Objective To investigate the effect of dexmedetomidine combined with sufentanil on postoperative analgesia and the vascular crisis in patients undergoing free flap transplantation. Methods Forty patients with ASA physical statusⅠ-Ⅱhaving underwent free flap transplantation were divided into groupⅠand groupⅡaccording to the random digits table method with 20 cases each. The drugs of patient controlled intravenous analgesia (PCIA) in groupⅠwere sufentanil 1.0μg/(kg·d)+tropisetron 5 mg/100 ml, and the drugs of PCIA in group Ⅱ were sufentanil 1.0 μg/(kg · d) +dexmedetomidine 1.0 μg/(kg · d) + tropisetron 5 mg/100 ml. The PCIA pump was set in 2 groups as follows: continuous perfusion rate 2 ml/h, single bolus 2 ml, lockout time 15 min. The visual analogue score (VAS), Ramsay sedation score, press number of PCIA pump within 48 h after operation, satisfaction score after operation, untoward reaction and vascular crisis were recorded. Results The VAS at 6, 12, 24 and 48 h after operation in group Ⅱ were significantly lower than those in group Ⅰ: (2.18 ± 0.41) scores vs. (3.00 ± 0.63) scores, (2.64 ± 0.51) scores vs. (3.82 ± 0.60) scores, (2.55 ± 0.52) scores vs. (3.36 ± 0.51) scores and (2.27 ± 0.47) scores vs. (3.09 ± 0.70) scores, the Ramsay sedation scores were significantly higher than those in group Ⅰ: (2.42 ± 0.51) scores vs. (2.00 ± 0.58) scores, (2.74 ± 0.45) scores vs. (2.11 ± 0.57) scores, (2.58 ± 0.51) scores vs. (2.05 ± 0.52) scores and (2.53 ± 0.51) scores vs. (2.00 ± 0.47) scores, and there were statistical differences (P<0.05). The press number of PCIA pump within 48 h after operation in groupⅡwas significantly lower than that in groupⅠ:(3.75 ± 1.45) times vs. (8.25 ± 2.61) times, the satisfaction score after operation was significantly higher than that in groupⅠ:(2.47 ± 0.51) scores vs. (1.60 ± 0.50) scores, and there were statistical differences (P<0.05). There were no statistical differences in the incidences of untoward reaction and vascular crisis (P>0.05). Conclusions Dexmedetomidine can relieve anxiety and nervousness, reduce postoperative consumption of sufentanil, and decrease the incidence of nausea and vomiting. In addition, dexmedetomidine does not affect the incidence of vascular crisis.

Objective To explore the incidence rates of lower respiratory tract infections after general anes-thesia in the elderly orthopedics patients and to analyze the related risk factors.Methods A total of 45 patients with lower respiratory tract infections in 479 elderly orthope -dics patients who received general anesthesia were enrolled in the study.The bacterial identification and drug susceptibility testing were preformed after the collection of sputum specimens.The univariate factor analysis and multivariate logistic regression analysis were performed to identify the risk factors for the lower respiratory tract infections after general anesthesia,including the age,gender,smoking histo-ry,chronic respiratory diseases history,basic cardiovascular disease,diabetes,mental disease,and endotracheal tube type,anesthesia ventilation time,postoperative extubation time,and postoperative analgesia.Results Smoking history (Wald =5.058,OR =4.618),chronic respiratory diseases history(Wald =37.950,OR =20.507),mental disease (Wald =26.303,OR =75.644),endotrac heal tube type(Wald =9.035,OR =11.758),anesthesia(Wald =15.035, OR =20.163)and postoperative extubation time(Wald =14.243,OR =12.613)were identified as the risk factors for lower respiratory tract infections after general anesthesia in the elderly orthopedics patients (all P <0.05 ). Conclusion Risk factors should be intervened in elderly orthopedics patients who receive general anesthesia,and the antibiotics should be chosen on the basia of the drug susceptibility testing.

Objective To report our method to determine lateral needle insertion point (intersection point skin marker) in closed reduction and percutaneous Kirschner wire fixation for pediatric supracondylar fracture of humerus.Methods From May 2012 to June 2014,125 children with supracondylar fracture of humerus were treated with closed reduction and percutaneous Kirschner wire fixation.Of them,60 did not use the intersection point method to determine the lateral needle insertion point (group A),including 46 boys and 14 girls,with an average age of 6.3 ±0.6 years.According to Gartland classification,28 cases were type Ⅱ and 32 cases type Ⅲ.In the other 65 children,the intersection point method was used to determine the lateral needle insertion point (group B),including 50 boys and 15 girls,with an average age of 6.4 ± O.9 years.According to Gartland classification,29 cases were type Ⅱ and 36 cases type Ⅲ.The 2 groups were compared in terms of operation time,fluoroscopy times,hospital stay and hospitalization cost.The efficacy was evaluated at the final follow-ups using Flynn criteria.The 2 groups were compatible without significant differences in preoperative general data (P ＞ 0.05).Results All the 125 children obtained successful closed reduction and percutaneous pin fixation,and an average follow-up of 13 months (from 12 to 15 months)as well.There were significant differences between groups A and B in average operation time (23.1 ± 15.3 min versus 17.5 ± 10.3 min) and fluoroscopy times (9.2 ± 1.0 times versus 5.3 ± 1.3 times) (P ＜ 0.05).There was no statistically significant difference between the 2 groups either in Flynn excellent to good rate [(98.3％ (59/60) versus 98.5％ (64/65)] (P ＞ O.05).Needle irritation occurred in 2 cases and Kirschner wire shift in one in group A while tensile blistering occurred in one in group B.Conclusion In closed reduction and percutaneous Kirschner wire fixation for pediatric supracondylar fracture of humerus,the intersection point skin marker is a simple and reliable method to determine the lateral needle insertion point,leading to considerable reduction in radiographic exposure for both patients and doctors.

Objective To detect the main virulence genes and biofilm formation of Enterococci strains isolated from blood samples .Methods Twenty-eight strains of Enterococcus faecalis ( E.faecalis) and 54 strains of Enterococcus faecium ( E.faecium) were collected from blood samples .Five main virulence genes (asa1, esp, hyl, cylA and gelE) were detected by multiplex PCR.Biofilm formation was investigated by using microtiter dish biofilm formation assay .Results All E.faecalis strains were positive for at least one kind of virulence genes , of which 14 strains were concurrently positive for asa1, esp, cylA and gelE.asa1, cylA and gelE were only detected in E.faecalis strains, while hyl gene only existed in E.faecium strains. Twenty-seven strains of E.faecium were esp positive, of which 12 strains were both hyl and esp positive. None of the 5 virulence genes were identified in 10 strains of E.faecium.85.7% of E.faecalis strains and 63.0%of E.faecium strains could form biofilm.Conclusion Compared with E.faecium strains, more types of virulence genes were detected in E.faecalis strains with higher positive rates .Moreover , E.faecalis strains were more likely to form biofilms than E.faecium strains.

Objective To investigate the expression of Toll-like receptor 4 (TLR4),and explore its relationship with neurological function after fluid percussion brain injury in rats.Methods 56 adult rats were randomly divided into traumatic brain injury group(TBI group,n=48) and sham operation group(SO group,n=8).The experimental models were established.The water content of edematous brain and the expression of TLR4 were measured with dry-wet measure,immunohistochemistry and Western Blot at 1 h,6 h,12 h,24 h,3 d,7 d after shock respectively.Results Compared with SO group,neuronal function score decreased in TBI group from 6 h(3.86±0.42),reached to the lowest level at 24 h(2.65±0.32),and gradually rose at 3rd day (3.25±0.17).TLR4 immunoreactive expression increased from 6 h,reached its maxmum at 24 h,lasted to 3rd day,and then began to drop at 7th day.The linear regression analysis indicated that expression of TLR4 had negative correlation with change of neuronal function score (r 1 =-0.824,r w =-0.867,P＜0.05).Conclusion TLR4 expression is upregulated following fluid percussion injury in rats and involved in neurological function impairment by inducing secondary inflammatory brain injury.

AIM To study the chemical constituents from Securidaca inappendiculata Hassk..METHODS The dichloromethane and ethyl acetate fractions of S.inappendiculata 95％ ethanol extract were isolated and purified by silica,gel column and recrystallization,then the structures of obtained compounds were identified by physicochemical properties and spectral data.RESULTS Ten compounds were isolated and identified as 8-hydroxy-1,3,4-trimethoxyxanthone (1),1,2,7-trimethoxyxanth-one (2),4-hydroxy-3,5-dimethoxybenzaldehyde (3),sesamin (4),2-methoxy-3,4-methylenedioxybenzophenone (5),1,3,7-trihydroxy-4-methoxyxanthone (6),1,3,7-t-rihydroxy-2-methoxyxanthone (7),2-hydroxy-1,7-dimethoxyxanthone (8),3,8-dih-ydroxy-1,4-dimethoxyxanthone (9),oα-spinasterol (10).CONCLUSION Compound 1 is first found in the form of natural product,compounds 2-4 are isolated from genus Securidaca for the first time.

According to the onset age, a total of 5 674 outpatients with gout admitted in the affiliated hospital of Qingdao University from January 2011 to January 2016 were divided into youth group (≤44 years, n=3 058), middle age group (45~64 years, n=2 101), and elderly group (≥65 years, n=515).Their clinical and biochemical characteristics were analyzed.The results showed that the proportion of gout in the males in three groups was higher than that in the females.The proportions of gout in male youth, middle age, and elderly groups were 98.1%, 93.4%, and 83.1%, respectively.The proportion of gout in females increased with age.The proportion of gout family history in youth group was higher than that in middle age and elderly groups(P<0.05).The proportions of hypertension and impaired fasting glucose(IFG) in elderly group were higher than those in youth and middle age groups (P<0.05), with lower proportions of hypertriglyceride and obesity (P<0.05).The levels of systolic blood pressure, blood urea nitrogen, creatinine in elderly group were increased compared with youth and middle age groups (P<0.05) while the levels of uric acid and triglyceride were decreased (P<0.05), with higher ratio of renal dysfunction (P<0.05).There were no differences in tophus and kidney calculi among three groups (P>0.05).The distributions of the onset joint among three groups revealed statistical difference(P<0.05), but the first plantar toe joint was mostly involved in each group.These results suggest that the clinical characteristics of patients with gout at different onset ages are not identical, should be treated differently.

Objective To explore the influence of epidural analgesia on stress,immune and survival in patients with ovarian cancer undergoing cytoreductive surgery.Methods 72 cases with ovarian cancer undergoing cytoreductive surgery were divided into group A and group B according to random number table method.Patients in group A were treated with epidural analgesia,while patients in group B were treated with intravenous analgesia.The stress index,the plasma cortisol and immune indexes,CD3+,CD4+,CD8+ and CD4+/CD8+ at 30 mins before surgery (T1),right after surgery (T2),12 h after surgery (T3),1 d after surgery (T4) and 3 d after surgery (T5) between the two groups were observed.The overall survival and free survival in the two groups were compared.Results The plasma cortisol levels was lower in group A than in group B (Fgroup=27.784,P=0.000).The plasma cortisol levels in the two groups increased first and then decreased (Ftime=109,268,P-=0.000),and the decrease ratein group A was higher than that in group B (Finteraction,=22.092,P=0.000).The levels of CD3+,CD4+ and CD4+/CD8+ werehigher in group A than in group B,while the level of CD8+ was lower in group A than in group B (Fgroup=5.893,6.110,7.283,5.593,P＜0.05).The levels of CD3+,CD4+ and CD4+/CD8+ in the two groups reduced first and then increased while the level of CD8+ increased first and then reduced (Ftime=12.220,14.430,15.592,11.102,P＜0.05).CD3+,CD4+ and CD4+/CD8+ in group A increased more while C D8+ reduced more than those in group B (Finteraction=8.251,9.792,8.092,7.103,P＜0.05).The overall survival rate and free survival rate of 3 years in group A and group B was 44.44％,22.22％ vs 38.89％,16.67％,respectivelyThedifferencehadnostatisticalsignificancebetweenthetwogroups (P＞0.05).Conclusion Epidural analgesia may reduce the stress response in patients with ovarian cancer undergoing cytoreductive surgery,and protect the immune function,but the influence on survival is not obvious.

Objective To evaluate the effect of neoadjuvant chemotherapy factor on neuromuscular block induced by cisatracurium in the patients undergoing radical gastrectomy.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 48-79 yr,with body mass index of 20-27 kg/m2,scheduled for elective laparoscopic radical gastrectomy,were divided into 2 groups (n =30each) according to whether the patient received neoadjuvant chemotherapy before operation or not:nonchemotherapy group (group A) and neoadjuvent chemotherapy group (group B).Anesthesia was induced with cisatracurium 0.15 mg/kg (3×ED95) injected intravenously.When T1 recovered to 10％ of control height,Ⅳ infusion of cisatracurium was started with an initial dose of 1.5 μg · kg-1 · min 1,and the infusion rate was adjusted with the amplitude of 0.2 μg · kg 1 · min-1 to maintain T1 at 5％-10％ of control height.The onset time,nonresponse time,time for T1 to recover to 10％,recovery index and time for train of four ratio to recover to 90％ were recorded.The consumption of cisatracurium was continuously recorded event 30 min starting from Ⅳ infusion of cisatracurium for 3 times,90 min in total.The mean infusion rate within 90 min was calculated.Results Compared with group A,the onset time,recovery index and time for train of four ratio to recover to 90％ were significantly prolonged,the nonresponse time and time for T1 to recover to 10％ were shortened,and the consumption of cisatracurium and mean infusion rate were increased in group B (P＜0.05).Conclusion Neoadjuvant chemotherapy factor can weaken neuromuscular block induced by cisatracurium in the patients undergoing radical gastrectomy.

Objective:To review the progress in vaginal mucoadhesive drug delivery systems. Methods:Based on the recently published papers,the research on the application of vaginal mucoadhesive drug delivery systems was classified and summarized. Re-sults:Vaginal mucoadhesive drug delivery systems not only showed safety,effectiveness and strong permeability but also avoided the first pass effect,prolonged drug residence time and improved bioavailability and compliance of patients. Conclusion:Vaginal mucoad-hesive drug delivery systems are becoming research hotspots and exhibit broad application prospects to replace the traditional delivery systems.