Objective To analyze the risk factors associated with postoperative respiratory failure (PRF) in elderly patients undergoing noncardiac surgery. Methods In a prospective randomized joint study, 582 patients conforming to the criteria established by the four medical centers were enrolled for analysis. Univariate analysis and multivariate logistic regression analysis were used to examine the relations between perioperative risk factors and PRF. PRF was defined as mechanical ventilation after operation lasting for more than 48h or reintubation and mechanical ventilation within 6h after extubation.Results Fifty-one patients developed PRF (8.8%) . Multivariate logistic regression analysis identified that the type of surgery, ASA physical status classification, history of COPD and plasma albumin upper abdominal surgery and peripheral vascular surgery. The reason that neurosurgery topped the list was that most neurosurgical patients suffered from severe head injury and postoperative mechanical ventilation was prolonged because of coma. Our study showed that physical status was also a significant predictor of PRF. According to ASA classification, one class higher increased the risk by 6.325 time s. Conclusion Based on these predictors of PRF, in high risk elderly patients necessary measures can be taken to decrease the development of PRF.

Objective To manage calcaneal fractures with an U-shaped external fixator combined with close manipulative reduction. Methods From February 1997 to November 2002, 31 patients with 34 calcaneal fractures were treated with self-designed U-shaped external fixator combined with close manipulative reduction. All patients were males aging from 7 to 50 years with an average of 32 years. The external fixation device consisted of two partial rings, three modular connecting rods and several pins. According to Essex-Lopresti classification, there were 10 extra-articular fractures without involving the subtalar joint, and 24 intra-articular fractures involving the subtalar joint. Two upper pins were inserted in cross through the distal tibia, and one of two lower pins was inserted laterally through the anterior part of calcaneus, the other was posterior into the calcaneous tuberosity or larger fragment connecting with Achilles tendon. After the manipulative reduction, the frames were applied. Results 31 calcaneal fractures were found with satisfactory reductions after manipulation. The widths of the heels were restored in certain extent; the heights of foot arch and calcaneus were resumed to normal; the B hler angle increased from 15? to 40? (mean, 25?). The duration of hospitalization was on an average of 7 days. The duration of external fixation was averagely 8 weeks. All patients were followed up with a mean period of 8 months (range, 6 to 12 months). All of the fractures healed well. No nonunion, delayed healing of bone or other complications was found. All patients resumed to walk on foot after 2 to 4.5 months. According to Fernandez scoring system, results were graded as excellent and good in 31(91%). Conclusion Using U-shaped external fixator combined with close manipulative reduction is a satisfying technique to treat calcaneal fractures. By ankle joint spanned traction and fixation, this technique overcomes displacement of fragments caused by contracture of tendo calcaneus, maintains width of heel and biodynamic anatomy of foot, avoids complications of wound caused by open reduction and internal fixation.

Objective To determine the changes in interleukin-8 (IL-8) and interleukin-1?(IL-1?) mRNA expressions in alveolar macrophages during isoflurane anesthesia. Methods Twenty-four ASA Ⅰ-Ⅱ male patients undergoing partial hepatectomy were randomly divided into two groups: group Ⅰ isoflurane; group Ⅱ general combined with epidural anesthesia. The age ranged from 43 to 67 years and body weight from 50 to 74kg. The patients were unpremedicated. Anesthesia was maintained with propofol infusion (4-6mg? kg-1?h-1 ) fentanyl and vecuronium in both groups. In addition 1% isoflurane was inhaled in group I and continuous epidural anesthesia with a mixture of 1 % lidocaine + 0.2% poutocaine (5ml/h) was performed in groupⅡ . ECG, SpO2, BP and HR were continuously monitored during anesthesia. Alveolar macrophages were harvested by bronchoalveolar lavage immediately and 4h after induction of anesthesia. RNA was extracted from harvested cells and cDNA was synthesized by reverse transcription. Expressions of IL-8 and IL-1? were measured by semiquantitative polymerase chain reaction using ?-actin as an internal standard. Results Gene expression of IL-8 and IL-1? in alveolar macrophages increased significantly at 4h after induction of anesthesia. The increase was greater in group Ⅰ than in group Ⅱ( P

Objective To explore the necessity of inferior vena cava(IVC) filter implantation during catheter directed thrombolysis (CDT) for acute deep vein thrombosis (DVT). Method Ninety-three patients with acute DVT were reviewed from Nov. 2006 to Dec. 2008. There were 35 men and 58 women, age averaging at (60 ±29) year old, treated with CDT followed by percutaneous transluminal angioplasty ( PTA). The course of DVT was from 5 h ～ 15 d (6. 28 ±7.08) d with 80 left lower limbs and 13 right lower limbs involved. Results There were 30 patients with prior IVC filter implanted compared with 63 patients without filters (67. 7% ,63/93). Among the patients without filter, there were 93. 6% (59/63) left lower limbs. DSA was redone after thrombolysis. Seventy-seven iliacfemoral thrombosis was resolved completely and stenosis or occlusion of the iliac vein were found in 90. 9% (70/77) cases. Endovascular treatment was performed in 57 patients. There was no patients suffering from symptomatic pulmonary embolism (PE). PE was found in 3 cases with a filter and 1 case without filter was suspected of PE on pulmonary CTA after treatment. Conclusion It is not necessary to routinely place an IVC filter during CDT for treating DVT on left lower limb when the thrombosis is not involing the IVC.

Objective To study the chemical constituents from the stems of Dendrobium nobile. Methods Compounds were isolated through various chromatographic techniques and identified by spectral data. Results Twelve phenolic compounds were obtained. Their structures were characterized as dihydroconiferyl dihydro-p-coumarate (Ⅰ), vanillin (Ⅱ), apocynin (Ⅲ), p-hydroxybenzaldehyde (Ⅳ), syringaldehyde (Ⅴ), syringic acid (Ⅵ), syringylethanone (Ⅶ), α-hydroxypropiosyringone (Ⅷ), coniferyl aldehyde (Ⅸ), dihydroconiferyl alcohol (Ⅹ), 2-hydroxyphenylpropanol (Ⅺ), and 3-hydroxy-4-methoxyphenylethanol (Ⅻ), respectively. Conclusion All above compounds are reported from this plant for the first time. Compounds Ⅰ and Ⅲ -Ⅻ are reported for the first time from the plants of Dendrobium Sw.

The modern physicians have different views on acupoint combination and acupuncture-moxibustion prescription and confuse them in clinical practice. It is significant to clarify the conception, connotation and relationship between them so as to normalize the therapeutic program of acupuncture and moxibustion and promote the standardization of acupuncture and moxibustion. Through the collection of relevant literature and analysis on the differences in the understandings among physicians, the conception, connotation and relationship between acupoint combination and acupuncture-moxibustion prescription are summarized. It is viewed that the acupoint combination is based on TCM theory. Under the guide of acupoint selection, in combination of the characters of clinical practice and acupoint indications, two or more than two acupoints of the same function are combined to enhance the collaborative effects of acupoints so as to achieve specific efficacy and improve clinical efficacy. Regarding acupuncture-moxibustion prescription, on the basis of disorder and syndrome differentiation of patients, the concrete therapeutic program is put forward, including acupoint composition and therapeutic method. Acupoint combination is the basic element of acupuncture-moxibustion prescription. Acupuncture-moxibustion prescription is the specific application of acupoint combination.
Acupuncture Points ; Acupuncture Therapy ; Humans ; Moxibustion

Objective To compare the effect of midazolam pretreatment on propofol sedation using closed-loop target-controlled infusion (TCI) between two age groups - the adult and the aged. Methods Forty-eight ASA Ⅰ-Ⅱ patients of both sexes weighing 45-81 kg undergoing elective lower abdominal or lower extremity operation under epidural anesthesia were divided into two age groups : (A) the adult group (18-39 yrs) and (B) the aged group (66-79 yrs). The two groups were further divided randomly into 2 subgroups : midazolam subgroup ( n=12) received midazolam 0.04 mg?kg-1 10 min before propofol TCI and placebo subgroup ( n = 12) received normal saline instead of midazolam 10 min before propofol TCI. The patients were unpremedicated. An intravenous line was established before operation, which was connected to a TCI system comprising a Graseby 3500 infusion pump and a closed-loop TCI automatic control system. BP, HR, SpO2 and BIS were continuously monitored during operation. During epidural anesthesia the patients were sedated with propofol administered by TCI. The initial target blood concentration of propofol was set at 1.5?g?ml-1 . The level of sedation was assessed by OAA/S scale (5 = alert,0 = no response to prodding). The target blood propofol concentration was then increased or decreased in 0.5?g?ml-1 increment to maintain OAA/S score at 3. The BIS value at this level of sedation (OAA/S=3) was used as feedback in controlling TCI of propofol. The induction dose and the total dose of propofol, induction time and emergence time (OAA/S=5) were recorded. Results Midazolam premeditation significantly reduced the induction dose and total dose of propofol, shorten the induction time and prolonged the emergence time compared with placebo in both groups, especially in the aged group (P

Objective:To investigate the structural alterations of mitochondria and its role in neutrophil death induced by ONO-AE-248.Methods:Human neutrophils were cultured in vitro with ONO-AE-248(5?10-5 mol/L)and medium alone. Transmission electron microscopy(TEM) was used to detect the structural alterations of mitochondria and the level of mitochondria membrane potential by flow cytometry using mitocapture dying.Results:ONO-AE-248 resulted in extremely swollen mitochondria within 6 hours. Meanwhile, a rapid loss of mitochondrial membrane potential of neutrophils occurred, especially in 3 hours and 6 hours. There were obviously differences between spontaneous apoptosis and non-apoptosis programmed cell death induced by ONO-AE-248.Conclusion:The experiment results suggest that changes of mitochondrial structure and function be typically morphological, physiological and biochemical features in this unique form of neutrophil death, and that the mitochondrial pathway might play a more important role in ONO-AE-248-induced death of neutrophils.

Bipolar disorder(BD)is a serious mood disorder with high prevalence,morbidity and mortality rates. Glycogen synthase kinase-3β(GSK-3β) is a multifunctional serine/threonine protein kinase that is generally located in eukaryotic cells with such functions as the adjustment of the synthe?sis of glycogen metabolism,cell proliferation and differentiation and gene expression. It is involved in multiple signaling pathways and regulates cell signaling proteins,structural proteins and transcription factors through phosphorylation,affecting the survival of the neurons and plasticity. According to gene poly?morphism and clinical studies,GSK-3β may be associated with BD. As a GSK-3β inhibitor,lithium is an effective BD therapeutic drug,and the small molecule inhibitor targeting GSK-3βis also a hotspot of BD treatment. GSK-3βmay be a potential target in the treatment of BD.

Objective To explore the effects of PP242 on the expression of apoptosis protein Bcl?2 in human lens epithelial cells(HLECs). Meth?ods Immortal HLECs SRA01/04 were cultured and treated with different concentrations of PP242. The cell growth was examined by MTT assay at 24 h and 48 h after PP242 treatment. Real?time quantitative polymerase chain reaction(RT?PCR)and Western blot were adopted to detect the mRNA and protein expression of Bcl?2 respectively. Results The cultured HLECs SRA01/04 were collected and treated with different concentra?tions(100,250,500,750,1 000,1 500 nmol/L)of PP242. After treatment for 24 h and 48 h,the inhibitory rate in each well was determined by MTT assay. The inhibition rate was as below,24 h:7.55%,9.43%,16.98%,22.64%,26.42%,30.19%;48 h:11.11%,23.81%,36.51%,42.86%, 49.21%,63.49%. Compared with the control group,the difference was statistically significant(P<0.05). Compared with the control group(0 nmol/L),the expression of Bcl?2 protein was significantly decreased with the increasing concentrations of PP242(P<0.05),while the expression of Bcl?2 mRNA was inhibited by PP242 based on the results of RT?PCR. Compared with the control group(0 nmol/L),the RT?PCR results of Bcl?2 mRNA were 0.723±0.039,0.517±0.028,0.353±0.052,0.167±0.046,respectively(P<0.05). Conclusion PP242 could inhibit cell proliferation of HLECs in vitro with a concentration and time depended manner. Bcl?2 protein is expressed in HLECs,which could be down regulated by PP242 treatment.