Objective To study the neuroprotective effect of sevoflurane on controlled hypotension in patients with coronary heart disease undergoing craniocerebral surgery. Methods Twenty-six patients with coronary heart disease undergoing craniocerebral surgery were randomly divided into two groups,receiving either inhaled 2%-5%sevoflurane plus intravenous sodium nitroprusside (treatment group,n=13) or intravenous sodium nitroprusside 3-8 μg·kg-1 alone (contorl group,n=13) for blood pressure control. The hemodynamic changes were recorded during the operation. Patient satisfaction with surgeons and the duration hospital stay after surgery were recorded. The levels of cardiac troponin I (TNI),creatine kinase-MB (CK-MBM),neuron specific enolase ( NSE) and S100 calcium binding proteinβ( S-100βprotein) in serum were detected at one day pre-operation,the end of the operation,and one day post-operation. Results The duration of hospital stay after surgery was significantly shortened in treatment group [(20. 3±3. 8) versus (23. 9±4. 6) d,P<0. 05) compared with control group. The average heart rate significantly decreased, patient satisfaction significantly increased, and serum levels of NSE and S-100β protein one day post-operation significantly decreased as compared to control group (all P<0. 05). Compared with the day before operation,serum levels of NSE and S-100βprotein in the two groups increased significantly at the end of surgery (P<0. 05),and the levels of TNI,CK-MBM,NSE and S-100βsignificantly elevated one day post-operation (P<0. 05). Compared with the end of operation,serum levels of NSE and S-100βin contorl group incarcerated remarkably (P<0. 05) Conclusion Sevoflurane plays an important neuroprotective role,as evidenced by improving patients' satisfaction,reducing hospital stay after surgery,and maintaining the balance of myocardial oxygen delivery and consumption in craniocerebral surgery patients with coronary heart disease during controlled hypotension. However,it can not prevent postoperative myocardial injury in these patients.

Objective To study the effects of controlled hypotension with sevoflurane on hymo-dynamics and cerebral metabolic rate of oxygen in neurosurgery.Methods Thirty-seven ASA Ⅰ or Ⅱpatients undergoing elective intracranial surgery were enrolled.The patients were treated with general anesthesia and assigned to two experimental groups,sevoflurane group (group S,n=20)and sodium nitroprusside group (group N,n=1 7).HR,BP,SpO2 and ECG were continuously monitored during operation.Blood samples were taken from radial artery and internal jugular bulb to determine cerebral arteriovenous oxygen differences (Da-jvO2 ) and cerebral metabolic rate of oxygen (CMRO2 ). Results The HR in group S were decreased during hypotension,5 min,10 min,20 min,and 30 min compared with group N (P <0.05).Da-jvO2 and CMRO2 both in two groups were decreased during hypotension(P < 0.05 ),but there was no difference between the two groups.RPP was lower in group S than in group N during hypotension.Conclusion Controlled hypotension with sevoflurane does not increase HR and improves cerebral blood flow-metabolism coupling.

The article explores the significant role supervisor system plays in the credit system in medical college,the scientific selection of supervisors,their management,duty and directions in order to guide the supervisor system in correct and scientific orbit so as to train constantly new type of medical talents.

Objective To evaluate the causes,treatment,and prevention of left ventricular rupture after mitral valvereplacement.Methods From May 1981 to November 2010,11 cases occurred in 4 male and 7 female patients aged 28 - 71 years old.There were 2 cases of New York Heart Association (NYHA) functional class Ⅱ and 9 cases of class Ⅲ.Echocardiography showed that the left ventricular end diastolic internal diameter (LVEDI) was 32 -62 mm.Results Rupture probably occurs after endocardial damage to a thin myocardium that has lost the internal buttress of the subvalvar apparatus.With the rise in intraventricular pressure at the end of bypass blood dissects into the myocardium,resulting in a large haematoma and eventual rupture.According to the onset of ruptures,there were 4 cases of delayed rupture which occured at several hours till days post operation after the patients had been back in the ICU,and 7 cases of early ruptur,which occured at the early stage of surgery,while the patient was still in the operation room.There were no cases of ruptures.The types of the ruptures were identified by operation or necropsy as 5 cases of type Ⅰ,4 cases of type Ⅱ,and 2 cases of type Ⅲ.Four patients were saved after emergency treatment,and 7 died.Conclusion It is difficult to repair left ventricle rupture,but effective prevention for onset can decrease its occurrence.The risk factors for left ventricular ruptures are female,advanced age,pathological changes characterized by mitral stenosis,small left ventricle (LVEDD ＜ 35 mm),and low weight( ＜50 kg ).The following actions raise the risk of let ventricular rupture.Isolated replacement of the mitral valve than after double valve replacement or mitral valve replacement and coronary artery bypass graft; aggressive removal of calcification at the mitral valve; undue selection and replacement of mitral valve prostheses; large size of prosthetic valve with a high bioprosthetic angle in particular; deep sutures at the valve ring; aggressive traction or removal of papillary muscle,hematoma,and heart move.Also we should continue correcting unstable hemodynamic especially with very high blood pressure.Once left ventricular rupture occurs,extracorporeal circulation should be established as soon as possible,and direet suture or intracardiac and extracardiac repair suited to actual conditions are reliable ways to save the patient's life.

Objective Atrial structure remodeling is the important pathologic basis of generate and development in chronic atrial fibrillation(AF) of valvular heart disease.To analyze the changed feature of AF in rheumatic mitral valve stenosis (MS) and mitral valve prolapse(MVP) after mitral valve surgery,along with fundamental change of hemodynamics in left atrial.Methods Firstly,divided into sinus rhythm (SR) group and AF group according to cardiac rhythm postoperative 6 months,and then divided into MS and MVP two subgroups with age matched,namely rheumatic sinus rhythm group (RS group),MVP sinus rhythm group(PS group),rheumatic AF group(RAF group) and MVP AF group(PAF group),30 patients in each group.Independent sample t test andx2 test were used in comparison among groups,and matched t test in preoperative and postoperative comparison of each group.Results There are 15 (50％) AF patients before surgery and 10 (33.3％) AF patients postoperative 1 month in RS group.But cardiac rhythm of MVP patients has no significant change.Left atrial diameter(LAD) in AF group was larger than in SR group significantly preoperative and postoperative 1 month and 6 months(P ＜ 0.05),and LAD have no significant difference between RAF and PAF group,P ＞ 0.05 ; LAD in RS group preoperative and postoperative 1 month was larger than in PS group(P =0.008 and 0.018,respectively),but there is no significant difference between RS and PS groups postoperative 6 months(P =0.558).Systolic peak velocity(Smm) at valve ring with PWTDI were(6.0 ± 1.4) cm/s,(6.7 ± 1.8) cm/s and (6.2 ± 1.6) cm/s preoperative and postoperative 1 month and 6 months,lower than normal range obviously; Smm before surgery in PAF group was(9.3 ± 3.7)cm/s,but reduced obviously after surgery 1 month and 6 months and near the level of rheumatic patients.Conclusion Generate and development mechanism of AF in MS and MVP patients exist some extent difference,the rhythm of partial MS patients with chronic AF will turn to and maintain sinus rhythm along with LAD decreased,there is no this characteristic in MVP patients.

Aim To investigate the effects of the alco-hol extract from Coreopsis tinctoria Nutt. on urinary metabolomics of spontaneous hypertension rats ( SHR) . Methods SHR were fed with normal diet for 1 week and then, they were randomly divided into six groups:untreated control, the high, middle, low dos-age group of the alcohol extract(3.2 g·kg-1 ,1.6 g· kg-1,0.8 g·kg-1) , captopril group(4 mg·kg-1) and Duzhong tablet group(187.5 mg·kg-1). The u-rine of normal rats and SHR hypertension model rats was collected on 1,2,3,4 weeks. The metabolic pro-files were analyzed using 1 H-NMR. PLS-DA methods were used to discriminate the difference and the bio-markers. Results Compared with model group, the blood pressure of all groups was significantly lowered after 4 weeks ( P <0.01 ) . The alcohol extract from Coreopsis tinctoria Nutt. could significantIy reduce blood pressure, and the urinary metabolic profiles trea-ted with Coreopsis tinctoria Nutt. were changed signifi-cantly such as IIL,creatine,β-glucose,etc. Conclusion The alcohol extract from Coreopsis tinctoria Nutt. could significantIy reduce blood pressure and change the urinary metabolomics profiles of SHR rats.

Objective To compare the clinical outcomes of dilator-kyphoplasty (DKP) and balloonkyphoplasty (BKP) in treatment of osteoporotic vertebral compression fractures. Methods From May 2007 to March 2009, 23 cases with 26 vertebrae were treated with DKP, while 29 cases with 29 vertebrae were treated with BKP procedures. The operating time, bleeding volume and injecting volume of cement were recorded during operation. The distribution of cement, the restoration of vertebral height and Cobb angle were observed. The patients' visual analogue scales (VAS) score and Oswestry disability index (ODI) score were evaluated after operation. Results There were no differences in operative time, bleeding volume of every vertebrae and cement injected volume between these two groups (P＞0.05). The vertebral height, Cobb angle, VAS and ODI scores were significantly improved than those of pre-operation in these two groups (P＜0.05). The height of the anterior vertebrae and Cobb angle in DKP groups were restored significantly than those in BKP groups (P＜ 0.05). There were 1 case (1 vertebra, 3.8%) underwent cement leakage in DKP groups and 5 cases (5 vertebrae, 17.2%) in BKP groups. Conclusion DKP and BKP were effective in the treatment of osteoporotic vertebral compression fractures. The height of the anterior vertebrae and Cobb angle in DKP groups were restored significantly than those in BKP groups.

[ ABSTRACT] AIM: To explore the effects of Mcl-1 signal pathway blockers on Mcl-1 expression, macrophage apoptosis and Mycobacterium tuberculosis in the model of mice infected with Mycobacterium tuberculosis H37Rv.METH-ODS:A mouse infection model was established by intraperitoneal injection of H37Rv suspension.The signaling pathway blockers AG490, PD98059 and LY294002 for JAK/STAT, MAPK and PI3K, respectively, were intraperitoneally injected into the mice infected with H37Rv.Cell acid-fast staining was used to observe whether the mouse peritoneal macrophages infected with H37Rv were successfully established.Immunocytochemical method was employed to detect Mcl-1 expression in the mouse peritoneal macrophages infected with H37Rv.The apoptotic rate in each group was measured by flow cytomer-ty.The scavenging capacity of apoptotic macrophages against H37Rv was determined by Mycobacterium tuberculosis colony counting.RESULTS:The result of cell acid-fast staining revealed the existence of dispersive arrangement of red short anti-acid Mycobacterium tuberculosis within infected macrophages.The result of cell immunocytochemistry showed strongly posi-tive expression of Mcl-1 protein in H37Rv infection group, AG490 treatment group and LY294002 treatment group, weakly positive expression of Mcl-1 protein in PD98059 treatment group, and negative expression of Mcl-1 protein in control group. The result of flow cytometry found that the macrophage apoptotic rate in H37Rv infection group was higher than that in con-trol group, while that in PD98059 treatment group was high than that in other groups with statistically significant differences (P<0.05).The result of Mycobacterium tuberculosis colony counting showed that PD98059 treatment had the most signifi-cant inhibitory effect on H37Rv strain.CONCLUSION: Mcl-1 signaling pathway blockers increase the apoptotic rate of macrophages infected with Mycobacterium tuberculosis H37Rv and inhibit the growth of Mycobacterium tuberculosis by inhibi-ting the signaling pathways of JAK/STAT, MAPK and PI3K, among which the MAPK has the most obvious interfering effect on Mcl-1, and leads to the highest apoptotic rate of infected macrophages and the strongest bacteriostasis.

OBJECTIVESince most reports on bystander effect have been only concerned with radiation-induced damage, the present paper aimed at disclosing whether low dose radiation could induce a stimulatory or beneficial bystander effect.

METHODSA co-culture system containing irradiated antigen presenting cells (J774A.1) and unirradiated T lymphocytes (EL-4) was established to observe the effect of J774A.1 cells exposed to both low and high doses of X-rays on the unirradiated EL-4 cells. Incorporation of 3H-TdR was used to assess the proliferation of the EL-4 cells, expression of CD80/86 and CD48 on J774A.1 cells was measured with immunohistochemistry and flow cytometry, respectively. NO release from J774A.1 cells was estimated with nitrate reduction method.

RESULTSLow dose-irradiated J774A.1 cells could stimulate the proliferation of the unirradiated EL-4 cells while the high dose-irradiated J774A.1 cells exerted an inhibitory effect on the proliferation of the unirradiated EL-4 cells. Preliminary mechanistic studies illustrated that the differential changes in CD48 expression and NO production by the irradiated J774A.1 cells after high and low dose radiation might be important factors underlying the differential bystander effect elicited by different doses of radiation.

CONCLUSIONStimulatory bystander effect can be induced in immune cells by low dose radiation.

Animals ; Antigen-Presenting Cells ; immunology ; metabolism ; radiation effects ; Antigens, CD ; immunology ; B7-1 Antigen ; immunology ; B7-2 Antigen ; Bystander Effect ; radiation effects ; Cell Division ; immunology ; Cell Line ; Coculture Techniques ; Dose-Response Relationship, Radiation ; Membrane Glycoproteins ; immunology ; Mice ; Nitric Oxide ; biosynthesis ; T-Lymphocytes ; immunology ; X-Rays