Objective To explore the effect of restrictive fluid administration on elderly patients with colorectal cancer in fasttrack.Methods From January 2008 to January 2009, the elderly patients (≥60 years old) diagnosed definitely as colorectal cancer were analyzed retrospectively, the clinical effects on post-operative early rehabilitation were studied and the difference between restrictive fluid regimen and tradition fluid regimen was compared. Results The difference of overall incidence of post-operative complications was statistically significant between the two groups (Plt;0.05). The incidences of anastomotic leakage and pulmonary infection of fluid restriction group were lower than those of tradition therapy group (Plt;0.05). The time of vent to normal, defecation to normal and postoperative first eating of fluid restriction group was shorter than those of tradition therapy group, the difference was statistically significant (Plt;0.05). Comparing the biochemical indicators, the difference of preoperative GLU 〔（6.70±2.93） mmol/L vs. （6.33±3.95） mmol/L〕, BUN 〔(5.84±2.03) mmol/L vs. （7.32±10.83） mmol/L〕and CREA 〔(76.19±19.85) μmol/L vs. （85.36±38.02） μmol/L)〕 was statistically significant (Plt;0.05), but the difference of postoperative results had no statistical significance. Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery for elderly patients, and have a certain promoter action to the early rehabilitation after rectal surgery.
Objective Tissue engineering advance in supplying the reparative and reconstructive medicine with promising tissue engineered medical products(TEMPs) and the new therapy alternative. The related supervision and administration of TEMPs is being developed and the standard research of TEMPs is also in progress. The Food and Drug Administration(FDA) of the United States has treated TEMPs as combined products and supervised them according to the level of risk to patients. Lately, FDA has determined that the Center for Devices and Radiological Health (CDRH) should take charge of examination and approval of TEMPs, with the cooperation of the Center for Biological Evaluations and Research(CBER). The regulatory controls have been established respectively in European Union and Japan. In China, TEMPs are identified as medical devices combined with cells. The Department of Medical Device of the State Food and Drug Administration (SFDA) is responsible for the examination and approval of TEMPs, and National Institute for the Control of Pharmaceutical amp; Biological Products(NICPBP) is responsible for evaluation tests. The standards of TEMPs are formulated mainly by the American Society of Testing Materials(ASTM) and International Standardization Organization(ISO).
Objective To compare the analgesic effects of fentanyl, tramadol and flurbiprofen axetil during vitrectomy under local anesthesia. Methods One hundred and twenty patients who underwent vitrectomy were randomly divided into four groups, 30 patients in each group. Control group (Group C): normal saline were given; Fentanyl group （group F): fentanyl 1 mu;g/kg; Tramadol group （group T): tramadol 1 mg/kg; Flurbiprofen group （group K): flurbiprofen axetil 1 mg/kg. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2), sedation classification (OAA / S) and pain score (NRS) were recorded prior to drug administration (T0) and the beginning of surgery (T1), 5 min (T2), 15 min(T3), 30 min (T4) and the end of surgery (T5) . The incidence of analgesic remedy and adverse reactions were also recorded after surgery. Results In group F, MAP at T1 and T2 were significantly lower than T0 and that of the other three groups at the same time point (F=5.367,5.967;P＜0.05). MAP at each time point of the other three groups had no significant changes (P＞0.05). In Group C, HR decreased significantly at T3and T4compared to T0 (F=7.900, 6.767;P＜0.05). In Group F, HR decreased significantly at T2 compared to T0 (F=3.117，P＜0.05). HR at each time point of group T and group K had no significant changes (P＞0.05). In group F, SpO2at T1 was significantly lower than T0 and that of the other three groups at the same time point (F=7.352, P＜0.05). SpO2of group F, group T and group K had no significant changes within groups (P＞0.05). In Group F, the median of OAA / S classification at T1 were grade four, which were lower than that at T0 and that of the other three groups at the same time point (chi;2=12.935, P＜0.05). There was no significant changes of the median of OAA / S classification at each time point in the other three groups (P＞0.05). In group C, the median of NRS score was three at T1 and was two at T2 respectively, which were higher than that at T0 and that of Group F and group T at the same time point (chi;2=13.748,11.616; P＜0.05). There were no significant changes of the median of NRS score in group F, group T and group K within groups (P＞0.05). Analgesic remedy percentages in group C, group F, group T and group K were 16.7%, 3.3%, 3.3%, 6.7%, respectively. The incidence of adverse reactions in group C, group F, group T and group K were 30.0%、23.3%、3.3%、16.7%, respectively.Conclusion Tramadol had efficient analgesic effects and low rate of adverse reactions during vitrectomy under local anesthesia.
Objective To observe the effects of intravenous thrombolysis with urokinase for central retinal artery occlusion (CRAO). Methods A total of 115 CRAO patients diagnosed by fluorescence fundus angiography (FFA) were enrolled in this study. The patients included 61 males and 54 females, with a mean age of (56.7plusmn;15.2) years (from 41 to 75 years). The duration ranged from 1 to 30 days. All the patients were affected unilaterally. All the patients were received the treatment of intravenous thrombolysis with urokinase (3000 U/kg, two times per day, continuous treatment for six to seven days) and retrobulbar injection of dexamethasone 2.5 mg (one time per day, continuous treatment for 14 days). Following that, 1.2 mg/kg brain protein hydrolysate (nerve nutrition) and 360 mg troxerutin (vasodilator) were given by intravenous drip (one time per day, continuous treatment for 14 days). Effectiveness of the thrombolytic and subsequent treatments including the recovery of vision and retinal arterial filling time before and after treatment were observed. Comparing the visual acuity of post-treatment and pre-treatment, improving three lines or more is considered as effective markedly, improving two lines as effective, no change or a decline as no effect. With FFA as the retinal circulation recovery index, the arm-retinal circulation time (A-Rct ) le; 15s and all branches of central retinal artery were filled with fluorescence within 2s filling (normal) as effective markedly; A-Rct improved but was in 15 - 20s range, all branches of central retinal artery were filled with fluorescence within 3～8s as effective; A-Rct improved but was still ge; 21s, all branches of central retinal artery were filled with fluorescence within ge;9s as no effect. The relationship between age, gender, the disease course, subsequent treat time and curative effectiveness were analyzed. Results There were 79 patients were examined for FFA again after thrombolysis treatment which including 11 patients with complete obstruction and 68 patients with incomplete obstruction. In 11 patients with complete obstruction, eight patients showed that optic disc vascular retrograde filling disappeared, A-Rct was 28-54s, and the filling time from retinal artery to tip was 18 - 55s; three patients showed persistent optic disc vascular retrograde filling within 3 - 4 minutes of FFA. In 68 patients with incomplete obstruction, A-Rct returned to normal in 35 patients (51.4%), effective in 18 patients (26.5%) and no effect in 15 patients (22.1%). Retinal circulation time was shorter than that before thrombolysis treatment (chi;2=11.4, Plt;0.05). Comparison of distribution of visual acuity before and after thrombolysis treatment, the difference was statistically significant (chi;2=12.1, Plt;0.05). Comparison of distribution of final visual acuity after subsequent treatment with that of after thrombolysis treatment, 48 eyes improved two lines or more, the efficiency was 41.7%, the difference was statistically significant (chi;2=14.6, Plt;0.05). Comparison to that of before treatment, vision changes showed effect markedly in 58 patients (50.4%), effective in 35 patients (30.4%), no effect in 22 patients (19.2%), the difference was statistically significant (chi;2=44.5, Plt;0.05). Comparison the average age to that of effective, valid and invalid patients, the difference was not statistically significant (t=0.98, 1.17, 0.55; Pgt;0.05). There was no relationship between effectiveness and gender (chi;2=2.6, Pgt;0.05). In 76 patients with duration within seven days, 43 patients were effective markedly and 22 patients were effective, the efficiency was 85.5%. In 25 patients with duration of 8 - 15 days, 11 patients were effective markedly and eight patients were effective, the efficiency was 76.0%. In 34 patients who received subsequent treatment 8 - 14 days, 18 patients were effective markedly and nine patients were effective, the efficiency was 79.4%. In 51 patients who received subsequent treatment 15-21 days, 27 patients were effective markedly and 18 patients were effective, the efficiency was 88.2%. Conclusion Intravenous thrombolysis with urokinase was effective in the treatment of CRAO.
Objective To observe the influence of cisplan on the expression of B7-H1 in retinoblastoma (RB) cells，and to investigate its mechanism. Methods Human RB cell line HXO-Rb44 cells were treated by 6 different concentrations of cisplan (0.000, 0.375, 0.750, 1.500, 3.000, 6.000 mu;g/ml), and their B7-H1 mRNA expression was determined by the reversetranscription polymerase chain reaction (RT-PCR) and fluorescence quantitative PCR (FQ-PCR); the B7-H1 protein expression was determined by immunofluorescence and flow cytometry. HXO-Rb44 cells were treated by 1.5 mu;g/ml cisplan for 0, 15, 30, 60, 120 min, then the phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2) was detected by Western blot.Results The expression of B7-H1 mRNA and protein in the 0.375, 0.750, 1.500, 3.000, 6.000 mu;g/ml group were significantly higher than that of the blank control group (F=395.478，112.03; P=0.000）. Western blot showed that cisplan (1.5 mu;g/ml) could activate ERK1/2 by increasing its phosphorylation in HXO-Rb44 cells. After cisplan treatment, the phosphorylation of ERK1/2 increased gradually and reached its peak at 30 min, and then went down gradually.Conclusion Cisplan can promote the expression of B7-H1 and activate ERK1/2 in RB cells.
Objective To observe the influence of the indomethacin on the proliferative and invasive activity of OCM-1 human choroidal melanoma cells. Methods OCM-1 cells were cultured with different concentrations of indomethacin (25, 50, 100, 200, 400 mu;mol/L ), and their proliferation were assessed by methyl thiazolyl tetrazolium（MTT）, invasive behaviors were examined by cell invasion assays, expression of survivin and VEGF were evaluated by reverse transcriptase polymerase chain reaction（RT-PCR）, immunofluorescence staining, ELISA and western blot analysis. Result All concentrations of indomethacin in this study can inhibit the proliferation and invasion of OCM-1 cells in a time and dosage-dependant manner（MTT/24 h：F=19.642，P＜0.01；MTT/48 h：F=136.597，P＜0.01；MTT/72 h：F=582.543，P＜0.01；invasion assays：F=54.225，P＜0.01）. Immunofluorescence staining indicated that survivin and VEGF mainly expressed in the cytoplasm of OCM-1 cells. Survivin mRNA in OCM-1 cells was inhibited by 100, 200, 400 mu;mol/L indomethacin（F=16.679，P＜0.01）. The concentrations of survivin were (787.3plusmn;47.37), (257.0plusmn;26.21), (123.3plusmn;8.02) pg/ml in control group and 100, 400 mu;mol/L indomethacin groups, respectively. Survivin expression was also significantly down-regulated in indomethacin-treated cells by Western blot analysis.Indomethacin had no effects on VEGF expression in OCM-1 cells.Conclusions Indomethacin can inhibit proliferation and invasion of OCM-1 cells in vitro,down-regulated expression of survivin may be the mechanism.
Objective To observe the inhibition effect of selective cyclooxygenase2 inhibitor（celecoxib）on the experimental choroidal neovascularization（CNV）. Methods Thirty 8-10 weeks old healthy male Brown-Norway（BN）rats were randomly divided into the control, laser and celecoxib group,with 10 rats in each group. At the dosage of 50 mg/kg, celecoxib was gavaged twice per day. After 7 days, experimental CNV was induced by Krypon laser on laser group and celecoxib group. Fundus fluorescein angiography (FFA) was performed on days 3, 7,14,21,30 after laser photocoagulation.On days 21 after photocoagulation, 5 rats in each group were sacrificed and the relative thickness of CNV membranes, the expression of COX-2, vascular endothelial growth factor(VEGF) and matrix metalloproteinase-2(MMP-2) were studied by histopathologic or immunohistochemistry examination.Results On days 21 after photocoagulation, the incidence of CNV in the celecoxib group is significantly lower than that in the laser group (chi;2=7.1068,P=0.0077); the relative thickness of the CNV membranes in the celecoxib group is reduced 41.38% compared to the laser group, the difference is statistically significant (t=16.760 0，P=0.0000).COX-2,VEGF and MMP-2 expression in the CNV membrane of celecoxib group were significantly lower than in control group (t=5.710 0,5.840 0, 8.020 0; P=0.000 0); the COX-2, VEGF and MMP-2 expressions in choroid and retina of control group were weak. Conclusion Prophylactic celecoxib can reduce the expression of VEGF and MMP-2 by inhibiting COX-2, and prevent the CNV induced by laser photocoagulation.
Objective To evaluate the safety repeated intravitreal injection of bevacizumab (Avastin) with different dosage in rabbitsprime;eyes. Methods Fourteen chinchilla rabbits were randomly divided into 3 groups, including both eyes of 2 rabbits in the control group,the right eyes of the other 12 rabbits in the experimental group,and the left eyes of the 12 rabbits in the experimental control group. The eyes in the experimental group underwent intravitreal injection of bevacizumab with the dosage of 2.5 mg/0.1 ml and 5.0 mg/0.2 ml of bevacizumab; the eyes in the experimental control group underwent intravitreal injection of normal saline with the same dosage as in the experimental group. Injections were performed every two weeks and lasted six weeks. Clinical observation and retinal function tests were performed before and two days after every injection. The eyes were sacrificed 1 week and 4 weeks after last intravitreal injection respectively.Electron and optical microscope and TUNEL were performed.Results After intravitreal injection,no obvious anterior chamber flare, abnormal change of the ocular fundus, or vitreous opacity and hemorrhage was observed in all of the eyes.No change was found by indirect ophthalmoscope,Bultrasonic inspection, ultrasound biomicroscopy and optical coherence tomography. The number of anterior chamber flare before and after the injection with the dosage of 2.5 and 5.0 mg, the difference among the 3 groups didnprime;t differ much from each other (Pgt;0.05).Amplitude and pattern of ERG responses and flash VEP were similar between the control and experimental groups (Pgt;0.05). Some inflammatory cells were found in the some bevacizumabinjected eyes 1 week after injection, and vanished 3 weeks later. The histological configuration of the retina didnprime;t change in both experimental control and the control group. Electron microscopy showed that plasma cells were presented and vacuolelike change was observed in part of the photoreceptor cells in 5.0 mg experimental group 1 week after injections.Cellular apoptosis was observed in the photoreceptor cell layer. The number of apoptotic cells was more in 5.0 mg experimental group than that in the control and experimental control group 1 week after injections (Plt;0.01). Conclusion Multiintravitreal injection with 5.0 mg bevacizumab may have mild toxicity to the retina in the rabbits.
Objective To observe the inhibitory effects and characteristics of intravitreal injection with bevacizumab on laser induced choroidal neovascularization (CNV).Methods Twelve male brown norway（BN）rats were divided into the bevacizumab group and control group with six rats in each group. One eye of rats were received a series of 8 diode laser esions around optic disc to induce CNV,then the rats in bevacizumab group and control group underwent intravitreal injection with 2 mu;l bevacizumab and ringer's lactate.On days 7,14,and 21，the morphology and leakage of CNV were observed by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA).On day 21 after photocoagulation,the photocoagulated eyes were enucleated and processed for histopathologic examination, including hematoxylin and eosin (Hamp;E) staining and immunohistochemistry staining for vascular endothelial growth factor（VEGF）.Results On day 7 after photocoagulation,ICGA showed that CNV developed in the bevacizumab group and the control group. FFA showed that leakage intensity in the bevacizumab group was significantly lower than that in the control group，but the bevacizumab group gradually increased over time. The mean thickness of CNV significantly decreased in the bevacizumab group.The CNV in the bevacizumab group were negative for VEGF according to the result of immmuohistochemistry staining.Conclusions Early intravitreal injection with 2 mu;l bevacizumab can reduce the thickness of CNV and inhibit the leakage of CNV. However, bevacizumab could neither block the formation of CNV, nor suppress the permeability permanently. Combined other therapies with bevacizumab may be more potential to treat CNV effectively.
Objective To observe the inhibition effect of curcumin on the proliferation of rabbit retinal pigment epithelial (RPE) cells and investigate its mechanism. Methods The 4th generation of RPE cells were selected and divided into curcumin group and blank control group. The concentration of curcumin included 10, 15, and 20 mu;g/ml. The MTT assay was used to evaluate the inhibition effect on the proliferation of RPE cells at the 24th, 48th, 72nd and 96th hour after cultured with curcumin (10, 15, and 20 mu;g/ml). The IC50 value of curcumin at different time points were calculated by Linear Regression. Flow cytometry was used to detect the effect on the cell cycle at the 72nd hour after cultured with curcumin (15 mu;g/ml); the expression and apoptosis of proliferating cell nuclear antigen (PCNA) were also determined at the 24th,48th, and 72nd hour after cultured with curcumin (15 mu;g/ml) respectively. The configuration of RPE cells were observed by transmission electron microscope. Results The IC50 value of curcumin at the 24th,48th, 72nd and 96th hour was 29.31, 17.50, 13.24, and 10.99 mu;g/ml respectively. Cell cycel analysis indicated that curcumin blocked cells in G0/G1 phase. At the 24th, 48th, and 72nd hour after cultured with curcumin (15 mu;g/ml), the expression of PCNA of RPE cells were 565.04plusmn;23.60, 473.61plusmn;36.88, and 396.15plusmn;32.45; the apoptosisrate were （12.83plusmn;0.13）%，（32.27plusmn;4.51）%，（56.81plusmn;8.67）%, respectively. The differeces of curcumin groups compared with the control group were significant (P＜0.05). Apoptosis of RPE cells was observed under transmission electron microscope. Conclusions Curcumin can inhibite the proliferation of RPE cells by inhibit the synthesization of PCNA and inducing the apoptosis of RPE cells. Curcumin may become a potential drug to prevent and treat PVR.