Objective To study the effects of different postoperative analgesia on the postoperative stress and cellular immune function in patients undergoing total hysterectomy.Methods Seventy-five patients undergoing total hysterectomy were divided into three groups by table of random digit with 25 cases each:morphine patient controlled epidural analgesia (PCEA) group (group A),tramadol PCEA group (group B) and butorphanol tartrate preemptive analgesia combined with tramadol PCEA group (group C).Peripheral venous blood samples were taken before anesthesia,the end of operation,1 and 3 d after operation for the serum levels of cortisol,norepinephrine (NE),epinephrine (E) and T-lymphocyte subsets (CD4+,CD8+).Results The serum levels of cortisol at the end of operation and 1,3 d after operation in group A and B had significant difference compared with those before anesthesia (P ＜ 0.05),the serum level of cortisol at 1d after operation in group C had significant difference compared with that before anesthesia (P ＜ 0.05).Compared with those before anesthesia,in the 3 groups,there were significant differences in the serum levels of E at the end of operation and 1 d after operation and the serum levels of NE at the end of operation and 1,3 d after operation (P ＜0.05).Compared with the same time of group A and B,there were significant differences in the serum levels of cortisol and E at 1 d after operation and the serum levels of NE at 1,3 d after operation in group C (P ＜ 0.05).CD4+,CD4+/CD8+ at the end of operation and 1,3 d after operation in 3 groups were significantly lower than those before anesthesia (group A:0.266 ±0.034,0.226 ±0.029,0.256 ±0.031 vs.0.313 ±0.030 and 1.3 ±0.3,1.0 ±0.1,1.1 ±0.2 vs.1.5 ±0.2,group B:0.271 ±0.031,0.242 ± 0.027,0.261 ± 0.030 vs.0.311 ± 0.034 and 1.3 ± 0.2,1.1 ± 0.1,1.2 ± 0.1 vs.1.5 ± 0.1,group C:0.282 ±0.036,0.276 ±0.030,0.290 ±0.028 vs.0.314 ±0.032 and 1.4 ±0.2,1.3 ±0.1,1.4 ±0.1 vs.1.5 ± 0.2,P ＜ 0.05).There were significant difference in CD4+ and CD4+/CD8+ 1,3 d after operation of group C than those of group A and B (P＜ 0.05).There was no significant difference in CD8+ among the 3 groups (P＞0.05).Conclusion Butorphanol tartrate preemptive analgesia combined with tramadol PCEA may reduce postoperative stress response and immune depress,compared with only morphine or tramadol PCEA.

The incidence of gastroesophageal junction cancers is rapidly increasing, the Year' s upwards rate being more than 5％ ～ 10％. Siewert in 1987 proposed a definition for adenocarcinoma of the esophagogastric junction (AEG), as a adenocarcinoma within 5 cm of the gastroesophageal junction (GEJ), and divided AEG in to three types. The majority of patients with AEG in Asian countries have type Ⅱ and Ⅲ cancers, and no obvious differences have been reported in 5-year survival rates between patients with different types of AEG. In contrast, in western countries, the distribution of each type of AEG is nearly equal,patients with AEG type Ⅰ cancer have the best prognosis, whereas the overall survival of patients with type Ⅲ cancer is the worst. Now people presume that the AEG is a special type of carcinoma which is not same as carcinoma of esophagus and stomach. The surgical routes and operative methods and the extent of lymph node dissection of AEG are still not completely clear, and AEG lacks also a independent TNM system for itself. We will summarize the actuality of diagnosis and therapy of AEG.

Objective To observe the efffects of angiotensin Ⅱ receptor antagonist (ARB) valsartan in decreasing blood pressure and protecting kidney to the patients suffering from mild-or-moderate hypertension companied with earlier type 2 diabetic nephropathy. Methods The patients suffering from mild-to-moderate hypertension and earlier type 2 diabetic nephropathy were divided into two groups. One of the groups were treated by valsartan, and the other were treated by betaloc and aldadinc. The period of the treatment and doses of the medicines were adjusted depending on the blood pressure 4 weeks later. The therapeutic effects of the two medicines were analyzed 6 months later. Results There was no difference in the effects of decreasing blood pressure and side-effects between the two groups. There are marked discrepancy between the two groups in the post-trearment 24h urinary albumin excretion rate (UAER) and the variation of 24h UAER (all P<0.05). There was no significant difference in others parameters (all P0.05). Conclusion Valsartan could prevent early proteinuria of type 2 diabetic nephropathy from developping and protect the function of kidney.

Objective To evaluate the effectiveness and to access the feasibility in reinforcing the quality of clinical teaching by introducing the conception of clinical pathway (CP) to the course of urology. Methods Sixty clinical medical students were randomly divided into two groups called CP group and tra-ditional group. The CP group's interns were provided with CP text which was considered as the core of the whole learning process. The interns would find the problems and solve problems according to the content of CP text. At last the teachers would summarize. Traditional group's teachers would introduce the disease systematically according to the teaching syllabus and screening suitable cases for interns to inquiry and have a physical examination. The two groups were evaluated systematically after four weeks of different teaching methods which concluded physical examination and written examination. An independent sample t test was used for the result of the operation and the written test and chi square test was used for satisfaction survey. Results The clinical pathway group's after-department examination score [(88.1±4.5) vs. (73.0± 7.3)], clinical skill scores [(88.1±4.5) vs. (73.0±7.3)] and the undergraduate interns' understanding of their comprehensive ability of disease (P=0.028) such as their team cooperation ability, their communication ability (P=0.0.15), (P=0.007) analysis and their ability to treat disease, as well as improving the evaluation ability and their comprehensive evaluation of teachers' teaching completion degree and teaching skills, , are all better than the traditional teaching group. Conclusion CP teaching applied in clinical teaching of urol-ogy is conducive to improving the quality of clinical teaching, and can enhance clinical interns' comprehen-sive ability and improve teaching satisfaction.

OBJECTIVE:To study the pharmacokinetic characteristics of esomeprazole capsules versus esomeprazole tablets in healthy volunteers and to evaluate their bioequivalence.METHODS:A single oral dose of 40 mg esomeprazole capsules or esomeprazole tablets was given to 24 healthy male volunteers who were randomly assigned to two groups in an open randomized crossover test.The plasma concentration was determined by HPLC.The pharmacokinetic parameters of esomeprazole were analyzed by DAS 2.0 program.The bioequivalence of the two preparations was evaluated.RESULTS:The pharmacokinetic parameters of esomeprazole capsules and esomeprazole tablets were as follows:Cmax were(884.71?265.97)ng?mL-1 and(919.53?218.44)ng?mL-1;tmax were(1.45?0.39)h and(1.65?0.45)h;t1/2 were(2.30?0.51)h and(2.23?0.47)h;AUC0～12 were(3 897.50?1 033.58)ng?h?mL-1 and(4 059.57?1 715.07)ng?h?mL-1;AUC0～∞ were(4 222.70?1 066.73)ng?h?mL-1 and(4 320.22?1 426.73)ng?h?mL-1.The relative bioavailability of esomeprazole capsules was(96.01 ?10.5)%.CONCLUSION:Esomeprazole capsules and esomeprazole tablets are bioequivalent.

Objective To investigate the clinical efficacy and safety of Ganluxiaodu micropills in treatment of helicobacter pylori(Hp)infected chronic atrophic gastritis.Methods 120 patients with chronic atrophic gastritis (pixu shire syndrome)from April 2013 to April 2014 were selected and divided into observation group and the control group (n =60)according to random number table method.The control group was given standard triple therapy,the observation group was given Ganluxiaodu micropills on the basis of the control group,7 days for a period of treatment. The symptoms changes of the two groups before and after treatment were observed and combined results of the gastro-scope and breath test,determined the clinical curative effect and eradication rate of Hp.The SF -36 scale score was used to evaluate the quality of life of the patients.Results The clinical symptom scores[(15.92 ±2.25)points vs (16.12 ±2.14)points ],SF -36 scale [(68.05 ±12.98)points vs (65.77 ±11.34)points]of the two groups before treatment had no statistically significant differences (t =-1.033,-1.239,all P >0.05).The clinical symp-tom scores and SF -36 score of the observation group and the control group after treatment [(8.24 ±1.23)points, (89.44 ±12.93)points;(12.65 ±1.75)points,(77.43 ±11.59)points ]were obviously improved than before treat-ment,the differences were statistically significant (t =2.574,2.765,2.133,2.047,all P <0.05);the observation group improved significantly better than the control group,the difference was statistically significant (t =2.394, 2.432,all P <0.05 ).The total effective rates of observation group and control group were 96.7% and 83.3%respectively,Hp eradicate rates were 93.3%,70.0% respectively,which in the observation group were significantly higher than the control group,the differences were statistically significant(χ2 =4.282,4.098,all P <0.05).There were no serious adverse reaction happened in the two groups,the incidence rate of adverse reactions of the two groups (11.67% vs 8.33%)had no statistically significant difference (χ2 =1.032,P >0.05).Conclusion Ganluxiaodu micropills can improve the Hp eradicate rate of standard triple therapy,the clinical efficacy of Ganluxiaodu micropills in treatment of Hp infected chronic atrophic gastritis (pixu shire syndrome)is significant,which is worthy of clinical popularization and application.

Objective To determine short-term therapeutic efficacy and side effect of postoperative 3-dimensional conformal radiotherapy for malignant glioma.Methods From January 2003 to January 2005, 62 patients with malignant glioma postoperation were randomized into two groups,32 entered in 3DCRT group and 30 entered in ordinary radiotherapy group.The dose of radiotherapy was 60 Gy/30 f, 6 weeks. Results The overall response rate in the 3DCRT group was 87.5 %(28/32),in the ordinary radiotherapy group was 73.3 %(22/30).There were no statistical significance(P=0.158).The survival rates at 1-,2-year were 90.6 % (29/32),81.3 %(26/32)in the 3DCRT group and 80 %(24/30),56.7 %(17/30)in the ordinary radiotherapy group. The difference was significant(P

Objective:To investigate the expression and significance of an inhibitor gene of apoptosis,Clusterin,in prostate cancer,and its relationship with the expression of bcl-2,FasL.Methods:The expression of Clusterin,bcl-2 and FasL in sample of 10 normal prostate,15 BPH and 49 prostate cancer were examined by immunohistochemical stain.Results:The rate of positive or weak positive for normal prostate,BPH and prostate cancer was 10%(1/10),66.6%(10/15)and 91.8%(45/49) respectively.The expression level of Clusterin in prostate cancer was much higher than in normal prostate(P

OBJECTIVE To analyze the characteristics of Klebsiella pneumoniae and the result of sputum culture and its clinical significance.METHODS The sputum was cultured to detect the susceptibility to antibiotics,as well as to accumulate the data of clinical cases.RESULTS Total of 82 strains were obtained.Imipenem sensitivity was 100.00%,followed by levofloxacin and ciprofloxacin,with sensitive rates(95.10% and 92.7%).Thirty-two ESBLs producing strains were accounted for 39.02%.CONCLUSIONS Part of the K.pneumoniae strains are extended spectrum beta-lactamase-producing Enterobacteriaceae and insensitive to the commonly used antibiotics.It is suggested the antibiotics be used according to drug sensitivity.

Objective:To explore the therapeutical effect of Tetramethylpyrazine on chronic allograft nephropathy of rat, reveal the relationship with CAN, then discovering mechanism of action that delaying the proceeding of CAN of rat, which provide a new way of therapy to extend survival time of transplanting kidney. Methods: We used Fisher rats as donors and Lewis rats as recipients to establish the model of CAN. 75 rats with transplanting kidney were divided into 3 groups: Ciclosporin group, TMP associating with Ciclosporin group and black group; every group for 25 rats. Renal cell apop totic index was examined by means of terminal deoxynucleotidyl transferase2mediated d-UTP nick end labeling (TUNEL). The expressions of Bcl-2 and Bax in kidney was immunohistochemically evaluated and. The kidney histology were observed by light microscope. Results:The rats of black group were died in two weeks. Ciclosporin group, appearance the histopathological changes of CAN since 4th week, it is thus evident that typical histopathological changes of CAN at 12th week. TMP associating with Ciclosporin group was later. There was significant difference(P