BACKGROUND:There are many multimodal analgesia schemes in perioperative period of total knee arthroplasty, but there is no ideal scheme. OBJECTIVE:To explore the effects of multi-mode and preemptive analgesia on analgesic effect after total knee arthroplasty. METHODS:120 patients with severe osteoarthritis who underwent unilateral knee arthroplasty were enroled in this study. According to different analgesic effects, the patients could be divided into four groups (n=30). In the control group, no corresponding analgesic measures were found before and during replacement. In the preemptive analgesia group, celecoxib was oraly taken before replacement. In the cocktail analgesia group, cocktail was periarticularly injected during replacement. In the multimodal combined analgesia group, celecoxib was oraly taken before replacement + cocktail was periarticularly injected during replacement. After replacement, intravenous patient-controled analgesia pump was applied in each group. Active flexion range-of-motion, visual analogue scale score in the resting and active states and knee Keen Society Score were measured at various time points after total knee arthroplasty in four groups. Adverse reactions were recorded after replacement. RESULTS AND CONCLUSION:Active flexion range-of-motion, visual analogue scale score in the resting and active states and knee Keen Society Score were better in the preemptive analgesia, cocktail analgesia and multimodal combined analgesia groups than in the control group at various time points after replacement (alP < 0.05). Above indexes were better in the multimodal combined analgesia group than in the preemptive analgesia and cocktail analgesia groups (alP < 0.05). No significant difference in above indexes was detected between the preemptive analgesia and cocktail analgesia groups (alP > 0.05). No significant difference in the number of cases affecting nausea and vomiting was detected at 2 weeks after replacement in the four groups (P > 0.05). There was no deep venous thrombosis of double lower limbs or necrosis and infection of incision. These findings suggest that the effects of preemptive analgesia before total knee arthroplasty, local injection analgesia during replacement, and the combined analgesia of intravenous patient-controled analgesia pump after replacement were ideal. Adverse reactions did not increase, and the operation was safe. At present, multimodal combined analgesia has been accepted by us, but to achieve truly painless results after total knee arthroplasty stil needs more efforts.

Objective To evatluate the effect of dexmedetomidine on intraoperative wake-up test during cerebral functional area operation performed under combined iv propofol-remifentanil anesthesia.Methods Twenty-seven ASA Ⅰ or Ⅱ patients (both sexes) aged 17-43 yr with a body mass index of 20-24 kg/m2 undergoing op-eration on cerebral functional area during which intraoperative wake-up test was performed were randomly divided into control group (group C,n =13) and dexmedetomidine group (group D,n =14).Anesthesia was induced with midazolam,sufentanil,etomidate and rocuronium and maintained with TCl of propofol (Cp =3-5 μg/ml) and remifentanil (Ce =2-6 ng/ml).BIS value was maintained at 55-65.In group D after dura of brain was opened,a loading dose of dexmedetomidine 0.3 μg/kg was administered iv over 15 min followed by continuous iv infusion at 0.2 μg· kg-1 · h-1 while TCI of propofol and remifentanil were suspended.In group C after opening of dura,Cp of propofol TCI was reduced to 0.5 μg/ml and Ce of remifentanil to 0.5 ng/ml.The wake-up time and development of hypertension,tachycardia,headache,dysphoria,delirium and awareness were recorded.Results All patients were successfully awakened.There was no significant difference in wake-up time between the 2 groups (P ＞0.05).The incidences of hypertension,tachycardia,headache and awareness were significantly lower in group D than in group C (P ＜ 0.05).Conclusion Dexmedetomidine does not affect intraoperative wake-up time during operation on cerebral functional area performed under iv propofol-remifentanil anesthesia,but can significantly reduce the incidence of adverse effects.

Filamentous fungi are widely used for large-scale production of cellulases. Morphological characteristics of mycelia under submerged condition are closely correlated with cellulases productivity. In order to find out the critical genes involved in the mycelial morphology development and cellulases production in liquid fermentation, 95 Neurospora crassa morphological mutants (named as SZY1-95) were screened for cellulases production. Compared with the wild type, cellulases production in four mutants SZY32, SZY35, SZY39 and SZY43 were significantly decreased, whereas mutants SZY63, SZY69, SZY87 and SZY11 produced much more cellulases than that of the wild type strain. Meanwhile, endo-beta-1,4-glucanase activity, beta-glucosidase activity, viscosity of broth and dry weight of these mutants were measured. The mycelial morphology of the mutants was also studied by microscope. Particularly, pellets were formed in mutant SZY11 and SZY43, whose viscosities were 25% and 50% of the wild type strain, respectively. Mutant SZY87 appeared long hyphae, and the viscosity of its broth was at least 2 folds of the wild type strain. These results indicate that a single gene deletion could influence the mycelial morphology in liquid fermentation, and increased the cellulases production. The low-viscosity related genes identified in our study will be the potential candidates for genetic modification of filamentous fungi.
Cellulases ; biosynthesis ; Fermentation ; Gene Deletion ; Industrial Microbiology ; Neurospora crassa ; genetics ; metabolism

Objective To investigate the effect of oral fluid resuscitation on circulatory oxygen dynamic parameters in dogs with burn shock.Method Eighteen male Beagle dogs were surgically prepared for the cannulation of carotid cartery and jugular vein,subjected to flame injury 50%total body surface area(TBSA)with fullthick ness 24 hours later,and they then randomly divided into 3 equal groups.The oral fluid resuscitation group (OR group)was intragastrieally injected with infusion of glucose-electrolyte solution(GES)according to parkland formula 0.5h after burn with a dose of 4mL·kg-1·% TBSA-1.Intravenous (IV) GES resuscitation group (VR group)was intravenously injected with infusion of GES as the same dose as OR group,and no-fluid resuscitation (NR)group did not receive any treatment during the first 24 hotrs.In the second 24 hours,all dogs received Ⅳ fluid resuscitation.At the end of 72 hours of injury.the mortality in each group was recorded.The mean arterial arterial pressure(MAP),hematocrit(HCT)and blood lactic acid(LAC)were determined,and blood gas analysis was evaluated for oxygen delivery(DO2),oxygen consumption(VO2)and oxygen uptake(O2ext)before injury and 2,4,8,24,48 and 72 hours after injury.Results Burn injury resulted in a 77.1%decrease in MAP,and a 48.5% increase in HCT and 533.7%increase in LAC in NR group,followed by pngressively lowering of DO2,VO2 and Oext till all animals died with in 24 hours after burn.MAP and HCT levels oftwo resuscitation groups gradually returned to the pre-injury levels within 72 hours after burn,but the LAC levels sill remained significantly higher than the pte-injury levels(P＜0.01).The MAPs of OR group were higher at corresponding intervals within 24 hours post burn than those of NR group(P＜0.01),but they were lower than those of VR group(P＜0.01).The serum LAC in OR group was markedly lowered than that in NR group,but it was higher than that in VR group.Twenty-four hours after burn injury,the DO2 level in OR group showed no significant differences compared with that of the VR group,but the levels of the VO2 and Oext were still much lower than those of VR group (P＜0.01).At the end of 72 hours,3 dogs of NR group died and none of IV group died.Caadusions Oral fluid resuscitation improves oxygen dynamic,alleviates hyperlactacidemia and reduces the mortality of animals with severe burn shock.

Objective To investigate the antitumor effect of tumor necrosis factor-related apoptosis-inducing ligand(TRAIL) gene transfection mediated by adenovirus into human pancreatic carcinoma cell line Panc-1,and the mechanisms involved in this effect.Methods TRAIL gene was transfected into pancreatic cancer cell line Panc-1 by an adenovirus vector(Ad-TRAIL).Level of TRAIL mRNA expression was determined using RT-PCR,and TRAIL protein synthesis was evaluated with Western blot.Cell-growth activities were determined by MTT assay.The bystander effect was observed by co-culturing the Panc-1 cells with and without the transfected TRAIL gene at different ratios.Apoptosis in pancreatic cancer cells was detected by flow cytometry.Proaspase-8 and procaspase-3 proteins were determined by Western blot.Results The stable overexpression of TRAIL was detected in Panc-1 cells transfected by Ad-TRAIL.Ad-TRAIL significantly inhibited cell viability of Panc-1 cells.Furthermore,co-culture of cancer cells transfected with TRAIL resulted in the nontransfected cell inhibition by bystander effect.Moreover,the percentage of apoptotic cells was significantly higher in the Ad-TRAIL-treatment group compared to the control groups(P

Objective: To investigate the anti-tumor effect of lymph oc yte-mediated immunity induced by Tca8113 cell lysate-pulsed dendritic cells(DC s). Methods: Human peripheral blood monocytes were cultured in R PMI 1640 medium countaning ?=10% FBS with GM-CSF + IL-4 + either TNF-? or n ot. Control cells were cultured without any cytokine. Nonadherent cells were har vested, and continuously incubated with Tca8113 cell lysate made by freez-thaw method, and then the cells were cultured together with autologous lymphocytes. T he activated lymphocytes were co-cultured with Tca8113 cells at E∶T ratio of 1 00∶1. The cells were observed morphologically and assessed by immunocytochemis try before and after the pulse, while the survival rate of Tca8113 cells was stu died by MTT method. All results were analyzed statistically. Results: (1) Typical DCs were generated with higher expression of CD83 in the group s with TNF-? treatment, or with tumor antigen stimulation. (2) The effective l ymphocytes induced by DCs inhibited the proliferation of Tca8113 cells. Conclusion: DCs generated from monocytes in the presence of GM-CSF an d IL-4 can develop to be mature after tumor antigen pulse. DCs induce the lymph ocyte-mediated suppression effect on Tca8113 cells; TNF-? can accelerate DC m ature.

Objective Nasal administration,as a common means of treatment of respiratory diseases,may normally cause bronchospasm,cough and other adverse reactions,the efficiency of nasal nebulizers has been criticized as well.This paper aims to develop a medicine atomizing device,pharmaceutically atomized in solving the existing problems,providing a modern instrument for treatment of respiratory diseases by traditional Chinese medicine.Methods The device could prepare medicine by decoction and filtration,which means this unit is divided into two functional modules,medicine preparation and herbal atomization.1 200 W heating plate is placed in decoction unit and is programmed to fit traditional decoction protocol.Steam and ultrasonic nebulised medicine are combined in atomizing unit.Another non-contact infrared heating unit also located in to control the temperature precisely.Different forms of traditional Chinese medicine and different filtration methods were selected to optimize the atomizing effect.Results An implementation of two sequence of filtration enabled optimization of atomizing.After 15 volunteers'trial,this device functioned well on Bama nasal medical protocol,and could effectively avoid the adverse reactions of the traditional way of cold fog atomizing.Conclusions The nasal nebulizer equipment on which Chinese herbal medicine treatments could directly performed,produced atomized mist particle size suitable for nasal treatment,and by generating warm steam to avoid the common clinical administration caused choking to hypoxia and other adverse reactions.Meanwhile,instrument has a friendly interactive feature to meet the clinical requirements for medicine nebulizer treatment.

Objective To study the effect of mild hypothermia combined with edaravone on the expressions of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in cerebrospinal fluid(CSF)of patients with severe traumatic brain injury(sTBI)and on their prognoses. Methods A prospective randomizd controled trial was conducted. Seventy-seven patients in the Center for Neurology and Neurosurgery of Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces were randomly assigned into control group(38 cases)and treatment group(39 cases)according to random number table. All the patients were treated with routine treatments such as dehydration of intracranial pressure(ICP),neural nutrition,anti-infection,mechanical ventilation and maintenance of water and electrolyte balance in control group,while in treatment group,the patients received mild hypothermia combined with edaravone on the basis of routine treatment within 24 hours after injury. The contents of TNF-αand IL-6 in CSF were measured by radio-immunoassay(RIA)at different time points in both groups. In the meantime,the ICP was also measured. The prognosis was evaluated after 6 months of injury according to Glasgow outcome scale(GOS). Results Compared to control group,in the treatment group,the expression levels of TNF-αand IL-6 in CSF had no significant difference(both P>0.05)on the 1st day after injury,but they were significantly increased on the 3rd day after injury,began to decline on the 7th day,and reached to the valley value on the 14th day after injury,the degree of descent in treatment group being more significant than that in control group〔TNF-α(μg/L):2.43±0.39 vs. 3.12±0.47,IL-6(ng/L):83.53±11.48 vs. 101.69±13.64,both P<0.01〕. Before the treatment,the level of ICP in treatment group had no significant difference from that of control group(P>0.05),but it was gradually increased on the 1st day after injury in both groups,it reached the peak value on the 3rd day after injury,and began to decline on the 7th day after injury,the degree of descent being more significant in treatment group〔mmHg(1 mmHg=0.133 kPa):14.88±3.73 vs. 21.76±4.78,P<0.01〕. The favorable prognosis rate was significantly higher〔35.9%(14/39)vs. 21.1%(8/38),P<0.05〕,and the mortality was obviously lower in treatment group than those of control group〔28.2%(11)vs. 42.1%(16),P<0.05〕. Conclusion In patients with sTBI,mild hypothermia combined with edaravone can protect brain tissue through alleviating high ICP and decreasing the expression levels of TNF-αand IL-6 in CSF, resulting in promoting the recovery of nerve functions and improving prognosis.

Objective: To detect the vascular paths in the lateral wall of maxillary sinus using cone beam computer tomography (CBCT), and to retrospect the surgical managements of avoiding bleeding complication during the lateral approach maxillary sinus elevation.Methods: The documents of 71 consecutive patients with 81 sides maxillary sinus elevation surgery were collected.The vascular paths in the lateral wall of maxillary sinus were detected by the preoperative CBCT, and the messages about the vascular in surgical records were analyzed.Results: The paths of the vascular could be detected in 77 (95.1%) sides maxillary sinus in the reconstruction panoramic images of CBCT.At the position of the first molar, the paths of the vascular of the lateral maxillary sinus walls could be detected in 54 sides (66.7%) in the reconstruction coronal images of CBCT, and the other 27 sides (33.3%) could not be detected.Two approximately parallel paths of the vascular were found in 3 sides (3.7%) of the lateral maxillary sinus walls.The different diagnoses occurred in 6 sinuses between two observers.The kappa of diagnostic consistency of the two observers was 0.842 (P<0.001).The mean distance between the lower border of the vascular path to the plane of the alveolar crest of 54 sides maxillary sinuses was about (13.0±4.7) mm.The mean distance between lower border of vascular path to the plane of the floor of the sinus was (9.3±4.8) mm.The vascular path was located in the floor wall in 1 sinus.During the lateral approach maxillary sinus elevation operation, intraosseous vessels were dissected in 4 sides sinus lateral wall, the vascular path was avoided consciously in 3 sides, and the sinus elevation surgery had to be given up in 1 side for the vessel was torn and bleeding.There were no vascular related messages in 73 sides of the lateral approach maxillary sinus elevation operation records.Conclusion: The vascular paths of maxillary sinus wall could be detected by CBCT in most cases.Preoperative CBCT examination was proved to be reliable.The vascular paths of maxillary sinus wall should be examined carefully.It was helpful to make the surgical design perfectible and reduce the risk of tearing the vessel in operation.

BACKGROUND: The researches of Pulling and Rotating Oblique Pulling Manipulation focus on clinical research and biomechanical changes of lumbar functional units, and the mechanical characteristics of manipulation are little reported.OBJECTIVE: To study the characteristics of the Pulling and Rotating Oblique Pulling Manipulation by digital method, so as to provide quantitative basis for inheritance, teaching and learning, promotion, and basic research of the manipulation.METHODS: The force-time curve and the force of the manipulators were tested and recorded with the multi-point membrane pressure measurement system. The kinetic parameters (the average load force, the average minimum force and the maximum impact force) were shown. The values of = the flip time, flip speed and impulse were measured by the test analysis system.RESULTS AND CONCLUSION: (1) The average load force was (145.86±34.80) N, duration was (1.43±0.46) s, the average minimum force was (72.24±13.87) N, the maximum impact force was (446.21±143.98) N, the flip time was (0.55±0.15) s, flip speed was (914.52±259.18) N/s, and the impulse was (256.21±82.30) N?s. (2) The rising slope of the impulse was (93.96±6.94), and the falling slope was (-82.70±26.10). (3) To conclude, the characteristics of manipulation from hand are analyzed in views of digitization, which provides an objective evaluation index for Lin's manipulation.