Objective To investigate the effect of remifentanil on protein kinase C (PKC) activity during renal ischemia-reperfusion (I/R) in rats.Methods Seventy-five male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 5 groups (n=15 each) using a random number table:sham operation group (group S),I/R group,remifentanil group (group R),naloxone group (group N),and naloxone + remifentanil group (group NR).Renal ischemia was induced by clamping the bilateral renal arteries for 45 min using an atraumatic clamp followed by reperfusion.In R and NR groups,remifentanil 1.0 μg · kg-1 · min-1was infused via the caudal vein starting from 15 min before ischemia until 30 min of reperfusion.In N and NR groups,naloxone 0.3 mg/kg was injected via the caudal vein at 20 min before ischemia and 35 min of ischemia,respectively.The rats were sacrificed at 24 h of reperfusion and the kidneys were removed for determination of the ultrastructure of the renal tubular epithelial cells (using transmission electron microscope),activity of PKC in renal tissues (by ELISA),and expression of the PKC in renal tissues (by immuno-histochemistry).Results Compared with group S,the activity of PKC in renal tissues was significantly increased in the other four groups,and the expression of the PKC in renal tissues was up-regulated in group R.Compared with group I/R,the activity of PKC in renal tissues was significantlyincreased,the expression of PKC in renal tissues was up-regulated,and the pathological changes were attenuated in group R.Compared with group R,the activity of PKC in renal tissues was significantly decreased,the expression of PKC in renal tissues was down-regulated,and the pathological changes were aggravated in N and NR groups.Conclusion The mechanism by which remifentanil attenuates renal I/R injury may be related to up-regulation of PKC expression and increase in PKC activity through activating opioid receptors in rats.

Objective To investigate the effects of angiotensin Ⅱ (Ang Ⅱ) or high glucose on the toll-like receptor 4 (TLR4) expression,inflammatory cytokines and fibrotic factors in human tubular epithelial cells (HK-2),revealing the innate immune-related pathogenesis of diabetic nephropathy (DN) which may have clinical implications.Methods Three TLR4 siRNA sequences were designed and synthetized.After transfection,the most effective siRNA was selected to use for further expriments.The experiment consisted of 2 parts.Part 1:Cells were divided into three groups:normal-glucose group (NG,5.5mmol/L glucose),mannose group (M,5.5 mmol/L glucose + 19.5 mmol/L mannose),High-glucose group (HG,25 mmol/L glucose),preliminary validated the effects of high glucose and high osmotic pressure.Part 2:Cells were divided into seven groups:NG group,HG group,Ang Ⅱ group,Ang Ⅱ + negative group,HG+ negative group,Ang Ⅱ + siRNA group and HG+ siRNA group.Real time PCR was used to analyze the mRNA expression of TLR4,myeloid differentiation factor 88 (MyD88),heat shock protein 47 (HSP47).Western blotting was used to observe the protein expression of TLR4,MyD88,HSP47,NF-κB,type Ⅳ collagen (ColⅣ).ELISA was used to detect the expression of monocyte chemotactic protein-1 (MCP-1) and interleukin-6 (IL-6).Results Compared with NG group,TLR4,MyD88,HSP47 mRNA and TLR4,MyD88,NF-κB,ColⅣ,HSP47 protein were highly expressed under high glucose or Ang Ⅱconditions (P ＜ 0.01),and the expression levels of MCP-1 and IL-6 also increased significantly (P ＜ 0.01).Compared with HG or Ang Ⅱ group,the above indicators were obviously inhibited in the TLR4 siRNA groups (P＜0.01).Comparison between blank vector transfected groups and HG group as well as Ang Ⅱ group indicated no statistic significance (P ＞ 0.05).Conclusions Both Ang Ⅱ and high glucose stimulate TLR4 expression,which result in the up-regulation of inflammatory and fibrotic factors in HK-2.Specific target of TLR4 gene silencing can block the TLR4 pathway that is activated by high glucose and Ang Ⅱ,and thus reduce the inflammatory and fibtogenic factors' release.TLR4 signal is the common innate immune response pathway which induces the release of inflammatory and fibrotic factors in HK-2 under high glucose or high angiotension conditions.

OBJECTIVE:To investigate the effect of different doses ambroxol hydrochloride on lung protection of patients in perioperative thoracotomy. METHODS:60 patients in perioperative thoracotomy were randomly divided into control group(30 cas-es)and observation group(30 cases). Control group received 30 mg Ambroxol hydrochloride injection from 1 week before surgery to 1 week after surgery,adding into 100 ml 0.9% Sodium chloride injection,intravenously,twice a day. Observation group re-ceived 300 mg Ambroxol hydrochloride injection from preoperative 1 week to postoperative 1 week,adding into 100 ml 0.9%Sodi-um chloride injection,intravenously,twice a day. All patients received the second-generation cephalosporin antimicrobial drugs for anti-infection after surgery. lung surfactant-associated protein A(SP-A),intercellular adhesion molecule(ICAM-1)levels preopera-tive 1 week and postoperative 1 week,and incidence of postoperative complications in 2 groups were observed. RESULTS:Preop-erative 1 week,there were no significant differences in the SP-A and ICAM-1 in 2 groups(P>0.05). Postoperative 1 week,SP-A and ICAM-1 in control group and ICAM-1 in observation group were significantly higher than preoperative 1 week,but SP-A and ICAM-1 in observation group were lower than control group,the differences were statistically significant(P<0.05),there were no significant differences in SP-A in preoperative 1 week and postoperative 1 week(P>0.05). The incidence of postoperative compli-cations in observation group was significantly lower than control group,the difference was statistically significant(P<0.05). CON-CLUSIONS:The effect of high-doses ambroxol hydrochloride on lung protection of patients in perioperative thoracotomy is signifi-cantly superior to small dose,which can reduce the incidence of lung complications.

Endodermal Sinus Tumor ; pathology ; Female ; Humans ; Infant ; Vaginal Neoplasms ; pathology

Objective To compare the effect of anesthesia management between enhanced recovery after surgery (ERAS) protocol and traditional protocol on stress level of thyroid surgery.Methods Sixty-two patients receiving thyroid surgery from May 2016 to August 2016, 13 males and 49 females, aged 18-65 years, of ASA physical status Ⅰ or Ⅱ, were randomly divided into group ERAS (n=29) and traditional group (group C, n=33).Each group had its own anesthesia management protocol.Operation method, operation duration, the level of pain during emergence and on the first postoperative day, the occurrence rate of complications and the satisfaction evaluation of pain and nausea and vomiting after the operation day were recorded.C-reactive protein (CRP), serum cortisol, interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor (TNF-α) before and after the operation day were evaluated.Results The visual analogue scale (VAS) pain score in group ERAS was lower than that in group C during emergence [(0.42±0.83) points vs (0.95±1.16) points]and on the first postoperative day [(1.90±1.21) points vs (2.73±1.40) points] (P<0.05).Group ERAS was more satisfied with pain relief at first day after the surgery than that of group C (P<0.05).The level of CRP in group ERAS was lower than that in group C on the operative day and the first postoperative day (P<0.05).In group C, the level of CRP on the operative day and the first postoperative day were much higher than those before the surgery (P<0.05).The occurrence rate of complications between the two groups had no statistical difference.Conclusion The perioperative ERAS anesthesia management of thyroid surgery is safe and effective in pain management, patient satisfaction and accelerated recovery.

Objective To investigate the correlation between the transport time of preterm infants with respira-tory failure and the clinical outcome. And to determine the transit time in critically ill premature infants. Methods Premature infants in level Ⅱ neonatal ward in Hunan Province Children's Hospital from January 1 to December 31, 2013,admitted to the Neonatal Intensive Care Unit requiring respiratory support(invasive and noninvasive),were re-viewed. All the patients were classified into non - standardized transport group and regulate transport group according to respiratory support that infants in the level Ⅱ neonatal ward required. Data on general information,the time of ventilator application,the time of exposure to oxygen,morbidity of bronchopulmonary dysplasia(BPD),the cure and improvement rate,length of stay,the total length of stay(length of stay in the local hospital and our hospital),and hospitalization ex-penses were collected. Results Among the 363 infants,there were 107 cases in the non - standardized transport group, and 256 cases in the regulate transport group. The time of ventilator application in the non - standardized transport group was longer than that in regulate transport group[(19. 75 ± 19. 53)d vs(13. 02 ± 12. 64)d,t = 18. 706,P ﹤ 0. 05],the time of exposure to oxygen was longer[(30. 60 ±24. 80)d vs(19. 50 ±19. 24)d,t =6. 883,P ﹤0. 05],the morbidity of BPD was higher[57. 01%(61/ 107 cases)vs 18. 36%(47/ 256 cases),χ2 = 53. 934,P ﹤ 0. 05],but the cure and im-provement rate was lower[70. 10%(75/ 107 cases)vs 83. 20%(213/ 256 cases),χ2 = 7. 912,P ﹤ 0. 05],and the total length of stay was longer[(59. 50 ± 34. 02)d vs(34. 48 ± 23. 69)d,t = 22. 967,P ﹤ 0. 05]than that in the regulate group. But there was no significant difference between the length of stay[(43. 99 ±28. 08)d vs(32. 79 ± 23. 76)d,t =2. 012,P ﹥0. 05]in the non - standardized transport group and regulate transport group,with the hospitalization expenses [(6. 55 ±4. 30)vs(4. 99 ±4. 12)thousands yuan,t =0. 552,P ﹥0. 05]. Conclusions The non - standardized transport group has higher morbidity of BPD,but lower cure or improvement rate,and it has longer length of stay. The 2013 edition of Chinese Neonatal Ward Hierarchical Construction and Management Guide(Proposal)is reasonable,level Ⅱ neonatal ward should be in strict accordance with it to transport regional neonatal.

Objective To study the effectiveness of family-integrated-care (FICare) for preterm infants with moderate to severe bronchopuhnonary dysplasia (BPD) in neonatal intensive care unit (NICU).Method Preterm infants with moderate to severe BPD in Hunan Children's Hospital from January 2015 to March 2016 were selected as the objects.These infants were assigned into two groups (FICare group and control group) in the base of whether the parents agreed to implement FICare.If the infant was enrolled into FICare group,the parents need to spend 3 hours in ward every day,and participate in nursing services under the guidance of nurses.The nursing services included bathing,cuddling,skin care,breast-feeding,and so on.If the infant was enrolled into control group,these nursing services were implemented by nurses.Oxygen exposure time,breast-feeding rate,time of begin oral feeding,time of total oral feeding,weight growth rate during hospitalization,weight of discharge,length of stay,readmission rate within 30 days,the rate of parents that mastered basic care knowledge and skills when discharge from hospital,the rate of satisfaction,and the rate of follow-up within 30 days of the two groups were compared.Result There were 106 cases in our study,54 in the FICare group and 52 in the control group.Compare the FICare group and the control group,there were statistical differences between two groups in the follow aspects (all P ＜ 0.05):oxygen exposure time [(57.1 ±20.9) d vs.(71.4 ±32.6) d],breast-feeding rate (77.8％ vs.44.2％),time of total oral feeding [(46.1 4 19.6) d vs.(59.4 ± 30.2) d,length of stay [(65.8 ± 18.4) d vs.(84.3 ±35.0) d],the rate of parents that mastered basic care knowledge and skills when discharge from hospital (96.3％ vs.82.7％),the rate of satisfaction (94.4％ vs.84.6％),the rate of follow-up within 30 days (92.6％ vs.73.1％).Conclusion FICare could significantly reduce oxygen exposure time of preterm infants with moderate to severe BPD,could improve the level of parents mastered basic care knowledge and skills of preterm infants,especially in critically ill preterm children,and could shorten length of stay of them.FICare is beneficial to the healthy growth of premature infants with BPD.

Objective To prepare a novel brain active-targeting endomorphin (EM) loaded hyperbranched polyglycerols-poly (lactic-co-glycolic acid) (HBPG-PLGA) nanoparticles (NPs) and study its mechanism of passing across blood brain barrier (BBB) in brain microvascular endothelial cells (BMEC).Methods The OX26 (transferring receptor monoclonal antibody) conjugated EM loaded HBPG-PLGA NPs was constructed according to water-in-oil-in-water emulation solvent evaporation technique as a novel biodegradable brain active-targeting drug delivery system.The properties of the NPs were evaluated by transmission electron microscope (TEM) in vitro.Through flow cytometry and laser scanning confocal microscope,the mechanism of passing across BBB was evaluated.Results The preparation methodology of NPs was optimized and established.The mean diameter was (170±20) nm and Zeta potential was about-27 mV.Core-shell construction was showed on TEM.Cellular uptake study showed that the uptake of NPs was via a caveolae-mediated endocytic pathway,then endomorphin and carrier were divided into two parts in BMEC.Conclusions The OX26 conjugated EM loaded NPs were stable,and demonstrate remarkable effects on crossing BBB.Cellular uptake by BMEC is a very important mechanism of the NPs' brain activating-targeting effect.

Objective To enhance awareness of the dangerous of multiple magnets ingestion in children and to explore the optimal treatment of it.Methods The clinical data of 3 cases with multiple magnet ingestion were retrospectively studied based on literature review.Results Ingestion of multiple magnets (range:2-5 magnets) magnets occurred in 3 cases.Age ranged from 1 to 8 years old.Magnet sources included:2 from children's family,1 from their kindergarten.All patients had several bowel perforations(range:2-4).One case was completed by laparoscopic,1 case was converted to open suegery after laparoscopy,1 case was done by open surgery.All cases got complete recovery after surgical treatment,and no complications occurred by follow-up.Conclusions Ingestion of multiple magnets may show minimal initial physical manifestations at beginning but may result in significant complications later.Two or more magnets separated from each other along the gastrointestinal tract can attract each other across bowel walls,with may result in pressure necrosis,bowel perforation,and fistulas formation and even death.Early surgical consultation with an aggressive surgical approach is recommended.Family and society should be aware of the dangers of magnet ingestion.

Aim To investigate the effect of indirubin derivative PHⅡ-7 and TRAIL on proliferation in breast cancer cell MCF-7 and its MDR counterpart MCF-7/ADR and the mechanism.Methods Growth inhibition rate was examined respectively by MTT assay under treatment with TRAIL or PHⅡ-7 or in combination. Cell apoptosis and ROS production were examined by flow cytometry.The change of TRAIL receptors(DR4/DR5 )in mRNA was analysed by realtime PCR.Re-sults IC50 of PHⅡ-7 on MCF-7 and MCF-7/ADR was (4.49 ±1.55 ),(3.44 ±0.90 )μmol · L-1 respec-tively;MDA-MB-231 was TRAIL sensitive cell line, and apparently TRAIL induced apoptosis in MDA-MB-23 1 .Low concentration of PHⅡ-7 in combination with TRAIL could augment TRAIL-induced cytotoxic effect including apoptosis while TRAIL or PHⅡ-7 treatment alone had limited cytotoxity to those cells.Besides, PHⅡ-7 at this concentration had little toxicity to hu-man peripheral blood mononuclear cells even if in com-bination with TRAIL.PHⅡ-7 generated ROS produc-tion inside MCF-7 and MCF-7/ADR cells and up-regu-lated DR4/DR5 expression concentration dependently. Once upon ROS scavenger NAC involved,the effect of TRAIL receptors up-regualtion by expression was abro-gated.Conclusions PHⅡ-7 at low concentration could improve the sensitivities of breast cancer cell MCF-7 and MCF-7/ADR to TRAIL,the mechanism of which may be the ability of ROS production by PHⅡ-7 help up-regulated TRAIL receptor DR4,DR5 .Our re-search set a solid foundation for PHⅡ-7 in combination with TRAIL in future clinical application.