Remifentanil preconditioning alleviating brain damage of cerebral ischemia reperfusion rats by regulating the JNK signal pathway and TNF-α/TNFR1 signal pathway.

Tumor necrosis factor (TNF) and the TNF receptor (TNFR) superfamily play very important roles for cell death as well as normal immune regulation. Previous studies have strongly suggested that c-Jun N-terminal kinase (JNK) signaling pathway plays a critical role in ischemic brain injury. The purpose of this investigation was to examine the protective effect of remifentanil preconditioning in cerebral ischemia/reperfusion injury (CIR) and its possible molecular mechanism. Results showed that Remifentanil pretreatment significantly decreased the CD4(+) and increased the CD8(+) in cerebral tissues. Additionally, CD4(+)/CD8(+) in CIR + Remifentanil group was markedly lower than that in CIR group. TNF-α and TNFR1 in CIR + Remifentanil group rats was found to be significant lower than that in CIR group rats. The expression levels of Cyt-c, caspase-3, caspase-9 and pJNK proteins in brain of CIR + Remifentanil group rats were found to significantly decreased compared to CIR group rats. In addition, decreased ROS level indirectly inhibit JNK activation and cell death in CIR rat receiving Remifentanil preconditioning. From current experiment results, at least two signal pathways involve into the process of Remifentanil preconditioning inhibiting cerebral damage induced by ischemia reperfusion. The inhibitory effects of Remifentanil preconditioning on the brain damage are achieved probably through blocking the activation of TNF-α/TNFR1, JNK signal transduction pathways, which implies that Remifentanil preconditioning may be a potential and effective way for prevention of the ischemic/reperfusion injury through the suppression extrinsic apoptotic signal pathway induced by TNF-α/TNFR1, JNK signal pathways. Taken together, this study indicated that regulation of the TNF-α/TNFR1 and JNK signal pathways may provide a new therapy for cerebral damage induced by ischemia and reperfusion.

[Expression and significance of HOXA10 gene in the eutopic and ectopic endometrium of endometriosis].

OBJECTIVES: To investigate the expression and clinical significance of HOXA10 gene in the eutopic and ectopic endometrium of endometriosis. Mehtods Between Jan.2009 to Aug.2010, 30 patients with endometriosis undergoing laparoscopic surgery in Maternal and Children's Hospital of Foshan. Eutopic and ectopic endometrium were obtained. In the mean time, 30 patients with benign ovary cyst or tubal infertility undergoing laparoscopic surgery were selected as controls. Their uterine endometrium were obtained real-time fluorescent quantitation, western blot and immunohistochemistry technique were used to detect mRNA and protein expression of HOXA10 gene in the eutopic endometrium group, ectopic endometrium group and control group. RESULTS: The mRNA and protein expression of HOXA10 gene were 0.61 ± 0.07 and 0.47 ± 0.05 in the eutopic endometrium of endometriosis, 0.64 ± 0.06 and 0.50 ± 0.05 in ectopic endometrium of endometriosis, which were significantly lower than 1.22 ± 0.14 and 1.42 ± 0.14 in control group (P < 0.01). However, the mRNA and protein expression of HOXA 10 between eutopic and ectopic endometrium of endometriosis did not reach statistical difference (P > 0.05). The expression of HOXA10 in eutopic and ectopic endometrium of endometriosis were decreased by immunohistochemistry staining. CONCLUSION: The lower expression of HOXA10 gene in the eutopic and ectopic endometrium of endometriosis might be associated with pathogenesis and infertility of endometriosis.

[Indications and contraindications of vaginal hysterectomy for non-prolapsed uterus].

OBJECTIVE: To study the indications and contraindications of vaginal hysterectomy for non-prolapsed uterus. METHODS: Totally 2086 patients underwent vaginal hysterectomy during the period of June 1992-June 2003 were analysed and the surgery quality and incidence of complications among patients with different sizes of uteri, with or without history of pelvic or abdominal surgery, with history of vaginal delivery and adnexectomy were compared. RESULTS: (1) The patients with uteri > 16 weeks of gestation were associated with longer operating time [(73 +/- 25) vs (42 +/- 16) min)], more blood loss [(237 +/- 86) vs (101 +/- 58) ml] and higher rate of pelvic infection (1.69% vs 0.78%) when compared to the patients with uteri < or = 16 weeks. The differences were statistically significant (P < 0.01). (2) There was no significant difference in the operating time and intraoperative blood loss between the patients with and without history of pelvic or abdominal surgery (P > 0.05), however, the surgery group had higher side injury rate during operation. In addition, 119 patients complicated with ovarian cyst underwent vaginal ovarian cystectomy successfully. CONCLUSION: Vaginal hysterectomy for patients with uteri < or = 16 weeks of gestation is safe and feasible. The procedure is relatively difficult for uteri > 16 weeks and should be determined according to the operator's experience and the patient's condition. A history of pelvic or abdominal operation increases the side injury rate in vaginal hysterectomy. The successful rate of vaginal hysterectomy in patients with uteri < or = 16 weeks of gestation is not affected by the history of vaginal delivery. During vaginal hysterectomy, ovarian cystectomy is feasible for the ovarian cyst < or = 6 cm. Skillful operator and use of appropriate instrument expand the indication of vaginal hysterectomy.

Investigation on current status of in-patient medical service and patient requirements.

OBJECTIVE: To conduct an investigation on current medical service for the in-patients in Zhujiang Hospital and to understand the requirement of the patients for the services. METHODS: A questionnaire was designed for that purpose to conduct the investigation in 130 in-patients from 19 clinical departments. RESULTS AND CONCLUSION: With the current medical service provided by the hospital, 87.4% of the patients expressed their satisfaction with the sanitation, 51.3% with the food and 51.3% considered the charges reasonable (to which 6.7% of patients disagreed and 8.3% wished to know the details of the costs from a report every 3 to 5 d). A total of 82.8% of the patients were satisfied with the medical care. As for the requirements and expectations of the medical service, 91.3% of the patients wished to have free rechecks and consultation within certain period after discharge. A proportion of 73.8% of the patients preferred domestically manufactured drugs or those by joint-venture companies, and 11.3% correlated the price of the drugs with their effects. The results also showed the shortage of single ward. As many as 93.2% of the patients wished to choose between alternatives on a basis of thorough knowledge concerning their treatment, but only half of the patients recognized the fulfillment of this right. The results of multiple analysis show that the service after discharge is of great importance in affecting the patients' satisfaction with the general medical service.