Objective To evaluate the therapeutic effect of catheter-directed thrombolysis (CDT) for the treatment of acute deep venous thrombosis (DVT) of the lower extremity.Methods Clinical data of 195 patients of acute DVT treated by CDT and adjunctive angioplasty and stenting from August 2010 to February 2014 were analyzed retrospectively.CDT by antegrade puncture of popliteal vein,CDT by great saphenous vein and CDT by retrograde puncture of contralateral femoral vein were used in these cases.Venous recanalization was graded by a thrombus score based on pre-and post-treatment venography.Results Technique success rate,clinical success rate,in popliteal vein group,great saphenous vein group and contralateral femoral vein group were 94.6％,72.2％ and 90.3％,97.3％,83.3％,and 90.0％.Patent rate of deep venous,patent rate of stenting and mild post-thrombotic syndrome (PTS) rate were 88.6％,66.7％ and 75.0％,83.3％,57.1％ and 88.9％,8.3％,26.7％ and 20.8％.Conclusion CDT by antegrade puncture of popliteal vein group combined with adjunctive angioplasty and stenting is safe and effective with higher clinical success rate and better long term results than other approaches for the treatment of DVT patients.

Objective To study the differentiation types of microglia induced by macrophage colony-stimulating factor (M-CSF).Methods Rat microglia cultured in vitro were inoculated on 6-well plates and divided into 3 groups (n=4 each) using a random number table method when cell confluence reached 70％:blank control group (C group),vehicle control group (P group) and M-CSF group.Group P was incubated with phosphate buffer solution for 7 days and group M-CSF with 20 ng/ml M-CSF for 7 days.The expression of a specific M1 phenotype marker tumor necrosis factor-alpha (TNF-α) and specific M2 phenotype markers interleukin-10 (IL-10) and brain-derived neurotrophic factor (BDNF) was determined by Western blot.Results Compared with C group,the expression of IL-10 and BDNF was significantly upregulated (P＜0.05),and no significant change was found in TNF-α expression in M group (P＞0.05),and no significant change was found in the expression of TNF-α,IL-10 or BDNF in P group (P＞0.05).Conclusion M-CSF can induce microglia to differentiate into a M2 phenotype.

There are many problems existing in the basic teaching of traditional surgery, such as much more content, difficult operation, fewer learning hours, more passive acceptance while less active learning and so on. Flipped class based on the WeChat and team-based learning (TBL) is based on the on-line and off-line class. We can use WeChat group and subscription to issue relevant learning materials, learning tasks and test before class. Also, we can summarize and explain incisively by discussion after field operation in class, and answer and test in the way of WeChat discussion after class. Finally, the three-dimensional hybrid teaching will be condensed and sublimated by brand competition based on the basis of surgery, achieving knowledge transfer before class, knowledge internalization in class, knowledge consolida-tion after class and brand competition sublimation, in order to improve the teaching effect of surgical basis.

Objective: To evaluate the effect of ATP-binding cassette B subfamily member 1 transporter (ABCB1) C3435T genetic polymorphism on the efficacy of postoperative analgesia. Methods: One hundred American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 18-60 yr, scheduled for elective thoracoscopic lobectomy under general anesthesia, were enrolled in this study.The gene mutation of ABCB1 C3435T was detected, and the patients were divided into 3 groups according to the genotypes: wild homozygote group (CC group), mutation heterozygote (CT group) and mutation homozygote group (TT group). Patient-controlled intravenous analgesia was performed with sufentanil after operation.Visual analogue scale (VAS) scores at 24 and 48 h after operation, postoperative consumption of sufentanil, sleep quality score at 24 h after operation and state-trait anxiety score were recorded. Results: Compared with CC group, VAS scores at 24 h after operation and postoperative consumption of sufentanil were significantly decreased in TT and CT groups, and the state-trait anxiety score was significantly decreased in TT group and increased in CT group (P<0.05). Compared with TT group, VAS scores at 24 h after operation, postoperative consumption of sufentanil and the state-trait anxiety score were significantly increased in CT group (P<0.05). There was no significant difference in sleep quality scores among the three groups (P>0.05). Conclusion ABCB1 C3435T genetic polymorphism may be one of the mechanisms of the individual variation in the efficacy of postoperative analgesia.

Dopaminergic neurons in the ventral tegmental area (VTA) play an important role in cognition, emergence from anesthesia, reward, and aversion, and their projection to the cortex is a crucial part of the "bottom-up" ascending activating system. The prelimbic cortex (PrL) is one of the important projection regions of the VTA. However, the roles of dopaminergic neurons in the VTA and the VTA^DA-PrL pathway under sevoflurane anesthesia in rats remain unclear. In this study, we found that intraperitoneal injection and local microinjection of a dopamine D1 receptor agonist (Chloro-APB) into the PrL had an emergence-promoting effect on sevoflurane anesthesia in rats, while injection of a dopamine D1 receptor antagonist (SCH23390) deepened anesthesia. The results of chemogenetics combined with microinjection and optogenetics showed that activating the VTA^DA-PrL pathway prolonged the induction time and shortened the emergence time of anesthesia. These results demonstrate that the dopaminergic system in the VTA has an emergence-promoting effect and that the bottom-up VTA^DA-PrL pathway facilitates emergence from sevoflurane anesthesia.
Anesthesia ; Animals ; Dopaminergic Neurons/metabolism* ; Rats ; Receptors, Dopamine D1/metabolism* ; Sevoflurane/pharmacology* ; Ventral Tegmental Area/metabolism*