ObjectiveTo investigate the effects of norepinephrine on oxygen metabolism and postoperative outcomes in the elderly patients undergoing fluid-restored abdominal surgery.MethodsAfter hospital ethics committee approval,and written informed consent was obtained from all patients,40 elderly patients,aged ＞ 64 yr,with a body mass index of 18-24 kg/m2,undergoing elective colorectal surgery,were randomly divided into 2 groups (n =20 each):routine fluid administration group (group A) and restricted fluid administration group (group B).In group A,lactated Ringer's solution was given routinely.Lactated Ringer's solution was given at a rate of 5 ml· kg- 1 · h- 1 and small dose of norepinephrine was infused intravenously at 0.01-0.03 μg· kg- 1 · h - 1 simultaneously during the surgery,and MAP was maintained ≥65 mm Hg in group B.Intraoperative blood loss was replaced with the equal volume of 6％ hydroxyethyl starch 130/0.4.Before the surgery ( baseline),1 and 2 h after beginning of the surgery,and while leaving postanesthesia care unit,mean arterial pressure (MAP),heart rate (HR),cardiac index (CI) and central venous pressure (CVP) were recorded,and arterial and central venous blood samples were drawn for blood gas analysis.Oxygen delivery index (DO2 I ),oxygen consumption index (YO2I) and oxygen extraction ratio (ERO2) were calculated.The gastric mucosal pH was determined before the surgery and 1 h after beginning of the surgery.Blood samples were taken form the peripheral vein to determine the concentration of Hb,serum albumin,blood urea nitrogen (BUN) and creatinine (Cr) concentrations before the surgery and 1 day after the surgery.The extubation time,duration of stay in hospital,the time when the patients passed the flatus,pulmonary complications,gastrointestinal complications,and wound infections were recorded.ResultsCompared with group A,CI,Hb,ScvO2 and DO2I were significantly increased,CVP and ERO2 were decreased during the surgery,the concentrations of Hb and serum albumin were significantly increased,1 day after the surgery,and the incidence of pulmonary complications and wound infections was significantly decreased after the surgery in group B (P ＜ 0.05 ).There were no significant differences in gastric muscosal pH,the indexes of renal function,extubatiotn time,the time when the patients passed the flatus,duration of stay in hospital and the incidence of gastrointestinal complications between the two groups ( P ＞ 0.05).ConclusionWhen small dose of norepinephrine is used to treat perioperative hypotension induced by fluid restriction,it can increase oxygen delivery,and reduce the incidence of postoperative complications,and has no adverse effects on gastrointestinal microcirculation and oxygen consumption in the elderly patients undergoing colorectal surgery.

Objective To investigate the effect of postoperative analgesia with oxycodone on T cell function after operative of cesarean section with chronic hepatitis B.Methods Sixty cesarean sec-tion women with chronic hepatitis B undergoing CS,aged 22-35,were randomly divided into two groups:oxycodone group (group O)and morphine group (group M).The changes of immune cells (Th1,Th2)and liver function were recorded after the analgesia (immediate,postoperative 24 h,48 h,72 h).The total number of pressing analgesia pump and the cumulative amount of PCA were re-corded.Results The Th1 of group O was higher than that of group M at 24 h,48 h after operation (P <0.05),while there was no significant difference of Th1 and Th2 in group M.The total patient-controlled pressing times and accumulated amount of PCA of group O were significantly lower than those in group M (P <0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Oxycodone can activate T cell function in postoperative analge-sia,while morphine causes the inhibition of Th1 cells.

Objective To investigate the relationship between lipopolysaccharide binding protein(LBP) in serum and degree of hepatic inflammation. Methods The levels of LBP in serum of 99 patients with chronic viral hepatitis (CVH) were detected by ELISA. The levels of LBP in 33 of all patients with chronic severe viral hepatitis were further detected 2～4 weeks after treatment. Results The serum levels of LBP in patients with chronic viral hepatitis were higher than that in normal patients [(79.62?45.52) ng/ml vs (50.22?31.44) ng/ml, P=0.001]. The serum levels of LBP in patients with chronic severe viral hepatitis were significantly higher than that in patients with moderate degree CVH group, severe degree CVH group, and normal group (P

The vocal cord polyp is easy to relapse after surgery, but if the patient has recurrence in a short term, it is necessary to consider it as postoperative vocal cord contact granuloma. If the patients with contact granuloma after surgical treatment had severe impact on the pronunciation, it is necessary to be operated and confirmed by pathology and given the treatment of acid suppression, in order to avoid postoperative recurrence.
Granuloma ; diagnosis ; Humans ; Otorhinolaryngologic Surgical Procedures ; adverse effects ; Polyps ; surgery ; Vocal Cords ; surgery

Objective To evaluate the effects of ethyl gallate (EG ) on sepsis-induced acute lung injury (ALI) in rats .Methods Forty-eight healthy male Wistar rats ,aged 10-12 weeks ,weighing 150-250 g ,were randomly divided into 3 groups (n=16 each) using a random number table :control group (group C) ,group ALI , and group EG .The animals were anesthetized with intraperitoneal pentobarbital sodium 50 mg/kg .Sepsis was induced by cecal ligation and puncture (CLP) .EG 1 ml/h (50 mg·kg-1 ·h-1 ) was infused intravenously via the femoral vein for 4 h starting from 6 h after CLP in group EG .The equal volume of normal saline was given instead in group ALI . The rats were sacrificed at 10 and 24 h after CLP (T1 ,2 ) , and the lungs were removed for determination of wet/dry lung weight ratio (W/D ratio ) , superoxide dismutase (SOD ) activity , contents of malondialdehyde (MDA ) and glutathione (GSH ) , and 3-NT expression (by immuno-histochemistry ) in lung tissues .The pathological changes of the lung were examined with light microscope .Results Compared with group C ,the W/D ratio ,MDA content and 3-NT expression were significantly increased and GSH content was decreased at T1 ,2 ,the SOD activity was significantly decreased at T2 in group ALI ,and the MDA content and 3-NT expression were increased at T1 ,and the W/D ratio ,MDA content and 3-NT expression were increased and GSH content was decreased at T2 in group EG ( P<0.05) .Compared with group ALI ,the MDA content was significantly decreased at T1 ,and the W/D ratio ,MDA content and 3-NT expression were decreased ,and GSH content and SOD activity were increased at T2 in group EG ( P<0.05) .The pathological changes of the lung were obvious in group ALI , and significantly attenuated in group EG .Conclusion EG can attenuate sepsis-induced ALI by antioxidative effects in rats .

Objective To evaluate the effect of sevoflurane on hippocampal calcium/calmodulindependent protein kinase Ⅱ (CaMK Ⅱ)/cyclic adenosine monophosphate response element-binding protein (CREB) signaling pathway in aged rats.Methods Sixty pathogen-free healthy male Sprague-Dawley rats,aged 18 months,weighing 600-750 g,were divided into 2 groups (n=30 each) using a random number table:control group (group C) and sevoflurane group (group Sev).Group Sev inhaled 2％ sevoflurane in the mixture of 50％ air and oxygen (2 L/min) for 4 h.Group C inhaled the mixture of 50％ air and oxygen (2 L/min) for 4 h.Morris water maze test was performed on 6 days before anesthesia and 1 day after anesthesia.The escape latency,swimming distance,frequency of crossing the original platform and time of staying at the platform quadrant Ⅱ were recorded.On 1,3 and 7 days after anesthesia,the rats were sacrificed,and the hippocampus was obtained for determination of the expression of CaMK Ⅱ,phosphorylated CaMK Ⅱ,CREB and phosphorylated CREB by Western blot.Results Compared with group C,the escape latency and swimming distance were significantly prolonged,the frequency of crossing the original platform was decreased,and the time of staying at the platform quadrant Ⅱ was reduced on 5th day of training and 1 day after anesthesia,and the expression of CaMK Ⅱ,phosphorylated CaMK Ⅱ,CREB and phosphorylated CREB was down-regulated after anesthesia in group Sev (P＜ 0.05).Conclusion Sevoflurane leads to cognitive decline through inhibiting hippocampal CaMK Ⅱ/CREB signaling pathway in aged rats.

Objective:To investigate differences in serum uric acid levels between elderly patients with prostate cancer and patients with benign prostatic hyperplasia(BPH).Methods:A total of 300 prostate cancer patients admitted to the urology department of our hospital between Feb.2010 and Jun.2019 were retrospectively analyzed.During the same period, 240 BPH patients and 400 elderly men with normal prostate size were enrolled as the control group.Serum uric acid and prostate-specific antigen(PSA)levels, C-reactive protein(CRP), neutrophil count and lymphocyte count were determined.Serum uric acid concentrations were monitored in prostate cancer patients with different clinicopathological characteristics.Results:CRP and Neu/Lym levels were higher in the prostate cancer group than in the BPH and control groups( P<0.05). The serum uric acid level was (327.0±58.3)μmol/L in the prostate cancer group, lower than in the BPH group(375.2±68.4)μmol/L and the control group(377.8±73.2)μmol/L( F=55.69, P<0.001). Multivariable Logistic regression analysis indicated that serum uric acid was a protective factor for prostate cancer( OR=0.593, 95% CI: 0.542-0.718, P=0.004). There were significant differences in serum uric acid levels between prostate cancer patients with different ages and pathological grades( t=-4.63, F=12.73, P<0.001). However, serum uric acid levels were not significantly correlated with clinical staging or lymph node metastasis( F=-2.72 and 0.77, P=0.068 and 0.460). Conclusions:Compared with BPH patients and healthy males, serum uric acid levels are reduced and inflammatory markers are increased in prostate cancer patients, indicating that serum uric acid may be a risk factor for the occurrence and progression of prostate cancer in the elderly.

Objective:To examine the risk of long-term cognitive impairment in elderly prostate cancer patients aged 75 years and older undergoing androgen deprivation therapy(DAT), and to analyze the correlation between DAT and cognitive impairment.Methods:This was a retrospective cohort study.Elderly prostate cancer patients aged 75 years and older in the National Cancer Database(SEER)from 1996-2003 were included.According to whether ADT was received, patients were divided into the ADT group(n=82 514)and the control group(n=121 856). Baseline clinical data were compared between the two groups. Kaplan- Meier survival analysis and the Log- rank test were used to compare the incidence of cognitive impairment(dementia and Alzheimer's disease)between the two groups. Cox risk ratio regression analysis was used to assess the relationship between ADT and cognitive impairment. Results:A total of 204 370 patients were enrolled in this study.The mean age of patients was(79.2±4.6)years.Compared with the control group, the ADT group was older and had higher prostate specific antigen levels, higher proportions of poorly differentiated tumors, more complications and a higher proportion of patients receiving radiotherapy( P<0.05). During the follow-up of(12.1±3.3)years, a total of 41 661 cases of dementia were diagnosed, including 13 634 in the ADT group and 28 027 in the control group, and 28 945 cases of Alzheimer's disease were diagnosed, including 9 372 in the ADT group and 19 573 in the control group.Kaplan-Meier survival analysis and the log-rank test showed that the incidence of dementia in the ADT group was higher than that in the control group( χ2=8.10, P=0.004), and the incidence of Alzheimer's disease was also higher in the ADT group than in the control group( χ2=5.06, P=0.024). Cox regression analysis results showed that ADT significantly increased the risk of dementia( HR=1.71, 95% CI: 1.14-2.57, P=0.01)and Alzheimer's disease( HR=1.63, 95% CI: 1.08-2.46, P=0.02), compared with treatment that did not include ADT. Conclusions:The risk of dementia and Alzheimer's disease is increased in elderly prostate cancer patients aged 75 years and older after ADT.

Objective To investigate the indications and clinical efficacy of combined application of laparoscope,choledochoscope and duodenoscope in the treatment of extrahepatic cholangiolithiasis.Methods The retrospective cohort study was adopted.The chnical data of 2 364 patients with extrahepatic cholangiolithiasis who were admitted to the First Hospital of Jilin University from January 2008 to December 2015 were collected.Of the 2 364 patients,861 patients had cholecystolithiasis combined with extrahepatic cholangiolithiasis and the diameter of common bile duct ≥ 8 mm,720 patients had cholecystolithiasis combine with extrahepatic cholangiolithiasis and the diameter of common bile duct ＜ 8 mm,783 patients had only extarhepatic cholangiolithiasis.In the patients diagnosed as cholecystolithiasis combined with extrahepatic changiolithiasis,laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration (LCBDE) were applied to patients with the diameter of common bile duct≥8 mm,and the T-tube placement or primary suture was used intraoperatively according to the status of individualized patients;endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD) + LC were applied to patients with the diameter of common bile duct ＜ 8 mm.For patients with only extrahepatic cholangiolithiasis or recurrent stones after cholecystectomy,EST or EPBD was applied,and LCBDE was applied to patients with multiple stones and maximum diameter ＞ 2 cm and unsuitable for EST or EPBD.If residual stones were found after operation in patients with T-tube placement,choledochoscope was used to extract stone;otherwise,EST or EPBD was used.Treatment outcomes including treatment method,success rate of minimally invasive lithotomy,operation time,incidence of complication,duration of postoperative hospital stay and treatment expenses,and the results of follow-up including 1-,3-year recurrence rate of stones were recorded.The follow-up was done by outpatient examination and telephone interview till January 2016.All the patients were reexamined blood routine,liver function and color doppler ultrasonography of the abdomen at 1 month,3 months,6 months,1 year and 3 years after operation.Suspected residual cholangiolithiasis found by ultrasound was varified by computer tomography (CT) or magnetic resonanced cholangiopancreatography (MRCP) imaging examination.For patients with T-tube placement,CT scan and biliary photography were performed at 2-3 months postoperatively to determine whether residual stones existed and T tube could be pulled out.Measurement data were presented as mean (range).Results Of 2 364 patients,2 271 patients received minimally invasive lithotomy successfully.Of 861 patients of cholecystolithiasis combined with extrahepatic cholangiolithiasis and the diameter of common bile duct≥8 mm,836 succeeded in minimally invasive lithotomy,with a success rate of 97.10％ (836/861),the other 25 patients were converted to open surgery.Seven hundred and three patients of 836 patients received T-tube placement in LCBDE,and the mean operation time,incidence of complications,duration of postoperative hospital stay and treatment expenses were 97 minutes (range,41-167 minutes),3.70％ (26/703),6.7 days (range,3.0-32.0 days) and 3.4 × 104 yuan (range,1.5 × 104-6.7 × 104 yuan),respectively.One hundred and thirtythree patients of 836 patients received primary suture,and the mean operation time,incidence of complications,duration of postoperative hospital stay and treatment expenses were 89 minutes (range,39-123 minutes),3.01％ (4/133),4.1 days (range,2.0-17.0 days),2.1 × 104 yuan (range,1.6 × 104-3.4 × 104 yuan),respectively.Of 720 patients with the diameter of common bile duct ＜ 8 mm who underwent EST or EPBD + LC,687 succeeded in minimally invasive lithotomy,with a success rate of 95.42％ (687/720),the other 33 patients were converted to open surgery.The mean operation time,incidence of complications,duration of postoperative hospital stay and treatment expenses of 687 patients were 101 minutes (range,69-163 minutes),2.91％ (20/687),5.6 days (range,2.0-15.0 days) and 2.8 × 104 yuan (range,2.0 × 104-6.4 × 104 yuan),respectively.In 783 patients with only extrahepatic cholangiolithiasis or recurrent stones after cholecystectomy,701 of 725 patients who were treated with EST or EPBD succeeded in minimally invasive lithotomy,with a success rate of 96.69％ (701/ 725),and the mean operation time,incidence of complications,duration of postoperative hospital stay and treatment expenses of 701 patients were 47 minutes (range,11-79 minutes),2.28％ (16/701),3.7 days (range,2.0-19.0 days),1.7 × 104 yuan (range,1.3 × 104-5.5 × 104 yuan),respectively;47 of 58 patients who were treated with LCBDE succeeded in lithotomy,with a success rate of 81.03％ (47/58),and the mean operation time,incidence of complications,duration of postoperative hospital stay and treatment expenses were 124 minutes (range,94-170 minutes),8.51％ (4/47),7.9 days (range,5.0-21.0 days) and 3.8 × 104 yuan (range,2.3 × 104-7.9 × 104 yuan),respectively.Of 2 364 patients,2 207 were followed up for a mean time of 38 months (range,1-72 months).The 1-,3-year recurrence rates were 2.74％ (19/693) and 5.08％ (24/472) in patients receiving LC + LCBDE,3.10％ (21/677) and 5.69％ (30/527)in patients receiving EST or EPBD +LC for cholecystolithiasis combined with extrahepatic cholangiolithiasis.The 1-,3-year recurrence rates were 3.22％ (20/621) and 6.11％ (25/409) in patients receiving EST or EPBD + LC,7.32％ (3/41) and 11.11％(2/18) in patients receiving LCBDE for only extrahepatic cholangiolithiasis or recurrent stones after cholecystectomy.Conclusions It is safe and effective to treat extrahepatic cholangiolithiasis based on combined application of laparoscope,choledochoscope and duodenoscope,with choosing appropriate indications as the key to improve the therapeutic effect.Primary suture in the LCBDE is recommended because it can protect patients from T-tube placement.

Objective: To investigate the effects of Fufang Jiangzhi No. 3, a compound traditional Chinese herbal medicine, on cholesterol-bile acid metabolism in rabbits with hypercholesterolemia and to explore the mechanism. Methods: Twenty-four male New Zealand white rabbits were randomly assigned into normal control group, untreated group and Fufang Jiangzhi No. 3 group, with 8 rabbits in each group. Rabbits in the untreated group and Fufang Jiangzhi No. 3 group were fed high cholesterol diet to induce hypercholesterolemia. After 4-week treatment, serum total cholesterol and bile acid contents were assessed. Activity of cholesterol 7alpha-hydroxylase (CYP7A1) in liver tissues was measured by enzyme-linked immunosorbent assay. The expressions of CYP7A1, bile salt export pump (BSEP) and small heterodimer partner (SHP) mRNAs in liver tissues were observed by real-time fluorescent quantitative polymerase chain reaction. Results: Compared with the normal control group, serum total cholesterol and bile acid contents in the untreated group were increased (P<0.01). Activity of CYP7A1 and expression of CYP7A1 mRNA were decreased and expressions of BSEP and SHP mRNAs were increased in liver tissues in the untreated group as compared with the normal control group (P<0.01). Serum total cholesterol level, and expressions of BSEP and SHP mRNAs in the Fufang Jiangzhi No. 3 group were lower than those in the untreated group (P<0.01). The CYP7A1 activity and expression of CYP7A1 mRNA in the Fufang Jiangzhi No. 3 group were increased as compared with the untreated group (P<0.01), however, there was no significant difference in bile acid between the Fufang Jiangzhi No. 3 group and the untreated group. Conclusion: Fufang Jiangzhi No. 3 can up-regulate the expression of CYP7A1 mRNA, raise the activity of CYP7A1, and inhibit the expressions of BSEP and SHP mRNAs to regulate the metabolism of total cholesterol in rabbits.