Angiotensin II ; metabolism ; Animals ; Male ; Muscle, Skeletal ; Muscular Atrophy ; etiology ; metabolism ; pathology ; Rats ; Rats, Sprague-Dawley

It has long been concerned about the mechanism , pathology and toxicology of anaesthetic involving drug addiction and its influence on human body .In recent years , as a short non-coding RNA negatively regulating the genes in cells , MicroRNAs (miRNAs) may turn out to be a focus issue which is related to apoptosis , metabolism, inflammation, and tumorigenesis.This article illuminates the influence on gene expression introduced by common anaesthetics and the interaction between gene and its target site . Analyzing the potential medical applications of miRNA , this article reviews the correlation between miRNAs and anaesthetic to provide new evidences in this emerging field .

18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) and bone marrow biopsy (BMB) have high consistency in the detection of lymphoma bone marrow infiltration (BMI).18F-FDG PET/CT has a high sensitivity to Hodgkin lymphoma (HL) and aggressive non-Hodgkin lymphoma (NHL) BMI,while the sensitivity of indolent NHL is low.Since 18F-FDG PET/CT may appears false positive or false negative,so it can not replace the conventional BMB.We can carry out a BMB under the guidance of 18F-FDG PET/CT,which can greatly improve the detection rate of BMI.

Infection can complicate different stages of acute pancreatitis.The probability of infection is related to the existence and extent ofpancreatic necrosis: up to 30% of patients with pancreatic necrosis develop infection.The timing of infection is variable and usually peaks in the second to fourth week after the onset of pancreatitis.IPN(infected pancreatic necrosis)is the most common type of secondary pancreatic infection.Infectious complications in severe acute pancreatitis are associated with considerable morbidity and mortality.Antimicrobial therapy is one of the fundamental elements of therapy.Diagnosis of secondary pancreatic infection is challenging and radiologic characteristic (air bubble sign) and CT guided fine-needle aspiration (FNA) are reliable diagnostic strategies.Antibioticuse should be rational in terms of a rational indication, a rational spectrum, and a rationalduration.Prophylactic antibiotics are not beneficial in improving prognosis.The only rational indication for antibiotics is documented infection.The empirical antibiotics should cover common microbials of hospital-acquired intra-abdominal infection and with good pancreatic penetration.Also, fungal infections are often present in thesepatients, and early diagnosis and antifungal coverage should be considered.Duration is in fact largely determined by the presence and efficacy of source control.When there is no or minimal residual infection left after a source control procedure, a duration of 7 to 10 days is probably sufficient.On the other hand, if the source of infection has not been removed completely, prolonged courses until the residual necrosis has been sterilized are necessary.

Objective To analyse the maternal and perinatal morbidity after 40 weeks and postdate pregnancy,and to research suitable time of labor induction. Methods Clinical data of 357 pregnant women after 40 weeks with normal menstrual period were analysed.They were divided into four groups according to the different weeks of gestation. Results There were no significant difference in the four groups for maternal and perinatal morbidity,the rate of spontaneons labor,the degree of cervical repine and the successful rate of labor induction.The successful rate of artificial rupture of membranes was higher in the groups with Bishop score ≥6(P

ADAM Proteins ; blood ; ADAMTS13 Protein ; Adult ; Case-Control Studies ; Female ; Fluorescence Resonance Energy Transfer ; Humans ; Male ; Middle Aged ; Purpura, Thrombotic Thrombocytopenic ; blood ; diagnosis ; Young Adult

ObjectiveTo evaluate the effectiveness of setting PEEP and tidal volume (VT ) according to pressure-volume (P-V) curve during one lung ventilation (OLV) in patients undergoing thoracic surgery.Methods Twenty-five ASA Ⅰ or Ⅱ patients of both sexes aged 44-64 yr weighing 57-75 kg undergoing lobectomy under general anesthesia were enrolled in this study.Double-lumen tube was inserted.Correct positioning was verified by flberoptic bronchoscopy.The patients were mechanically ventilated.P-V curve was measured by SSS system during OLV.Lower inflection point (LIP)and upper inflection point (UIP) were determined.The pressure at LIP (PLIP) and volume at UIP (VUIP) were measured.Bilateral lungs were ventilated for 30 min (T0) at first before OLV was started.PEEP was set at PLIP + 0.196 kPa and VT was set at VUIP,and the patients were ventilated for 30 min (T1).VT was then reduced to 80％ of VUIP.OLV was performed for another 30 min (T2).VT was then further reduced to 60％ of VUIP and the patients were ventilated for 30 min (T3).PEr CO2 was maintained at 4.67-6.00 kPa.Arterial blood and central venous samples were taken at T0-3.Blood gas analysis was performed.Qs/Qt was calculated.MAP,HR,CVP,peak airway pressure (Peak),airway resistance (Rsw) and lung compliance (CL) were measured and recorded at T0-3.ResultsHR,Ppeakk,Rsw and Qs/Qt were significantly increased while CL and PaO2 decreased at T1-3,CVP was significantly increased at T1.2 and MAP and PaCO2 were increased at T3 as compared with the baseline values at T0.Ppeak and Rsw were significantly decreased at T2.3 and PaO2 was significantly increased while Qs/Qt decreased at T2,CVP was decreased,MAP and PaO2 were increased at T3 as compared with the values at T1.ConclusionsMechanical ventilation with VT set at 80％ of VUIPandPEEPatPUIP+0.196kPa provides best ventilatory efficacy for OLV in terms of PaO2 and hemodynamics.

Objective To investigate the effect of penehyclidine (PHCD) on Toll-like receptor 4 (TLR4)mRNA and Toll-like receptor 2 (TLR2) mRNA expression in the lung tissue in rats with acute lung injury induced by lipopolysaccharide (LPS) .Methods Sixty healthy SD rats of both sexes weighing 200-220 g were randomly divided into 5 groups ( n = 12 each) :control group (group C) , LPS group and P1-3 groups. Acute lung injury was induced by intraperitoneal (IP) LPS 8 mg/kg in LPS and P1-3 groups. PHCD 0.3, 1.0 and 3.0 mg/kg were given IP after LPS administration in P1-3 groups. The animals were anesthetized at 6 h after IP LPS. Blood samples were collected for determination of serum TNF-α and IL-6 concentrations ( by ELISA) and then sacrificed, the lungs were immediately removed for determination of TLR4 mRNA and TLR2 mRNA expression (by RT-PCR), and microscopic examination. Results LPS significantly increased TLR4 mRNA and TLR2 mRNA expression in the lung tissue and serum TNF-α and IL-6 concentrations. PHCD 1.0 or 3.0 mg/kg significantly inhibited LPS-induced increase in TLR4 mRNA and TLR2 mRNA expression in the lung tissue and serum TNF-α and ILr6 concentrations.The lung histopathologic damage was significantly ameliorated in P2 and P3 groups as compared with group LPS.Conclusion PHCD can protect the lungs against LPS-induced acute lung injury through inhibiting TLR4 mRNA and TLR2 mRNA expression in the lung tissue and reducing the inflammatory response.

Objective To investigate the effect of intravenous injection of parecoxib before operation on the efficacy of postoperative analgesia in patients undergoiag thoracic surgery.Methods Ninety ASA Ⅰ -Ⅲ patients,aged 38-76 yr,weighing 44-82 kg,scheduled for thoracic surgery under general anesthesia combined with thoracic epidural block,were randomly divided into 3 groups(n = 30 each): group A,B and C.Epidttral anesthesia was performed at the T6-7 interspace before general anesthesia. Anesthesia was induced with sufentanyl 0.4 μg/kg,vecuronium 0.12 mg/kg and propofol 1.5-2.0 mg/kg.Double-lumen bronchial tube was inserted and the patients were mechanically ventilated.Group A received iv injection of normal saline 2 ml 30 min before skin incision.Group B received iv parecoxib sodium 40 mg after extubation.Group C received iv parecoxib sodium 40 mg 30 min before skin incision.Anesthesia was maintained with propofol,vecuronium,sufentanyl and lidocaine.The patients received patient-controlled epidural analgesia(PCEA)with ropivacaine and 0.5 μg/ml sufentanil after surgery.The VAS score was maintained≤ 3.The comfort level was evaluated with Bruggrmann comfort scale(BCS)at 4,12,24 and 48 h after operation.The consumption of sufentanil during operation and within 48 h after operation was recorded.The adverse reactions were also recorded.Results Compared with group A,the consumption of sufentanil was significantly decreased in group B and C,the BCS score was significantly increased at 4 h after operation in group B,and the BCS score was significantly increased at each time point and the consumption of sufentanil during operation was significantly decreased in group C(P ＜ 0.05).The BCS score was significantly higher,and the consumption of sufentanil during operation and within 48 h after operation was significantly lower in group C than in group B(P ＜ 0.05).There was no significance difference in the adverse reactions among the 3 groups(P ＞ 0.05).Conclusion Intravenous injection of parecoxib 40 mg before operation reduces the perioperative sufentanil consumption in patients undergoing thoracic surgery.

Objective To assess and compare the roles of plasma concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis and treatment of septic acute kidney injury (AKI) in adult Surgical critically ill patient . Methods One hundred patients were divided into two groups ,the group of 63 cases of AKI and AKI group of 37 cases ,plasma NGAL and Cystatin C level of the 2 groups were determined by the method of enzyme‐linked immunosorbent (ELISA) ,latex en‐hanced immune turbidimetry (PETIA) respectively on arrival in the surgical intensive care unit(SICU) (T0 ) and 24 h after arrival in SICU(T1 ) .Results Compared with patients in non AKI group ,both plasma NGAL and Cystatin C level of patients in AKI group on T0 and T1 increased significantly ,the difference between the two groups had significant statistical difference (P<0 .01);Although ,plasma NGAL on T1 performed less well (AUC=0 .69) ,with a threshold value of 92 ng/mL(70 .3% sensitivity ,57%specificity) .Plasma NGAL showed significant discrimination for AKI diagnosis (AUC=0 .85) with a threshold value of 65 .95 ng/mL(81 .8% sensitivity ,76 .2% specificity) on T0 .Both plasma Cystatin C on T0 and T1 worked well for the diagnosis of AKI (AUC=0 .90 ,0 .88 ,thresholds 1 .49 and 1 .47 mg/L ,respectively) ,with diagnostic sensitivity of 89 .2% ,82 .5% respectively ,speci‐ficity of 83 .8% ,76 .2% respectively .Conclusion Plasma NGAL and Cystatin C are useful markers in predicting AKI in surgical critically ill patients ,the early diagnosis value of plasma Cystatin C for AKI is better than plasma NGAL on arrival in the surgical intensive care unit .