Multi-tragets are used for deep brain stimulation (DBS) to promote wakefulness, such as midbrain, thalamus, hypothalamus, etc. Lateral hypothalamic area may be one of the most potential tragets.

Objective To explore the effect of vagus nerve stimualtion on wake-promoting and the expression of 5-hydroxytryptamine (5-HT) 2A receptor in the prefrontal contex of coma rats with traumatic brain injury. Methods 72 Sprague-Dawley rats were randomly divid-ed into control group, sham-stimulated group, stimulated group and antagonist group with 18 rats in each group. Traumatic brain injury mod-el was established by a weight-drop head injury. The antagonist group was injected with SB334867, and both the antagonist group and the stimulated group received vagus nerve stimulation. Their behaviors were recorded. And immunohistochemistry technique was used to detect the expression of 5-HT2A receptor in the prefrontal cortex. Results 12 rats in the stimulated group, 9 in the antagonist group and 4 in the sham-stimulated woke up. The expression of 5-HT2A receptor from low to high was ranged as the control group, the antagonist group, the sham-stimulated group and the stimulated group (χ2=11.464, P=0.009). Conclusion Vagus nerve stimulation could raise consciousness in co-ma rats after traumatic brain injury, which may be related to up-regulating the expression of 5-HT2A receptor.

OBJECTIVE To investigate the degree of risk of viral prevalence of HBV,HCV and HIV through blood transfusion in Beijing Hospital in China,and to assess the need of a national Haemovigilance System. METHODS Retrospectively,7883 blood bank specimens (collected from 2004 to 2007) were re-examined using 8 indicators (including 5-item Hepatitis B,anti-HCV,anti-HIV and Syphilis) for the prevalence of most common viral infection. RESULTS From the blood bank specimens,the prevalence of HBsAg was 0.88% (69),the anti-HBc positive blood,only the anti-HBc was found in 2.65% of the specimens,while both the anti-HBc and the anti-HBe were found in 2.09% of the specimens. The prevalence of anti-HCV was 0.09% (7). CONCLUSIONS We need to establish the national Haemovigilance System to strengthen the monitoring of the above HbsAg,HBcAb and HCV indicators to prevent the transfusion-transmitted infection. Only in this way can the public confidence in blood safety be improved.

Objective To analyze the therapeutic effect of the radical operation for gastric cancer in elderly patients and to investigate relevant factors affecting the efficacy Methods 216 cases of elderly patients with gastric cancer were divided into two groups:radical distal-and proximal-gastrectomy group (n=108,each).The therapeutic effect in the near future,intraoperative and postoperative recovery,numbers of lymph nodes resection as well as factors affecting the long-term survival rate were compared between two groups.Results The radical distal-versus proximal-gastrectomy group showed that the mean operation time was (241.8 ± 40.2) min vs.(244.7 ± 39.7)min,blood loss was(299.5 ± 114.9) ml vs.(273.8-± 121.4) ml,the number of lymph node dissection was(28.4± 9.4) vs.(27.7 ± 9.1) particles,the complication rate was[14/108 (13.0％)] vs.[15/108 (14.0 ％)],3-year survival rate was (46.9 ％) vs.(47.5 ％),without statistically significant differences (all P ＞ 0.05).Multiple regression analysis showed that TNM stage (OR =1.536),lymph node metastasis(OR =0.739),cancer infiltration depth (OR =1.534) and chemotherapy regimens (OR =1.337)are risk factors for the postoperative 3-year survival rate.Conclusions Surgical treatment of elderly patients with gastric cancer is significantly effective,TNM stage,lymph node metastasis,depth of invasion,tumor size and the chemotherapy regimens are closely associated with the life quality of patients.

Objective To investigate the effect of Shenqi Fuzheng injection on serum CRP,IL-6 and IL-10 levels in elderly patients with coronary heart disease.Methods 64 elderly patients with coronary heart disease from Wenling First People's Hospital hospital were selected and randomly divided into the control group and the experiment group.32 cases in each group, the control group were treated by conventional symptomatic treatment, the experiment group were treated with Shenqi Fuzheng injection on the base of control group.The serum ( C-reactionprotein,CRP) ,white blood cell mediated IL-6 and leukocyte mediated element IL-10, systolic blood pressure, diastolic blood pressure(DBP),glycerin,total cholesterol(TC),triglyceride(TG), low density lipoprotein(LDL-C) and high density lipoprotein(HDL-C) levels were recorded,and the clinical efficacy and adverse reaction conditions were compared.Results The effective rate of treatment in the control group was 68.75% lower than that in the experiment group 90.63%(P<0.05). Compared with the control group after treatment,the serum CRP, IL-6, IL-10, systolic blood pressure, diastolic blood pressure, TC,TG and LDL-C levels were lower,theHDL-C level was higher,has statistical significance(P<0.05).Conclusion Shenqi Fuzheng injection in the treatment of elderly patients with coronary heart disease has a significant effect,can reduce serum CRP, IL-6 and IL-10 levels.

Objective To evaluate the effect of type Ⅱ odontoid fracture,type Ⅰ Hangman fracture,C2-C3 disc injury on stability of C1-C2 and C2-C3 segments and investigate the clinical significance.Methods Ten fresh-frozen cadaveric cervical specimens (5 men and 5 women; 25-45 years of age,mean 35.7 years) were selected to test the stability of C1-C2 and C2-C3 segments in the settings of intact condition (control group),type Ⅰ Hangman fracture,type Ⅱ odontoid fracture,type Ⅰ Hangman fracture + type Ⅱ odontoid fracture,type Ⅰ Hangman fracture + type Ⅱ odontoid fracture + C2-C3 disc injury.Range of motion (ROM) and neutral zone (NZ) of those segments were measured.Results Compared with the intact condition,type Ⅰ Hangman fracture produced no significant variations in C1-C2 ROM in all loading modes and C2-C3 ROM during left and right lateral bending; type Ⅱ odontoid fracture produced no significant variations in C2-C3 ROM in all loading modes and C1-C2 ROM during left and right rotation; type Ⅰ Hangman fracture + type Ⅱ odontoid fracture revealed no significant variations in C1-C2 ROM during left and right rotation and C2-C3 ROM during extention; type Ⅰ Hangman fracture + type Ⅱ odontoid fracture + C2-C3 disc injury produced no significant variations in C1-C2 ROM during left and right lateral bending and extension-flextion and C2-C3 ROM in all loading modes (P ＜ 0.05).Conclusions Type Ⅰ Hangman fracture can reserve C1-C2 segmental left and right rotation and extension-flextion; type Ⅱ odontoid fracture can reserve C1-C2 segmental left and right lateral bending and extension-flextion; type Ⅰ Hangman fracture + type Ⅱ odontoid fracture + C2-C3 disc injury can reverse atlantoaxial rotationary stability and C1-C3 segmental stability in all directions.This study provides the biomechanical basis for clinical treatments and the related researches of internal fixation.

Objective To approach the effect of protective mechanical ventilation on acute lung injury after orthotopic liver transplantation, by observing changes of plasma markers of lung injury and inflammatory mediators.Methods Sixty patients scheduled for liver transplantation under general anesthesia, 42 males and 18 females, aged 21-62 years, weighing 43-80 kg, ASA physical status Ⅱ-Ⅳ, were randomly divided into 2 groups: protective mechanical ventilation group (group P) and unprotective mechanical ventilation group (group U).Pulmonary artery blood for plasma markers of lung injury and inflammatory mediators were collected at the following time points: before operation (T1), 3 hours after mechanical ventilation (T2), 2 hours (T3) and 4 hours in neohepatic stage (T4).These mediators included clara cell secretory protein (CC16), surfactant proteins (SP-D), soluble receptor for advanced glycation end-products (sRAGE), TNF-α, IL-6 and IL-8.Moreover, blood gas results were recorded at these 7 time points: T1-T4, 2 hours after operation (T5), before tracheal extubation (T6) and 2 days after operation (T7).The postoperative awakening time, tracheal extubation time, ICU stay time and the incidence of ALI were recorded.Results Compared with T1, plasma level of CC16 in the two groups increased at T2 and T3 (P<0.05 or P<0.01), however, plasma level of SP-D, sRAGE, TNF-α, IL-6 and IL-8 did not increase until T3 (P<0.01).Moreover, plasma level of sRAGE, TNF-α, IL-6 and IL-8 at T4 were higher than those at T1 (P<0.05 or P<0.01).Compared with T1, OIs in the two groups increased at T2, T5 and T6 (P<0.05 or P<0.01), while decreased at T4 in group P (P<0.01) and at T3 and T4 in group U (P<0.01).In group P, patients showed a lower plasma level of CC16 at T2 and T3 (P<0.05 or P<0.01), a higher OI at T3 (P<0.05) and an earlier tracheal extubation after operation [(8.9±3.2) h vs (9.3±2.8) h, P<0.05] compared with group U.There was no significant difference of acute lung injury incidence between the two groups after operation, which was 5(16.6%) and 7 (23.3%), respectively.Conclusion Protective mechanical ventilation may promote oxygenation index, and shorten tracheal extubation time, thus protect lung function of patients in liver transplantation to some extend.

Objective To evaluate the effects of lung-protective ventilation on acute lung injury after liver transplantation.Methods Sixty patients of both sexes,aged 21-64 yr,with body mass index of 18-28 kg/m2,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,scheduled for elective orthotopic liver transplantation,were divided into 2 groups (n =30 each) using a random number table:conventional mechanical ventilation group (group CMV) and lung-protective ventilation group (group LPV).In group LPV,the patients were mechanically ventilated (tidal volume 6-8 ml/kg,respiratory rate 10-15 breaths/min,positive end-expiratory pressure 3-10 cmH2 O),and lung recruitment mnaneuver was pertormed every 2 h.Before skin incision (T1),at 3 h of preanhepatic phase (T2),at 30 min of anhepatic phase (T3) and at 2 and 4 h of neohepatic phase (T4.5),bronchoalveolar lavage fluid (BALF) was collected and blood samples from the radial artery were simultaneously collected for determination of tumor necrosis factor-alpha and interleukin-8 concentrations in BALF and serum by enzyme-linked immunosorbent assay.At 2 h after operation (T6),before tracheal extubation (T7) and at 2 days after operation (T8),blood samples from the radial artery were collected for blood gas analysis,and oxygenation index was calculated.The concentrations of serum Clara cell secretory protein 16,surfactant protein D and soluble receptor for advanced glycation end-products were determined at T1-T8 using enzyme-linked immunosorbent assay.The postoperative emergence time,extubation time,duration of intensive care unit stay and development of acute lung injury were recorded.Results Compared with group CMV,the cxtubation time was significantly shortened,serum concentrations of Clara cell secretory protein 16 at T2,T3,T6 and T7,serum surfactant protein D concentrations at T5 and serum concentrations of soluable receptor for advanced glycation endproducts at T5 and T6 were decreased (P＜0.05),and no significant change was found in tunor necrosis factor-alpha and interleukin-8 concentrations in serum and BALF at each time point or postoperative incidence of acute lung injury,oxygenation index,emergence time and duration of intensive care unit stay in group LPV (P＞0.05).Conclusion Although lung-protective ventilation dose not decrease the development of acute lung injury after liver transplantation,it attenuates lung tissue injury to some extent.

Objective To explore an ideal screw insertion point and optimal trajectory for anterior axis pedicle screw (AAPS) so as to provide an anatomical basis for AAPS placement.Methods CT scan of the cervical spine was performed for 40 healthy Chinese adults.Then,the CT data were imported into the Mimics software to reconstruct the three-dimensional images of the axes.The data were divided into two groups according to the gender.The following data were measured:pedicle centerline minimal diameter on both left and right sides,pedicle axial length,the distance between entrance point and upper endplate,the distance between entrance point and median sagittal plane,the distance between entrance point and peak of crista lambdoidalis of C2 vertebral body,extraversion angle and sagittal angle.The screw fixation parameters for AAPS were measured using the Mimics software.Results There was no statistical difference between the left and right sides as well as between the genders (P ＞ 0.05).The entrance point for insertion of AAPS was recommended to be on (4.39 ± 0.67) mm from the upper endplate,and on (3.95 ± 0.44) mm from the median sagittal plane.The ideal pedicle axial length was (34.15 ± 2.93) mm,and the pedicle centerline minimal diameter was (7.04 ± 0.87) mm.The distance between the entrance point and the peak of crista lambdoidalis of C2 vertebral body was (1.45 ± 0.19) mm.The ideal extraversion angle was (30.80 ± 2.79) °,and the ideal sagittal angle was (36.35 ± 3.26) ° . Conclusion The ideal insertion pathway of AAPS placement can avoid spinal canal,foramen intervertebrale and other important anatomical structure,which is feasible in regard of anatomy.The insertion point can refer to the peak of crista lambdoidalis of C2 vertebral body.However,AAPS placement should be individualized in term of its anatomy variability.

Objective To clarify the role and significance of Toll?like receptor 4(TLR4)in myocardial damage following paraquat(PQ)poisoning in mice. Methods Male wild type C57BL/6J mice(WT)and male TLR4 deficient mice(TLR4?ko)were divided into four groups in the study:(1)control group(WT mice,n=6);(2)TLR4?ko group(TLR4?ko mice,n=6);(3)WT+PQ group(WT mice,n=30);(4)TLR4?ko+PQ group (TLR4?ko mice,n=30). The mice in group 1 and group 2 were injected intraperitoneally with saline;mice in group 3 and group 4 were injected in?traperitoneally with 75 mg/kg of PQ. At 2 h,4 h,8 h,16 h and 24 h after PQ administration,6 mice of WT+PQ group and TLR4?ko+PQ group were euthanized and the heart tissue specimens were harvested. All the specimens were analysed by histology,while the expression of TLR4 mRNA was only detected in samples of WT+PQ mice. The specimens at 2 h,8 h and 24 h after PQ administration were used for cytokines detection for WT+PQ group and TLR4?ko+PQ group;in addition,Western blot analysis was performed for WT+PQ group. At 8 h after treatment,control mice and TLR4?ko mice were euthanized by the same method. Mice were anesthetized for cardiac geometry and functional assessment using a 2?D guide M?mode echocardiography at 8 h following injection of either PQ or saline. Results During myocardial damage due to PQ exposure in WT+PQ mice,obvious histopathological changes were observed,as well as a noticeable decrease of heart function and increased expressions of TNF?αand IL?1β. Compared with the WT mice,TNF?αand IL?1βprotein levels,changes in heart function and histopathological changes were significantly attenuated following PQ exposure in myocardial damage in TLR4?ko mice. Conclusion The TLR4gene is involved with in heart functional injury and histopathological changes in myocardial damage following PQ poisoning in mice,which may through the regulation of TNF?αand IL?1βexpression. Our findings indi?cate that TLR4 plays an important role in mediating myocardial injury due to PQ.