Objective To investigate effects of intrathecal injection of sufentanil combined with bupivacaine on postoperative analgesia and immunity function in elderly patients under lower extremity orthopaedic surgery.Methods Totally 60 elderly patients with ASA Ⅰ or Ⅲ under lower extremity orthopaedic surgery were randomly divided into two groups:bupivacaine and sufentanil group (each n =30).3 ml bupivacaine (2 ml 0.75％ bupivacaine plus 1 ml 0.9％ normal saline) were given in bupivacaine after successful spinal anesthesia and 3 ml sufentanil (1 ml 0.75 ％ bupivacaine plus 1 ml 0.9％ normal saline and 1 ml with 5 μg sufentanil) were used in sufentanil group respectively.The anesthetic feeling and block level before operation recovery time were recorded postoperation.Visual analogue scale (VAS) and adverse reaction were recorded at 1,6,12,24 and 48 h after surgery.Cellular and humoral immunity function were recorded at the following time points:T0,the day before surgery; T1,the day after surgery; T2,the first 5 postoperative days; T3,the first 10 postoperative days; T4,the first 15 postoperative days.Results The sensory and motor block levels in sufentanil group were T9～～T10 and T11～T12 respectively,which were higher than in bupivacaine (T7～T8 and T8～T10).The recovery time in sufentanil group was shorter than in the bupivacaine (P＜0.05).There were no significant differences in VAS scale between the two groups at any postoperative time points (P＜0.05).The incidence of skin pruritus was higher in sufentanil group (6 cases) than in bupivacaine (P＜0.05).There were significant differences in the indexes for the immune condition including CD3+,CD4+/CD3+,CD4/HLADR,CD8/HLADR,B-cell,NK-cell between time points of T2[(48.7±2.3)％,(33.4±1.8)％,(10.2±1.8)％,(0.75±0.07)％,(1.02±0.16)％,(3.12 ±0.19) ％,(2.53±0.14)％,respectively] and T0 in bupivacaine (P＜0.05).There were significant differences in the indexes for the immune condition including CD3+,CD4+/CD3+,CD4/HLADR,CD8/HLADR,B-cell,NK-cell at T2 between sufentanil group [(54.5 ± 2.4) ％,(36.3 ± 1.7) ％,(15.1±1.6)％,(1.32±0.11)％,(1.25±0.14)％,(4.96±0.25)％,(4.17±0.10)％,respectively] and bupivacaine (P＜0.05).Conclusions Intrathecal injection of 5 μg sufentanil combined with low concentration bupivacaine can be safely and effectively applied in elderly patients under lower extremity orthopaedic surgery,and can reduce local anesthetic concentration,shorten recovery time of anesthesia and accelerate the recovery of postoperative immunity function.

At present, the theory and experiment teaching of forensic toxicology are faced with difficulties such as lake of practical cases and toxic types, content being abstract and difficult to un-derstand. On that account, we collected and collated many typical cases from Public Security Bureau and our school's medico legal expertise center, and then a relatively systematic and complete teaching case base in forensic toxicology has been constructed, and will be supplement constantly, so as to pro-vide extensive teaching resources and improve the teaching quality of forensic toxicology.

0.05, E tube), and increased by 177% and 212% with mechanical stimulation (bubbling) at 30th min and 60th min (P

To develop and validate a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of epirubicin hydrochloride (EPI) in rat plasma, daunorubicin hydrochloride was used as internal standard. The plasma samples were deproteinated with methanol, and separation was performed on a reversed-phase CAPCELL PAK C18 column (3.0 mm x 50 mm, 3 microm). The mobile phase contained methanol-0.1% formic acid (80:20). Detection was carried out by multiple reaction monitoring on a HP1200-6410 QQQ LC/MS system. Different preparations of EPI solution, EPI-LIP (EPI-liposome) and EPI-LTSL (EPI-thermosensitive liposome) was administered in rats by i.v with the same dosage (12 mg kg(-1)). The pharmacokinetic model and parameters were fitted and calculated by the DAS ver2.0 software. The calibration curve was linear in the range of 0.01-50 microg mL(-1). The limit of quantification was 0.01 microg mL(-1). RSDs of intra- and interbatch precisions were all less than 11.9%. The average extract recovery was 89.3% and 92.1%, respectively. The pharmacokinetics of EPI in rats with all preparations were fitted to three compartments, which all fast distributed and slowly eliminated. The t1/2 alpha, t1/2 beta, t1/2 gamma, AUC(0-infinity), and MRT(0-infinity) of EPI-LTSL group were 7.5, 1.3, 12.6, 12.9, 3.7 times those of EPI solution group; and 1.6, 1.4, 12.3, 2.9, 2.6 times those of EPI-LIP group. Moreover, the CL of the latter two groups was about 13.4 times of the former EPI-LTSL group. EPI-LTSL can significantly improve AUC and prolong the circulation time of EPI in rat plasma.

Associations between "lipid-related" candidate genes, blood lipid concentrations and coronary artery disease (CHD) risk are not clear. We aimed to investigate the effect of three newly identified lipids loci from genome-wide association studies on CHD and blood lipid levels in Chinese Han population. The genotypes of SNPs at three newly identified lipid loci and blood lipids concentrations were examined in 1360 CHD patients and 1360 age- and sex-frequency matched controls from an unrelated Chinese Han population. Allele T of rs16996148 occurred less frequently in CHD patients with the odds ratio (OR) being 0.64 (95% CI 0.50 to 0.81), after adjusting for conventional risk factors and was associated with a 33% decreased CHD risk (P<0.01) comparing with the major allele G. Individuals with GT genotype had the lowest CHD risk. No associations were found between the polymorphisms of other two loci with CHD risk and all three SNPs had no effect on lipid profile in this population. SNP rs16996148 on chromosome 19p13 is significantly associated with lower risk for CHD in Chinese Han population. However, it remains unresolved why these lipid-related loci had significantly less effects than the correspondingly expected effects on blood lipids levels in this population.

Objective To explore the correlation of peritumoral brain edema( PTBE)size,histologi-cal grades and the expression rate of Ki-67 in gliomas. Methods The data and specimens about 74 cases of gliomas in People's Hospital of Xinjiang Uygur Autonomous Region during 2010-2013 were collected. All cases were confirmed by surgery and pathology. According to preoperative MRI,PTBE was graded. Immunohisto-chemical discriminate the expression of Ki-67. HE coloration distinguish the histological grades. Results In this study,90. 54%(67/74)patients occured PTBE,the incidence of PTBE inⅠ,Ⅱ,Ⅲ,Ⅳlevel of groups were 100%(3/3),78. 95%(15/19),83. 33%(15/18),100%(34/34). Ki-67 expression was positive in 75. 68%(56/74)patients,and the rates were 0,36. 84%(7/19),94. 44%(17/18),94. 12%(32/34) in Ⅰ,Ⅱ,Ⅲ,Ⅳ level of groups. The expression rate of Ki-67 was 57. 14%(4/7),60. 00%(6/10),and 80. 70%(46/57)in normal group,Ⅰ-level groups of PTBE,Ⅱ-level groups of PTBE. The result of Kruskal-Wallis H showed that the PTBE from different grades was statistically significant(H=11. 304,P=0. 010). The expression rate of Ki-67 in different grade gliomas was statistically significant(H=38. 530,P﹤0. 05), The difference of expression Ki-67 in gliomas of different PTBE was statistically significant( H=6. 478,P=0. 039). The result of Spearman rank correlation analysis showed that the PTBE level increased with the histo-logical grade up in gliomas(r=0. 385,P=0. 001). The expression rate of Ki-67 increased with the histologi-cal grade up in gliomas(r=0. 692,P﹤0. 05),and the expression rate of Ki-67 increased with the degree of PTBE up in glomas( r =0. 256,P =0. 028 ). Conclusion Accorrding to the PTBE size,the histological grades and proliferation ability of glioma can be judged pre-operation. Ki-67 can be used as the indicator of pro-liferation activity of tumor,and also be used as the important basis of histological grades.

Objective To discuss the relationship between peptic ulcer in children and food-specific IgG, and to evaluate the effect of avoiding the intolerant food on treatment of peptic ulcer. Method Fourteen kinds of food specific IgG in 69 cases of peptic ulcer were tested by ELISA. The patient′s intolerance to different foods and its relationship with age , sex and different ulcer were analyzed. The efficacy of avoiding the intolerant food was assessed after 8 weeks. Results Total positive of food-specific IgG in children with peptic ulcer was 94.2%. For preschool children, the highest intolerance rates were in milk and eggs; for school-age and adolescence children, the highest intolerance rate was in eggs. As the age increases, kinds of intolerant food increased too. Ulcer healing rate in observation group was higher than that in the control group after 8 weeks. Conclusions High positive percentage of food- specific IgG was found in children with peptic ulcer , indicating a possible correlation of peptic ulcer and food-intolerance. Kinds of intolerant food correlates with the age group , but not with sex and ulcer sites. Avoiding the intolerant food may increase ulcer healing rate.

Objective To analyze operation resection of craniopharyngioma operation experience,and to evaluation of therapeutic effect of operation.Methods Clinical data of 26 cases patient of craniopharyngioma treated by craniotomy from July 2008 to July 2013 in the Department of Neurosurgery of the People's Hospital of Xinjiang Uygur Autonomous Region for microsurgical operation resection were retrospectively analyzed.The main clinical manifestations, imaging features, the selection of operation treatment and operation approach, extent ofsection of tumor after operation, the occurrence of complications and follow up outcome were analyzed.Results Six cases with brain frontal botton+longitudinal fissure+brain endplate approach,4 cases with brain frontal botton approach, 5 cases with cerebral longitudinal fissure + callosum approach, 11 cases with pterion approach.Total removal was achieved in 19 cases, subtotal resection in 6 cases, most resection in 1 cases.Bilateral olfactory nerve in 22 cases of complete retention, unilateral olfactory nerve stretch mutilation in 4 cases,20 cases of pituitary stalk were identified, and 1 cases of anterior communicans anterior rupture give electrocoagulation cut.Enamel cell type in 23 cases, squamous epithehal cells type 3 cases.Postoperative diabetes insipidus 18 cases, electrolyte disturbances 16 cases, pituitary function decline 5 cases, secondary brain edema 2 cases, 1 case of postoperative epilepsy, 1 cases of death.The pursuit of total was diabetes insipidus factors(x2 =4.807, P =0.046), 5 cases of recurrence, 3 cases go again operztion treatment, 2 cases for the gamma knife treatment, the tumor recurrence rate of total removal lower subtotal resection and most resection (Z =-3.718 P=0.000).The tumor recurrence rate of puget tumor grade level 2 higher than puget tumor grade level 0 and puget tumor grade level 1 (Z =-3.124 P =0.000).The quality of life score (KPS) more than 70 points in 15 cases,60-70 points in 8 cases, ≤60 points in 2 cases.Conclusion Craniopharyngioma preferred operation treatment.Evaluation of preoperative imaging and operation approach is the key to successful operation.The correct operation of the surgery and treatment strategies, advantageous to resection tumor, effective prevention of postoperative complications.Postoperative residual tumor is the main cause of recurrence of craniopharyngioma.Recurrence of craniopharyngioma treatment should individualized therapy after weigh the advantages and disadvantages.

OBJECTIVE:To provide reference for rational use of antibiotics in terminal stage patients with malignant tumor. METHODS:The inpatients with malignant tumor who died in the department of medical oncology of our hospital from Mar. 2013 to Mar. 2016 were analyzed retrospectively in respects of general situation,infection situation and antibiotics use. RESULTS:Among 149 inpatients,a total of 129 infection cases were found in 113 patients(75.8%). The most frequent sites of infection were lung(65.9%),followed by digestive tract/abdomen(13.2%),and skin/wound(6.2%). 100 patients (67.1%)received antibiot-ics,61.1% of which were empiric treatment. β-lactam/β-lactam lactamase inhibitor(41.8%),fluoroquinolone(21.7%)and cepha-losporin(16.9%)were the top 3 frequently prescribed antibiotics. The effective rate of antibiotics treatment was as low as 15.8%, which was believed to be linked with the survival duration since infection occurred (P<0.001),the Karnofsky performance scale (KPS)score when infection occurred(P<0.001)and the duration of antibiotics treatment(P=0.025). CONCLUSIONS:Terminal stage patients with malignant tumor are vulnerable to infections,especially to pulmonary infection. The empirical broad-spectrum an-tibiotics are widely used in terminal patients with malignant tumor,but the effectiveness rate of antibiotic treatment is in low level. For those terminal stage patients with malignant tumor and with KPS score<60 points,when futile antibiotics treatment last for more than 7 days,timely termination of antibiotics treatment is a better choice.

Objective To discuss the efficacy of the flexible ureteroscopy combined with Holmium laser lithotripsy for kidney calculi with HIV positive patients.Methods From May 2015 to May 2016,47 cases of patients with renal calculi were treated by the flexible ureteroscopy combined with Holmium laser lithotripsy in our hospital.There were 29 cases male,18 cases female,aged from 22 to 56 years old,average 39 years.There were 38 cases with single stone,9 cases with multiple stones.There were 9 cases with stones on both sides.Flexible ureteroscopy channel sheath was used in surgery.Stones were fragmented by Holmium laser.During one-month follow-up after surgery,stone removal and stone free rate were recorded.Residual stones were re-treated with a secondary lithotripsy or ESWL.Results The flexible ureteroscopy channel sheath was indwelled successfully in all the cases.All stones were detected.The average operation time was 63min (range,42-141min) and the median postoperative stay was 4.5days (range,2-16 d).Among the 47 patients,41 patients underwent first-stage lithotripsy,6 patients underwent second-stage ESWL after lithotripsy,and 1 patient underwent third-stage lithotripsy.The one-month stone free rate was 87.2％ (41/47).The total stone free rate was 97.9％ (46/47) after second-stage lithotripsy.Postoperative fever occurred in 4 cases after lithotripsy.No blood transfusion,systemic infection,ureteral perforation,or ureteral avulsion occurred.The total complication rate was 8.5％ (4/47).The mean number of CD4 +T lymphocytes before lithotripsy was 402/μl,and was 410/μl 3 days after lithotripsy.There was no Statistical differences between them.Conclusions Flexible ureteroscopy combined Holmium laserlithotripsy could be a safe and effective treatment for kidney calculi patients with HIV/AIDS positive.