Objective To evaluate the effect of dexmedetomidine on left ventricular function in patients undergoing coronary artery bypass grafting (CABG) by transesophageal echocardiography (TEE).Methods The study was a prospective,randomized and placebo-control clinical trial.Eighty patients undergoing CABG with cardiopulmonary bypass (CPB) were divided into dexmedetomidine group (group D)and control group (group C) by random digits table method with 40 cases each.A loading dose of dexmedetomidine 0.5 μg/kg was injected intravenously 10 min after induction followed by infusion at 0.4 μ g/(kg· h) until the end of operation in group D,while equal volume of normal saline was given in group C.Left ventricular function was assessed by transesophageal echocardiography before the infusion of dexmedetomidine (T1),at the end of the infusion of loading dose (T2),before CPB (T3) and at the end of the operation (T4).Results Compared with those at T1,left ventricular ejection fraction and fractional area change decreased significantly [(58.0 ± 12.0)％,(60.0 ± 9.6)％ vs.(63.0 ± 8.6)％ and (46.0 ± 9.3)％,(48.0 ± 8.4)％ vs.(51.0 ± 6.7)％] (P ＜ 0.05 or ＜ 0.01),E/A ratio increased significantly (1.05 ± 0.27,1.07 ±0.31 vs.0.98 ±0.19)(P ＜0.05 or ＜0.01) and myocardial performance index (MPI) decreased significantly (0.46 ± 0.14,0.45 ± 0.12 vs.0.51 ± 0.14) (P ＜ 0.05) at T2 and T3 in group D,while stroke volume was not significantly changed (P＞ 0.05).Compared with that in group C,E/A ratio and rapid filling fraction in group D was significantly higher [1.06 ± 0.18 vs.0.97 ± 0.18,(62.0 ± 7.1)％ vs.(58.0 ± 7.3)％],and S/D ratio and MPI was significantly lower at T4(1.17 ± 0.21 vs.1.29 ± 0.22,0.43 ± 0.15 vs.0.50 ± 0.15),and there were significant differences (P ＜ 0.05).There was no difference in the parameters indicating left ventricular systolic function (P ＞ 0.05).Conclusions Dexmedetomidine restrains left ventricular systolic function in the patients undergoing CABG,but does not decrease the cardiac output,and improve relaxation dysfunction of left ventricular diastolic function.Global left ventricular function is improved by dexmedetomidine after CABG.

Objective To explore the application of gastric(enteric)-pharyngeal anastomosis for cervical esophageal carcinoma. Methods The clinical data of 12 cases with surgical management of cervical esophageal carcinoma were retrospectively analyzed. Results The resectability of cervical esophageal carcinoma was 100%,no case complicated with pharyngeal fistula.Swallowing function of all cases was in a good state.The overall follow-up was 1 to 7 years,among them 9 surviving,3 dead.The surviving 5 cases are over 3 years,the ongest beyond 7 years. Conclusions Gastric(enteric)-pharyngeal anastomosis is a good primarily rehabilitating method of the cervical esophageal defect after surgical treatment of cervical esophageal carcinoma.

A.niger M1, the initial strain, was treated by UV and a mutant with 30% higher xylanase activity was obtained. Zymogram for detecting xylanase showed there are three different xylanases in the mutant mature culture, while two xylanases in initial strain. After orthogonal experiment, the optimum fermentation conditions of the mutant were obtained as follows: concentration of the major carbon resource 4 %, ratio between bran and corncob 5:5, concentration of glucose 0.1%, concentration of ammonium oxalate as supplemental nitrogen resource 2.0%, the initial pH of liquid medium 5.0, 100mL/250mL flask.

Objective To explore the value of Artis zeego robot imaging system endoscopic retrograde cholangiopancreatography (ERCP) for biliary calculi. Methods ERCP was performed on 12 patients with biliary tract dilation, diagnosed by B ultrasonography. Artis zeego robot was used simultaneously to acquire 3D images and biliary system reconstruction. The diagnostic consistency was assessed based on endoscopy and surgery if necessary. Results 3D rotating acquisition and biliary reconstruction were performed in the 12 patients. All diagnosis coincided with those of surgery and ERCP findings, achieving a consistency rate of 100%. Patients with extrahepatic bile duct stones of uncertain number (n = 2), with suspected biliary duct calculi ( n = 1 ) and with suspected intrahepatic bile duct stones ( n = 2) under ERCP were all diagnosed by the robot imaging system. Conclusion During ERCP, 3D rotating image acquisition and biliary reconstruction with Artis zeego robot is helpful for precise diagnosis of biliary tract stones.

Objective To evaluate the changes in the right ventricular systolic and diastolic function during the early period after cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting (CABG).Methods Eighteen ASA physical status Ⅱ or Ⅲ patients of both sexes,with coronary heart disease (NYHA Ⅱ or Ⅲ),aged 50-80 yr,weighing 51-96 kg,with left ventricular ejection fraction≥50％,scheduled for elective CABG under CPB,were enrolled in this study.Before splitting of sternum and at 5 min after termination of CPB,the parameters of hemodynamics,cardiac output (CO)and variables of right ventricular function (using transesophageal echocardiography) including tricuspid annular plane systolic excursion (TAPSE),right ventricular fractional area change (RVFAC),tricuspid annular peak velocity during isovolumic contraction (IVV),peak velocity during ejection phases (St),early diastolic peak velocity (Et),late diastolic peak velocity (At),E/Et ratio and Et/At ratio were recorded.Results Compared with the baseline value before splitting of sternum,TAPSE,IVV,St,RVFAC,CO,E,Et and At were significantly increased,and no significant change was found in the parameters of hemodynamics and E/Et and Et/At ratios at 5 min after termination of CPB.Conclusion For the patients undergoing CABG,the right ventricular systolic function is significantly enhanced,and there is no obvious improvement in the right ventricular diastolic function during the early period after CPB.

Objective To evaluate the effect of acute plateletpheresis (APP) and back-transfusion on platelet activation in the patients undergoing open heart surgery with cardiopulmonary bypass (CPB).Methods Forty patients,aged 35-64 yr,with body mass index within the normal range,of ASA physical status Ⅱ or Ⅲ (NYHA Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement under CPB,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and APP group.In group APP,after induction of anesthesia,APP was performed,packed red blood cells and platelet-poor plasma were transfused back to the patient after termination of the previous cycle,and another cycle was started simultaneously.Platelet-rich plasma (PRP) was harvested and transfused back to the patient after termination of CPB and neutralization of heparin with protamine.Before induction of anesthesia (baseline),after APP and before heparinization,after neutralization of heparin with protamine and before back-transfusion of PRP,at the end of operation,and at 24 h after operation,venous blood samples were collected for determination of the expression of CD62p and PAC-1 in inactivated platelets and activated platelets by adenosine diphosphate (ADP).After APP and before heparinization,and after neutralization of heparin with protamine and before back-transfusion of PRP,the expression of CD62p and PAC-1 in inactivated platelets and ADP-activated platelets was detected in the whole blood and PRP in group APP.Results Compared with C group,the expression of CD62p and PAC-1 in inactivated platelets was down-regulated at the end of operation,and the expression of CD62p and PAC-1 in ADP-activated platelets was upregulated in APP group.The expression of CD62p and PAC-1 in inactivated platelets was down-regulated in PRP,and the expression of CD62p and PAC-1 in ADP-activated platelets was up-regulated in PRP as compared with those in the whole blood.Conclusion APP can not induce platelet activation,however,platelet back-transfusion can enhance platelet activation in the patients undergoing open heart surgery with CPB.

Objective To establish CFPAC-1 cell lines deficient in CDC25B2 by recombinant lentivirus, and to investigate the role of this gene. Methods After CFPAC-1 cells were transduced with recombinant lentivirus producing CDC25B2 siRNA, stably transduced cells with green fluorescent protein were selected by flow cytometer. The mRNA and protein expression of CDC25B2 was examined by RT-PCR and Western blot analysis. The effect of the lentivirus on the cell proliferation, cell cycle, clone-forming, migration and invasion ability was analyzed by MTr method, flow cytometer, plate clone-forming assay and Transwell chamber method respectively. Results CDC25B2 siRNA knocked down CDC25B2 expression in CFPAC-1 cells significantly. The silencing efficiency of siRNA transduction by recombinant lentivirns was very high. Proliferation, cloneforming, migration and invasion ability of human pancreatic cancer cell line CFPAC-I were significantly in-creased, while cell cycle was not affected. Conclusion CDC25 B2 plays an important role in cell proliferation, clone-forming, migration and invasion of pancreatic cancer. This research provides experimental evidences for targeting CDC25B2 in gene therapy against pancreatic cancer.

Objective To evaluate the effect of sevoflurane-based anesthesia on the interventricular synchronization in the patients undergoing coronary artery bypass grafting (CABG) with cardiopuhnonary bypass (CPB).Methods Twenty-four Amnerican Society of Anesthesiologists physical status Ⅱ or Ⅲ patients,aged 52-75 yr,with body mass index of 17-31 kg/m2,with body surface area of 1.7-2.2 m2,of New York Heart Association Ⅱ or Ⅲll,with left ventricular ejection fraction (LVEF) ≥45％,scheduled for elective CABG with CPB,were divided into 2 groups (n=12 each) using a random number table:propofol combined with remifentanil anesthesia group (group C) and sevoflurane combined with propofol and remifentanil anesthesia group (group S).After induction of general anesthesia,the patients were en-dotracheally intubated and mechanically ventilated.Anesthesia was maintained by Ⅳ infusion of propofol,remifentanil and cisatracurium,and the cerebral state index value was maintained at 40-60.In group S,the patients inhaled sevoflurane (the end-tidal concentration was 1.80％ for 50-59 yr and 1.60％ for 60-75 yr) for 60 min starting from 15 min after termination of CPB.After induction of anesthesia and before splitting of sternum,immediately before inhaling sevoflurane and at 30 and 60 min of sevoflurane inhalation,heart rate,cardiac index,LVEF,right ventricular eject fraction,QRS width and interventricular mechanical delay were recorded,and the occurrence of interventricular dyssynchrony was recorded.Results There were no significant differences between group C and group S in the heart rate,cardiac index,LVEF,right ventricular eject fraction,QRS width,interventricular mechanical delay or incidence of interventricular dyssynchrony (P＞0.05).Conclusion Sevoflurane-based anesthesia exerts no marked effect on interventricular synchronization in the patients undergoing CABG with CPB.

Objective To investigate the effect of nicardipine on the hepatic blood flow in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Twenty-six patients of both sexes,aged 30-64 yr,weighing 50-90 kg,with New York Heart Association Ⅱ or Ⅲ,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective mitral or aortic valve replacement,were randomly divided into either nicardipine group (group P,n =13) or control group (group C,n =13) using a random number table.Transesophageal echocardiography was used to measure the indexes of blood flow in the hepatic vein.Nicardipine 0.2-0.5 μg · kg-1 · min-1 was infused intravenously starting from beginning of CPB,and the infusion was stopped at termination of CPB in group P.After induction of general anesthesia,at 30 min after beginning of CPB,at 10 min before termination of CPB,and at 30 min after termination of CPB,the diameter of the right and middle hepatic veins (DR and DM),blood flow index in the right hepatic vein (QIR),blood flow index in the middle hepatic vein (QIM),and total blood flow index in the hepatic vein (QIR+M) were recorded,and the percentage of QIR+M in cardiac index (CI) (QIR+M/CI) or in QICPB (QIR+M/QICPB) was calculated.Before operation,and at 1 and 2 days after operation,blood samples were obtained from the median cubital vein for determination of total bilirubin,alanine aminotransferase,and aspartate aminotransferase (AST) levels in serum.Results Compared with group C,the serum levels of AST at 1 day after operation and serum levels of AST at 1 day after operation were significantly decreased (P＜0.05),and no significant change was found in DR,DM,QIR,QIM,QIR+M,QIR+M/CI and QIR+M/QICPB at each time point in group P (P＞0.05).Conclusion Nicardipine (0.2-0.5 μg · kg-1 · min-1) infused intravenously during CPB exerts no effect on the hepatic blood flow,and it is not related to the improvement in hepatic function in the patients undergoing cardiac valve replacement.

ObjectiveTo assess the blood-saving effect of acute plateletpheresis (APP) and back-transfusion in patients undergoing open.heart surgery with CPB.MethodsThirty ASA Ⅱ or Ⅲ patients aged 41-63 yr weighing 52-72 kg undergoing open heart surgery with CPB were randomly divided into 2 groups (n =15 each):control group (group C) and APP group.In APP group,platelet-rich plasma was harvested immediately after induction of anesthesia and transfused back to the patient after termination of CPB and neutralization of heparin with protamine.In group C plateletpheresis was not performed.Hb,Plt,PT,APTT and Fib were measured before induction and at 1,24 and 48 h after operation.CPB time,aortic crossclamping time,postoperative chest tube drainage and blood product transfusion requirements were recorded.ResultsIn APP group the volume of the whole blood processed for plateletpheresis was (1285 ± 185) ml and ( 192 ± 38) ml of platelet-rich plasma was sequestered.The platelet count of the sequestered plasma was(817 ± 282) × 109/L,accounting for (21 ± 3) ％ of the total number of Pit in the whole blood volume.The plateletpheresis took (35 ± 10) min.The platelet count at 1 h after operation was significantly higher in APP group than in group C.The volume of postoperative chest tube drainage at 24 h after operation was significantly lower in APP group than in group C.Less allogeneic RBC and Plt were transfused in APP group than in group C.There was no significant difference in other variables between the 2 groups.ConclusionAPP has blood-saving effect in patients undergoing open heart surgery with CPB.