Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) preferentially induces apoptosis in tumor cells but not in normal cells. It induces apoptosis in its target cells by interacting with surface death receptors DR4 and DR5,which contain a cytoplasmic region designated as thedeath domain. Clinical use of rhTRAIL and its agonistic antibodies is limited due to partial or completetolerance to TRAIL in human tumor cell lines. As TRAIL binding to its death receptors is the initial and crucial step in initiating apoptosis, the mechanisms of TRAIL-tolerance in tumor cells is closely related to the expression,location,distribution and function of TRAIL receptors . Personalized care combined with other therapies targeting TRAIL receptors may be expected to overcome the TRAIL-tolerance of tumor cells eventually.

Objective To investigate the effects of different concentrations of isoflurane on neuronal apoptosis in hippocampus and cerebral cortex in the aged rats. Methods Ninety female pathogen-free SD rats 22-24 months old weighing 497-593 g were randomly divided into 3 groups: group Ⅰ oxygen group inhaled air enriched with 40% O2,groupⅡ and Ⅲ were anesthetized with 1.2% and 1.8% isoflurane for 3 h respectively. Morris water maze was used to assess the cognitive function. The animals were killed at 24 and 72 h and on the 7th day after emergence from anesthesia and their brains were removed. Neuronal apoptosis in hippocampus and cerebral cortex was detected by TUNEL. Results The average escape latency was significantly longer on the 2nd and 3rd day after isoflurane anesthesia in isoflurane group than in oxygen group (P < 0.05 ). The neuronal apoptesis rate was significantly higher in the 2 isoflurane group than in oxygen group (P < 0.05 or 0.01 ). Conclusion Isoflurane anesthesia can result in transient cognitive dysfunction, and the mechanism may be involved in apoptosis in cerebral cortex in the aged rats.

Objective To assess the accuracy of MRI measurement of hippocampal formation in predicting postoperative cognitive dysfunction (POCD) in elderly patients.Methods Forty-one ASA Ⅱor Ⅲ patients aged≥65 yr undergoing gastrointestinal tract surgery were enrolled in this study.MRI was performed to measure the volume of hippocampal formation before surgery and the results were standardized according to the individual intracranial volume.All patients underwent a battery of neuropsychological tests including sensitive tests on the Wechsler adult memory scale and Wechsler adult intelligence scale,trail making test and the grooved pegboard test.We used the Z score to identify POCD as recommended by Moiler.All patients were then divided into POCD group and non-POCD group according to the results of the neuropsychological tests.The results of the tests were correlated with the volume of hippocampal formation measured by MRI.The value of MPI measurement of hippocampal volume in predicting POCD was analyzed.Results Thirty-six patients completed the whole battery of neuropsychological tests after surgery.Thirteen of the 36 patients were found to have COPD (36%) on the 4th postoperative day.The hippocampal volume was significandy smaller in POCD group (4.75±0.23) than in non-POCD group(5.06±0.31).Hippocampal volume was found to be effective in predicting POCD.The overall accuracy of prediction was 77.8%(28/36 patients) with 92.3% sensitivity (12/13 patients),70.0% specificity (16/23 patients) and 0.623 Youden index.Conclusion The MRI measurement of hippocampal volume is valuable as a predictor of POCD in the elderly.

Objective To explore the effect and significance of systemic inflammatory response syndrome(SIRS )score in predicting prognosis in acute craniocerebral trauma. Methods The clinical data of 620 patients were collected at admission from January 2003 to December 2007, GCS and SIRS score were calculated in 24 hours.The relation of the mortality rates and GCS score were analyzed in different SIRS score patients by controlling age. Results With SIRS score increasing,mortality rates increased as well,and pa-tients with SIRS (score≥2) mortality rates had significantly higher,and also in the same age and GCS score group.Mortality rotes were significant in staifistics (P<0.05). Conclusion SIRS score is significant inde-pendent predicting prognosis in acute craniocerebral trauma and in clinic.

Objective To investigate the hemodynamic and rheological effects of acute hypovolemic hemodilution with 6% hydroxyethyl starch (HES) at different infusion rates. Methods 20 ASA Ⅰ adult patients undergoing elective surgery were randomized to one of two groups with 10 patients each. The patients were premedicated with intramuscular midazolam 0.06 mg/kg and atropine 0.01 mg/kg 30 min before anesthesia. Before anesthesia an intravenous line was established and lacted ringer solution was infused at a rate of 5 ml. kg-1. h-1 . Anesthesia was induced with midazolam 0.2mg/kg , fentanyl 5μg/kg and vecuronium 0. lmg/kg and maintained with inhalation of 50 % N2O and 1% isoflurane. After tracheal intubation the patients were mechanically ventilated and PET CO2 was maintainted between 4.6-6.0 kPa.Swan-Ganz catheter was inserted via right internal jugular vein. The dorsalis pedis artery was cannulated for direct measurement of arterial pressure. 6% HES infusion rates were 10 ml.kg-1.h-1 in group Ⅰ and 20ml.kg-1 .h-1 in group Ⅱ respectively. ECG, heart rate (HR), arterial blood pressure (SBP, DBP and MAP), CO, CL, CVP, PAP, PCWP, SpO2, PET CO2 and inhalation concentrations of N2O and isoflurane were monitored before and 30, and 60 min after infusion was started. Arterial and venous blood samples were taken for blood gas analysis and rheological studies. Results The two groups were comparable with respect to demographic data. During HES infusion HR decreased and CL increased in both groups and there was no significant difference between the two groups. BP increased slightly at 60 min in group Ⅰ , whereas in group Ⅱ it tended to decrease. CVP, PAP and PCWP increased significantly in both groups especially at 60 min. Hct decreased from 36.2% ±4.5% to 30.4% ±4.1% in group Ⅰ and from 39.6%±8.0 % to 30.8% ± 5.9 % in group Ⅱ at 60 min. Hb and K value of erythrocyte sedimentation rate (ESR) equation decreased significantly in both groups especially at 60 min. Conclusions Intravascular volume expansion ismore efficient with increased infusion rate of HES but the influences on hemodynamics would be more significant. HES infused at 20 ml. kg-1 . h -1 is safe in healthy patient during operation with blood loss.[Key Words] Hemodilution; Hydroxyethyl starch; Hemodynamics; Hemorheology

Adolescent ; Adult ; Aged ; Agranulocytosis ; complications ; drug therapy ; Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Child ; Female ; Humans ; Leukemia ; complications ; drug therapy ; Male ; Middle Aged ; Treatment Outcome ; Vancomycin ; administration & dosage ; therapeutic use ; Young Adult

Purpose:To study the significance of resecting the lymph nodes adjacent to the recurrent laryngeal nerve in the operation on cNo thyroid papillary carcinoma,and its value inselecting the fashion of operation .Methods:Reviewing the clinical-pathological material of 186 cases of cNo thyroid papillarycary cinoma,and analyzing the relationship between lymph nodes adjacent to the recurrent laryngeal nerve and lateral cervical nodes metastasis. Results:Of 186 cases of cNo thyroid papillary cacinoma,there were 42.5% (79/186) with metastatic lymph nodes adjacent to the recurrent laryngeal nerve,63.2% of which had lateral cervical nodes or distant metastasis,while only 8 cases had metastasis in the negative group. Conclusions:The thyroid papillary carcinoma with metastatic nodes adjacent to the recurrent laryngeal nerve means there is a higher chance of metastasis in regions of the neck. Resecting the lymph nodes adjacent to the recurrent laryngeal nerve and frozed pathological examination can be a basis to determine whether redical neck dissection should be performed.

Objective To compare the clinical efficacy and tolerability of 0 75% ropivacaine(8～10ml) versus 1% lidocaine plus 0 2% dicaine in epidural anesthesia cesarean section.Method Parturients for elective cesarean were randomly designed to receive 0 75% ropivacaine(groupⅠ,n=15) or 1%lidocaine plus 0 2% dicaine(groupⅡ,n=15) epidural anesthesia. Sensory block,intraoperative pain(VAS score) and abdominal wall relaxation were assessed together with adverse reaction. Results The percentage of sensory block to reach T6 level was higher in groupⅠ than that in groupⅡ(P

Objective To evaluate the effects of a novel inducible nitric oxide synthase (iNOS) inhibitor (FR260330) in prevention of chronic rejection in a model of rat aortic allograft and to investigate the mechanism of the arterial wall lesion of chronically rejecting solid organ grafts. Methods Male Lewis (LEW, RT1~ l) rats received male ACI (RT1~ a) aorta allografts or LEW aorta isografts. Seven groups (n≥12) were involved in this study. FR260330 and/or tacrolimus were administered orally for 14 or 90 days according to protocol. The degree of intimal proliferation of graft aorta was determined by a computerized image system.Results Both low and high doses of FR260330 or tacrolimus treated grafts showed significantly decreased intima/(intima+media) ratios at day 90 compared with placebo controls. Combined therapy of low-dose of FR260330 with low-dose of tacrolimus produced a significant decrease of intima/(intima+media) ratios with intact endothelium as compared with placebo controls. Anti-?-actin immunohistochemical staining demonstrated that one of the mechanisms of intimal proliferation was related to migration of vascular smooth muscle cells. The intima in iNOS inhibition groups was more smooth than in placebo control group and low-dose FK506 treated groups.Conclusions A selective inhibitor of nitric oxide synthase, FR260330 plays a protective role in chronic aortic allograft rejection in the rat. Combined therapy of low-dose of FR260330 with tacrolimus produces significant protection of immune injury and may serve to improve long-term graft survival and function.

Objective To analyze the diagnosis, therapy and prognosis of the most severe type ulcerative colitis or critical ulcerative colitis. Methods Forty cases of severe ulcerative colitis in recent 18 years in our hospital were reviewed. Based on the criteria from literatures, a self generated criterion was used to identify the critical ulcerative colitis, i.e.: ① bloody stool≥9 times/d;② body temperature≥38?C;③ pulse rate≥90 beats/min;④ Hb