Volume 92  ·   Issue 13  ·  2012

We have repeatedly seen that at the entrance of many operating rooms, children refuse to enter the operating room for fear of surgery, crying and noisy, so that their mothers shed tears, while anesthesiologists are a little helpless, often taking coercive measures, and a shot of ketamine to settle the matter. As anesthesiologists, are they indifferent when they see such a scene? Don't you want to change something? In an era of "people-oriented" medicine, parents have higher and higher requirements for the overall development of their children's physical and mental health. Pediatric anesthesia has changed from just making children "no physical pain" to "no psychological trauma" at the same time. We anesthesiologists can no longer use needles to deal with our children! I would like to take this opportunity to talk about the current situation and some suggestions of preoperative anesthesia induction in pediatric anesthesia in China. 1. Individualized preoperative fasting and drinking. The discomfort caused by the preoperative fasting and drinking time of children is often one of the reasons why children cry. The surgical reception and fasting time are often difficult to control, and some elective pediatric operations have a short time and a large number of operations. Large general hospitals or children's hospitals can often arrange 10-30 operations a day, and many of them have sudden fever and cold on the same day and temporarily change the operation date. Therefore, anesthesiologists and surgeons are often worried that the original fasting time is not enough because the rhythm of reception is changed, so the idea of fasting and drinking time is more obvious than short.

Objective To assess the difficult airways preoperatively in neonates with Pierre Robin sequence (PRS).Methods A total of 18 newborn PRS with difficult intubation were evaluated with the assessment grade.The scores were based upon clinical observation,weight gain,airway obstruction and Cormack-Lehane classification.Results A total of 14 neonates (77％) had medium (n =8) and severe (n =6) airway obstruction.And 89％ (n =16) failed to display glottis and unsuccessful tracheal intubation (50％).Conclusion The assessment practice of clinical observation,weight gain,airway obstruction and Cormack-Lehane classification may help to identify the difficult airways in neonates with PRS.

Objective To apply ultrasoni(c) technology in positioning and monitoring for pediatric caudal blocks and comparc it with traditional landmark approach and Swoosh test.Methods After obtaining the approval of hospital ethics committee and written parental informed consent,a total of 102 American Society of Anesthesiologists (ASA) Ⅰ- Ⅱ pediatric patients aged from 1 month to 8 years and scheduled for urologic or perineal surgery were recruited.Patients were randomly divided into 2 groups:ultrasound group (n =52 ) and control group (n =50 ).The sites of sacral cornu and sacral hiatus were determined by ultrasonic imaging or classic method of anatomical surface landmarks.Patients of two groups were punctured according to the scheduled site.Local anesthetic was injected slowly into caudal space after a successful caudal puncture and the positive reaction in caudal space was monitored simultaneously by ultrasound and classic swoosh test.The observational results and relevant date were recorded.Results In ultrasound and control groups,the number of puncture attempts was 1.10 ± 0.30 vs 1.56 ± 0.63,the duration of puncture ( 1.40 ± 0.39 ) vs ( 3.23 ± 1.23 ) min,the success rate at the first puncture attempt 90.4％ vs 66％ and the total puncture success ratc 100％ vs 92％ respectively.After the injection of local anesthetic,the positive reaction rate of ultrasonography and swoosh test was 97.96％ vs 62.24％ respectively.All of above results in ultrasound group were superior to those in control group or with classic test.And the difference had statistical significance (P ＜ 0.01 ).Conclusion Ultrasonic positioning and monitoring for pediatric caudal block is both scientific and reasonable.The positioning detected by ultrasonic imaging is accurate and the monitoring results of ultrasound are reliable.It is obviously superior to traditional method and has clinical application values for caudal block in children.

Objective To explore the effect of different doses of dexmedetomidine on the sedation of recovery period and the postoperative early pain scores in pediatric patients undergoing cleft lip and palate repair.Methods A total of 100 American Society of Anesthesiologists (ASA) Ⅰ - Ⅱ pediatric patients undergoing cleft lip and palate repair were randomly divided into 5 groups( D1,D2,D3,D4 and C,n =20 each).Groups D1-D4 received a continuous pump infusion of dexmedetomidine at 0.25,0.5,0.75,1.0 μg · kg-1 · h-1 respectively for 1 h before the completion of operation.Then an intravenous injection of 1 μg/kg was prescribed over 10 min as a loading dose.Group C,taken as control,received an equal volume of normal saline. Propofol 2 mg/kg was added for the occurrence of emergence agitation. Mean arterial pressure (MAP),heart rate (HR),respiratory rate (RR),partial pressure of end-tidal carbon dioxide (PETCO2),Riker sedation-agitation scale,times of additional propofol requirements,times of additional artificial ventilation,extubation time,discharge time,side effects and face,legs,activity,cry and consolability (FLACC) scale were observed and recorded.Results The Riker sedation-agitation scale were 5.3 ± 0.9,4.3 ± 0.8,3.5 ± 0.8,2.6 ± 0.6 and 6.1 ± 0.7,times of additional propofol requirements were 4.7 ± 1.7,2.5 ± 1.4,0.8 ± 0.9,0.1 ± 0.4 and 5.7 ± 0.7 in groups D1,D2,D3,D4 and C respectively.In short,group D4≈group D3 ＜group D2 ＜ group D1 ＜ group C(P ＜0.05).As compared with group D4,the extubation time and discharge time significantly increased in groups D1,D2,D3 and C(P ＜0.05).The FLACC scales in groups D2,D3 and D4 were lower than those in groups D1 and C.Side effects:2 cases developed sinus bradycardia in group D4 and heart rate returned to normal after treatment.Conclusion At a load dosage of 1 μg/kg and a maintenance dosage of 0.75 μg · kg-1 · h- 1,dexmedetomidine shows excellent effects on the recovery period of cleft lip and palate repairing in pediatric patients.The FLACC scale decreases with fewer side effects,but extubation time and discharge time increase.

A 60-year-old male was admitted to the Department of Rheumatology and Immunology of Peking Union Medical College Hospital in November 2009 due to multiple joint swelling and pain for 1 year. In November 2008, the patient showed swelling and pain of both wrists, metacarpophalangeal joints and knee joints without obvious entrapment, accompanied by morning stiffness for about 30 min. The erythrocyte sedimentation rate (ESR) was 41 mm/1 h in the local hospital, and rheumatoid factor (RF) was positive, and he was diagnosed with rheumatoid arthritis (RA). After intermittent treatment with traditional Chinese medicine, the disease recurred from time to time, and gradually appeared arthralgia of both shoulders and elbows, and swelling and pain of proximal interphalangeal joints of both hands. In November 2009, the symptoms aggravated, and the physical examination showed that there were no subcutaneous nodules, swelling and tenderness of the third metacarpal finger and the second and third proximal interphalangeal joints of both wrists and hands, limited movement, swelling and tenderness of the left knee joint, and palpable cystic mass in the popliteal fossa. Blood routine: white blood cells 5.47×109/L, hemoglobin 134 g/L, platelets 260×109/L; Urine routine, liver and kidney function and blood lipids were all normal; ESR 55 mm/1 h, C-reactive protein (CLRP) 18.6 mg/L; RF 0.273×106 U/L, anti-cyclic citrulline peptide antibody 0.468×106 U/L, anti-perinuclear factor antibody, anti-keratin antibody positive, anti-nuclear antibody negative; X-ray films of both hands showed that the bones of both hands and wrist joints were osteoporotic, the space between both wrist joints was slightly narrow, and there was no obvious bone erosion on the articular surface; The B-ultrasound of the left knee joint showed popliteal cyst. According to the RA classification criteria revised by the American College of Rheumatology in 1987, the diagnosis of RA was confirmed. After methotrexate 10 mg/week and leflunomide 10 mg/d, the joint swelling and pain gradually improved. In January 2010, the patient had swelling and pain of the left lower limb without obvious trigger, no fever, chest pain, hemoptysis, and dyspnea. The follow-up medical history was no history of hypertension, diabetes, coronary heart disease, kidney disease or malignant tumor, no history of varicose veins, long-term bed rest, trauma or surgery, and no history of smoking or drinking. Blood test routine: white blood cells 5.59×109/L, hemoglobin 127 g/L, platelets 278×109/L; ESR 68 mm/1 h, CRP 15.7 mg/L;

Objective To evaluate the efficacy of ultrasound guidance for ilioinguinal or iliohypogastric nervc block in pediatric outpatients undergoing inguinal surgery. Methods The present study was approved by the ethics committee of our hospital.One hundred children with ASA status Ⅰ,aged 4 - 8 years old,scheduled for unilatcral inguinal surgery were randomly divided into ultrasound group ( Group U) and traditional group ( Group T ) ( n =50 each ).Upon entering operation room,they were monitored by electrocardiography ( ECG),heart rate ( HR ) and oxygcn saturation ( SpO2 ).After an induction of general anesthesia, intravenous access was established and laryngeal mask inserted with spontaneous breathing.Intraoperative anesthesia was maintained with 2％ sevoflurane in 50％ nitrous oxide with 50％ oxygen.Children in Group U received an ilioinguinal or iliohypogastric block under ultrasonic guidance with a mixture of 0.8％ lidocaine and 0.25％ levobupivacaine at 0.2 ml/kg while those in Group T performed according to the traditional method of anatomical localization with the same local anesthetic at 0.3 ml/kg.During surgery,the vital signs of HR,respiratory rate ( RR),SpO2,partial pressure of end-tidal carbon dioxide (PETCO2 ) and exhaled sevoflurane concentration were recorded.Additional intraoperative analgesic requirements were recorded.Face legs activity cry consolability ( FLACC ) score was used to assess the pain score postoperatively at recovery time,2 and 4 h postoperation respectively.If the pain score was above 3,the child received acetaminophen rectally.The number of postoperative rectal acetaminophen was recorded.The degrees of parental satisfaction were investigated at 2 and 4 h oostoperation. Intra-or postoperative adverse events were also recorded.Results HR at skin incision and sac traction in Group U was significantly lower than those in Group T (P ＜ 0.05).Six children ( 12％ ) needed to increase inhaled sevoflurane concentration during operation in Group U versus 17 (34％) in Group T ( P ＜ 0.05 ).The pain score at recovery time,2 and 4 h postoperation in Group U was significantly lower than those in T group (P ＜0.05 ).Only 4 children (8％) needed postoperative rectal acetaminophen in Group U versus 13 (26％) in Group T ( P ＜ 0.05 ).The degree of parental satisfaction at 2 h postoperation was significantly higher in Group U than that in Group T ( P ＜ 0.05 ).One case in Group T had needle puncturing into blood vessels.No other adverse event was observed in two groups. Conclusion The method of ultrasonic guidance for ilioinguinal or iliohypogastric nerve block is both feasible and effective.It can not only enhance the effect of nerve block,reduce the occurrences of complications,lower the quantity of local anesthetic and alleviate the medicinal toxicity.

Objective To audite and compare the perioperative practices ot intravenous fluids and electrolyte & glucose monitoring in children undergoing operations for scoliosis in 2008,2010,prior to and after the publication of guideline in 2009.Methods Retrospectivc audit was conducted at Peking Union Medical College Hospital,a tertiary referral teaching hospital in Beijing,China.Children under 14 years old with scoliosis treated surgically in 2008 and 2010 were recruited.The following data were collectcd from medical files:age,gender,weight,duration of hospitalization,concurrent illness,operation,anesthesia,fluid prescribed during perioperative fasting period,electrolyte monitoring and postoperative pain control,etc.Results Among 235 American Society of Anesthesiologists (ASA) Ⅰ - Ⅱ cases,75 children received dextrose 5％ or saline 0.9％ during the preoperative fasting period. Intraoperatively, the anesthesiologists preferred dextrose 5％ or saline 0.9％ in children under 6 years old (n =15,2008; n =15,2010) and Ringer's solution in those aged 6 - 14 years ( n =84,2008 ; n =94,2010) and hypotonic fluid was not used.And 82.3％ and 94.3％ of them received electrolyte examinations preoperatively.The electrolyte results were unavailable postoperatively in 27/122 (in 2008) and 13/113 (in 2010) and serum electrolytes were not assessed before fluid treatment postoperatively.Electrolytes were monitored only once in 82.3 ％ ( in 2008 ) and 70.5％ ( in 2010) patients.Compared with the prcoperative concentration of sodium ion,the mean decrease was approximately 2.0 mmol/L at Day 1 postoperation.Hyponatremia at Day 1postoperation in 2010 was more common than that in 2008 ( 26.2％ vs 23.6％ ; P =0.044 ). But no significant difference existed between the incidence of hyperglycemia of the same day in 2008 and that in 2010 (P- 0.306 ). Conclusion Compared with that in 2008,our recent practice of intravenous fluid prescription and electrolyte monitoring is ill-consistent with the recommendations in 2009.Implementation of optimal perioperative fluid management is warrantcd.

Objective To explore the correlation between surgical timing and clinical prognosis for ruptured intracranial aneurysms. Methods A series of 187 patients with intracranial aneurysm treated surgically at our department were analyzed retrospectively.Among them,101 patients received an average follow-up period of 9 months (range:6-14).Tinings of operation that might affect the clinical efficacies of microsurgery were analyzed.The modified Rankin scale (mRS) of discharge and the corresponding follow-up mRS were all analyzed. Results Timing of operation was negatively correlated with mRS of hospital discharge(P ＜ 0.05 ),but it had no correlation with follow-up mRS (P ＞ 0.05 ); patients whose discharge mRS were 1,2,3 or 4 had better long-term efficacies (P ＜ 0.05 )while those with a discharge mRS of 5 fare worse ( P ＞ 0.05).Conclusion The short-term efficacy of early microsurgery for intracranial aneurysms is worse than those of medium aud late microsurgery.But no obvious differences exist between the long-term efficacies of early,medium and late microsurgery.The patients whose discharge mRS were 1,2,3 or 4 have better long-term efficacies.

[Abstract] Objective To explore the efficacy and safety of tandospirone for adolescents with anxiety disorder.Methods In this multicenter open-label 12-week study,a total of 169 adolescents met the criteria of DSM-Ⅳ for anxiety disorder were treated with flexible dose of tandospirone.The effects and safety of treatment were assessed by the Hamilton anxiety scale (HAMA),state-trait anxiety inventor (STAI),clinical global impression (CGI) and side effects at baseline and Weeks 2,4,8 and 12.Results In 151cases completing the 12-week treatment,the scores of HAMA decreased by 18％ ± 12％,38％ ± 16％,54％ ±20％ and 63％ ± 17％ at Weeks 2,4,8 and 12.Significant reductions in HAMA scores were seen at Weeks 2 12 (P ＜ 0.01 ) and marked improvement appeared in 8 1.5％ cases at Week 12 (reduction rate of HAMA:50％ ).At Week 12,the HAMD17 scores were markedly lower versus baseline (7 ±2 vs 13 ±3,P ＜ 0.01 ).Adverse effect of tandospirone was scarcely found ( 9.9％ ). Conclusion Tandospirone is an effective and safe anti-anxiety drug for adolescents.

Objective To compare the mechanism of depressive disorder and schizophrenia' mental rotation ability so as to provide specific objective clinical indicators for identifying mental illness.Methods Thirty depressive disorder (15 males,15 females ),30 schizophrenia (15 males,15 females) and 28 healthy participants (14 males,14 females) were tested to perform mental rotation tasks with the letter F and R graphics.The subjects were required to decide whether the stimulus was a normal or a mirror version of an alphabet letter presented in different views and angular orientations.The mouse left key was pressed for a normal and the mouse right button for a mirror.Results ( 1 ) Error rate:As compared with the normal control group (normal:29％ ±10％,mirror:32％ ±3％ ),the normal error rate was significantly higher while the mirror error rate significantly lower in depressive disorder (normal:31％ ± 13％,mirror:22％ ± 4％,P ＜0.01 ) ; the normal error rate was significantly lower while the mirror error rate significantly higher in schizophrenia ( normal:27％ ± 9％,mirror:42％ ± 2％,P ＜ 0.01 ). (2) Normal reaction rate:As compared with the normal control group (50％ ± 9％ ),the normal reaction rate was significantly lower in depressive disorder (38％ ± 12％,P ＜ 0.01 ) and significantly higher in schizophrenia (60％ ± 9％,P ＜0.01).(3) Response time:As compared with the normal control group( normal (602 ± 25 ) ms,mirror (606 ± 14) ms ),the normal and mirror response durations were both significantly longer in depressive disorder(normal (653 ± 23) ms,mirror (714 ± 13) ms,P ＜ 0.01) while significantly shorter in schizophrenia(normal (571 ± 18) ms,mirror (587 ± 11 ) ms,P ＜ 0.01 ).Conclusion Normal mental rotation ability is severely impaired in depressive disorder,but its mirror counterpart becomes compensated.In schizophrenia,mirror mental rotation ability is severely impaired,but its normal counterpart becomes compensated.It hints that normal and mirror rotation ability may be interchangeable so as to serve as a state index.The impairment of mental rotation ability impaired can be used as specific objective clinical indicators of identifying mental illness.

Objective Central venous oxygen saturation (ScvO2) is a useful therapeutic target in septic shock and high-risk postoperative patients. We tested the hypothesis that central venous-to-arterial carbon dioxide difference ( △PCO2 ) combine with ScvO2 to guide shock resuscitation is better than ScvO2 only.Methods A retrospective study was conducted for 93 septic shock and high-risk postoperative patients.They underwent resuscitation through early goal-directed therapy.We calculate whether there were correlations between the △PCO2 and tissue perfusion index or blood flow index,including the beginning of resuscitation (T0) and after 6 hour resuscitation (T6).They were divided into 4 groups according to △PCO2 and ScvO2.Then the clearance of lactate was compared between the groups.Results No correlation existed between △PCO2 and tissue perfusion index.But there was some correlation between △PCO2 and the indices of blood flow such as CO,ScvO2 and clearance of lactate.At TO,the correlation (r) between△PCO2 and cardiac index was 0.858 ( P =0.029 ) and the correlation between△PCO2 and ScvO2 - 0.403 ( P =0.000).At T6,the correlation (r) between △PCO2 and ScvO2 was - 0.363 ( P - 0.000) and the correlation between △PCO2 and clearance of lactate -0.3t4 (P =0.002). After continuous 6-hour resuscitation,there was significant difference in clearance of lactate between the groups.The clearance of lactate was the highest in the group of patients achieving the goals of both ScvO2 ＞70％ and △PCO2 ＜6 mm Hg.We further analysis the △PCO2 ＜ 6 mm Hg and ScvO2 ＞ 70％ subgroup and found that the 6 h lactate clearance rate were statistically significant difference.Conclusion The combination of △PCO2 and ScvO2 may guide thc shock resuscitation.It helps identify the inadequately resuscitated when the ScvO2 goal is reached.

Objective To compare the safety and efficacies of traditional open versus percutaneous monosegmental pedicle screw fixation in the treatment of incomplete thoracolumbar spinal fracture.Methods A retrospective analysis was conducted for 44 inpatients with a diagnosis of incomplete thoracolumbar spinal fracture ( AO classification:A3.1 and A3.2 ) undergoing monosegmental pedicle instrumentation (MSPI) from September 2008 to January 2011.There were 24 cases in percutaneous group and 20 cases in traditional open group. The mean operative duration,blood loss,blood drainage,visual analogue scale/ score (VAS) and vcrtcbral kyphotic angle at pre- and post-operation were evaluated. Results No significant differences existed in operative durations between two groups (P ＞ 0.05 ). Significant differencesbetween two groups were observed in terms of intra-operative blood loss and VAS scores at Week 1 postoperation (P ＜ 0.05 ). There were no significant differences in VAS score preoperation, 1 year postoperation or pre-and post-operative vertebral kyphotic angle ( P ＞ 0.05 ).No complications of iatrogenic neurological injury or hardware failure occurred.Conclusion The application of percutaneous monoscgmcnt pedicle instrumentation in the treatment of thoracolumbar fractures in type of A 3.1 and A 3.2 is both feasible and safe.Its postoperative therapeutic effect is comparable to that of traditional open monosegmental fixation.

Objective To localize the sensory motor cortex of human brain by analyzing the power change in Gamma band ( ＞ 60 Hz ) of electrocorticography (ECoG) data.Methods Eight patients with intractable epilepsy underwent temporary placement of subdural electrodes. After surgery,scnsory cvokcd potential (SEP),electrocortical stimulation (CES) and event-related synchronization analysis of Gamma band ( Gamma ERS analysis) were performed to reduce the risk of complications.The results of Gamma ERS analysis were compared with those of SEP and CES.Results The results of Gamma ERS analysis had 80.7％ electrodes fitting perfectly those of CES and SEP.And the percentage reached 92.3％ if electrodes were superimposed or added adjacently.Conclusion The Gamma ERS analysis is a new sensitive and precise method for cortical function mapping.

Objective Evaluate the microbiological and epidemiological characteristics of primary bloodstream infections as well as the associated patients' clinical features at Peking Union Medical College Hospital.Method Microbiological and clinical data of the adult patients with primary bloodstream infections during January 1,2008 and December 31,2009 were retrospectively collected and evaluated.Pearson x2 test was used to compare the difference between proportions and Logistic regression was used in multivariate analysis.Result Five hundred and eighty-six strains of microbes were isolated from 494 adult patients with primary bloodstream infections.There were 80 patients with polymicrobial primary bloodstream infection of the 586 isolates,coagulase-negative staphylococci ( 175,29.9％ ) was the most common,followed by Escherichia coli( 93,15.9％ ),Enterococcus species ( 60,10.2％ ),Streptococcus species ( 41,7.0％ ),and Staphylococcus Aureus (39,6.7％ ).Central-line was the leading suspected infective source among the suspected infective source involving 108 (18.4％) isolates. Excluded the 108 isolates with suspected sources,77 (45.3％) out of 167 patients with the primary bloodstream infections caused by coagulasc-negative staphylococci or Staphylococcus Aureus had a central-line,with a higher proportion of the patients with a central-line than the patients with bloodstream infection caused by other pathogens ( x2 =10.419,P =0.001 ).One hundred and fourteen patients died during hospitalization,with the crude mortality rate 23.0％.Fifty-nine patients (11.9％) died due to primary bloodstream infection.The patients with polymicrobial bloodstream infection were with a higher attributable mortality( OR =2.159 ;95％ CI 1.165 -4.002 ;x2 =6.194,P =0.013 ).In the multivariate analysis,the independent risk factors of crude mortality rate to primary bloodstream infections were elderly patients,central neurological disorder,mechanical ventilation,and reservation a central-line. Conclusion The most common microbe causing primary.bloodstream infections was G + cocci.Polymicrobial primary bloodstream infection added risk to attributable in-hospital fatality ratio.Elderly patients,neurological disorder,reservation of central-line,and mechanical ventilation were the independent risk factors of crude in-hospital fatality ratio.

Objective To investigate the link between the antituinor efficacy of sorafenib and its cutaneous side effects in advanced hepatocellular carcinoma(HCC).Methods We retrospectively analyzed the incidence of hand-foot skin reactions (HFRS) of 51 patients with advanced HCC who treated by sorafenib combined with transcatheter arterial chemoembolization (TACE),comparing tumor disease control rate (DCR),median progression free survival (mPFS) and median overall survival(mOS) in the different severity HFRS groups.The Cox proportional hazard model was applied to the multivariate survival analysis for the PFS.Results Fifty-one HCC patients treated with sorafenib combined with TACE were included in this study.13/51 without HFRS( grade 0),38/51 developed at all grade 1 -3,27 developed at grade 1 -2,11 dcvcloped at grade 3.The DCR were 38.5％,70.4％ and 90.9％ in the three groups (P ＜0.05).Group grade 0 vs grade 1 -3,P=0.031,the difference had statistical significance.Group grade 1 -2 vs grade 3,P =0.352,the difference had no statistical significance.The mPFS were 2.8 months(95％ CI 1.6 -4.0 ),4.5 (95 ％ CI 1.3 - 7.7 ) months and 12.8 ( 95 ％ CI 3.7 - 21.9 ) months ( P ＜ 0.05 ),group grade 0 vs grade 1 - 2,P =0.019,HR ( hazard ratio):2.8 (95 ％ CI 1.3 - 6.3 ),P =0.010,group grade 0 vs grade 3,P ＜0.01,HR 6.6(95％ CI 2.3 - 19.0),P ＜0.01,group grade 1 -2 vs grade 3,P =0.054; the three groups' mOS were 8.5 months (95 ％ CI 5.9 - 11.1 ),13.0 (95％ CI 10.1 - 15.9 ) months and 25.4 months,P ＜0.05,there were statistically significant differences between the any two groups.Conclusions HFRS should be closely monitored in HCC patients treated with sorafenib in relation to its potential role as a surrogate narker of efficacy,but it has yet to be demonstrated whether the efficacy increasing with the severity of HFRS or not.

Objective To investigate the effects of obesity on the lipid and glucose metabolism in female rats.Methods The litter size was adjusted to 4 pups per litter for the small litter ( SL,treatment group) and 12 neonates per dam in the normal litter (NL,controls) at postnatal day 0.Body weights were measured weekly.At the age of 6 weeks,bilateral ovariectomy was performed.Tbe blood levels of free fat acid,triglyceride,total cholesterol,free blood glucose and free insulin were evaluated. The muscular expression of AMP-activated protein kinase was detected by immune staining.Results As compared to normal litters,the levels of fat acid,triglyceride,total cholesterol,free blood glucose and free insulin significantly increased.The muscular activity of AMP-activated protein kinase decreased.All difference were statistically significant (P ＜ 0.05).Conclusion Obesity in early life has obvious effects on the lipid and glucose metabolism in female rats.

Objective To observe the effects of blueberry on rat with hepatic fibrosis and ultrastructural.of hepatocytes.Methods Sixty (60) healthy Wistar rats were randomly divided into six groups:normal control group( group A),hepatic fibrosis model group( group B),blueberry at low,middle and high concentration groups ( group C,D,E),Fu-Fang-Bie-Jia-Ruan-Gan tablet group ( group F).The hepatic fibrosis model of rat was established by intraperitoneal injection of porcine serum once daily for 12 weeks.Simultaneously,rats in groups C - F were respectively perfused with blueberry juice or Fu-Fang-BieJia-Ruan-Gan tablet for 12 weeks except for the normal control group which accepted saline alone.Upon terminal sacrifices of all rats at the end of the twelve weeks.Pathology of hepatic tissue was evaluated by hematoxylin-eosin (HE), Masson staining and transmission electron microscope. Liver index were measured.Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum were examined.Activities of superoxide dismutase (SOD),the contents of malondialdehyde (MDA),hydroxyproline (Hyp) and reduced glutathione (GSH) in liver homogenates were determined.Results Refer to the serum levels of ALT and AST,there is no significant difference existed in all groups(P ＞ 0.05).Activities of SOD,the contents of GSH in liver homogenates of group D and E were significantly higher than those of group B ( P ＜ 0.05 ),while liver index,the contents of Hyp,MDA in liver homogenates were significantly lower than those of group B ( P ＜ 0.05 ).Compared with the group B,the pathological stages of hepatic fibrosis in group D and E were significantly reduced ( P ＜ 0.05 ),the expression of collagen were decreased,ultrastructural alterations were markedly improved. Conclusion Blueberry may have certain preventional protective effects on porcine serum induced rat hepatic fibrosis and exhibit certain protective effects on organelles of hepatocytes ( such as mitochondria),especially in middle and high does of blueberry.Its mechanism is probably related to increase the ability of antioxidant stress by increasing SOD activity and GSH content and reducing MDA content.

The patient, a 39-year-old female, found a mass in her right breast in July 2004, about 2 cm in diameter, without pain and itching, and was not treated. In July 2005, the mass was found to be gradually enlarged and accompanied by obvious tenderness, about 3.2cm ×3.0cm in size, and went to the Second Affiliated Hospital of Zhejiang University School of Medicine for treatment. Breast ultrasound examination showed multiple hypoechoic masses in her right breast with uneven texture, considering multiple cysts and breast cancer to be discharged. He was admitted to hospital for surgical treatment. Physical examination showed that the mass was hard, with clear borders and no obvious adhesion to the skin. Intraoperative frozen pathological examination showed that the mass was 3.2 cm ×3.0cm ×3.0 cm in size, unclear borders, gray-red, and the tissue had obvious hemorrhage, and medium texture. Microscopically, the tumor was composed of epithelioid or spindle cells with obvious atypia, with more vascular lumen-like structures, considering angiosarcoma. Simple right mastectomy was performed. Postoperative paraffin section showed that the tumor showed diffuse proliferation of abnormal blood vessels, intertwined and anastomosed, with inconsistent lumen size and thin wall, resembling capillary hemangioma and cavernous hemangioma-like surface However, vascular endothelial cells have large nuclei, deep chromatin stain, and infiltrate mammary lobules. About 20% of the cells in the region are spindle-shaped or solid distribution, with obvious abnormalities, accompanied by focal necrosis, and easy to see mitotic phase (Figure 2).