Objective:To explore the change of dominant atrial cycle length(DACL)for atrial fibrillation waves during the procedure of pharmaceutical defibrillation for persistent atrial fibrillation(AF).Methods:The AF waves had been sampled for thirty patients with persistent AF before and after oral amiodarone loading for 14 days.DACL and the ratio of the power of second peak to power of first peak(P2/P1)for each patient were calculated from frequency spectrum.Results:After 14 days,twenty-one patients restored to sinus rhythm among the thirty patients and the rest 9 patients were still in persistent AF.All patients' DACL was prolonged,but the ratio of P2/P1 was decreased.DACL of 21 patients who restored to sinus rhythm before cardioversion had prolonged more obviously than patients who were under atrial fibrillation.Conclusion:DACL is a useful parameter in judging whether atrial fibrillation has been relieved or not.

Objective To observe the analgesic effect and safety of dezocine used in the periextubation period in pediatric pa-tients undergoing cleft lip and palate repair surgery under general anesthesia .Methods 60 American Society of Anesthesiologists (ASA ) grade Ⅰ - Ⅱ pediatric patients undergoing elective cleft lip and palate repair surgery under under general anesthesia in the central anesthesia department from January 1 to August 1 ,2013 were selected and randomly divided into group D ,F and N ,20 cases in each group .All the cases were performed the endotracheal intubation general anesthesia .At 15 min before the end of operation , the group D was intravenously injected by dezocine 0 .10 mg/kg ,the group F by fentanyl 1 .00 μg/kg and the group N (control group) by the isodose normal saline .The mean arterial pressure(MAP) and heart rate(HR) in all groups were recorded before in-duction ,extubation and at 5 min after extubation respectively .The extubation time ,Riker sedation-agitation scores and face ,legs ,ac-tivity ,cry and consolability(FLACC) scores at 30 min after extubation ,occurrence rates of various complications within 30 min after extubation(breathing and circulation depression ,nausea and vomiting ,drowsiness ,headache and extrapyramidal reactions were ob-served and recorded .Results The three groups completed the operation successfully .There were no significantly differences in age , body weight ,operation time and sevoflurane inhalation concentration among the three groups (P>0 .05) .HR and MAP in extuba-tion and at 5 min after extubation in the group D were lower than those in the group N and F(P<0 .05) ,but HR and MAP in extu-bation and at 5 min after extubation had no statistically significant difference between the group D and F (P>0 .05) .There was no statistically significant difference in the extubation time among 3 groups(P>0 .05) .The Riker sedation-agitation scores and the FLACC scores at 30 min after extubation in the group D were significantly lower than those in the group N and F with statistically significant difference( P< 0 .01 ) .Adverse reaction such as respiratory inhibition ,nausea ,vomiting ,lethargy ,headache ,vertebral body reaction were not found in the 3 groups after 30 minutes .Conclusion Dezocine used in pediatric patients with cleft lip and pal-ate repair surgery is safe and effective .

Pancreatic cancer is an aggressive malignant gastrointestinal tumor,surgical resection offers the only chance of cure. Due to its anatomic and biological characters,early stage pancreatic cancer is usually clinically silent,80％-85％ of patients present with advanced unresectable disease. Furthermore,pancreatic cancer responds poorly to most radiochemotherapeutic agents.In this article,we discuss some clinical aspects including early diagnosis,preoperative systemic assessment,surgery and perioperartive adjuvant therapy,and we hope to find the challenges as well as strategies for pancreatic cancer in order to further improve the current level of diagnosis and treatment in China.

Pancreatic cancer is a highly malignant tumor.It is of great importance to improve the effectiveness of treatment by studying the mechanisms which lead to invasion and metastasis in pancreatic cancer.In some malignant tumors,tumor associated macrophage (TAM) plays an important role in tumor progression and invasion.TAM also plays an important role in pancreatic cancer which consists mainly of stromal elements.Research into the mechanisms for occurrence and development of pancreatic cancer,the role played by TAM as well as TAM transformation between the different phenotypes may bring a breakthrough in the treatment of pancreatic cancer.

Objective To analyze the clinical characterist ic s and treatment of chronic idiopathic intestinal pseudo-obstruction(CIIP). Methods We retrospectively reviewed 8 C IIP patients admitted to our hospital from 1980 to 1999. There were 4 males and 4 females, with an average age of 29 years. Results The earliest onset of symptom was at an age of 2 years old. Re current abdominal distention is the most common symptom. Gastrointestinal imagin g and colonoscopy showed dilated loops of bowels with no evidence of mechanical obstruction. Delayed gastric emptying was presented by radionucleotide(~99m Tc-Sc) gastric emptying test. Gastrointestinal manometry showed low pressure in esophagus and colon. Biopsy taken in 2 patients showed chronic inflammation. On e patient underwent total colectomy for the treatment of lesions confined within the colon. Prokinetic agents have limited efficacy. Conclusions CIIP is a rare disease. Operation is not a prima ry method for treatment. The patients usually have poor prognosis.

Objective To investigate the clinical characters of pancreatitis in patients with primary hyperparathyroidism (PHPT).Methods The clinical data of patients with PHPT undergoing parathyroidectomy from Jan.2009 to May.2014 in Peking Union Medical College Hospital were retrospectively analyzed for coexistent pancreatitis.Results 571 patients received parathyroidectomy due to PHPT during this period.Thirteen patients (2.3％)with PHPT were confirmed with coexistent pancreatitis by clinical manifestation and abdominal imaging evaluation,including acute pancreatitis in 9 patients and chronic pancreatitis in 4 patients.PHPT with pancreatitis was associated with preoperative serum intact parathyroid hormone(iPTH)higher than 500 pg/ml (P=0.025)and occurrence of hypercalcemic crisis (P=0.013).The age and sex of patients,preoperative serum calcium,gallstones,urinary calculi and bone fracture were not related with pancreatitis in this group.The average follow-up period for these patients was 34(ranging from 13 to 68)months.All patients were free from hyperparathyroidism recurrence.Only one young lady with chronic pancreatitis suffered from repeated pancreatitis after surgery.Conclusions Serum iPTH higher than 500 pg/ml and occurrence of hypercalcemic crisis were possible risk factor of pancreatitis in patients with PHPT.Parathyroidectomy can help to prevent the recurrence of pancreatitis in these patients.

Objective EGFR targeted therapy mediated by adeno-associated virus is a promising way to treat pancreatic cancer.This study aimed to assess the feasibility and activity of combining rAAV-anti EGFR,gemcitabine,and radiation in pancreatic cancer cells.Methods Aspc-1 human pancreatic carcinoma cells were divided into several groups,in vitro and in vivo,which were respectively exposed to gemcitabine alone,radiation alone,rAAV-anti EGFR alone,the combination of rAAV-anti EGFR with gemcitabine,the combination of rAAV-anti EGFR with radiation,and the combination of all three agents.The pancreatic cancer tumor growth and apoptotic rate were measured.Results The apoptotic rate was higher in cells treated with a single or combination of agents compared to the negative control (P＜0.05).The combination of rAAV-EGFR,gemcitabine,and radiation produced the highest induction of apoptosis compared to a single agent alone (P ＜ 0.05).Treatment with rAAV-anti EGFR greatly inhibited growth in the tumor xenografts (P＜0.05),and a synergistic effect of rAAV-anti EGFR,gemcitabine,and radiation was found.The number of tissue cancer cells that expressed cleaved caspase-3 after treatment with rAAV EGFR was more than that of the control group (P＜0.05).The combined treatment of rAAV-anti EGFR,gemcitabine,and radiation induced the highest numbers of cells expressing cleaved caspase-3 compared to that with a single agent alone (P＜0.05).Conclusions The rAAV-anti EGFR therapy in combination with chemotherapy and radiation therapy demonstrated a greater efficacy over therapy with a single agent alone.rAAV-anti EGFR increased the efficacy of gemcitabine and radiation in the treatment of pancreatic cancer cells.

PurposeTo assess the level of agreement and interchangeability among Excel and CMRtools (2012) for calculation of T2* values in iron overload.Materials and Methods T2* images in 27 cases withβ-thalassemia major were imported into CMRtools (2012). The regions of interest (ROI) were drawn and interference signal removed to obtain T2* values. The T2* images were also measured using default MR software and manually entered into Excel to obtain T2* values after removal of the interference signal. The agreement between the two methods in calculating T2* values was compared.Results For 27 patients withβ-thalassemia major, 10 cases showed myocardial iron overload. 25 cases had liver iron overload. The T2* values from two methods were not statistically significant (t=-0.152 and-0.691,P>0.05) for the liver.Conclusion There is good agreement and interchangeability between Excel and CMRtools (2012) in calculating T2* values. Excel can be used clinically to evaluate iron overload.

BACKGROUND: KATP channel regulates the response of cells to hypoxia and ischemia, mediates and is involved in the protection for cells or tissue organs. Our previous research confirms that Shenfu injection has good protective effect on myocardial ischemia/reperfusion injury in rats. There have been no reports on whether this protective effect is related to KATP channel in WeiPu deriodical database, WanFang database and Medline database until October 2005.OBJECTIVE: To observe the protective effect of Shenfu injection on myocardial ischemia/reperfusion injury in rats, and analyze its correlation with KATP channel.DESIGN: Completely randomized grouping design, randomized controlled trial.SETTING: Department of Anesthesiology, Second Hospital Affiliated to Dalian Medical University; Department of Anesthesiology, Second Hospital Affiliated to Chongqing Medical University.MATERIALS: Twenty-four adult SD rats of clean grade, of either gender, weighing 240 to 320 g, were employed in this trial. Shenfu injection (Sanjiu Medical & Pharmaceutical, Co., Ltd., Batch No. 031002) and glibenclamide (National Institute for the Control of Pharmaceutical and Biological Products) were employed.METHODS: This trial was carried out in the Laboratory of Anesthesiology, Second Hospital Affiliated to Chongqing Medical University from April to December 2004. Myocardial ischemia/reperfusion injury models were employed. Twenty-four rats were randomized into 4 groups, with 6 in each group: sham-operation group [putting through thread, but without ligation of left anterior descending coronary artery, 8 mL/kg normal saline, intravenous injection (i.v.)], ischemia/reperfusion group (8 mL/kg normal saline, i.v.), Shenfu injection group (8 mL/kg Shenfu injection, i.v.) and Shenfu injection + glibenclamide group (0.33 mg/kg glibenclamide and 8 mL/kg Shenfu injection, i.v.). Administration in each group was conducted 15 minutes before ligation except for that in sham-operation group (immediately after putting through thread). About 6 mL blood was taken from cardiac apex. Left ventricular anterior wall was divided into 3 parts, and then which were used for homogenate, electron microscope observation and immunohistochemical detection separatety. The superoxide dismutase (SOD) activity, malondialdehyde (MDA) level, expressions of tumor necrosis factor-α(TNF-α) and interleukin 6 (IL-6)and plasm cTnl level in myocardial tissue were detected. Ultra-structural changes of myocardial tissue were observed.MAIN OUTCOME MEASURES: SOD activity, MDA level, expressions of TNF-α and IL-6, plasm cTnI level and ultra-structural changes of myocardial tissue. RESULTS: All the 24 rats were involved in the result analysis, without deletion. ① Compared with sham-operation group,SOD activity in myocardial tissue in ischemia/reperfusion group was decreased, while the expressions of TNF-α and IL-6 were increased, with statistical difference (P ＜ 0.01). MDA level in the ischemia/reperfusion group was higher than that in the sham-operation group (P ＜ 0.01); Compared with ischemia/reperfusion group, SOD activity was increased, MDA level and expressions of TNF-α and IL-6 were all decreased in Shenfu injection group(P ＜ 0.01); There were no significant differences in above-mentioned indexes between Shenfu injection group and Shenfu injection + glibenclamide group (P ＞0.05). ②Compared with sham-operation group, the plasm cTnl level in the ischemia/reperfusion group and Shenfu injection+ glibenclamide group was significantly increased (P ＜ 0.01); Compared with ischemia/reperfusion group, plasm cTnl level in the Shenfu injection group was significantly decreased in Shenfu injection group (P ＜ 0.01); There were no signifi cant differences in plasm cTnl level between Shenfu injection group and Shenfu injection + glibenclamide group. ③ In the sham-operation group, the ultrastructure of myocardial cells was basically normal and mitochondrium swelled a little; In the ischemia/reperfusion group, karyolysis appeared, mitochondrium swelled obviously and considerable neutrophils infil trated; In the Shenfu injection group, myofilament of myocardial cells dissolved, mitochondrium swelled and nuclear mem brane was integrity; In the Shenfu injection + glibenclamide group, mitochondrium obviously swelled, myofilament present ed focus dissolving, sarcoplasmic reticulum expanded a little and allochromacy assembled in the edge of cells. CONCLUSION: Glibenclamide suppresses myocardial KATP channel, but does not eliminate the protective effect of Shenfu injection on myocardial ischemia/reperfusion injury. KTAP channel does not play an important role in the protection of Shenfu injection for myocardial ischemia/reperfusion injury.

BACKGROUND: It has been confirmed that Shenfu parenteral injection can ameliorate and treat various shocks, heart failure, myocardial ischemia and supraventricular/ventricular arrhythmia, and it also has a good protective effect on myocardial ischemia/reperfusion injury in rats.OBJECTIVE: To observe the effects of Shenfu parenteral injection on the protein expressions of myocardial apoptosis-related genes of Bcl-2, Bax and c-Fos in rats with acute ischemia/reperfusion injury.DESIGN: A complete randomized grouping design, controlled experiment.SETTING: Department of Anesthesiology, the Second Affiliated Hospital,Chongqing University of Medical Sciences.MATERIALS: The experiments were carried out in the Staff Room of Anesthesiology, the Second Affiliated Hospital, Chongqing University of Medical Sciences from April to December in 2004. Thirty-five healthy adult Wistar rats were provided by the experimental animaI center of Daping Hospital, Third Military Medical University of Chinese PLA. Shenfu parenteral injection was the TCM formula of Shenfu Tang, which is for recuperating depleted yang and rescuing the patient from collapse, and its main components are ginsenoside and aconitum alkaloid. It was the product of Yaan Sanjiu Pharmaceutical Co., Ltd., 10 mL/piece, the batch number was 030110.METHODS: In vivo models of myocardial ischemia/reperfusion injury were used. The 35 rats were divided into 5 groups according to the number of random number table, with 7 rats in each group: ① Sham-operated group: The rats were treated with only insertion of thread without ligation, followed by intravenous injection of saline (8 mL/kg), and then observed for 120 minutes. ② Shenfu parenteral injection 30-minute group: The rats were treated with intravenous injection of Shenfu parenteral injection (8 mL/kg) at 15 minutes before ligation, and then the left coronary artery anterior descending branch was ligated for 40 minutes and reperfused for 30 minutes. ③ Shenfu parenteral injection 120-minute group: The rats were reperfused for 120 minutes, and the others were the same as those in the Shenfu parenteral injection 30-minute group. ④ Saline 30-minute control group: The rats were treated with intravenous injection of saline (8 mL/kg) at 15 minutes before ligation, and then the left coronary artery anterior descending branch was ligated for 40 minutes and reperfused for 30 minutes. ⑤ Saline 120-minute control group: The rats were reperfused for 120 minutes, and the others were the same as those in the saline 30-minute control group. The expressions of Bcl-2, Bax and c-Fos proteins in myocardial tissues were detected with immunohistochemical method.MAIN OUTCOME MEASURES: The expressions of Bcl-2, Bax and cFos proteins in myocardial tissues of rats in each group were observed.RESULTS: All the 35 rats were involved in the analysis of results without deletion. ①As compared with the sham-operated group, the expressions of Bcl-2, Bax or c-Fos protein in myocardium were significantly increased(P ＜ 0.01), but the Bcl-2/Bax ratios were significantly decreased (P ＜0.01) in the saline 30 and 120-minute groups. ② As compared with corresponding saline groups, the expressions of Bcl-2 protein in the Shenfu parenteral injection 30 and 120-minute groups were significantly increased (P ＜ 0.01), the expressions of Bax and c-Fos proteins were remarkably decreased (P ＜ 0.01), and the Bcl-2/Bax ratios were significantly increased (P ＜ 0.01).CONCLUSION: Protective effect of Shenfu parenteral injection on ischemia/reperfusion myocardium may be correlated with its promotion of Bcl-2 protein expression, restrain to Bax and c-Fos protein expressions, and increase of Bcl-2/Bax ratio, and it restrains the apoptosis of myocardial cells.