Adolescent ; Adult ; Anesthesia, Intravenous ; Anesthetics, Intravenous ; Cardiopulmonary Bypass ; Female ; Fentanyl ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Sufentanil

Adult ; Anesthetics, Inhalation ; administration & dosage ; Desflurane ; Electroencephalography ; methods ; Female ; Humans ; Isoflurane ; administration & dosage ; analogs & derivatives ; Male ; Middle Aged ; Monitoring, Intraoperative ; Nitrous Oxide ; administration & dosage

Objective To investigate the effectivity of bispectral index(BIS)and auditory -evoked potentials index(AEP index)in monitoring the depth of desflurane anesthesia in the elderly. Methods Sixty patients(ASA gradeⅠ～Ⅱ)without obvious auditory and psychiatric dysfunction undergoing general anesthesia were enrolled in this study,and they were devided into the elderly group (n=30)and the non-elderly group(n=30)according to the age.After the endotracheal intubation,the lungs were ventilated with desflurane in oxygen.End-tidal concentrations of desflurane were maintained at 0.6,1.0 minimum alveolar concentrations(MAC)and 1.3 MAC for 20 minutes, respectively.The changes of BIS,AEP index,mean arterial blood pressure(MAP)and heart rate (HR)were recorded simultaneously.Results In the elderly and non-elderly groups,BIS were 94.14?6.5 and 94.5?4.6(P＞0.05),and AEP index at pre-anesthesia were 87.2?11.7 and 89.2?6.9(P＞0.05)respectively,which showed no statistic difference between two groups.BIS and AEP index decreased significantly in each time point at pre-anesthesia compared with those during anesthesia in two groups (P＜0.05).In the periods of increasing concentration of desflurane,BIS decreased gradually in two groups(P＞0.05),but BIS in the elderly group were higher than in the non-elderly group at the same end-tidal desflurane concentration(P＞0.05),and BIS negatively correlated with the end-tidal desflurane concentration in two groups.In the elderly group,AEP index decreased significantly at the concentration of 1.0 MAC and 1.3 MAC of desflurane compared with that of 0.6 MAC(P＜0.05),but there was no difference in AEP index with increasing end-tidal desflurane concentration from 1.0 MAC to 1.3 MAC(P＞0.05).At every concentration of desflurane,AEPindexintheelderlygroupwaslessthaninthenon-elderlygroup(P＜0.05).Conclusions BIS and AEP indexes correlate well with the end-tidal desflurane concentration,and are valuable for monitoring the depth of desflurane anesthesia in the elderly.AEP index can predict the difference in depth of anesthesia at the same end-tidal desflurane concentration between the elderly and the non-elderly.

Objective:To construct the lentiviral-vector encoding human interleukin-10 protein(LV-hIL-10) and to observe the effect of LV-hIL-10 on controlling neuropathic pain via intrathecal administration in CCI rats. Methods:hIL-10 gene fragment was isolated and amplified from pCYIL-10 plasmid by PCR, and was cloned into pWPXL. The recombinant plasmid pWPXL-IL-10,envelope plasmid pMD2.G and packaging plasmid psPAX2 were cotransfected into 293T cells, LV-hIL-10 is prepared by concentrating the collected supernatant .At the same time, the empty plasmid pWPXL-GFP,pMD2.G and psPAX2 were cotransfected into 293T cells, LV-GFP is prepared for contrast.135 sheer breed pathogen-free adult male Sprague-Dawley rats divided into 9 arrays at random: CCI models 4 arrays (C0,C1,C2,C3), sham operatived rats 4 arrays (S0,S1,S2,S3) and a normal contrast array (N), each respectively intrathecal injection LV-hIL-10 (C1,S1)、LV-GFP (C2, S2),isotonic Nachloride (C3,S3) and control (no implanted catheters and no administration, C0,S0), the pain threshold of each array and the expression of mRNA and protein of IL-10 in spinal cord,pallium and hippocampus on different time were observed after intrathecal administration LV-hIL-10 in successful CCI model rats . Results:The hIL-10 gene fragment was obtained from pCYIL-10 plasmid, pWPXL-hIL-10 was recombinated successfully. the cloned gene segment was validated by DNA sequencing .High titer(2?1010)and highly purified LV-hIL-10 particles were obtained by three plasmids were cotransfected into 293T cells. The mechanical allodynia and thermal hyperalgesia were alleviated via intrathecal injection LV-hIL-10 in CCI rats. The overexpression of IL-10 were detected in spinal cord,pallium and hippocampus , especially in the spinal cord .Conclusions:The mechanical allodynia and thermal hyperalgesia can be relieved by intrathecal injection LV-hIL-10 in CCI rats.

OBJECTIVE: To examine the characteristics of drug-induced fatal adverse effects in the United States from 1999 to 2004 and put forward suggestions for China's control of drug-induced adverse effects. METHODS: The data came from the compressed mortality file of Centers for Disease Control and Prevention (CDC) of the United States. Drug-induced mortality was used to analyze the effects of gender, race, age, and drug on drug-induced fatal adverse effects. RESULTS: During 1999-2004, 1 700 persons died of drug-induced adverse effects (mortality, 0.10/100,000). No difference was found in mortality between males and females. The drug-induced mortalities of whites, blacks and Native Americans, and other racial groups were respectively 0.10, 0.12, and 0.04 per 100,000 persons. The mortality increased quickly with the increase of age since the age group of 5-9. In this period, the 5 most common drugs that led to deaths were: (1) agents primarily affecting blood constituents; (2) analgesics, antipyretics, and anti-inflammatory drugs; (3) primarily systemic agents; (4) systemic antibiotics; and (5) hormones and their synthetic substitutes and antagonists, not elsewhere classified. At the age group of 20-84, 3 most common drugs leading to deaths for whites were: anticoagulants,opioids and related analgesics, and insulin and oral hypoglycaemic drugs. For blacks and Native Americans, they were: hydantoin derivatives, anticoagulants, and anaesthetic, unspecified. For people ages older than 84, anticoagulants, opioids and related analgesics, and drug or medicament, unspecified, were the 3 most common drugs resulting in deaths. For the rest of racial groups, the number of deaths caused by all kinds of drugs was less than 3. CONCLUSION Obvious differences on race, gender, age, and drug were found for drug-induced fatal adverse effects in the United States during 1999-2004, and these differences should be considered by the government when interventions are developed. China can learn something from the United States in controlling drug adverse effects, and improve its surveillance system of drug adverse effects as soon as possible.
Adolescent ; Adult ; Adverse Drug Reaction Reporting Systems ; organization & administration ; Aged ; Aged, 80 and over ; Analgesia ; adverse effects ; Anticoagulants ; adverse effects ; Child ; Child, Preschool ; Drug-Related Side Effects and Adverse Reactions ; epidemiology ; etiology ; mortality ; Female ; Humans ; Male ; Middle Aged ; United States ; epidemiology ; Young Adult

Objective To investigate the effect of human cytomegalovirus (HCMV) on proliferation of colony forming unit T-lymphocyte (CFU -TL)and its interference methods. Methods Normal CFU - TL culture was used as blank control. Normal CFU- TL culture system plus inactivated HCMV fluid as inactivated HCMV control. The dilution of 1:10,1:100,1:1000 were added into CFU -TL colonies culture system directly as infected group. Astragalus (AMI) and ganciclovir(GCV) were added into culture system with HCMV dilution of 1:10 as experimental group. By methylcellulose semi-solid culture, different concentrations of HCMV - AD1699 affect CFU-TL and interfered by astragalus AMI, GCV. CFU - TL were surveyed. The effect of HCMV on CFU-TL proliferation was measured by MTT; HCMV-AD169 DNA in CFU-TL was found by PCR. Results 1. Compared with control group, the numbers of CFU -TL in the HCMV infection groups decreased significantly(P

ObjectiveTo study the risk factors of renal artery pseudoaneurysm (RAP) following partial nephrectomy.MethodsOpen partial nephrectomy was performed on a total of 464 cases of renal cell cancer from July 2003 to May 2010. Five patients ( 1.1％ ) had postoperative hemorrhage from RAP.The surgery technique of the open partial nephrectomy, the clinical presentation, imaging findings and treatment of RAP were reviewed. The anatomical characteristics of these five renal tumors on enhanced CT were quantified using the R.E.N.A.L. Nephrometry Score System.ResultsAll five cases were male, two had tumors on the left side and three on the right side. Median tumor size was 3.6 cm ( range from 2.5 to 5 cm; Radius score 1 - 2). Four tumors were exophytic of these, three had a major endophytic component (≥50％) deep in the parenchyma (Exophytic/endophytic score 2 ), one was entirely endophytic (score 3 ). The distance of all the tumors to the collecting system was ≤4 mm ( Nearness score 3 ). Four of the five tumors were across the polar line and/or renal axial midline ( Location score 3 ). The other tumor was located under the lower pole ( Location score 1 ) but close to the renal hilar. All patients presented with delayed gross haematuria and decreasing hemoglobin occurred on mean postoperative day 12 (3 -23 day). Four patients complained of flank pain, two of which had signs of hypovolemia requiring blood transfusion. The diagnosis was confirmed by the contrast medium-enhanced CT and selective angiography, and RAP was found most commonly arising from the segmental branch of renal artery. Superselective microcoil angioembolization was successfully performed in four cases, once in three cases and twice in the remaining case. The procedure failed in one patient and a nephrectomy was done. At a mean follow-up of 21 months (12 -30) , all patients had normal renal function without evidence of recurrence.ConclusionsRAP should be considered in all patients who had delayed hematuria after partial nephrectomy. A central, deep tumor and its relationship to the segmental branch of renal artery could be an important risk factor for this complication. Choosing the case properly for partial nephrectomy and suturing the transected vessels and the defect of parenchymal correctly could reduce occurrence of this serious complication. Early use of selective angioembolization could be a primary choice of treatment.

ObjectiveTo evaluate term efficacy of focal cryoablation for localized single lesion prostate cancer and the protection of erectile function.MethodsFrom June 2008 to December 2009, 12 patients with localized single lesion prostate cancer were treated with focal cryoablation. All diagnoses were confirmed by transrectal ultrasound-guided prostatic biopsy. The mean Gleason score was ≤ 7; three cases had a Gleason score of 5, five cases a score of 6, and four cases a score of 7. The average preoperative value of PSA was 9.7 ng/ml ( 4.2 - 14.9 ng/ml ). The PSA level was obtained every three months for the first year and then every six months thereafter. Patients with a PSA nadir greater than 1.0 ng/ml or if the PSA nadir increased more than 2 ng/ml underwent repeat biopsy to exclude tumor recurrence.ResultsThe mean operative time was (82 ±26) minutes. The mean postoperative hospital stay was (5 ± 2) days. After catheter removal, all 12 cases had good continence and 10 had erectile function before surgery. Of the 10 patients, eight had erectile function after surgery. The follow - up ranged from 12 to 30 months ( mean 23 ).The lowest average serum PSA nadir was 2.2 ng/ml, nine patients had a minimum PSA nadir of less than 1.0 ng/ml and three had a minimum PSA nadir of more than 1.0 ng/ml. Four patients underwent repeat biopsy after abnormal PSA, and prostate cancer was detected in the contralateral gland in one patient.ConclusionsUltrasound-guided transperineal focal cryoablation is a safe and effective treatment with few complications for localized single lesion prostate cancer. Additional studies with longer follow-up are necessary for long-term efficacy.

Objective To evaluate the safety and short-term efficacy of transrectal ultrasound-guided transperineal cryosurgical ablation(TRUSCSA) for localized prostate cancer. Methods The data of 26 patients who were diagnosed with clinically localized prostate cancer (T_(1a)N_0M_0 - T_(2x)N_0M_0) by biopsy were reviewed. The data of serum prostate-specific antigen (PSA) level, clinical stage and Gleason score were collected. The Gleason score of all cases was ≤7; among them 6 cases were 2 - 4 and 20 cases were 5 - 7. The average pretreatment value of PSA was 11. 9 ng/ml (4. 7 - 19. 2 ng/ml). All the patients were treated with TRUSCSA, with a dual freeze-thaw cycle by using ultrathin 17-gauge cryoneedles. Immediate and delayed morbidities were evaluated. The PSA level was obtained every 3 months for the first 2 years and then every 6 months thereafter, and failure was defined as the inability to reach a nadir of 0. 5 ng/ml or less. All patients were strongly encouraged to undergo routine biopsies despite a stable PSA level. Results The operative time was (102±32)min. The postoperative hospital stay was (6±2)d. After withdrawal of the catheter, 22 cases had good continence) 4 had temporary incontinence for 3 - 7 d. Before operation 9 cases had normal sex life, and among them 5 cases had erectile dysfunction after operation. No one developed urinary retention or urethro-rectal fistula. The follow-up ranged from 6 to 30 months (mean 22). The PSA level at the last follow up visit was less than 0. 5 ng/ml in 23 patients (88%) and 0. 5 ng/ml or more in 3(12%). Postoperative biopsies were taken in 20 cases and the results were negative at the 6th month. Conclusions Transrectal ultrasound-guided percutaneous cryosurgical ablation for clinically localized prostate cancer could be effective and safe. Additional studies with longer follow-up are necessary to determine the sustained efficacy of this procedure.

Objective To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation for small renal tumors. Methods Ten selected patients cases with 11 renal tumors were included in present study. There were 3 cases of left renal tumor, 6 cases of right renal tumor and 1 case of bilateral renal tumors. Tumors were located at the upper pole (2), middle (6), or lower pole (3). All tumors were located distant from the collecting system, without evidence of metastatic disease. Mean tumor size was 2. 8 cm (range: 1.5-4.0). All the patients were managed with a double freeze-thaw cycle of retroperitoneal laparoscopic renal cryoablation. The preoperative Hb was (137± 21)g/L, ESR was (27±12)mm/1 h, SCr was (92±41)μmol/L, GFR was (42±10)ml/min.All the patients were taken routine biopsies. Results Cryoablation was technically successful in all 10 patients (11 tumors). The mean time of the operations was (101 ± 31) min, and the mean blood loss was (42±21) ml. None of the cases received blood transfusion post-operation. No operative complication was seen. The postoperative hospital stay was (4±2) d. The postoperative Hb was (129 ±18)g/L,ESR was (31±14)mm/1 h,SCr was (95±39)μmol/L,GFR was (40±11)ml/min. There was no statistic change of Hb, ESR, SCr and ECT-GFR after operations(P＞0. 05). The biopsy results revealed that 8 tumors were renal clear cell carcinomas, and 2 tumors were papillary renal cell carcinomas, and 1 tumor was renal angiomyolipoma. All the patients had a minimum follow-up of 6 months (mean 16, range 6 to 21). Follow-up magnetic resonance imaging at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesions. Follow-up biopsie of the cryoablated tumor site was negative in the only patient who have undergone the biopsy. No evidence of local or port-site recurrence was found, and no metastatic disease. ConclusionsRetroperitoneal laparoscopic renal cryoablation for small renal tumors could be an accurate and effective intervention with a relatively low incidence of complications. Critical long-term data regarding laparoscopic renal cryoablation are awaited.