Objective To assess the anesthetic effect of different concentrations of hyperbaric ropivacaine used in lumbar anesthesia for elderly transurethral prostatic resection. Methods We randomly divided 58 elderly patients who un-derwent transurethral prostatic resection with ASA (American Surgical Association) physical status level Ⅰ-Ⅱ into 2 groups as group A and B, using numeric random table method. Each group includes 29 cases. After being punctured between L3-L4, patients were injected with 0.5%(group A) and 0.75%(group B) hyperbaric ropivacaine (diluted with 10%glucose) to the subarachnoid space in a speed of 0.1-0.3 mL/s and the overall dose was 12.5 mg in each case. Then the extents of sen-sory and motor block were compared between two groups, and their anesthesia effect and adverse reactions were also record-ed. Results Compared with group A, onset time of sensory block in group B was significantly shorter (P＜0.05), while onset time for motor block was of no significant difference;By contrast to group A, acting time of sensory block in group B pro-longed significantly (P＜0.05) while acting time of motor block was of no statistically significant difference(P>0.05);By con-trast to group A, the anesthesia effect of group B was more effective while the adverse reactions of the two groups was of no significant difference (P>0.05). Conclusion 0.75%hyperbaric ropivacaine in lumbar anesthesia for elderly patients un-dergoing transurethral prostatic resection could provide a better anesthesia and analgesia effect than 0.5%hyperbaric ropiva-caine without more significant adverse reactions.

Objective To assess the association of vascular endothelial growth factor (VEGF) gene-460C/T and-634C/G polymorphism with diabetic retinopathy (DR) among patients in Asia and European by meta-analysis.Methods A systematic search of electronic databases (PubMed,Cochrane Library,EMBASE,VIP,Wanfang technological,CNKI,etc.) was carried out until Jun,2014.Case-control studies on the relationship between genetic polymorphism of VEGF-460C/T and VEGF-634C/G with diabetic retinopathy were included in this analysis.The data were quantitatively analyzed by RevMan 5.0 software after assessing the quality of included studies.The pooled odds ratios (OR) and their corresponding 95％ confidence intervals (CI) were used to assess the strength of the association.Results VEGF-460C/T (7 studies:899 cases and 786 controls) and VEGF-634C/G (10 studies:1615 cases and 1861 controls) were inclued in this meta-analysis.Significant association was found for-460C/T polymorphism in Aisa (C versus T:OR=1.52,95％CI was [1.22,1.90],Z=3.72,P=0.0002;CC versus CT+TT:OR=1.61,95％CI was [1.19,2.19],Z=3.05,P=0.002;TT versus CT+CC:OR=0.64,95％CI was [0.41,0.98],Z=2.07,P=0.04),and VEGF-634CC gene type was associated with DR in European (OR=1.56,95％CI [1.08,2.25],Z=2.37,P=0.02).No significant publication bias was found.Conclusions The metaanalysis demonstrated that DR was associated with VEGF-460C/T polymorphism in Asia,and C alleles and CC gene type was the risk polymorphism;VEGF-634C/G polymorphism was not associated with DR,but its CC genotype maybe the risk factor in European.Further case-control studies based on larger sample size are still needed,especially for-634C/G polymorphism.

Objective To determine the median effective effect-site concentration (EC50 ) of remifentanil inhibiting responses to laryngeal mask airway insertion when combined with propofol in elderly male patients . Methods Thirty ASA physical status Ⅰ or Ⅱ male patients ,aged 65>yr ,with body mass index <30 kg/m2 , scheduled for elective transurethral resection of bladder tumor or prostate under general anesthesia ,were enrolled in this study .Anesthesia was induced with target-controlled infusion of propofol with a target plasma concentration (Cp) of 3 μg/ml .When Observer′s Assessment of Alertness/Sedation (OAA/S ) score ≤1 ,remifentanil target-controlled infusion was started with the initial target Cp set at 4.0 ng/ml . The concentration of propofol was adjusted until BIS value reached 55-65 ,and then the laryngeal mask airway was inserted .Modified Dixon’s up-and-down method was used to determine the Cp of remifentanil . Each time the Cp of remifentanil increased/decreased in the next patient depending on whether or not the response to laryngeal mask airway insertion occurred . The ratio of the two successive Cps was 1.2 .The response to laryngeal mask airway insertion was defined as development of coughing ,laryngospasm and/or body movement during insertion or within 3 min after insertion .The number of patients in whom inhibition of responses to insertion was effective/ineffective was recorded .The EC50 of remifentanil required to inhibit responses to laryngeal mask airway insertion and the 95% confidence interval when combined with propofol were calculated .Results The EC50 (95% confidence interval ) of remifentanil required to inhibit responses to laryngeal mask airway insertion was 1.86 (1.64-2.12) ng/ml when combined with propofol in elderly male patients .Conclusion The EC50 of remifentanil required to inhibit responses to laryngeal mask airway insertion is 1.86 ng/ml when combined with propofol in elderly male patients .

Objective To evaluate the efficacy of entecavir treatment in chronic hepatitis B virus ( HBV ) infected patients with mild hepatic dysfunction and marked pathological injury.Methods One hundred and fifty five chronic hepatitis B ( CHB) patients with HBV DNA>1.0 ×104 U/mL admitted in Lishui People’ s Hospital during January 2008 to October 2011 were enrolled in the study.Patients were divided into three groups: those with serum ALT <2 ×ULN and liver inflammation injury ≥G2 and/or fibrosis stage≥S2 were in observation group ( n=75 ); patients with ALT ( 2-5 ) ×ULN were in control group 1 (n=38);patients with ALT>5 ×ULN were in control group 2 (n=42).All patients were given entecavir (0.5 mg, 1/d, p.o) treatment.ALT normalization rates, HBV DNA negative rates, HBeAg negative conversion rates and seroconversion rates at 12-, 24-,48-, 96-and 144-week were observed and compared among groups.Variance analysis andχ2 test were performed for measurement data and numeration data, respectively.Results ALT normalization rates in observation group were 86.7%, 90.7%, 90.7%, 92.0%and 96.0%at 12-, 24-, 48-, 96-and 144-week, which were higher than those in control group 1 (χ2 =2.04, 2.15, 2.78, 2.69 and 2.47, P <0.01), but no statistically significant difference was observed between observation group and control group 2 (χ2 =2.53,2.42,2.09,2.24 and 2.32,P>0.05) . HBV DNA negative rates in observation group were 70.7%, 78.7%and 82.7%at 12-, 24-and 48-week, which were higher than those in control group 1 (χ2 =4.56, 4.23 and 4.28, P<0.05), but no statistically significant difference was observed between observation group and control group 2 (χ2 =2.75, 2.62 and 2.98, P>0.05).HBeAg negative conversion rates in observation group were 6.6%, 21.3%and 25.3%at 48-, 96-, and 144-week, which were higher than those in control group 1 (χ2 =4.68, 4.78 and 5.01, P<0.05), but no statistically significant difference was observed between observation group and control group 2 (χ2 =2.24, 2.57 and 2.13, P>0.05).HBeAg seroconversion rate in observation group was 4.0%at 24-week, which were higher than that in control group 1 (χ2 =2.87, P <0.05), but the seroconversion rates at 96-and 144-week were lower than those in control group 2 (χ2 =2.92 and 3.14, P<0.05).Conclusion The efficacy of entecavir treatment for HBV infected patients with mild hepatic dysfunction and marked pathological injury is satisfactory.

Objective To observe the effect of Sini decoction on inflammatory response and immune function in septic rats and to discuss its possible mechanism.Methods 66 Sprague-Dawley (SD) rats were randomly divided into normal control group (n=6),model group (n=30),and Sini decoction group (n=30).Septic model was reproduced by intraperitoneal injection of lipopolysaccharide (LPS,5 mg/kg).After the reproduction of sepsis,rats in Sini decoction group received Sini decoction (5 g/kg) by gavage,while those in model group were given equal dose of normal saline in the same way.Rats in normal control group did not receive any treatment.Blood was collected via eye sockets at 2,12,24,48,72 hours after LPS administration,then the rats were sacrificed.The concentrations of inflammatory mediators,such as interleukin (IL-1,IL-6,IL-10),tumor necrosis factor-α (TNF-α),and the expression level of monocyte human leukocyte antigen-DR (HLA-DR) were determined with enzyme linked immunosorbent assay (ELISA),and the pathological changes in intestinal mucosa were observed under electron microscope.Results The concentration of IL-1 (ng/L) at 2 hours in model group was gradually increased and peaked at 48 hours (4.07 ± 0.10),and then gradually decreased,while the IL-1 level in Sini decoction group peaked at 12 hours (2.98 ± 0.12) followed by a gradual decrease.IL-6 (ng/L) in model and Sini decoction groups peaked twice at 12 hours (91.39 ± 1.55,73.00 ± 2.38) and 48 hours (82.51 ± 1.49,64.68 ± 1.68) respectively.IL-10 (ng/L) in model group gradually decreased after peaking at 2 hours (86.66 ± 6.12),and that in Sini decoction decreased at 12 hours (71.61 ± 2.35) followed by an increasing tendency,and approached normal level at 48 hours (109.09 ±4.77 vs.124.01 ± 7.89,P＞0.05).TNF-α (ng/L) in model group was gradually increased and peaked at 48 hours (83.37 ±3.79),and that in Sini decoction peaked at 12 hours (48.52 ± 1.21),and decreased to normal level at 72 hours (18.59 ± 1.97 vs.15.50 ± 2.68,P＞0.05).During the course of the experiment,as compared with those of the model group,level of IL-1,IL-6,and TNF-α were significantly lower at all time points in Sini decoction group,and IL-10was significantly higher.The expression level of HLA-DR (μg/L) in model and Sini decoction groups peaked at 2 hours (4.86 ± 0.15,4.85 ± 0.17),and then gradually lowered.HLA-DR expression μg/L) at 48 hours and 72 hours in Sini decoction group was significantly lower than that in model group (48 hours:4.21 ± 0.12 vs.2.74 ± 0.16,72 hours:3.80 ± 0.09 vs.2.27 ± 0.12,both P＜0.01).Pathological study of intestinal mucosa showed that the intestinal mucosa were infiltrated significandy by inflammatory cells,and villi were damaged severely in both model group and Sini decoction group at 2 hours after LPS challenge.Infiltration of inflammatory cells in Sini decoction group was less intense after 12 hours,and the intestine villi repair was more obvious compared with model group.Conclusion Sini decoction could regulate systemic inflammatory response,and promote the repair of intestinal mucosa,the intestinal function and the immune status of septic rats.

Objective To compare the effects of aspirin and clopidogrel on platelet aggregation function by TEG,and to study the antiplatelet agents tailored therapy of Thrombelastography(TEG)in treatment of cerebral infarc-tion patients.Methods 100 patients with acute cerebral infarction were included in two groups:aspirin group and clopidogrel group.The inhibitory rates of AA and ADP receptor pathway in platelets were detected by TEG.The effect of inhibitory rates in group aspirin and clopidogrel was compared with nerve function and the recurrence rate of stroke. Results The inhibitory rates of group aspirin (85.23 ±21.98)% was higher than group clopidogrel (47.31 ± 22.37)% (t =7.340,P =0.005).The patients with which the inhibitory rates showed goodby TEG in group aspirin and clopidogrel got better neurological recovery,and the patients showed goodby TEG in group aspirin got lower stroke recurrence rate within 1 year(χ2 =4.460,P =0.035;χ2 =7.232,P =0.007).Conclusion TEG had guided the antiplatelet individual therapy for cerebral infarction patients,and can be used to predict and confirm the efficacy of antiplatelet drug.

Objective To evaluate the role of glycogen synthase kinase-3 beta (GSK-3β) in spinal cord ischemia/reperfusion (I/R) injury in rats.Methods Forty-eight male Sprague-Dawley rats,aged 3 months,weighing 250-300 g,were randomly divided into 3 groups (n =16 each) using a random number table:sham operation group (group S),group I/R and I/R+ GSK-3β inhibitor LiCl group (group LiCl).The animals were anesthetized with intraperitoneal 10％ chloral hydrate 300 mg/kg.Spinal cord ischemia was induced by 45 min occlusion of the abdominal aorta followed by reperfusion.In I/R and LiCl groups,normal saline 5 ml and LiCl 15 mg/kg were injected,respectively,via the caudal vein at 30 min before ischemia.The animals were sacrificed at 48 h of reperfusion and the lumbar segment (L4-6) of spinal cords was removed for microscopic examination and for determination of neuronal apoptosis in the anterior horn of the spinal cord (by TUNEL),and the expression of interleukin-6 (IL-6),IL-8 and IL-10 was detected (by immunohistochemistry).The apoptosis rate was calculated.Results Compared with group S,the apoptosis rate was significantly increased,IL-6 and IL-8 expression was upregulated,and IL-10 expression was down-regulated in I/R and LiCl groups.Compared with group I/R,the apoptosis rate was significantly decreased,IL-6 and IL-8 expression was down-regulated,IL-10 expression was up regulated,and the pathological damage was attenuated in LiCl group.Conclusion Activated GSK-3β is involved in the development of spinal cord I/R injury possibly by promoting synthesis and release of inflammatory factors in rats.

Objective To investigate the effect of propofol on rat′s limb ischemia reperfusion injury .Methods Sixty healthy SD rats were randomly divided into sham operate group ,ischemia-reperfusion group and propofol group (n= 20) ,each group was divided into 4 subgroups according to the different reperfusion time .To copy the right lower limb ischemia reperfusion model ,5 min before reperfusion ,use propofol injection (50 mg/kg ,intraperitoneal inject) ,various subjects in the corresponding time points (3 ,6 , 9 ,12 h) were sacrificed .TNF-α ,NF-κB of blood and MDA ,SOD of Skeletal muscle were measured ,calculate muscle wet dry weight ratio .Results Compared with ischemia reperfusion group ,propofol could significantly reduce expression of TNF-alpha ,NF-κB lev-els in serum (P< 0 .05) ,inhibit the increase of the MDA level and decrease of the SOD level in muscle (P< 0 .05) ,also reduce the extent of skeletal muscle cell edema(P< 0 .05) .Conclusion Propofol can attenuate limb ischemia reperfusion injury by inhibiting inflammation response and reducing the oxygen free radicals′ damage .

Objective To investigate the effects of valproic acid ( VPA ) on SD rats with experimental autoimmune encephalomyelitis ( EAE) and its possible immunomodulatory mechanism .Meth-ods Fifty female Sprague-Dawley ( SD) rats were randomly divided into five groups by random digit table , including control group (n=10), EAE group(n=10), low dose VPA treated group (100 mg/kg, n=10), median dose VPA treated group (300 mg/kg, n=10) and high dose VPA treated group (600 mg/kg, n=10).The SD rat model of EAE was induced by immunizing with a guinea pigs′spinal cord homogenate (GPSCH).Normal saline and various doses of VPA were given to rats in according groups twice a day from day 0 to day 19 ( close to the peak stage of EAE ) .The severity of EAE was scored according to the signs and symptoms.Pathological changes were observed through Hematoxylin-Eosin staining, and then the degrees of inflammatory infiltration were evaluated .The numbers of activated neuroglia that expressed Iba-1 in cerebral and lumber cords were counted by immunohistochemistry .The expression of IFN-γ, IL-17 and IL-10 in cer-ebral and lumber cords were measured by ELISA .Results Compared with EAE group , rats in the low, me-dian and high dose VPA treated groups had lower incidence of EAE and prolonged latency , but only the me-dian dose treated group showed significant alleviation in clinical symptoms (P<0.05).Both the median and the high dose treated group showed decreased inflammatory cell infiltration in CNS (P<0.05).Immunohisto-chemistry results showed that the numbers of activated microglia were significantly inhibited in rats treated with median and high dose of VPA in comparison with those in EAE group (P<0.05).Results of ELISA demonstrated that the expression of IFN-γand IL-17 in both median and high dose VPA treated groups were significantly decreased compared with those in EAE group (P<0.05), but only the median dose treated group showed a remarkably increased expression of IL-10 (P<0.05).Conclusion VPA, especially medi-um dose of VPA ( 300 mg/kg ) , had neuroprotective effects on rats with EAE .The possible mechanism might be associated with the inhibited activation of microglia and the increased percentage of anti -inflammato-ry cytokines .

Objective To investigate the clinical efficacy of combination therapy of ambroxol with vibration? expectoration machine on ventilator-associated pneumonia Methods A total of 96 patients from the Department of Critical Care Medicine were selected and randomly divided into 3 groups:control group,ambroxol group and ammonia ambroxol + vibration expectoration machine group (n=32,each).The ventilator-associated pneumonia (VAP) was randomly divided into three groups (n =32,each).All patients were treated with conventional therapy including anti-inflammatory,suction,airway humidification,nutritional support.On this basis,ambroxol group was given ambroxol 30 mg in 100 ml normal saline,intravenously dripped 3 times a day.On the basis of treatment in the ambroxol group,ammonia ambroxol + expectoration machine were given G5 vibration expectoration machine to expectorate sputum 2 times every other day.Results There were significant differences in acute physiology and chronic health evaluation (APACHE Ⅱ),PaO2/FiO2,respiratory rate (RR),heart rate (HR) before versus after the treatment of the three groups (F =5.736,9.432,6.361,5.862,respectively,all P＜0.05).After treatment in the three groups,APACHE Ⅱ,PaO2/FiO2,RR and HR showed statistically significant differences inter-group among three groups (F=4.674,8.665,7.351,6.562,respectively,all P＜0.05).Clinical effective rates of the three groups were 71.9％,84.4％,93.8％ respectively,and showed statistically significant differences inter-group among three groups (all P＜0.05).Conclusions Combination therapy of ambroxol and vibration expectoration machine shows significant effects on VAP,and it is better than ambroxol alone.