Objective To analyze the clinical application of double tube laryngeal mask airway in endoscopic retrograde cholangiopancreatography under total intravenous anesthesia. Method 60 patients between the ages of 60 and 80 years who were scheduled for elective ERCP were enrolled. The patients were randomly assigned to two groups: groups A and B. Those in group A underwent the procedure with sedation without any airway instruments and those in group B underwent procedure after sedation and airway management with double tube laryngeal mask airway. Intraoperative and postoperative vital signs as well as the satisfaction of the endoscopists were recorded. Result The time of successful insertion of esophagus in group B was shorter than that in group A, and the visual analogue score of pain in group B was lower than that in group A, and the satisfaction degree of endoscopic physicians in group B was higher than that in group A. The incidence of desaturation during ERCP was significantly higher in group A than in group B. Conclusion In conclusion, ERCP should be performed under optimal conditions to avoid the occurrence of unwanted complications, such as aspiration-related disorders. Therefore, according to the structural properties of double tube laryngeal mask airway, sedation anesthesia application with double tube laryngeal mask airway in ERCP will be safer, more comfortable, and more effective.

OBJECTIVETo investigate the expression of RhoA and NF-κB in gastric carcinoma and their correlation with clinicopathological fearures. To determine the effective prognostic factors of long-term suivival of gastric carcinoma patients.

METHODSThe role of RhoA and NF-κB in gastric carcinoma was assessed by tissue array technology and the levels of RhoA and NF-κB expression in paraffin-embedded tissues was quantified by immunohistochemistry from 189 cases of gastric carcinoma, 54 cases of their adjacent tissues, and 32 cases of normal gastric mucosa. The prognosis of gastric carcinoma was evaluated by Kaplan-Meier survival analysis and Cox multivariate regression analysis.

RESULTSThe positive rates of RhoA expression were 84.7%, 68.5% and 65.6% in gastric carcinoma, adjacent tissues and normal mucosa, respectively. The expression of RhoA in gasric carcinoma was significantly higher than that in adjacent tissues and normal mucosa (P < 0.05). The positive rates of NF-κB expression were 75.1%, 42.6% and 15.6%% in gastric carcinoma, adjacent tissues and normal mucosa, respectively. The expression of NF-κB in gasric carcinoma was significantly higher than that in adjacent tissues and normal mucosa (P < 0.05). RhoA was positively linked with NF-κB (r = 0.203, P = 0.005). In gastric carcinoma, the expression of RhoA was related with depth of invasion (P < 0.05), and the expression of NF-κB was related with depth of invasion and lymph node metastasis (P < 0.05). The Kaplan-Meier survival analysis showed that the tumor size, lymph node metastasis, depth of invasion, expression of RhoA and NF-κB can shorten the cumulative survival rate. With these paramaters entering the Cox multivariate regression analysis mode, it was revealed that expression of NF-κB, lymph node metastasis and depth of invasion are independent prognostic factors.

CONCLUSIONSThe overexpression of RhoA and NF-κB is involved in the occurrence and development of gastric carcinoma. RhoA is positively linked with NF-κB. They are correlated with the invasion and metastasis of gastric carcinoma. The expression of NF-κB, lymph node metastasis, depth of invasion are independent prognostic factors playing an important role in prediction of the clinical outcome after radical resection of gastric carcinoma.

Adult ; Aged ; Carcinoma ; metabolism ; pathology ; Female ; Follow-Up Studies ; Gastric Mucosa ; metabolism ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; NF-kappa B ; metabolism ; Neoplasm Invasiveness ; Proportional Hazards Models ; Stomach Neoplasms ; metabolism ; pathology ; Survival Rate ; rhoA GTP-Binding Protein ; metabolism

Objective To study the airway patency during sitting position and supine position in bronchoscopy during anesthesia. Method Forty-eight patients underwent bronchoscopy during Non-intubation anesthesia were randomly allocated to two groups.There were 24 cases in each group by observeing the airway patency and vital signs of the two groups during the procedure. Result Sitting position in bronchoscopy during anesthesia have the shorter average time to reach the carina, on securing a clear airway. The incidence of desaturation, hypertension and agitation were lower in sitting position during bronchoscopy. Conclusion Bronchoscopy anesthesia can reduce discomfort and fear, but traditional supine bronchoscopy anesthesia can cause displacement of the tongue, collapse of the upper airway in the oropharynx, soft palate and vocal cord related to gravity may seriously obstruct the upper airway, not only brings inconvenience to the inspection, but also increases the risk of airway correlation and hemodynamic instability, Sitting bronchoscopy ensure the airway patency and maintain a more stable hemodynamic state, so that sitting position in the sedation of bronchoscopy anesthesia is safer and more convenient.

Objective:To evaluate the accuracy of lung recruitment maneuver (LRM) combined with brachial artery peak velocity variation (ΔVp) in predicting fluid responsiveness.Methods:Sixty-four patients of both sexes, aged 18-64 yr, with body mass index 19-26 kg/m 2, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with New York Heart Association class Ⅰor Ⅱ, scheduled for elective open gastrointestinal surgery under general anesthesia, were enrolled in this study.LRM (positive airway pressure was maintained at 30 cmH 2O for 10 s) and volume loading test were performed in sequence after anesthesia induction.ΔVp was measured by ultrasonography at the beginning of LRM.Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) and stroke volume (SV) were recorded before LRM (T 1), during LRM (T 2), before volume expansion (T 3) and after volume expansion (T 4). The changing rate of each index before and after LRM (ΔMAP LRM, ΔHR LRM, ΔCVP LRM, ΔSV LRM) and before and after volume expansion (ΔMAP VE, ΔHR VE, ΔCVP VE, ΔSV VE) were calculated.ΔSV VE≥15% was considered to be a positive response after volume expansion, and patients were divided into response group (≥ 15%, R group) and non-response group (< 15%, NR group). Results:There were 34 cases in R group and 30 cases in NR group.Compared with NR group, MAP at T 2 and SV at T 1, 2 were significantly decreased, ΔMAP LRM, ΔMAP VE, ΔSV LRM and ΔSV VE were increased, and ΔVp was increased in group R ( P<0.05). There was a positive correlation between ΔVp and ΔSV VE ( r=0.829, P<0.05), a negative correlation between ΔSV LRM and ΔSV VE ( r=-0.876, P<0.05), and a negative correlation between ΔVp and ΔSV LRM ( r=-0.819, P<0.05). The area under the receiver operating characteristic curve of LRM combined with ΔVp was 0.808, and the cut-off value was 32.3%, the sensitivity 75.3%, and the specificity 88.2%. Conclusion:LRM combined with ΔVp (≥32.3%) can accurately predict the intraoperative fluid responsiveness in patients.

OBJECTIVETo analyze the phenotype and genotype of a family with inherited dysfibrinogenemia.

METHODSAssays of coagulation, including activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time (TT), were carried out with Stago Compact in the proband and his family members. The activity and antigen of fibrinogen in plasma were determined by Clauss and immunoturbidimetry, respectively. Fibrinogen and its constituent were analyzed by Western blot with nonreducing 4%-20% SDS-polyacrylamide gel electrophoresis (PAGE). All exons and exon-intron boundaries of fibringen genes FGA, FGB and FGG were analyzed by PCR and then direct sequencing.

RESULTSThe proband had normal APTT and PT, but prolonged TT. The activity of fibrinogen in plasma was decreased while its antigen level was normal. These abnormalities were also found in his mother and a sister. Genetic analysis revealed heterozygous G1233A in the exon 2 of FGA originating from his mother, which resulted in Arg16His missense mutation.

CONCLUSIONInherited dysfibrinogenemia was caused by Arg16His mutation in exon 2 of FGA, and this is the first case reported in a Chinese family.

Fibrinogen ; genetics ; Genotype ; Humans ; Mutation ; Pedigree ; Phenotype

Objective To develop a matrix metalloproteinase(MMP)-responsive hyaluronic acid(HA)-based controlled-release material for brain-derived neurotrophic factor(BDNF)to provide a novel therapeutic strategy for intervention and repair of traumatic brain injury(TBI).Methods HA was modified with amination,followed by condensation with Suflo-SMCC carboxyl group to form amide,and then linked with glutathione(GSH)to synthesize HA-GSH.The recombinant glutathione S-transferase(GST)-tissue inhibitor of metalloproteinase(TIMP)-BDNF(GST-TIMP-BDNF)expression plasmid was constructed using molecular cloning technique with double enzyme digestion by Bam H Ⅰ and Eco R Ⅰ.The recombinant GST-TIMP-BDNF protein was expressed in the Escherichia coli prokaryotic expression system,and purified by ion exchange chromatography,confirmed by Western blotting.MMP diluents were supplemented with PBS,MMP inhibitor marimastat,and varing concentrations(0.4,0.6,0.8 mg/ml)of GST-TIMP-BDNF or GST-BDNF.MMP-2 activity was analyzed using an MMP activity detection kit to evaluate the inhibitory effect of the recombinant protein on MMP.Primary rat neurons were extracted and cultured to establish an iron death model induced by RSL3.The effect of recombinant protein GST-TIMP-BDNF on neuronal injury was detected by immunofluorescence staining.Results MRI hydrogen spectrum identification confirmed the successful synthesis of HA-GSH.Western blotting results showed the successful expression of the recombinant protein GST-TIMP-BDNF containing the GST tag using the E.coli prokaryotic expression system.MMP activity detection results indicated that the recombinant protein GST-TIMP-BDNF had a superior inhibitory effect on MMP-2 activity compared to GST-BDNF(P<0.05).Immunofluorescence staining results showed a significant increase in fluorescence intensity in rat neurons treated with GST-TIMP-BDNF after RSL3 induction(P<0.05).Conclusion A MMP-responsive HA-based BDNF controlled-release material has been successfully developed,exhibiting a protective effect on neuron damage.

Macrophages are a group of immune cells with pluripotency and plasticity that can differentiate into different phenotypes under different microenvironments in vitro and in vivo. In the development of pulmonary fibrosis, there are alveolar macrophages and interstitial macrophages, which are polarized to different cell phenotypes at different stages of development. And their polarized phenotypes include M1 macrophages and M2 macrophages. In the inflammation early stages of pulmonary fibrosis, the increase of classical activated macrophages are helpful to clear pathogenic microorganisms and promote the progress of inflammation. In the fibrosis stage, the alternatively activated macrophages increased, which inhibiting the inflammatory reaction or directly promoting tissue fibrosis, on the other hand, it also promoting the fibrosis degradation. To clarify the polarization and polarization mechanisms of macrophages in pulmonary fibrosis will be conducive to the treatment of pulmonary fibrosis. In IPF, the polarization mechanism of M1 and M2 is closely related to TGF-β1/Smad. TGF-β1/Smad pathway plays an important regulatory role in liver fibrosis, renal fibrosis, myocardial fibrosis, scars, tumors and other diseases. Blocking the signaling of TGF-β1 by Smad3 and Smad4 is beneficial to inhibit the polarization of AM, which in turn helps to inhibit the progression of IPF.
Fibrosis ; Humans ; Inflammation ; Macrophages ; Pulmonary Fibrosis ; Signal Transduction

Objective To study the optimal waist circumference (WC) cut-off values for identifying metabolic risk factors in middle-aged and elderly subjects in Shandong Province of China.
Methods A total of 2 873 men and 5 559 women were included in this cross-sectional study. Metabolic syndrome (MetS) was diagnosed according to the definition of Chinese Diabetes Society in 2004. The relation between WC and MetS was analyzed by multivariate logistic regression analysis. The optimal WC cut-off values were identified using the area under the ROC curve and the different diagnostic criteria for central obesity were compared.
Results The WC was the risk factor for MetS independent of BMI, blood glucose, blood lipid, and blood pressure. The optimal WC cut-off value was 83.8 cm and 91.1 cm for identifying MetS in women and men, respectively. Compared with 80 cm and 85 cm for women and men, 85 cm and 90 cm had a higher Youden index for identifying all metabolic risk factors and MetS in women and men.
Conclusion The appropriate WC cut-off value is 85 cm and 90 cm for identifying central obesity and MetS in women and men in Shandong Province of China.

Objective Electromagnetic navigation was used to observe and measure important anatomical structures through endoscopic endoscopic approach (EEA) to the ventral skull base to provide data for clinical surgery. Methods Using electromagnetic navigation to measure the anatomical structure of the central and paracentral ventral skull base on 10 fresh cadavers, the internal carotid artery (ICA) was the most important. Results Electromagnetic navigation helped to determine the course of important neurovascular. The ICA of the ventral skull base was divided into 5 segments+ 7 major branches, and the length and course of each were measured and recorded. Conclusion The identification and protection of ICA is the key to EEA treatment of ventral skull base lesions, and electromagnetic navigation assistance can improve the efficiency and safety of EEA surgery.

To understand the history development and changes of Citri Grandis Exocarpium and initially establish its standard system after exploring the historical origins and modern development of Citri Grandis Exocarpium. In CNKI, Wanfang database and other academic search platforms were searched for literature on Citri Grandis Exocarpium and Chinese medicine standard system； the books related to its modern cultivation techniques and processing technology were also accessed, and after combining with the actual situation analysis, the prospective design of the standard system of Citri Grandis Exocarpium was finally established with research conclusion. The earliest records of the Citri Grandis Exocarpium were documented in the Northern and Southern Dynasties, but its medicinal value was discovered in the Song Dynasty. Its drug use was developed on the basis of Jupi（orange peel） and Citri Exocarpium Rubrum. In 21st century, a number of large-scale, intensive Citri Grandis Exocarpium bases have been formed due to high price, good planting efficiency, and rapid growth of cultivation areas. The standard system includes the technical specifications of seed selection and seedling cultivation of Citri Grandis Exocarpium, technical norms of cultivation, technical specifications of fertilizing and weeding, technical specifications of irrigation and drainage, technical standard of pest and disease control, standard of medicinal materials grade, standard of processing technology of sliced pieces and the quality standard of slices, etc.