Objective To investigate whether protease inhibitor (ulinastatin, UTI) can protect liver from ischemia-reperfusion injury in hepatocellular carcinoma (HCC) patients undergoing hepatectomy after hepatic inflow occlusion. Methods A prospective randomized control study was designed. Thirty-one HCC patients undergoing hepatectomy after hepatic inflow blood occlusion were randomly divided into the following two groups. UTI group (n=16), 1?105 units of ulinastatin was given intravenously in operation, then the dosage was continuously used twice a day up to 5 days postoperatively. Control group (n=15), the patients received other liver protective drugs. Liver function, plasma C-reactive protein (CRP) and cortisol level were compared between these two groups. Results The postoperative liver function of the UTI group was significantly improved compared with the control group. For example, on the third postoperative day the aspartate transaminase (AST), alanine transaminase (ALT) and total bilirubin level in the UTI group were significantly lower than those in the control group, respectively (P

Objective To explore the prognostic index for nasopharyngeal carcinoma (NPC). Methods The expression of nm23-H 1 protein in the tissue specimens of 115 NPC patients was detected by immunohistochemical S-P staining before radiotherapy. The 115 patients were treated in 1992～1994, underwent the whole radiotherapy, and were followed up for over 5 years. The association of nm23-H 1 protein expression with the clincal staging of NPC, radiosensitivity of tumor, survival rate of patients, and relapse and metastasis of carcinoma was analyzed. Results The positive rate of nm23-H 1 expression in NPC was 47.8%. The tumor clinical staging, lymph nodes metastasis, and patient survival rate were closely correlated with the low level expression of nm23-H 1 protein in NPC. Conclusion The low level expression of nm23-H 1 protein may be associated with the development and poor prognosis of NPC.

Objective To study the feasibility and reliability of median nerve somatosensory evoked potential monitoring in neurosurgery around the brain stem. Methods in selected 43 patients SEP N20, waveforms were recorded after stimulation of left and right median nerves respectively. Anesthesia was maintained with intravenous anesthetics throughout the operation. As soon as N20 waveform changed significantly, the surgeon was informed and the operative procedure was modified whenever possible. Results SEP waveforms were almost stable during maintaining with total intravenous anesthesia (TIVA). Within 43 cases, SEP waveform of & patients significantly changed. In these cases, SEP of 5 patients returned to normal gradually and no further neurologic dysfunction happened postoperatively. The other 3 cases did not recover, and postoperative neurologic complications happened. There was no false-negative or false-positive result. The correlation between intraoperative SEP changes and postoperative neurologic alterations was significant statistically. Conclusions SEP recording is a reliable technique for intraoperative monitoring during neurosurgery around the brain stem. TIVA is helpful for SEP monitoring.

AIM: To investigate whether hepatocyte apoptosis is contributed to liver ischemia-reperfusion (I/R) injury and the relationship between liver caspase-3 activity and hepatocyte apoptosis in cirrhotic rats. METHODS: Liver ischemia-reperfusion is induced by Pringle maneuver. The cirrhotic rats were randomized into two groups: Group A: simple hepatic blood inflow occlusion (HBIO); Group B: HBIO + inhibitor, before HBIO, ZVAD-fmk 15 mg/kg was injected via dorsal penis vein; Group C: healthy rat, simple HBIO. The ischemia time was 30 min in these groups. Serum aspartate aminotransferase(AST), liver caspase-3 activity, and apoptotic hepatocytes were examined in the three groups. RESULTS: After 6 h of reperfusion, the liver caspase-3 activity was markedly elevated and reached its peak, which was statistically higher than that of before I/R [(18.1?1.8 ) ?mol?h -1 ?g -1 (tissue) vs (6.6?2.0) ?mol?h -1 ?g -1 (tissue), P

AIM: To investigate the protective effect of ischemic preconditioning (IPC) on hepatic ischemia reperfusion(I/R) injury in cirrhotic rats and its possible mechanism. METHODS: Hepatic I/R was induced by Pringle maneuver. The cirrhotic rats were randomized into three groups: Group A: before 30 min of ischemia, a short period of 5 min ischemia and 5 min reperfusion were given; Group B: before 30 min of ischemia, a short period of 10 min ischemia and 10 min of reperfusion were given; Group C: 30 min ischemia only. The serum alanine transferase (ALT), hepatic Fas mRNA, caspase 3 activity and hepatocyte apoptosis were analyzed. RESULTS: The 7 day survival rate in the group A and B were 100%, respectively. However, it was only 62.5% in the group C. After 6 h of reperfusion, the ALT levels in both group A and B were significantly lower than that of in group C, P

Objective To observe the effects of propofol or sevoflurane combined with remifentanil on cerebral blood flow (CBF) and cerebral autoregulation in patients undergoing gynecologic laparoscopic surgery. Methods Forty patients were randomly divided into two groups: the propofol group (group P, n=20) and the sevoflurane group (group S, n=20). Anaesthesia was induced with target-controlled infusion (TCI) of propofol and remifentanil in group P, with an inhaled induction of sevoflurane and TCI of remifentanil in group S, respectively. The depth of anesthesia was regulated according to bispectral index (BIS). The pressure of end-tidal carbon dioxide (P_(ET)CO_2) was kept at 35-40 mmHg by mechanical ventilation. The mean arterial pressure (MAP), heart rate (HR), pressure of arterial carbon dioxide (PaCO_2), P_(ET)CO_2, time-averaged peak flow velocity (TAP) and the transient hyperaemic response ratio (THRR) were recorded at 7 different time points: supine position (T_1) and supine lithotomy position before induction (T_2), the instant and 5 min after tracheal intubation (T_3,T_4), the instant and 15 min after abdominal CO_2 insufflation and trendelenburg-lithotomy position (T_5,T_6), and 10 min after the deflation abdomen (T_7), respectively. Results Compared with the baseline values at T_1, TAP was not significantly changed at T_2, T_5, or T_6 in group P, but was markedly decreased at T_3, T_4 and T_7. TAP in group S only decreased at T_4 and T_7, while it was much higher than that in group P at T_3. In group S, THRR was markedly lowered at T_3 compared with that at T_1; but in group P, it showed a significant increase at T_3. Conclusions Combined with remifentanil, propofol decreased CBF, but has no effect on the brain self-regulation. When inhaled in high concentrations, sevoflurane significantly reduces the brain self-regulation. Intraoperation pneumoperitoneum and postural factor significantly increase CBF, playing a stronger role than the narcotic drugs in clinical dosage (propofol, sevoflurane), without any influence on the brain self-regulation.

AIM: To investigate whether hepatocyte apoptosis is contributed to liver ischemia-reperfusion (I/R) injury and the relationship between liver caspase-3 activity and hepatocyte apoptosis in cirrhotic rats. METHODS: Liver ischemia-reperfusion is induced by Pringle maneuver. The cirrhotic rats were randomized into two groups: Group A: simple hepatic blood inflow occlusion (HBIO); Group B: HBIO + inhibitor, before HBIO, ZVAD-fmk 15 mg/kg was injected via dorsal penis vein; Group C: healthy rat, simple HBIO. The ischemia time was 30 min in these groups. Serum aspartate aminotransferase(AST), liver caspase-3 activity, and apoptotic hepatocytes were examined in the three groups. RESULTS: After 6 h of reperfusion, the liver caspase-3 activity was markedly elevated and reached its peak, which was statistically higher than that of before I/R ［(18.1±1.8 ) μmol*h-1*g-1 (tissue) vs (6.6±2.0) μmol*h-1*g-1 (tissue), P＜0.01］. The same change occurred in hepatocyte apoptosis between 6 h of reperfusion and before I/R (20.9%±4.9% vs 0.5%±0.3%, P＜0.01). As the reperfusion prolonged, the caspase-3 activity and apoptotic hepatocyte decreased gradually. The 7th-day survival rate was 62.5% in group A. The serum AST, liver caspase-3 activity and apoptotic hepatocytes were significantly higher in group A than those in group B and C, representing the most severe liver injury among the three groups. CONCLUSION: Hepatocyte apoptosis is the major form of cell death in liver ischemia-reperfusion injury in cirrhotic rats. Hepatoctye apoptosis induced by I/R is caspase-3 dependent, and inhibiting caspase-3 can alleviate liver injury. The caspase-3 dependent hepatocyte apoptosis is highly contributed to the pathological phenomenon that the ischemic sensitivity of cirrhotic liver is higher than normal liver.

Objective To investigate the value of interventional therapy in bile duct injury (BDI) due to laparoscopie cholecystectomy (LC). Methods Data of 24 BDI patients, who received interventional treatment after LC from June 1997 to May 2007, were retrospectively analyzed. Results According to Liu Yunyi criteria of BDI classification, there were 5 cases of type Ⅰ , 11 cases type Ⅱ , 2 type Ⅲ and 6 type Ⅳ. BDI was found during LC in 2 patients and the operation was switched to open cholecysteetomy, but bile duct infection was experienced 10 months and 2 years after the operation, respectively. BDI was diagnosed postoperatively in 22 patients, in which 13 eases occurred 3-12 days after LC, 7 cases 20-60 days after LC, and 2 cases 2 years after LC. Complete remission was achieved by interventional therapy in 5 patients, the other 19 patients received curative operation after control of cholangitis and jaundice. Among 13 patients who were diagnosed BDI 3-12 days after LC, 6 underwent emergency operation and failed. Of the 7 other patients who received interventional therapy, 3 were cured and the others underwent curative operation after cholangi-tis and jaundice were controlled. Conclusion Application of interventional therapy in BDI after LC can a-chieve successful bile duct support and drainage, and can obtain complete image of bile duct system, which is effective not only in control of cholangitis and jaundice for the safety of the following surgery, but also in cure of BDI.

Objective To investigate tbe pharmacodynamics of different local anesthetics administered intrathecally for caesarean section. Methods Ninety-six parturients with singleton term pregnancies undergoing caesarean section under combined spinal-epidural anesthesia were enrolled in this study. The patients were randomly divided into 3 groups ( n = 32 each ) and received intrathecal (IT) 0.5 % bupivacaine, 0.5 %levobupivacaine and 0.5% ropivacaine respectively. The initial doses was 9 mg in all 3 groups. The ratio of two successive doses was 0.9. If the upper sensory block reached T7 or above and there was no need for additional dose in the 45 min after the initial dose, the IT analgesia was considered to be effective. The median effective dose ( ED50 ), the 95 % effective dose( ED95) and 95 % confidence interval (95 % CI )were calculated by Dixon. Results The ED50 and ED95 and 95%CI of bupivacaine were 6.15 (95%CI 5.48-6.68) mg and 7.62 (95%CI 6.91-11.82) mg; of levobupivacaine were 8.06 (95%CI 7.46-8.62) mg and 9.59 (95%CI 8.86-13.42) mg;of ropivacaine were 10.55 (95%CI 9.73-11.49) mg and 12.80 (95%CI 11.66-21.42) mg. The relative potency potency ratio between bupivacaine, levobupivacaine and rupivacaine is 1.00:0.76:0.58.

AIM: To analyze the lovastatin-induced differential gene expression in HepG2 cells using a cDNA microarray assay. METHODS: Total RNA was extracted from the lovastatin-treated HepG2 cells and control group. cDNA was synthesized from RNA with Cy3/Cy5-labelled dCTP. Then the hybridization was conducted. The result was analyzed using Imagene and Genespring software. RT-PCR was carried to confirm the hybridization results. RESULTS: 30 genes were up-regulated while 11 genes were down-regulated in lovastatin-treated HepG2 cells, involved in some major functional areas including signal transduction, cell cycle regulation, tumor immunity, and so on. CONCLUSION: The analysis of differentially expressed genes in lovastatin-treated HepG2 cells is helpful to explore the mechanism of the anti-tumor activity of statins.