OBJECTIVETo analyse the preoperative conditions and intraoperative anesthetic managements of parturients who underwent Caesarean section and explore possible relationship between perianesthetic managements and prognosis of parturients and fetuses.

METHODSA group of 30 parturients who underwent Caesarean sections under general anesthesia were analysed retrospectively.

RESULTSAll the 30 Caesarean sections were smooth in terms of both procedure and anesthesia.

CONCLUSIONSGeneral anesthesia is still indicated in Caesarean section, although multiple risks may still exist. Considerate perinatal planning, careful preoperative preparations, and delicate intraoperative managements positively contribute to the good prognosis of parturient and fetus.

Adult ; Anesthesia, General ; Anesthesia, Obstetrical ; Apgar Score ; Cesarean Section ; Female ; Humans ; Pregnancy ; Retrospective Studies

Objective To summarize our experience in prevention and treatment of stricture after esopageal burns in the past thirty years.Methods There were 168 cases in this series.Of them,158 cases underwent surgical management in this study.Modified intraluminal stenting was used in 34 cases, colon interposition without resection of strictured esophagus in 77 cases,gastric transposion with resection of the stricture in 27,repair of cervical stricture with platysma myocutaneous flap in 22,and miscellane- ous operation in 12.Eleven cases experienced operation twice or more at our department.Results Twenty-nine cases recovered after treatment with intraluminal stenting,and 5 re-experienced stricture after stent removal.One of the 5 cases with failed stent responded to bougienage,and the remaining 4 cases re- quired esophageal reconstruction later.Of the 77 colon interpositions,5 cases died postoperatively,and complications of cervical anastomotic fistula occurred in 14 cases,anastomotic stenosis in 4,and abdomi- nal incision dehiscence in 2 cases.In the 27 cases with gastric transpositions,postoperative complications of anastomotic stricture occurred in 2 cases and empyema in 1 patient.There was a cervical leak in 3 ca- ses of the 22 cases treated with the repair of cervical esopageal or anastomotic stricture with a platysma myocutaneous flap.In the 12 cases treated with miscellaneous operation,one died of intestinal obstruc- tion.All the survivors had regular diet after discharge.Conclusions Intraluminal stenting can prevent the formation of caustic esophageal stricture.The location of the cicatricial esophagus dictates whether to perform concomitant esophagectomy during esophageal reconstruction.Platysma myocutaneous flap repair is an excellent method for the treatment of severe cervical esophageal or anastomotic stricture.

Objective　To explore the effect of video-assi sted thoracic surgery (VATS) on common diseases of chest. Methods　Video-assisted thoracoscopic surgery was performed on 131 patients with ches t diseases from April 1994 to December 2000 in which 109 cases were spontane ous pneumothorax and hemothorax, 10 pulmonary tuberculoma, 5 pulmonary carcinoma , 3 esophageal carcinoma, 2 localized benign mesothelioma, 1 pulmonary hamartoma and 1 myasthenia gravis. Results　There was no operative death in all cases. Four patients with spontaneous pneumothorax complicated persist ent air leak(more than 7 d) and 1 patient with hemopneumothorax formed hemoth orax after the operation, which was stopped by the second VATS. The others recov ered well without any postoperative complications. Conclusion　 VATS is characterized by safety and mild tissue injury in the operation, and les s pain, fewer complications, rapid recovery and short duration of hospitalizatio n after the operation.

In this study, a 15-mer phage display peptide library was employed to pan against human rotavirus immobilized on solid phase. 4 different peptides were selected and could bind with rotavirus particles specifically. Plaque reduction neutralization test and MTT analysis results indicated that 3 of the peptides can inhibit rotavirus infecting in vitro. A peptide which sequence is QSNPIHIITNTRNHP showed the best efficiency--93% neutralization infectivity. Two other peptides, A and B, showed 40% and 50% neutralization infectivity respectively. Amino sequence analysis results indicate the 3 peptides containing 2 conserved motifs: SNPIHII and NIP. No putative trypsin hydrolysis site was found in C peptide, however, 4 and 3 potential sites were found in A and B peptides respectively. Using trypsin inhibitor, both A and B peptides showed the similar antiviral effect as that of C peptide. It suggests that the intactness of the 2 conserved motifs play an important role in counteracting virus infection. According to the results of this study, peptide C is hopeful to be exploited as an antiviral peptide drug.
Amino Acid Sequence ; Animals ; Antiviral Agents ; isolation & purification ; pharmacology ; Cell Line ; Cell Survival ; drug effects ; Dose-Response Relationship, Drug ; Drug Evaluation, Preclinical ; Humans ; Molecular Sequence Data ; Neutralization Tests ; Peptide Library ; Peptides ; chemistry ; immunology ; pharmacology ; Protein Binding ; Rotavirus ; drug effects ; growth & development ; immunology ; Sequence Analysis, Protein ; Viral Plaque Assay

OBJECTIVETo systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting (CABG) surgery.

METHODSElectronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardium in adult patients undergoing CABG surgery. Two authors independently extracted patients' perioperative data, including patients' baseline characteristics, surgical variables, and outcome data. For continuous variables, treatment effects were calculated as weighted mean difference (WMD) and 95% confidential interval (CI). For dichotomous data, treatment effects were calculated as odds ratio (OR) and 95% CI. Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity (Q test P<0.05). Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects. Publication bias was explored through visual inspection of funnel plots of the outcomes. Statistical significance was defined as P<0.05.

RESULTSOur search yielded 13 studies including 696 patients, and 402 patients were allocated into sevoflurane group and 294 into propofol group. There was no significant difference in postoperative mechanical ventilation time, inotropic support, mortality, myocardial infarction, and atrial fibrillation between the two groups (all P>0.05). Patients randomized into sevoflurane group had higher post-bypass cardiac index (WMD=0.39, 95% CI: 0.18 to 0.60, P=0.0003), lower troponin I level (WMD=-0.82, 95% CI: -0.87 to -0.85, P=0.0002), lower incidence of myocardial ischemia (OR=0.37, 95% CI: 0.16 to 0.83, P=0.02), shorter ICU and hospital stay length (WMD=-10.99, 95% CI: -12.97 to -9.01, P<0.00001; WMD=-0.78, 95% CI: -1.00 to -0.56, P<0.00001, respectively).

CONCLUSIONThis meta-analysis has found some evidence showing that sevoflurane has better myocardial protection than propofol in CABG surgery.

Adult ; Anesthetics ; therapeutic use ; Cardiotonic Agents ; therapeutic use ; Coronary Artery Bypass ; methods ; Humans ; Methyl Ethers ; therapeutic use ; Myocardial Ischemia ; drug therapy ; Myocardial Reperfusion Injury ; physiopathology ; prevention & control ; Propofol ; therapeutic use

BACKGROUNDStudies suggested that anesthetics administered upon the early reperfusion or "anesthetic postconditioning" could protect post-ischemic hearts against myocardial ischemia reperfusion injury (MIRI). However, the mechanism responsible for such protection was not well-elucidated. We investigated the cardioprotection induced by sevoflurane postconditioning (SpostC) in rat hearts in vitro, and the respective role of phosphatidylinositol-3-kinase (PI3K), extracellular signal-regulated kinase 1 and 2 (ERK 1/2), mitochondrial K(ATP) channels (mitoK(ATP)) and mitochondrial permeability transition pore (mPTP), by selectively inhibiting PI3K, ERK 1/2, mitoK(ATP), with LY294002 (LY), PD98059 (PD), 5-hydroxydecanoate (5-HD) and by directly opening of mPTP with atractyloside (ATR), respectively.

METHODSIsolated rat hearts were randomly assigned to one of the 12 groups (n = 15): Time control (continuous perfusion), ISCH (30 minutes of ischemia followed by 60 minutes of reperfusion alone), SpostC (3% sevoflurane postconditioning was administered during the first 15 minutes of reperfusion after 30 minutes of ischemia), ISCH + LY, ISCH + PD, ISCH + ATR, ISCH + 5-HD and ISCH + dimethyl sulfoxide (DMSO) groups (LY, PD, ATR, 5-HD and DMSO (the vehicle) was administered respectively during the first 15 minutes of reperfusion following test ischemia), SpostC + LY, SpostC + PD, SpostC + ATR and SpostC + 5-HD groups (LY, PD, ATR and 5-HD was coadministered with 3% sevoflurane, respectively). Hemodynamics was compared within and between groups. Infarction size was determined at the end of experiments using triphenyltetrazolium chloride (TTC) staining. Lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) released from necrotic myocardium, were compared among TC, ISCH and SpostC groups. To investigate the relationships between RISK and mPTP implicated in SpostC, NAD(+) content in myocardium, a marker of mPTP opening, was compared among some experimental groups (TC, ISCH, ISCH + LY, ISCH + PD, ISCH + DMSO, SpostC, SpostC + LY, SpostC + PD). To further investigate whether the anti-apoptotic mechanism is implicated in SpostC-induced cardioprotection and its association with mitochondria, TUNEL staining was performed in some experimental groups (TC, ISCH, ISCH + 5-HD, ISCH + ATR, ISCH + DMSO, SpostC, SpostC + 5-HD, SpostC + ATR).

RESULTSWhen compared with unprotected hearts subjected to 30 minutes of ischemia, exposure to 3% sevoflurane for 15 minutes during early reperfusion significantly improved functional recovery, decreased myocardial infarct size, decreased LDH, CK-MB and cTnI release, and decreased cardiomyocyte apoptosis (P < 0.05). However, such cardioprotective effects of hemodynamic recovery and infarct size reduction by sevoflurane was completely abolished by any one of LY294002, PD98059, atractyloside and 5-hydroxydecanoate (P < 0.05). Additionally, either LY294002 or PD98059 could reverse the inhibitory effect of SpostC over mPTP opening upon reperfusion (P < 0.05). Both atractyloside and 5-hydroxydecanoate could abrogate the anti-apoptotic effects of SpostC (P < 0.05).

CONCLUSIONThese findings demonstrate that PI3K, ERK 1/2, mitoK(ATP) and mPTP are key players in sevoflurane postconditioning induced cardioprotective mechanisms in isolated rat hearts subjected to MIRI.

Anesthetics, Inhalation ; therapeutic use ; Animals ; Apoptosis ; drug effects ; Heart ; drug effects ; Male ; Methyl Ethers ; therapeutic use ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; prevention & control

OBJECTIVETo observe the experience and the outcome of pharyngo-colonic anastomosis for esophageal reconstruction in diffuse corrosive esophageal stricture involving hypopharynx.

METHODSThis retrospective report reviews the experience and results of 14 patients who underwent esophageal reconstruction by pharyngo-colonic anastomosis without resection of intra thoracic stricture esophagus. The left half colonic segment was pulled up to the neck through the substernal space in all patients.

RESULTSThere was no operative or hospital death. Postoperative complications include cervical anastomotic fistula in four patients, rupture of the abdominal incision in 1. The length of follow-up ranged from half year to 10 years with an average of 4 years. Anastomotic stenosis occurred in 2 patients. One case improved after dilatation and the other one healed by plastic operation. One patient began to vomit after diet in seven months later with barium swallowing the abdominal colon graft was redundant and this patient was cured with side by side between the colon and the stomach.

CONCLUSIONThe successful reconstruction for hypo-pharyngo-esophageal stricture requires a correct and larger hypopharyngeal opening and a good anastomotic technique. From our experience this procedure is shown to be safe and effective.

Adolescent ; Adult ; Anastomosis, Surgical ; Burns ; complications ; Child ; Child, Preschool ; Colon ; surgery ; Esophageal Stenosis ; etiology ; surgery ; Esophagoplasty ; methods ; Female ; Humans ; Male ; Pharynx ; surgery ; Retrospective Studies

OBJECTIVETo investigate the dynamic distribution of human bone marrow mesenchymal stem cells (hBM-MSCs) in mdx mice.

METHODSTwenty-four 8-10-week-old immunocompromised mdx mice were transplanted with 1 x 10(7) passage 5 hBM-MSCs labeled with bromodeoxyuridine (BrdU) by means of injection into the tail vein. The mice were euthanized 48 hours and 2, 4, 8, 12, 16, 20, and 24 weeks after transplantation. BrdU-positive cells in tissue and organs of the mice were detected by immunofluorescence analysis. Skeletal muscle was stained for anti-human nuclei mouse monoclonal antibody (anti-Hu) and analyzed for human dystrophin (Dys) expression by immunohistochemistry and reverse transcription-polymerase chain reaction.

RESULTSAfter transplantation, BrdU-positive cells were found in most organs (especially in bone marrow, liver, and lung) within 4 weeks, and these cells in liver and lung decreased gradually after 4 weeks. At 48 hours after transplantation, BrdU-positive cells were found in bone marrow, which reached a peak level after 2 weeks and were still detectable after 16 weeks. BrdU-positive cells in skeletal muscle increased gradually over time of transplantation. A small number of anti-Hu positive cells were detected in skeletal muscle 2 weeks after transplantation. A small number of Dys positive cell were seldom found at 4 weeks and small Dys mRNA expression detected 4 weeks after transplantation. The proportion of anti-Hu in parallel with Dys positive cells and Dys mRNA in skeletal muscle of mdx mice increased gradually over time of transplantation.

CONCLUSIONAfter being transplanted into mdx mice, hBM-MSCs are mainly distributed in bone marrow, liver, and lung during the early time (2-4 weeks) , and then in bone marrow and skeletal muscle (after 4 weeks).

Animals ; Bone Marrow Cells ; cytology ; Dystrophin ; genetics ; metabolism ; Humans ; Immunocompromised Host ; Immunohistochemistry ; Mesenchymal Stem Cell Transplantation ; methods ; Mice ; Mice, Inbred mdx ; Muscle, Skeletal ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction

Adult ; Female ; Hemodynamics ; drug effects ; physiology ; Humans ; Hypertension ; diagnosis ; drug therapy ; physiopathology ; Intubation, Intratracheal ; instrumentation ; methods ; Laryngoscopy ; methods ; Male ; Middle Aged ; Monitoring, Physiologic ; instrumentation ; methods ; Preoperative Care ; instrumentation ; methods ; Reproducibility of Results ; Sensitivity and Specificity ; Time Factors

Objective　To study the effect of epidermal growt h factor receptor(EGFR) on the development and progress of thymoma. Me thods Expression of EGFR was detected by immunohistochemical stain in t he tissues of 11 cases of normal thymus and 29 cases of thymoma. Result s　 The positive expression of EGFR was 75.9%(22/29) in thymomas and 18.2%(2/11) in normal thymus. The difference was significant(P<0.01). The positive rate of EGFR was higher in invasive thymomas than in non-invasive ones (P<0.01). T he positive rate of EGFR increased with Masaoka stage with a significant increm ent in Ⅲ-Ⅳ stage compared with I stage (P<0.01). EGFR was strongly expre ssed in 5 cases of invasive thymomas, in which recurrence or metastasis occurred in 3 during the follow-up period after operation. But there was no statistical correlation with whether complicated with myasthenia gravis (MG) and histolog ical type. Conclusion　EGFR might be related to the tumori genesis and development of thymoma. There is high risk of recurrence and metast asis in case of EGFR over-expression and radiotherapy, chemotherapy and follow up should be enhanced.