Objective To observe the effect of continuous incision infusion different concentra-tion of ropivacaine for postoperative analgesia after radical mastectomy.Methods One hundred pa-tients under radical mastectomy,aged 40-70 years,ASA Ⅰ or Ⅱ,were randomly divided into four groups (n =25 each):0.2% (group R1),0.3% (group R2),0.4% (group R3)ropivacaine incision continued infiltration group and patient-controlled intravenous analgesia (group PCIA)as control group.VAS pain scores,sedation Ramsay score and side effects were recorded at each time point in rest and turning over 90°,2 h (T1 ),4 h (T2 ),8 h (T3 ),12 h (T4 ),24 h (T5 ),48 h (T6 )after the operation.Results VAS scores in group R1 at T1-T6 in rest and turn over 90°were significantly high-er than that of group PCIA (P <0.05).There were no significant differences among the group PCIA, group R2 and group R3.Sedation score in PCIA group was significantly higher than that in the other three groups (P <0.05),and the adverse reactions,such as nausea and vomiting,in group PCIA (2 cases)were more serious than that in the other groups (0 cases ).There were no significant differences among the other groups.Conclusion Ropivacaine plays an effective role in infiltration an-algesia when its concentration reaches 0.3% subcutaneous after radical mastectomy.

Objective To evaluate the therapeutic results of percutaneous transhepatic stent angioplasty for portal vein stenosis following liver transplant.Methods From 2005 to 2007,7 patients developed portal vein stenosis following liver transplant.Percutaneous transhepatic stent angioplasty of the portal vein was performed in all patients.The therapeutic results were monitored by clinical follow-up and imaging examination.Results In seven patients,the percutaneous transhepatic stents were placed successfully.The follow up period ranged from 3 months to 34 months.Portal venous patency Was maintained in six patients(one patient died due to hepatic arterial thrombosis and ischemic insult to bile duct at three months following the stent placement).No complications due to stent angioplasty occurred.Conclusion Percutaneous transhepatic stent angioplasty is an effective and safe method for treatment of portal vein stenosis following liver transplant.

Objective To investigate the effects of Helicobacter priori (H.prlori) strains from the patient with gastric cancer on the expression of DNA mismatch repair (MMR) genes in AGS cells in vitro. Methods AGS cells were co-cultured with ten strains of H.prlori from five patients with gastric cancer and five patients with gastritis respectively.The expressions of DNA MMR genes (hMSH2 and hMLH1) in mRNA and protein levels were determined by RT-PCR and Western blot.The enteropathogenic E.coli served as a bacterial control.Results E.coli and H.priori strains from gastritis have no effects on the expression of hMSH2 and hMLH1 in both protein and mRNA levels on the whole,while all the H.prlori strains from gastric cancer reduced expression levels of hMSH2 and hMLH1.Conclusions There are different effects between H. prlori strains from gastric cancer and those from gastritis on DNA MMR in AGS cell line,indicating that infec- tion of some H.prlori strains might lead to the inhibition of DNA MMR,and that in turns increases the risk of gastric carcinogenesis during chronic H.prlori infection.

Objective In order to avoid potential injuries imposed to human body, it can be feasible to use the musculoskeletal models which can be reconstructed from the cadaver color cryosection (CCC) images, computerized tomography (CT) images, magnetic resonance (MR) images or other images to analyze the dynamic properties of muscles in vivo during human movement. Methods We reconstruct the lower limb musculoskeletal model and define the uniform joint coordinate system (JCS) on the model and the subject. The coordinate transformation of the muscle attachment points both on the model and the subject is described in detail. Results The length and the moment arm of the biceps femoris (short head) during knee flexion are calculated and analyzed. Conclusion This method plays an important role in improving the kinematics and dynamic simulation and the muscle force estimation.

OBJECTIVETo investigate the clinical features of ventilator-associated pneumonia (VAP) caused by acinetobacter.

METHODSThe clinical manifestations of 45 cases with ventilator-associated pneumonia caused by acinetobacter between 1995 and 2002 were analyzed. Bacterial susceptibility of acinetobacter strains was determined by Kerby-Bauer method.

RESULTSThe mean age of the subjects was 58 +/- 13 years with 31 patients older than 60 years. All the patients had underlying diseases, most of which were respiratory diseases (37.8%), nervous system diseases (22.2%), and trauma (22.2%). Thirteen cases (28.9%) were mixed infections with other bacteria. The main manifestations were fever, purulent secretion, and solidification in the lung. X-ray revealed inflammatory infiltration in lower lobes of both sides. The mortality was 37.8%. The in vitro activity tests of 28 antibiotics against the acinetobacter strains showed that they were multiresistant. Polymysin B, imipenem, minocycline, ofloxacin, and amikacin were relatively active.

CONCLUSIONThe patients with VAP caused by acinetobacter usually had underlying diseases without unique features and high mortality, and the isolated strains were often mutiresistant. It is necessary to make early diagnosis, select the appropriate agents, and improve the disinfection of the breath loop in the ventilator.

Acinetobacter ; isolation & purification ; Acinetobacter Infections ; microbiology ; Aged ; Cross Infection ; etiology ; Drug Resistance, Bacterial ; Female ; Humans ; Male ; Middle Aged ; Pneumonia, Bacterial ; microbiology ; Ventilators, Mechanical ; microbiology

OBJECTIVETo investigate the protective effect of mouse astrocyte-conditioned medium (ACM) on hypoxic and mechanically injured neurons by a cell model in vitro, and to explore the possible mechanism.

METHODSThe model of hypoxic neuronal injury was caused by 3% O2 in three-gas incubator. Neurons were cultured with ordinary medium or 20% ACM respectively and randomly divided into hypoxic group (hypoxia for 4, 8, 24 h and marked as H4R0, H8R0, H24R0) and hypoxia reoxygenation group (H4R24, H8R24, H24R24). Mechanical injury model was developed by scratching neurons cultured in 20% ACM or ordinary medium to different degrees. Neurons in both medium were divided into normal control group, mild, moderate and severe injury groups. The 20% ACM was added 24 h before hypoxia/reoxygenation or mechanical injury. The morphology and survival of neurons were observed and counted by trypan blue staining. The concentration of NO, lactic dehydrogenase (LDH) and membrane ATPase activity were detected by corresponding kits.

RESULTSIt was showed that 20% ACM can obviously promote the survival rate of hypoxia/reoxygenated neurons and scratched neurons as well. The morphology and number of neurons exposed to hypoxia or scratch injury showed great difference between groups with or without ACM treatment. Compared with control group, the concentration of NO and LDH was much lower in hypoxic/reoxygenated neurons treated with 20% ACM, and the ATPase activity was higher. For the mechanical injury model, neurons with moderate injury also revealed a lower NO and LDH concentration than the control group. All the differences were statistically significant (P less than 0.05).

CONCLUSIONACM can promote the survival and functional recovery of neurons following hypoxia or scratching to a certain degree. The mechanism may be associated with reducing the synthesis and release of NO and LDH as well as increasing the activity of membrane ATPase.

Animals ; Astrocytes ; physiology ; Cell Hypoxia ; Cell Survival ; Cells, Cultured ; Culture Media, Conditioned ; Mice ; Nerve Growth Factors ; physiology ; Neurons ; physiology

Objective To investigate the influence of competitive flow at different lelves on wall shear stress (WSS) of left internal mammary artery graft after coronary artery bypass grafting. Methods The left internal mammary artery (LIMA) left anterior descending (LAD) anastomotic model was extracted and reconstructed from CT images based on thresholding method by using SimVascular software. The competitive flow was divided into three groups according to different stenosis of LAD, including no competitive flow group (100% stenosis of LAD), mild competitive flow group (50% and 75% stenosis of LAD) and severe competitive flow group (0% and 30% stenosis of LAD). The hemodynamic performace of the anastomotic model under different conditions of competitive flow was observed by computational fluid dynamics (CFD) method. Results With the increment of competitive flow, the value of WSS was decreased gradually while the oscillation of WSS was increased remarkably in LIMA graft. The time average WSS (TAWSS) of LIMA graft in severe competitive flow group (0% stenosis: 2.73 Pa, 30% stenosis: 2.85 Pa) was lower than that in the mild competitive flow group (50% stenosis: 4.77 Pa, 75% stenosis: 6.01 Pa) and no competitive flow group (100% stenosis: 8.64 Pa), while its oscillatory shear index (OSI) (0% stenosis: 0.206; 30% stenosis: 0.085) was much higher than that in other two groups (50% stenosis: 0.014; 75% stenosis: 0.013; 100% stenosis: 0.006). Conclusions When the stonosis of LAD was smaller than 50%, the WSS in LIMA graft was obviously lower and oscillatory due to severe competitive flow. Such unfavorable feature of WSS may influence the long term-patency of LIMA graft and long term-survival of operations.

OBJECTIVEMany children were found to have low free carnitine level in blood by tandem mass spectrometry technology. In some of the cases the problems occurred secondary to malnutrition, organic acidemia and other fatty acid oxidation metabolic diseases, and some of cases had primary carnitine deficiency (PCD). In the present article, we discuss the diagnosis of PCD and evaluate the efficacy of carnitine in the treatment of PCD.

METHODWe measured the free carnitine (C0) and acylcarnitine levels in the blood of 270 000 neonates from newborns screening program and 12 000 children with suspected clinical inherited metabolic diseases by tandem mass spectrometry. The mutations of carnitine transporter protein were tested to the children with low C0 level and the diagnosis was made. The children with PCD were treated with 100 - 300 mg/kg of carnitine.

RESULTSeventeen children were diagnosed with PCD, 6 from newborn screening program and 11 from clinical patients. Mutations were found in all of them. The average C0 level [(2.9 ± 2.0) µmol/L] in patients was lower than the reference value (10 µmol/L), along with decreased level of different acylcarnitines. The clinical manifestations were diverse. For the 6 patients from newborn screening, 4 were asymptomatic, 1 showed hypoglycaemia and 1 showed movement intolerance from 2 years of age. For the 11 clinical patients, 8 showed hepatomegaly, 7 showed myasthenia, 6 showed cardiomyopathy, 1 showed chronic abdominal pain, and 1 showed restlessness and learning difficulty. Among these patients, 14 cases were treated with carnitine. Their clinical symptoms disappeared 1 to 3 months later. The C0 level in the blood rose to normal, with the average from (4.0 ± 2.7) µmol/L to (20.6 ± 8.3) µmol/L (P < 0.01). However, the level was still lower than the average level of healthy children [(27.1 ± 4.5) µmol/L, P < 0.01].

CONCLUSIONSeventeen patients were diagnosed with PCD by the test levels of free carnitine and acylcarnitines in blood with tandem mass spectrometry, and gene mutation test. Large dose of carnitine had a good effect in treatment of the PCD patients.

Cardiomyopathies ; diagnosis ; drug therapy ; genetics ; Carnitine ; analogs & derivatives ; blood ; deficiency ; genetics ; Child, Preschool ; DNA Mutational Analysis ; Female ; Follow-Up Studies ; Humans ; Hyperammonemia ; diagnosis ; drug therapy ; genetics ; Infant ; Infant, Newborn ; Male ; Muscular Diseases ; diagnosis ; drug therapy ; genetics ; Mutation ; Neonatal Screening ; methods ; Organic Cation Transport Proteins ; deficiency ; genetics ; Reference Values ; Tandem Mass Spectrometry

Adult ; Aged ; Biomechanical Phenomena ; Bone Screws ; Female ; Humans ; Joint Instability ; physiopathology ; surgery ; Lumbar Vertebrae ; physiopathology ; surgery ; Male ; Middle Aged ; Spinal Diseases ; physiopathology ; surgery ; Spinal Fusion ; instrumentation

Asian Continental Ancestry Group ; Bartter Syndrome ; genetics ; Child ; Chloride Channels ; genetics ; Humans ; Male ; Mutation