Objective To investigate the optimum concentration and dose of ropivacaine for caudal block in the neonates undergoing laparotomy under general anesthesia.Methods One hundred pediatric patients of both sexes,aged 9-30 days,weighing 2.5-4.5 kg,scheduled for elective pyloromyotomy,were randomly divided into 5 groups (n =20 each) using a random number table:control group (group C),0.10％ ropivacaine 1.0 ml/kg group (group 0.1％ L1),0.15 ％ ropivacaine 1.0 ml/kg group (group 0.15 ％ L1),0.10 ％ ropivacaine 1.2 ml/kg group (group 0.10 ％ L2),and 0.15 ％ ropivacaine 1.2 ml/kg group (group 0.15 ％ L2).Anesthesia was induced with sevoflurane and cisatracurium.The pediatric patients were tracheally intubated and mechanically ventilated.Remifentanil was infused intravenously at 0.2-0.3 μg· kg-1 · min-1 in group C.In 0.10 ％ L1,0.15 ％ L1,0.10 ％ L2 and 0.15％L2 groups,the corresponding concentrations and doses of ropivacaine were injected into the sacral canal under the guidance of ultrasound.The operation was started at 15 min after administration and sevoflurane was inhaled and the end-tidal concentration of sevoflurane was maintained at 0.8-1.0 MAC.Before induction (T1),at pyloric muscle retraction (T2),and at 4,8,12 and 24 h after operation (T3-6),blood samples were collected from the central vein for determination of plasma concentrations of cortisol and interleukin-6 (IL-6).Pain was assessed using CRIES score at T3-6.When CRIES scores ＞ 3,10％ chloral hydrate 0.5 ml/kg was given by retention enema for analgesia,and the requirement for chloral hydrate was recorded.The emergence time,extubation time,duration of stay in post-anesthesia care unit (PACU) and hospital discharge time were recorded.Bradycardia and hypotension during operation,and development of motor block of lower extremities,infection and dehiscence of incision,vomiting,and urinary retention after operation were also recorded.Results Compared with group C,no significant changes were found in the emergence time,extubation time,duration of stay in PACU,hospital discharge time,plasma concentrations of cortisol and IL-6,the requirement for chloral hydrate,and the incidence of bradycardia,hypotension,motor block of lower extremities,and infection and dehiscence of incision in 0.10％ L1 and 0.15 ％ L1 groups,the emergence time,extubation time,duration of stay in PACU,hospital discharge time were significantly shortened,and the plasma concentrations of cortisol and IL-6,requirement for chloral hydrate,and the incidence of hypotension and infection of incision were decreased in 0.10％ L2 and 0.15％ L2 groups,and the incidence of vomiting and urinary retention was increased in 0.15％ L1 and 0.15％ L2 groups.Compared with group 0.10％ L2,the incidence of vomiting and urinary retention was significantly decreased,and no significant changes were found in the other parameters mentioned above in 0.15％ L2 group.Conclusion The optimum concentration and dose of ropivacaine are 0.10％ and 1.2 ml/kg,respectively,for caudal block in the neonates undergoing laparotomy under general anesthesia.

Objective To compare the clinical pharmacodynamics of domestic and imported propofol by target-controlled infusion. Methods This was a prospective,randomized,double-blind,cross-over study. Eighteen ASA Ⅰ or Ⅱ patients aged 45-55 yr undergoing substitute valve operation for severe deep venous were randomly divided into sequential Ⅰ and Ⅱ , in sequence Ⅰ , the imported propofol was applied in the first stage of surgery and then domestic propofol in the second stage surgery, while in sequence Ⅱ the order was reversed. The target plasma concentration of propofol was initially set at 0.5 μg/ml, followed by increments of 0.5 μg/ml when the effect-site concentration and plasma concentrations was balanced, until the predicted effect-site concentrations reached 3.5 μg/ml. BIS value, RR, SpO2 and hemodynamics were recorded at 0,0.5, 1.0,1.5,2.0,2.5,3.0 and 3.5 μg/ml effect-site concentration level, the predicted effect-site concentrations and the BIS value at loss of consciousness in 5%, 50% and 95% of the patients were calculated. Adverse reactions were recorded during the trial period.Results Under the same effect-site concentration,there was no significant difference in BIS value,RR, SpO2 and hemodynamic monitoring indicators between the two drugs( P ＞ 0.05). There was no significant difference in predicted effect-site concentrations of propofol, the BIS value at loss of consciousness in 5%, 50% and 95% of the patients and the incidence of adverse reaction between the two drugs ( P ＞ 0.05). Conclusion The domestic propofol and imported propofol have clinical bioequivalence.

Objective To investigate the effect of acute hypervolemic hemodilufion (AHHD) on EC50 of propofol by target-controlled infusion (TCI) for loss of consciousness (LOC). Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr scheduled for vertebral eolunm or total hip replacement surgery were randomly divided into 4 groups (n = 15 each) : group Ⅰ target plasma concentration of propofol (Tp) ;group Ⅱ target effect-site concentration of propofol (Te) ;group Ⅲ AHHD + Tp and group Ⅳ AHHD + Te. All the patients recoived iv infusion of lactated Ringer's solution 0.7 ml·kg-1 ·h-1 via peripheral vein for 30 min. At the same time 4% gelofusion 15 ml/kg was infused over 30 min via internal jugular vein in group Ⅲ and Ⅳ. At the end of gelofusine infusion TCI of propofol was started. The initial target concentration was set at 1.2 μg/ml. After the target concentration was steadily maintained for 30 s, the consciousness of the patients was evaluated by an anesthesiologist not involved in the study using OAA/S scale. The target concentration was increased in 0.3 μg/ml increment until the patients lost consciousness (OAA/S = 0). The target plasma concentration and effect-site concentration were then recorded. EC50 and 95% confidence interval (CI) of propofol for LOC were calculated by probit analysis. Results The ECho (95 % CI) of propofol for patients in group Tp, Te, AHHD + Tp and AHHD + Te (group Ⅰ-Ⅳ) were 3.74 (3.46-4.16), 2.32 (2.17-2.42), 4.12 (3.81-4.32) and 2.38 (2.14-2.56) μg/ml respectively. EC50 was significantly higher for loss of consciousness in AHHD + Tp group (group Ⅲ)than in Tpgroup (group Ⅰ), but there was no significant difference in EC50 between group Te and group AHHD + Te. Conclusion AHHD can increase the EC50 of target plasma concentration of propofol by TCI for LOC but has no effect on EC50 of target effect-site concentration.

Objective To evaluate the correlation between CYP3A4 enzyme and analgesia with fentanyl after gynecological operation. Methods One hundred and fifty-nine ASA Ⅰ or Ⅱ patients, aged 30-50 yr, scheduled for elective myomectomy or abdominal total hysterectomy, were enrolled in this study. Anesthesia was induced with midazolam, remifentanil, propofol and succinylcholine and maintained with iv infusion of propofol and remifentanil and intermitent iv injection of atracurium. Venous blood samples were obtained for determination of the plasma 1'-hydroxymidazolam and midazolam concentrations at 1 h after iv injection of midazolam. The ratio of the 1'-hydroxymidazolam concentration to the midazolam concentration was used to reflect the effect of CYP3A4 enzyme. Pain was assessed with visual analog scale (VAS) after consciousness was regained. When VAS score ＞ 4,the patients were given fentanyl 10 μg every 5 min until VAS score ≤ 4 and then PCIA with fentanyl was performed. VAS score was maintained ≤4. The times of successful delivery within 24 h after operation and during the period of 24-28 h after operation and fentanyl consumption within 48 h after operation were recorded. Pearson correlation was used to analyze the data. Results There was no correlation between the effect of CYP3 A4 enzyme and the times of successful delivery or fentanyl consumption, and the correlation coefficients were 0.16, 0.13 and 0.11 respectively ( P ＞ 0.05). Conclusion CYP3A4 enzyme is not the major enzyme metabolizing fentanyl.

Objective To validate the Partin table 1997,2001 and 2007 for their accuracy in predicting pathologic stage in Chinese prostate cancer patients.Methods From January 1997 to June 2007,109 consecutive patients with clinically localized prostate carcinoma underwent open retropubic or laparoscopic radical prostatectomies and met all inclusion criteria well enrolled.Receiver operating characteristic(ROC)analysis was performed tO test the predictive accuracy of organ confined disease (0CD),extraprostatic extension(EPE),seminal vesicle involvement(SVI)and lymph node involvement(LNI). Results OCD,EPE,SVl and LNl were noted in 70%,17%,13%and 0%of cases respectively.The area under curve(AUC)of ROC for Partin table 1997 was 0.727,0.654 and 0.811for 0CD.EPE and SVl respectively,and was 0.693,0.633 and 0.835 for Partin table 2001 and 0.669.0.611 and 0.778 for Partin table 2007.Conclusions Partin tables 1997,2001 and 2007 are able to accurately predict the pathologic feature of seminal vesicle involvement.However,only Partin table 1997 can more accurately predict organ confined disease in this external validation for Chinese patients.

Objective To evaluate the effect of dexmedetomidine on cognitive dysfunction after thoracic surgery in patients undergoing one-lung ventilation.Methods Sixty-two patients,aged 45-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index ranged from 17.5 to 25.5 kg/m2,scheduled for elective thoracic surgery,were randomly allocated into 2 groups (n =31 each) using a random number table:dexmedetomidine group (Dex group) and control group (C group).Dexmedetomidine 0.5 μg/kg was infused for 10 min starting from the time point before induction of anesthesia,followed by continuous infusion at a rate of 0.5 μg · kg-1 · h-1 until 30 min before the end of surgery in Dex group.The equal volume of normal saline was administered instead in group C.Before induction and at 24,48 and 72 h after surgery,venous blood samples were collected for determination of levels of S-100 beta protein and neuronspecific enolase in serum by ELISA.Cognitive function was assessed by Mini-Mental State Examination at 72 h after surgery.Results The levels of S-100 beta protein and neuron-specific enolase in serum were significantly increased after surgery than before induction in the two groups.Compared to C group,the levels of S-100 beta protein and neuron-specific enolase in serum were significantly decreased after surgery,and the incidence of postoperative cognitive dysfunction was decreased in Dex group (26％ vs 6％).Conclusion Dexmedetomidine can effectively reduce the nerve damage during one-lung ventilation and significantly inhibit the development of postoperative cognitive dysfunction in patients undergoing thoracic surgery,indicating that dexmedetomidine is suitable for thoracic surgery.

Objective:To describe our diagnostic and therapeutic experience of patients with urinary tract endometriosis.Methods:We performed a retrospective analysis of 22 cases of urinary tract endometriosis with histopathological results from 2001 to 2007.Results:The mean patient age was 36.0 years.Of the 22 patients,4 had bladder involvement and 18 ureteral involvement.In those with bladder endometriosis,the diagnosis was made by cystoscopy and biopsy in 4 patients.The treatments consisted of partial cystectomy in 3 patients and transurethral resection of the bladder in 1 patient.One of the patients who underwent transurethral resection of the bladder experienced 1 relapse.The relapse was treated with partial cystectomy.In the patients with ureteral endometriosis,the diagnosis was mainly established by ultrasound(18 cases),intravenous urography(11 cases),retrograde pyelography(7 cases),CT(14 cases) and MRI(5 cases).The treatments consisted of ureterolysis in 1 patient,ureteroneocystostomy in 4,and ureteral resection and end-to-end anastomosis in 13 of them.All the patients pathologic results were of endome-triosis.Conclusion:Urinary tract endometriosis is an uncommon disease.Partial cystectomy should be considered as the therapeutic option for bladder endometriosis.For cases of ureteral endome-triosis,the first technique depends on the location,extent and depth of the lesion.

Objective:To evaluate the role of ten-eleven translocation methylcytosine dioxygenase 3 (TET3) in trigeminal ganglion in maxillofacial inflammatory pain in mice.Methods:Forty SPF healthy male C57BL/6J mice, aged 8-10 weeks, weighing 19-23 g, were divided into 5 groups ( n=8 each) using a random number table method: control group (group C), inflammatory pain group (group IP), control+ TET3-siRNA group (group C+ siTET3), inflammatory pain+ TET3-siRNA group (group IP+ siTET3) and inflammatory pain+ negative control Scrambled-siRNA group (group IP+ siNC). Normal saline or complete Freund′s adjuvant (CFA) 10 μl was injected into the temporomandibular joint of mice, respectively, and the mechanical paw withdrawal threshold (MWT) was measured at 1, 4, 8 and 12 days after injection (T 1-4). Before injection of normal saline or CFA, 0.75 μl siTET3 or siNC was injected into the trigeminal ganglion and the animals were then sacrificed and trigeminal ganglion was removed at T 2 for determination of the expression of TET3 by Western blot in C+ siTET3, IP+ siTET3 and IP+ siNC groups. Results:Compared with group C, MWT was significantly decreased at T 1-3 , the expression of TET3 in trigeminal ganglion was up-regulate in group IP ( P<0.05 or 0.01). Compared with IP and IP+ siNC groups, MWT was significantly increased at T 2, 3, and the expression of TET3 in trigeminal ganglion was down-regulate in group IP+ siTET3 ( P<0.05 or 0.01). Conclusion:TET3 in trigeminal ganglion is involved in the development of maxillofacial inflammatory pain in mice.

Objective To evaluate the changes in the expression of Toll-like receptor 4 (TLR4) mRNA and its down-stream cytokines IL-1β and TNF-α mRNA in spinal cord in a rat model of incisional pain.Methods Fifty-eight male Sprague-Dawley rats,weighing 180-220 g,were used in this study.A 1-cm longitudinal incision was made through skin,fascia and muscle of the plantar aspect of the hindpaw in isoflurane-anesthetized rats.Mechanical paw withdrawal threshold to yon Frey filament stimulation (MWT) on the operated and non-operated sides was measured before operation and at 0.5,1,2,6 and 12 h and 1,2,3,5 and 7 days after operation.Six rats were chosen and sacrificed before operation and at 2 and 8 h and 1,2,3,5 and 7 days after operation.Their lumbar segments (L4-6) of the spinal cord were removed for determination of the expression of TLR4,IL-1β and TNF-α mRNA by real-time PCR.Results Compared with the baseline value before operation,MWT on the operated side was significantly decreased at 0.5 h-5 days after operation,and the expression of TLR4,IL-1β and TNFα mRNA was up-regulated at 2 and 8 h and 1,2 and 3 days after operation (P ＜ 0.05),and no significant change was found in MWT on the non-operated side (P ＞ 0.05).MWT on the operated side was lowest at 2 h after operation and then gradually increased,the expression of TLR4 mRNA peaked on 1 day after operation,and the expression of IL-1 and TNF-α mRNA peaked at 8 h after operation (P ＜ 0.05).The TLR4 mRNA expression was negatively correlated with MWT on the operative side (r =-0.484,P ＜ 0.05),and IL-1 mRNA and TNF-α mRNA expression was positively correlated with TLR4 mRNA (r =0.294 and 0.540,respectively,P ＜ 0.05).Conclusion The expression of TLR4 mRNA and its down-stream cytokines IL-1β and TNF-α(mRNA in spinal cord is up-regulated,this change is involved in the maintenace of incisional pain,but it does not play an important role.

Objective To analyze the clinical characteristics of renal cell carcinoma (RCC) and unveil the current status of diagnosis and treatments. Methods The registry data from 23 medical centers cover different areas of China. A total of 2030 new cases of RCCs in the 23 centers from Au-gust 2007 to October 2008 were collected, in which 1975 cases had integrated data for analysis. The symptoms, diagnostic techniques, pathology features, and therapeutic selection were analyzed. Re-sults A total of 1975 new cases were reviewed, with 1329 males and 634 females. The male and fe-male ratio was about 2.1 : 1.0. Of all cases, 1238 patients (62.7%) were asymptomatic and detected by examination, while 711 patients (36.0%) were symptomatic. 1260 patients (63.8%) were clinical stage Ⅰ , most of them were asymptomatic. 1844 patients were treated surgically, 1500(81.3%) un-derwent radical nephrectomy, 325 (17. 6%) underwent partial nephrectomy. Among the operations, open operation was performed in 1493 cases(81.0%), laparoscopic procedure in 351 cases(19.0%). There were 1522(84.5%) clear cell carcinomas, 98 (5.44%) papilliform renal cell carcinomas. Con-clusions Routine health examination could be an important way to diagnose early stage RCC. Open radical nephrectomy is the most often used surgical technique among the centres of present study.