Objective To assess the anticonvulsant effect of midazolam, thiopental and propofol on the convulsion induced by ropivacaine in rats and the underlying mechanism.Methods Fifty male SD rats, 4-6 months of age, weighing 250-300 g were randomly divided into five groups of 10 animals each : (1) control group (C); (2) ropivacaine group; (R) (3) midazolam-ropivacaine group (MR); (4) thiopental-ropivacaine group (SR) and (5) propofol-ropivacaine group (PR) . In control group normal saline 2 ml was infused i.v. . In ropivacaine group (R) 0.75% ropivacaine was infused i.v. at 0.5 ml?min-1 until convulsion occurred. In midazolam - ropivacaine group (MR) midazolam 0.23 mg?kg-1 was injected i.v. 3 min before 0.75% ropivacaine infusion. In SR and PR groups thiopental 2 mg?kg-1 or propofol 1 mg?kg-1 was injected i.v. 1 min before 0.75% ropivacaine infusion. As soon as convulsion occurred ropivacaine infusion was stopped. The animals were decapitated and their brains were removed and kept in liquid nitrogen for determination of the contents of excitatory ammo-acids (aspartic acid and glutamic acid) and the inhibitory amino-acids [glycine and ?-amino butyric acid (GABA)] by high-performance liquid chromatography . The amount of ropivacaine infused in each group was recorded and calculated.Results The dose of ropivacaine needed to produce convulsion was 4.6?0.5 mg?kg-1 in group R and was significantly increased in the 3 groups pretreated with general anesthetics and was 2.96 times the dose in group R in MR group, 2.84 times in SR group and 1.54 times in PR group. The 4 amino-acid concentrations in the brain were significantly higher in group R than in control group. Compared to group R the Asp, Gly and GABA concentrations were significantly lower in group MR and PR but in group SR only Asp concentration was significantly lower. There was no significant difference in glutamic acid concentration among the4 roopivacaine groups (group 2-5).Conclusion Midazolam, thiopental and propofol can all increase the dose of ropivacaine needed to induce convulsion and midazolam and thiopental are more effective than propofol.

Adult ; Female ; Granuloma, Respiratory Tract ; pathology ; Humans ; Lung, Hyperlucent ; pathology ; Male ; Middle Aged

Objective To investigate incidence,diagnosis and treatment strategy of delayed esophageal complications after anterior cervical spine surgery.Methods The clinical data of 2316 patients who had undergone anterior cervical spine surgery from January 2001 to December 2011 were analyzed.The delayed esophageal complications were defined as esophageal perforation,esophago-tracheal fistula,esophago-cutaneous fistula,diverticulum of esophagus,esophagopleural fistula and esophageal stenosis that occurred 2 weeks after spine surgery.Results Delayed esophageal complications occurred in 4 patients,and the incidence was 0.17％.Esophageal perforation occurred in 2 patients; the incidence was 0.09％.Case 1 was a 31-year-old man who was found to have esophageal diverticulum and perforation 7 years after anterior cervical spine surgery.Then he underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 2 was a 46-year-old man who was found to have esophageal diverticulum 3 years after cervical spine surgery.He also underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 3 was a 58-year-old woman who was found to have esophageal diverticulum 5 years after cervical spine surgery.She underwent removal of implant,excision of diverticulum,and repair of esophagus with sternocleidomastoid muscle flap.Case 4 was a 56-year-old woman who was found to have esophageal perforation 3 years after cervical spine surgery.She underwent removal of implant and repair of esophagus with sternocleidomastoid muscle flap.All 4 patients recovered after operation.Conclusion The incidence of delayed esophageal complications after anterior cervical spine surgery is low,and the diagnosis is difficult.X-ray,digestive tract radiography,and gastrointestinal endoscopy are the main diagnostic tools.Surgical treatment is the main and effective management.

Objective To establish nursing intervention for patients with diabetes mellitus and discuss in-fluence of community nursing on rehabilitation of patients with diabetes mellitus. Methods Patients with con-finned diagnosis of type two diabetes mellitus (61 cases) were selected,individual health records were established and health education was given to them,including diet,exercises,psychological nursing,medication instruction and regular blood glucose monitoring. Patients compliance,control of fasting blood glucose and glycosylated hemoglobin were compared before and after nursing intervention. Results Patients compliance such as regular physical ex-amination,diet control,regular blood glucose monitoring and exercises treatment improved after intervention com-pared with those before community intervention (P<0.05). The control of fasting blood glucose and glycosylated hemoglobin was better after intervention compared with those before community intervention (P<0.01). Con-clusion Community nursing intervention for patients with diabetes mellitus proved to have good effect.

Objective To evaluate the training quality of anaesthesiology residents in different hospitals. Methods The scores of 125 residents,attending Shanghai resident clinic skill examination from 2005 to 2007,were analyzed. ResultsThe scores of examinees from municipal hospitals were higher than those from district hospitals,municipal specialized hospitals and traditional Chinese medicine hospitals.The scores of practice part were higher than those of theory part in all groups. Conclusion The training quality is related to the comprehensive strength of the hospital in which examinees work,but the training of theory knowledge still need to be strengthened.

AIM: To evaluate the preservation of anterior capsule during vitrectomy and lensectomy.ment (RD) and grade C proliferative vitreoretinopathy (PVR)underwent pars plana vitrectomy (PPV) and pars plana lensectomy (PPL) with preservation and polishing of the anterior capsule. Of the 15 eyes, 4 eyes had giant tear, 3 had recurrent rhegmatogenous retinal detachment (RRD), 2 had diabetic retinopathy. Totally 6 eyes had gas and 9 had silicone oil tamponade. The surgeries were evaluated according to the visual acuity (VA) and the postoperative complications during the follow-up of at least 3 months.in all eyes, improved by 3± 3 lines overall. Eight eyes were implanted posterior chamber intraocular lens (PCIOL) successfully at 2-3 months after operation, including 6 having gas and 2 having silicone oil tamponade. No eyes had central anterior capsule opacity, corneal decompensation, puplillary block, retina redetachment or other complications.an intact anterior capsule in eyes with RD and PVR. Preserving the anterior capsule can help preventing intraoperative and postoperative complications of gas or silicone oil, simplify future PCIOL placement, and maintaining a normal iris appearance.

Background Clinical researches showed that antimicrobial-resistance of bacterium is gradually serious.It is very important to master pathogen distribution and antimicrobial susceptibility after eye surgery.Objective This study was to investigate the distribution and drug sensitivity of pathogenic bacteria from ocular operative infection in 3-year duration to provide a reference for reasonable selection of antibiotics.Methods Sixtyfive positive specimens were obtained from 65 patients due to postoperative infection in Department of Ophthalmology of Shenzhou Hospital and Shengjing Hospital from 2009 January through 2011 December.The pathogenic bacteria were isolated and then the drug sensitivity test of conventional antibiotics was performed.Results Among the 65 ophthalmic specimens,35 strains of Gram-positive bacteria were isolated with the constituent ratio 53.8％,and 15 strains of Gram-negative bacteria accounted for 23.1％.Fungus was found in 15 cases with the constituent ratio 23.1％.Staphylococcus epidermidis accounted for 42.9％ in Gram-positive bacteria,and Pseudomonas aeruginosa accounted for 33.3％ in Gram-negative bacteria.Aspergillus was the main component of fungus,which accounted for 60.0％ of the proportion 3 strains of methicillin-resistant Staphylococcus aureus (MRSA) in 8 strains of Staphylococcus aureus,but no vancomycin-resistant Enterococcus (VRE) and vancomycin-resistant Staphylococcus (VRS) were seen.The in vitro drug sensitivity test showed that the main Gram-positive bacteria,Staphylococcus epidermidis and Staphylococcus aureus,were sensitive to linezolid,vancomycin,levofloxacin and ciprofloxacin with the sensitive rates ＞50.0％,and these bacteria were lowly sensitive to penicillin and erythromycin with the sensitive rates ≤30.0％.Pseudomonas aeruginosa appeared to be the main Gram-negative bacteria,showing a sensitive rate ≥ 80.0％ to tobramycin,amikacin,ceftazidime,cefepime,cefoperazone/sulbactam,piperacillin/tazobactam,imipenem and meropenem.Conclusions Staphylococcus epidermidis,Staphylococcus aureus,Pseudomonas aeruginosa and Aspergillus are primary pathogens in ocular infection after operation.Antibiotics such as penicillin,erythromycin,levofloxacin,cefotaxime seem to be relatively high resistant to eye infection.To choose sensitive antibiotics timely and reasonably is a key to the prevention and control of ocular infection after operation.

Immunosuppressive tumor microenvironment is a part of the tumor microenvironment that plays an immunosuppressive function.It consists of suppressor cells and inhibitory cytokines.In recent years,be-cause of its important role in tumor immunity,CAR-T and PD-1/PD-L1 signal pathway has become a hot top-ic of immunotherapy, which can suppress immune through different mechanisms to promote tumor progression. Therefore,taking more effective anti-tumor therapies against the above mechanisms is possible to rescue the pro-gress of tumor.In this article,the influence of immunosuppression microenvironment in CAR-T cell therapy and PD-1/PD-L1 signaling pathway in the anti-tumor process is reviewed.

Objective To investigate the correlation between immature granulocyte and CD34+ cells, mononuclear cells (MNC) in donor's peripheral blood by recombinant human granulocyte colony-stimulating factor (rhG-CSF). Methods The stem cell were mobilized by rhG-CSF 7.25-10 μg·kg-1·d-1 from 122 allo-PBSCT donors. Before and after mobilization, to test CD34+ cells of peripheral blood stem cell graft and number of MNC, immature granulocyte, CD34+ cell per patient' weight were calculated. Results White blood cell count and immature granulocyte gradually increased, and reached the peak on the frith day. There was a good relationship between increased immature granulocytes and increased CD34+ cells. The patients all achieved completed donor engraftment and achieved hematopoietic recovery. The chromosome, blood type and HLA type were transformed to be donor's type. Ph1 changed to be negative in CML patients. Conclusion rhG-CSF (7.25～10 μg·kg-1·d-1) had a good effect to mobilize PBSC. There was a good relationship between in-creased immature granulocytes and increased CD34+ cells after mobilization by rhG-CSF. The number of immature granulocytes can reflect indirectly the count of stem/progenitor, so the MNC and immature granulo-cytes can become a threshold of dosage standard.

Objective To investigate the expression of lung keratinocyte growth factor receptor (KGFR) in rats with acute spinal cord injury (ASCI) in different time points and its role in lung edema.Methods Thirty-two adult Wistar rats weighing 240 g to 260 g were assigned to experimental group (n =16) and control group (n =16) according to the random number table.Each group consisted of time points of 24 hours,3 days,1 week and 2 weeks after the modeling (4 rats per time point).A rat model of ASCI in experimental group was induced at C7 segment by dropping a weight of 10 g from the height of 2.5 cm (Allen' s method).In control group,laminas were removed only,leaving spinal cord at C7 intact.Rats were sacrificed at each time point for measurement of lung wet/dry weight ratio,Western blot analysis of expression of lung KGFR protein and RT-qPCR detection of lung KGFR mRNA expression.Results After ASCI in rats,the expressions of lung KGFR protein and mRNA began to drop at 24 hours (0.23 ±0.06,0,012 1 ±0.002 3),reached the trough at 3 days (0.17 ±0.04,0.008 5 ±0.001 7)and picked up at 1 week.Expression of lung KGFR mRNA in experiment group showed statistically significant difference from that in control group at 24 hours and 3 days (P ＜ 0.05),whereas in each time point the difference of KGFR protein expression between experiment and control groups was statistically significant(P ＜0.05).Variation trend of KGFR expression was in parallel with the severity degree of pulmonary edema.Conclusion Lung KGFR presents significant down-regulation in ASCI rats and this may be associated with the development of pulmonary edema after ASCI.