Objective To determine the protective effects of endotoxin preconditioning on the brain ischemic injury and explore its protective mechanism. Methods Global ischemia for 20 min by four-vessel occlusion model was used in 140 Wistar rats, in which 70 rats were pretreated with MPL at dose of 20 ?g/kg 24 h before global ischemia. Another 10 Wistar rats served as normal controls. Ischemic neurons and neuron density of the hippocampal CA1 region, MPO activity, TNF-? activity, IL-1? activity were assayed at 4, 12, 24, 48, 72, 120, 168 h after reperfusion. Results Pretreatment with endotoxin produced significant reductions in ischemic neuron number, MPO activity, TNF-? activity and IL-1? activity. Conclusion Endotoxin preconditioning protects brain from subsequent ischemic injury, in which the suppression of cellular inflammation may be the protective mechanism.

Objective To determine the effects and significance of endotoxin preconditioning on iNOS activity,nNOS activity in rat cerebral cortex,hippocampus and cerebella region after global brain ischemia/reperfusion.Methods Global ischemia for 20 min was made by four-vessel occlusion model(4-vo) in 60 Wistar rats,among which 30 were injected of 20 ?g/kg MPL through caudal vein 24 h before model establishment.Another 8 rats undergoing sham operation served as controls.The dynamic change of iNOS activity,nNOS activity and neuron density of the cerebral cortex,hippocampus and cerebella region were observed at 1,4,8 h after reperfusion. Results The activity of iNOS and nNOS decreased significantly after endotoxin preconditioning in the regions mentioned above,as compared with that of rats only undergoing the ischemia/reperfusion.The neuron number in rat hippocampus decreased after ischemia/reperfusion,but no significant difference was found between control and endotoxin preconditioning groups.Conclusion The activity of iNOS and nNOS changed significantly after global brain ischemia/reperfusion.That endotoxin preconditioning decreased iNOS and nNOS activities may be the protective mechanism.

Objective To summarize the first 16 eases in mainland China and to discuss the cli-nical experience of robot-assisted laparoseopie radical prostateetomy(RLRP). Methods Sixteen pa-tients with localized prostate carcinoma underwent RLRP with da Vinci S surgical system (Intuitive Surgical Inc.). The age of the patients was 62-76 years, average 69 years. The preoperative t-PSA level was 0.2-79. 2. Ng/ml. The volume of prostate was 9.8-232.9 ml. Fifteen patients were with biopsy-proven prostate cancer, the average Gleason score was 7(4-9). Three were T2a. N0 M0, 4 were T2b N0 M0 and 8 were T2c N0/M0 by clinical stage. One was prostatic intraepithelial neoplasm-Ⅲ. The level of t-PSA in serum and the result of urinary continence were followed up after RLRP. Results All the operations were accomplished successfully. The mean preoperative set-up time of the da Vinci surgical system was 64(60--90)min;the mean operation time was 236(190--390)rain;the mean esti-mated blood loss was 231(50-500)m.L The patients were ambulant between the 2nd and 3rd postop-erative days. Foley catheter was sueeeasfully removed on day 10 to 14, and mean hospital stay was 13 (6-19) days. Two eases had positive surgical margins, the pathological stages were both pT3b N0 M0. The average serum t-PSA was less than 0. 1 ng/ml during a median follow-up of 9(6-12) months. By the conventional definition of urinary continence (0 to 1 pads daily), 94%(15/16) and 100% (16/16)of patients were continent at 3 and 6 months, respectively. Of the patients, 75% (12/16)and 88% (14/16)had no urinary leakage(0 pads daily). Conclusions RLRP is small incision and safe. It is the direction of minimally invasive urologic surgery.

Objective To assess the predictive value of thiopurine methyltransferase genotyping and enzyme activity in relation to side effects in patients with inflammatory bowel disease (IBD) who were treated with azathioprine (AZA). Methods One hundred and eleven IBD patients (26 with ulcerative colitis and 86 with Cronh's disease) with indication of AZA administration between April 2004 and Dec. 2009 were enrolled. All patients received 2 mg/kg of AZA daily. Polymerase chain reaction and high performance liquid chromatography were used to genotype the TPMT * 2, * 3A, * 3B, * 3C and to detect TPMT activity, respectively. The association of TPMT genotype and activity with side effects was analyzed in patients treated with AZA for 24 weeks or more, or in those discontinued AZA because of adverse effects. Results Adverse effects were reported in 38(33. 9%) patients, the most frequent being myelosuppression (20. 5%). The frequency of TPMT * 3C heterozygous mutation was 0. 9% (1/112). The TPMT activity was (12. 9±4. 8) U/ml RBC with unimodal distribution. One patient with TPMT * 3C heterozygous mutation developed myelosuppression at the 4th week after AZA treatment. The TPMP genotype myelosuppression patients. Conclusions TPMT genotype mutation and low enzyme activity can be used to predict myelosuppression with high specifically and low sensitivity. In patients treated with AZA, co-administration of 5-ASA results in a high frequency of myelosuppression with no effect on TPMT activity.

Objective To compare the efficacy of different target concentrations of sufentanil target-controlled infusion used to supplement topical anesthesia for fiber-optic bronchoscopy (FOB)-assisted awake nasotracheal intubation in patients with obstructive sleep apnea syndrome (OSAS).Methods Forty-five ASA physical status Ⅱ or Ⅲ patients with OSAS,aged 28-60 yr,with body mass index of 30-40 kg/m2,scheduled for elective surgery,were randomly assigned into 3 groups (n =15 each):control group (group C) and sufentanil with the target plasma concentration of 0.4 ng/ml (group S1) and 0.6 ng/ml groups (group S2).Naso-pharyngeal and laryngeal mucous membrane was sprayed with 2％ lidocaine mixed with 1％ ephedrine for topical anesthesia in both groups.In addition 1％ tetracaine 3 ml was injected into trachea through cricothyroid membrane.FOB-assisted awake nasotracheal intubation was performed after the target concentration was achieved.The degree of airway obstruction was scored during intubation.The highest values of MAP and HR,rate-pressure product ＞ 12 000,decreased respiratory rate and hyoxemia were recorded during the period between induction of anesthesia and 3 min after intubation was completed.The changes in MAP and HR as percent of baseline values were calculated.Before topical anesthesia (T0),when target concentrations were reached (T1),and at 1 and 3 min after intubation (T2,3),blood samples were taken to determine the plasma concentrations of epinephrine (E),norepinephrine (NE) and cortisol.Results Compared with group C,the airway obstruction score was significantly decreased in group S1,the incidence of changes in MAP and HR ＞ 30％ of baseline values and rate-pressure product ＞ 12 000 was decreased,the plasma concentrations of E,NE and cortisol were decreased in S1 and S2 groups,and the incidence of the respiratory rate was decreased and hypoxemia was increased in group S2 (P ＜ 0.05).Compared with group S1,the airway obstruction score were significantly decreased,and the incidence of respiratory rate was decreased and hypoxemia was increased in group S2 (P ＜ 0.05).Compared with the baseline value at T0,the plasma concentrations of E,NE and cortisol were significantly increased at T2,3 in group C,while decreased at T1 in S1 and S2 groups (P ＜ 0.05).Conclusion Compared with pure topical anesthesia,sufentanil with the target plasma concentration of 0.4 ng/ml does not induce respiratory depression,maintains hemodynamics stable,attenuates the stress responses and provides better intubation conditions when used to supplement topical anesthesia for FOB-assisted awake nasotracheal intubation in patients with OSAS.

Objective To investigate the effect of different doses of sufentanil combined with dexmedetomidine ( DEX) on hemodynamic and Narcotrend index ( NI) during pediatric anesthesia induction. Methods A total of 45 children with lower abdominal surgery were randomly divided into three groups evenly: sufentanil 0. 1 μg·kg-1+ DEX (S1 group),sufentanil 0. 2 μg·kg-1+DEX (S2 group),and sufentanil 0. 3μg·kg-1+DEX (S3 group). Patients in each group began with intubation at the peak point of administration. Blood pressure,heart rate,perfusion index (PI) and NI were detected at the baseline (t0), delivering DEX 0.5 μg·kg-1·h-1 and sufentanil intravenously for 5 min (t1),delivering sufentanil for 3 min (t2),time of intubation ( t3 ) ,1 min ( t4 ) ,and 5 min ( t5 ) after intubation. The application rate of atropine and propofol was recorded. Patient recovery time and adverse reactions were observed. Results Compared with basicline value at t0 time point, hemodynamic parameters and NI were decreased at t1 and t2 ,while PI was increased in both groups. At t3 ,t4 ,and t5 ,all of the indicators in S1 group were significantly different from those at t0 ,and also significantly different from those in S2 and S3 group. Six patients were treated with propofol in S1 group and four presented with agitation after operation,more than S2 and S3 groups. Three patients were treatment with atropine in S3 group. Conclusion Sufentanil (0. 2 μg·kg-1 ) combined with dexmedetomidine can be used to induce intubation for pediatric anesthesia with stable hemodynamic profile and low incidence of adverse effects.

AIM:To observe related biological parameters of 3 minutes dark-room provocative test in patients with laser peripheral iridectomy(LPI) in the fellow eyes of acute primary angle-closure (APAC) by ultrasound biomicroscopy (UBM).To explore the risk factors in primary angle closure suspect(PACS) patients with progressive angle closure after LPI.METHODS: Seventy-eight eyes of APAC patients without peripheral anterior synechia were selected.Each eye underwent 3 minutes dark-room provocative test after LPI.Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber angle open distance500 (AOD500), peripheral iris thickness (PIT), iris convex (IC), the position of iris insertion and trabecular-ciliary process distance (TCPD), and the number of positional angle closure(NPAC) were observed and analyzed by statistic methods.RESULTS:Patients with APAC were examined by UBM after LPI and 26 eyes(33%) occurs at least one positional angle closure,19 eyes(24%)were positive in 3 minutes dark-room provocative test among them.It occurs a positive relationship between the elevation intraocular pressure and the number of positional angle closure in dark-room provocative test(r=0.84, P<0.01).AOD500, IT and IC were significantly changed from normal light to darkroom between positional angle closure positive group and positional angle closure negative group(all P<0.01).In single factor analysis, AOD500(P=0.003), IT(P=0.012), IC(P=0.043), TPCD(P=0.015), the position of iris insertion(P=0.024) were correlative factors of positive results.In multiple-factor analysis, only IT(P=0.011), TPCD(P=0.009), iris root attachment points(P=0.02) were independent risk factors of positive results.CONCLUSION:A certain proportion of patients with PACS after LPI appeared positional angle closure in a dark room.Peripheral iris hypertrophy, anterior displacement of the ciliary body and iris root attachment points are vital risk factors.Long-term follow-up study and intervention treatment are required in these patients after LPI.

OBJECTIVE: To investigate the clinical diagnosis, treatment and prognosis of carcinoma showing thymus-like differentiation (CASTLE) of thyroid, and to improve the understanding of CASTLE. METHOD: In 6 patients with CASTLE, we performed region VI lymph node dissection, the lesion resection of thyroid lobe and isthmus. After the operation, except one case of 68 years old patient, the rest patients were treated with radiotherapy 60 Gy in anterior cervical region after third week of operation and 5 courses of chemotherapy with cisplatin, each interval of 2 weeks. Insist on the oral Euthyrox. RESULT: All patients were alive without recurrence and metastasis. CONCLUSION The diagnosis of CASTLE depends on the histology and immunohistochemistry. Operation was the main treatment. CASTLE is a rare type of thyroid carcinoma with slow progress and good prognosis.
Carcinoma ; diagnosis ; therapy ; Humans ; Immunohistochemistry ; Neck Dissection ; Neoplasm Recurrence, Local ; Prognosis ; Thyroid Neoplasms ; diagnosis ; therapy

Objective:To observe the changes in percentages and subsets of invariant nature kiler T (iNKT) cells in adipose and related tissues at different stages of obesity, and analyze the role of iNKT cells during chronic inflammation in adipose tissues in a mouse model of obesity established with high-fat diet.Methods:Changes in mouse body weight, mental state, glucose tolerance and insulin tolerance were recorded. Hematoxylin and eosin (HE) staining was used to observe pathological changes in adipose tissues. Flow cytometry was performed to detect the percentages and subsets of iNKT cells as well as the percentages and subtypes of macrophages. The levels of cytokines in serum samples and the culture supernatants of lymphocytes in adipose tissues were detected with CBA. The expression of related proteins in adipose tissues was detected by Western blot.Results:(1) The volume of adipose cells increased significantly after four weeks of high-fat feeding, but the infiltration of inflammatory cells was not obvious. Significantly increased infiltration of inflammatory cells was observed after 12 weeks of high-fat feeding. (2) High-fat feeding could reduce the percentage of iNKT cells, increase the proportion of iNKT1 subgroup and decrease the proportion of iNKT10 subgroup in adipose tissues. The proportion of iNKT1 subgroup in thymus increased, but that of iNKT2 subgroup decreased. The percentage of macrophages and the proportion of M1 subgroup in adipose tissues increased, while the proportion of M2 subgroup decreased, which were more obvious after 12 weeks of high-fat feeding. (3) High-fat feeding resulted in decreased expression of E4BP4 and arginase-1 (Arg-1) in adipose tissues and increased expression of inducible nitric oxide synthase (iNOS). (4) High-fat feeding significantly increased the pro-inflammatory cytokines and decreased the anti-inflammatory cytokines in mouse serum and culture supernatants of lymphocytes in adipose tissues with more significant changes observed after 12 weeks of high-fat feeding.Conclusions:Increased iNKT1 and decreased iNKT10 in obese adipose tissues might be closely related to the increased M1 polarization and the imbalance of iNKT subsets might be involved in the progression of chronic inflammation in obese adipose tissues.

ObjectiveTo study the effects of the Behavior Therapy on outpatient with schizophrenics in relieving symptoms, insight, and attitude to treatment. Methods96 outpatients with schizophrenia were randomly assigned to the Behavior Therapy group and the control group. The Behavior Therapy courses were given to the Behavior Therapy group for six months. All the subjects were evaluated with Positive and Negative Syndrome Scale(PANSS) and Insight and Therapeutic Attitude questionaire(ITAQ). Results94 cases completed the trial. The scores of PANSS, the Negative Subscale, the General Psychopathology Subscale of the Behavior Therapy group decreased significantly after treatment(P<0.01). The score of ITAQ of the Behavior Therapy group increased significantly after treatment(P<0.01).The reductions of PANSS, the Positive Subscale, the Negative Subscale, the General Psychopathology Subscale and ITAQ between two groups were significant different(P<0.05-P<0.01). Conclusions The Behavior Therapy may play an important role in augmenting optimal pharmacotherapy for outpatients with schizophrenia and it is effective in improving symptoms, insight and therapeutic attitude.