Objective To investigate the clinical effects of remifentanil and propofol anesthesia in patients undergoing mammary plastic surgery. Methods Forty patients (ASA Ⅰ -Ⅱ ) were random-ized into two groups with 20 cases in each. Group R was administered remifentanil and propofol and Group F was administered fentanyl and propofol. The variation of blood pressure (BP) and heart rate (HR) during induction, endotracheal intubation and maintenance, the time of spontaneous breathing recovery, extubation, response to vebal commands, the incidence of intraoperative awareness and postoperative complications, such as vomiting and nausea, were observed. Results There were signif-icant difference in the changes of BP and HR during surgery between two groups (P<0.05). As to the tracheal extubation and the response to vebal commands, the time of group R was significantly shorter than that of group F (P<0.05). There was no significant difference in the incidence of post-operative complications, such as vomiting and nausea, between the two groups. Conclusions The he-modynamie variables are stable in the procedure of total intravenous anesthesia with remifentanil and propofol for mammary plastic surgery. The consciousness recovery is faster in remifentanil and propo-fol anesthesia. Attention should be paid on earlier postoperative analgesia setting for patients undergo-ing remifentanil and propofol anesthesia.

Objective To confirm the interaction betweem NLK and Smad 4 and to explore the effect of NLK on the function of Smad4.Methods Co-immunoprecipitation and GST Pull-down were used to detect the interaction between NLK and Smad4.GST Pull-down was used to map the domain through which Smad 4 interacts with NLK.Luciferase reporter gene assay was used to study the effect of NLK and NLK (KM), the NLK mutant lacking kinase activity , on the transcrip-tion activity of Smad4.In vivo phosphorylation assay was used to detect whether NLK phosphorylated Smad 4 or not.Results The data of Co-immunoprecipitation and GST Pull-down showed that NLK interacted with Smad 4 in vivo and in vitro.The result of GST Pull-down showed that Smad4 interacted with NLK via MH2 domain.The results of luciferase reporter gene assay indicated that both NLK and NLK (KM) inhibited the transcription activity of Smad4.The result of in vivo phospho-rylation assay showed that NLK could not phosphorylate Smad 4 in vivo.Conclusion NLK interacts with Smad4 and inhibits the transcription activity of Smad 4 independent of the kinase activity of NLK .The mechanism through which NLK negatively regulates the transcription of Smad 4 requires further research .

Objective To assess surgical strategies and its therapeutic effect on treating tumors invading of the great vessels. Methods 23 patients underwent tumor resection along with reconstruction of great vessels from Jan. 2001 to Dec. 2005 were retrospectively reviewed. Results 19 cases (82.6%) experienced radical resection along with reconstruction of great vessels, 4 cases (17.4%) underwent palliative resections. 20 cases (86.9%) were followed up by various imaging examination methods. 4 cases (17.4%) died perioperatively and 7 cases (30.4%) had complications in perioperative period. Up to Aug. 2005, the postoperative survival times in patients were from 1.5 to 59.0 months. 3 cases (15.0%,3/20) existed more than 48 months, 4 cases (20.0%,4/20) more than 36 months, 6 cases (30.0%,6/20) more than 24 months, 9 cases (45.0%,9/20) more than 12 months and 12 cases(55.0%,11/20)more than 6 months. No complications related to vascular graft occlusion and tumor recurrence next to grafts occurred in these patients. In 2 cases appeared partial thrombosis in grafts in perioperatively. Conclusion Combination of radical resection of tumor and reconstruction of great vessels could extend survival time and improve quality of life in selected patients with tumor invading thoracic and abdominal great vessels.

Objective:To investigate the effect of ulinastatin(UTI) on the changes of IL-6,TNF-?,IL-10 and IL-4 expression during perioperative period of surgical correction of adolescent idiopathic scoliosis(AIS).Methods: Twenty patients with AISⅠ-Ⅱ scheduled to receive surgical correction of spinal deformities were equally randomized into 2 groups-UTI group and control group.Patients in UTI group received intravenous infusion of 10 000 U/kg UTI with 250 ml normal saline just before operation and every 4 h thereafter if necessary;patients in control group received same amount of normal saline.ECG,CVP,SpO_(2)and P_(ET)CO_(2) were continously monitored during operation in both group.Mean arteral pressure(MAP) was maintained at(60?5) mmHg(1 mmHg=0.133 kPa).Venous blood samples were collected immediately before induction of anaesthesia(T_(1)),10 min after induction(T_(2)),1 h after UTI administration(T_(3)),30 min after extubation(T_(4)) and 24 h postoperatively(T_(5)).The plasma levels of IL-6,TNF-?,IL-10 and IL-4 were measured by enzyme-linked immunosorbent assay(ELISA),and their mRNA expression was assayed by real-time quantitative reverse transcription polymerase chain reaction.Results: At T_(3),T_(4) and T_(5),plasma levels of IL-6 and TNF-? and their mRNA copies in control group were significantly higher than that at T_1(P

Objective To evaluate the feasibility of blind intubation via Cookgas intubating laryngeal airway (CILA) in patients under general anesthesia. Methods Sixty ASA Ⅰ or Ⅱ patients aged 11-65 yrs scheduled for elective plastic surgery under general anesthesia were randomly allocated into 2 groups ( n = 30 each): blind intubation group (B) and fiberoptic bronchoscope group (FOB) . All patients were evaluated before operation to identify patients with difficult airway. Anesthesia was induced with midazolam 0.05 mg?kg-1 , fentanyl 2 ?g?kg-1 , propofol 2 mg?kg-1 and vecuronium 0.1 mg?kg-1 . CILA was inserted in all patients. The patients in group B were blindly intubated via CILA, while in group FOB tracheal intubation was guided with fiberoptic bronchoscope via CILA. The time spent in intubation and the success rate of tracheal intubation were recorded. SBP, DBP, HR and SpO2 were recorded immediately before and after induction of anesthesia, immediately after insertion of CILA, immediately after tracheal intubation and immediately after CILA was withdrawn. Results CILA was inserted successfully in all patients. In group B tracheal intubation was accomplished at first attempt in 26 patients, at 2nd or 3rd attempt in 2 patients and failed in 2 patients. In group FOB tracheal intubation was much easier and accomplished at 1st attempt in 29 patients and at 2nd attempt in 1 patient. Twenty four of 25 patients expected to be difficult intubation were intubated successfully. The two groups were comparable with respect to hemodynamic changes during intubation. Conclusion It is possible to intubate via CILA. The success rate is high with minimal cardiovascular response.

ObjectiveTo evaluate the use of carotid shunting for the protection of cerebral function during extra-cranial carotid surgery. MethodsTwenty-three patients with carotid artery related disease underwent surgery under carotid shunting, with age ranging from 11 to 76 years (mean of 55). Carotid endarterectomy was performed for carotid atherosclerotic stenosis in 12 cases, excision for carotid body tumor (CBT) in 4 cases, resection of carotid pseudoaneurysm in 4 cases, partial excision of internal carotid aneurysm in 2 cases, and segmental resection of carotid artery and end to end anastomosis in one case. ResultsThere was no mortality nor complications related to cerebral ischemia. Horner signs developed in one case of CBT. ConclusionThe protecting effect of carotid shunting is excellent for surgical procedures involving carotid artery.

The main progress in international critical care medicine in 2020 are: the reflections on the mandatory of implementation of the 1-hour cluster treatment strategy for sepsis are still continuing; the "metabolic resuscitation" therapy, represented by large dose of vitamin C, failed to yield positive results; the global epidemic of coronavirus disease 2019 (COVID-19) continues to spread, with evidences indicating Dexamethasone, Remdesivir or interferon β-1b (IFNβ-1b), Lopinavir/Ritonavir and ribavirin as promising therapy; conservative oxygen therapy did not exert positive effects neither for mechanical ventilated patients nor for acute respiratory distress syndrome (ARDS) patient; the concept of lung- and diaphragm-protective mechanical ventilation illuminates a new opportunity to potentially improve clinical outcomes for critically ill patients; there was no positive evidence for stress ulcer prophylaxis and timing of endoscopy for severe acute upper gastrointestinal bleeding; early initiation of renal-replacement therapy (RRT) for critically ill patients with acute kidney injury (AKI) has not shown positive effect. At last, artificial intelligence (AI) has shown good potential in identifying ARDS phenotypes and early predicting sepsis.

Objective To compare the volatile oil and constituent content in Pog ostemon cablin Benth. propagated by cuttage and tissue culture. Methods The vola tile oil assay of Chinese pharmacopoeia and GC-MS method were used. Results The volatile oil and constituent content of Pogostemon cablin Benth. reproduced by cuttage was 14.2 mL/kg and 81.31 %,respectively. The volatile oil and constituent content of Pogostemon cablin reproduced by tissue culture was 12.2 mL/kg and 82.98 %,respectively. Conclusion The volatile oil content and constituent content of Pogostemon cablin Benth. reproduced by tissue culture are similar to which reproduced by cuttage.

A comparison of the number of clinicians per 1000 residents in the province,and analysis of their distribution and characteristics identified an imbalance of such resources between regionsand between urban and rural areas.A further analysis of the payment flow of medical insurance fund of the counties and districts probed into the deployment efficiency of clinical in the province,holding that the hck of a human resources deployment and guidance mechanism for clinical resources is key to toor healthcare equity and difficulties in accessibility of healthcare service.

Objective To test thyroid-stimulating hormone (TSH) suppress GLUT4 expression and translocation by stimulating TNF-α secretion in 3T3-L1 adipocytes via a cAMP-PKA pathway.Methods 3T3-L1 preadipocytes were induced to differentiate into adipocytes.The adipocytes were treated with bovine TSH,Forskolin,H89 and Rapamycin,respectively.The concentration of TNF-α in the cell culture medium was measured by ELISA.The level of GLUT4 mRNA in adipocytes was assessed by real time polymerase chain reaction.Protein levels of GLUT4 in total cell lysates and plasma membrane lysates were quantified by Western blotting.Results Incubating 3T3-L1 adipocytes with TSH markedly increased the concentration of TNF-α in medium in a time-and dosedependent manner (P ＜ 0.05); meanwhile,the levels of GLUT4 mRNA and total and plasma membrane GLUT4 protein were decreased in a dose-dependent manner (P＜0.05 or ＜0.01).H89 and rapamycin could block the above effects respectively (326.7±43.2 vs.341.9±12.0,P＞0.05).However,there was no statistical difference in the TNF-α levels between stimulation with 1 μmmol/L forskolin versus 0.04 μmmol/L bovine TSH (481.9± 28.4 vs.522.7± 36.2,P＞0.05).Conclusions TSH can down-regulate GLUT4 expression and translocation in 3T3-L1 adipocytes by stimulating TNF-α secretion through a cAMP-PKA pathway.