ObjectiveTo evaluate the effects of thoracic and lumbar epidural block on the depth of propofol sedation.MethodsForty-five ASA Ⅰ or Ⅱ patients with stomach cancer ( n =15) or colorectal cancer ( n =30) aged 20-64 yr weighing 46-79 kg with body height 151-179 cm undergoing elective radical operation were enrolled in this study.The 30 patients with colorectal cancer were randomly divided into 2 groups ( n =15 each):group control (group Ⅰ ) and group lumbar epidural group(group Ⅱ ).The 15 patients with stomach cancer received thoracic epidural block (group Ⅲ ).Epidural block was performed at L2.3 interspace in groups Ⅰ and Ⅱ and at T9.10 interspace in group Ⅲ.After a test dose of 3 ml 1.5％ lidocaine,a bolus of 1.5％ lidocaine 12 ml (in groupsⅡ and Ⅲ ) or 12 ml of normal saline (in group Ⅰ ) was injected into epidural space.Target-controlled infusion(TCI) of propofol was started at 12 min after epidural lidocaine.Target plasma concentration of propofol was set at 4 μg/ml.Fentanyl 4 μg/kg was injected iv as soon as the patients lost consciousness.Tracheal intubation was facilitated with vecuronium 0.1 ng/kg.The patients were mechanically ventilated.Radial artery was cannulated for direct BP monitoring and blood sampling.BIS value was monitored (Aspect Medical System).The number of spinal sequent affected in the subarachnoid epidural anesthesia was counted before propofol TCI.Arterial blood sampies were collected at 2,3,4 and 5 min of propofol TCI for determination of plasma concentration of propofol ( by HPLC).BIS value and plasma concentration of propofol calculated by TCI pump were recorded at 2,3,4 and 5 min of propofol TCI.ResultsThe BIS values were significantly lower in groups Ⅱ and Ⅲ than in group Ⅰ and in group Ⅲ than in group Ⅱ.There was no significant difference in plasma propofol concentration measured by HPLC and plasma concentration of propofol calculated by TCI pump.ConclusionThe efficacy of thoracic epidural block enhancing propofol sedation is higher than that of lumbar epidural block.

Objective To discuss the diagnosis and inductive chemoradiotherapy of stage Ⅲ and stage Ⅳa invasive thymoma.Methods Clinical data of 13 cases with incomplete resected invasive thymoma were analyzed retrospectively,among which 8 cases were in stage Ⅲ and 5 cases in stage Ⅳa.All the 13 cases had invasion of major vessels,pericardial and lung tissues,or had metastasis of pleura and pericardium.Each patient got pathological diagnosis by fine needle aspiration,video-assisted thoracoscopic biopsy or anterior mediastinal biopsy.After 3 cycles of NP or CAP inductive chemotherapy and synchronous radiotherapy,tumors shrank and got palliative or complete surgical resection.The Follow up ranged from 2.8 to 9 years.Results All the 13 cases were malignant thymoma,including 4 cases of type B2,6 cases of type B3 and 5 cases of type C.7 patients got radical resection and 2 got palliative resection.9 patients survived more than 3 years after operation,7 patients survived more than 5 years,one patient even lived 8 years,and the other 4 patients without getting surgery died in 4 years.Conclusion Inductive chemoradiotherapy could shrink stage Ⅲ and stage Ⅳa invasive thymoma,reduce clinical stage,improve the resection rate,and prolong survival.

Actins ; metabolism ; Adult ; Breast Diseases ; metabolism ; pathology ; surgery ; Breast Neoplasms ; pathology ; Calcium-Binding Proteins ; metabolism ; Carcinoma ; pathology ; Diagnosis, Differential ; Fasciitis ; metabolism ; pathology ; surgery ; Female ; Fibroma ; pathology ; Fibrosarcoma ; pathology ; Follow-Up Studies ; Humans ; Microfilament Proteins ; metabolism ; Vimentin ; metabolism ; Young Adult

Adult ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Spinal Fractures ; surgery ; Surgical Wound Infection ; therapy

This retrospective analysis showed that the most frequent pathogen causing bacterial liver abscess was Klebsiella pneumoniae in 138 patients.Compared with the patients without diabetes mellitus,it was found that:( 1 ) the percentage of diabetic patients having typical abdominal pain was lower ( P ＜ 0.05 ) ; ( 2 ) neutrophilic granulocytosis was more marked,but albumin and hemoglobin levels were lower in diabetic patients( P＜0.05 ) ; ( 3 )more diabetic patients were complicated with urinary tract infection and suffered from septicemia( P＜0.05 ) ; (4) the clinical course of treatment in diabetic patients was much more prolonged( P＜0.05 ).

Objective To investigate the effects and the migration mechanisms of stromal derived factor-1 (SDF-1) and CXC chemokine receptor-4 (CXCR-4) in rats with white matter damage treated with human umbilical cord mesenchymal stem cells (hUC-MSCs).Methods A total of 108 three-day old Sprague-Dawley rats were randomly divided into the experimental group,control group and sham group.The left common carotid artery was ligated and then exposed to hypoxia of 6％ O2 and 94％ N2 in rats in the experimental and control groups.Rats in sham group were neither ligation nor hypoxia.After 24 hours,rats in the experimental group were administered 0.5 ml hUC-MSCs (1 × 106/ml) intraperitoneally,and rats in control and sham groups were administered 0.5 ml saline by the same way.Immunohistochemistry and reverse transcription-polymerase chain reaction were used to determine the expression of SDF-1 and CXCR-4 protein and mRNA in 5-,7-and 14-day-old rats.Analysis of variance and the LSD test were used for statistical analysis of the data.Results HE staining showed that,in 14 day-old rats of the experimental group,bilateral cerebral ventricles were similar with no cellular edema or necrocytosis.In the sham group,bilateral cerebral ventricles were also normal.However,in the control group,ventriculomegaly,cellular degeneration and necrocytosis were observed on the left side.On the 5th,7th and 14th day,SDF-1 protein levels were 0.15±0.06,0.24±0.01 and 0.12±0.01,and CXCR-4 protein levels were 0.35±0.16,0.60±0.21 and 0.72±0.25,respectively,in the experimental group; SDF-1 protein levels were 0.13 ± 0.01,0.16± 0.01 and 0.08± 0.01,and CXCR-4 protein levels were 0.18 ± 0.04,0.17 ± 0.09 and 0.25 ± 0.06,respectively,in the control group,and all were higher than those in the sham group (SDF-1 protein levels were 0.03 ± 0.01,0.04± 0.01 and 0.02±0.01; and CXCR-4 protein levels were 0.04±0.02,0.05±0.03 and 0.05±0.03,respectively) (LSD test,all P＜0.05).SDF-1 protein increased to a peak on the 7th day and decreased on the 14th day in the experimental group,however,these values were both higher than those in the control group (LSD test,both P＜0.05).CXCR-4 protein increased on the 5th day and continued to increase up to the 14th day in the experimental group,and these values were higher than those in the control group at the three time points (LSD test,all P＜0.05).In 5-,7-and 14-day-old rats,SDF-1 mRNA levels were 3.52 ± 0.33,4.18± 0.28 and 2.60± 0.21,respectively,in the experimental group,which were higher than those in the control group (2.07± 0.34,3.73 ± 0.28 and 2.08± 0.15,respectively),and were even higher than those in the sham group (0.99±0.17,1.00±0.16 and 1.31 ±0.32,respectively) (LSD test,all P＜0.05).In the experimental group,SDF-1 mRNA levels reached a peak on the 7th day,and on the 14th day,it decreased to the level lower than that on the 5th day (LSD test,all P＜0.05).In the control group,SDF-1 mRNA levels also reached a peak in 7-day-old rats,but not in 14-day-old rats,which was similar to 5-day old rats (LSD test,9＞0.05).In 5-,7 and 14-day-old rats of the experimental group,CXCR-4 mRNA levels were 1.32±0.29,1.75±0.36 and 2.33±0.49,respectively,higher than those in the sham group (1.00±0.16,0.94±0.16 and 0.81±0.14,respectively) and the control group (0.97±0.14,0.97±0.15 and 1.07±0.25,respectively) (LSD test,all P＜0.05).In the experimental group,CXCR-4 mRNA levels were higher in 14-day-old rats than that in 5-and 7-day-old rats (LSD test,both P＜0.05).Conclusions SDF-1/CXCR-4 may play a vital role in the migration of hUC-MSCs homing to damaged brain.

Objective To study the main subtypes messenger ribonucleic acid(mRNA) and the basal enzyme activity of phosphodiesterase (PDE) in rat pulmonary microvascular endothelial cells (PMVECs) through the examination mRNA expression and activity of PDE in vitro. The data were offered to reveal the relationship between PDE distributions, activity change and to accumulate data for the possibility of drug regulation of its functional alteration. Methods The cells were cultured with tissue-sticking method;the gene expression of PDEs was detected by reverse transcript polymerase chain reaction (RT-PCR), and the activity of PDEs was calculated by cyclic nucleotides content change examined with high performance liquid chromatogram (HPLC) before and after the PDE reaction( n ＝3). Results The PMVECs identified by cell immunofluorescence with polyclonal antibody of CD31 were dissociated and cultured, mRNAs of PDE1A, 1C, 2A,3A, 3B, 4A, 4D, 5A, 7A, 7B, 8A, 8B, 9A, 10A,11A were expressed in PMVECs, but there was no mRNA of PDE1B expressed in PMVECs. cAMP/cGMP-PDE in the extent of 5-20μl had a good linear correlation with its activity. Conclusion There are 17 kinds of PDE gene expression existing in PMVECs which contain of the basic enzyme with a higher activity.

Objective To compare adductor canal block(ACB)with topical anesthesia for postoperative analgesia in the patients undergoing arthroscopic knee surgery.Methods Sixty patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status ⅠorⅡ,scheduled for elective arthroscopic meniscectomy,were divided into 2 groups (n=30 each) using a random number table:ACB group and topical anesthesia group(TA group).In group ACB,0.2% ropivacaine 20 ml was injected into the adductor canal under the guidance of ultrasound at 30 min before operation to perform ACB.In group TA,0.25% ropivacaine 20 ml was injected into the articular cavity at 5 min before the end of operation.The development of effective analgesia (VAS scores ≤4)and weakened quadriceps femoris muscle strength(muscle strength 0-2 grade,post-operative muscle strength was assessed by using manual muscle testing),related complications(local anesthetic intoxication,bleeding at the puncture site and hematoma) and occurrence of postoperative nausea,vomiting and delayed emergence were recorded.Results Compared with group TA,the rate of effective analgesia within 12 h after surgery was significantly increased (P<0.01),and no significant change was found in the incidence of weakened quadriceps femoris muscle strength,nausea and vomiting in group ACB(P>0.05).Local anesthetic intoxication,bleeding at the puncture site,hematoma or delayed emergence was not observed in the two groups.Conclusion ACB produces better efficacy for postoperative analgesia than topical anesthesia in the patients undergoing arthroscopic knee surgery.

Objective To study the response of NG2 positive and other glial cells in the facial nucleus after facial nerve axotomy,and explore the changes of the microenvironment in the facial nucleus.Methods Rat facial nerve axotomy models were established.Immunofluorescence double staining,and immunohistochemical staining combined with cresyl violet staining were used to observe the response of NG2 cells and other glial cells,and Western blotting was performed to test NG2 protein expression in facial nucleus at postoperative 1,2,7,14,and 28 days.Results Microglia formed dense circles closely around the injured neurons.Astrocytes formed wreath-like structure near the injured neurons.NG2 protein in the injured nucleus has a regular timephase change and NG2 positive cells showed an extensive detachment of synaptic terminals on the damaged neurons after facial nerve axotomy.NG2 cell response was almost the same as microglia.Conclusions All kinds of glial cells may be involved in the formation of glial scar.NG2 positive cells could insulate the damaged neurons against the potential damage from the excitatory input.

AIM:To investigate the safety and effect of femtosecond laser-assisted cataract surgery with Cionni modified capsular tension ring (MCTR) implantation in the management of traumatic lens subluxation.METHODS: Totally 11 patients (11 eyes) with traumatic lens subluxation were divided into three groups according to the severity of lens dislocation, ranging from 90° to 120° (4 eyes), 120° to 180° (5 eyes) and 180° to 270° (2 eyes).The contact LenSx femtosecond laser cataract surgery platform was applied to create the capsulotomy, prepare nuclear fragmentation and make corneal wound creation.Anterior vitrectomy was performed in some patients during the surgery.After capsular retractors insertion and phacoemulsification, the MCTR was inserted to the capsular bag and fixed to the sclera.Finally, the IOL was implanted into the capsular bag.Postoperative visual acuity, intra-and post-operative complications, anterior capsular opening, IOL and MCTR position and intraocular pressure (IOP) were assessed.RESULTS:The duration of follow-up was 2mo.All the operations were completed successfully.Five eyes underwent cataract surgery combined with anterior vitrectomy.Four eyes had been inserted with 2-eyelet MCTR and seven eyes with 1-eyelet MCTR.The best corrected visual acuity (BCVA) after operation was better than 0.5 in 4 eyes, between 0.3 and 0.5 in 3 eyes, between 0.1 and 0.3 in 3 eyes, and less than 0.1 in 1 eye.Compared with preoperative BCVA, the difference was statistically significant (P<0.05).All the IOLs were stably centered and the eyelet of MCTR was fixated steadily between the iris and the anterior capsule.The common intra-and post-operative complications were subconjunctival hemorrhage, incomplete capsulotomy, residual cortex, secondary glaucoma and posterior capsular opacification.CONCLUSION:Femtosecond laser-assisted cataract surgery can improve the success rate of capsulorhexis, and reduce the difficulty of nuclear fragmentation.Femtosecond laser-assisted cataract surgery combined with MCTR implantation is an ideal surgical method for traumatic lens subluxation.