Objective To investigate the reasonable and effective administration ofdexmedetomidine for thoracic surgery anesthesia.Methods Eighty ASA Ⅰ-Ⅱ patients,aged 18-60 years old scheduled for elective thoracotomy were randomly assigned to 4 groups(each 20 patients).Group A:dexmedetomidine before anesthesia induction + bupivacaine before closed thorax cavity.Group B:dexmedetomidine before anesthesia induction + dexmedetomidine and bupivacaine before closed thorax cavity.Group C:0.9％ sodium chloride before anesthesia induction + bupivacaine before closed thorax cavity.Group D:0.9％ sodium chloride before anesthesia induction + dexmedetomidine and bupivacaine before closed thorax cavity.Mean arterial pressure (MAP) and heart rate (HR) were measured before infusing dexmedetomidine or 0.9％ sodium chloride (T0),after infusing dexmedetomidine or 0.9％ sodium chloride (T1),instant time after intubation (T2) and 3 min after intubation (T3),5 min after intubation (T4).The scores of visual analogue scale(VAS) and the consumption of analgesics were compared.Results There was no significant difference including gender,age,weight and operation time among four groups (P ＞ 0.05).Compared with T0,MAP and HR were significantly decreased at T1 in group A and group B (P ＜ 0.05),and were significantly increased at T2 in group C and group D (P＜ 0.05).Respectively compared with group A and group B,MAP and HR were significantly increased at T2,T3 in group C and group D (P ＜ 0.05).The scores of VAS in group B [(2.47 ± 1.43) scores] and group D [(2.00 ± 1.68) scores] were lower than those in group A [(4.78 ± 1.26) scores] and group C [(4.88 ± 1.62) scores] after operation 12 h.The times of using postoperative analgesics in group B [(0.6 ± 0.4) times] and group D [(0.8 ± 0.1) times] were significantly less than those in group A [(1.3 ± 0.5) times]and group C [(1.5 ± 0.4) times] (P ＜ 0.05).Conclusions Intravenous dexmedetomidine before anesthesia induction can control the effect of double-lumen endobronchial tube responses and make hemodynamics stable.Intercostal nerve block with 0.5 μ g/kg bupivacaine and 0.375％ dexmedetomidine can enhance the analgesia effect and prolong the analgesia time.

Objective To analyze the outcomes of frozen-thawed blastocyst and cleavage embryo transfer after whole embryos cryopreservation. Methods The data of 489 IVF-ET cycles in reproductive medicine center of our hospital from September 2012 to August 2013 were analyzed retrospectively. Whole embryos cryopreservation in 214 patients were carried out with vitrification method and served as group A , 275 cycles performed fresh embryo transfer were served as group B. Then group A and group B were subdivided into group A1 (83 cycles),group A2 (131 cycles), group B1 (120 cycles)and group B2 (155 cycles)according to blastocyst transfer or cleavage-stage embryo transfer. The clinical outcomes of all groups were compared each other. Results The pregnancy rate and embryo implantation rate in group A1 were significantly higher(71.1% ,53.0%)than those in group A2, B1 and B2 (A2 group: 57.3%, 34.0%, B1group: 55.0%,42.1%, B2 group: 52.9%, 32.7%,respectively)(P<0.05). The embryo implantation rate in group B1 were higher than those in group B2 (P < 0.05). Conclusion F-ET after whole embryos freezing could significantly improve the embryo utilization rate and clinical pregnancy rate. Frozen-thawed blastocyst transfer could get better clinical outcomes than frozen-thawed cleavage-stage embryo transfer.

Objective To evaluate the clinical value of frozen-thawed blastocyst transfer and the blastocyst derived from frozen-thawed cleavage stage embryo transfer.Methods The data of 5 1 8 cycles in reproductive medicine center of the hospital from Sep-tember 2012 to August 2013 were analyzed retrospectively.According to the frozen-embryos type,all patients were divided into three groups,group A:frozen-thawed blastocyst transfer,129 cycles;group B:blastocysts derived from frozen-thawed cleavage stage embryos transfer,123 cycles;group C:frozen-thawed cleavage embryos transfer,266 cycles.The clinical outcomes of all groups were compared with each other,and the rates of blastocyst formation and cancellation were compared between group A and group B.Re-sults The rates of biochemical pregnancy,clinical pregnancy and embryo implantation in group A(70.5%,61.2%,42.3%)and group B(67.5%,58.2%,40.2%)were significantly higher than group C(53.0%,42.5%,23.1%)(P<0.05);there were no signif-icant differences in the rates of early abortion,ectopic pregnancy,multiple pregnancy among three groups(P>0.05);there were no significant differences in the blastocyst formation rates of the high quality cleavage embryos at D3 in fresh cycles and the frozen-thawed cleavage embryos(62.5%vs.57.7%)(P>0.05)and those two groups were both significantly higher than the poor quality cleavage embryos at D3 in fresh cycles(20.3%)(P<0.05).Conclusion Blastocyst transfer in vitrified-thawed cycles could get rel-atively satisfactory clinical outcomes.There are higher blastocyst formation rate and better clinical outcomes of transfer blastocyst derived from frozen-thawed cleavage embryo.

Objective To study the induction of IL-6 on expression and activity of tissue factor (TF)in peripheral blood monocytes(PBMCs).Methods rhIL-6 100 ng/L and rhIL-6 100 ng/L+ rhIL-6 MoAb 10?g/L were used respectively to stimulate the PBMCs for 24 h,PBMCs without any stimulation as control group,to study the changes of antigen content,mRNA expression and the ac- tivity of the TF.Results The antigen content,mRNA expression and activity of TF were increased significantly in 100 ng/L rhIL-6 group as compared with rhIL-6 100 ng/L+rhIL-6 MoAb 10?g/L and control groups(P＜0.01).Conclusions rhIL-6 can induce the increase of antigen expression,activity and mRNA expression in PBMCs,and these effects can be suppressed successfully by rhIL-6 MoAb. This study demonstrated that there was potential relations between cytokines and thrombogenesis, which may play an important role the pathogenesis of chronic rejection.

The relationship between vascular endothelial growth factor-C (VEGF-C)/vascular endothelial growth factor receptor 3 (VEGFR-3) expression and clinicopathologic features of the patients with non-small cell lung cancer (NSCLC) was investigated. The expression of VEGF-C and VEGFR-3 was assessed in 65 patients with NSCLC by immunohistochemistry. The significance of VEGF-C and VEGFR-3 expression was analyzed statistically. The results showed that VEGF-C and VEGFR-3 were highly expressed in cytoplasm and membrane in lung cancer tissues with the positive rate being 55.4 % and 52.3 % respectively, while there was no expression in the normal lung tissues. The expression of VEGF-C was significantly increased in adenocacinoma as compared to other types of NSCLC (P<0.05). The VEGFR-3 expression was closely related with lymph node metastasis (P<0.01) and TNM stage (P<0.05). There was a positive correlation between the VEGF-C and VEGFR-3 expression in NSCLC patients (r=0.658, P<0.01). It is suggested that VEGFR-3 plays an important role in the lymphatic metastasis of NSCLC. The interaction between VEGF-C and VEGFR-3 may be deeply involved in the mechanism of lung cancer metastasis.

Deflazacort (DFZ, a prodrug) is well absorbed and rapidly metabolized into the active metabolite 21-hydroxydeflazacort (21-OH DFZ) after oral administration. The aim of this study is to evaluate the pharmacokinetic properties of 21-OH DFZ in healthy Chinese volunteers after a single and multiple oral administration of DFZ tablets under fed condition. Twelve volunteers (six males and six females) were administered a single dose of 6 mg or 12 mg or 24 mg of DFZ in three different periods separately, according to the 3 x 3 Latin square design. Between each administration period there was a washout period of one week. The multiple-dose study of 12 mg dose DFZ per day for 7 consecutive days was started after a 1 w washout period when the single-dose study completed. The pharmacokinetic parameters of 21-OH DFZ after the single oral administration of 6 mg, 12 mg and 24 mg DFZ tablets were as follows: (37.7 +/- 11.6), (61.5 +/- 17.7) and (123 +/- 23) ng x mL(-1) for C(max); (1.90 +/- 0.32), (1.96 +/- 0.27) and (2.13 +/- 0.34) h for t1/2; (96.6 +/- 25.9), (190 +/- 44) and (422 +/- 107) ng x h x mL(-1) for AUC(0-14 h), respectively. After the multiple dose administration, the mean plasma concentration at steady-state C(av) was (7.00 +/- 1.66) ng x mL(-1) and the degree of plasma concentration fluctuation DF was 7.7 +/- 1.2. The results showed that the pharmacokinetic characteristics of 21-OH DFZ in healthy Chinese volunteers were linear over the dose range of 6 to 24 mg. No significant gender differences were found in the pharmacokinetics of 21-OH DFZ in healthy Chinese volunteers. After the multiple dose administration of 12 mg DFZ for 7 d, no accumulation of 21-OH DFZ in healthy Chinese volunteers was observed.

Denys-Drash Syndrome ; diagnosis ; Humans ; Infant ; Male

Objective To monitor the changes of resting energy expenditure in ventilated critically ill children,to compare the results of standard equations and indirect calorimetry (IC) in predicting energy expenditure,and to investigate the possible influence factors of the metabolic status of the critically ill children.Methods From September 2012 to September 2013,56 critically ill children on assisted ventilation and fitting the requirements of IC in pediatric intensive care unit of Shanghai Children's Medical Center were enrolled in this prospective study.IC measurements were performed using metabolic cart on day 1,4,7,10 after trachea intubation.General clinical data of these children were recorded.Results 130 IC measurements were performed in the 56 children.The measured resting energy expenditure (MREE) did not exhibit significant differences among day 1,4,7,and 10 (P =0.379).Although there were no significant differences between MREE and energy expenditure predicted with Schofield and WHO equations (P =0.917,P =0.995),the agreement was poor between the measured and predicted values (R2 =0.185,R2 =0.322).The metabolic status of the children on day 1 of ventilation was only correlated with age (P =0.000) and height (P =0.027),not with severity of underlying diseases or clinical outcomes.Conclusions MREE of IC method in ventilated critically ill children did not significantly change over time in this study.A poor agreement was observed between equationpredicted energy expenditure and MREE.IC measurement of resting energy expenditure is recommended for guiding individual nutritional support among critically ill children so as to improve clinical outcome.

Objective To explore the clinical value of the duplex ultrasonography (duplex US) for evaluating the re-stenosis after peripheral arterial bypass grafting. Methods Eighty prosthetic grafts of sixty-three patients with femoral-pop-liteal arterial bypass grafting were follow-up regularly by duplex US. They were divided into non significant stenosis group (n=56), the significant stenosis group (n=15) and occlusion group (n=9) according to the tube diameter and arterial blood flow-ing parameters, which changed postoperatively. The diagnostic results were compared and analyzed between duplex US and digital subtraction angiography (DSA). The peak flow velocity of middle grafts (MG) to 40 cm/s was defined to evaluate risk of graft occlusion. Results The diagnostic coincidence rate of duplex US and DSA for grafts stenosis classification was 90%. The diagnostic sensitivity of duplex US to grafts stenosis was 91.7%, and the specificity was 92.9%. The positive pre-dictive value was 84.6%for grafts stenosis, and the negative predictive value was 96.3%, the false positive rate was 16.7%, and the false negative rate was 8.3%. The grafts occlusion rate was higher in MG<40 cm/s group than that of MG≥40 cm/s group. Conclusion There was a good consistency with Duplex US and DSA for the diagnosis of peripheral artery bypass graft restenosis. Duplex US showed characteristics of non-invasive, simple and easily accepted by patients.

Objective To study the clinical significance of chromosome karyotyping in pregnant women with a history of abnormal pregnancy. Methods The fetal chromosome karyotypes of 1 193 pregnant women with a history of abnormal pregnancy in Peking University First Hospital from January 4, 2005 to December 31, 2013 were analyzed. According to the etiology of their previous abnormal pregnancy, these women were divided into four groups: 273 women had children with inherited metabolic disorders or single-gene genetic diseases (group A), 81 women had children or fetuses with chromosome abnormalities (group B), eight cases had an abnormal chromosomal karyotype in either husband or wife (group C), and 833 women had abnormal pregnancy of unknown causes(group D). Results Forty-eight [4.0%(48/1 193)] and fetuses were found to have abnormal chromosomal karyotypes, including 26 cases of chromosome polymorphism variations and 22 cases of numerical and structural abnormalities (four cases of trisomy 21, four cases of numerical sex chromosome abnormalities, three cases of trisomy 18, three cases of extra small chromosome mosaicism, three cases of reciprocal translocation, one case of Robertsonian translocation, one case of chromosome six inversion between the arms, one case of chromosome three inversion between the arms, one case of mosaicism of trisomy 14 and one case of structural abnormality of chromosome 14). In group A, four cases (1.5%) of chromosomal abnormalities of clinical significance and four cases of chromosome polymorphism variations were detected. Meanwhile, 61 fetuses with inherited metabolic disorders or single-gene genetic diseases and two cases of gene mutation carriers were detected in group A, but among whom, there were no abnormal chromosome karyotype cases. In group B, two cases (2.5%) of chromosomal abnormalities were found. In group C, two cases (2/8) of reciprocal translocation were found, whose karyotypes were the same as the parents. In group D, three cases of trisomy 21, three cases of trisomy 18, two cases of extra small chromosome mosaicism and two cases of numerical sex chromosome abnormalities were found. All the mothers in this group were of advanced age. Four cases of structural abnormalities and 22 cases of chromosome polymorphism variations were also found in this group, chromosomal analysis was subsequently performed in those couples, and found that the abnormal chromosomal karyotypes in the fetuses were the same as those in the parents. Conclusions Appropriate prenatal cell genetic diagnostic methods should be chosen according to the causes of abnormal pregnancy history.