Objective To evaluate the effect of intrathecal administration of ?-conopeptide SO3 on inducible nitric oxide synthase(iNOS)expression of spinal cord and the ligated sciatic nerve in a rat model with chronic constriction injury(CCI).Methods 40 male SD rats were randomly divided into 4 groups of 10 animals each.Rats in the N group served as controls;in group C 4 loose ligatures were placed around the right sciatic nerve for 14 days;in group CN,normal saline 1?l/h was injected intrathecally slowly for 7 days seven days after the ligation;in group CS,?-conopeptide SO3 30ng/h was administered intrathecally slowly for 7 days seven days after the ligature.Local expression of iNOS was assayed in samples taken from injured nerves(between and distal to the CCI site)and the spinal cord using Western blotting analysis,with GAPDH as an internal reference.Results A 130 kDa band,corresponding to iNOS protein was detected in the middle and distal sections of the injured nerves and the spinal cord.The iNOS immunoreactivity was inhibited by continuous intrathecal injection of ?-conopeptide SO3.There was no difference in the expression of iNOS between group CN and group C.Conclusion The expression of iNOS in the spinal cord and injured nerves of CCI rats was enhanced.Intrathecal injection of ?-conopeptide SO3 can inhibit the expression of iNOS.The data suggested that N-type calcium channel blocker took part in the expression of iNOS.

Objective To determine the content of ferulic acid, water and extract of Angelica formula particles, provide a reliable method for evaluation and quality control, and compare the quality of Angelica formula particles and Angelica pieces. Methods HPLC method was used with Kromasil C18 column (4.6 mm×250 mm, 5μm), flow rate of 1.0 mL/min, detection wavelength of 316 nm, column temperature at 28 ℃. The mobile phase was acetonitrile-0.05%phosphoric acid in water gradient elution system. Results Ferulic acid showed good linear relationship in the range of 0.033-0.165 μg (r=0.999 8). The average recovery was 98.78% and RSD=0.99%. Angelica formula particles met the quality requirement in the content indicators, the content of ferulic acid was higher than Angelica pieces. Conclusion The HPLC method for determination of ferulic acid in Angelica formula particles is simple and reliable, with good reproducibility, and can be used as the quality control method of Angelica formula particles.

Objective To review our experiences on perioperative anesthetic management for patients who received percutaneous nephroscopic peripancreatic necrectomy for acute necrotizing pancreatitis.Method The clinical data on 18 patients with acute necrotizing pancreatitis who received percutaneous nephroscopic peripancreatic necrectomy in our hospital from August 2008 to January 2011 were retrospectively analyzed.Results There was a marked fluctuation in hemodynamic status of the patients which required the use of vasoactive drugs during perioperative period.PETCO2 significantly increased after pneumoperitoneum.Tracheal extubation was possible in 11 patients immediately after surgery in the operation room,while 7 patients required tracheal intuhation to be transported back to the surgical intensive care unit (SICU).Conclusion Most patients who underwent percutaneous nephroscopic peripancreatic necrectomy had a varying degree of shock and multi-organ injury before operation.Proper anesthetic induction and maintenance,correct use of vasoactive drugs and lung protective ventilation strategy,and active fluid resuscitation are the keys to good perioperative anesthetic management and to improve treatment results.

Objective To investigate the correlation of CT features and pathological characteristics with epidermal growth factor receptor(EGFR)gene mutations in invasive peripheral pulmonary adenocarcinoma.Methods The amplification refractory mutation system was used to determine EGFR mutations in 1 9 3 surgically resected invasive peripheral pulmonary adenocarcinomas.CT features and pathological characteristics were analyzed retrospectively.Results The total EGFR mutation rate was 62.2% (120/193).Among the features on CT,the maximum tumor diameter (Dmax)in axial plane CT images was significantly smaller in patients with EGFR mutations than that with wild-type EGFR patients [(2.52 ± 1.01)cm vs (3.11 ± 1.34)cm,P<0.05].Receiver operating characteristic (ROC)results indicated that Dmax=2.01 cm was the diagnosis threshold in forecasting EGFR gene mutations,with the sensitivity and specificity of 79% and 64%,respectively.The frequency of EGFR mutations was significantly greater in tumors with ground-glass opacity(GGO)than that without GGO (78.0% vs 56.6%,P<0.05),and in tumors without cystic airspaces than that with cystic airspaces (65.5% vs 40.0%,P<0.05).No correlations were observed between EGFR mutations and other CT features,including GGO/tumor ratio(G/T),lobulation,spiculation,pleural retraction,vascular convergence,air bronchograms,and vacuole signs (P>0.05).Among pathological characteristics,compared with other subtypes,EGFR mutations occurred most frequently in lepidic predominant adeno-carcinomas (77.5% vs 58.2% in other subtypes,P<0.05),and the least frequently in solid predominant adenocarcinomas(26.3%vs 66.1% in other subtypes,P<0.05).The EGFR mutation rate was significantly higher in tumors without lymph node metastases than that with lymph node metastases (66.9%vs 50.9%,P<0.05).Conclusion The CT features and pathological characteristics may be useful indicators to predict EGFR mutation status in invasive peripheral pulmonary adenocarcinoma.

Objective To study the MSCT appearances of thymic neuroendocrine tumors (NETs)and its correlation with the WHO histological grade.Methods MSCT features of 16 patients with thymic NETs confirmed by pathology were analyzed retro-spectively.The patients were divided into 2 groups according to tumor's grade,i.e.low and intermediate grade,high grade.Results There were 8 patients in low and intermediate grade,8 in high grade.No difference was found among tumor location,size,tumor morphology,calcification,pericardiac thickening,pericardial effusion,pleural thickening,pleural effusion,disappearance of fat line around tumor and mass-pulmonary interface with irregular shape,but significant difference was detected in lymph node metastasis. On enhanced MSCT scanning,statistical difference was detected in linear enhancement of the blood vessels in the tumors,but no difference was found between necrosis and peripheral vessel invasion.Conclusion MSCT findings of different grades in thymic NETs have some characteristics and can be helpful in the grades of predictability.

Objective To explore the MSCT features of airway-invasive pulmonary aspergillosis.Methods MSCT features of 27 cases of airway-invasive pulmonary aspergillosis confirmed by pathology or clinical experience were analyzed retrospectively.Results The lesions in 27 cases were distributed along the blood vessel and bronchus and located mainly in the upper and middle lung field in 19 cases.Multiple centrilobular nodules and tree-in-bud sign were found in 27 cases and bronchial wall thickening and patchy opacities around the bronchi were in 25 cases.Bronchiectasis was seen in 17 cases,and cavity-like change and inter-cavity separation were in 15 cases.In 22 cases of follow-up,the lesion progressed within 1 week after diagnosised and treatmented in 20 cases and recurred in slow recovery stage in 5 cases.Conclusion MSCT findings of airway-invasive pulmonary aspergillosis are various which may rapidly progress within a short time.MSCT palys an important role in the evolution and follow-up of airway-invasive pulmonary aspergillosis.

Objective To analyze the relationship between CT image characteristics and the pathological subtypes of small lung adenocarcinoma (≤3 cm) with ground-glass opacity(GGO).Methods Two hundred and three cases of small lung adenocarcinoma proved by pathology were collected.Use the 2015 World Health Organization(WHO) classification of lung cancers as pathology standard.The relationship between CT findings and pathologic classification were analyzed statistically.Results There was a positive correlation between CT type and pathological type (rs =0.756).The size of atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS) and minimally invasive adenocarcinoma(MIA) lesions were smaller than invasive adenocarcinoma(IAC).AAH lesions were smaller than MIA(P＜0.008 3).However,there were no significant size differences in AAH and AIS lesions,or in AIS and MIA lesions (P＞0.008 3).The critical point of non-or-little-invasive (AAH,AIS and MIA) and IAC was 15.35 mm (sensitivity 80.8％,specificity 90.4 ％).Differences in lobulation,air bronchogram,vacuole sign,pleural indentation and vascular convergence among pathological types were statistically significant (P ＜0.05).Differences in shape,speculation and cavity among groups were not significant (P ＞0.05).Conclusion The higher CT type,lower GGO content and bigger lesion size are all associated with increasing tumor degree of malignancy.The size of IAC lesion is usually greater than 15.35 mm.Lobulation,air bronchogram,vacuole sign,pleural indentation and vascular convergence can help to diagnose IAC.

OBJECTIVE: To investigate the maximum dose of continuous mivacurium infusion for intraoperative neuromonitoring (IONM) and observe the adverse reactions during thyroid surgery under total intravenous anesthesia (TIVA). METHODS: Thirty patients undergoing IONM during thyroid surgery received continuous infusion of mivacurium at the initial rate of 14.97 μg · kg RESULTS: The EC CONCLUSIONS In patients undergoing thyroid surgery under TIVA, the EC
Anesthesia, Intravenous ; Humans ; Mivacurium ; Propofol ; Remifentanil ; Thyroid Gland

OBJECTIVE: To determine the maximum dose of continuously infused mivacurium for intraoperative neuromonitoring and observe its adverse effects in thyroid surgery. METHODS: Twenty-eight patients undergoing thyroid surgery with intraoperative neuromonitoring received continuous infusion of mivacurium at the initial rate of 5.43 μg?kg?min, and the infusion rate for the next patient was adjusted based on the response of the previous patient according to the results of neurological monitoring. The depth of anesthesia was maintained with sevoflurane and remifentanil during the surgery. The LD50 and 95% of mivacurium were calculated using Brownlee's up-and-down sequential method. RESULTS: The LD50 of continuously infused mivacurium was 8.94 μg?kg?min (95% : 8.89- 8.99 μg?kg?min) during thyroid surgery, which did not affect neurological function monitoring. Transient chest skin redness occurred after induction in 9 patients (32.1%). None of the patients experienced intubation difficulties or showed intraoperative body motions during the surgery. CONCLUSIONS In patients undergoing thyroid surgery under anesthesia maintained by inhalation and intravenous infusion, the LD50 of mivacurium was 8.94 μg?kg?min (95% : 8.89-8.99 μg?kg?min) for continuous infusion, which does not cause serious adverse effects during the operation.
Anesthesia ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Humans ; Intraoperative Neurophysiological Monitoring ; methods ; Lethal Dose 50 ; Mivacurium ; administration & dosage ; adverse effects ; Neuromuscular Nondepolarizing Agents ; administration & dosage ; adverse effects ; Remifentanil ; Sevoflurane ; Thyroid Gland ; surgery

Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.