Aged ; Humans ; Male ; Middle Aged ; Mycoses ; complications ; Nasal Septal Perforation ; complications ; microbiology ; Sinusitis ; complications ; microbiology

Objective To discuss the feasibility and safety of continuous spinal anesthesia (CSA) in renal transplantation through comparing the effects of combined spinal and epidural anesthesia (CSEA) and CSA renal transplantation. Methods Sixty patients undertaking renal transplantation were divided into two groups randomly. Group A, 30 patients, undertaking operation with CSEA; Group B, 30 patients, undertaking operation with CSA. The patients in group A were injected 2 mL 0.75% ropivacaine, then epidural catheter was inserted, 0. 75% ropivacaine 10 mL was administered when needed. The patients in group B were injected 2 mL 0.75% ropivacaine into spinal through Spinocath catheter, and 0.75% ropivacaine 1ml was administered through Spinocath catheter when needed. We observed the effects of the two anesthesia methods and the changes of the patients' vital signs. Results The patients in group A and B all completed the operation smoothly; there were no significant differences in the circulatory function before and during operation; there were no complications related to anesthesia in all the patients; group B was superior to group A in the aspects of the control and maintaining of anesthesia. Conclusion Continuous spinal anesthesia applied to renal transplantation is safe and feasible.

Objective To discuss the effects of high glucose on human mesangial cells (HMC)Wnt-β-catenin signaling pathway,and the intervention of rhein on it.Methods High concentration of glucose (30 mmol/L) combined with different concentrations of rhein were used to intervene cultured human mesangial cells.The activity of mesangial cell proliferation after all the interventions was examined by MTT measurement.Total Wnt、β-catenin RNA was detected By RT-PCR in normal mesangial cells and cells intervened by high glucose and Rhein.Results ①Inhibition effect to human mesangial cells:compared with NG group for 24 h,48 h and 72 h (OD values were 0.169± 0.051,0.228±0.074,0.285±0.075),human mesangial cells proliferation in HG group(OD values were 0.307± 0.074,0.507 ±0.038,0.711±0.075),HG+R1 group(OD value were 0.241± 0.027,0.334±0.015,0.499±0.063),HG+R2 group (OD value were 0.244±0.081,0.386±0.033,0.531±0.011),and HG+R3 group(OD value were 0.277±0.036,0.407± 0.057,0.594±0.042) were iucreased significantly (P＜0.05、P＜0.01) ; Compared with HG group for 24 h,48 h and 72 h,the HG+R1 group,the HG+R2 group and the HG+ R3 group showed a downward trend at 24 h,but not significantly; but the trend decreased significantly at 48 h and 72 h,and the performance expressed a time,concentration-dependent (P＜0.05,P＜0.01).② In the normal state,the mesangial cells expressed s certain amount of Wnt and β-catenin,when they were stimulated by high glucose,the expression of Wnt、β-catenin in mRNA increased (P＜0.05) ; while the expression of them was significantly reduced in high glucose-induced mesangial cells in HG+R1 group,HG+R2 group and HG+R3 group(P＜0.05).Conclusion Rhein may inhibit the proliferation of high glucose-induced mesangial cells through the Wnt and β-catenin gene expression.

Yinchenzhufu decoction (YCZFD) is a classic formula for treating Yin Huang syndrome, which can improve liver injury caused by cholestasis. However, the mechanism of action of YCZFD still remains unclear. This article used network pharmacology, molecular docking, animal experiments, and molecular biology methods to explore the mechanism of YCZFD in treating liver injury caused by cholestasis. A mouse model of acute cholestasis induced by lithocholic acid was used to investigate the effects of YCZFD on liver injury. The experimental procedures described in this paper were reviewed and approved by the Ethical Committee at the Shanghai University of Traditional Chinese Medicine (approval NO. PZSHUTCM190823002). The results showed that YCZFD could reduce the levels of blood biochemical indicators and improve hepatocyte damage of cholestatic mice. Then, multiple databases were used to predict the corresponding targets of YCZFD active components on cholestatic liver injury. An intersection target protein-protein interaction (PPI) networks based on String database and Cytoscape software was used to demonstrate the possible core targets of YCZFD against cholestatic liver injury. The results indicated that core targets of YCZFD include tumor necrosis factor, interleukin-1β, non-receptor tyrosine kinase Src, interleukin-6, etc. GO (gene ontology) and KEGG (kyoto encyclopedia of genes and genomes) enrichment analysis indicated that YCZFD may regulate the tumor necrosis factor signaling pathway, nuclear factor-κB signaling pathway, bile secretion, and other related factors to ameliorate the cholestatic liver injury. AutoDockTools software was used to perform molecular docking verification on the core targets and components of YCZFD. To verify the results of network pharmacology, UPLC-MS/MS method was used to determine the effect of YCZFD on levels of bile acid profiles in mouse liver tissues. It was found that treatment with YCZFD significantly reduced the content of free bile acids, taurine bound bile acids, and total bile acids in the liver tissues of cholestatic mice. Then, results from real time PCR and Western blot also found that YCZFD can upregulate the expression of hepatic nuclear receptor farnesoid X receptor, metabolizing enzyme (UDP glucuronidase transferase 1a1), and efflux transporters (bile salt export pump, multidrug resistance-associated protein 2, multidrug resistance-associated protein 3, etc) in cholestasis mice, promote bile acid metabolism and excretion, and improve bile acid homeostasis. Moreover, YCZFD can also inhibit pyroptosis and inflammation by regulating NOD-like receptors 3 pathway, thereby inhibiting cholestatic liver injury.

Objective To summarize the methods of diagnosis and results of surgical treatment of pancreatic insulinoma. Methods The clinical data of 137 patients with insulinoma treated in our hospital during the past twenty-six years were reviewed retrospectively.Results There were 77 males and 60 females. All of them were characterized by the Whipple′s triad. The sensitivity of ultrasonography, CT and MRI for localization was 35.1%, 67.9% and 58.1% respectively. One hundred and tweenty-six patients underwent operation. Of them, 102 cases had tumor enucleation, 4 cases had pancreaticoduodenectomy, 16 cases had distal panreatectomy, and the other 4 cases had only laparotomy. Of the 122 patients, who underwent resection, the tumor was benign in 118(96.7%) and malignant in 4(3.3%). The diameter of the tumor was less than 2cm in 86.9% of cases. In 98.4% of cases the tumors were single and in 1.6% of cases were multiple. 13.1% of the tumors located in the head, 46.7% in the body, and 40.2% in the tail.Conclusions Whipple′s triad and the measurement of fasting glucose, IRI, IGR, C-peptide, and proinsulin levels contribute to the diagnosis of insulinoma. However, the preoperative tumor localization is still difficult. Tumor enucleation is the technique of choice when feasible. Patients in whom tumor localization is unsuccessful at operation should be carefully evaluated to be certain of the diagnosis, and in general should not undergo blind resection.

Objective To investigate the effect of dexmedetomidine on awareness during intraoperative Wake-up tests in patients undergoing spinal surgery under propofol-remifentanil anesthesia .Methods 36 patients ,requiring intraoperative arousal test during posterior spinal surgery were randomly divided into the group D (DEX ,n= 18) and C (NS ,n= 18) .DEX 1 μg/kg followed by 0 .2 μg · kg -1 · h-1 and equal volume NS were infused respectively 10 min before anesthesia induction and maintenance of anesthe-sia in two groups .Hemodynamic parameters were monitored 5 min(T1) before anesthesia induction ,3 min(T2)after anesthesia in-duction ,at the beginning of wake-up test(T3) ,at the end of the test(T4) and 5 min(T5) after deepen anesthesia respectively . Meanwhile the wake-up time ,success rate of arousal ,incidence agitation and the dosage of nitroglycerin during wake-up were also recorded .Results Successive rate of arousal awakening time between two group had no statistically significance (P>0 .05) .less in-cidence of agitation was found in group D compared with group C ,the dosage of nitroglycerin used during wake-up in group D was less than that in group C(P<0 .05) .Conclusion Dexmedetomidine auxiliary propofol remifentanil anesthesia can effectively implement intraoperative wake up ,during the awakening the hemodynamic was more smoothly ,and it has lower incidence of adverse events .

Objective To detect the levels of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and investigate its relationship with liver function, ascites and heart structure in patients with liver cirrhosis. Methods The levels of plasma NT-proBNP and various clinical and biochemical parameters were determined in 60 patients with liver cirrhosis and 30 healthy controls. Meanwhile Child-Pugh liver function was classified. All people underwent color Doppler echocardiography. Results The level of plasma NT-proBNP was significantly elevated in patients with liver cirrhosis [(38.63±36.05)pmol/L], compared with that of the controls [(7.50±8.25)pmol/L],P<0.01. There was no significant difference in different Child-Pugh class and aseites amount of liver cirrhosis. E/A < 1 and E wave decelerate time (EDT) was in-creased in liver cirrhosis. Conclusion The levels of plasma NT-proBNP in liver cirrhosis are significantly elevated, and related to early impairment of diastolic function. But it does not correlate with liver function and aseites.

Objective To investigate the value of combination of B-flow imaging and spatio-temporal image correlation in prenatal diagnosis of congenital heart diseases. Methods Volume images of 50 normal fetuses and 14 fetuses with congenital heart diseases were recruited in the study. Surface mode was used to reconstruct the volume images. Results Sixty-three and twenty-six qualified volume images were obtained in 50 normal fetuses and 14 fetuses with congenital heart diseases respectively. All volume images were reconstructed successfully and showed the spacial relationship of cardiac blood vessel directly. Conclusions The combination of B-flow imaging and spatio-temporal image correlation was feasible and useful in prenatal diagnosis of congenital heart diseases.

Purpose To investigate the diagnosis and differentail diagnosis of metastatic small cell carcinoma of bone in needle biopsy, especially for the differentail diagnosis with Ewing sarcoma of bone. Methods Clinicopathological informations of 11 cases of metastat-ic small cell carcinoma and 20 cases of Ewing sarcoma were collected, and markers for differentail diagnosis were detected in two groups by immunohistochemistry of EnVision. Results The positive rates of CD99 and FLI-1 were 27. 3% and 54. 5% in metastatic small cell carcinoma group, while the positive rate of CK was 15. 0% in Ewing sarcoma group. Patient′s age, single lesion, expression of CK, vimentin, CD99, FLI-1, CD56 were significantly different in two groups. Conclusions Metastatic small cell carcinoma and E-wing sarcoma share similar histopathologic features in needle biopsy, no single immunohistochemical marker can specifically distinguish small cell carcinoma from Ewing sarcouma. The correct diagnosis should comprehensive analyze clinicopathologic characters and a se-ries of immunohistochemical markers.

Objective To observe the relationship of awake bispectral index (BISawake) and the postoperative cognitive dysfunction (POCD). Methods 100 patients aged 60~75 years with ASA status Ⅰ~Ⅱ, underwent elective lower abdominal surgery with intravenous anesthesia (propofol, remifentanyl and rocuronium). The BIS was adjusted in 40~60 during the surgery. Their cognitive function was assessed with the neuropsychological test battery commended by International study of postoperative cognitive dysfunction (ISPOCD). Results 8 patients withdrew for unwilling or serious complications. The BISawake was more than 65 in 68 patients (group A), and less than 65 in 24 patients (group B). The difference of the verbal learning immediate and delayed of Hopkins Verbal Learning Test-Revised was more in the group B than in the group A. Conclusion Lower BISawake may be associated with the decline of postoperative cognitive function.