OBJECTIVETo explore the effect of lappaconitine on patient-controlled intravenous analgesia (PCIA) and serum complement 3 and 4 (C3 and C4) levels of cancer patients undergoing rectum surgery.

METHODSTotally 60 patients, who were scheduled for rectum carcinoma surgery, were recruited to the study and assigned in 3 groups, the blank control group, the tramadol group, and the lappaconitine group, 20 in each group. Lappaconitine (8 mg) was intravenously dripped to patients in the lappaconitine group 30 min before ending the operation. PCIA started as soon as the end of the surgery and the total dose of lappaconitine was 36 mg. Patients of the tramadol group were treated with tramadol (100 mg) intravenously within 30 min before ending the operation. The dripping was completed within 30 min. PCIA was started as soon as the end of the surgery and the total dose of lappaconitine was 36 mg. Tramadol (100 mg) was intravenously dripped to patients in the tramadol group 30 min before ending the operation. PICA was started as soon as the end of the surgery and the total dose of tramadol was 900 mg. Pethidine (50 mg) and droperidol (2. 5 mg) was intramuscularly injected to patients in the blank control group for pain relief according to their complaints. Pain degrees were assessed by visual analog scale (VAS) 12 h before surgery, 12, 24, 48, and 72 h after surgery. Blood samples were withdrawn at the same time point. Contents of serum C3 and C4 were determined by immunoturbidimetry.

RESULTSVAS scores of the blank control group were significantly higher after surgery than before surgery (P <0. 01). There was no statistical difference in VAS scores between before surgery and after surgery in the tramadol group and the lappaconitine group (P >0. 05). VAS scores were significantly lower at each post-surgery time point in the tramadol group and the lappaconitine group than in the blank control group with statistical difference (P < 0.01). There was no statistical difference in VAS scores at each post-surgery time point between the tramadol group and the lappaconitine group (P >0. 05). Compared with before surgery, contents of serum C3 and C4 significantly decreased in all of the three groups at 12, 24, and 48 h after surgery (P < 0.05, P < 0.01). They recovered to the pre-surgery level till 72 h after surgery (P > 0.05). Serum C3 and C4 contents at 48 h after surgery were higher in the tramadol group than in the blank control group (P < 0.05). Serum C3 and C4 contents at 24 and 48 h after surgery were higher in the lappaconitine group than in the blank control group (P < 0.05). There was no statistical difference in serum C3 and C4 contents at each time point between the tramadol group and the lappaconitine group (P > 0.05). VAS scores were obviously negatively correlated with serum contents of C3 and C4 (r = -0.622, r = -0.649, P < 0.01).

CONCLUSIONSLappaconitine (used at the dose in this study) showed better pain relief effect after surgery. Besides, it could inhibit the surgic wound and pain, and elevate serum contents of C3 and C4.

Aconitine ; analogs & derivatives ; therapeutic use ; Analgesia, Patient-Controlled ; methods ; Analgesics, Non-Narcotic ; therapeutic use ; Complement C3 ; metabolism ; Digestive System Surgical Procedures ; Humans ; Neoplasms ; Orthopedic Procedures ; Pain Measurement ; Pain, Postoperative ; Postoperative Period ; Rectum ; surgery ; Tramadol

Objective To explore the trend of variation and relationship of postoperative pain and serum complement C 3 and C4 in cancer patients undergoing rectum surgery .Methods 100 patients ,who were scheduled for rectum carcinoma surgery ,were se-lected to the study .Pain was assessed by a visual analog scale at 12 h before operation and 4 ,8 ,12 ,24 ,48 ,72 ,120 h after surgery . The blood samples were obtained at the same time .The contents of serum complement C3 and C4 were determined by immunoturbi-dimetry .Results The VAS values in 4 ,8 ,12 ,24 ,48 ,72 h post-operation were significantly higher than 12 h pre-operation(P<0 .01) ,and in 120 h post-operation returned to 12 h pre-operation level .Compared with 12 h pre-operation ,the contents of serum complement C3 and C4 in 4 ,8 ,12 ,24 ,48 h post-operation were significantly decreased (P<0 .01) .The contents of serum comple-ment C3 and C4 returned to 12 h pre-operation level in 72 h post-operation .The results of correlative study on VAS values and the contents of serum complement C3 showed a negative correlation(r= -0 .622 ,P<0 .01) .The results of correlative study on VAS values and the contents of serum complement C4 also showed a negative correlation(r= -0 .649 ,P<0 .01) .Conclusion Postoper-ative pain can induce complement activation ,reduce the levels of serum complement C3 and C4 ,and inhibit immunoreactions .

Objective 6 recurrent cases of Primary retroperitoneal tumors(PRPT) after opertion were reviewed, to discuss the value of dignosis of recurrent PRPT in ultrasonography. MethodsAll (4 men and 2 women) were verified by operation and biopsy. Results4 of 6 cases were sarcomas, 4 cases were recurred once time, two times and four times each one. ConclusionUltrasonography can not only diagnose location of PRPT, but also provide reliable information for therapy or surgery. It can also be used in finding out the local recurrent masses after operation. Follow-up must be important in sarcoma.

Objective:To investigate the expression of apolipoprotein A-Ⅰ( ApoA-Ⅰ) in eight histo-logical types of renal neoplasms and to explore a new biomarker for differential diagnosis .Methods:The immunochemistry was used to detect the expression of ApoA-Ⅰ in 23 cases of renal tumors , including clear cell carcinoma , papillary cell carcinoma , chromophobe cell carcinoma , oncocytoma , multilocular cystic carcinoma , renal pelvis invasive urothelial carcinoma , metanephric adenoma and collecting ducts carcinoma.Five cases of cancer-adjacent normal tissues were obtained from another five renal tumor pa-tients and were chosen as control group .Results: In the 23 cases of renal tumors , ApoA-Ⅰ was ex-pressed in 21 cases(positive rate was 91.3%).There were only two in five cases of normal tissues which expressed this protein ( positive rate was 40 .0%) .A significant differentiation was observed between the two groups(Z=-2.829,P=0.003).In renal clear cell carcinoma(RCC), ApoA-Ⅰ expression level was correlated with the grade and stage of tumor tissues .ApoA-Ⅰ was stained much more stronger in RCCⅡ-Ⅲ than in RCCⅠ( Z=-2.070,P=0.038).In various histological types of renal cancer , ApoA-Ⅰwas all expressed to some degrees .Conclusion:ApoA-Ⅰcan be chosen as a tumor biomarker to differentiate various histological types of renal neoplasms .

Objective To explore the distribution of temperament types and its related influencing factors of school-age twins.Method Childhood temperament were evaluated by standardized Middle Childhood Temperament Questionnaire (MCTQ) in a total of 125 pairs of 8 to 12 years old twins,and temperament related factors were measured by FACES Ⅱ-CV.Results The majority of temperament types of school-age twins were easy and intermediate-low.Easy,intermediate-low,difficult,intermediate-high and start-to-warm up took a percent of 41.6％,38.0％,11.2％,6.4％ and 2.8％,respectively.The heritability of temperament types was 0.454.The distribution of temperament types were influenced by the family cohesion,parenting rearing style,zygotic,age,father's occupation,mother's educational level and the method of delivery.Conclusion The temperament types of school-age twins were both influenced by genetic and environmental factors.

Objective To investigate Toll-like receptor-4 (TLR4) protein expression in human pancreatic adenocarcinoma,and to evaluate the relationship between TLR4 protein expression and angiogenesis.Methods Sixty-two surgically resected human pancreatic adenocarcinoma specimens and 35 normal para-cancerous tissues were investigated for TLR4 protein expression by immunohistochemical SP methods,and CD31 antibody was used to mark microvascular endothelial cells and determine the microvessel density (MVD).The correlation among TLR4 protein expression and MVD and clinicopathologic features of pancreatic adenocarcinoma were analyzed.Results TLR4 protein positive expression rate and MVD in human pancreatic adenocarcinoma was 74.2％ (46/62) and 47.3 ± 13.5,respectively,which were significantly higher than those in the normal pancreatic tissue [17.1％ (6/35),12.6 ±4.8; P ＜0.01].TLR4 protein positive expression rate in the cases with lymph node metastasis was 83.8％,which was significantly higher than that in the cases without lymph node metastasis (60.0％,P =0.036).TLR4 protein positive expression rate in the patients with stage Ⅲ and Ⅳ of TNM classification was 85.3％,which was significantly higher than that in the patients with stage Ⅰ and Ⅱ (60.7％,P=0.028).MVD was closely related to tumor size,lymph node metastasis and TNM stage of pancreatic adenocarcinoma (P =0.008,0.036,0.010).There was a strong positive correlation between TLR4 protein expression and MVD (r =0.534,P ＜0.01 ).Conclusions TLR4 protein expression is closely related to the development and progression of human pancreatic adenocarcinoma and its potential mechanism is related to the promotion of tumor angiogenesis.

Objective To investigate the expression of peroxisome proliferator-activated receptor-γ(PPAR-γ) and angiotensin receptor (AT2R) in chronic pancreatitis tissue. Methods Between April 2006 and February 2009, 24 patients were pathologically diagnosed as chronic pancreatitis were enrolled and 12 samples of normal pancreatic tissues were treated as controls. Immunohistochemical staining was used to detect PPAR-γ and AT1R, AT2R expression in pancreatic tissues. Results PPAR-γ and AT1R were mostly negatively expressed in normal pancreatic tissues, the positive scores were 0.33±0.49 and 0.42 ± 0. 51, respectively, while AT2R were weakly positively or negatively expressed in acinus and islet cell, and it was weakly positively expressed in ductal epithelial cells, the positive score was 2. 33 ± 1. 37. In chronic pancreatitis tissue, PPAR-γ, AT1R and AT2R were positively expressed in acinus, ductal epithelial cells, and islet cell, the positive scores were 3.28 ± 2.46, 4.36 ± 2.80 and 4.61 ± 2.89, which were significantly higher than those in the normal group (P<0.01, P <0.01, P<0.05). Conclusions PPAR-γ, AT1R and AT2R were positively expressed in chronic pancreatitis tissue, and they may be the treatment target of chronic pancreatitis.

Objective To investigate the effects of sevoflurane pretreatment on renal ischemia-reperfusion (I/R)-induced apoptosis in kidney in rats. Methods Thirty pathogen-free male SD rats weighing 220-260 g were randomized into 3 groups (n=10 each):group control (group C);group I/R and group sevoflurane(group S). Renal I/R was induced by clamping the left renal pedicle for 45 min in I/R and S groups. In group S inhalation of 2.2% sevoflurane in O2 was started at 30 min before operation and maintained throughout the experiment.Venous blood samples were taken at 3 h of reperfusion for determination of serum BUN and Cr concentrations. The animals were then sacrificed and the left kidneys were removed for microscopic examination, detection of apoptosis(by TUNEL)and determination of heme oxygenase-1(HO-1) mRNA and protein expression (by RT-PCR and Western blot).Results Renal I/R significantly increased serum BUN and Cr concentrations, apoptotic index(percentage of apoptotic cells) and the severity of necrosis of renal proximal convoluted tubules (0=normal,4=necrosis of whole segment of proximal convoluted tubules).Sevoflurane inhalation attenuated the I/R-induced changes mentioned above.HO-1 mRNA and protein expression was up-regulated by I/R and HO-1 mRNA expression was further up-regulated by sevoflurane inhalation.Conclusion Sevoflurane pretreatment can protect kidney against I/R injury by attenuating cell apoptosis.Up-regulation of HO-1 mRNA expression may be involved in the mechanism.

Objective To investigate the effect of α-tocopherol on fibrosis of chronic pancreatitis (CP) rat and explore its mechanism.MethodsMale Wistar rats were randomly divided into control group,acute necrotizing pancreatitis (ANP) group,α-tocopherol group.CP was induced by dibutyltindich loride ( 8 mg/kg) infusion into the tail vein.Gastric lavage of α-tocopherol (800 mg/kg body weight,daily) was started 24 hours after dibutyhindich loride infusion for 4 weeks.The rats in ANP and control group received 0.6 ml salad oil gastric lavage.The rats were sacrificed 4 weeks later.Pancreatic tissue was harvested for histological examination and collagen staining,and measurement of the levels of hydroxyproline and malondialdehyde (MDA) of the pancreas were performed.The mRNA expression of transforming growth factor (TGF)-β１ was measured by real time PCR.ResultsAfter gastric lavage for 4 weeks,the pancreatic tissue inflammation,fiber deposition and abnormal structure in rats of α-tocopherol group were greatly reduced.The levels of MDA and hydroxyproline in rats of α-tocopherol group were significantly lower than those in ANP group [ (0.40 ±0.20) vs (1.07 ±0.41) nmol/100mg,(402.49 ±27.62) vs (664.92 ±29.04) μg/g,P＜0.05].The expressions of TGF-β1 mRNA in rats of o-tocopherol group were significantly lower than those in ANP group (2.24 ± 0.89 vs 3.35 ± 0.66,P ＜ 0.05 ).Conclusions Tocopherol gamma can improve pancreatic inflammation and fibrosis by reducing the oxidative stress level and down-regulating the expression of TGFβ1mRNA in rats with CP.

Objective To observe the changes of inflammation cytokines in pancreas tissues of experimental acute necrotizing pancreatitis (ANP) rats treated with rhubarb.MethodsThirty-three rats were randomly divided into sham operation group,ANP group and rhubarb treatment group with 11 rats in each group.ANP model was induced by retrograde injection of 3％ sodium taurocholate into the biliopancreatic duct,and jejunostomy was performed.Rats in rhubarb treatment group were fed with 1 g/ml rhubarb at the dose of 1 ml/kg body weight via jejunum route.Thirty-six hours later the rats were sacrificed.The serum level of amylase was measured; part of the pancreatic tissue was harvested for routine pathologic examination; total RNA was extracted from pancreatic tissue.The expression of IL-6,IL-8,and TNF-α mRNA was measured by real-time PCR.ResultsAfter ANP induction,the serum level of amylase was significantly increased,and pancreatic tissue necrosis,bleeding and inflammatory cell infiltration were observed,which was consistent with changes of ANP.The expressions of IL-6,IL-8,and TNF-α mRNA were 0.29 ±0.13,0.35 ±0.15,1.09 ±0.32 in sham operation group,while they were 2.23 ±0.49,2.26 ±0.51,5.24 ±0.59 in ANP group,which were significantly higher than those in sham operation group ( P ＜ 0.05 ).The corresponding values were 0.97 ±0.30,1.02 ±0.34,2.59 ±0.36 in rhubarb treatment group,which were significantly lower than those in ANP group,but they were still significantly higher than those in sham operation group ( P ＜ 0.05 ).ConclusionsRhubarb lavage via jejunum route can decrease the expressions of IL-6,IL-8,and TNF-α,therefore attenuate the pancreatic pathologic injuries.