Objective:To evaluate the effectiveness and safety of patient-controlled intravenous analgesia (PCIA) for elderly patients.Methods:900 patients after operation (except for cerebral operation) were allocated to the aged group ( n =600,aged 65～90 years,ASAⅡ-Ⅳ) or the control group (young or middle-age group, n =300,aged 18～63 years,ASAⅠ-Ⅲ) and received PCIA.The PCIA solution consist of tramadol 600 mg,fentanyl 0.3 mg,droperidol 5 mg and NS 40 ml.Loading dose 3～5 ml,background infusion 0.7～1 ml/h,bolus 0.5ml,lockout time 10～15 min.The intensity of pain,level of sedation,scale of comfort and side effects were assessed.Meanwhile,RR,MAP,HR,SpO 2 were monitored and the total dosage of analgesic were recorded also.Results:There was no significant difference in VAS (Visual analogue scale),RSS(Ramesay sedation),and BCS (Bruggrmann comfort scale) in both groups.But,the consumption of the aged group was significantly fewer.The incidence of the adverse effects was lower in both groups and there was no significant difference between groups.The respiration and circulation was smooth in both groups throughout analgesia period.Conclusion:The efficacy of patient-controlled intravenous analgesia (PCIA) in elderly patients is good.The incidence of adverse effects is low.With adequate dosage and monitoring PCIA can be used safely for elderly postoperative analgesia.

Objective:To study the management of anesthesia and to assess the changes in blood glucose and electrolytes during operative hysteroscopy.Methods:80 patients undergoing operative hysteroscopy were allocated to GA group (the general anesthesia group, n =36) and EA group (the epidural anesthesia, n =44).The electrolytes (Na +,K +,Cl -),blood glucose,blood gas(HCO - 3,PaCO 2,pH),Hb,Hct were observed before operation,at 30 min during operation and after operation respectively.Meanwhile,the irrigating fluid volume and operation procedure were recorded.Results:The blood glucose level increased markedly at 30 min during operation as compared with that before operation and after operation as compared with that during operation.There was a significant higher blood glucose level after operation than that at 30 min during operation and there was no significant difference between the two groups.Serum sodium was significantly changed in electrolytes.There was a significantly lower sodium level at 30 min during operation as compared with that before operation and after operation as compared with that during operation.There was no significant difference between the two groups.There was also no significant difference between the groups in volume irrigating fluid.Conclusion:The intravenous-inhaled combined anesthesia and epidural anesthesia can be used safely for operative hysteroscopy.It is one of the important means to monitor the blood glucose and electrolytes in operative hysteroscopy.

Objective:To evaluate the clinical effect of intraoperative autotransfusion on postoperative hematoma of intracranial meningiomas and to expand the clinical application of blood callbacked in intracranial surgery.Methods:90 patients undergoing elective surgery for intracranial meningiomas were randomly allocated to the M group (the experiment group, n =60) and the C group (the control group, n =30).In the M group,the autologous blood retransfusion was given with the Haemonetics Cell-Caver5,and the blood gas analysis,Hb,Hct were observed before hemorrhage,after hemorrhage and retransfusion respectively.In the C group,the allogeneic blood transfusion was performed considering the intraoperative hemorrhage.All patients were followed up for volume of allogeneic blood transfusion,postoperative hematoma and postoperative infection.Results:The hemodynamics was steady.The Hb and Hct were maintained in the normal range during operation in both groups.The blood volume of postoperative allogeneic transfusion showed no significant difference between two groups.The incidence of the postoperative hematoma showed no significant difference between two groups,but the incidence of postoperative infection was lower in the M group than that of C group.Conclusion:Intraoperative autotransfusion could not influence the incidence of postoperative hematoma of intracranial meningiomas.With the perioperative management,the intraoperative autotransfusion can be used safely for intracranial surgery.

Objective:To investigate the effects of pneumoperitoneum with carbon dioxide(CO2)on the hemodynamics,arterial blood gas and ventilatory function in old patients undergoing retroperitoneoscopy.Methods:Thirty patients over 65 years undergoing elective retroperitonoscopy were studied under general anesthesia,ASAⅡ-Ⅲ.Before anesthesia,before and after CO2 insufflations, the changes of MAP,HR,SPO2,PetCO2 at 5?10?30?60?120min were observed and the blood gas at different time was analysed.Results:The MAP and HR were increased significantly respectively(P

Objective To construct inducible lentiviral vector containing MST1 gene, which provides an ideal model for further study of the relationship between liver cancer and MST1 gene. Methods We cloned MST1 into inducible lentiviral vector. Two lentiviral vectors (pLVPT-tTRKRAB-MST1 and pLV-tTRKRAB-Red) with package plasmids were contransfected into 293FT respectively, and the lentiviral viruses were harvested from 293FT. Viruses were used to infect liver cancer cell line (Huh-7) in tandem. We used doxcycline to induce the expression of target gene MST1 which was indentified by Western blot after 7-day cell culture. Results The recombinant inducable lentiviral vector containing MST1 gene was successfully constructed. The lentiviruses were also obtained and mediated by 293FT, which were highly efficient to infect liver cell lines Huh-7. The expression of MST1 was identified under Dox induction. Conclusions The recombinant inducable lentiviral vector containing MST1 gene has been successfully constructed. It is viable to obtain inducible cell lines Huh-7 with MST1 gene expression under Dox induction.

Objective: To study the risk factors of postoperative hematoma after craniotomy and to reduce the occurrence of post-operative hematoma.Methods: The clinical data of 687 cases of intracranial neoplasms(meningioma,glioma,aneurysm) were analyzed retrospectivel.Results: Meningioma surgery carried a higher risk for postoperative hematoma than other intracranial neoplasms.The incidence of post-operative hematoma showed no significant difference between patients with glioma and these aneurysm.The incidence of post-operative hematoma in the elder was higher than that in the young or the middle-age with.The incidence of postoperative hematoma in patients with dysfunction coagulation was higher.Conclusions: The incidence of postoperative hematoma was higher for craniotomy in neurosurgery.The morbidity of postoperative hematoma in patients undergoing intracranial surgery was different regarding types of operation,age of patients and alteration of coagulation.

Hypoxia-inducible factor-I is the critical factor existed in mammal and human cells which plays an important role in maintaining the oxygen balance. Many hypoxia-responding genes can be activated by H1F-1. So, the relationship between HIF-land matrix matalloproteinases/stromal-derived factor-I/special CXC chemokin receptor/angiogenesis related factors is the hot spot in research of the tumor invasion and me-tastasis.

Objective To evaluate the centralization of the distal stem of hip femoral prosthesis after total hip replacement with CT imaging. Methods T he 4th zone of the femoral stem of hip prosthesis in 18 cases was scanned with c omputerized tomography; the affected limb was fixed, the window level was 1 500 to 2 000. The rectangular coordinat was established, its origin was the center o f femoral medullary cavity, and the line parallel with the connecting line betwe en the posterior borders of femoral medial lateral condyles was X axis. The foll owed variables were recorded on CT imaging: 1)the distance of the centers(the me dullary cavity center and femoral prosthetic center); 2) medullary cavity radius ; 3) the distance of the centers/medullary cavity radius; 4) the relationship of the prosthetic hip and quadrant; 5) metal pseudo imagines.The distal femoral st em of hip prosthesis could be measured and analyzed. Results Through CT scan, th e location of the distal stem in femoral medullary cavity could be accurately sh own and viewed directly. The distances between the femoral stem tips and the cen ters of medullary cavity, the radius of femoral medullary cavity, and the quadra nt which the stem tips are located at, could be considered as quantitative indic es on the centralization of the femoral distal stem of hip prosthesis. Conclusio n The centralized status of the distal stem of hip prosthesis can be observed wi th CT imaging. CT imaging is a kind of accurate and quantitative analysis method . It not only can guide the doctor to study and improve the surgical techniques, but also offer a reliable basis for correlative research. [

BACKGROUND:It is a key to choose an appropriate method to trans-differentiated bone marrow mesenchymal stem cells (BMSCs)into neuron-like cells for clinical therapy of neural system injury.OBJECTIVE:To observe the feasibility of the differentiation of rat BMSCs supplemented with rat dentate gyrus extract(DGE)into neuron-like cells.METHODS:DGE was applied to induce rat BMSC trans-differentiation,using 20,40,60,80 mg/L protein concentration.Neuron differentiation was measured using Western blot to screen an optimal dosage.After trans-differentiation,different concentration treated cells were collected.Morphology change was observed following differentiation under an inverted microscope.Neuron specific enolase(NSE)and NeuN expression was determined using Western blot.NeuN expression in cells was detected using immunofluorescence technique.RESULTS AND CONCLUSION:After 7 days,60 mg/L DGE was the optimal induction dose detected by Western blot.With increased concentration,NSE and NeuN expression was increased.At 80 mg/L mass concentration,NSE and NeuN expression was reduced.At 60 mg/L DGE,BMSCs following induction became long,with synapses,Immunofluorescence NeuN staining found that neuron-like cells were positive for NeuN following induction.Results indicated that DGE is an effective biological inductor that can induce BMSC differentiation.

ObjectiveTo explore adrenal insufficiency in the preterm infants who had critical lung diseases and the relationship between adrenal insufifciency and long-term or short-term prognosis.Methods The basal cortisol and ACTH of iffty preterm infants enrolled were tested. The peak cortisol at 30 minutes after low dose ACTH stimulation was tested. The adrenal insufifciency was deifned as the concentration of the basal cortisol less than 15 μg/dl or the increment of cortisol concentration after low dose ACTH stimulation less than 9 μg/dl. The pretern infants with adrenal insufifciency were the AI group and others were the adrenal normality, AN group.Results Thirty-one cases were adrenal insufifciency in 50 preterm infants with critical lung disease. The incidence was 62%. The concentrations of the basal and peak cortisol in AI group were lower than those in AN group (P<0.01). The increment of cortisol concentration after low dose ACTH stimulation had not signiifcant difference between two groups. The concentration of ACTH in AI group was lower than that in AN group (P<0.01). The mean arterial blood pressure in AI group was lower than that in AN group (P<0.01). The blood sugar, potassium and sodium had no signiifcant difference between two groups (P>0.05). There was no signiifcant difference in the mortality and the incidence of BPD between two groups (P>0.05).Conclusions The incidence of adrenal insufifciency was high in the preterm infants with critical lung diseases, which may be due to insufifcient production of endogenous ACTH. When the adrenal insufifciency was happened, the blood pressure is relatively low in preterm infants with critical lung diseases, but it was not related to the mortality and the incidence of BPD.