMSC: myopoietin could not be found expressed in traumatic fluid group, but strongly expressed in 5-azacytidine group.CONCLUSION: Muscular traumatic fluid can promote the proliferation of BMMSC, but has no myogenic effect.