Objective To investigate the changes in the expression of nerve growth factor (NGF) and brain-derived neurotrophic (BDNF) in the dorsal root ganglion (DRG) and spinal dorsal horn following peripheral inflammatory hyperalgesia induced by formalin injected into the plantar region of the right hindpaw in rats. Methods Twenty-four adult SD rats weighing 250-400 g were studied. Peripheral inflammatory hyperalgesia was induced by an intraplantar injection of 5% formalin into right hindpaw. The animals were randomly divided into 4 groups (n=6 in each group), group A:control; group B:2 h after formalin injection; group C:24 h after formalin injection and group D: 48 h after formalin injection. Pain response was recorded. The expression of NGF and BDNF in the inflamed skin, DRG and spinal dorsal horn was detected using immuno-histochemistry technique and image analysis method. Results There were significant bi-phasic nociceptive responses induced by intraplantar injection of formalin in rats. The expression of NGF started to increase 2 h after injection, in the inflamed skin, ipsilateral DRG and dorsal horn neurons and reached the peak level at 24 h after injection. The expression of BDNF in ipsilateral DRG and dorsal horn neurons was unchanged 2 h after injection and started to increase at 24 h after injection. There was a positive correlateion between the expression of NGF and BDNF in ipsilateral DRG neurons.Conclusion NGF is not only an important transmitter in the peripheral mechanicsm of inflammatory pain but also involved in central sensitization through facilitating expression of BDNF in dorsal horn neurons.

Objective To evaluate the relationship between pharmacodynamics of sufentanil-induced respiratory depression and age factors. Methods Forty ASA Ⅰ or Ⅱ patients scheduled for elective abdominal surgery were randomly divided into 2 groups according to the age: young and middle-aged group (25-64 yr, group M) and elderly group (65-80 yr, group E). EC50 was determined by up-and-down sequential trail. The initial target effect-site concentration (Ce) of sufentanil was set at 0.40 and 0.35 μg/ml in group M and E respectively.Each time Ce decreased/increased by 10% in the next patient depending on whether or not the respiratory depression occurred. Respiratory depression was defined as VT ≤ 5 ml/kg, RR ≤ 8 bpm/min, SpO2 ≤ 94%,PET CO2 ≥ 55 mm Hg, and/or apnea ≥ 15 s. Results The EC50 and 95 % confidence interval of sufentanil causing respiratory depression were 0.61 (0.54-0.70) μg/ml and 0.41 (0.38-0.45) μg/ml in group M and E respectively with the significant difference. Conclusion The efficacy of sufentanil-induced respiratory depression is related to age factors and the elderly patients are more sensitive to sufentanil-induced respiratory depression.

Objective To assess the efficacy of ropivacaine in combination with different doses of sufentanil for epidural anesthesia in patients undergoing hysterectomy. Methods Eighty ASA Ⅰ or Ⅱ patients aged 30-55 yrs weighing 40-70 kg undergoing elective hysterectomy were randomly divided into 4 groups ( n = 20 each) : ropivacaine group (R) and 3 ropivacaine-sufentanil groups (R-S1-3). The patients were unpremedicated. ECG, BP, HR and SpO2 were monitored during ansthesia. Each patient received an epidural catheter placed at L2,3 interspace. After correct placement of epidural catheter was confirmed 0.75% ropivacaine 13 ml and normal saline (NS) 2 ml were given through epidural catheter in group R whereas in the 3 R-S groups 0.75% ropivacaine 13 ml and sufentanil 10 (R-S1), 20 (R-S2) or 30 (R-S3) ?g in NS 2 ml were injected into epidural space. BP, HR and SpO2 were recorded every 3 min. The onset time, upper spread and duration of sensory block; onset and duration of motor block (Bromage scale); degree of abdominal muscle relaxation; level of sedation (OAA/S scale); anesthetic efficacy and side-effects were recorded. The dose-response curve constructed by probit regression analysis was established to calculate ED50 and ED95. Results The onset time, the time needed to reach the highest sensory level were significantly shorter and the duration of sensory block was significantly longer in the 3 R-S groups than in R group ( P

Objective To investigate the effects of different doses of dexmedetomidine on cerebral oxygen saturation and pulmonary shunt fraction in patients undergoing one-lung ventilation (OLV). Methods Sixty ASAⅠ-Ⅱpatients, aged 46-71 years, with body mass index (BMI)18-24 kg/m2 and scheduled for thoracotomy were randomly divided into three groups (n=20 each):high dose dexmedetomidine group (group D1), low dose dexmedetomidine group (group D2) and control group (group C). Dexmedetomidine 1μg/kg was infused in group D1 after anesthesia induction, and then a rate of 0.5μg·kg-1·h-1 was continuously infused. Dexmedetomidine 0.5μg/kg was infused in group D2 after anesthesia induction, and then a rate of 0.3μg · kg-1 · h-1 was continuously infused. Group C was received the equal volume of normal saline. Anesthesia was main?tained with propofol-remifentanil and intermittent iv boluses of rocuronium. Arterial and jugular venous blood samples were collected before anesthesia induction (T0), at 15 min after two-lung ventilation (T1), at 5 min (T2) and 30 min (T3) of OLV for blood gas analysis. Value of Qs/Qt was calculated and SctO2 was recorded at the same time. Results Compared with group C and group D2, Qs/Qt was decreased at T2 in group D1 (P<0.05). Qs/Qt was lower at T3 in group D1 and D2 than that of group C, and which was lower in group D1 than that of group D2 (P<0.05). In group C and group D1 a significant de?crease in SctO2 was observed at T2 and T3 compared to that at T0 and T1 (P<0.05). SctO2 was significantly higher at T2 and T3 in group D2 than that in group C and group D1 (P<0.05). Conclusion Dexmedetomidine given during OLV undergoing thoracotomy can improve oxygenation, decrease pulmonary shunt fraction and reduce the occurrence of low SctO2.

Objective To evaluate the values of maternal serum levels of lipid and uric acid at second trimester in predicting preeclampsia,gestational diabetes mellitus and macrosomia. Methods Concentrations of selected metabolic markers including total cholesterol,triglyceride,low density lipoprotein-cholesterol,high density lipoprotein-cholesterol,apolipoprotein AI,apolipoprotein B and uric acid were examined in 1000 healthy singleton primiparous who accepted regular prenatal healthcare in Naniing Drum Tower Hospital,at 20 weeks of gestation from June 2009 to January 2010.All the pregnant women were followed up to their deliveries.Pregnancy complications,such as preeclampsia and gestational diabetes mellitus (GDM),the data of maternal and neonatal outcomes such as gestational age at delivery,neonatal birthweight were recorded.Relationship between adverse outcome and blood lipid,uric acid levels was analyzed by Logistic regression,and the risk factors were confirmed; predictive values of those sensitivity and specificity were calculated by receiver operating characteristic curve. Results Among the 1000 pregnant women, 61 (6.1％) developed preeclampsia and 100 (10.0％) developed GDM.The mean gestational age of delivery was (39.3±1.2) weeks,and the incidence of preterm delivery was 1.5％ (15/1000).The mean birthweight was (3389.6±4 422.8) g,and the prevalence of macrosomia was 8.9％ (89/1000).Women who had elevated triglyceride levels had a 3.42-fold increased risk of preeclampsia (95 ％ CI:1.88-6.22,P =0.000) and 2.12-fold increased risk of GDM (95％ CI:1.38-3.35,P =0.001).Hyperuricemic women experienced a 2.09-fold increased risk of preeclampsia (95％CI:1.24-3.53,P=0.005) and 2.22-fold increased risk of GDM (95％CI:1.32-3.43,P=0.002).Women who had decreased high density lipoprotein-cholesterol level experienced a 2.34-fold increased risk of preeclampsia (95 ％ CI:1.20-4.55,P =0.011),2.03-fold increased risk of GDM (95 ％ CIr:1.33-3.11,P =0.001 ) and 1.67-fold increased risk of macrosomia (95％CI:1.06-2.64,P=0.026).The area under receiver operating characteristic curve of these metabolic markers was 0.56-0.65, the sensitivity was 28％-82％ and the specificity was 34％-85％. Conclusions Hypertriglycemia,hyperuricemia,and hypo high density lipoprotein-cholesterolcmia at 20 weeks of gestation might relate to preeclampsia,GDM and macrosomia,but the predictive values of them are limited.

BACKGROUND: Ghildren refractory clubfoot includes idiopathic multiple contracture, untreated idiopathic clubfoot in older children and failure cases of repeated operations. It is very difficult to treat this type of children patients. It has important significance in the exploration of new therapeutic methods.OBJECTIVE: To improve the therapeutic effectiveness of refractory clubfoot in children with Ilizarov method.DESIGN: a self-controlled study.SETTING: Department of Orthopedics, Nanjing Children' s Hospital, Nanjing Medical University.PARTICIPANTS: Totally 3 cases of children idiopathic multiple contracture, 2 cases of idiopathic clubfoot in children aged more than 10 years old without treatment and 6 cases of postoperative recurrent idiopathic clubfoot were admitted by the Department of Orthopedics of Nanjing Children' s Hospital Affiliated to Nanjing Medical University during 1999 to 2000. All cases manifested abnormal ankylosis and shortening deformity in foot.METHODS: Twelve refractory clubfeet in eleven patients were treated with the Ilizarov method. After achilles tendon lengthening and posterior release,kieschner' wires or olive wires with tension were penetrated through multiple planes of the middle lower 1/3 of tibia, calcaneus and the 1st to the 5th metatarsals, which were fixed respectively to external bone fixer of a ring,half-ring or horseshoe shape and connected with each other by multiple screw bars into a three-dimensional external bone fixing set. Plantarflexion, inversion, adduction and shortening deformities were corrected by the adjustment of the distance between each part of the external bone fixing set through extension, compression, and rotation, etc., and navicular and cuboid osteotomy.MAIN OUTCOME MEASURES: All 11 cases were followed up for 2 to 10 years with an average period of 4. 5 years. Indices like foot morphology,talocrural articualr activity range and deformity correction were observed during the follow up.RESULTS: The results were excellent in 5 cases (6 feet), good in 4 cases (4 feet), fair 2 cases(2 feet) according to the Garceau standard scale. The rate of excellent and good clinical results was 83.3%. Mild forefoot adduction was left in 2 feet of 2 cases and quite obvious tarsal articular ankylosis was found in 4 feet of 4 cases; however, there were no significant differences of gait and load bearing between these patients and normal children.CONCLUSION: The Ilizarov technique is a safe and effective method for the treatment of refractory children clubfoot while its indications should be controlled strictly.

Objective To discuss the success rate of external cephalic version (ECV) for breech presentation in singleton pregnancies and the factors influencing ECV,and complications induced by ECV.Methods A prospective study was conducted which included 204 pregnant women who underwent regular prenatal examinations and delivered in Nanjing Drum Tower Hospital between March 1,2011 and February 29,2012.The 204 cases were single pregnancy with breech presentation identified by ultrasound during 32-37+6 weeks of gestation,and without other indications for cesarean section (CS).According to willingness of the participants,204 cases were divided into two groups.The 101 pregnant women who refused EVC (control group) were asked to practice knee-chest position twice a day; and 103 pregnant women volunteered to undergo EVC (ECV group) during 32-37+6 weeks of gestation.The proportion of cephalic presentation at delivery,CS rate and the incidence of PROM,premature delivery and cord around the neck were compared between the two groups.Factors influencing the success rate of ECV were analyzed.Chi-square or adjusted Chi-square test were used for statistical analysis.Results The proportion of cephalic presentation at delivery in the ECV group was higher than that in the control group [68.9％ (71/103) vs 29.7％ (30/101),x2=31.39]; the CS rate in the ECV group was lower than that in the control group [49.5％ (51/103) vs 78.2％ (79/101),x2=18.18],as was the rate of CS due to breech presentation [62.7％ (32/51) vs 89.9％ (71/79),x2=13.86],all P＜0.05.The success rates in frank breech presentation,complete breech presentation and incomplete breech presentation were 77.1％ (37/48),72.7％ (24/33) and 45.5％ (10/22),respectively (x2=7.37,P＜0.05),and the success rate in frank breech presentation was higher than that in incomplete breech presentation (x2=6.84,P＜0.017).No significant differences were observed in the success rates between primiparas and multiparas [67.7％ (63/93) vs 8/10,x2=0.19],placenta attached at front wall of uterus and other attachment sites [61.0％ (25/41) vs 74.2％ (46/62),x2=2.01],and EVC performed at 32-35+6weeks of gestation and 36-37+6 weeks [70.5％ (62/88) vs 9/15,x2=0.65],allP＞0.05.No significant differences were observed for the incidence of PROM [7.8％ (8/103) vs 6.9％ (7/101)],premature delivery [2.9％ (3/103) vs 2.0％ (2/101)] and cord around the neck [17.5％ (18/103) vs 21.8％ (22/101)] between the ECV and control group (x2=0.05,0.19 and 0.60,all P＞0.05).Conclusions ECV for breech presentation in singleton pregnancies can effectively correct the fetal position and reduce the CS rate.ECV performed after 32 weeks of gestation does not increase the risk of PROM and premature delivery.

ObjectiveTo observe the change of cardiac function after acute myocardial infarction (AMI) in rabbit model,and to study MRI characteristics of left ventricular remodeling (LVR).Methods Forty-five japanese white rabbits underwent chest-opening coronary artery ligation surgery to obtain rabbit myocardial infarction model The animals were scanned on a 1.5 T MR scanner ( GE Healthcare,Chalfont St.Giles,UK) at six time-points as surgery,1,2,4,6,8 weeks after surgery. Cardiac function parameters were measured,including left ventricular end diastolic volume ( EDV ),stroke volume ( SV ),ejection fraction (EF),peak ejection rate ( PER ) and peak firing rate (PFR).At each time point,5 rabbits were randomly selected and performed re-thoracotomy to obtain heart specimen.Each specimen was examined by MRI with the diffusion tensor imaging ( DTI ).The value of ADC and fractional anisotropy (FA) were collected. Cardiac function data sets of different time points were analyzed using repeated measures data of ANOVA.The FA and ADC values of infarction myocardium set of different time points or different parts of the myocardium were analyzed using one-way ANOVA. The average was compared statistically between two adjacent groups using LSD-t test. Results Left ventricular EDV increased in progress with the time.It was increased from ( 2.21 ± 0.35 ) ml preoperatively to ( 3.15 ± 0.57 ) ml 8-week postoperatively.But the difference was not statistical significant ( F =1.384,P =0.220).EF was decreased from(57.31 ± 11.11 )％ to( 34.71 ± 8.72 )％.It dropped significantly and the difference was statistically significant (F =27.134,P =0.001 ).EF showed a downward trend with the increase of EDV.By linear regression analysis,an equation was set up with y =- 5.58x + 57.7 ( F =8.855,P =0.005 ).On the other hand,PER showed a progressive decline from (27.31 ± 13.06) ml/s to ( 17.31 ± 6.41 ) ml/s ( F =2.105,P =0.037 ),and PFR decreased from ( 23.79 ± 14.15 ) ml/s to ( 12.07 ± 6.91 ) ml/s ( F =2.366,P =0.011 ).FA value decreased from 0.442 ±0.093 to 0.107 ±0.037( F =12.61,P =0.001 ),and ADC valueshowed upward trend from (5.07 ± 1.15) ×10-4 mm2/s to(6.39 ±0.78) ×10-4 mm2/s (F=4.166,P =0.022 ).FA values of infarct,adjacent and remote region were 0.201 ± 0.049,0.316 ± 0.127 and 0.323 ± 0.117 respectively( F =3.896,P =0.004 ),and the ADC values in these regions were (6.19 ± 1.78 ) ×10 -4,(5.44 ± 2.63 ) × 1 0 -4,(5.29 ± 2.02 ) × 10 -4 mm2/s respectively ( F =3.248,P =0.018 ).FA and ADC values were significantly different between the infarct region and adjacent region ( t =7.327,P =0.001 ;t =3.292,P =0.005,respectively),but there was no significantly different between adjacent region and remote region ( t =1.024,P =0.129 ; t =1.467,P =0.164,respectively ).ConclusionsMRI measurement of parameters of cardiac function can be used to monitor the process of left ventricular function remodeling after AMI.The process of micro-structural remodeling of myocardium can be reflected by DTI.MRI provides a feasible imaging modality for LVR after AMI.

Objective To evaluate the effects of long?term glucocorticoid administration on cisatra?curium?induced neuromuscular blockade in the patients undergoing laparoscopic operation. Methods Six?ty?four patients of both sexes, aged 40-64 yr, with body mass index of 18-22 kg∕m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic operation under general anesthesia, were assigned into 4 groups ( n=16 each) according to whether or not glucocorticoid was used for a long?term period: control ( non?hormone and non?laparoscopic operation ) group ( group C ) , hor?mone + laparoscopic operation group ( group HL ) , non?hormone + laparoscopic operation group ( group NHL) and hormone +non?laparoscopic operation group ( group HNL) . Midazolam 0.03 mg∕kg was injected intravenously, 8% sevoflurane was inhaled by mask, and the concentration of sevoflurane was decreased by 2% every 30 s until the concentration of 4% was reached. After loss of eyelash reflex, remifentanil 2μg∕kg was injected intravenously over 1 min, and 30 s later sevoflurane inhalation was stopped. The patients were tracheally intubated and mechanically ventilated. Anesthesia was maintained with propofol and remifentanil given by target?controlled infusion. Neuromuscular blockade was monitored with accelerograph TOF?watch
SX. At 20 min of pneumoperitoneum in NHL and HL groups or 20 min after intubation in C and HNL groups, cisatracurium 0. 15 mg∕kg was injected intravenously. The onset time, maximal degree of N?M block, clinical duration and recovery index of cisatracurium were recorded. Results Compared with group C, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clini?cal duration was shortened, and the recovery index was decreased in HL and HNL groups ( P<0.05) , and the clinical duration was significantly prolonged, the recovery index was increased ( P<0.05) , and no sig?nificant change was found in the onset time in group NHL ( P>0.05) . Compared with group HNL, the clin?ical duration was significantly prolonged, the recovery index was increased (P<0.05), and no significant change was found in the onset time in group HL ( P>0.05) , and the onset time was significantly shortened, the clinical duration was prolonged, and the recovery index was increased in group NHL ( P<0.05) . Com?pared with group NHL, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clinical duration was shortened, and the recovery index was decreased in group HL ( P<0.05) . Conclusion Long?term glucocorticoid administration can weaken cisatracurium?induced neuromus?cular blockade in the patients undergoing laparoscopic operation.

To explore the possibility to employ　99mTc-MIBI to monitor biological response of tumor cells after irradiation and to observe the relation between the radiation doses and the uptake levels of　99mTc-MIBI in tumor cells, the cells were irradiated with a single dose of 2 Gy, 10 Gy and 20 Gy respectively. The uptake of　99mTc-MIBI in each dosage group was determined before and 24, 48, 72 h after irradiation respectively. Apoptosis index (AI), plating efficiency (PE) of tumor cells was simultaneously determined. There was a positive correlation between uptake levels of　99mTc-MIBI and AI(r=－0.91, P<0.05). A negative correlation was noted between the uptake levels and PE (r=－0.86, P<0.05). It is suggested that　99mTc-MIBI may be used as a tracer to monitor the change of viability state of tumor cells after being irradiated with different doses.