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Objective To evaluate the treatment effect of combination of dexmedetomidine and droperidol on emergence agitation during general anesthesia recovery period in the elderly undergoing thoracotomy. Methods Sixty patients with severe emergence agitation during general anesthesia recovery period undergoing thoracotomy for esophageal cancer or pulmonary lobectomy, aged 66-75 years, falling into ASA physical status Ⅱ or Ⅲ, were divided into three groups, 20 patients in each according to table of random number: group droperidol (group F) and group dexmedetomidine (group D) and group dexmedetomidine combining droperidol (group DF). In group F, 0.06 mg/kg droperidol was administrated via central vein. In group D, 1 μg/kg dexmedetomidine was pumped via central vein in 10 min, followed by continuous infusion of dexmedetomidine in 0.2 μg·kg-1·h-1 for 1 h. While in group DF, 0.03 mg/kg droperidol was administrated via central vein and 0.5 μg/kg dexmedetomidine was pumped via central vein in 10 min, then followed by continuous infusion of dexmedetomidine in 0.2 μg·kg-1·h-1 for 1 h. The agitation scores and the Ramsay scores were collected after the beginning of anti-agitation. Arterial blood partial pressure of carbon dioxide was tested. Postoperative complications including nausea and vomiting were recorded. Results Compared with group D, the agitation scores at 5, 10, 15 and 20 min in group DF were lower (P ＜ 0.05). Comparing with group F, the agitation scores at 60, 90 and 120 min in group DF were lower (P ＜ 0.05). The incidence of over-sedation in group DF and in group D was less than that in group F (P ＜ 0.05). PaCO2 was unaltered in all the groups after treatment. The incidence of nausea, vomiting, bradycardia, hypertension, hypotension and respiration depression and long QT interval between the groups were comparable. Conclusion Combination of dexmedetomidine and droperidol is effective and safe in the treatment of agitation during sevoflurane general anesthesia recovery period in the elderly undergoing thoracotomy.
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Objective To evaluate the safety and clinical efficacy of retroperitoneal laparoscopic partial nephrectomy (LPN) in patients with incidental renal cell carcinoma.Methods Twenty-six patients with T1 incidental renal cell carcinoma treated with retroperitoneal LPN from Dec.2011 to Oct.2013 were analyzed retrospectively.The operation time,warm ischemia time,intraoperative blood loss,complications and prognosis of perioperative periods were collected.Results All 26 cases were operated successfully without conversion to open or other surgery.The operation period was 90-190 minutes.Blockage of renal artery was applied in all 26 cases,and the warm ischemia time was 15-30 minutes.The intraoperative blood loss was 100-360 ml.The drainage was removed 3-7 days postoperatively,and the hospitalization period was 7-12 days.All cases were clear cell renal cell carcinoma by pathological examinations,and showed negative surgical margins.No complications such as postoperative bleeding,inflammation and leakage of urine were occurred.All cases had normal renal function during the follow-up of 3-25 months without local recurrence or distant metastasis.Conclusion Retroperitoneal LPN for the treatment of T1 incidental renal cell carcinoma is worthy of application with the advantages of safety,minimal invasiveness,fewer complications,quick recovery and good nephron-sparing functional recovery.
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10.3969/j.issn.1000-8179.2013.12.005
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Objective To detect the change of the plasma hydrogen sulfide in patients with chronic heart failure (CHF) and explore its clinical significance.Methods A total of 118 patients with CHF was enrolled in this study.According to the NYHA standard,they were classified into grade Ⅱ (34 cases),grade Ⅲ (54 cases),grade Ⅳ (30 cases).The patients were divided into normal treatment group and sodium nitroprusside treatment group with 59 cases each.Another 30 healthy person were selected as control group.The plasma hydrogen sulfide level was detected by spectrophotometer.Results The plasma hydrogen sulfide level in CHF patients and healthy person was (32.45 ± 3.86),(54.26 ± 5.63) μ mol/L,and there was significant difference (P ＜ 0.05).The plasma hydrogen sulfide level in CHF patients of grade Ⅱ,Ⅲ,Ⅳwas (43.26 ±4.73),(31.87 ±4.12),(23.66 ±3.54) μmol/L,and there was significant difference (P＜0.05).The plasma hydrogen sulfide level before treatment in normal treatment group and sodium nitroprusside treatment group was(31.66 ± 3.75),(33.04 ± 4.02) μ mol/L,and there was no significant difference between two groups (P ＞ 0.05).The plasma hydrogen sulfide level after treatment in normal treatment group and sodium nitroprusside treatment group was (36.83 ± 4.32),(44.54 ± 4.68) μ tmol/L,and there was significant difference (P ＜0.05).The plasma hydrogen sulfide level after treatment in two groups was increased compared with that before treatment,and there was significant difference (P ＜ 0.05).The total effective rate in normal treatment group and sodium nitroprusside treatment group was 42.4％ (25/59) and 67.8％(40/59),and there was significant difference between two groups (P ＜ 0.05).Conclusions The abnormal plasma hydrogen sulfide level may be involved in the occurrence and development process of CHF,which could be used as a factor to monitor the disease.The upregulation of plasma hydrogen sulfide level can significantly improve the prognosis of CHF patients.
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Objective To measure the expression of SFRP1 in bladder cancer and explore the corresponding mechanism,in order to study the roles of SFRP1 in the pathogenesis of bladder cancer.Methods SFRP1 mRNA was detected by RT-PCR.Methylation status of SFRP1 was detected by methylation specific PCR.SFRP1 protein was determined by Western blotting.Results SFRP1 was methylated in bladder cancer cell lines T24 and 5637,not in SCaBER.SFRP1 mRNA and protein were detected in SCaBER,but not in T24 and 5637.Six hours after treating T24 and 5637 with 5'-aza-deoxycytidine,both T24 and 5637 expressed SFRP1 mRNA and protein.In 45 bladder cancers,methylation of SFRP1 was detected in 28 (62.2％).In matched cancer adjacent tissues,6 (13.3％) were found with SFRP1 methylation.The methylation rate in bladder cancers was significant higher than that in matched cancer adjacent tissues (P ＜ 0.01).Conclusions SFRP1 is downregulated in some bladder cancers due to methylation.SFRP1 methylation and aberrant expression may be involved in the pathogenesis of bladder cancers.
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Objective To investigate the correlation between glycosylated hemoglobin(HbAlc),plasma NTproBNP and the cardiac function in patients with acute coronary syndrome(ACS).Methods 53 patients with both ACS and type 2 diabetes mellitus(T2DM)(T2DM group),67 patients with ACS(ACS group)were selected as the objects.The HbAlc level was detected by immunohistochemical than turbidimetry,and the content of NT-proBNP was detected by electrochemiluminescence method.Results The levels of HbAlc,plasma NT-proBNP of the T2DM group were(9.21±1.23)％,(3.56±1.12)ng/ml,respectively,which were higher than those of ACS group[(5.09±0.67)％,(0.14±0.04)ng/ml](t=6.495,9.277,all P＜0.01);The cardiac function of ACS patients was positively correlated with the levels of HbA1c and plasma NT-proBNP(r=0.517,0.589,all P＜0.01),and there was positive correlation between the levels of HbAlc and plasma NT-proBNP in ACS patients(r=0.431,P＜0.05).Conclusion The HbAlc and NT-proBNP can promote the injury of the cardiac function of ACS patients,and can be used as diagnostic indicators of the injury of the cardiac function of ACS patients.
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Objective To summarize the diagnosis,treatment and prevention of dysuria within 6 months after the suprapubic transvesical prostatectomy. Methods Twenty-four cases were retrospectively reviewed,including the data on the diagnosis, treatment and prognosis. Results Twenty-one of the 24 cases had received surgery. There were 9 cases with bladder neck stricture,9 cases with posterior urethra stricture and 3 cases with of remnant glands. Nine cases received transurethral bladder neck incision, 9 received open surgery ( bladder neck,posterior urethral incision) and 3 received transurethral resection of the prostate (TURP) plus bladder neck incision. The other 3 diagnosed as detrusor weakness were conservatively treated by indwelling catheter and they were improved one months later. None of these patients was readmitted into hospital for dysuria within 6 months after treatment. Conclusion The recurrence of dysuria post prostatectomy mostly ( 75% ) occurred within 6 months after surgery. A majority of these patients need a second surgery. To avoid a second surgery for postoperative dysuria, much attention should be paid to the operating technique and postoperative management.
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Objective To investigate the effect of preoperative pravastatin preconditioning on myocardial ischemia-repedusion(I／R)injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Sixty ASA Ⅱ orⅢpatients of both sexes aged 18-64 yr undergoing cardiac valve replacement under CPB were randomly divided into 4 groups(n=15 each)：control group(group C)and 3 pravastatin groups receiving oral pravastatin 10，20 and 40 mg respectively every night for 7 days before operation(group P1-3).The number of patients receiving dopamine(≥5 μg·kg-1·min-1)and adrenaline was recorded from the termination of CPB to the end of operation，from the end of operation to 12 h after operation，during 12-24 h after operation and during 24-48 h after operation.Venous blood samples were taken from central venous line for measurement of plasme cTnI and CK-MB concentrations at 7 days before operation，before induction of anesthesia，at opening of the aorta and at 2，24 and 48 h after opening of aorta.Results The number of patients receiving dopamine and adrenaline was significantly less in group P3 than in group C(P<0.05).Plasma CK-MB and cTnI concentrations were significantly lower in group P3 than in group C(P<0.05).Conclusion Preconditioning with oral pravastatin(40mg／d for 7 consecutive days)can protect myocardium against I／R injury in patients undergoing cardiac valve replacement with CPB.
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ObjectiveTo investigate the expression of Snail in bladder urothelial carcinoma and evaluate its relationship with E-cadherin and a subset of T cell groups.MethodsImmunohistochemical method was used to detect the expression of Snail and E-cadherin proteins in tissue from 156 cases of bladder urothelial carcinoma and 80 cases of the para-cancerous mucosa. The proteins expression status was analyzed with clinico-pathological data. Meanwhile, correlations with Snail and CD4+, CD8+, CD4+/CD8+ were analyzed.ResultsThe positive rate of Snail in bladder urothelial carcinoma was 65.4％ , which was significantly higher than that in para-cancerous mucosa (48.8％). The expression of Snail was significantly correlated with the clinical stage, pathological grade, tumor quantity, distant metastasis and tumor recurrence.There was negative correlation between the expression of Snail and E-cadherin in bladder urothelial carcinoma. Positive expression of Snail had a negative correlation with the number of CD4+ and CD4+/CD8+ , whereas it had no significant correlation with the number of CD8+.ConclusionsBy inhibition of the E-cadherin expression and inducing local immunosuppression, Snail might play an important role in the process of the invasion and metastasis of bladder urothelial carcinoma.
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Objective To explore the relationship between KISS-1 gene and metastasis of bladder carcinoma,and to study the effect of the stable expression of KISS-1 gene on the invasion of bladder carcinoma cell line T24.Methods Fluorescent quantitative PCR was used to detect the expression of KISS-1 mRNA in primary bladder carcinoma without metastasis and primary bladder carcinoma with metastasis.Recombinant vector pIRES2-AKS-1 was constructed and transfected into T24 cells.Single clone of stably transfected cells was screened,and the changes in the invasive ability of T24 cells was detected after transfection.Results The expression level of KISS-1 mRNA in primary bladder carcinoma with metastasis was significantly lower than that in primary bladder carcinoma without metastasis(P＜0.05).The expression of KISS-1 protein in the single clone of stably transfected cells increased significantly,and the invasive ability significantly decreased(P＜0.05).Conclusion KISS-1 gene is correlated with the metastasis of bladder carcinoma,and the up-regulated expression of KISS-1 gene can inhibite the invasiveness of T24 cell line.
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Objective To investigate the surgical outcome of lumbar spinal canal stenosis. Methods Forward analysis of 160 cases of the patients with lumbar spinal canal stenosis getting operative treament was performed. 87 cases were male and 73 case were female. The average age was 51 years old (18 ～ 78years old). The average course of deseases was 5 years (1 month ～ 36years). All of the cases used lumbar spinal canal decompression combined with pedicle screws fixation and posterolateral bone graft. All cases had a follow - up of 3 months to 5 years (mean 34 months). Results The (COA) recovery rate among the tolal patients was cassified as exellent in 120 ca-ses , good in 31 cases , fair in 7 cases. The excellent and good rate was 94.4%. Conclusion The operative intervention was an effective method for patients with severe or progressive clinical lumbar spinal canal stenosis. The procedure in decompressed compretely through pos-terior approach and the instability of cerrical apinein had the satisfactory clinical outcome.
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Objective To study the effect of erythropoietin on cardiac function of the patients with acute mycardial infarction (AMI). Methods 48 patients with AMI successfully treated with thrombolytic therapy were randomized into two group,2000 units of recombinant human erytfu-opoietin(rh-EPO) were administrated once a time in therapeutic group,3 times on alternate days in one week and total for 4 weeks. The peak value of serum creatine kinase(CK) and creatinkinase isozyme MB (CK-MB)were measured, myocardial infarct size (S) was estimated by Hindmen's QRS scoring system, and the diameter of left ventricular end diastolic(LVEDd) and left ventricular injection fraction (LVEF) were determined with echocardiography at the 4th weekend in both groups. Results CK, CKMB and S in therapeutic group were lower than in control group (P < 0.05). LVEDd and LVEF were also improved in the therapeutic group. Conclusion rh-EPO can significantly lessen the size of isehemia and infarct myocardium, mitigate the infarction degree and improve the cardiac function slightly in AMI patients.
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AIM: To observe the enhanced green fluorescent protein (EGFP) gene expression and cytotoxicity in human adipose derived adult stem cells (hADSCs) by pEGFP-N1, Ad5-EGFP and rAAV-2/1-EGFP, and investigate the suitable gene-transferred vehicle. METHODS: The experiment was conducted at Chinese National Human Genome Center and the Third Hospital of Peking University from January to July 2006. ①After the patients and their relative were informed consent, the subcutaneous adipose tissue was obtained from the patients undergoing routine total hip joint replacement in Department of Orthopaedics, Third Hospital of Peking University. pEGFP-N1 was provided by Clotech Company, Ad5-EGFP and rAAV-2/1-EGFP by Vector Gene Technology Company. ②hADSCs were cultured in vitro after isolated from the adipose tissue after dissected and digested with type I collagenase. ③hADSCs of passage 3 were infected with pEGFP-N1, Ad5-EGFP and rAAV-2/1-EGFP and the EGFP expression and the cell toxicity were observed. ④Twenty-four hours after being transfected, 5?104 cells were reseeded in a 24-well plate and the solution was changed three times every week. The growth curves of each group were drawn. Normal non-transfected cells served as control. The influence of different transfection ways on the growth of hADSCs was observed. RESULTS: ①Comparison of transfected efficiency with different ways: pEGFP-N1 transfection showed a higher cytotoxicity and lower efficiency of 10.5%; Ad5-EGFP could efficiently transfect hADSCs (multiplicity of infection=5?102, 82.5%); when MOI was 0.05); however, the growth capability of hADSCs was decreased significantly in the pEGFP-N1 transfection group compared with the control, and the differences were significant at day 3-10 after transfection (P
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Background and purpose:Fatty acid synthase(FAS)is a new tumor marker,the high expression of which has been reported to be associated with poor prognosis of cancer patients.This study investigated the expression of FAS in transitional cell carcinoma(TCC) of bladder and its clinical significance.Methods:The expressions of FAS were detected by streptavidin-peroxidase immunohistochemical method in the paraffin embedded sections of 65 TCC patients and the clinical data had been reviewed.15 normal bladder tissues were used as control group.Results:The positive rate of the expression of FAS in TCC was 58.5%(38/65),while only 2 of 15 cases in control group expressed FAS protein.The difference was statistically significant,the expression of FAS was related to the histological grades and recurrence but not different pathological stages.Survival analysis revealed that the 5-yr survival rate was lower in FAS positive patients than in negative patients(18% vs.44%,P
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Background and purpose:To investigate the clinico- pathological characteristics, prognosis and diagnosis of primary renal sarcoma that is a rare, highly malignant tumor with poor prognosis and survival. Methods:9 cases of renal sarcoma in our hospital were reviewed and analyzed. Nephrectomy was the main treatment for the patients. All the specimens were stained with histochemicial and immunohistochemical method, correlated literatures were also reviewed.Results:The distributions of pathology were malignant fibrous histiocytoma leiomyosarcoma, liposarcoma, myxosarcoma synoviosarcoma. Immunohistiochemical test was essential for the diagnosis of renal sarcoma.Conclusions:Pain and palpable mass were the common symptoms. Early radical surgery remains the optimal treatment, the role of chemotherapy and radiotherapy in the treatment modalities of the disease is still controversial.
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Ojective To research the appropriate routes the clinical results of the three different procedures for the laparoscopic adrenalectomy routes were compared. Methods Eighty six patients underwent laparoscopic adrenalectomy through three different routes-transperitoneal anterior (TAA), retroperitoneal lateral flank(RLA) and retroperitoneal posterior lumbar approaches(RPA). Results The time for performing operation through RPA and RLA was shorter than that through TAA(P
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Objective To study the telomerase activity in the tissue adjacent to bladder cancer and to investigate its clinical significance. Methods Telomerase activity was detected with telomeric repeat amplification PCR (TRAP) assay. The telomerase activity in the tissue adjacent to bladder cancer was evaluated. Results Telomerase activity was positive in the tissue samples adjacent to bladder cancer in 10 of the 24 cases(42%). Telomerase activity in the adjacent tissue has been related with the tumour grades and stages. The tumour recurrence was also related with the telomerase activity in the adjacent tissue. Conclusions The detection of telomerase activity in the tissue adjacent to bladder cancer could be a prognostic marker for bladder tumor recurrence.
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Objective To study the potential effects of telomerase inhibitor on the apoptosis of bladder cancer cells. Methods A phosphorothioate oligonucleotide (PS ODN) with sequence 5′ d(TTAGGG) 3′, as the telomerase inhibitor, was incubated with a bladder cancer cell line EJ. Such treated cells were studied with many approaches for the telomerase activity, the growth status and the morphological changes. Results The PS ODN inhibited the telomerase activity in the cells, arrested the cell growth, and induced the apoptosis of the cells. Conclusions The apoptosis of bladder cancer cells could be induced by PS ODN with 5′ d(TTAGGG) 3′ sequence as a telomerase inhibitor.