Objective To evaluate the effect of permissive hypercapnia on pulmonary function and in-flammatory responses of the collapsed lung of patients underwent video-assisted pulmonary lobectomy after one-lung ventilation.Methods Fifty patients,aged 38-65 years,ASA Ⅱ or Ⅲ,including 30 males and 20 females,scheduled for video-assisted pulmonary lobectomy were selected and divided into two groups ran-domly,with 25 patients in each group.During the surgery,PaCO2 of patients in group C were maintained during 35 to 45 mm Hg,while in group H the value were 55 to 65 mm Hg.The arterial blood samples were collected at 1 min before one-lung ventilate (T1 ),30 min after one-lung ventilate (T2 )and 30 min after re-flow of the collapsed lung (T3 )for arterial blood gas analysis,then the respiratory index of each patient was evaluated.Peripheral venous blood and bronchoalveolar lavage fluid draw from left lower lobar of the col-lapsed lung were collected to evaluate the levels of TNF-α,IL-6,and IL-10 at T1 ,T2 and T3 .The peak in-spiratory pressure,plateau pressure and tidal volume were also recorded to calculate lung dynamic compli-ance.Results Compared to group C,peak inspiratory pressure of group H was significantly higher;the IL-10 level of bronchoalveolar lavage fluid of the collapsed lung and the pulmonary dynamic compliance of group H were significantly higher at T2 and T3 ,and the concentrations of TNF-α,IL-6 of bronchoalveolar lavage fluid,the peak pressure,and respiratory index of group H were lower significantly at the same point of time (P <0.05).Conclusion Permissive hypercapnia would inhibit inflammation response of collapsed lung after one-lung ventilation effectively,improve lung diffusion capacity and pulmonary compliance.

To observed the Clinical effect of ropivacaine (Rop) of different concentration used for analgesia of labor, and ex plore the ideal concentration and dosage. Methods: 45 case s of ASA Ⅰ-Ⅱ primiparae nearing labor were vandomly divided three groups rand omly (0.16% Rop group, 0.2% Rop group were assigned 15 cases). The analgesia, in which the cervical os had opened up to 2-3cm; the controlled group was not giv en the analgesia of labor. BP, SpO2, EKG, PETCO2, cerrical contraction , fetal cardiac sounds were monitored continuously in the perinatal analgesia pe riod. The analgesia effects were determined by giving a mark for pain by VAPS, motor nerve blockings were given amark by Bromage scale; Apgar scale were conduc ted 1-5 min after neonates were labored out. Results: The vital signs of three groups were stable in perinatal; the VAPS scale was lower s ignificantly in observed group than in controlled group; while the blocking freq uency and extent of motor nerve were highest from 0.2% Rop, which had light inhi bitory effect to cervical contraction, causing the dosage of oxytocin to increas e relatively; the NACS scale 24 h after labor was more increased significantly in observed group than controlled group. Conclusion: The un ique blockings to sense and motor were obviously separate, having no obvious eff ect to blood stream of uterus and placenta, being benificial to analgesia in per inatal. The 0.16% Rop was a more ideal local anaesthesia agent than 0.2% Rop .

Objective To evaluate therapeutic effects of metformin on the expression of serum cytokines,balance of splenic Th17/regulatory T cells (Treg) and expression of splenic AMPK-mTOR in collagen-induced arthritis (CIA) rats,and the mechanism thereof.Methods The rat model of CIA was established by injecting bovine type Ⅱ collagen.Forty rats were randomly divided into five groups:the CIA model group(sterile water by gavage),Met-30 mg/kg group (metformin 30 mg ·kg-1 ·d-1 by gavage),Met100 mg/kg group(metformin 100 mg ·kg-1 ·d-1 by gavage),Met-300 mg/kg group(metformin 300 mg ·kg-1 ·d-1 by gavage) and control group (sterile water by gavage).The hind paw volume was recorded once a week.The serum level of cytokines,tumor necrosis factor (TNF)-α,interleukin (IL)-1β,IL-6,and IL-17,were measured by enzyme linked immunosorbent assay (ELISA) 35 days after the initial immunization.The quantity of Th17 and Treg cells were examined by flow cytometry.The expression of AMPK,p-AMPK,mTOR and p-mTOR were examined by western blotting.One-way analysis of variance was used to evaluate the experimental data.Results The values of hind paw volume were decreased on the 35 d of the initial immunization in the Met100 mg/kg [(2.43±0.37) ml,t=2.97,P＜0.05] and Met-300 mg/kg groups [(2.58±0.21) ml,t=2.96,P＜0.05] than those of CIA model group (2.97±0.23) ml.The serum levels of TNF-α,IL-1β,IL-6 and IL-17 on the 35-d after the initial immunization were significantly lower in the metformin therapeutic groups [Met-300 mg/kg group TNF-α (104±8) pg/ml,t=42.77,P＜0.05;IL-1β (183±24) pg/ml,t=60.457,P＜0.05;IL-6 (19.3±2.8) pg/ml,t=53.62,P＜0.05;IL-17 (64.5±6.7) pg/ml,t=47.92,P＜0.05] than those of the CIA model group [TNF-α (246±8) pg/ml;IL-1β (1 336±40) pg/ml;IL-6 (87.0±5.1) pg/ml;IL-17 (282.3±6.8) pg/ml].The quantity of Th17 and Treg cells were significantly different in the Met-300 mg/kg group than those of the CIA model group 35 d after the initial immunization [Th17(6.57±0.39) vs (9.89±0.53),t=8.74,P＜0.05;Treg (7.60±0.45) vs (3.94±0.61),t =8.37,P＜0.05].The expression of p-AMPK on the 35 d after the initial immunization in the metformin therapeutic groups was significantly higher than in the CIA model group(P＜0.05),and the expression of p-mTOR was significantly lower (P＜0.05).Conclusion Metformin can significantly inhibit the serum levels of TNF-α,IL-1β,IL-6 and IL-17 in CIA model rats,and regulate the balance of Th17/Treg through AMPK-mTOR signaling pathway.

Objective To explore the clinical efficacy of laparoscopic gastric ulcer perforation repair com-bined with Helicobacter pylori(Hp)cure.Methods Laparoscopic repair was used in the treatment of gastric ulcer perforation in 45 cases,and 42 cases of postoperative infection were combined Hp eradication therapy.Results The average operative time was 52.5min (36 -83min),mean blood 17.2mL(8 -45mL)in the 45 patients,with no sig-nificant intraoperative complications.The mean 4.5d (3 -8d)normally discharged after an average follow -up of 25 months (18 to 36 months)without significant complications and recurrent perforation.In 42 cases infected with Hp,cure rate of 97.6%,inefficiency of 3.4%,2 -year recurrence rate of 4.9%.Conclusion Laparoscopic gastric ulcer perforation is a minimally invasive,safe and effective surgical method.The surgery is simple,minimal trauma, less pain,faster recovery and fewer complications,Hp infected radical surgery combined with Hp eradication has good efficacy,less recurrence and important clinical significance and value.

BACKGROUND: Recently, one focus of research has been Annexin Ⅴ (AnV) existing on hepatic cells membranes as a fundamental receptor related to hepatitis B virus (HBV) infection. Also its expression in placental tissues has been a matter of debate. The study of the relationships between placental cells infected with HBV and their AnV expression will be of great value in future prevention strategies and treatments.OBJECTIVE: To investigate the presence of AnV in HBV infected human's placental cells and its potential role in HBV intrauterine transmission.DESIGN: Randomized controlled experiment.SETTING: Taishan Medical College.MATERIALS: Placental tissue was collected from HBsAg positive full term pregnant women (30 cases) admitted to Jinan Institute for Maternal and Child Health, Taian Central Hospital and Taian Institute for Maternal and Child Health from January 2003 to December 2004. Maternal serum was also obtained. Informed consents for participating in this study were obtained from all the involved pregnant women and this experiment was approved by the Hospital Ethics Committee. Rabbit-anti-human AnV purified affinity antibody (first antibody), rat-anti-human HBs mAb (first antibody),and biotinylated goat-anti-mouse IgG (secondary antibody) were supplied by Wuhan Boster Bioengineering Company.METHODS: Using SABC immunohistochemical staining reagent, 18 HBsAg positive placentas were obtained from 30HBsAg infected patients in full term pregnancy. These were considered as the positive group and the other 12 were used as negative controls. The staining process included dewaxing, dehydration of embedded slides and microwave antigen restoration. In the wet box, rabbit-anti-human AnV purified antibody (first antibody, 1:60, monoclonal antibody)was added on the slides and kept at 4 ℃ overnight. Rat-anti-human antibody HBs mAb(secondary antibody, 1:50) was added and kept at 4 ℃ ovemight, after this procedure, biotinylated goat-anti-mouse IgG(1:100), the first fluorescent antibody such as FITC-goat anti-rabbit IgG (1:50) and the second fluorescent antibody (Avidin-Cy3) were used,respectively. The slides were sealed with buffered glycerol and examined under a confocal laser scanning microscope.The images on the slides were analyzed with IPP 4.5 image programs.MAIN OUTCOME MEASURES: Detecting the simultaneous existence and distribution of HBsAg/AnV in placental cells with HBV infection.RESULTS: Ten cases from the positive group were simultaneously detected for HBsAg/AnV by double-labeled immunofluorenscence assay and confocal laser scanning microscope. AnV expression was detected in the trophoblastic, interstitial cells and vascular endothelial cells of villi interstitial blood vessels, and the coexistence of HBsAg/AnV was found even in one cell.CONCLUSION: HBsAg combined with the receptor AnV in the same placental cells is a common finding in HBV infected full term pregnant women. This finding is very suggestive of a mechanism where AnV could promote hepatitis B virus to enter the placental cells and cause intrauterine infection.

Objective To study the promotive effect of neovascularization on rats with cerebral infarction by nasal administration of granulocyte colony-stimulating factor.Methods A blinded,vehicle-controlled study of ING-CSF and IHG-CSF administration was performed by intraluminal middle cerebral artery occlusion (MCAO) model.All Sprague-Dawley rats were randomly divided into sham-operation group,model group,INNS group,IHGCSF group and ING-CSF group.The neurologic behavioral tests were assessed after reperfusion 72 h.Mter 72 h of MCAO,the brains of rats were stainned with TTC and the infarcted volume was calculated by computer image analysis.The expression of vascular endothelial growth factor (VEGF) in the brain was determined by immune-histochemistry.The density of angiogenesis in the brain was counted under fluorescence microscope.Results The score of neurological function of ING-CSF group(3.90± 1.65)was improved significantly compared with the IHG-CSF group (10.55±2.19) at the point of 72 h after cerebral infarction (P＜0.01).The cerebral infarct volume of ING-CSF group((20.01±3.29) ％) was reduced evidently compared with the IHG-CSF group((33.48±4.49) ％) at 72 h (P＜ 0.01);while the cerebral infarct volume of INNS group ((60.20±7.72) ％)was not markedly different compared with the model group((61.49±6.41)％) at 72 h (P＞0.05).The expression of VEGF in the brains of ING-CSF group was significantly higher than other groups at 72 h.Conclusion Intranasal administration G-CSF can improve neurological function and vascular angiogenesis in rats following MCAO.

Objective To analysis the changes of heart function in early stage after lung transplantation,and to explore its relationship with decreased pulmonary artery pressure.MethodsFrom 2002 to 2010,echocardiography results of 90 patients before and after lung transplantation in Wuxi People's Hospital were collected, 20caseshadcompletedateofpreoperativeandpostoperative echocardiography.Echocardiographic changes had been analyzed.Pearson linear correlation analysis was applied to determine the relationship between the early postoperative changes in cardiac structure and function and decreased pulmonary artery systolic pressure.ResultsPostoperative pulmonary artery systolic pressure ([38.30 ± 8.92]mm Hg) compared with preoperative([60.05 ± 29.10]mm Hg) was significantly lower(t =3.120, P = 0.006) , Postoperative right ventricular diameter was significantly reduced compared with the preoperative(t = 36.000, P = 0.008) , tricuspid and pulmonary valve regurgitation significantly reduced (t =57.000 and 66, Ps ＜ 0.05) .Postoperative left atrial diameter and left ventricular end diastolic diameter ([35.15± 5.73]mm and [43.25 ± 5.56]mm) compared with preoperative([32.40 ± 7.29]mm and [40.15 ± 6.20]mm)were significantly expanded (t =-2.384 and t =-2.153, Ps ＜ 0.05) .Although postoperative stroke volume ([59.54 ± 14.97]ml)compared with preoperative ([44.18 ± 15.85]ml)significantly increased (t =-3.918, P = 0.004) , but the postoperative left ventricular ejection fraction ([63.10 ± 8.48]％)compared with preoperative ([71.75 ± 8.10]％)was significantly decreased (t =3.742, P = 0.001) .Pearson linear correlation analysis showed the greater degree of decreased systolic pulmonary artery pressure after lung transplantation, the larger rate of increased postoperative left atrial diameter and left ventricular end diastolic diameter, and the bigger range of decreased postoperative LVEF (r = 0.642,0.737 and 0.448, P ＜ 0.05) .ConclusionIn early stage after lung transplant, right heart structure was normalization, right heart function improved,left heart enlarged, stroke volume increased, but left ventricular function reduced.There were a linear correlation between those changes and reduced systolic pulmonary artery pressure.

ObjectiveTo observe the clinical effect of acupoint application on lipid metabolism in elderly diabetics with hyperlipidemia.Methods60 elder diabetics were divided into two groups.In the drugs group,patients were purely treated with simvastatin or lipanthyl.In the acupoint group, patients received acupoint application.The serum total cholesterol(TC), triglyceride (TG), low-density lipoprotein (LDL-C), high-density lipeprotein (HDL-C), aPoprotein A(ApoA) and apoprotein B(ApoB) ere measured respectively.Adverse events were observed.ResultsThe levels of TC、TG、LDL-C、ApoB were significantly dechned(all P ＜0.01 ～0.05).However,the rates of reduce lipid had no significant difference in two groups(P ＞0.05).The levels of HDL-C and ApoA were increased in the drugs group,but the homologous levels in the acupoint group showed no significantly change(all p ＞ 0.05).The adverse reaction in the acupoint group was significantly lower than that in the drugs group(P ＜0.05).ConclusionAcupoint application could decrease the blood lipid spectrum in the senile diabetics with hyperlipidemia.This therapeutics could reduce adverse drug reactions.

BACKGROUNDCarinal resection and reconstruction is an emphasis in surgical treatment of carinal tumor and bronchogenic carcinoma involving carina. The aim of this study is to discuss the clinical value of carinoplasty in lung cancer surgery.

METHODSFrom 1982 to 2004, 41 cases of central bronchogenic carcinoma that invaded the carina accepted carinal resection and reconstruction in this hospital. Of the 41 patients, 25 patients underwent simutaneously additional cardiovascular plasty operation besides carinoplasty. There were 12 different types of carinal resection and reconstruction in this series.

RESULTSThere was 1 perioperative death (because of anastomotic leakage) in this group. Arrhythmia occured in 12 patients, atelectasis in 6 patient and pneumonia in 5 patients. Five patients were assisted ventilation through breathing machine because of pulmonary function failure. The 1-, 3-, and 5-year survival rates were 76.21%, 47.23% and 26.83% respectively.

CONCLUSIONSThe carinoplasty is a good method to treat central bronchogenic carcinoma which invaded the carina. With this method lung cancer tissue can be resected maximally, meanwhile, it can save pulmonary function of patient maximally. Postoperative multi-modality therapy is helpful to increase postoperative survival rate and improve quality of life.