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We studied patients with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) associated with or without lymphoma and measured risk factors suggestive of an underlying lymphoma and follow-up outcomes.CLIPPERS patients associated with or without lymphoma were included into this study. Clinical presentations were documented, risk factors suggestive of an underlying lymphoma were tested, and prognostic differences in terms of death were compared.Ten patients had a diagnosis of CLIPPERS associated with lymphoma, with 6 B-cell non-Hodgkin lymphoma, 2 T-cell non-Hodgkin lymphoma and 2 Hodgkin lymphoma. Using multivariate logistic analysis, the following 3 independent risk factors were found to be related to a final diagnosis of lymphoma: hyperreflexia (HR 16.56; 95% CI 1.03-265.29; p = 0.032), elevated protein in CSF (HR 11.59; 95% CI 1.24-108.39; p = 0.047), and recurrences between 2 months and 1 year after treatment (HR 29.27; 95% CI 2.09-409.58; p = 0.012). The model calibration was satisfactory (p = 0.392 with the Hosmer-Lemeshow test), and the discrimination power was good (area under the receiver operating characteristic curve 0.921; p 0.001, 95% CI 0.826-1.000). Patients with CLIPPERS associated with lymphoma had higher mortality rate and lymphoma was a significant predictor of total mortality (HR 0.040; 95% CI 0.006-0.262; p = 0.001).Hyperreflexia, elevated protein in CSF and recurrences between 2 months and 1 year after treatment are risk factors suggesting an underlying lymphoma. Relapses during high-dose steroids maintenance therapy can be indicative of lymphoma, too. Patients having CLIPPERS associated with lymphoma have a worse prognosis than those without lymphoma.

We examined the cross-sectional association between mushroom intake and mild cognitive impairment (MCI) using data from 663 participants aged 60 and above from the Diet and Healthy Aging (DaHA) study in Singapore. Compared with participants who consumed mushrooms less than once per week, participants who consumed mushrooms >2 portions per week had reduced odds of having MCI (odds ratio = 0.43, 95% CI 0.23-0.78, p = 0.006) and this association was independent of age, gender, education, cigarette smoking, alcohol consumption, hypertension, diabetes, heart disease, stroke, physical activities, and social activities. Our cross-sectional data support the potential role of mushrooms and their bioactive compounds in delaying neurodegeneration.

As a primary nonpharmacological tool, exercise training is neuroprotective after experimental ischemic stroke by relieving neuroinflammation. However, the specific mechanism of which and anti-inflammatory effect of exercise at different intensities require in-depth investigations. To explore the issue, middle cerebral artery occlusion-reperfusion (MCAO-r) in mice were utilized, with subsequent exercise training at different intensities (high-intensity interval training versus moderate-intensity continuous training, i.e. HIIT vs. MICT) during an early phase post-modeling. The neurobehavioral assessment showed that MICT improved the performance of neurological deficit scores and rotarod test earlier, while HIIT appeared to be more efficacious to meliorate locomotor impairments and aerobic fitness at the end of intervention. Both exercise regimens inhibited the expressions of NLRP3 inflammasome components (NLRP3, ASC, and Cl.caspase-1) and pyroptosis-associated proteins (GSDMD, Cl.IL-1β, and Cl.IL-18) as indicated by western blot and immunofluorescence co-staining. Multiplex assay panel revealed that both exercise regimens reduced the levels of pro-inflammatory cytokines and upregulated anti-inflammatory cytokine. Furthermore, an increased proportion of M2-like microglia and a diminished proportion of M1-like microglia in the peri-infarct zone were observed by colocalization analysis, which was jointly validated by western blot. Here, for the first time, our study demonstrated that HIIT elicited better improvements at functional and cardiovascular levels than MICT after ischemic stroke, and anti-inflammatory effect of exercise might result from suppression in inflammasome-mediated pyroptosis by shifting microglial polarization toward neuroprotective M2 phenotype.

CT-guided microwave coagulation is a minimally invasive surgery for patients with liver cancer. Total intravenous anesthesia with propofol and fentanyl is commonly used. The depth of anesthesia during microwave coagulation for liver cancer is still monitored by clinical signs. There are few subjective and effective indicators. This study explored the application of Narcotrend-assisted "depth of anesthesia" monitoring on microwave coagulation for patients with liver cancer during total intravenous anesthesia with propofol and fentanyl.Forty liver cancer patients underwent CT-guided microwave coagulation were randomly assigned to receive Narcotrend index monitoring or standard clinical monitoring for depth of anesthesia with 20 patients in each group. All patients received total intravenous anesthesia with propofol and fentanyl. The depth of anesthesia for patients in the Narcotrend group was measured according to a Narcotrend index, which was maintained between D2 and E0. The depth of anesthesia for those in the standard clinical practice group was measured according to heart rate, mean arterial pressure, and patient movement. Changes of hemodynamics, the duration of the emergence from anesthesia, and the recovery of orientation were recorded. The doses of propofol and fentanyl, postoperative visual analogue scores (VAS), and the incidence of postoperative nausea and vomiting were also recorded.There was no significant alteration in heart rate or mean arterial pressure between the two groups. Compared with other anesthetic stages, both heart rate and mean arterial pressure decreased during the induction of the anesthesia in the two groups(P0.05). The doses of propofol were higher in the standard clinical practice group than in the Narcotrend group [(460+/-30) mg vs. (380+/-35) mg, P0.01]. The duration of emergence and orientation were longer in the standard clinical practice group than in the Narcotrend group [(9.5+/-2.9) min vs. (4.9+/-2.2) min, P0.01; (12.2+/-3.5) min vs. (6.6+/-3.2) min, P0.01, respectively]. There was no difference in the dosage of fentanyl, VAS, or the incidence of postoperative nausea or vomiting between the two groups (P0.05).For patients with liver cancer, monitoring the depth of anesthesia with Narcotrend on microwave coagulation can contribute to lower dosage of propofol and shorten duration of recovery during total intravenous anesthesia with propofol and fentanyl.

A retrospective study was conducted, and 576 human immunodeficiency virus-infected children with total lymphocyte count (TLC) and CD4 count were recruited from China. Spearman rank order correlation and receiver-operating characteristic were used. An overall positive correlation was noted between TLC and CD4 count (prehighly active antiretroviral therapy [pre-HAART], r = 0.789, 6 months of HAART, r = 0.642, 12 months of HAART, r = 0.691, P = 0.001). TLC ≤ 2600 cells/mm(3) predicted a CD4 count of ≤ 350 cells/mm(3) with 82.9% sensitivity, 79.6% specificity pre-HAART. Meanwhile, the optimum prediction for CD4 count of ≤ 350 cells/mm(3) was a TLC of ≤ 2400 cells/mm at 6 months (73.6% sensitivity and 74.1% specificity) and 12 months (81.7% sensitivity and 76.5% specificity) of HAART. TLC can be used as a surrogate marker for predicting CD4 count of human immunodeficiency virus-infected children before and during HAART in resource-limited countries.

To measure and accumulate imaging anatomical data of lacrimal sac and medial canthal artery, and provide the knowledge for clinical diagnosis and therapy of lacrimal diseases.80 volunteers(80 eyes) who were eliminated the tearing related diseases by ophthalmologist were included. GE Voluson E8 ultrasound diagnostic apparatus with probe of high frequency 5-12 MHz was used, the probe of the three-dimensional ultrasound contacted eyes indirectly. The vertical diameter, anteroposterior diameter, width of lacrimal sac were measured, and vertical distance between top to bottom of lacrimal sac and medial canthus to skin, vertical distance between medial canthal artery and medial canthus to skin were also measured.The measurement results of adult male subjects of lacrimal sac cavity vertical diameter and anteroposterior diameter and diameter were (13.3 ± 2.0) mm, (6.2 ± 1.1) mm, (5.0 ± 0.9) mm; the measurement results of adult female subjects of lacrimal sac cavity vertical diameter and anteroposterior diameter and diameter were (13.1 ± 2.2) mm, (5.8 ± 1.0) mm, (4.8 ± 0.8) mm, the difference was not statistically significant(t = 1.63, 1.45, 1.41, P0.05). The measurement results of adult male subjects of lacrimal sac cavity (top, bottom) to the top of the skin surface and medial canthal were (6.5 ± 0.1) mm, (5.9 ± 0.1) mm, (6.8 ± 0.1) mm, (8.8 ± 0.1) mm; the adult female group measurements were (6.1 ± 0.1) mm, (5.7 ± 0.1) mm, (6.2 ± 0.1) mm, (8.6 ± 0.1) mm, the difference was not statistically significant(t = 1.30, 1.56, 1.45, 1.63, P0.05). The measurement results of adult male subjects vertex are angular artery to the skin surface and medial canthal were (7.7 ± 0.1) mm, (8.0 ± 0.0) mm; the adult female group measurements respectively (7.6 ± 0.1) mm, (7.9 ± 0.1) mm, the difference was not statistically significant(t = 1.38, 1.34, P0.05).Lacrimal sac and medial canthal artery can be showed clearly in three-dimensional ultrasound reconstruction, this can provide the guidance for clinical diagnosis and therapy of lacrimal diseases.

Hepatocellular carcinoma (HCC) is one of the most common cancers in the world and is particularly prevalent in China. China is also a hyperendemic area for hepatitis B virus (HBV) infection. Although a strong association between HBV infection and HCC has been established previously, the role of hepatitis C virus (HCV) infection and the interaction between HBV and HCV in the development of HCC has not been adequately explored. The major objective of this study is to determine the relationship between HBV or HCV infection and HCC by use of case-control study in Henan, China.In all, 152 HCC patients and 115 control patients were collected from four hospitals in Henan, China between January 1994 and October 1995. The demographic characteristics of the two groups were comparable. In further analysis, a 1:1 pair-matched case-control study was performed. Of 152 HCC patients, 113 were randomly selected to be pair-matched by sex and age (+/-5 years) to controls with non-hepatic disease. All the cases and controls were interviewed during hospitalization by two specially trained interviewers using a standard questionnaire. All sera were tested for HBV and HCV markers. Odds ratios (OR) and 95% CI for HCC risk factors were calculated by logistic regression model controlling for possible confounding factors such as sex and age. The multivariate analysis was done on the basis of the univariate analysis.The results of this study indicated that the prevalence of hepatitis B surface antigen (HBsAg) and antibody to HCV (anti-HCV) were much higher in HCC patients (63.2% and 11.2% respectively) than in the control patients (5.2%, 3.5%). The difference between two groups was significant (P0.05). Risk factor analysis revealed that both HBV and HCV infection were important factors for HCC in Henan, China and HBV appeared to have a key role in the development of HCC. Odds ratios of HBsAg and HBV infection were 28.82 (95% CI: 11.18-78.78) and 31.22 (95% CI: 13.86-72.15), respectively. Moreover, the risk of developing HCC increased significantly and showed an additive effect when both viral markers of HBV and HCV infection were considered (OR = 42.85). Results from the 1:1 pair-matched case-control study also showed that HBV infection was an important risk factor for HCC, which was consistent with the results from the group-matched case-control study.This is the first reported case-control study of HCC in Henan, China. This study provides further evidence that chronic HBV infection is strongly associated with the development of HCC among this population. Our results have demonstrated that HCV and HBV infection are independent and probably additive risk factors for HCC.One of the most common cancers in the world, hepatocellular carcinoma (HCC) is particularly prevalent in China. China is also a hyperendemic area for hepatitis B virus (HBV) infection. Findings are presented from a case-control study conducted in Henan, China, to determine the relationship between HBV or hepatitis C virus (HCV) infection and HCC. 152 HCC patients and 115 control patients were recruited from 4 hospitals in Henan between January 1994 and October 1995. In further analysis, 113 of the 152 HCC patients were randomly selected to be 1:1 pair-matched by sex and age to controls with nonhepatic disease. All cases and controls were interviewed and had their sera tested for HBV and HCV markers. The prevalences of hepatitis B surface antigen (HBsAg) and antibody to HCV (anti-HCV) were 63.2% and 11.2%, respectively, in HCC patients, and 5.2% and 3.5%, respectively, in the controls. Risk factor analysis found that both HBV and HCV infection were important factors for HCC, with HBV appearing to have a central role in the development of HCC. Odds ratios of HBsAg and HBV infection were 28.82 and 31.22, respectively. The risk of developing HCC increased significantly and showed an additive effect when the viral markers of both HBV and HCV infection were considered. Results from the 1:1 pair-matched case-control study also showed HBV infection to be an important risk factor for HCC, consistent with the results from the group-matched case-control study.

To investigate the relationship between phenomenon of aggregation on multiple metabolic abnormalities and their family history.A random cluster sampling was carried out to study the phenomenon of multiple metabolic abnormalities among the adult inhabitants in a county of Henan province. Questionnaire, physical examination and biochemical tests were admitted. Multiple correspondence analyses were used to explore the aggregation of multiple metabolic abnormalities among objects including hyperlipidemia, diabetes, coronary heart disease etc. Corresponding relationships between objects and their parents on multiple metabolic abnormalities were also analyzed.In total, 3901 people were investigated including 1428 (36.6%) males and 2473 (63.4%) females. The mean age of them was 32.8±6.3. Data showed that the Cronbach's α were 0.547 and 0.387 while Eigen values were 1.971 and 1.535 in two dimensions, regarding the correspondence analysis on their parents' multiple metabolic abnormalities. Cronbach's α levels were 0.598 and 0.457 together with Eigen values as 2.263 and 1.743 in two dimensions on the correspondence analysis of the objects' and their parents' multiple metabolic abnormalities. Results from Multiple correspondence analysis diagrams showed that there was an aggregation of variety metabolic abnormalities in both objects and their parents but not between objects and their parents or between fathers and mothers, though χ2 test showed a weak correlation between some of the categories. The ranges of contingency coefficients between metabolic abnormalities were 0.04 to 0.11, 0.04 to 0.08 and 0.04 to 0.11 between parents, objects and fathers, objects and mothers, respectively. When compared with simple obesity, the central obesity aggregated appeared more obviously with other metabolic abnormalities.Both objects and their parents showed an aggregation of variety metabolic abnormalities. Aggregation of central obesity showed more obvious on other metabolic abnormalities than the simple obesity. Family histories of metabolic abnormalities played a moderate role in the generations suffering from multiple metabolic abnormalities.

To investigate the frequencies of leukotriene gene single nucleotide polymorphisms (SNPs) in the asthmatic subjects of Han population in Wenzhou district, and the association between SNPs and response to montelukast treatment.Sequenom matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) was used to genotype six polymorphisms in 60 asthmatic patients and 61 controls. According to the SNPs results, 11 cases with the LTC(4)S (rs730012) CC + AC genotype and 11subjects with the AA genotype were given montelukast treatment, and evaluated by the response of pulmonary function and urinary leukotriene E(4).The frequencies of mutant SNPs in ALOX(5) (rs2115819, rs4986832, rs4987105), LTA(4)H (rs2660845), ALOX(5)AP (rs10507391) and LTC(4)S (rs730012) were less than 50%. There were no statistical differences of the haplotype distribution (P values were 0.914, 0.609, 0.609, 0.315, 0.752 and 0.636 respectively). No statistical differences of the mutant allele frequencies were observed in the genes ALOX(5) (rs2115819, rs4986832, rs4987105) and LTA(4)H (rs2660845) (OR values were 1.112, 0.964, 0.964 and 0.673 respectively, all P0.05). The invalid value (OR = 1.0) was included in the 95%CI of odds ratios. There were no differences of genotype distribution in the above loci (χ(2) values were 0.792, 2.684, 2.683 and 2.524 respectively, all P0.05). There was a statistical difference in the ALOX(5)AP (rs10507391) mutant allele between the 2 groups, and the frequency of mutant allele A in the asthma group was 23.3% (OR = 2.016, 95%CI = 1.027 - 3.959, P0.05). There was a statistical difference in the LTC(4)S (rs730012) mutant allele between the 2 groups, and the frequency of the mutant allele C in the asthma group was 25.0% (OR = 1.926, 95%CI = 1.007 - 3.685, P0.05). Compared with the AA genotype, the LTC(4)S (rs730012) CC + AC genotype showed a significant improvement of FEV(1) (t = 6.185, P0.01) and urinary LTE(4) level (t = 2.925, P0.05) after receiving montelukast treatment.These results suggest that the SNPs of ALOX(5)AP (rs10507391) and LTC(4)S (rs730012) are associated with asthma in our patients. The LTC(4)S (rs730012) locus genetic polymorphism contributes to improvement in montelukast response.

To explore the effect of triptolide on airway remodeling and the expression of nuclear factor-kappaB, Bcl-2 in asthmatic rats.40 rats were randomly divided into 5 groups (n = 8): (1) Control group; (2) Asthmatic 4 week group; (3) Asthmatic 6 week group; (4) Therapeutic 4 week group; (5) Therapeutic 6 week group. The airway resistance and eosinophilic inflammation of airway wall were observed. The airway wall thickness (WA/Pi), the bronchial smooth muscle thickness (smooth muscle area/Pi) and the number of bronchial smooth muscle nucleus (N/Pi) were measured by image analysis system. The expression of PCNA, nuclear factor-kappaB and Bcl-2 protein were determined by immunohistochemical staining and Western blot. The expression of Bcl-2 mRNA was determined by reverse transcription-polymerase chain reaction(RT-PCR).(1) The expression of NF-kappaB protein in asthmatic 4 week group and asthmatic 6 week group was significantly higher than that in control group, respectively (P0.01). The above-mentioned parameters of therapeutic 6 week group were significantly lower than those of asthmatic 4 week group, asthmatic 6 week group and therapeutic 4 week group, respectively (P0.01, P0.01 P0.05). (2) The expression of Bcl-2 protein and mRNA of asthmatic 4 week group and asthmatic 6 week group were significantly higher than those in control group respectively (P0.01). The expression of Bcl-2 protein of therapeutic 6 week group was significantly lower than those of asthmatic 4 week group, asthmatic 6 week group and therapeutic 4 week group respectively (P0.05, P0.01, P0.01), but the expression of Bcl-2 mRNA was significantly higher than the above-mentioned groups respectively (P0.01), the expression of Bcl-2 protein and mRNA of therapeutic 6 week group were higher than control group respectively (P0.05, P0.01). (3) The expression of PCNA protein of asthmatic 4 week group and asthmatic 6 week group were significantly higher than those of control group respectively (P0.01). (4) The WA/ Pi, the smooth muscle area/Pi and the N/Pi of asthmatic 4 week group and asthmatic 6 week group were significantly higher than those of control group, respectively (P0.01). The above-mentioned parameters of therapeutic 6 week group were significantly lower than those of asthmatic 4 week group, asthmatic 6 week group and therapeutic 4 week group, respectively (P0.01). (5) The airway resistance of asthmatic 4 week group and asthmatic 6 week group were significantly higher than those of the control group, respectively (P0.01). The above-mentioned parameters of therapeutic 6 week group were significantly lower than those of asthmatic 4 week group, asthmatic 6 week group and therapeutic 4 week group, respectively (P0.01, P0.01, P0.05).The proliferation of airway smooth muscle(ASM) is related with apoptosis of airway smooth muscle cells in asthma. NF-kappaB may be involved in the process. Triptolide may prevent apoptosis of ASMCs and decrease the proliferation of ASM by inhibiting the expression of NF-kappaB, Bcl-2.

To analyze the region cluster and risk factors of hypertension in the Chinese adult population and to explore the application of multilevel regression model in the risk factors of hypertension.Multi-stage random sampling technique was used to choose 15,540 individuals aged 35-74 years from 10 regions in China. Two-level logistic regression models were fitted under MLwiN 2.02 software.The region cluster of hypertension existed and variance portion coefficient was 3.1%. After adjusting for the age and gender, overall obese people (BMIor =28 kg/m2) were 4.50 (95% CI: 4.00-5.06) times, overweight people (BMI=24-27.9 kg/m2) were 2.26 (95% CI: 2.07-2.46) times more likely to be hypertensive as compared with those of normal BMI (18.5-23.9 kg/m2), and those centrally obesive people (Waist circumferenceor =85 cm in male or 80 cm in female) were 2.62 (95% CI: 2.42-2.83) times more likely to be hypertensive as compared with those of normal WC. The age-and gender-adjusted odds ratios (ORs) of triglyceride (TG), serum total cholesterol (TC), glucose, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and drinking alcohol were 2.10 (95% CI: 1.89-2.33), 2.08 (95% CI: 1.84-2.35), 1.85 (95% CI: 1.60-2.14), 1.58 (95% CI: 1.38-1.81), 1.49 (95% CI: 1.32-1.69) and 1.15 (95% CI: 1.05-1.27), respectively.The prevalence of hypertension was not only affected by individual risk factors, such as obesity, drinking alcohol, abnormal glucose and serum lipids profile, but also affected by the geographic environment where people resided in. Population-and risk factors targeted strategies, proved a promising way to reduce individual risk of hypertension in the primary prevention of hypertension.

Tumor-induced acute airway stenosis is a medical emergency. Metal airway stent implantation can relieve dyspnea of patients suffering from this symptom and provide time for their further treatment. This study was to investigate the clinical application, efficacy, and complication management of tracheal stent implantation for the treatment of tumor-induced acute airway stenosis.Nickel-titanium (Ni-Ti) alloy stent implantation was performed under the guidance of fiber-optic bronchoscopy in 52 patients with tumor-induced acute airway stenosis.Stent implantation was successful in all 52 patients. Dyspnea in all patients was significantly relieved. Values of arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and Karnofsky performance status (KPS) changed from (7.74+/-0.99) kPa, (5.37+/-0.39) kPa, and (68.85+/-8.08) preoperatively to (11.12+/-0.61) kPa, (4.58+/-0.30) kPa, and (84.62+/-5.03) postoperatively (P0.01). The three-year survival rate was higher in lymphoma group than in lung cancer or esophageal cancer group. Postoperative complications were properly managed in all cases after symptomatic treatments.Tracheal stent implantation is an effective palliative treatment for acute dyspnea caused by local tumor compression or tumor invasion of large airways. It can rescue patients at risk for airway obstruction, improve the quality of life in terminal cancer patients, and provide further treatment opportunities for them.

Percutaneous radiofrequency ablation (PRFA) is a new and effective microinvasive operation for small hepatocellular carcinoma, but the effect of local anesthesia or single analgesic injection as regular anesthesia is unsatisfied. This study was to evaluate the efficacy and safety of continuous intravenous infusion of remifentanyl combined with propofol as total intravenous anesthesia during PRFA.Sixty patients scheduled for PRFA were randomized into remifentanyl group (R) and fentanyl group (F). Each group contained 30 patients. Group R received remifentanyl infusion at the dose of 0.1 microg x kg(-1) x min(-1) by micro pump; group F received bolus intravenous injection of fentanyl at 1.5 microg x kg(-1) before operation. Anesthesia was maintained with propofol. The mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SPO2), respiration rate (RR), partial pressure of carbon dioxide in artery (PaCO2) and recovery time were measured and recorded by monitor. The limb movement, apnea, body movements, and chest wall rigidity were recorded during operation.The recovery time of group R was significantly shorter than that of group F [(5.0+/-1.8) min vs. (10.7+/-3.0) min, P0.001]; the total consumption of propofol was less in group R than in group F [(172.0+/-37.3) mg vs. (330.3+/-61.2) mg, P0.001]. Group R had less cases with limb movement (5 cases vs. 12 cases) but more cases with apnea (12 cases vs. 6 patients) as compared with group F.Total intravenous anesthesia with remifentanyl and propofol for PRFA is safe and reliable. Respiratory depression should be monitored instantly and strictly.

To understand the incidence of post-stroke depression (PSD) and the therapeutic effect of acupuncture-moxibustion.Five hundred and sixty cases were rating with Hamilton depression scale, and lesion parts, gender, age and property of stroke between the PSD and non-PSD were compared by analysis of variance, chi2 test, and then the patients of PSD were randomly divided into two groups and treated respectively with Prozac-20 and acup-moxibustion at Sishencong (EX-HN 1), Anmian, Neiguan (PC 6), Shenmen (HT 7), Zusanli (ST 36), Sanyinjiao (SP 6), Taichong (LR 3), Zhaohai (KI 6), Shenmai (BL 62).The total incidence rate of PSD was 43.9%, with no relation to the lesion parts, gender, age and property of stroke (P0.05), and there were very significant differences in HAMD scores before and after treatment in the two groups (P0.0001), with no significant difference in the effective rate between the two groups (P0.05).PSD has a high incidence and influences the recovery of nervous function, and it should be treated at early stage. Acup-moxibustion and Prozac-20 have similar therapeutic effect.

The elderly esophageal cancer patients undergoing esophagectomy are increasing now. How to protect their cardiac functions and reduce perioperative mortality and morbidity of cardiac events is an urgent problem to be solved. Prophylactic beta-blockers have been recently applied during surgery. This study was to evaluate the beneficial effects of metoprolol on perioperative cardiac function of elderly esophageal cancer patients.The esophageal cancer patients, no less than 65 years old, scheduled for elective esophagectomy were enrolled, and randomized into metoprolol group and control group. The patients of metoprolol group received metoprolol to control heart rate from anesthesia induction to 72 h after operation. Perioperative hemodynamic data were recorded at time points of baseline, drug administration, 2 min after induction, intubation, 4 min after intubation, incision, thoracic exposure, 60 min after incision, 10 min before the completion of operation, the completion of operation, extubation, and 15 min after extubation. The serum level of cardiac troponin T (cTnT), the occurrence of perioperative cardiac events and postoperative sinus tachycardia were also recorded.Compared with preoperative values, systolic arterial pressure was significantly higher at intubation (P0.05), heart rate was significantly faster at intubation and extubation (P0.05) in control group; while the hemodynamic data had no obvious changes in metoprolol group (P0.05). The serum level of cTnT was elevated in 3 patients of control group within 3 days after operation, and remained normal in all patients of metoprolol group (P=0.237); cardiac events occurred in 6 patients of control group (including 2 cases of myocardial ischemia and 4 cases of atrial fibrillation), but didn't occur in metoprolol group (P=0.024). No myocardial infarction and death occurred in the 2 groups during operation. The occurrence rate of tachycardia was significantly higher in control group than in metoprolol group (15 cases vs. 6 cases, P0.05).Metoprolol can reduce the occurrence of perioperative cardiac events and postoperative tachycardia in the elderly esophageal cancer patients undergoing esophagectomy, and restrain the effects of tracheal intubation or extubation on heart rate and blood pressure.

Ulinastatin is a kind of broad- spectrum hydrolase inhibitors purified from urine of healthy males.There was no data showing whether ulinastatin could affect alveolar inflammatory reactions.This study was designed to investigate the changes of pulmonary alveolar interleukin-8 during one lung ventilation (OLV) in surgery and the effects of ulinastatin on alveolar IL-8.Sixty patients,ASA II- III,who underwent lobectomy, were randomly divided into two groups [30 patients in each group,surgery group(II) and control group (I)].Patients in surgery group were treated with ulinastatin 5,000 u/kg preoperatively. Alveolar IL-8 was harvested by bronchoalveolar lavage at 0, 1, and 2 hours after one lung ventilation and at the end of surgery. The changes of concentration of IL-8 in bronchoalveolar lavage fluid were analyzed statistically.(1)Alveolar interleukin 8 was significantly higher at 2 hours after OLV [(160.85+/-46.58)ng/L] than before OLV [(128.26+/-35.35)ng/L] in control group. The results indicated that OLV and/or the stimulation of surgery could induce the pulmonary inflammatory reaction. (2)The concentrations of alveolar IL-8 at 2 hours [(140.32+/-41.25)ng/L] after OLV and at the end of surgery [ (156.74+/-43.58) ng/L] were significantly lower in surgery group than those in control group [(160.85+/-46.58)ng/L and (172.41+/-52.60)ng/L] respectively(P0.05).Ulinastatin could alleviate the pulmonary alveolar inflammatory reactions in OLV.

Morphine has been proved to inhibit human immune system, and large dose of fentanyl also decrease the activation of natural killer cells. This study was designed to investigate the effects of different doses of fentanyl on T-lymphocyte subpopulations and natural killer cells during esophageal cancer surgery under general anesthesia.Forty-five patients with esophageal cancer were randomly divided into 3 groups (I, II,III) with 15 cases in each group respectively. The doses of fentanyl in three groups were 5, 10, and 20 microg/kg, respectively. Central venous blood samples (6 ml) were collected before anesthesia, 24 hours and 48 hours after the operation, respectively. Monoclonal antibodies assay was used to identify T cells and NK cells.The counts of CD3(+) (T%) (Group I 50.30+/-8.42, Group II 48.53+/-9.62, GroupIII 46.58+/-8.56), CD4(+) (T%) (Group I 30.04+/-7.24, Group II 28.67+/-7.52, Group III 26.65+/-6.55),and NK cells (Group I 3.26+/-1.62, Group II 3.01+1.56, GroupIII 3.01+/-1.54) in three groups decreased significantly at 24 hours after surgery (P0.01). The decrease at 48 hours after surgery were more significant in groupIII (CD3(+) 48.89+/-9.82, CD4(+) 22.64+/-6.02, NK Cells 3.41+/-1.88) than in group I(CD3(+) 57.32+/-9.13, CD4(+) 35.62+/-5.98, NK cells 5.96+/-1.08) and group II(CD3(+) 55.62+/-10.21, CD4(+) 34.24+/-6.85, NK cells 6.04+/-1.09) (P0.05). There was no statistical significance in the counts of CD3(+), CD4(+), and NK cells between the time of 48 hours after the operation and preoperation in group I and group II.Fentanyl, as a kind of opiate drug, could contribute to the immunosuppression, and large-dose fentanyl administration would be more effective in suppression of immunity function than small dose fentanyl.

Morphine is a widely used analgesic in management of postoperative pain with well documented analgesic properties and side effects. Tramadol, a new synthetic mu-opioid receptor agonist, little is known about its efficacy and side effects when administered in epidural for pain relief. The aim of this study is to compare the efficacy and side effects of tramadol, morphine versus their combination for postoperative analgesia.One hundred and twenty patients undergoing abdominal cancer surgery were assigned to one of three groups randomly, tramadol group (Group T, n = 40), morphine group(Group M, n = 40) and combination of tramadol and morphine group(group T + M, n = 40), for postoperative analgesia. In group T, 12 mg/kg tramadol and 0.125% bupivacaine 100 ml were used for 48 h postoperative analgesia. In group M, 0.12 mg/kg morphine and 0.125% bupivacaine 100 ml; and in group T + M, 6 mg/kg tramadol, 0.12 mg/kg morphine and 0.125%. Bupivacaine 100 ml were used for postoperative analgesia. Efficacy was assessed by comparing visual analogue scale(VAS), Bruggman comfort score (BCS), global satisfaction score (GSS) at several time points over 48 hours. Possile adverse events were recorded.There is no significant difference among three groups in VAS, but in group T, there are more patients whose VAS5 score than those in group M and group T + M. BCS; GSS in group T + M are lower than that in group T and group M. The occurrence rate of nausea and vomiting in group T + M are lower than that in group M.The efficacy of tramadol in epidural postoperative analgesia is similar to that of morphine, but varied from patient to patient, so the dose of tramadol should be individualized. Combination of tramadol and morphine can provide effective analgesia for postoperative pain and cause little adverse effect, especially reduce the occurrence rate of nausea and vomiting.

Midazolam is a useful drug used preoperatively because it can produce anxiolysis and sedation. This study compared the propofol requirements and haemodynamic effects during anaesthetic induction using propofol with premedication of midazolam or luminal.Thirty patients (aged 20-65, ASA I-II) undergoing tumor surgery were randomly assigned into 2 groups (group M and group L): group M, receiving 0.5 mg atropine and 0.05 mg/kg midazolam; group L, receiving atropine and 2 mg/kg phenobarbital sodium 30 min before induction as premedication. Anesthesia was induced with propofol at the rate of 30 mg.kg-1.h-1 to achieve enough depth of anesthesia to intubate. Induction time, total propofol dosage, blood pressure, heart rate were recorded before and after induction, and after intubation. Awaken time was also recorded.The time of induction and the propofol dosage in group M (2.8 +/- 0.37 min and 79.9 +/- 15.3 mg) were significantly (P0.05) less than that in group L (3.3 +/- 0.54 min and 98.9 +/- 17.4 mg). Blood pressure was unchanged in M group after propofol induction and after the intubation. Heart rate change was much less in group M (P0.05).The results indicate that midazolam compered to phenobarbital sodium as premedication could reduce the usage of propofol, and also provide stable cardiovascular state during propofol induction.