ObjectiveTo compare the clinical effect of 0.2% ropivacaine and bupivacaine combined with fentanyl respectively for postoperative continuous epidural analgesia(CEA).Methods50 patients of American Society of Anesthesiologists(ASA) grade Ⅰ~Ⅱ after abdomen operation were divided randomly into group ropivacaine + fentanyl(RF) and bupivacaine + fentanyl(BF). 5min before operation finished, group RF was given 0.2% ropivacaine plus 5 μg/ml fentanyl 5 ml, group BF was given 0.2% bupivacaine plus 5μg/ml fentanyl 5ml, and followed by a continuous infusion of 0.2% ropivacaine or bupivacaine plus 2 μg/ml fentanyl 2 ml/h at the end of operation respectively. The analgesic and paralytic effects expressed in VAS and modified Bromage degrees respectively were recorded 1h, 8h, 24h and 48h after operation.ResultsThere were no significant difference between group RF and group BF in VAS scales(P>0.05), but there were significant difference between group RF and group BF in modified Bromage degrees (P<0.05).ConclusionRopivacaine and bupivacaine combined with fentanyl could be safely and effectively used for postoperative analgesia. Because of the lower incidence of complications, ropivacaine combined with fentanyl will be more satisfactory.

BACKGROUND:Currently, there are few researches on the effect of punicalagin on the formation and differentiation of osteoclasts, and fewer researches on the mechanism of bone resorption diseases induced by wear particles. OBJECTIVE: To establish a model of titanium particles induced mouse monocyte/macrophage cel line (RAW264.7) differentiating into osteoclasts and to observe the effect of different concentrations of punicalagins on osteoclast proliferation and differentiation. METHODS: Mouse monocyte/macrophage cel lines (RAW264.7) were divided into five groups, cultured in the culture medium of common (blank group), 0.1 g/L titanium particle suspension, 0.1 g/L titanium particle suspension with 25 μmol/L punicalagins, 0.1 g/L titanium particle suspension with 50 μmol/L punicalagins, 0.1 g/L titanium particle suspension with 100 μmol/L punicalagins, respectively. The cel proliferative activity was detected by cel counting kit-8 assay at 1, 3 and 5 days. At 5 days after culture, number of osteoclasts was measured by tartrate-resistant acid phosphatase staining, the phosphorylation of IκBα and NF-κB p65 was detected by western blot assay, the mRNA expressions of nuclear factor of activated Tc1, tartrate-resistant acid phosphatase and matrix metaloproteinase-9 were measured by reverse transcription-PCR. RESULTS AND CONCLUSION:Compared with control group, titanium particles and different concentrations of punicalagin had no effect on the proliferation of RAW264.7 cels (P > 0.05). The number of tartrate-resistant acid phosphatase staining -positive cels, the phosphorylation of IκBα and NF-κB p65 as wel as the mRNA expressions of nuclear factor of activated Tc1, tartrate-resistant acid phosphatase and matrix metaloproteinase-9 were significantly increased compared with those of control group (P < 0.05,P < 0.01). And punicalagins in a concentration-dependent manner decreased the expression of the above indicators. These results indicate that punicalagin can inhibit osteoclast formation and differentiation.

Objective To investigate the value of low-dose MDCT in the diagnosis of breast cancer using ROC analysis. Methods Retrospectively analyze the breast images of 105 cases that had performed both 64-row CT and pathological examinations. The case number that underwent CT examination with routinedose parameters was 48; and that with low-dose was 57. Two radiologists with clinical experiences more than 5 years evaluated the breast lesions, respectively. And ROC curve was used to test the diagnostic efficacy of breast cancer between the two groups. Results Compared with the routine-dose group, the quality of CT image was high enough to disclose the breast lesions while the exposure dose was significantly decreased. The areas under the ROC curve between the routine-dose group (0.943) and the low-dose group (0.908) did not show significant difference (P >0.05). Conclusion Low-dose thin-slice MDCT with contrast enhancement can efficiently and safely diagnose breast cancer.

Objective To investigate and analyze application of syndrome-differentiated nursing care in the hospitals of TCM in Hunan. Methods A self-designed questionnaire was used to investigate and analyze 485 nurses-in-charge or higher positions in 116 hospitals of TCM in Hunan. Results 90.93% of nursing staff hold that syndrome-differentiated nursing care benefits patients' health; 32.37% of nurses were not familiar with syndrome-differentiated nursing care, and the rate of familiarity was higher among the nurses in municipal and provincial hospitals of TCM than those in county and district hospitals of TCM; hospitals of TCM that carry out syndrome-differentiated nursing care exceeding 70% accounted for 12.37%, with municipal and provincial hospitals of TCM higher than county and district hospitals of TCM. Conclusions Application of syndrome-differentiated nursing care in the hospitals of TCM is of concern. Reform of management model, training system, regulations and laws is needed to encourage nurses' application of syndromedifferentiated nursing care.

Objective To retrospectively review the experience of anesthesia for aortic valve insufficiency complicated with extremely dilated left ventricle.Methods The patients were premedieated with morphine 10 mg and scopolamine 0.3 mg IM.Anesthesia was induced with etomidate 0.1-0.2 ms/ks.sufentanil 1μ/kg and pipecuronium 0.1 mg/kg.After the patients were intubated,anesthesia wag maintained beween 1.0%and 1.5% isoflurane and intermittent Ⅳ boluses of sufentanil and pipecuronium.ECG,direct BP,SpO2,PET CO2,CVP and body temperature were monitored during anesthesia.Result All patients Were rehabilitated without ventricular fibrillation and arrhythmia.Conlusions Measures are taken before the surgery to maintain preload,increase heart rate,reduce afterload moderately and maintain myocardial contractility.After the surgery,maintenance of preload is helpful for ensuring adequate forward flow and benefcial to patients using dopamine and nitrolycerin.

BACKGROUND:Structural and functional changes of endothelial cels are the common pathological basis of cardiovascular disease. Severe structural and functional damage of endothelial cels are found in patients with hypertension or coronary heart diseases.
OBJECTIVE:To explore a new treatment method for hypertension from the perspective of vascular endothelial progenitor cels.
METHODS: PubMed and Wanfang databases were retrieved using the keywords “hypertension, EPCs” and approximately relevant 200 English and 100 Chinese literatures were obtained. Forty-nine eligible literatures were screened finaly.
RESULTS AND CONCLUSION:Endothelial progenitor cels have strong differentiation and proliferation capacities. This review may provide a new insight into potential sources of cels for diagnosis and treatment of hypertension.

BACKGROUND:Whether determination of tacrolimus blood concentration by different immunoassay methods can influence predictive ability to immunosuppressive effects and toxicity, and whether it can be more sensitive to reflect blood concentration in patients with renal dysfunction are worthy of studying.
OBJECTIVE:To analyze the correlation of tacrolimus (FK506) concentrations determined by enzyme-multiplied immunoassay technique (EMIT) and enzyme linked immunosorbent assay (ELISA) in combination with renal function parameters.
METHODS:133 clinical blood samples were col ected. EMIT and ELISA techniques were used to determine the FK506 concentration. The correlation of two determination methods were analyzed, combined with renal function. RESULTS AND CONCLUSION:In patients with renal dysfunction, the mean results and standard deviation mensurated by ELISA were higher than those by EMIT. For blood concentration in 5-20μg/L by ELISA, the incidence of renal dysfunction occurred less than by EMIT. The overal mean results of blood concentration for two methods appeared no significant difference (r=0.904 5, P>0.05). When the concentration was less than 2.0μg/L, the concentration results by EMIT were higher than those by ELISA (P<0.01). When the concentration was more than 2.0μg/L, there was no significant difference between two determination methods (P>0.05). These findings indicate that EMIT and ELISA has good correlation, which are both suitable for clinical routine determination of plasma concentration. It is not recommended for applying EMIT method to determine low blood concentrations (<2.0μg/L). The reference range of concentration should be compartmentalized depending on combination of determination methods and renal function.

Objective To explore the clinical characteristics and diagnosis of autoimmune pancreatitis(AIP) with the aim to raise awareness of AIP.Methods Clinical data of 32 patients with AIP were retrospectively analyzed,including clinical manifestations,imaging features,laboratory examination,histopathology and treatment from November 2009 to April 2013 in the First Affiliated Hospital of Medical School,Zhejiang University.Results All 32 AIP patients including 25 males and 7 females had a median age of (62.5 ± 12.6) years (27-84 years).The initial symptoms included obstructive jaundice in 50.0％patients (16/32),abdominal pain in 43.8％ (14/32),fatigue and weight loss in 12.5％ (4/32),and bloody stool in 6.3％ (2/32).Laboratory findings revealed abnormal liver function in 6.3％ (2/32)patients,increased immunoglobulins in 71.9％ (23/32)patients and elevated IgG4 in 8/10 patients.Computerized tomography(CT) scan and ultrasonography were performed in all patients.Diffusely enlarged pancreas were found in 62.5％ (20/32) patients and focally enlarged in 37.5％ (12/32),additionally main pancreatic duct stenosis in 62.5％ (20/32) patients.Nineteen patients obtained histopathological examination,indicating pancreatic interstitial fibrosis,and infiltration of lymphocytes and plasma cells.Conclusions Autoimmune pancreatitis is an autoimmune disease which may be misdiagnosed as pancreatic cancer.The clinical features,laboratory findings,imaging characteristics,and typical histopathologic presentation,as well as good response to glucocorticoids provide supportive evidence for the diagnosis of AIP.

Objective To select 15 short tandem repeat(STR) loci that are highly and steadily polymorphic,and study the genetic relationships between Luoba ethnic group,Tibetan living in Lassa and Changdu area,and other Asian populations by using 15 STR polymorphism.Methods The blood samples of unrelated individuals from Luoba ethnic group,Lassa Tibetan and Changdu Tibetan were collected.DNA templates were screened using AmpF/ STR Identifiler kit and ABI3100Avant DNA analyzer with Genescan and Genotype software.The STR data of Luoba,Lassa Tibetan,Changdu Tibetan,other 21 Chinese ethnic groups and six Asian populations were compared;phylogenesis tree was constructed;the genetic relationships among ethnic groups living in Tibet and other Asian populations were analysed.Results Eight Hans clustered,and five ethnic groups of Guangxi clustered firstly;then the two clustered with Luoba,and two groups of Tibetan secondly;and then clustered with other Chinese populations,and then the Chinese groups clustered with other six Asian populations and Chinese Uygur lastly.Conclusion The results of this study are basically consistent with geographic distribution,and histories of these ethnic groups.They can provide the genetic proofs for the origin,migration,formation and development of ethnic groups living in Tibet.