At present, filtration surgery remains an important treatment of glaucoma, and filtering bleb fibrosis is the main cause for treatment failure. Filtering bleb fibrosis is a common fiber hyperplastic disease, and it relates to the activation and proliferation of fibroblasts and the excessive production of extracellular matrix ( ECM) such as collagen protein. The most frequently-used drugs for filtering bleb fibrosis in clinic are 5-fluoro-2,4 (1h, 3h) pyrimidinedione ( 5 - Fu ) and mitomycin ( MMC ) . Although they are effective in some degree, they also have some serious side effects which restrict their clinical use. Triptolide ( TPL) is a major active component of the medicinal plant, tripterygium wilfordii hook. f. ( TWHF) . TPL has multiple pharmacological activities including immunosuppressive, anti- inflammatory, anti- cancer and anti-fertility activity. Reviewing related literatures published in recent ten years, we confirmed that TPL seemed to possess a pharmacological activity in treating filtering bleb fibrosis. Since it has three major functions:1. inhibit the activation and proliferation of fibroblasts and the excessive production of collagen protein; 2. alleviate the inflammatory reaction after surgical wound to suppress fibrous scar formation; 3. TPL has a protective effect on retinal ganglion cells ( RGCs ) . We further find that TPL's anti-fibrosis activity mainly results from that it inhibits TGF-β/Smad,NF-κB and PI3K/AKT signal transduction pathway. This comprehensive analysis about the feasibility of Triptolide's role in treating filtering bleb fibrosis after the filtration surgery of glaucoma can help us develop new drugs for filtering bleb fibrosis and exploit TPL's clinical value on some level.

Objective To investigate the effect of parecoxib on intrapulmonary shunt during one-lung yentilation in patients undergoing esophageal cancer operation. Methods Forty-five ASA Ⅰ orⅡ patients of both sexes aged 47-57 yr weighing 42-59 kg undergoing esophageal cancer resection were randomly divided into 2 groups:control group (group C,n = 23) and parecoxib group (group P,n = 22). Left radial artery and right internal jugular vein were cannulated for MAP and CVP monitoring and blood sampling. Parecoxib 40 mg in 10 ml of normal saline was injected iv slowly before induction of anesthesia in group P while in group C normal saline 10 ml was injected instead of parecoxib. Anesthesia was induced with TCI of propofol (Ce 4 μg/ml) and sufentanil (Ce 0.3 ng/ml). Insertion of double lumen tube was facilitated with rocuronium 0.9 mg/kg. Correct position of the double lumen tube was verified by fiberoptic bronchoscopy. Anesthesia was maintained with TCI of propofol and sufentanil and intermittent iv boluses of cis-atracurium. BIS was maintained at 50-55 during operation. MAP, HR, CVP,mean airway pressure were monitored and recorded after induction of anesthesia (To), at 15, 30 min and 1 h of OLV (T1.2.3) and 30 min and 1 h after re-expansion of the collapsed lung (T4.5). Blood samples were taken simultaneously from jugular vein and radial artery for blood gas analysis. Intrapulmonary shunt (Qs/Qt) was calculated.Results There was no significant difference in MAP, HR, CVP, mean airway pressure and Qs/Qt during onelung ventilation between the two groups. Conclusion Parecoxib has no effect on hypoxic pulmonary vasoconstriction during one-lung ventilation in patients undergoing esophageal cancer resection.

OBJECTIVETo observe the effect of Modified Yiqi Chutan Recipe (MYCR) on blood flow perfusion in treating mid-late stage non-small cell lung cancer (NSCLC) patients by using multislice CT perfusion (CTP) , and to assess the relationship between each CTP parameter and the prognosis as well.

METHODSTotally 87 mid-late stage NSCLC patients were randomly assigned to the treatment group (44 cases, Shenyi Capsule + MYCR +chemotherapy) and the control group (43 cases, chemotherapy alone) in the ratio of 1:1. And 21 days consisted of 1 therapeutic course, 4 courses in total. All of them underwent CTP of primary tumor and routine thoracic CT examination (plain CT and enhancement CT) 3 times (before therapy, after 2 and 4 cycles). CT findings were analyzed for tumor size and perfusion parameters [blood flow (BF), blood volume (BV), permeability surface (PS), mean transit time (MTT), and time to peak (TP) before and after treatment, and relationship between perfusion parameters and prognosis was also assessed.

RESULTSIn 87 cases, 7 dropped out and 80 cases were available, 40 in the treatment group and 40 in the control group. (1) The relief rate was 47.5% (19/40) and the total stable rate was 77.5% (31/40) in the treatment group, and they were 40.0% (16/40) and 65.0% (26/40) in the control group, with no statistical difference between the two groups (χ² = 0.672, 1.227; P > 0.05). (2) Compared with before treatment group in the same group, BF and PS decreased, and MTT increased in the two groups after 2 and 4 courses (P < 0.05); BE and PS decreased, and MTT increased in the control group after 2 courses (P < 0.05). Compared with the control group after 4 courses, BE decreased more significantly in the treatment group (P < 0.05). (3) After 4 courses, all patients were assigned to the remission group (35 cases) and the non-remission group (45 cases) according to the RECIST standard. Compared with before treatment in the same group, BF, BF, and PS all decreased, and MTT increased in the remission group after treatment (all P < 0.05); BF increased in the non-remission group after treatment (P < 0.05). (4) All patients were assigned to the BE increase group (34 cases) and the BE decrease group (46 cases) according to changed BE values after treatment. Results showed the mean survival rate was 246 days in the BF increase group (the 1-year accumulative survival rate being 13.0%) and 387 days in the BE decrease group (the 1-year accumulative survival rate being 53.1%). The life span was prolonged and the 1-year accumulative survival rate was elevated in the BE increase group, with statistical difference as compared with the BE decrease group (χ² = 19.057, P < 0.01).

CONCLUSIONSShenyi Capsule plus MYCR could reduce BE in mid-late stage NSCLC patients , improve vascular permeability, showing better synergistic effect with chemotherapy. CTP could not only reflect the change of tumor size, but also reflect vascular function of the tumor. Meanwhile, changes of CTP parameters were closely associated with prognosis. Patients with post-treatment decreased BE value had better prognosis and longer life span.

Capillary Permeability ; drug effects ; Carcinoma, Non-Small-Cell Lung ; diagnosis ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Phytotherapy ; Tomography, X-Ray Computed

AIM: To investigate the effect of detoxifying herbs polygonum cuspidatum, and hawthorn, herb of promoting blood flow, on pathologic morphology and inflammatory factors in apolipoprotein E gene knockout mice, in order to approach the possible regulatory mechanism of polygonum cuspidatum and hawthorn for treating artherosclerosis (AS) unstable plaque. METHODS: The animals were divided into 7 groups (12 mice in every group). The ApoE (-/-) mice fed with high fat diet were divided into polygonum cuspidatum group, hawthorn group, polygonum cuspidatum + hawthorn group, Xuezhikang group and high fat diet model group. Moreover, ApoE (-/-) mice fed with normal diet (normal diet group) and C57BL/6J mice fed with normal diet (normal control group) were set up. After intragastric administration for 17 weeks, serum hs-CRP was detected, aorta structure was observed under light microscope and NF-κB protein expression was determined by immunohistochemistry. RESULTS: The pathological change of AS in aorta in all groups fed with high fat diet and normal diet group were observed with different degree. The changes of aortic lesion in all treatment groups were reduced. The levels of NF-κB and hs-CRP in high fat diet group were significant higher than those in normal control group and normal diet group. Serum NF-κB and hs-CRP levels decreased in every treatment group, which were significant different from those in high fat diet model group (P<0.01). Among them, the changes in polygonum cuspidatum and hawthorn groups were the best. CONCLUSION: Chinese herbs of polygonum cuspidatum and hawthorn reduce inflammatory factors NF-κB and hs-CRP expression and play a role in anti-AS formation.

Objective To determine the half-effective target effect-site concentration (EC50 ) of sufentanil inhibiting the urethroscope insertion response when combined with propofol by target-controlled infusion (TCI) in the elderly patients undergoing transurethral resection of prostate (TURP) . Methods Twenty-two ASA Ⅰ- Ⅲ patients, aged 65 -79 yr, weighing 47-81 kg, undergoing TURP, were enrolled in the study. Anesthesia was performed with TCI of propofol and sufentanil. The target plasma concentration of propofol was 4 μg/ml. The target effect-site concentration of sufentanil was determined by up-and-down sequential trial. The initial target effect-site concentration of sufentanil was 0.3 ng/ml and the ratio of the target concentrations between the two consecutive patients was 1.1. The ECW and 95% confidence interval of sufentanil required to inhibit the response to urethroscope insertion were calculated. Results The EC50 of sufentanil required to inhibit the urethroscope insertion response was 0.23 ng/ml (95% confidence interval 0.12-0.44 ng/ml). Conclusion When combined with propofol by TCI (target plasma concentration 4 μg/ml), the EC50 of sufentanil inhibiting the response to urethroscope insertion is 0,23 ng/ml in the elderly patients undergoing TURP.

Objective To investigate the effects of different degrees of acute normovolemic hemodilution (ANH) with 6% HES 20010.5 on serum S-100B protein concentration and cerebral oxygen metabolism at 37℃ in rabbits.Methods Thirty-two adult rabbits weighing 2.0-2.5 kg were randomly assigned into 4 groups (n = 8each) : Ⅰ control group underwent no ANH and Ⅱ , Ⅲ , Ⅳ ANH group underwent ANH with hematocrit (Hct)reduced to 24%, 18% and 12% respectively. The animals were anesthetized with iv 20% urethane 5 ml/kg,tracheostomized and mechanically ventilated (VT = 15 ml/kg, RR = 30 bpm). The body temperature was maintained at 37℃. Left carotid artery and jugular vein were cannulated for BP monitoring, blood gas analysis and blood sampling. Right jugular vein was cannulated for CVP monitoring. Left femoral artery and vein were cannulated for hemodilution. Blood withdrawn from femoral artery was simultaneously replaced by iv infusion of equal volume of HES (200/0.5) until the target Hct was achieved. Hemodynamics parameters, were recorded and blood gases were analyzed and serum S-100B protein concentration and cerebral O2 metabolic rate (CERO2) were determined before (baseline) and at 2, 4 and 8 h after ANH. Brain water content was measured by wet/dry brain weight ratio. Results There were no significant differences in serum S-100B protein concentration, CERO2 and pH value between group Ⅰ and group Ⅱ (Hct 24%). Serum S-100B protein concentration and CERO2 were significantly increased at 8 h after ANH as compared with the baseline before ANH in group Ⅰ (Her 18%). Serun S-100B protein concentration and CERO2 were significantly increased at 2, 4 and 8 h after ANH as compared with the baseline before ANH in group Ⅳ (Hct 12%). There was no significant difference in brain water content among the 4 groups. Conclusion ANH does not affect cerebral O2 metabolic when Hct is reduced to 24%. CERO2 can not be sustained and ischemic cerebral injury may occur when Hct is reduced to≤18%.

Objective To define the role of melatonin in the pathogenesis of chickens scoliosis following pinealectomy and constant light irradiation. Methods Ten white leghorn chickens in the control group were kept in light-dark (12h:12h) cycle, 500 lx in daytime and 0-5 lx in nighttime after birth. Pinealectomy was performed in 20 white leghorn chickens when 3-day-old and then kept in light-dark cycle as the control group. Constant light (500 lx) irradiation was used to reduce the secretion of melatonin in 20 chickens after their births. Radiologic examinations were performed on all chicken spines for scoliosis monthly. When the chickens were 3-month-old, their mid-day and mid-night serum samples were collected and analyzed with ELISA kit for melatonin. Results There was no scoliosis in the control group and constant light group when the chickens were 3-month-old. In the pinealectomy group, 4 chickens had obvious scoliosis in the first month when X-ray examination was taken. The curved deformity progressed and became serious when the chickens grew up. There were 7 chickens with severe curved deformity in the second month. When the chickens were 3-month-old, there were totally 11 chickens with scoliosis, Cobb' angle 11?-85?, average 30.63?. The level of melatonin in control group was low in daytime (10.6 pg/ml) and high in nighttime (110.4 pg/ml) alternately. The melatonin level was much lower, daytime 8.4 pg/ml and nighttime 6.9 pg/ml in pinealectomy group and 10.8 pg/ml in constant light group. There was no statistical significance in the serum melatonin between the pinealectomy group and constant light group. Both groups remained low level of serum melatonin. Conclusion Pinealectomy can reduce the secretion of melatonin and induce scoliosis in chickens. Although constant light could suppress the secretion of melatonin in chicken serum, it did not induce scoliosis. The pathogenesis of chickens scoliosis might not be mediated by low-level melatonin.

Purpose There is no agreement for contrast enhanced ultrasound (CEUS) in differential diagnosis of benign and malignant thyroid nodules. This paper aims to evaluate the diagnostic value of the conventional and contrast-enhanced ultrasonography in the diagnosis of thyroid nodule by meta analysis. Materials and Methods Literature search was performed in PubMed, CNKI and Wanfang databases to identify relevant English and Chinese literatures by using pathological results as the gold standard from January 1990 to September 2014. The quality of each selected study was evaluated by QUADAS. The pooled weighted sensitivity, specificity and the corresponding 95% CI were calculated. Summary receiver operating characteristic curves (SROC), area under curve (AUC) and the Q* index were also calculated. Results A total of 14 literatures (1970 nodules) were included, the pooled weighted sensitivity and specificity of conventional ultrasonography were 0.74 and 0.70; those of contrast-enhanced ultrasonography were 0.86 and 0.82. The AUC by using the two methods were 0.84 and 0.93, respectively, and the Q* index were 0.77 and 0.86, respectively. Conclusion In the diagnosis of thyroid nodule, the accuracy of contrast-enhanced ultrasonography is better than conventional ultrasound; however, both of them have high clinical value in the diagnosis of thyroid nodule, thus they are helpful in avoidance of unnecessary surgical treatment in patients with thyroid disease.

Objective To explore the surgical treatment effect reconstructing calcaneus partial defect with deep iliac circumflex artery illium lamella and sural nerve slap. Methods Sevens of calcaneus fracture with posterior part defect from July 2005 to July 2010 were rehabilitated with deep iliac circumflex artery ilium lamella whose artery were anastomosed to posterior tibial artery and whose skin were repaired with sural nerve slap. Results All patients were obtained follow-up,which ranged from 9 to 30 months with a mean of 19.5 months. Its Bohler angle maintain a range from 35 to 45 degree and foot bridge maintain its figure,as well as perfect skin.According to Maryland grades system,the result were excellent in 3 cases with score 90,good in 2 with score 85 and fair in 2 with score 75. Conclusion It is a perfect method for calcaneus trauma which lose its foot bridge to rehab its figure and function with deep iliac circumflex artery ilium lamella and sural nerve slap.

Background Diabetes mellitus (DM) can provoke the apoptosis of retinal cells and downregulate the expression of calcitonin gene related peptide (CGRP) in the retina.Capsaicin promotes the release of CGRP and elicits protective effects on human organs.However,whether CGRP protects retinal cells in diabetic retinopathy (DR) is still unclear.Objective The study was designed to examine the effect of capsaicin on the apoptosis of retinal cells in diabetic rats and its relationship with CGRP.Methods Forty clean healthy adult male Sprague-Dawey rats were randomly divided into the diabetes group,capsaicin pretreated group,streptozocin (STZ)control group,capsaicin control group and plain control group,with 8 rats per group.The diabetic model was established by the intraperitoneal injection of 60 mg/kg in all rats except those of the plain control group.0.4 mL of a 1％ capsaicin injected at 20 mg/kg was subcutaneously injected for 3 consecutive days prior to model establishment in the capsaicin pretreated group,after which 1.2 mL of STZ was intraperitoneally injected on the fourth day.Rats from the STZ control group were administered intraperitoneally 1.2 mL of 0.1 mol/L,pH 4.5,citrate buffer.The capsaicin control group received subcutaneous injections of 0.4 mL of 1％ capsaicin at 20 mg/kg for 3 consecutive days,after which 1.2 mL of 0.1 mol/L,pH 4.5,citrate buffer was administered intraperitoneally.The rats were sacrificed at the tenth week after model establishment and retinal specimens were prepared for the apoptosis assay by TUNEL staining and the quantitative analysis of caspase-3 activity.Expression of CGRP in the retina and serum was detected using ELISA.The use of experimental animals followed the Regulations for the Administration of Affairs Concerning Experimental Animals by State Science and Technology Commission.Results Retinal cell apoptosis was mainly localized to the retinal ganglion cell (RGC) layer.The apoptosis rate of RGCs was (43.4±5.0)％ in the DR model group and (30.0±5.1)％ in the capsaicin pretreated group,showing a significant difference (t =5.930,P＜0.01).Compared with the DR model group and capsaicin pretreated group,the apoptosis rates of the DR control group (12.4±9.9) ％ and the capsaicin control group (17.6-±6.1) ％ were significantly lower (t =8.800,t =4.925,P＜0.01).The apoptosis rate of the plain control group was (16.2±6.9)％,exhibiting significant differences in comparison with the DR control group and capsaicin control group (t =-0.989,t =0.951,P＞0.05).The specific activity of caspase-3 was (2.19±0.86) in the DR model group and (1.96±0.56) in the capsaicin pretreated group,presenting a significant difference (t =-0.515,P＜0.05).Those of the DR control group and capsaicin control group were (1.47±0.14) and (0.74±0.27),respectively,with considerable decline in comparison with the DR model group and capsaicin pretreated group (t=2.142,t=2.797,P＜0.05).The retinal and serum CGRP levels were (424.4±44.2)and (148.8±39.1) ng/L,respectively,displaying significantly lower levels than (543.2±74.4) and (237.5±78.7) ng/L (t =3.070,2.359,P＜0.05) from the capsaicin pretreated group.Conclusions Apoptosis of retinal ganglion cells occurs in the STZ-induced diabetic rats.Pretreatment of capsaicin reduces retinal cell apoptosis,which may be associated with an increase of CGRP in the retina.