Background::Intravertebral and general anesthesia (GA) are two main anesthesia approaches but both have defects. This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion (TCI) on blood loss and transfusion for total hip arthroplasty (THA) in elderly patients in comparison with combined spinal-epidural anesthesia (CSEA) or GA.Methods::Totally, 240 patients (aged ≥65 years, American Society of Anesthesiologists [ASA] I-III) scheduled for posterior THA were enrolled from September 1st, 2017 to March 1st, 2018. All cases were randomly divided into three groups to receive CSEA (group C, n = 80), GA (group G, n = 80), or subarachnoid anesthesia and propofol TCI (group T, n= 80), respectively. Primary outcomes measured were intra-operative blood loss, autologous and allogeneic blood transfusion, mean arterial pressure at different time points, length of stay in post-anesthesia care unit (PACU), length of hospital stay, and patient satisfaction degree. Furthermore, post-operative pain scores and complications were also observed. The difference of quantitative index between groups were analyzed by one-way analysis of variance, repeated measurement generalized linear model, Student-Newman-Keuls test or rank-sum test, while ratio index was analyzed by Chi-square test or Fisher exact test. Results::Basic characteristics were comparable among the three groups. Intra-operative blood loss in group T (331.53 ± 64.33 mL) and group G (308.03 ± 64.90 mL) were significantly less than group C (455.40 ± 120.48 mL, F = 65.80, P < 0.001). Similarly, the autologous transfusion of group T (130.99 ± 30.36 mL) and group G (124.09 ± 24.34 mL) were also markedly less than group C (178.31 ± 48.68 mL, F= 52.99, P < 0.001). The allogenetic blood transfusion of group C (0 [0, 100.00]) was also significantly larger than group T (0) and group G (0) ( Z = 2.47, P = 0.047). Except for the baseline, there were significant differences in mean arterial blood pressures before operation ( F= 496.84, P < 0.001), 10-min after the beginning of operation ( F = 351.43, P < 0.001), 30-min after the beginning of operation ( F = 559.89, P < 0.001), 50-min after the beginning of operation ( F = 374.74, P < 0.001), and at the end of operation ( F= 26.14, P < 0.001) among the three groups. Length of stay in PACU of group T (9.41 ± 1.19 min) was comparable with group C (8.83 ± 1.26 min), and both were significantly shorter than group G (16.55 ± 3.10 min, F = 352.50, P < 0.001). There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores. Patient satisfaction degree of group T (77/80) was significantly higher than group C (66/80, χ 2= 7.96, P = 0.004) and G (69/80, χ 2 = 5.01, P = 0.025). One patient complained of post-dural puncture headache and two complained of low back pain in group C, while none in group T. Incidence of post-operative nausea and vomiting in group G (10/80) was significantly higher than group T (3/80, χ 2 = 4.10, P = 0.043) and group C (2/80, χ 2 = 5.76, P = 0.016). No deep vein thrombosis or delayed post-operative functional exercise was detected. Conclusions::Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients, with less blood loss and peri-operative transfusion, higher patient satisfaction degree and fewer complications.

OBJECTIVETo study the effect of Buyang Huanwu decoction (BYHWD) inducing angiogenesis on the neuroblast migration from the subventricular zone and its mechanisms after focal cerebral ischemia.

METHODThe middle cerebral artery occlusion (MCAO) was performed to mice for 30 minutes to establish the model. The rats were divided into sham group, model group, BYHWD group and endostatin group. BYHWD (20 g x kg(-1), ig) and endostatin (10 μg, sc) were administered 24 h after ischemia once a day for consecutively 14 days. At 14 d after ischemia, the density of micro-vessel and the number of neuroblasts in the ischemia border zone were determined by immunofluorescence staining. The mRNA and protein expression of cell-derived factor-1 (SDF-1) and brain-derived neurotrophic (BDNF) were examined by real-time PCR and Western blot.

RESULTCompared with the model group, BYHWD significantly increased the density of micro-vessel and the number of DCX positive cells in the ischemia border zone (P < 0.01), and significantly increased the SDF-1 and BDNF mRNA and protein expression (P < 0.01). Compared with BYHWD group, endostatin significantly reduced the density of micro-vessel and the number of DCX positive cells in the ischemia border zone (P < 0.01), as well as the SDF-1, BDNF mRNA and protein expression (P < 0.01).

CONCLUSIONBYHWD could promote the neuroblast migration from the subventricular zone via inducing angiogenesis after cerebral ischemia, the mechanism may be correlated with up-regulating the expression of SDF-1 and BDNF.

Angiogenesis Inducing Agents ; pharmacology ; Animals ; Brain Ischemia ; pathology ; physiopathology ; Brain-Derived Neurotrophic Factor ; analysis ; genetics ; Cell Movement ; drug effects ; Cerebral Ventricles ; pathology ; Chemokine CXCL12 ; analysis ; genetics ; Drugs, Chinese Herbal ; pharmacology ; Male ; Mice ; Mice, Inbred ICR ; Neurons ; drug effects ; physiology

5' and 3' flanking region of ovine BLG were amplified from sheep genomic DNA according to the published whole sequence of ovine BLG and cloned to pGEM-T vector correspondently. By partially sequencing, the sequences of BLG 5' and 3' flanking were the same as that of publication completely. The recombinant structure used to direct exogenous gene especially to express in mammary gland was constructed by joining 4.2 kb 5' flanking with 2.1 kb 3' flanking. In order to assess the efficiency of BLG regulatory elements, green fluorescent protein (GFP) gene as a reporter was fused with BLG construct and transfected the mammary epithelial cells (TD47). Through observation under UV microscope and detection by fluorometer, it is demonstrated that the GFP has been successfully expressed in TD47 cell line. By virtue of direct observation and quantitative analysis, the BLG-GFP construct can be served as a model for the quick assessment of mammary gland expression construct.
3' Flanking Region ; genetics ; 5' Flanking Region ; genetics ; Animals ; Breast ; cytology ; Cell Line ; Cloning, Molecular ; Gene Expression Regulation ; Genes, Reporter ; Green Fluorescent Proteins ; Lactoglobulins ; biosynthesis ; genetics ; Luminescent Proteins ; biosynthesis ; genetics ; Sheep

OBJECTIVETo evaluate the effect of the diameter of abdominal aortic aneurysm (AAA) on endovascular exclusion (EVE) and its results.

METHODSFrom March 1997 to June 2007, 429 AAA patients were treated with endovascular stent-graft exclusion. According to the maximal diameter of abdominal aortic aneurysm, the patients were divided into two groups: group A (diameter < 55 mm, n = 274) and group B (diameter > or = 55 mm, n = 155). The diameter of AAA, involvement of iliac artery, length, diameter and distortion of aneurismal neck in the two groups were recorded and compared retrospectively.

RESULTSPatients in group B were significantly older than group A (73.7 vs 71.1 years, P < 0.05). More patients in group B was complicated with coronary artery disease than those in group A (P < 0.05). The mean diameter of AAA in group A was (46.6 +/- 6.8) mm, and (66.8 +/- 11.2) mm in group B (P < 0.05). Proximal aneurysmal necks were shorter, wider and more tortuous in group B than those in group A (P < 0.05). Extraperitoneal approach, embolism of inner iliac artery and reconstruction of another inner iliac artery and stretch technique were more applied in group B. There were more endoleak during operation in group B and more stent-grafts were used. There was significant difference in morbidity rate between the two groups, while no statistic difference in mortality. And in group B, there were a high rate of endoleak and secondary intervention post operation.

CONCLUSIONSThe diameter of AAA affects EVE and its results. In small aneurysms, EVE carries better outcome than in big aneurysms.

Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; pathology ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stents ; Treatment Outcome

Tetramethylpyrazine (TMP), an effective component of traditional Chinese medicine Chuanxiong, is commonly used to resolve embolism. Its possible therapeutic effect against atherosclerosis has received considerable attention recently. Angiotensin II (Ang II) is highly implicated in the proliferation of vascular smooth muscle cells (VSMCs), resulting in atherosclerosis. The mechanisms of TMP in the proliferation of VSMCs induced by Ang II remain to be defined. The present study was aimed to study the effect of TMP on Ang II-induced VSMC proliferation through detection of nuclear factor-kappaB (NF-kappaB) activity and bone morphogenetic protein-2 (BMP-2) expression. Primary cultured rat aortic smooth muscle cells were divided into the control group, Ang II group, Ang II + TMP group and TMP group. Cells in each group were harvested at different time points (15, 30 and 60 min for detection of NF-kappaB activity; 6, 12 and 24 h for measurement of BMP-2 expression). NF-kappaB activation was identified as nuclear staining by immunohistochemistry. BMP-2 expression was observed through Western blot, immunohistochemistry and in situ hybridization. The results showed that: (1) Ang II stimulated the activation of NF-kappaB. Translocation of NF-kappaB p65 subunit from cytoplasm to nucleus appeared as early as 15 min, peaked at 30 min (P<0.01) and declined after 1 h. (2) TMP inhibited Ang II-induced NF-kappaB activation (P<0.01). (3) Ang II increased BMP-2 expression at 6 h but declined it significantly at 12 and 24 h (P<0.01). (4) BMP-2 expression was also kept at high level at 6 h in Ang II + TMP group but maintained at the normal level at 12 and 24 h. (5) There was no significant difference in NF-kappaB activation and BMP-2 expression between the control group and TMP group. These results indicate that TMP inhibits Ang II-induced VSMC proliferation through repression of NF-kappaB activation and BMP-2 reduction, and BMP-2 expression is independent of the NF-kappaB pathway. In conclusion, TMP has therapeutic potential for the treatment of atherosclerosis.
Angiotensin II ; antagonists & inhibitors ; Animals ; Atherosclerosis ; drug therapy ; Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; analysis ; antagonists & inhibitors ; Immunohistochemistry ; Muscle, Smooth, Vascular ; cytology ; drug effects ; metabolism ; Myocytes, Smooth Muscle ; metabolism ; NF-kappa B ; analysis ; antagonists & inhibitors ; Pyrazines ; pharmacology ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta ; analysis ; antagonists & inhibitors

OBJECTIVETo investigate the factors upgrading the International Society of Urological Pathology (ISUP) Gleason score using the specimens from preoperative prostatic biopsy and radical prostatectomy.

METHODSA total of 164 patients diagnosed with prostate cancer by biopsy underwent radical prostatectomy. We retrospectively analyzed their age, prostate volume, preoperative PSA level, PSA density (PSAD) , the time interval between biopsy and surgery, the number of positive punctures, positive surgical margin, seminal vesicle invasion, lymphatic invasion, and Gleason scores from biopsy and prostatectomy. We also determined the predictors of Gleason score upgrading by logistic regression analysis.

RESULTSOf the 164 cases analyzed, 95 (57.93% ) showed a consistency between the Gleason score of preoperative prostatic biopsy and that after radical prostatectomy, 55 (33.54% ) increased and 14 (8.52%) decreased after prostatectomy as compared with preoperative biopsy. The prostate volume (P < 0.01) and biopsy score (P < 0.05) were independent predictors of Gleason score upgrading. The risk of Gleason score upgrading was 27 times higher in the patients with the prostate volume ≤ 25 ml and 9 times higher in the 25-40 ml group than in the > 60 ml group (P < 0.05).

CONCLUSIONLow Gleason score of biopsy (≤ 6) and small prostate volume (≤ 40 ml) may be the predictors of Gleason score upgrading after radical prostatectomy.

Biopsy ; Humans ; Male ; Neoplasm Grading ; Organ Size ; Prostate-Specific Antigen ; blood ; Prostatectomy ; Prostatic Neoplasms ; classification ; surgery ; Retrospective Studies ; Risk Factors

OBJECTIVETo investigate the risk factors related to post-asphyxial multiple organ dysfunction (PA-MOD) in neonates.

METHODSA total of 397 neonates with birth asphyxia were enrolled from January 2009 to December 2010.The patients were divided into PA-MOD group (n=179) and non-PA-MOD group (n=218). The risk factors of PA-MOD were retrospectively studied.

RESULTSMultivariate logistic regression analysis showed that severe asphyxia, fetal distress, abnormal labor, and decreased amniotic fluid were the risk factors for PA-MOD among the neonates. Spearman rank correlation analysis showed that the number of the involved organs increased along with the increase of age at admission (P<0.05) and with the decrease of gestational age and birth weight (P<0.05).

CONCLUSIONSThe efforts should be made to enhance perinatal care for neonates, especially for preterm infants and low-birh-weight infants, to decrease the incidence of MOD.

Asphyxia Neonatorum ; complications ; Female ; Humans ; Infant, Newborn ; Logistic Models ; Male ; Multiple Organ Failure ; etiology ; prevention & control ; Risk Factors

Destructive injury is defined as a very serious damage both to the bone and the soft tissues. But in clinical practice we found that in some fracture cases, the damage to soft tissues is not as severe as "destructive injury" indicates, whereas comminuted fractures still cannot show the severity of bone damage. Therefore we proposed a new term "destructive fractures" after combining the definition of destructive injury with typical clinic cases. Destructive fractures refer to the fractures whose osseous tissues are damaged too seriously to be repaired, but soft tissues, nerves and veins are less severely injured and can be repaired. From the year 2001 to 2010, 75 cases of destructive fractures were admitted in our department. According to whether the fractures interlinked with the external environment, together with the fracture sites, they were divided into 6 types: a1 type, closed diaphysis destructive fracture; a2 type, open diaphysis destructive fracture; b1 type, closed joint-involved destructive fracture; b2 type, open joint-involved destructive fracture; c1 type, closed mixed destructive fracture; c2 type, open mixed destructive fracture. Corresponding clinical treatments were conducted for each type.The new classification criterion of destructive fracture is simple and practical and thus can be used as an important guide to make reasonable treatment plans for destructive fractures.
Fracture Fixation, Internal ; Fractures, Closed ; Fractures, Comminuted ; surgery ; Fractures, Open ; surgery ; Humans

OBJECTIVETo evaluate the therapeutic effect of endovascular placement of iodine-125 seed strand and stent combined with transcatheter arterial chemoembolization (TACE) to treat hepatocellular carcinoma (HCC) with tumor thrombus in the main portal vein (MPVTT).

METHODSFifty patients with HCC complicated by MPVTT were enrolled into this study. There were 46 men and 4 women with a mean age of 53.9 years. TACE was performed after the iodine-125 seed strand and self-expandable stent placement in the obstructed segment of the main portal vein (MPV).

RESULTSTechnical success rate was 100% for placement of iodine-125 seed strand and stent in the target segment of MPV. No serious procedure-related complications occurred. The mean follow-up duration was 208.5 d. The mean and median survival time was 370.1 d and 223.0 d, respectively. The 90-, 180-, 360-day cumulative survival rates were 97.5%, 59.3%, and 38.4%, respectively. The mean and median patent time of stent was 524.2 d and 407.4 d, respectively. The 90-, 180-, 360-day cumulative patency rates of stent were 94.9%, 75.2%, and 64.5%, respectively.

CONCLUSIONEndovascular placement of iodine-125 seed strand and stent combined with TACE is an effective therapy for HCC with tumor thrombus in the main portal vein.

Adult ; Aged ; Carcinoma, Hepatocellular ; pathology ; therapy ; Chemoembolization, Therapeutic ; methods ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Iodine Radioisotopes ; therapeutic use ; Liver Neoplasms ; pathology ; therapy ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; Portal Vein ; pathology ; Stents ; Survival Rate