Research Progress of Indocyanine Green Fluorescence Laparoscopic Technique in Clinical Application / 中国医疗器械杂志

Indocyanine green (ICG) is the most commonly used near-infrared fluorescent (NIRF) dye in clinical practice, and its mediated near-infrared fluorescence imaging technology is gradually applied in clinical practice. It has shown great potential in invasive surgery (MIS) and is expected to become the standard technology for surgical diagnosis and treatment of diseases. The clinical application of ICG fluorescence laparoscopy is reviewed here.

Optimization of the Water Extraction and Ethanol Pricipitation Technology of Zhuang Medicine Baijin Granules by Pharmacodynamics Combined with Orthogonal Test / 中国药房

OBJECTIVE：To optimize the water extraction and ethanol precipitation technology of Zhuang medicine Baijin granules. METHODS ：HPLC method was adopted to determine the content of bergenin in Baijin granules extract. The extraction routes of Baijin granules （water decoction ，70％ ethanol reflux extraction ，water decoction combined with 70％ ethanol reflux extraction）was screened primarily with the yield of extract and the experiment of reducing uric acid of mice. The orthogonal test was adopted to optimize water extraction technology of Baijin granules with water multiple ，extraction time and extraction times as factors，taking the extraction yield and the bergenin content as index ，then the validation test was carried out. The orthogonal test was adopted to optimize the alcohol precipitation process of Baijin granules including the relative density of medicinal materials ， alcohol content and the alcohol precipitation time ，then the validation test was carried out. By the experiment of reducing uric acid ， the effects of medicinal materials extract of Baijin granules extract were compared before and after ethanol precipitation. RESLUTS：Established method for content determination of bergenin with linearity range of 0.007 2-0.288 mg/mL，had good precision，reproducibility，stability and accuracy. The initially chosen extraction process of Baijin granules was water decoction extraction. The optimal water extraction technology was soaked for 0.5 h，then decocted for 3 times with 14-fold water （mL/g）and 1.0 h each time. The optimal ethanol precipitation process was to concentrate the water extract to a relative density of 1.0 g/mL with alcohol content of liquid at 60％ and precipitated for 12 h. Validation tests showed that RSDs of extract yield and beragenin content were all lower than 2％（n＝3）. The experiment of pharmacodynamics showed that water extract （before ethanol precipitation ）and water extract after alcohol precipitation could significantly decrease the level of uric acid in hyperuricemia model mice （P＜0.01）. There was no statistical significance in the reduction of uric acid between 2 groups（P＞0.05）. CONCLUSIONS ：The optimized water extraction technology can obtain good extract yield and bergenin content ，and combined with ethanol precipitation technology for removing excess impurities would not affect the pharmacodynamics. The water extraction and ethanol precipitation technology is feasible，and can be used for extracting the medicinal materials of Baijin granules and its edulcoration.

Application of CT imaging in diagnosis of internal hernia / 中华全科医师杂志

Internal hernia is the protrusions of the viscera through the peritoneum or mesentery in the abdominal cavity.It lacks specific clinical symptoms and has a poor prognosis.According to the anatomical classification,the intra-abdominal hernia can be divided into Duodenal paralysis,Winslow hernia,mesenteric hernia and mesenteric hiatal hernia.Among various imaging methods,multi-slice spiral CT has a higher value for preoperative diagnosis of internal hernia.This article will focus on the imaging features of several intra-abdominal hernias under multi-slice spiral CT,and summarize the general diagnostic strategies of internal hernia.

Application of CT imaging in diagnosis of internal hernia / 中华全科医师杂志

Internal hernia is the protrusions of the viscera through the peritoneum or mesentery in the abdominal cavity. It lacks specific clinical symptoms and has a poor prognosis. According to the anatomical classification, the intra-abdominal hernia can be divided into Duodenal paralysis, Winslow hernia, mesenteric hernia and mesenteric hiatal hernia. Among various imaging methods, multi-slice spiral CT has a higher value for preoperative diagnosis of internal hernia. This article will focus on the imaging features of several intra-abdominal hernias under multi-slice spiral CT, and summarize the general diagnostic strategies of internal hernia.

Application of CT and MRI in diagnosis and preoperative evaluation of periampullary carcinoma / 中华全科医师杂志

Periampullary carcinoma includes carcinoma of head of pancreas, carcinoma of lower common bile duct, ampullary carcinoma and adenocarcinoma of duodenum. Most of the periampullary cancers shows the same clinical symptoms their imaging manifestations are overlapping or non-specific. Accurate qualitative positioning and staging of periampullary cancers are of great value in guiding of treatment plan and evaluate postoperative outcomes. CT and MRI examination have made progress in the diagnosis of periampullary carcinoma. CT scan has a good spatial and temporal resolution, while MRI has a good tissue resolution. CT and MRI examination can be used for preoperative assessment of tumor resectability and invasion range, which is of certain value.

Application of CT and MRI in diagnosis and preoperative evaluation of periampullary carcinoma / 中华全科医师杂志

Periampullary carcinoma includes carcinoma of head of pancreas, carcinoma of lower common bile duct, ampullary carcinoma and adenocarcinoma of duodenum. Most of the periampullary cancers shows the same clinical symptoms their imaging manifestations are overlapping or non-specific . Accurate qualitative positioning and staging of periampullary cancers are of great value in guiding of treatment plan and evaluate postoperative outcomes. CT and MRI examination have made progress in the diagnosis of periampullary carcinoma. CT scan has a good spatial and temporal resolution, while MRI has a good tissue resolution. CT and MRI examination can be used for preoperative assessment of tumor resectability and invasion range, which is of certain value.

Application of BIS and muscle relaxation monitors in robot-assisted laparoscopic radical prostatectomy / 临床麻醉学杂志

Objective To evaluate the effect of bispectral index (BIS) and muscle relaxation monitoring on robot-assisted laparoscopic radical prostatectomy in elderly patients.Methods One hundred elderly patients (aged 65-80 years,ASA Ⅰ or Ⅱ) who underwent robot-assisted laparoscopic radical prostatectomy were randomly allocated into BIS and muscle relaxation monitoring group (group AA,n=50) and control group (group AC,n=50).In group AA,propofol was infused to achieve the BIS value of 45-55,and we monitored the muscle relaxation to conduct closed-loop infusion of cisatracurium.In group AC,we regulated the depth of anesthetic with the patients` vital signs according to anesthetists` experience.Mean arterial pressures (MAP),heart rates (HR),airway platform pressure (Pplat),and airway peak pressure (Ppeak) were recorded at following time points: before anesthesia induction (T0),after anesthesia induction (T1),10 min (T2),60 min (T3) after artificial pneumoperitoneum,and the end of operation (T4).We recorded dosage of propofol,cisatracurium,sufentanil,remifentanil,vasoactive agent,extubation time and PACU stay time.Results At T1,T2 and T4,the MAP and HR in group AC were significantly higher than those in group AA (P<0.05);at T3,MAP in group AC were apparently lower than those in group AA (P<0.05).Compared with T0,MAP and HR in group AC were significantly increased at T1,T2 and T4(P<0.05),MAP in group AC were obviously reduced at T3 (P<0.05),MAP and HR in group AC were also fluctuated obviously at different time points.MAP and HR in group AA at each point had no statistically significant difference.Compared with T1,Pplat and Ppeak in the two groups were significantly increased at T2-T4 (P<0.05).Pplat and Ppeak in grpup AC were higher than those in group AA at T2,T3 (P<0.05).Compared with group AC,the dosages of propofol and cisatracurium were less in group AA.The postoperative extubation time and PACU stay time were shorter in group AA.Conclusion BIS and muscle relaxation monitoring in robot-assisted laparoscopic radical prostatectomy can effectively stablize hemodynamics,reduce airway pressure fluctuation and the dosage of anesthetics.It also shortens the extubation time and the PACU stay time and improves the anesthesia recovery quality.

Effects of low-dose low molecular weight heparin on lipopolysaccharide-induced acute lung injury / 重庆医学

Objective To explore the effect of low-dose low molecular weight heparin(LMWH) on acute lung injury(ALI) induced by lipopolysaccharide(LPS).Methods Thirty-six male SD rats were divided into 3 groups:normal control group(A),LPS group(B) and LPS plus LMWH group(C),12 cases in each group.ALI was induced by intraperitoneal injection of LPS 6 mg/kg in group B,C.The group C accepted intraperitoneal injection of LMWH 100 U/kg,the groups B accepted intraperitoneal injection of the same volume of normal saline.The animals were killed after 6 h,the pathological changes of the lung were observed under light microscope.Arterial blood gases,lung wet to dry ratio (W/D) and protein content in BALF were detected;the levels of MPO and MDA in lung tissue were determined.The levels of serum interleukin1β(IL-1β),IL-6 and tumor necrosis factor-α(TNF-α) were determined by ELISA method.Results The PaO2 and pH values in the group B and C were significantly lower than those in the group A,and which in the group C were markedly increased compared with those in the group B(P＜0.05);the lung W/D ratio,protein content in BALF,MDA and MPO levels in the lung tissue in the group B and C were significantly higher than those in the group A(P＜0.01),while the lung W/D ratio,protein content in BALF,MDA and MPO levels in the lung tissue in the group C were significantly decreased compared with the group B (P＜0.05).The levels of plasma TNF-α,IL-1β and IL-6 levels in the group B and C were markedly increased compared with the group A,while which in the group C were significantly decreased compared with those in the group B (P＜0.01).Conclusion The LMWH treatment might attenuate LPS-induced acute lung injury.

Effects of low-dose low molecular weight heparin on lipopolysaccharide-induced acute lung injury / 重庆医学

Objective To explore the effect of low-dose low molecular weight heparin(LMWH) on acute lung injury(ALI) induced by lipopolysaccharide(LPS).Methods Thirty-six male SD rats were divided into 3 groups:normal control group(A),LPS group(B) and LPS plus LMWH group(C),12 cases in each group.ALI was induced by intraperitoneal injection of LPS 6 mg/kg in group B,C.The group C accepted intraperitoneal injection of LMWH 100 U/kg,the groups B accepted intraperitoneal injection of the same volume of normal saline.The animals were killed after 6 h,the pathological changes of the lung were observed under light microscope.Arterial blood gases,lung wet to dry ratio (W/D) and protein content in BALF were detected;the levels of MPO and MDA in lung tissue were determined.The levels of serum interleukin1β(IL-1β),IL-6 and tumor necrosis factor-α(TNF-α) were determined by ELISA method.Results The PaO2 and pH values in the group B and C were significantly lower than those in the group A,and which in the group C were markedly increased compared with those in the group B(P＜0.05);the lung W/D ratio,protein content in BALF,MDA and MPO levels in the lung tissue in the group B and C were significantly higher than those in the group A(P＜0.01),while the lung W/D ratio,protein content in BALF,MDA and MPO levels in the lung tissue in the group C were significantly decreased compared with the group B (P＜0.05).The levels of plasma TNF-α,IL-1β and IL-6 levels in the group B and C were markedly increased compared with the group A,while which in the group C were significantly decreased compared with those in the group B (P＜0.01).Conclusion The LMWH treatment might attenuate LPS-induced acute lung injury.

Relationship analysis between health expenditure and GDP based on health outcomes / 中国卫生政策研究

Objective:To put forward some suggestions for the national health development in the filed of health expenditure indicators .Methods:Two health expenditure indicators and four health outcomes indicators were chosen from WB and WHO official websites , and researches on the relationship between health expenditure and outcomes were conducted .We put forward proposed value of the health cost indicator .Results: With different levels of GDP per capita , the scatter diagram of health expenditure and GDP per capita had different rules .When health outcomes were taken into consideration , the rules were the same .When GDP per capita was at different level , better health outcomes were not related to higher health expenditure .Input-output ratio should be taken into consideration fully . Suggestions:The study should be dynamic as GDP develops .More factors can be added in the research , if the data of the factors is available .In this study , the GDP per capita was divided into 4 sections .The division standard of the GDP per capita can be more delicate .What is more important for the development of health expenditure is not contin-uing input , but better input-output ratio because of diminishing of marginal returns .One set of standards cannot be a-dapted to all countries and districts .We should give full consideration to the improvement of people's health instead of increasing input because the ultimate goal is the former .

Effect of propofol pretreatment on endoplasmic reticulum stress-mediated apoptosis during focal cerebral ischemia-reperfusion in rats / 中华麻醉学杂志

Objective To evaluate the effect of propofol on the endoplasmic reticulum stress-mediated apoptosis during focal cerebral ischemia-reperfusion (I/R) in rats.Methods Eighty adult male Sprague-Dawley rats,weighing 240-280 g,were randomly divided into 4 groups (n =20 each):shame operation group (group S) ; focal cerebral I/R group (group FCIR); propofol pretreatment group (group P); intralipid pretreatment group (group Ⅰ).Focal cerebral I/R was induced by 4 h middle cerebral artery occlusion followed by reperfusion.Propofol was infused at a rate of 12 mg· kg-1 · h-1 starting from 30 min before ischemia until 15 min of ischemia in group P,while intralipid was given instead of propofol in group I.Neurological deficit scores (NDSs) were measured at 6 h of reperfusion in 10 rats chosen from each group and the rats were then sacrificed.Their left brains were removed for determination of brain water content.The left 10 rats were sacrificed and their brains were immediately removed for determination of the expression of C/EBP homologous protein (CHOP),Bcl-2,and activated caspase-3 in the left hippocampi by Western blot.Results Compared with group S,NDSs and brain water content were significantly increased,the expression of CHOP and activated caspase-3 was up-regulated,and the expression of Bcl-2 was down-regulated in group FCIR,NDSs was increased in group P (P ＜ 0.05).Compared with group FCIR,NDSs and brain water content were significantly decreased,the expression of CHOP and activated caspase-3 was down-regulated,and the expression of Bcl-2 was up-regulated in group P,and no significant change was found in each parameter in group Ⅰ (P ＞ 0.05).Conclusion Propofol can reduce focal cerebral I/R injury through inhibition of the endoplasmic reticulum stress-mediated apoptosis in rats.

Protective effect of polymyxin B in liver transplantation in rats / 中华器官移植杂志

Objective To investigate the protective effect of polymyxin B (PMB) to the liver graft after liver transplantation and the underlying mechanism in rats.Methods Male SD rats were selected as the donors and recipients.Non-artery whole liver transplantation model was established in rats according to Kamada's two-cuff method.The rats were divided into two groups by the way of random number table method:control group (normal saline,0.5 ml) and PMB group (PMB,1 mg/ml,0.4 mg/kg+ normal saline 0.5 ml).The levels of portal vein plasma endtotoxin (EU/ml)were determined by endotoxin-analyzing machine of BET-24A. ALT,BUN,and TNF-α,IL-6 in serum were measured by using machine of Automatic Analyzer and ELISA,respectively.The CD14,TLR4,NFκB and AP-1 in the grafts were measured by RT-PCR and Western blotting,and pathological changes were observed. Results PMB decreased the levels of portal vein plasma endotoxin 1 h after reperfusion in PMB group as compared with control group (P＜0.05),and the levels of portal vein plasma endotoxin returned to the normal levels 6 h after reperfusion in both two groups (P＞0.05).After operation,the levels of ALT,TNFα and IL-6 in serum were significantly reduced (P＜0.05),the expression of CD14 and TLR4 mRNA in the grafts was significantly decreased (P＜0.05),the expression of Hsp60 protein and mRNA,and NF-κB and AP1 proteins in the grafts were reduced (P＜0.05),and the pathological damage to the grafts was significantly alleviated in PMB group as compared with control group.Conclusion PMB reduced the levels of portal vein plasma endotoxin after reperfusion in liver transplantation in rats.PMB improved liver function,reduced the injury of inflammatory response,decreased the levels of endotoxin signal pathway markers and alleviated the pathological damage to the grafts.

Relationship between hepatic arterial buffer response and early biliary complications and small-for-size syndrome after living donor liver transplantation / 中华肝胆外科杂志

Objective To study the relationship between hepatic arterial buffer response (HABR),recovery of liver function,early biliary complications and small-for-size syndrome (SFSS).Methods Early hepatic hemodynamic parameters (including hepatic arterial flow (HAF),portal venous flow (PVF) were measured using duplex Doppler sonography in 34 patients who received living donor liver transplantation (preoperatively n＝26,intraoperatively n=26) and on postoperative days 1,2,3,and 7.Alanine aminotransferase (ALT),aspartate aminotransferase (AST) and total bilirubin (TBIL) level were measured preoperatively and on postoperative days 1,2,3,7,14,21,and 28.If TBIL level was elevated,we used B ultrasonography or CT and even ERCP to diagnose early biliary complications.The days taken for AST,AI T and TBIL to recover and the number of patients with early (＜60 days) biliary complications (bile leakage or bile stricture) and with small-for-size syndrome (SFSS) were recorded.Results Passive hepatic artery buffer response (HABR) was present in 11 patients early after living donor liver transplantation (group 1) and it disappeared in 23 patients (group 2).The recovery in days taken for normalization of AST (10.6± 8.8),AIT (11.6±9.0) and TBlL (average of 29) in group 1 were shorter than in group 2.However,the differences did not reach statistics difference (P＞0.05).The overall incidences of early biliary complications and small-for-size syndrome (SFSS) in group 1 were significantly lower than in group 2 (P=0.04).The survival rate in group 1 was 82 ％,compared with 74 ％ in group 2.Conclusions Passive hepatic arterial buffer response (HABR) disappeared in some patients early after living donor liver transplantation.There were high incidences of early biliary complications and small-for-size syndrome (SFSS) in these patients.Measurcment of hepatic buffer response in the early stage after living donor liver tranaplanta tion is valuable for predition of early biliary complications and small-for-size syndrome (SFSS),thus helping to prevent failure in transplantation.

The dynamic changes of plasma endotoxin in portal vein following partial liver transplantation in rats / 中华器官移植杂志

Objective To investigate and compare the dynamic changes of plasma endotoxin and CD14/TLR4 levels in the portal vein following partial liver transplantation in rats. Methods 100 %(group Ⅰ), 50 % (group Ⅱ) and 30 % (group Ⅲ) orthotopic liver transplantation models in the SD rats→SD rats were established in vivo according to "Kamada two-cuff method". Based on the principle of dynamic turbidity law, the plasma endotoxin (EU/ml) levels were determined at the postoperative time points of 1, 3, 6, 12, 24 h in recipients. The mRNA expression levels of CD14 and TLR4 in liver grafts were detected by using real-time RT-PCR. Results Under the condition of no significant difference in surgical factors, the plasma endotoxin levels in the portal vein of groups Ⅱ and Ⅲ were higher than in group Ⅰ , and reached the peak at the first h postoperation. The endotoxin levels in group Ⅱ were lower than in group Ⅲ. The endotoxin levels in sham-operation group were the highest. The mRNA expression levels of CD14 and TLR4 in groups Ⅰ, Ⅱ and Ⅲ were significantly increased as compared with sham-operation group (P＜0. 01). Conclusion There exists portal vein plasma endotoxima in 100 %, 50 % and 30 % orthotopic liver transplantation in the rats. The smaller the graft volume, the higher and longer plasma endotoxin in portal vein, so is the relative quantification of the TLR4 and CD14 mRNA in liver grafts.

Effect and Mechanisms of Isoflurane on energy metabolism after Ischemia in Isolated Rat Hearts [WT5BZ] / 中国药理学通报

Aim To determine the effects and mechanisms of isoflurane on energy metabolism during ischemia and reperfusion in isolated rat hserts.Methods The rat Langendorff model was used,and isolated per-fused rat hearts were separated into untreated,isoflurane,chelerythrine(PKC inhibitor)plus isoflurane,and chelerythrine groups.All the hearts were subjected to treatment before ischemia,followed by 30 min of ischemia and 60 min of reperfusion.Hemodynamic variables were recorded,and metabolites were measured by high-performance liquid chromatography,and analyzed subcellular localization of PKC isoforms by Western blot analysis.Results The recovery of left ventricular developed pressure after ischemia was(33?8)%,(56?9)%,and(30?5)% in the untreated,isoflurane,and isoflurane with chelerythrine groups respectively.Compared with the untreated hearts,isoflurane significantly improved the recovery of left ventricular developed pressure(P