Objective To evaluate the effects of different time courses and depths of acute normovolemic hemodilution (ANH) with hematocrit (Hct) on injury to the mucous membrane of small intestines in rabbits.Methods Thirty-two adult rabbits,weighing 2.0-2.5 kg,were randomly divided into 4 groups (n=8 each) using a random number table:control group (group C),Hct 18％ group (H1 group),Hct 15％ group (H2 group) and Hct 12％ group (H3 group).The animals were anesthetized with iv 20％ urethane 4 ml/kg,tracheostomized and mechanically ventilated.Blood samples were taken from the left femoral artery.Blood withdrawn from the femoral artery =2 ×body weight× body fluid per kilogram × (initial Hct-target Hct) ÷ (initial Hct+target Hct),and was simultaneously replaced with the equal volume of 6％ hydroxyethyl starch 130/0.4 infused over 30 min via the left femoral vein until the target Hct was achieved in H1,H2 and H3 groups.At 30 min of stabilization after puncture (T0) and 2,4 and 8 h after ANH (T1-3),blood samples were obtained from the superior mesenteric artery and vein for blood gas analysis and for determination of plasma concentrations of tumor necrosis factor-α (TNF-α) in the superior mesenteric vein.Oxygen extraction rate (ERO2) was calculated.Small intestinal mucosal tissues were obtained at T3 to observe the pathological changes with light microscope.Results Compared with those at T0,the plasma concentrations of TNF-α at T3 and ERO2 at T1-3 were significantly increased in H1 group,and the plasma concentrations of TNF-α at T3 and ERO2 at T1-3 were increased in H2 and H3 groups.The injury to the mucous membrane of small intestine was mild in group H1,and was severe in H2 and H3 groups.Conclusion ANH performed with 6％ hydroxyethyl starch causes injury to the mucous membrane of small intestine when Hct is 18％ and the time course ≥ 8 h,and when Hct ≤ 15％ and the time course ≥ 2 h in the rabbits.

Objective:To study attitude of medical students to dying and death in order to improve medical education.Method:451 medical students were investigated with self-made questionnaire.Results:Having encountered death of others,having dying family members had great influence on attitude to death.The acceptance of family to death and dying,and culture viewpoint on death had also significant influence.

Objective To investigate the role of the Wnt/LRPS/3-catenin signaling pathway in the pathogenesis of postmenopausal osteoporosis.Methods Fifty female Wistar rats aged 6-month-old,were randomly divided into control group ( NS,n =24 ) and ovariectomized group ( NOVX,n =26),NOVX underwent bilateral ovariectomy.At 0,4 and 8 weeks,all of rats were measured blood estrogen ( E2 ) and bone mineral density (BMD),4 and 8 weeks,low density lipoprotein receptor-related protein 5 (LRP5),3-catenin and Runx2 mRNA in bone were measured respectively by reverse transcription (RT)-PCR.Results In 4 and 8 weeks,compared with NS which had (117±29) and (114+15) pmol/L in E2 level,(0.098 ± 0.016 ) and (0.095 ± 0.028 ) g/cm2 in BMD,NOVX had significantly decreased to ( 92±15 ) and(95±22) pmol/L in E2 level ( P＜0.05 ),( 0.076 ± 0.016) and ( 0.052 ± 0.013 ) g/cm2 in BMD values ( P ＜ 0.01 ).And bone tissue LRP5,β-catenin and Runx2 mRNA expression was 1.02 ± 0.06,1.04 ±0.05,1.07 ±0.21 in NS,NOVX was significantly reduced to 0.97 ± 0.04,0.58 ± 0.05,0.86 ±0.03 (P＜0.05).Conclusion Wnt/LRP5/β-catenin signaling pathway may be important in the pathogenesis of postmenopausal osteoporosis.

Objective To evaluate the accuracy of auditory evoked potential index (AAI) in monitoring the anesthetic depth during isoflurane anesthesia.Methods Thirty ASA Ⅰ or Ⅱ patients aged 18-55 years and undergoing elective surgery under general anesthesia were enrolled in this study. The patients were unpremedicated. Anesthesia was induced with midazolam 0.05 mg/kg, fentanyl 3 μg/kg and propofol 1 mg/kg. Tracheal intubation was facilitated with recuronium 0.1 mg/kg. The patients were mechanically ventilated (VT:40 mm Hg. Anesthesia was maintained with isoflurane inhalation and intermittent intravenous boluses of vecuronium. Isoflurane was started with high-flow (FGF, 3 L/min) for 12 min followed by low-flow (LGF, 0.5 L/min). The inspired isoflurane concentration was set at 3%. The electrocardiogram (ECG), mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2), end-tidal isoflurane concentration and AAI were continuously monitored during anesthesia and recorded before induction of anesthesia (baseline, To ), immediately after induction (T1), immediately before isoflurane inhalation (T2), at 3 min(T3), 6 min (T4), 9 min (T5) and 12 min (T6) during high-flow wash-in and at the end-tidal isoflurane concentrations of 0.8 MAC (T7), 1.0 MAC (T8) and 1.3 MAC (T9) during low-flow inhalation of isoflurane, respectively.Results AAI decreased gradually while the end-tidal isoflurane concentration increased during high-flow wash-in. And AAI was negatively correlated with the end-tidal isoflurane concentrations ( r = -0.896, P ＜ 0.01 ) during low-flow inhalation of isoflurane anesthesia.

Objective To study the extracellular signal-regulated kinase 1/2(ERK1/2) expression of renal cells in epilepsy rats induced by kainic acid,and elucidate the mechanism of renal injury caused by epilepsy.Methods 70 male Wistar rats were randomly divided into two groups:epilepsy group and control group,35 rats in each group.Rat epilepsy model was prepared by injection of kainic acid into amygdala under three-dimensional positioning devices.At different time points(0,2,6,12 and 24 h) after epilepsy spasm,the renal tissue specimens were immediately prepared for immunohistochemistry.The ERK1/2 expression of rat renal cells was calculated and compared with control group.Results The ERK1/2 expression(gray value) of renal tubular epithelial cells in epilepsy rats began to increase gradually after epilepsy spasm.It reached peak at 6 h after epilepsy spasm.The ERK1/2 expression of renal tubular epithelial cells in epilepsy rats was significantly higher than at 0 h(P0.05).There were no major pathological changes in kidney of rats with epilepsy stained with HE.Conclusion ERK1/2 activation may have important role in the renal injury caused by epilepsy.Inhibition of the activation of ERK1/2 may lead to the renal protection.

Objective To retrospectively evaluate the role of consolidative repeat radiofrequency ablation (CRRFA) based on safety margin (SM) analyses in local tumor control for alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) patients who had been shown to have radiological complete ablation (CA) with radiofrequency ablation (RFA). Methods From July 2002 to July 2009,152 AFP negative HCC patients who were shown to have radiological CA with RFA therapy were retrospectively analyzed. Among them, 110 patients had a SM of less than 1 cm and the other 42 patients had a SM of 1cm or more. Among 110 patients with SM less than 1 cm, fifty nine patients accepted CRRFA within 6 months after the first RFA and 51 did not. From these patients, a narrow SM-CRRFA group (n=41) and a narrow SM-single RFA group (n=37) were enrolled respectively. The wide SM-single RFA group (n= 30) was enrolled from the 42 patients with a SM of 1 cm or more.The LTP (local tumor progression)-free survival rate of the 3 groups were compared with a log-rank test. Results One-, two-, three-, four-, and five-year LTP-free survival rates respectively were 97. 1%, 90.9%, 69.6%, 47.2%, and 33. 0% in the narrow SM-CRRFA patients. 85.9%, 66. 5%,43.5%, 15.8%, and 0. 0%, in the narrow SM-single RFA patients, and were 92.7%, 83.7%,59.3%, 36. 9%, and 9.2% in the wide SM-single RFA patients. There were statistically significant differences (χ2 = 14. 789, P= 0. 001) between the groups. Conclusions An ablation zone with an SM of 1 cm or greater was the most important factor for local control of AFP negative HCC ranging from 3 to 5 cm in diameter. For these patients with a SM of less than 1 cm, CRRFA improved the overall local control outcomes.

Purpose:To evaluate the role of multi - detector row CT(MDCT) using reconstruction techniques in the assessment of patients with obstructed diseases of biliary tract.Materials and Methods: 47 Patients with obstructed diseases of biliary tract confirmed clinically underwent MDCT and their reconstructed images of biliary tract including multi-planar reconstruction (MPR) images and curved planar reconstruction(CPR) images were compared with those of 50 patients without obstruction and dilatation of biliary tract.The display effect of biliary duct structure and biliary duct wall and the display ability of biliary tract by MPR and CPR images between the 2 groups were compared and analysed.The reconstruction images of biliary tract were analysed retrospectively to evaluate the location and possible causes of biliary obstruction.Results: The display effect of biliary duct structure and biliary duct wall in MPR and CPR images of the group with biliary obstruction is better than that of control group,and the display ability of biliary tract in CPR images of the group with biliary obstruction is also better than that of control group.The accuracy of localization and cause evaluation of obstruction by MPR and CPR images is 100% and 89.4% respectively.Conclusions: The MPR and CPR images of MDCT provide a good display of biliary duct structure,biliary duct wall and an accurate evaluation of obstruction localization.The reconstruction technique of MDCT such as MPR and CPR should be widely applied in the evaluation of biliary obstruction.

Objective To compare the efficacy of different target concentrations of etomidate in combination with midazolam,fentanyl and rocuronium used to induce anesthesia for tracheal intubation.Methods Eighty ASA Ⅰ or Ⅱ and Mallampati Ⅰ or Ⅱ patients of both sexes,aged 25-50 yr,weighing 57-76 kg,scheduled for elective non-cardiac surgery under general anesthesia,were randomly allocated into 4 groups according to the target effect-site concentration of etomidate (n =20 each) ∶ 0.5 μg/ml group (group E0.5),0.7 μg/ml group (group E0.7),0.9μg/ml group (group E0.9) and 1.1 μg/ml group (group E1.1).The patients were unpremedicated.Anesthesia was induced with midazolam 0.05 mg/kg,fentanyl 3 μg/kg,rocuronium 0.6 mg/kg and etomidate given by target-controlled infusion.When the effect-site concentration of etomidate reached 0.5,0.7,0.9 or 1.1 μg/ml,endotracheal intubation was performed.Auditory evoked potential index was recorded before induction of anesthesia (baseline),immediately before intubation,during insertion of the laryngoscope,and at 1,3 and 5 min after intubation.Myoclonus,injection pain,the requirement for vasoactive agents and burst suppression (BS) were recorded during induction of anesthesia.Results Compared with group E0.5,the requirement for urapidil was significantly decreased in group E0.7,the requirement for esmolol and urapidil was significantly decreased and the incidence of BS was increased in group E0.9,the requirement for esmolol and urapidil was significantly decreased,and the requirement for atropine and ephedrine and incidence of BS were increased in group E1.1 (P ＜ 0.05).The incidence of BS was significantly higher in group E0.9,and the requirement for atropine and incidence of BS were significantly higher in group E1.1 than in group E0.7 (P ＜ 0.05).The incidence of BS was significantly higher in group E1.1 than in group E0.9 (P ＜ 0.05).There was no significant difference in auditory evoked potential index and incidences of myoclonus and injection pain among the four groups (P ＞ 0.05).Conclusion The optimum target concentration of etomidate is 0.7μg/ml when combined with midazolam,fentanyl and rocuronium used to induce anesthesia.

Objective To observe the therapeutic effect of balance cupping therapy on non-specific low back pain.Methods 75 patients with non-specific low back pain were randomly divided into the control group (n=25), cupping therapy group (n=25) and balance cupping therapy group (n=25). The patients in the control group were received diclofenac sodium enteric-coated capsule; the cases in other two groups were treated with cupping therapy and balance cupping therapy separately. After 3 weeks' treatment, the changes of the visual analogous scores and Oswestry disability index of two groups' patients were observed.Results The visual analogous scores and Oswestry disability index of the balance cupping therapy group were significantly lower than that of the control group and cupping therapy group ( P<0.05) after 3 weeks' treatment. But between the control group and cupping therapy group there was no difference.Conclusion Balance cupping therapy is one of effective treatment methods for non-specific low back pain.

Objective To compare short-term therapeutic outcomes and the safety of percutane-ous radiofrequency ablation (PRFA) with left single lung ventilation (LSLV) for liver cancer of the hepatic dome (LCHD) and that of PRFA for right liver carcinoma in favorable location. Methods Thirty one patients with hepatocellular carcinoma (belonging to LCHD) receiving PRFA with LSLV (Group LCHD) between January 2006 and January 2009 in our hospital were selected, and 45 control patients with right lobe HCC ≥1 cm away from the liver capsule, gallbladder, and main portal bran-ches were also included. One month after PRFA, residual tumors were followed up with contrast en-hanced CT and alpha fetal protein and PRFA was repeated in the presence of residual foci. Tumor-free survival time was defined as the duration from complete ablation to diagnosed local tumor progression.The Mann-Whitney test was used to compare age, tumor diameter, and average number of punctures between LCHD patients and controls. A χ2 test was used for comparison of the incidence of complica-tions and incomplete tumor ablation rate. The Kaplan-Meier's method was used for calculation of local tumor-free survival rate compared with a log-rank test. Results The incidence of right shoulder pain was significantly higher in LCHD patients than in controls (87. 1% vs 11. 1%, P<0. 01). LCHD pa-tients showed no difference from controls in the average number of punctures (2. 8±. 5 vs 3. 2±. 5,P>0. 05). Meanwhile, there was no difference between the 2 groups in average duration of treatment and hospitalization, and the complete tumor ablation rate at first PRFA. No differences were observed in the 1-, 2- and 3-year local tumor-free survival rates between LCHD patients (85. 5% , 65. 8% , and 36. 4% ,respectively) and controls (87.7%, 62. 3% , and 34.0% , respectively). Conclusion PRFA with LSLV for LCHD seems to promise comparable short-term outcomes and safety to PRFA for right liver carcinoma of fa-vorable location and should be preferred as one of the therapeutic options for LCHD patients with tumor di-ameters≤5 cm regardless of its unique location.