ObjectiveTo study the toxic effect of bupivacaine encapsulated in liposomes on spinal cord in rats.MethodsOne hundred and eight SD rats (200-225 g) in which intrathecal (IT) catheter was successfully implanted without complications were randomly divided into 6 groups ( n =18 each):control group (group C) ; liposome group (group L) ; 0.5％ and 1.0％ bupivacaine groups (groups B1 and B2 ) and 0.5％ and 1.0％ bupivacaine encapsulated in liposomes groups (groups LB1 and LB2 ).In groups L,B1,B2,LB1 and LB2,liposome,0.5 ％ bupivacaine,1.0 ％ bupivacaine,0.5 ％ liposomal bypivacaine and 1.0 ％ liposomal bupivacaine 20 μl were injected IT respectively once a day for 7 consecutive days,while in group C nothing was injected IT.Pain threshold was measured by mechanical stimulation of the plantar surface of hindpaw.Motor function of the hindlimbs was also assessed.The animals were sacrificed at 8 day after IT injection.The lumbar segment of the spinal cord was removed for microscopic examination,detection of neuronal apoptosis (by flow cytometry) and Fos protein expression (by immuno-histochemistry).Results1.0％ bupivacaine IT significantly increased the percentage of apoptotic neurons in group B2 as compared with control group.0.5％ and 1.0％ bupivacaine IT significantly increased the number Fos protein positive cells in group B1 and B2 as compared with group C.1.0％ bupivacaine IT induced severe histologic damage including shrinkage of nucleus and vacuole formation in mitochondria.Encapsulation of bupivacaine in liposomes significantly attenuated bupivacaine-induced increase in apoptosis and Fos protein expression and histologic damage in group LB2 as compared with group B2.ConclusionThe encapsulation in liposomes can decrease the neurotoxicity of 1.0 ％ bupivacaine administered IT in rats.

Objective To evaluate the stimulative role of the enhanced recovery program after surgery (ERAS) protocol in patients undergoing radical resection for gastric cancer.Methods A total of 102 consecutive patients undergoing elective gastric resection were included in either the ERAS (n =35,received ERAS perioperative treatment from June 2013 to June 2014) or the control group (n =67,received conventional perioperative treatment from June 2011 to June 2013).Outcomes related to nutrition index,stress index,and recovery index were measured.Results The nutritional index of patients (total lymphocyte count,serum albumin and prealbumin) in the ERAS group was improved on postoperative day (POD) 1 compared with that in the control group [(1.25±0.65) × 109/L vs (1.09±0.71) × 109/L,(36.4±5.2) g/L vs (31.3±4.1) g/L,(0.19±0.08) g/L vs (0.17±0.05) g/L,P ＜ 0.05,respectively].The level of negative nitrogen balance on POD 1 in the ERAS group was slightly lower than that in the control group (P ＞ 0.05),and the level of negative nitrogen balance on POD 7 in the ERAS group was higher than that in the control group (-0.93±2.17 vs -3.87±4.45,P ＜ 0.05).The postoperative cortisol level in the control group was elevated on both POD 1 (P ＜ 0.05) and POD 7 (P ＜ 0.05) compared to the preoperative level [(5.06±1.87) mg/L vs (3.60±1.5) mg/L],(5.15±1.33) mg/L vs (3.60±1.51) mg/L,P ＜ 0.05,respectively].However,the cortisol level was not increased until POD 7 in the ERAS group [(5.08±1.18) mg/L vs (3.20±1.43) mg/L,P ＜ 0.05].The level of IL-6 was elevated in postoperative period compared to preoperative period both in two groups (P ＜ 0.05).And the level of IFN-γin the ERAS group on POD 1 was reduced compared to the preoperative level (P ＜ 0.05).Whether in preoperative or postoperative,the level of IL-1β and TNF-α showed no statistical significance change.In addition,the postoperative recovery conditions (day of oral all-liquid recovery,first day of defecation,hospital stay,maximum pain on visual analogue scale) in the ERAS group were better than those in the control group (P ＜ 0.05).The incidence rates of complications between the two groups were 13.4 ％ (9/67) and 17.1％ (6/35) respectively (P ＞ 0.05).Conclusion ERAS protocol can alleviate surgical stress response and accelerate postoperative recovery without compromising patients' safety.

Objective To explore the effect of prenatal steroid (PNS) treatment on preventing early severe non-oliguric hyperkalemia in Extremely-Low-Birth-Weight (ELBW) infants.Methods Retrospective comparative analysis was performed on 31 ELBW infants who had been admitted to the hospital’s NICU between July 2001 and Jun 2005. Infants whose mothers received a full course of steroids before delivery (PNS group; n=18) were compared with those infants whose mothers did not receive steroids (NSG group; n=13). Infants were included in the PNS group if their mother was given one full course of dexamethasone ( 10 mg q12h4 doses) before delivery. The last dose must have been given at least 24 hours before delivery. The arterial blood gas , serum concentrations of potassium, sodium and creatinine were measured every 24 hours, and fluid intakes, urine outputs were monitored every day. Results Hyperkalemia was significantly lower in the PNS than in the NSG infants at the first 72 hours of age [5/18 cases ( 27.78%) vs 9/13 cases (69.23%)],P=0.023). However, the serum concentrations of sodium, creatinine, fluid intakes, urine outputs were not significantly difference in both groups. Conclusions Prenatal steroids treatment can reduce early severe non-oliguric hyperkalemia in EVBL infants.

Objective To investigate the role of CXC chemokine receptor 4-focal adhesion kinase (CXCR4-FAK) signaling pathway in migration and adhesion of hypoxia-preconditioned bone marrow mesenchymal stem cells (BMSCs) towards damaged tissues resulting from spinal cord ischemia-reperfusion (I/R) injury in rats.Methods Part I Rat BMSCs transfected with recombinant adenovirus-mediated green fluorescent protein gene 3 were seeded in 24-well plates and randomly divided into 5 groups (n =18 wells each):control group (group C),normoxia-incubated group (group N),HP group (group H),HP + CXCR4 antagonist AMD3100 group (group HA) and HP + FAK inhibitor FAK-related nonkinase group (group HF).In group C,BMSCs were incubated in DMEM culture medium.In group N,BMSCs were exposed to 21％ O2-74％ N2-5％ CO2 for 36 h.In group H,BMSCs were exposed to 0.5％O2-94.5％ N2-5.0％CO2 for 24 h followed by 12 h exposure to normoxia.In groups HA and HF,5 μg/ml AMD3100 and 10 μg/ml FAK-related nonkinase were added to the culture medium before HP,respectively.The expression of stromal derived factor-1α (SDF-1α),CXCR4 and phosphorylated FAK (p-FAK) in BMSCs was determined by Western blot.The migratory capability and adhesive ability of BMSCs were measured by Transwell invasive assay and fibronectin adhesive assay,respectively.Part Ⅱ Two hundred and sixteen male Sprague-Dawley rats weighing 300-350 g were used and 210 out of the 216 rats underwent spinal cord ischemia by occlusion of the thoracic aorta combined with controlled hypotension.Thirty-six rats were chosen and sacrificed before spinal cord I/R and at 12 h and 1,3,5 and 7 days of reperfusion (T0-5) and the lumbar segment of spinal cord was removed for detection of the content of SDF-1α.The left 180 rats with spinal cord I/R were randomly divided into 5 groups (n =36 each).IT DMEM medium 300 μl was injected in group C and BMSC suspension 300 μl (1 × 106/ml) was injected in groups N,H,HA and HF immediately after onset of reperfusion.Neurological function was scored at T0-5.The animals were then sacrificed and the lumbar segment of spinal cord was removed for detection of the degree of BMSC aggregation.Results There was no significant difference in the expression of SDF-1α,CXCR4 and p-FAK,migratory capability and adhesive ability of BMSCs,neurological function scores and degree of BMSC aggregation between groups C and N (P ＞ 0.05).Compared with group N,the expression of SDF-1α,CXCR4 and p-FAK was significantly up-regulated,and migratory capability and adhesive ability of BMSCs,neurological function scores and the degree of BMSC aggregation were increased in group H,while no significant change was found in the expression of p-FAK,migratory capability and adhesive ability of BMSCs,neurological function scores and degree of BMSC aggregation in HA and HF groups (P ＞ 0.05).Compared with group H,the expression of p-FAK was down-regulated and the migratory capability and adhesive ability of BMSCs,neurological function scores and degree of BMSC aggregation were decreased in groups HA and HF (P ＜0.05).The content of SDF-1α was significantly higher at T2,3 than at T0.Conclusion HP can promote migration and adhesion of BMSCs towards damaged tissues resulting from spinal cord I/R injury through CXCR4-FAK signaling pathway in rats; thus CXCR4-FAK signal pathway provides the protective effect on spinal cord.

Objective To investigate the effect of hypoxic preconditioning on anti-inflammatory responses of bone marrow mesenchymal stem cells (BMSCs) in rats through in vitro and in vivo experiments.Methods In vitro experiment The isolated rat BMSCs were cultured by whole bone marrow adherence method.The cells at passage 3 were seeded in 24-well plates at a density of 1 × 106 cells/ml and randomly divided into 5 groups (n =8 wells each) using a random number table:control group (group C),normoxia-incubated group (group N),hypoxic preconditioning group (group H),hypoxia preconditioning + STAT3 inhibitor Stattic group (group HS) and hypoxia preconditioning + anti-IL-10 monoclonal antibody group (group HA).In group C,BMSCs were incubated in DMEM culture medium.In group N,BMSCs were exposed to21％ O2-74％ N2-5.0％ CO2 for48 h.In group H,BMSCs were exposed to 0.5％ O2-94.5％ N2-5.0％ CO2 for 24 h followed by 24 h exposure to normoxia.In HS and HA groups,500 μg/ml Stattic and 100 μg/rnl anti-IL-10 monoclonal antibody were added to the culture medium before hypoxia preconditioning,respectively.The expression of phosphorylated STAT3 (p-STAT3) and IL-10 was determined by Western blot.In vivo experiment Healthy male Sprague-Dawley rats,weighing 300-350 g,in which intrathecal catheters were successfully implanted without complications,underwent spinal cord ischemia by occlusion of the thoracic aorta combined with controlled hypotension.Three hundred rats with spinal cord I/R injury were randomly divided into C,N,H,HS and HA groups (n =60 each) using a random number table.Immediately after onset of reperfusion,DMEM medium 300 μl was injected intrathecally in group C,and BMSC suspension 300 μl (1 × 106 cells/ml) was injected intrathecally in N,H,HS and HA groups.Neurological function was scored before ischemia and at 4,12,24 and 48 h of reperfusion (T0-,).The animals were then sacrificed and the lumbar segment of spinal cord was removed for detection of the content of IL-10,TNF-α,IL-1β,IL-6,monocyte chemotactic protein-1 (MCP-1),and macrophage inflammatory protein-1 α (MIP-1 α) (by ELISA) and the number of activated microglia (by immuno-histochemistry).Results Compared with C and N groups,the expression of pSTATβ and IL-10 was significantly up-regulated,the neurological function score and IL-10 content were increased,the content of TNF-α,IL-1β,IL-6,MCP-1 and MIP-1α and the number of activated microglia were decreased in group H (P ＜ 0.05).Compared with group H,the expression of p-STAT3 and IL-10 in group HS and expression of IL-10 in group HA was significantly down-regulated,and the neurological function score and IL-10 content were decreased,and the content of TNF-α,IL-13,IL-6,MCP-1 and MIP-1α and the number of activated microglia were increased in HS and HA groups (P ＜ 0.05).Conclusion Hypoxic preconditioning can enhance anti-inflammatory effects of BMSCs,thus increasing BMSCs-induced reduction of spinal cord ischemia-reperfusion injury in rats.

Objective To improve the preoperative diagnosis accuracy of cerebellopontine angle tumors through analyzing MRI findings. Methods Ninety-six cases with cerebellopontine angle tumors, confirmed by pathology and surgery, were collected and underwent MRI scan plus enhanced MRI. Among the 96 capes, we observed acoustic neurinoma in 55 cases, meningioma in 20 cases, cholesteatoma in 9 cases, trigeminal neuroma in 7 cases,cavernous hemangioma in 3 cases,arachnoid cyst in 2 cases. The MRI characteristics of all cases were analyzed retrospectively. Results The chief type of tumor happened in the cerebellopontine angle zone was acoustic neurinoma,followed in order by meningioma,cholesteatoma,trigeminal neuroma,cavernous hemangioma and arachnoid cyst. The accuracy of preoperative localization and qualitative diagnosis were 100% and 94.7%respectively.Conclusion MRI has a high value in the diagnosis and differential diagnosis of cerebellopontine angle tumors,which can be used as a preferred preoperative examination method in cerebellopontine angle tumors.

Objective To investigate the effects and significance of neuronavigation and electrocorticography monitoring in resection of eloquent brain glioma. Methods Thirty-six cases with intracranial tumors accepted microneurosurgery resection under neuronavigation and electrocorticography monitoring. The clinical data and postoperative outcome were analyzed. Results The mean registration error was (2.0 ±0. 5)mm in all operations and all skin flaps and bone windows designed by neuronavigation could fit the operation demands. Total resectin of the tumor was achieved in 31 cases and subtotal resection in 5 cases. Neurological symptoms improved and no severe complications or death happened in all patients. Conclusion Neuronavigation combined with electrocorticography monitoring can accurately locate the eloquent glioma and retrieve the brain shift. This method is a real-time technique and has functional test ability. It can improve the total removal rate and decrease the mortality and disabled rate.

BACKGROUND: A better understanding of medical students' attitude towards living liver donation in China would be of importance significance in the development of organ transplantation. OBJECTIVE: To investigate the medical students' attitude toward living liver donation in China and to analyze the factors that affect such an attitude.METHODS: A random sample of 250 medical students was taken and stratified by grades with 50 students in each grade. The attitude was evaluated by a modified psychosocial questionnaire from Spain. The questionnaire was completed anonymously and was self-administered. A bivariate analysis including the Student's t test and the Chi-square test was performed using SPSS software. RESULTS AND CONCLUSION: The questionnaire completion rate was 97.2% (n=243) for the medical students. Among the respondents, only 13.2% (n=32) of them were in favor of unrelated living liver donation. Another 66.3% (n=161) were only in favor if the donation was for a relative. Of the rest, 6.6% (n=16) did not agree with living liver donation, and the remaining 14.0% (n=34) were undecided. The factors related to this attitude were the decision of donating the organs of a family member (P=0.002), attitude toward deceased donation (P=0.000), a willingness to receive a donated living liver organ if one were needed (P=0.000), attitude toward living kidney donation (P=0.000). The medical students have a favorable attitude toward living liver donation in China. The students' attitude toward other types of organ donation and the willingness to accept living donated liver influence their attitude toward living liver donation. There is a great lack of education about the organ donation and transplantation for the medical students in China and more education programs should be incorporated into their traditional curriculum.

Objective To establish a discriminant method based on clinical and laboratory data and common examinations for early predicting the severity of pediatric infection. Methods Consecutive hospitalized patients diag-nosed as septic shock were included who were admitted between June 2014 and May 2015 retrospectively. Gender (male - female ratio:1. 25∶ 1. 00)and age(1 month to 6 years old)were matched in all of 18 patients with septic shock,and 27 patients diagnosed as systemic inflammatory response syndrome(SIRS),sepsis and severe sepsis on ad-mission were included respectively in order of sequential admission number during the same period. Additional 36 gen-der - and age - matched children with common infection(non - SIRS)were enrolled as controls. The clinical and labo-ratory examination data of all the included patients were collected and then the pediatric critical illness scores(PCIS) were made according to the worst condition within 24 hours of hospitalization. The parameters correlated with the severi-ty of infection were evaluated by rank correlation and Logistic regression analysis. The discriminant models were estab-lished based on κth - nearest - neighbor analysis and evaluated with clinical diagnosis by interrater agreement test. Results Except for platelet count,the other indexes including PCIS,neutrophil count,C - reactive protein,procalcito-nin(PCT),international normalized ratio of prothrombin time,activated partial thromboplastin time,thrombin time,fi-brinogen,fibrin/ fibrinogen degradation product(FDP)and D - dimer(D - D)all had differences among groups with varying infection severity(all P ﹤ 0. 001). The Spearman's coefficient ρ of PCIS,PCT,D - D and FDP correlated to in-fection severity were - 0. 837,0. 680,0. 679 and 0. 648,respectively(all P ﹤ 0. 001). Multivariate cumulative odds Lo-gistic regression analysis showed PCIS,D - D and PCT were related to infection severity(all P ﹤ 0. 05). The total error rate of discriminant models based on 3 - index combination(Mahalanobis transformation,k = 2)was 0. 091 that was lower than any models based on 2 - index combination or single - index. Using the discriminant model based on three -index combination,the infection severity of 26 patients admitted during June 2015 were predicted with a high interrater a-greement(weighted Kappa coefficient:0. 670,P ﹤ 0. 001)compared to clinical diagnosis. Conclusion The discriminant model based on combination of PCIS,D - D and PCT could assist predicting the severity of pediatric infection earlier.

Objective To explore the status of C57BL/6J mouse brown fat adipogenic differentiation function with aging.Methods C57BL/6J female and male mice at the ages of 0-week (newborn),4-week,8-week,12-week old were selected from the same brood,brown adipose tissue was obstained from their interscapular region,and the brown adipose was identified by using immunohistochemical markers.Then the total RNA was extracted from the brown adipose and quality identification was determined at the same time.The expression levels of the related genes (PPARα,C/EBPα,PGC-1α,PPARγ,FOXC2,BMP7) induced by brown adipose adipogenic differentiation were detected by quantitative real-time PCR in 0-week,4-week,8-week,12-week mice.Results Uncoupling protein -1 (UCP1) immunohistochemical data indicated that positive deep-colour substance was brown adipose tissue.Quantitative Real-time PCR also indicated that the expression volume of adipogenesis gene gradually reduced with aging,and there were significant differences at the different time points [PPARα (F =11.96,P ＜ 0.000 1),C/EBPα (F =9.39,P ＜0.000 1),PGC-1α(F =17.21,P ＜0.000 1),PPARγ(F =13.11,P ＜0.000 1),FOXC2(F =12.23,P ＜0.000 1),BMP7(F =16.44,P ＜0.000 1)].Conclusions The adipogenic differentiation ability and activity of mouse brown adipose gradually reduce with aging.But the regulatory factors for its function needs to be further investigated.