Volume 88  ·   Issue 09  ·  2008

First, Chinese anesthesiology has been integrated into the World. After the unremitting efforts of Chinese anesthesiologists for several generations, the anesthesiology branch of Chinese medical association has become an official member of the World Federation of Societies of Anaesthesiologists (WFSA) in 2004. We have sent official representatives to attend the WFSA Congress held in Paris.

The pharmaceutical industry is a special industry, which involves national health, social stability and economic development [1]. However, there are many problems in the pharmaceutical field at present, such as inflated drug prices, pharmaceutical rebates, fake and inferior drugs from time to time, inability to recall drugs, false propaganda of medical treatment and drugs, etc.

Objective To determine the median effective dose(ED50)of 2%lidocaine to control the onset time of sciatic nerve blockade within 15 min by using 2%lidocaine and 0.75%ropivacaine 10 ml.Methods Fifty patients underwent sciatic nerve blockade and lumbar plexus blockade for operations of unilateral lower extremities.2% lidocaine was allocated into 7 ranks in geometric proportion between 4.2 ml and 12.5 ml.The observed index was the blockade onset time less than 15 min of the lateral cutaneous branch of sural nerve,fibular nerve,and rami calcanei mediales nervi tibialis.The ED5n of 2% lidocaine was determined respectively in the patients in which dorsiflexion or plantarflexion was elicited by in up-and-down sequential method.Results Combined with ropvacaine,the values of ED50 of 2% lidocaine in the patients in which dorsiflexion and plantarflexion were elicited bv up-and-down sequential method were 6.88 ml and 6.19 ml respectively when the onset time of blockade of sciatic nerve was within the range of 15 min.Conclusion The dosage to elicit plantarflexion is similar to the dosage to elicit dorsiflexion in sciatic nerve blockade.

Objective To study the feasibility of using non-depolarizing relaxant in intraoperative facial nerve monitoring(IFNM)during total intravenous anesthesia(TIVA).Methods Thirty adult patients,aged 37(20～50),with ASA class Ⅰ or Ⅱ,without disorder of facial nerve,underwent IFNM during TIVA,using fentanyl,midazolam,and propofol,to record the compound muscle action potentials (CMAPs)of the facial nerve.Train of four(TOF)pattern was used to evaluate the degree of peripheral neuromuscular blockade.The relationship between the TOF value and CMAP was studied.Results When the TOP value was 1 the wave amplitude of the CMAP of facial nerve was 0.19±0.08 mv,significantly lower than that when no muscle relaxant was used(2.72±0.34 mv,P＜0.01),however,when the TOF values were≥2 there were no statistically significant differences in the amplitude of the CMAP of facial nerve.In addition,clear graph of CMAP could be obtained when the TOF values were≥2.Conclusion IFNM can be safely and efficaciously performed when neuromuscular blockade is monitored carefully during TIVA.

Objective To determine the optimal target plasma concentration of propoibl required to induce EEG burst suppression administered by TCI in order to decrease cerebral metabolic rate and increase tolerance to cerebral ischemia and hypoxia. Methods One hundred and fifty ASA Ⅰ-Ⅱ patients(aged 18-55 vears old,BMI＜30,Mallampati Score Ⅰ-Ⅱ)scheduled for elective surgery undergoing general anesthesia were enrolled in this study.Patients with systemic diseases or other factors effecting the electrical activitv of brain were excluded. ECG,IBP,SpO2,PetCO2,Temperature and EEG(two-channel referential montage system)were continuously monitored during the procedure.Patients were induced with TCI propofol (the target plasma concentration was initially set at 5.4 μg/ml),After induction and intubation,target plasma concentration was increased by 0.3 μg/ml increment and sustained 15 minutes until EEG burst suppression appeared(stable burst suppression waveform and BSR＞50%),and this target concentration was recorded.Results The mean target plasma concentration of propofol with TCI required to induce EEG burst suppression was 6.1±0.6 μg/ml with 95% confidence interval of 5.99-6.19 μg/ml.There was no significant difference between the genders.Conclusions The target plasma concentration of propofol reached 6.2 μg/ml can induce EEG burst suppression,which is better for intraoperative cerebral protection.

objective To investigate the clinical effects of epidural clonidine pretreatment in epidural patient-controlled analgesia(PCA)using sufentanil combined with levobupivacaine.Methods Sixty patients undergoing abdominal hysterectomy of ASA status Ⅰ～Ⅱ were randomly divided into 3 equal groups:C2 group was pretreated with epidural clonidine 2 μg/kg at the L2-3 interspace,15 min later,epidural anesthesia was performed with 0.5% levobupivacaine,and then 0.4 μg/ml combined with levobupivacaine 2 mg/ml was given for postoperative epidural patient-controlled analgesia.C4 group was pretreat4ed with epidural clonidine 4 μg/kg,and C0 group was pretreated with normal saline.The analgesic effect,PCA drug dosage,adverse reaction,and visual analog scale(VAS)score were recorded.Results Anesthesia was clinically satisfactory in all patients.The rate of atropine use of the C4 group was 30%,significantly higher than those of the C2 group(15%)and C0 group(5%,both P＜0.05).The rate of VAS ≤3 at rest 24 h postoperatively of the C2 and C4 groups were 88%and 93%respectively,both significantly higher than that of the C0 group(75%,P＜0.01 and P＜0.01).The rate of VAS≤3 while coughing 24 h postoperatively of the C2 and C4 groups were 61%and 79%respectively,both significantly higher than that of the C0 group(48%).The dosages of PCA drug of the C2 and C4 groups were significantly lower than that of the C0 group by 11.8%and 22.8%respectively(both P＜0.05).The dosage of PCA drug 0～4 h after operation of the C2 was significantly higher than that of the C4 group.The sedative degree of the C4 group was higher than that of the Co group.The rate of postoperative vomiting of the Co group was 40%,significantly higher than that of the C4 group(10%,P＜0.05).Conclusion Epidural clonidine 2～4 μg/kg pretreatment improves the clinical effects of epidural PCA using sufentanil combined with levobupivacaine.

Objective To study the expression of human leukocyte antigen(BLA)-DR in the lungs of the patients with idiopathic pulmonary fibrosis(IPF),and to explore the possible autoimmunity mechanisms of lung fibrosis.Methods Methods Immunohistochemistry(SP method)was used to detect the expression of HLA-DR in the lung specimens from 10 IPF patients and in 5 specimens of normal lung tissue immediately adjacent to lung carcinomas as controls.Results HLA-DR antigens were expressed in the hyperplastic bronchio-alveolar epithelial cells in IPF,but not in the epithelial cells of the normal control lung tissues.The accumulated positive scores of HLA-DR of the IPF group was 27,significantly higher than that ofthe control group(2,Z=-3.002,P=0.001).Conclusions Inappropriate HLA-DR expression is present in the bronehio-alveolar epithelium in IPF.Immune dysfunction may play an important role in the development of IPF.

Objective To summarize the experience in diagnosis and surgery of lumbar disc herniation sequestrating to upper spinal canal.Methods Seventeen patients,9 males and 8 females,aged 41(27～54),with the diseased intervertebral discs herniated and upward sequestrated that were confirmed by lumbar MRI,all with definite clinical manifestations of nerve root compression,underwent operation,including 14 cases undergoing semi-laminectomy and discectomy and 3 cases undergoing laminectomy,discectomy,and fusion.Japanese Orthopedic Association(JOA)(29 scores)evaluation standard was used to before the operation and 14 days and 3 months after the operation to evaluate the curative effects.Results The average operation time was 80 min 50～180 min),and the average blood loss was 170 ml(20～350 ml).Cerebrospinal fluid leakage occurred after operation in 2 cases.The JOA score was 6.7 preoperationally,and then rose to 24.2 14 days and 26.5 3 months post-operationally.The clinical effect was satisfied.Conclusion Lumbar disc herniation sequestrating tO upper spinal canal is often misdiagnosed as intraspinal tumor.Confirmed diagnosis depends on the operators'experience and intensive MRI.Operation is necessary for this type of lumbar disc herniation.Lumbar stability must be considered during decompression and discectomy.

Objective To discuss the clinical diagnosis and surgical treatment of congenital contractural arachnodactyly(CCA).Methods The clinical data of 6 CCA patients,1 male and 5 female,aged 7.5(5～14)were analyzed.All cases had kyphoscoliosis,2 in the thoracic segments and 4 in the thoracolumbar segments.The average scoliosis Cobb angle was 88.6°(85°～117°).The average kyphosis Cobb angle was 93.6°(75°～123°).All of the cases underwent internal fixation with pedicle screw and lamina hooks instrnmentation,in which 4 cases underwent posterior Smith-Petersen osteotomy.The diagnosis was based on a constellation of clinical findings.The clinical manifestations included marfanoid habitus,flexion contractures of multiple joints(elbow,knee,hip,and finger),kyphoscoliosis,muscular hypoplasia,and abnormal pinnae("crumpled" outer helices).Molecular genetic testing showed mutation in the fibrillin-2(FBN2)gene encoding the extracellular matrix microfibril.Four cases were followed up for 6～9 months.Results After operation the average Cobb angle of the scoliosis and kyphosis were 37.6° (35°～52°)and 38.6°(28°～54°)immediately,with 62.3%and 68.7% curve correction respectively.Three cases got excellent synostosis of posterior lamina,1 case underwent revision with lamina hook because the distal screw was loose and hurt the nerve root,and the other 2 cases lost follow-up.The patients'body appearance and pulmonary function were obviously improved. Conclusion The characteristic clinical manifestation include severe and stiff kyphoscoliosis,difficult to correct,and enhanced Cobb angle,and pedicle dysplasia of vertebral pedicle leading to difficulty in installing screws.Smith-Petersen osteotomy is often necessary.CCA should be differentiated with Marfan syndrom(MFS),Stickler syndrome,Homocystinuria,and distal arthrogryposis,especially MFS.

：objective To investigatethe expression of nuclear factor-κ-B(NF-κB)/P65 and fragile histidinetriad (FHIT) in colorectal carcinoma and clinical significance thereof. MethodsImmunohistochemistry(PV6000 method)was used to detect the expression of NF-κB/P65and FHIT in 359 samples of colorectal carcinoma and 35 samples of normal mucosa at least 5cm away from the carcinoma tissues.198 of the patients were successfully followed up bytelephone interview.Results The positive expression rates of NF-κB/P65and FHIT in the colorectal carcinoma were 67.7%(243/359) and 46.0%(165/359)respectively.NF-κB/P65 and FHIT were all related to theclinical stage,lymphatic invasion,and distant metastasis(all P＜0.05).The expression of FHITwas negatively correlated with invasion and differentiation degree(r=-0.285 and -0.254respectively,both P＜0.05).The 5-year survival rate of thepailents with NF-κB/P65 expression was significantlylower than that of the patients negative in the NF-κB/P65 expression while the5-year survival rate of the patients positive in FHIT expression was significantly higherthan those negative in the FHIT expression(x2=23.25 and 51.13 respectively,both P＜0.05).NF-κB/P65expression in colorectal carcinoma was negatively correlated with the FHIT expression (r=-0.167,P=0.019).The expression rate of NF-κB/P65 in carcinoma wassignificantly higher,but the expression rate of FHIT in carcinoma was significantly lowerthan those in normal mucosa tissues(x2=40.78 and 15.93 respectively,both P＜0.05).NF-κB/P65was an independent prognostic indicator for disease-free survival and overallsurvival.Conclusion NF-κB/P65 and FHIT play significant rolesin the generation and evolution of eoloreetaI carcinoma and may be used as usefulindicators for clinical assessment of tumor biological behavior and prognosis in patientswith colorectal carcinoma.

Objective To investigate the effect of the regimen of lamivudine(LAM)combined with hepatitis B immunoglobulin(HBIG)in prevention and treatment of re-infection of hepatitis B virus ( HBV) and recurrence of hepatitis B after orthotopic liver transplantation(OLT)for HBV related end stage liver disease.Methods The clinical data of 183 adult liver transplantation patients who lived more than 6 months and were followed up for 14.6 months with complete data were studied retrospectively.According to the HBV prevention strategy,these recipients were divided into two groups:group of pure IAM(n=106) and group of LAM plus intramuscular injection of low dose HBIG(n=77).Results The rate of HBsAg negative conversion 1 week after OLT of the LAM group was 82.10%(87/106).significantly lower than that of the LAM + HBIG group [94.81%(73/77),P=0.010 ].The rates of HBV reinfection,HB recurrence,and YMDD mutation of the lamivudine group were 16.98%(18/106),11.32%(12/106),and 8.49%(9/106)respectively,all significantly higher than those of the JJAM+HBIG group[6.49%(5/77),2.60%(2/77),and 1.30%(1/77)respectively,P=0.035,0.028,and 0.035 respectively].All the patients with YMDD mutation were treated with adefovir(ADF)with improvement.Analysis showed no obvious difference in the effect of LAM given intramuscularly or intravenously.Conelusion The protocol of combination of LAM and HBIG is highly effective,safe,and cost-effective in preventing the recurrence of HBV after OLT.YMDD mutation can be treated by ADF with satisfactory results.

Objective To investigate the mRNA expression levels of nucleostemin(NS)in human esophageal squainous cell carcinoma tissue.Methods Real-time PCR was used to quantify the mRNA expression of NS in the samples of esophageal squamous eell carcinoma tissue and their matched normal esophageal mucosa tissue from 62 patients,36 males and 26 females,aged(61±10)(38-75).The relationship between NS mRNA expression level and clinical pathological features was analyzed.Results The NS mRNA expression level of the 62 cases of esophageal squamous cell carcinoma tissue was ( 4.5±2.1),significantly higher than that of the matched normal esophageal mucosa tissue[(2.1±1.3),t=-5.045,P=0.000 ].The mRNA expression level of NS was associated with tumor grade,depth of infiltration,and lymph node metastasis(all P＜0.05),but not with gender,age,and pathological type(all P＞0.05).Multiple linear regression analysis revealed that clinical and pathological features influenced the NS mRNA expression level(P=0.000),and the depth of infiltration and lymph node metastasis were important influencing factors for NS mRNA expression level(both P＜0.05).Conclusion NS may play an important role in the progression and proliferation of esophageal squamous cell carcinoma.

：Objective To study theefficacy of bilateral intercostal nerve protection on pain relief afterthoracotomy.Methods Sixty patients in need of thoracotomy were.randomized into 3groups:Group C(control group,undergoing standard posterolateral thoracotomy,n=18),GroupU(unilateral intercostal nerve protection group,undergoing protection of intercostal nerveabove the incision based on the standard posterolateral thoracotomy,n=20),and GroupB(bilateral intercostal nerve protection group,undergoing protection of intercostal nervesabove and below the incision based on the standard posterolateralthoracotomy,n=22).Numeric rating scale(NRS)was adopted to document the severity of pain atdifferent time points after surgery.The amount of analgesic use was recorded aswell.Results The pain scores recorded on the postoperative days 2 to 7 and 1 month aftersurgery of Group B were all significantly lower than those of Group C(all P＜0.05).Significant pain relief wasobserved in Group U within the 7 postoperative days compared with Group C;however,therewere not significant differences in pain scores among different groups 1 month aftersurgery.Pain relief after the removal of chest tubes was found only in GroupB(P=0.020).The incidence of morbidity was similar among the 3 groups.Conclusion Protectionof bilateral intercostal nerves around the incision contributes to significant pain reliefafter operation without increase of the morbidity of complications.

Objective To investigate the STEAP1 gene function of the newly discovered gene six transmembrAne epithelial antigen of the prostate-1(STEAP1).Methods Total RNA was obtained from human prostate cancer tissue and underwent PCR amplification.The full length of STEAP1 gene thus obtained was cloned. Mammalian expression vector pcDNA3. 1-STEAP1 was constructed and Stably transfected into the human thyroid epithelial cells of the line FRTAP2320.A growth curve of the transfected cells was drawn.The intracellular reactive oxygen species(ROS)level was determined by flow cytometry (FC)with dichlorodihydrofluorescein diacetate(DCFHDA).Results The growth curve showed that the STEAP1 transfected cells grew faster than the control cells.FC showed that the fluorescence intensity of he intracellular ROS of the STEAP1 transfected cells was 42.13±1.13,significantly higher than those of the cell transfected with blank plasmid(10.02±1.42)and un-transfected cells(13.02 ±2.42,both P＜0.01).Conclusion STEAP1 promotes the cell growth through inducing the intracellular ROS level.

Objective To study the effects of 5-aminolevulinic acid photodynamie therapy(ALAPDT)on human cervical cancer,and to identify the best administration regimen with the least phototoxic reaction.Methods Seventy-two BALB/c nude mice underwent subcutaneous iniection of human cervical cancer cells of the line Mel 80 so as to establish animal models,and then randomly divided into 6 equal groups:pure topical administration group(undergoing injection of ALA 60 mg/kg around the tumor),pure intravendus administration group(undergoing injection of ALA 250 mg/kg into the caudal vein),topical administration and PDT group ( undergoing injection of AIJA 60 mg/kg around the tumor and radiotherapy of 630 nm He-Ne laser 6 h after the drug administration),intravenous administration and PDT group (undergoing injection of ALA 250 mg/kg into the caudal vein and radiotherapy of 630 nm He-Ne laser 6 h after the drug administration),and control group(undergoing none of the treatment).24 h later 6 mice from each group were killed with their tumors taken out.On the days 3,7,14,and 21 after treatment the remaining mice underwent measurement of the tumor size.HE staining and pathological examination were performed.Immunohistochemical study was conducted to detect the protein expression of the apoptosis-inhibiting genes of survivin and vascular endothelial growth factor(VEGF).RT-PCR was used to detect the mRNA expression of the apoptosis-inhibiting gene of Bcl-2 and apoptosis-promoting genes of P53,Bax,and Bad.Results The tumor volnines after treatment of the pure topical administration and pure eaudal vein administration groups were(0.09±0.02)cm3 and(0.14±0.04)cm3 respectively,both significantly smaller than that of the control group [(0.67±0.06)cm3,both P＜0.01 ].The tumor volume of the pure topical administration group 7～14 days after treatment was the smallest.HE staining showed remarkable sabcutaneous necrosis in the 2 PDT groups.Immunohistochemistry showed remarkable down-regulation of protein expression of sunrivin and VEGF in the PDT groups.RT-PCR showed that the mRNA expression levels of survivin and Bcl-2 were both significantly lower than that of the control group(both P＜0.01),and the mRNA expressionlevels of P53,Bax,and Bad were higher than those of the control group,however,not significantly(all P＞0.05).Conclusion ALA-PDT is effective in treatment of cervical cancer.Topical ALA administration+PDT is recommended in treating cervical cancer so as to minimize the side-effects and inconvenience of phototoxic reaction brought by PDT.

Objective To study the effects of high fat diet on the functions of islet β cells and the role of uncoupling protein-2(UCP2)therein and possible mechanism.Methods Fonv SD rats were randomly divided into two equal groups:high-fat-(HF)diet group,fed with HF diet for 20 weeks,and normal diet control(NC)group,fed with normal diet.At the end of the twentieth week blood samples were collected from the heart to determine the serum fasting blood glucose(FBG)and fasting insulin(FINS),and plasma nitrotyrosine,malondialdehyde(MDA),and glutamylcysteinylglycine(GSH),indicators of oxidative stress.Glucose infusion rate(GIR)was measured using euglycemic hyperinsulinemic clamp test to evaluate the peripheral insulin resistance.Pancreatic islets were isolated and collected.Islet perfusion was conducted to evaluate the insulin secretion in the islet β cells.Real-time PCR was used to detect the expression of insulin receptor substrate-1(IRS-1),IRS-2,and uncoupling protein 2(UCP2)genes in the islet.Immunohistochemistry was used to detect the protein expression of IRS-1 and IRS-2.Results ( 1) The concentrations of plasma nitrotyrosine and MDA of the HF group were both significantly higher than those of the NC group(both P＜0.05).However,the plasma GSH of the HF group was significantly lower than that of the NC group(P＜0.01).(2)The blood glucose of both groups became stable since 60 min after insulin secretion(GSIS)of the HF group was significantly lower than that of the NC group;and the GSIS peak increase In comparison with the NC group.(4)In comparison with the NC group,the mRNA expression levels of IRS-1 and IRS-2 genes of the HF group were significantly lower,by 42.3%and 28.1% respectively(both P＜0.05),and the expression of UCP2 was significantly higher,by 32.5%(P＜0.05).(5)Compared with the NC group,the protein expression levels of IRS-1 and IRS-2 in the islets of the HF group were lower,by 26.3%and 11.2%respectively,however not significantly(both P＞0.05).(6)There was a significantly negative correlation between the UCP2 and IRS-1/IRS-2 gene expression in islet β cells in the HF group(r=-0.621 and r=-0.436,both P＜0.05).Conclusion High-fat-diet impairs the expression of insulin signal transduction molecules and the function of islet β cells that may be correlated with overexpression of UCP2.The basic insulin secretion of HF group was significantly higher than that of the NC group;but the glucose-stimulated insulin secretion(GSIS)peak decreased in comparison with the NC group.Compared with the NC group,tIle protein expression levels of IRS-1 and IRS-2 in the islets of the HF group were lower,by 26.3%(P＜0.05)and 11.2%(P＞0.05)respectively.

：Objective To explore theeffect of mucosal administration of α-fodrin in inhibition ofautoimmunity in Sj(o)gren's syndrome(SS).Methods Thirty-four 4-week-old NOD mice wererandomly divided into 4 equal groups:to be immunized by nasal administration of α-fodrin1 μg/dose and 10 μg/dose respectively every twodays(experimental groups),and phophate-buffered saline(PBS)or glutathion2Stansferased(GST)(contml groups).The weekly volume of water drinking was calculated.Thesalivary flow was maintained.Serum samples were obtained to detect theanti-SSA,anti-SSB,RF,ANA,anti-fodrin and anti-type 3 muscarinic acetylcholie receptorpolypeptide(M3RP)by immunofluorescence or ELISA.The cytokines of IFN-γ and IL-10 were measured with ELISA.The salivary glands wereexamined by HE staining and immunohistochemical analysis.Flow cytometry was used to detectthe proportion of Foxp3+ CD4+ CD25+ T cells.Results The titers of anti- -fodrin antibodyand M3 RP antibody of the mice immunized with-fodrin were lower than those of the 2control groups(all P＜0.05),however,there was not significant diffencesbetween these two α-fodrin immunized groups.Five of the 8 mice in theGST group.5 mice in the PBS group,2 mice in the α-fodrin 1 μg/dosegroup,and 3 mice in the α-fodrin 10 μg/dose showed ANApositive.The serum IFN-γ levels in the mice of α-fodrin1 μg/dose and 10 μg/dose groups,PBS group,andGST group were(42±16),(37±15),87±18),and(72±11)pg/ml respectively,those of the fodringroups being significantly lower than those of the control groups(all P＜0.05).Therewere not significant differences in the level of serum IL-10 among these four groups.Thenumbers of Foxp3+ CD4+ CD25+ regulatory T cells were higher in the fodrin groups than inthe PBS and GST control groups(all P＜0.05).The lymphocyticinfiltration and expression of α-fodrin were decreased in theα-fodrin administrated groups.The volume of water drinking of the α-fodrin1 μg/dose group,α-fodrin 10 μg/dosegroup,PBS group,and GST group were(39.2±2.1),(40.4±2.5),(49.3±3.1),and(51.6±2.8)mlrespectively.Conclusion Mucosal administration of α-fodrin effectively inhibitsthe progression of experimental Sj(o)gren's syndrome autoimmunity.

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic and progressive synovial inflammation and symmetrical, progressive and erosive arthritis as the main clinical manifestations. The extraarticular manifestations of RA can affect all systems in the body, including cardiovascular system.

The 50-year-old patient was admitted to the hospital on December 13, 2006 due to abdominal distension accompanied by chest tightness and palpitations for one year. After one year of observation and conservative treatment with traditional Chinese and western medicine before admission, the symptoms did not alleviate, and obvious varicose veins of lower limbs appeared, Grade 3 blowing-like systolic murmur could be heard in the apical area, and the cardiac function was Grade II B.

Sponsored by Chinese Medical Association and Anesthesiology Branch of Chinese Medical Association, and undertaken by Hunan Medical Association and Hunan Anesthesiology Branch, the 2007 National Anesthesiology Annual Conference of Chinese Medical Association was held in Changsha International Convention and Exhibition Center of Hunan Province on September 6-9, 2007.