Objective To investigate the analgesic effect and the safety assessment of intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine for post-cesarean analgesia.Methods One hundred and eighty parturients (ASA Ⅰ-Ⅱ) undergoing elective cesarean section with combined spinal and epidural anesthesia were divided into morphine group (group A),sufentanil + morphine group(group B),flurbiprofen axetil+sufentanil+ morphine group(group C) with 60 cases in each group.All patients were used subarachnoid epidural anesthesia,at the end of the surgery,1.5 mg morphine diluted to 5 ml saline was injected into the epidural space of each patient.Additional,group B and group C received patient-controlled intravenous analgesia after cesarean section.Flurbiprofen axetil and sufentanil were diluted to 100 ml with saline.The visual analog scale (VAS) of rest and dynamic incisional pain and uterine contraction pain,Ramsay sedation scale (RSS),and adverse events were recorded at 6,12,24 h after operation.Results At 6,12,24 h after operation,the VAS scores of rest and dynamic incisional pain and uterine contraction pain in group B and group C were statistically lower than those in group A [rest incisional pain:(2.6 ± 0.6),(2.7 ± 0.4),(2.8 ± 0.3)scores in group A; (2.3 ± 0.3),(2.3 ± 0.4),(2.2 ± 0.3) scores in group B; (1.8 ± 0.4),(1.7 ±0.5),(1.9 ±0.4) scores in group C; dynamic incisional pain:(5.7 ±0.9),(5.5 ± 0.8),(5.6 ± 1.0) scores in group A; (3.8 ± 0.4),(3.7 ± 0.5),(3.7 ± 0.4) scores in group B ; (2.7 ± 0.4),(2.4 ± 0.5),(2.4 ± 0.6) scores in group C ; uterine contraction pain:(5.7 ± 1.2),(5.9 ± 0.9),(5.8 ± 1.1) scores in group A; (3.0 ± 0.5),(3.1 ± 0.6),(3.2 ± 0.7)scores in group B; (2.5 ± 0.5),(2.5 ± 0.6),(2.4 ± 0.4) scores in group C],and group C were lower than group B,and there were significant differences (P＜0.05).At 6,12,24 h after operation,Ramsay score in group B and group C was higher than that in group A [(1.8 ± 0.5),(1.7 ± 0.4),(1.9 ± 0.5) scores in group A; (3.4 ± 0.8),(3.2 ± 0.7),(3.3 ± 0.6) scores in group B; (2.7 ±0.7),(2.7 ±0.5),(2.6 ± 0.4)scores in group C],and group C was higher than group B,and there were significant differences (P ＜ 0.05).The incidence of adverse events in group A and group C was lower than group B [8.3％(5/60) and 23.3％(14/60) vs.40.0％(24/60)],and group A was lower than group C,and there were significant differences (P ＜ 0.05).Condusion Intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine could perform better analgesic on postoperative incisional and uterine contraction pain after cesarean section and the incidence of adverse events is less than sufentanil combined with morphine.

Objective To search for the factors which may be responsible to the increase in plasma homocysteine(Hcy)levels after surgery.Methods Blood samples were taken from 40 patients(20 patients with coronary artery bypass and the remainders with off-pump coronary artery bypass)1 day before operation and 1,3,5 and 7 day(s)after operation.Hcy,copper,ceruloplasmin,ferrei ion,folate,vitamin B12 and C-reactive protein(CRP)were then measured using clinical chemistry methods.Results The plasma concentrations of ceruloplasmin,copper and Hcy increased significantly at 3rd,4th and 6th day after operation respectively.The plasma concentrations of ferreous ion and vitamin B12 declined obviously at 3rd day after operation,and then increased slowly.In contrast,the plasma concentration of CRP increased significantly at 3rd day after operation,then decreased gradually to normal level.No significant changes were found in folate level before and after operation.Those findings mentioned above showed no significant difference between the two groups.Conclusions The increased plasma concentration of Hcy after operation may be caused by the internal metabolism of copper rather than by the coronary artery bypass.

70 years, history of stroke, and a tear of the pleura. Conclusions The incidence of AF in CABG and off-pump CABG were almost similar. Old age of the patient was the pathological basis for developing AF, and the history of stroke and a tear of the pleura were the predisposing factors.

Objective To analyze the hemodynamic changes during coronary artery bypass grafting with or without cardiopulmonary bypass.Methods Thirty patients undergone coronary artery bypass grafting from January to June,2006 were retrospectively analyzed.Among them,12 patients were operated on with cardiopulmonary bypass(CCABG)and 18 without cardiopulmonary bypass(OPCAB).The stabilizator(type Octops III)was used to fix target vessels in OPCAB group.In CCBAG group,the extracorporeal circulation was used routinely,and internal mammary artery and saphenous vein were used to anastomose with target branches of coronary artery.The hemodynamic changes at different time points during and after operation were monitored,and the relevant parameters were also recorded.Results The anaesthesia time,intraoperative blood loss and fluid input,and ventilating time after operation in CCABG group were significantly higher than those in OPCAB group,and the postoperative haematocrit(HCT)was significantly lower in CCABG group than that in OPCAB group(P

Objective To compare the reversal effects of short hairpin RNA (shRNA) interference and tetrandrine on multidrug resistance (MDR) of human colorectal cancer cell line LoVo/5-fluorouracil(5-FU ).Methods An eukaryotic expression plasmid of shRNA targeting MDR1 was constructed and transfected into human colorectal cancer cell line LoVo/5-FU (transfection group).LoVo/5-FU was also pretreated with tetrandrine (tetrandrine group).Drug sensitivity was detected by methyl thiazolyltetrazolium colorimetric method.Cell cycle,apoptosis of cells and positive expression rate of P-glycoprotein (P-gp) were determined by flow cytometry assay.The expressions of MDR1 mRNA and P-gp were detected by real-time polymerase chain reaction and Western blot,respectively.All data were analyzed by analysis of variance and SNK-q test.Results (1)Drug sensitivity:the 50％ concentration of inhibition(IC50)of the control group,tetrandrine group and transfection group were (7.3 ± 0.3),(4.4 ±0.7) and (2.4 ±0.4) mmol/L,respectively,a significant difference between the 3 groups was found(F =65.27,P ＜ 0.05 ).There was a significant difference in the IC50 between the tetrandrine group and the transfection group (q =6.67,P ＜ 0.05 ).(2) Changes of cell cycle:the proportion of cells in the G1 phase and S phase of the control group,tetrandrine group and transfection group were 38.13％ ± 3.75％,51.36％ ± 2.76％,59.24％±4.31％ and 20.46％±2.23％,14.32％± 1.91％,9.40％± 1.65％,respectively,a significant difference between the 3 groups was found(F =25.23,24.37,P ＜ 0.05 ).There were significant differences in the proportion of cells in the G1 phase and S phase between the tetrandrine group and the transfection group(q =3.67,4.35,P ＜ 0.05 ).(3) Cell apoptosis:the cell apoptotic rates of the control group,tetrandrine group and transfection group were 1.32％ ± 0.47％,3.24％ ± 0.26％,5.88％ ±- 0.44％,respectively,a significant difference between the 3 groups was found(F =99.26,P ＜ 0.05 ).There was a significant difference in the cell apoptotic rate between the tetrandrine group and transfection group(q =11.48,P ＜ 0.05 ).(4)The expression of P-gp:the positive expression rates of P-gp of the control group,tetrandrine group and transfection group were 96.9％ ± 2.3％,61.6％ ± 4.9％,76.6％ ± 3.6％,respectively,a significant difference between the 3 groups was found(F =67.83,P ＜ 0.05 ).There was a significant difference in the positive expression rate of P-gp between the tetrandrine group and transfection group (q =6.97,P ＜ 0.05 ).(5)The mRNA expression of MDR1:the mRNA expressions of MDR1 of the control group,tetrandrine group and transfection group were 1462 ±161,570 ±85,233 ± 81,respectively,a significant difference between the 3 groups was found(F =90.59,P ＜ 0.05 ).There was a significant difference in the mRNA expression of MDR1 between the tetrandrine group and transfection group (q =5.12,P ＜ 0.05 ).Conclusions MDR1 shRNA and tetrandrine could reverse M DR1 gene-mediated m.ultidrug resistance in human colon cancer cell line LoVo/5-FU,but the effect of MDR1 shRNA is better than that of tetrandrine.MDR1 shRNA and tetrandrine might take effect by inhibiting P-gp expression and down-regulating mRNA expression of MDR1.

Objective To discuss the way and management of extracorporeal circulation (ECC) for totally robotic assisted cardiac surgery. Methods A Total of 226 patients underwent cardiac surgery using da Vinci S robotic surgical system, including 111 patients underwent atrial septal defect repair ( ASDR) , 9 patients underwent ventricular septal defect repair ( VSDR) ,51 patients underwent mitral valvuloplasty ( MVP) , 20 patients underwent mitral valve replacement( MVR) , 27 patients underwent left atrial myxoma excise and 4 patient underwent right atrial myxoma excise. ECC for most of patients was achieved with femoral arterial cannula, femoral venous cannula and right internal jugular venous cannula, except for 1 patient underwent MVP with femoral arterial cannula and femoral two-stage venous cannula. In all the cases, vacuum-assist venous drainage ( VAVD) , continuous blood gas monitoring and ultrafiltration were used during ECC. myocardial protection was pertic cross-clamp time was 40 ～219 (105.9+38. 8)min and 21 ～166 (69.5±30.0)min respectively. During ECC, the mean urine volume was 100-2100 (771.7±477.6) ml, ultrafiltration volume was 1000-4800 (2495.4 ±811.6) ml, and the total fluid balance was subzero-balanced (172 cases) or zero-balanced(13 cases) in most of patients. Conclusion The establishment of ECC system through peripheral vessels, using VAVD and continuous blood gas monitoring are the key points of ECC for totally robotic assisted cardiac surgery, also certain learning curve of perfusion technique and close communication between the surgical team are essential during ECC.

Objective To study the value of CRP and HCY in each TCM type of T2DM with HUA and provide the basis for classification and treatment.Methods 103 cases of T2DM and HUA were divided into four Chinese medicine syndrome groups including deficinecy syndrome of wind-cold and damp-heat phlegm accumlatoin and blood stasis syndrome deficinecy syndrome of Qi and Yin deficinecy syndrome of Yin and yang.Results The differentiation of TCM symptom among four groups was uncorrelated with the level of CRP and Hcy.But the serum CRP and HCY levels increased slighly as compared with those of normal control group.Conclusion The elevation of CRP and Hcy is closely correlated with phlegm accumlation and blood stasis syndrome in patients of T2DM with HUA.As an inflammatoy biomarker,CRP and Hcy may be regard as two of the microcosmic indicators of toxin in Chinese medicine.They can be used as two important indexes of TCM syndrome differentiation of T2DM with HUA.

AIM: To investigate the effects and quantitative relations of co-administering probenecid OF different dosages on pharmacokinetics of cefaclor in rabbits and approach the possible mechanisms involved as well. METHODS: Monitor plasma and urine cefaclor concentrations. 24 male rabbits were randomly divided into 4 groups by Cefaclor 50 mg·kg-1,Cefaclor50 mg·kg-1+Probenecid 100 mg·kg-1,Cefaclor 50 mg·kg-1+Probenecid 250 mg·kg-1 and Cefaclor 50 mg·kg-1+Probenecid 625 mg·kg-1.Blood and urine samples were collected according to the regular time schedule after intragastric administration. The concentration of cefaclor in blood and urine were determined by HPLC. Pharmacokinetic parameters were calculated by DAS (Drug and Statistical) software. Measur plasma protein-binding rate of cefaclor. The experimental groups and drug dosage were same as described above. The blood sample was drawn at 1 hour after administration,and the protein-binding rate of cefaclor was determined by equilibrium dialysis. RESULTS: Within the dosages of probenecid ranged from 0-250 mg·kg-1,T1/2ka,Tmax,Cmax and AUC of cefaclor increased in accordance with increasing dosage of co-administering probenecid while CL/F and Vd/F were decreased(P＜0.01); However,when the dosage of co-administering probenecid was 625 mg·kg-1,Cmax of cefaclor strikingly decreased(P＜0.01),while AUC and CL/F maintained at the levels of those with probenecid250 mg·kg-1.In this experiment, urinary excretive peak time of cefaclor in its prototype pos tponed gradually,biological half life prolonged and urinary excretive accumulation percentage decreased obviously(P＜0.01).To the dosages of probenecid ranging from 0-250 mg·kg-1,protein-binding rate of cefaclor decreased notably(P＜0.01)going with increasing dosages of co-administration probenecid; While the dosage of co-administration probenecid reached 625 mg·kg-1,the protein-binding rate of cefaclor corresponded to that of cefaclor 50 mg·kg-1 without probenecid (P＜0.01).CONCLUSION: Co-administering probenecid can strikingly change pharmacokinetics of cefaclor and the influential degree of pharmacokinetics parameters is dependent on dosages of probenecid used in the experiment. Biological half life prolongs and urinary excretive accumulation percentage of cefaclor decreases obviously.

Objective:To test the psychometric characteristics of the Chinese Version of the Illness Attitudes Scale(IAS-CV).Methods:Totally 297 patients (with somatoform disorders,major depressive disorder,generalized anxiety disorder,panic disorder,and obsessive-compulsive disorder diagnosed with ICD-10) and 212 normal people were assessed with IAS-CV,Beck Depression Inventory-Ⅱ and Beck Anxiety Inventory.Results:The confirmation factor analysis result of the nine-factor model of IAS-CV was x2/df=1.99,GFI =0.86,RMSEA =0.06.The total score of IAS-CV was correlated with BAI scores (r =0.45,P ＜0.01) and BDI-Ⅱ scores(r =0.42,P ＜0.01).Patients with somatoform disorders (62 ± 17) had higher scores than patients with other disorder,such as depression (43 ± 16),anxiety (46 ± 21),obsessive compulsive disorder (46 ± 15),and normal controls (35 ± 13).The Cronbach's α coefficients were 0.91 for IAS-CV and 0.62-0.91 for each subscale.The test-retest coefficients were 0.95 for the total scale and 0.67-0.93 for each subscale (P ＜ 0.01).Split-half coefficient was 0.94.The cut-off score of IAS-CV for screening somatoform disorders was 44.Conclusion:It suggests that the Chinese Version of the Illness Attitudes Scale(IAS-CV) has good psychometric features and could be used in clinical practice and research in China.

Objective To sum up the experiences in radical surgery for tetralogy of Fallot(TOF) in infancy.Methods One hundred and twenty-two infants(82 males and 46 females,6 months to 2 years old) suffered from TOF were treated with radical surgery from January 1996 to December 2007.Median sternotomy was routinely performed in all patients,and a longitudinal incision of right ventricular outflow tract was made to widen the conduit adequately,the ventricular septal defect was closed with polyfluortetraethylene patch,and the outflow conduit was reconstructed by autologous pericardial patch.Modified ultrafiltration technique was adopted routinely before cardiopulmonary bypass termination.Results Seven of the 128 infants died after operation with the early mortality of 5.5%.The death causes were: severe low cardiac output syndrome(n=2),severe pulmonary complications(n=4) and multiple organ failure(n=1).The major post-operative complications included 12 cases of low cardiac output syndrome,5 cases of atelectasis and 6 cases of perfusion lung.Conclusions The preferable operative age of radical surgery for TOF is about 1 year old,and the clinical outcome could be satisfactory.Low cardiac output syndrome and severe respiratory complications are the major problems after radical surgery for TOF in infants.