Efficacy of oxycodone for improvement of general anesthesia for laparoscopic cholecystectomy in elderly patients / 中华麻醉学杂志

Objective To evaluate the efficacy of oxycodone for improvement of general anesthesia for laparoscopic cholecystectomy in elderly patients.Methods A total of 160 patients of both sexes,aged 65-75 yr,with body mass index ＜30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective laparoscopic cholecystectomy,were divided into 2 groups (n =80 each) using a random number table method:general anesthesia group (group GA) and oxycodone + general anesthesia group (group OX+GA).Anesthesia induction:propofol was given by closed-loop infusion at the initial target plasma concentration of 2 μg/ml,the target bispectral index (BIS) value was set at 50,and 2 min later remifentanil was given by target-controlled infusion at the target plasma concentration of 4 ng/ml,and cisatracurium 0.2 mg/kg was intravenously injected when BIS value was decreased to 70.Laryngeal mask airways were inserted and the patients were mechanically ventilated when BIS value was decreased to 50 and TOF ratio was decreased to 25％,and end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.Anesthesia maintenance:propofol was given by closed-loop infusion,the target BIS value was set at 50,cisatracurium 0.1 mg/kg was intravenously injected when TOF ratio was increased to 10％;remifentanil was given by target-controlled infusion at the target plasma concentration of 4-6 ng/ml.Oxycodone 0.07 mg/kg was intravenously injected at 5 min before stretching internal organs.Before anesthesia,at 5 min after laryngeal mask airway placement,at skin incision and while stretching internal organs,analgesia nociception index value and perfusion index value were recorded,the development of intraoperative cardiovascular events,emergence time,time for removal of laryngeal mask airway,time of post-anesthesia care unit stay and development of nausea and vomiting and back and shoulder pain within 48 h after surgery were also recorded.Results Compared with group GA,the analgesia nociception index value and perfusion index value were significantly increased while stretching internal organs,and the incidence of intraoperative hypertension,tachycardia,and nausea and vomiting and back and shoulder pain within 48 h after surgery were decreased in group OX-GA (P＜0.05).Conclusion Oxycodone can inhibit nociceptive stimuli,is helpful in maintaining stable hemodynamics and reduces postoperative complications in elderly patients undergoing laparoscopic cholecystectomy under combined general anesthesia.

Significance of expression and promoter methylation of LITAF gene in B-cell lymphoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate promoter methylation status of LITAF gene in B-cell lymphoma and to explore transcription regulation of 5-Aza-2'-deoxycytidine (5-Aza-CdR) on LITAF gene.</p><p><b>METHODS</b>One hundred and five paraffin specimens including 54 cases of diffuse large B cell lymphoma (DLBCL), 15 small lymphocytic lymphoma (SLL), 8 mucosa-associated lymphoid tissue lymphoma (MALT) and 6 follicular lymphoma (FL) were included. Five reactive lymphoid hyperplasia samples were collected as control. Methylation status of CpG island in LITAF gene in the specimens and in Raji, Pfeiffer and Daudi cell lines were detected by methylation-specific PCR (MSP). LITAF expression in Raji, Pfeiffer and Daudi cell lines with or without 5-Aza-CdR treatment was detected by Western blot and immunohistochemistry. The inhibitory ratio in the three cell lines was measured by MTT assay.</p><p><b>RESULTS</b>The frequency of LITAF gene methylation in B-cell lymphoma was 89.5% (94/105) . Among them, 3.8% (4/105) showed complete hypermethylation. In control group, however, there was no methylation in CpG island of LITAF gene promoter. The expression of LITAF was recovered or increased along with the cell growth inhibition when the cells exposed to demethylating reagent.</p><p><b>CONCLUSIONS</b>LITAF gene silencing with aberrant CpG methylation is probably one of the critical events to the oncogenesis of B-cell lymphoma, which may have important implications as a candidate marker for diagnosis and target gene therapy.</p>

Intravascular Ultrasonic Features of Unstable Atherosclerotic Plaques in Unstable Angina patients / 中国基层医药

Objective To investigate the characteristics of plaque morphology of the patients with unstable angina(UA)by intravascular ultrasound(IVUS). Methods24 patients with stable angina pectoris(SA)and 33 patients with unstable angina(UA)were examined by coronary coronary arteriograph(CAG)and intravascular ultrasound(IVUS).The culprit lesions about the characteristic of the plaque were studied,the external elastic membrane cross-sectional area and lumen cross-sectional area were measured,the plaque area,plaque burden,eccentricity index were calculated,and the remodeling index was examined. ResultsExternal elastic membrane area,plaque area and vascular remodeling ratio were significantly greater at target lesions in UA patients than in patients with SA(P＜0.05).Positive remodeling and soft plaque were predominantly in UA patients(P＜0.05). ConclusionThe morphological features of coronary artery plaques in UA group were significantly different from those in SA group.More soft plaque,plaque rupture,thrombus formation,and positive remodeling were found in UA patients compared with SA patients.

Insulin therapy for blood glucose fluctuation in diabetes / 中国实用内科杂志

For different individuals with diabetes,blood glucose control varies.In the blood glucose controlling,blood glucose levels are sometimes higher than the target,sometimes the diabetic patients may develop hypoglycemia.In insulin therapy for blood glucose fluctuations,the most important thing is to avoid hypoglycemia.Finding out regular patterns of blood glucose fluctuations,then according to that,we need to choose the right insulin preparations to treat the condition.For the patients with irregular fluctuations of blood glucose,insulin pump therapy should be a proper choice.