ve To evaluate the performance of the target controlled infusion (TCI) system of midazolam for sedation during operation in terms of safety and ease of use in the elderly and the young. Methods Forty-four unpremedicated ASA I - II patients scheduled for elective surgery under epidural or combined spinal-epidural (CSE) anesthesia were included in this study. The patients were divided into two age groups: the elderly group aged 61-82 yr ( n = 22) and the young group aged 19-43 yr (n = 22) . Patients with neurological or severe cardiopulmonary diseases or abnormal liver or kidney function were excluded. The block height was maintained below T4. The TCI system consisted of Intel Pentium III 450 MHz computer and Graseby 3500 computerized infusion pump. The software we used was Stelpump Version 1.05 written by Pina and Coetzee and the pharmacokinetic model and parameter were described by Arram and Buhrer. The effect site concentration of midazolam was targeted and started from 50ng?ml-1, then increased in increment of 50 ng?ml-1 (in the young group) or 25ng?ml-1 (in the elderly group) until the patient did not respond to light shaking (defined as unconsciousness) . Each incremental increase was maintained for 15 min. Arterial blood samples were taken in ten patients randomly selected from each group at 10 and 15min after each incremental increase of midazolam concentration for determination of plasma midazolam concentration by high performance liquid chromatography ( HPLC) .Results The bias (median performance error) of the TCI system of midazolam was 7.9% in the elderly group and 11.6% in young groups. The precision (median absolute performance error) was 20.0% in both groups. They were clinically acceptable. Conclusions The TCI system of midzolam can provided sedation for patients undergoing surgery under spinal and/or epidural anesthesia safely and efficiently in both the old and young.

Objective To assess the changes in heart rate variability (HRV) during midazolam sedation with TCI in the elderly and young patients. Methods Thirty-eight ASA I - Ⅱ patients scheduled for elective surgery on lower abdomen or lower extremities under epidural or combined epidural-spinal anesthesia were divided into two groups of 19 patients each: the young group (18-40 yr) and the elderly group (60-89 yr). Radial artery was cannulated for intra-arterial pressure monitoring and blood sampling. HRV was monitored by HXD-1 monitoring system. HRV parameters included total power (TP), low frequency(LF), high frequency(HF), LF/HF, nuLF(LF/TP ?100%) and NuHF(HF/TP ? 100%) . The height of block was maintained below T5. TCI was used to achieve a rapid induction and maintenance of a stable target blood midazolam concentration. Target blood midazolam concentration was started from 50 ng/ml and gradually increased with increment of 25 ng/ml in elderly group or 50ng/ml in the young group until loss of consciousness (OAA/S =1). Arterial blood samples were taken at each target blood midazolam concentration for determination of blood midazolam concentration. HRV parameters were recorded at different OAA/S scores during both the induction of and recovery from sedation. Results With increasing depth of sedation, most of the HRV parameters (LF, nuLF, LF/HF and TP) decreased progressively, while nuHF increased and HF remained unchanged. During recovery from midazolam-induced sedation, HRV parameters returned gradually to the baseline values. OAA/S scores and HRV parameters were well correlated(r = 0.502-0.719). The trend of changes in HRV was consistent in both groups. At the same OAA/S score, most values of HRV parameters were not significantly different between the two groups. Only during deep sedation (OAA/S=1), values of all HRV parameters were significantly lower in the elderly group than those in the young group, except LF/HF. Conclusions During profound sedation (OAA/S=1) midazolam depresses the activity of the autonomic nervous system more markedly in the elderly than in the young, but the elderly without cardiovascular and autonomic nervous system disorders has the same ability to keep the balance between the sympathetic and parasympathetic nervous system as theyoung.

This article reviewed the effects of acupuncture on structure and function of central nervous system (CNS). Acupuncture is effective on motor function and ability of learning and memory. The mechanism is complex, including cerebral blood flow, pathomorphism, energy metabolism, free radicals metabolism, cell apoptosis, synaptic connections, and expression of neurotrophic factor, etc.

Objective To explore the influence of proteasome inhibitor, MG-132 (N-benz0y1oxycarbonyl(Z)-Leu-Leuleucina1) on the expressions of carboxyl terminus of the Hsc70-interacting protein (CHIP) and heat shock protein 70 (HSP70) in ischemia reperfusion (I/R) rats and investigate the underlying mechanism of myocardial protection by the inhibitor. Methods Totally 54 adult SD rats were randomly divided into 3 groups, sham group (n=6), I/R group (n=24) and treatment group (I/R+T, n=24). The later 2 groups were further equally divided into 3 subgroups according different time of reperfusion. Left anterior descending (LAD) coronary artery was ligated for 30 min and then released for 2 h or 24 h or 7 d in different subgroups. Five minutes before reperfusion, MG-132 at dose of 0.75 mg/kg was given intravenously in I/R+T group,but I/R group and sham group were given the same volume of normal saline. The levels of CHIP and HSP70 at mRNA and protein level were detected by real-time PCR and Western blotting respectively. The correlation between CHIP and HSP70 expression was analyzed. Results Compared with I/R groups, the mRNA levels of CHIP and HSP70 were significantly increased in I/R+T groups (P

Objective: To study the elimination half-life of propofol in mouse brain. Methods: One hundred and forty mice were injected with propofol 32 mg/kg through caudal vein. The mice were divided into 14 groups with different time points, i.e. 1,2,3,4,5,6,7,8,9,10,15,30,45,and 60 min,with 10 mice in each group. The mice were killed to obtain arterial blood by picking off their eyeballs, and their brains by cutting off their heads. The concentrations of propofol in serum and brain were measured by high performance liquid chromatography. The parameters of elimination half-life were calculated by software 3P97. Results: Time to peak concentration of propofol in serum was about 1 min, and time to peak concentration of propofol in brain was about 3 min. The elimination half-life of propofol in brain were (9.6? 0.5) mins. Conclusion: The peak concentrations of propofol in brain was later than it in serum. There is correlation between the concentrations of propofol in blood and in brain. The metabolism of propofol in effect site could be measured accurately by the elimination half-life in brain.

UV second derivative spectrophotometry was used for the analysis of compounded Chinese medicinal prescription in order to eliminate interference from prescription base. Amplitude D and △A were taken as the quantitative informatious. Synthetic decanoyl acetaldehyde in compounded Chinese medicinal prescription were determined by two methods. The Correlation coefficicnts of the standard curve were found to be 0.9994 and 0.9996,the mean recovery to be 98.10% and 96 31%.

Objective:Both URL and MPCNL have been widely applied in the treatment of ureteral calculi.In this study,the safety,efficiency and degree of injury were compared between retrograde and antegrade access ureterolithotripsy for the calculi complicated with infection,in order to clarify the indications of the two types of minimally invasive techniques.Methods:A total of 192 patients with upper ureteral calculi complicated with infection were treated with ureterolithotripsy.The operation was performed via retrograde transurethral access in 72 patients and via antegrade percutaneous nephrostomy tract in 120 patients.Results:The success rate of retrograde approach was 93.1%.Mean operating time was 45.9?16.5min(20-90 min) with mean hospital stay of 5.1?1.8(2-6) days.The stone free rate was 84.7%(61/72) at 1 month follow-up.5 patients with residual calculi required combined ESWL.Complications were noted in 5.6%,CRP was 10.59?5.12 mg/L before operation,and was 38.63?4.61 mg/L 24h after the operation.The success rate of antegrade approach was 99.2%.Mean operating time was 62.4?17.6 min(40-120 min) with mean hospital stay of 8.57?2.57(5-15) days.The stone free rate was 100% and 1 complication was noted(0.01%).CRP was 11.29?5.38 mg/L before the operation,34.93?7.82 mg/L 24h after the operation.For the success rate and stone free rate,antegrade approach was higher than retrograde approach(P0.05)between the two groups before operation,but antegrade approach had lower CRP(P

BACKGROUND: Hippocampal structure in brain is the division related to learning and memory, generally it is closely relevant to spatial cognitive activity. Marginal division of striatum is a latest discovered subdivision related to learning and memory function of brain, whether is its learning and memory function different from that in hippocampus?OBJECTIVE: To compare the difference, function and importance in learning and memory function between marginal division of striatum and hippocampus in brain and observe the difference in escape learning and memory between marginal division of striatum and hippocampus.DESIGN: Completely randomized controlled experiment.SETTING: Institute of Neuroscience in Zhujiang Hospital Affiliated to First Military Medical University of Chinese PLA.MATERIALS: The experiment was performed in Institute of Neuroscience in Zhujiang Hospital Affiliated to First Military Medical University of Chinese PLA from March 2002 to July 2003. Totally 109 normal male adult SD rats were employed and 75 rats of them were screened as the qualified animals by twice Y-maze test. Randomly, 25 rats were divided into damaged marginal division of striatum group (DMD group), 10 rats were into bilateral fimbria-fornix transection group (FFT group), 30 rats were into the control of marginal division of striatum (MD control) and 10 rats were into the control of bilateral fimbria-fornix group (FF control). After 24 hours training in Y-maze,In DMD group, 10 g/L kainic acid 0.1 to 0.2 μL was used to damage bilateral marginal division of striatum of rats. In MD control, physiological saline of minim dose was injected in bilateral marginal division of striatum of rats. In FFT group, bilateral fimbria-fornix was transectioned. In FF control, the cortical tissue of the superficial layer of bilateral fimbria-fornix was transectioned. The operation was done on the second day after the 2nd screening. The behavior of rats in learning and memory was observed in Y-maze on the 5th day after operation (during 30 times of maze test, if success frequency ≥ 15,normal capacity of learning and memory was identified.).MAIN OUTCOME MEASURES: Success frequency of rats in different groups in Y-maze learning before and after operation.RESULTS: Of 109 normal male adult SD rats, 75 rats were screened to be qualified after twice Y-maze test. During the experiment, 3 rats were died and other 32 rats fell into disuse for the drug or physiological saline was not injected accurately to the marginal division of striatum. Terminally, 40 rats entered the analysis in total, of which, 11 rats were in DMD group, 9 rats in MD quency in Y-maze learning of rats in DMD group after operation was lower than MD control, FFT group and FF control [(9.27±4.29) times, (22.56±4.25)frequency in Y-maze learning of rats in DMD group after operation was also significantly lower than that before operation [(9.27±4.29) time, (18.27±3.07)FFT group was basically same as FF control and MD control (P=0.660 and P=0.489) and it was basically same to the success frequency in Y-maze learning before operation (P=0.700).CONCLUSION: The learning of Y-maze in rats with damaged marginal division of striatum was remarkably reduced and there was no obvious change in learning and memory between the rats with fimbria-fornix transaction and without transaction. It is verified that marginal division of striatum can reflex complex learning and memory behavior in electric Y-maze test, which cannot be achieved in hippocampus. It is further explained the difference of the two divisions in controlling learning and memory in cerebrum, the marginal division of striatum is able to control hippocampus in learning and memory function.

BACKGROUND: The marginal division, a new sub-region in rat brain striatum discovered in recent decades, has been found to closely relate to learning and memory function of the brain. The immediate-early genes such as c-fos and c-jun participate in the signal transduction of learning and memory in the marginal division. But what other intermediate events are initiated in the marginal division in the process of learning and memory?Cyclic adenosine monophosphate (cAMP) response element-binding protein (CREBP) is an molecule essential for the formation of long-term memory,and investigation of the expression and distribution of phosphorylated CREBP in the striatum may help understand the signal transduction mechanism in the striatum during learning and memory at the molecular level.OBJECTIVE: To investigate the expression of phosphorylated CREBP in rat brain stratum during learning and memory process.DESIGN: Completely randomized controlled study.SETTING: Institute of Neurosciences, Zhujiang Hospital of the First Military Medical University of Chinese PLA.MATERIALS: This experiment was conducted in the Institute of Neurosciences, Zhujiang Hospital of the First Military Medical University of Chinese PLA between April and August 2003. Totally 48 normal male adult SD rats were provided from the Experimental Animal Center of First Military Medical University, and after two Y-maze tests, 40 rats were selected for this study (MG-2 type, Sanshengxing electricity company).METHODS: The 40 SD rats were randomized into 4 equal groups. The rats in the first group were subjected to training to acquire dark avoidance reflex in a Y maze, those in the second group underwent sham training with only light stimulation in the Y maze without electricity on the floor.The rats in the third group were trained in the Y maze with electricity on the floor but not light stimulations, with the rest 10 rats serving as the control group subjected to sham training in the Y maze without either electric or light stimulations. After the training in the Y maze, the rats were sacrificed immunohistochemical detection of phosphorylated CREBP expression in the brain striatum.MAIN OUTCOME MEASURES: Expression of phosphorylated CREBPin rat brain striatum.RESULTS: All the 40 rats enrolled in this study were examined for phosphorylated CREBP expression. Positive expression of phosphorylated CREBP was observed in the medial marginal division of the brain striatum after the rats were trained in the Y maze with electric stimulation, but no obvious expression was seen in rats in the sham training or control groups.Massive expression of phosphorylated CREBP could be observed, typically,in the hippocampus, front prefrontal lobe cortex and cingulate gyrus of the rat brain.CONCLUSION: The transcriptional factor phosphorylated CREBP in the marginal division of the striatum participates in the signal transduction for learning and memory in rats receiving Y maze training to acquire dark avoidance reflex.

Objective To explore the surgical treatment of bile duct necrosis.Methods Clinical data of 94 cases of bile duct necrosis treated in this hospital from May1990 to December 2008 were retrospectively analyzed.Results There were no death or severe complications such as biliary fistula and massive hemorrhage in these patients.Conclusion Bile duct necrosis should be treated with a proper surgical approach based on its features.