AIM:To observe the effects of fasudil on inflammatory reaction in cerebral ischemia/reperfusion rats.METHODS:Focal cerebral ischemia/reperfusion model in rats was made by transient occlusion of middle cerebral artery for 1.5 h followed by 24 h reperfusion.Fasudil was injected intraperitoneally before operation and 12 h after operation.The neurological function was scored and the infarct volume was measured after operation.The water content of brain was measured with dry-wet weight;The myeloperoxidase(MPO)activity was determined by spectrophotometer;The permeability of the blood brain barrier was evaluated by measurement of the Evans Blue(EB)content in the brain with spectrophotometer;The brain content of IL-8 was evaluated with ELISA;The level of NF-?B p65 mRNA expression was determined by RT-PCR;The expressions of ICAM-1,VCAM-1 and NF-?B p65 protein were observed by immunohistochemistry;The MCP-1 and the expression of NF-?B p65 protein in the nuclear extracts were detected by western blotting.RESULTS:Fasudil improved the neurological function,decreased the infarct size,reduced the permeability of blood brain barrier and brain water content,inhibited the MPO activity,decreased the content of IL-8 and the protein expressions of ICAM-1,VCAM-1 and MCP-1 in brain tissue,inhibited the expressions of NF-?B p65 mRNA and protein and reduced the content of NF-?B p65 protein in the nuclear extracts significantly(P

Objective To evaluate the clinical features and treatment of pelvi-ureteric junction obstruction (PUJO) in a duplex kidney. Methods From 1993 to 2010, 752 patients were diagnosed as PUJO in our hospital and 18 patients (2.4%) with PUJO in duplex kidneys. Three patients had obstruction in the complete duplicated systems and 15 in the incomplete duplicated systems. Five patients had obstruction of the upper moiety and 13 of the lower moiety. All of the 18 patients underwent B-ultrasonography, with 15 enhanced CT scan, 11 intravenous urography and 10 retrograde pyelography.All patients had serum creatinine test after admission and during the follow-up. Results Sixteen patients underwent operations and 2 patients were treated conservatively. Nine patients underwent pyeloplasty and 7 patients underwent heminephroureterectomy. Pathology shows derangement of the lamina muscularis at pelvi-ureteric junction and infiltration of inflammatory cells in mesenchymal. They were followed up from 6 months to 3 years with a mean of 24 months. The clinical symptoms of patients who underwent surgery were cured in all cases. B-ultrasound and IVU showed that hydronephrosis was obviously relieved and the levels of serum creatinine remained the same or decreased. The hydronephrosis and serum creatinine of patients who underwent conservative treatment remained stabilized. Conclusions PUJO in duplicated system is a rare condition. Careful preoperative evaluation is needed to reach the final diagnosis and retrograde pyelography has high specificity. Treatment should be individualized according to split and partial renal function.

Objective To explore the therapeutic effect of combined endoscopic embelization and variceal ligation (EVL) for management in cirrhotic patients with gastroesophageal variceal bleeding. Meth-otis One hundred and fifty-six cases of active gastric fundal variceal bleeding combined with esophageal var-ices of over degree Ⅱ, and with other causes leading to upper digestive tract bleeding excluded, were ran-domized into therapeutic group (n = 80) and control group (n = 76). For the therapeutic group, endoscopic cyanoacrylate injection for embelization of gastric fundal varices and EVL for esophageal varices were per-formed simultaneously. For the control group, EVL was performed 2 months after embolization. Results There was no complication in beth groups. The rate of hemostasis in therapy group was 96. 3% (77/80), and that in control group was 97. 4% (74/76, P >0.05). There was significant difference between two groups, regarding the rates of early re-bleeding [6. 4% (5/78) vs 21.3% (16/75), P < 0. 05] and re-bleeding at 6 months [13.0% (9/69) vs 25. 4% (17/67), P < 0. 05]. There was no significant difference between two groups, regarding the effective rate in disappearance of gastric fundus varices (61.6% vs 59. 1%), and in that of esophageal varices (74. 0% vs 67.9%). Conclusion Endescopic embelisation of gastric fundus vaxices, combined with EVL for esophageal varices, is a safe and effective procedure for the treatment of gastroesophageal variceal bleeding, and it can reduce the rate of re- bleeding.

Aim To investigate the effects of fasudil on neuronal apoptosis after cerebral ischemia/reperfusion(I/R) injury in rats.Method Focal cerebral ischemia/reperfusion model in rats was made by transient occlusion of the middle cerebral artery for 90 minutes followed by 24 h reperfusion.The number of neural apoptotic cells was measured by the method of TUNEL staining;Bcl-2,Bax,Caspase-3 protein expressions were observed by immunohistochemical staining;the expression of phospho-MYPT and phospho-Akt protein was determined by Western blot.Result Compared with the MCAO group,fasudil could decrease the number of neural apoptotic cells,upregulate the expression of Bcl-2 and phospho-Akt protein and inhibit the expression of Bax,Caspase-3 and phospho-MYPT protein significantly(P

Objective To investigate the effects of remifentanil postconditioning on apoptosis in hippocampal neruons in a rat model of cerebral ischemia-reperfusion(I/R)and the mechanism involved.Methods Twentyfour male SD rats weighing 250-300 g were randomly divided into 4 groups(n = 6 each): sham operation group (group S);global cerebral I/R group(group I/R);remifentanil 0.6μg·kg- 1·min-1+global cerebral I/R group (group R1)and remifentanil 1.8μg·kg-1·min-1 + global cerebral I/R group(group R2).Global cerebral ischemia was induced by 10 min occlusion of bilateral common carotid combined with hypotension.In group R1 and R2,remifentanil at 0.6 and 1.8μg·kg-1·min-1 were infused for 5 min before ischemia respectively.The cognitive function was tested with Morris water maze and step-down tests from the day 3 to day 8 after reperfusion.When Morris water maze test was finished,rat brains were removed for HE staining and determination of the expression of caspase-3 in hippocampal CA1 region by immuno-histochemistry.Apoptosis in neurons in hippocampal CA1 region was detected by TUNEL assay.Results Compared with group S,the cognitive function was significantly decreased and the number of apopotic neurons in hippocampus CA1 region increased in group I/R,R1 and R2,and the expression of caspase-3 was up-regulated in group I/R(P＜0.05).Compared with group I/R,the cognitive function was significantly increased,the expression of caspase-3 was down-regulated,and the number of apopotic neurons in hippocampus CA1 region was significantly decreased in group R1 and R2(P＜0.05).Conclusion Remifentanil postconditioning can improve the cognitive function through down-regulating caspase-3 expression and inhibiting the apoptosis in hippocampal neruons in a rat model of cerebral I/R.

ObjectiveTo investigate the effects of morphine preconditioning on myocardial ischemiareperfusion (I/R) injury and the expression of phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK1/2)in rats with chronic heart failure.MethodsForty-eight healthy male SD rats weighing 220-250 g were randomly divided into 6 groups ( n =8 each):control group (group C),sham operation group (group S),I/R group and preconditioning with low,median and high doses of morphine groups (groups MP1-3 ).Chronic heart failure was induced by iv edriamycin 2.0 mg/kg once a week for 6 weeks in groups S,I/R and MP1-3.Left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were measured using ultrasound,and left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were calculated at the end of 14th day after the end of adriamycin administration.Blood samples from the carotid artery were collected after ultrasonography for determination of the plasma brain natriuretic peptide (BNP) concentration.Myocardial I/R was induced by 30 min occlusion of left anterior descending branch of coronary artery followed by 120 min reperfusion at 2 day after ultrasonography in groups I/R and MP1-3.In groups MP1-3,iv morphine 0.015,0.030 and 0.050 mg/kg were repeated 3 times at 5 min interval at 30 min before ischemia respectively,while normal saline 5 ml/kg was given in group I/R.The animals were sacrificed at the end of reperfusion in groups S,I/R and MP1-3,and the hearts were removed to measure the area at risk (AAR),infarct size (IS),and IS/AAR ratio was calculated.The p-ERK1/2 expression in myocardium was assessed by Western blot.ResultsThe LVESD and plasma BNP concentration were significantly higher,while the LVEF and LVFS lower in the other 5 groups than in group C (P ＜0.01).No myocardial infarction was found in group S.The p-ERK1/2 expression was significantly lower in groups I/R and MP1 than in group S (P ＜ 0.05).IS and IS/AAR ratio were significantly lower,and p-ERK1/2expression was significantly higher in groups MP2.3 than in group I/R ( P ＜ 0.05).There were no significant differences in IS,IS/AAR ratio and p-ERK1/2 expression between groups MP1 and I/R (P ＞ 0.05).IS and IS/AAR ratio were decreased gradually,and the p-ERK1/2 expression was up-regulated gradually in groups MP1-3 ( P ＜0.05).ConclusionMorphine preconditioning can confer cardioprotection against myocardial I/R in a dose-dependent manner in rats with chronic heart failure.Up-regulation of p-ERK1/2 expression is involved in the underlying mechamism.

Objective To explore the value of transesophageal doppler in transurethral resection prostate.Methods Thirty-six patients (aged 60-85 years, falling into ASA grade Ⅰ-Ⅲ) of benign prostatic hyperplasia for undergoing transurethral resection prostate were enrolled.Through multifunction monitor, CVP, Narcotrend index(NI) were monitored before anesthesia induction (T0), 20 minutes after anesthesia induction (T1), after irrigating fluid of 5 000 ml (T2) and 10 000 ml (T3) and 15 000 ml (T4) and 20 000 ml (T5).By transesophageal doppler, FTc(corrected flowtime), SV(stroke volume), ΔPV(peak flow vaviable quantity) were monitored at T1-T5.Results CVP at T1-T5 were not significantly changed compared with that at T0.Compared with T1, FTc, SV at T3-T5were significantly increased and ΔPV at T2-T5were significantly decreased (P<0.05).CVP levels correlated significantly with both FTc (r=0.702, P<0.01) and SV (r=0.595, P<0.01).CVP negatively correlated significantly with ΔPV (r=-0.351, P<0.05).Furthermore, FTc correlated significantly with the concentrationof Na+(r=0.672,P<0.01).No patient had serum sodium ion concentration less than 125 mmol/L.Conclusion FTc of transesophageal doppler is as accurate as central venous pressure in monitoring hemodynamic changes, and even more sensitive than CVP.It is useful in early diagnosis and treatment of TURS.

Objective To explore influences of the fistula's location on the procedure and outcome of a transvaginal vesicovaginal (VVF) repair.Methods The medical data of patients undertaken transvaginal VVF repairs in Peking University First Hospital between Janurary 2009 and Auguest 2016 were retrospectively collected,including age,past history,causes of the fistula,disease course,past treatment,outcomes of the cystoscopy and imaging test and surgical information.The follow-ups were performed.Patients who had incomplete clinical data and lost to follow-up were not included.The present study included 68 VVF subjects with the median age of 46 years (range:24-64 years).The univariate analysis was performed to figure out potential risk factors for the VVF repair outcome.The duration and blood loss of VVF repairs were compared among the subjects with the fistulae located at bladder neck,trigone and supra-trigone region.Results There were 5,23 and 40 cases having VVFs located at bladder neck,trigone and supratrigone region respectively.The overall repair success rate was 88.2％ (60/68).According to results of the univariate analysis,subjects with more past repair times had significantly lower success rates.There were no significant differences in success rates of surgical repairs for VVFs located at bladder neck (80.0％,4/5),trigone (91.3％,21/23) and supra-trigone region (87.5％,35/40).And the location of VVFs had no significant association with the duration and blood loss during the VVF repair.Conclusions The location of VVFs had no influences on the procedure and outcomes of the transvaginal repairs.The VVF repair approach may not be determined based on the fistula's location alone.

Objective To study the indication of pelvic autonomic nerve preservation(PANP)for patients undergoing rectal carcinoma resection and evaluate the operative procedure and post-operative urine function.Methods Materials of 18 cases of middle and lower rectum carcinoma,receiving PANP radical resection from Jan. 2000 to Nov. 2002 were reviewed. The perioperative urodynamic index and postoperative long-term sexual function were analyzed.Result Pelvic autonomic nerve was preserved in all 18 patients and they have normal urine function and satisfactory long-term sexual function.Conclusion Male patients aged younger than 60 yrs., with rectal carcinoma of Ducks A to C are suitable for receiving PANP radical resection for better maintenance of the urinal and sexual function.

Objective To evaluate gastric varices embolization by endoscopic ultrasonography (EUS). Methods One hundred and eighty-five hepatic cirrhosis patients complicated with gastric varices were divided into two groups, the EUS group, 109 patients and the control group, 76 patients. Ninty-nine patients with confirmed gastric varices by EUS in the EUS group were treated by Histoacryl. All of the patients were examined by EUS soon after the embolization and at three months later. While 76 cases confirmed by endoscopy in the control group were treated by Histoacryl who only examined by EUS three months later. Results The rate of hemostasic both were 100% and rebleeding never occurred within three weeks in EUS group while the rate of the early rebleeding in the control group was 11. 8% (9/76). There was significant difference between the two groups (P