Analgesia and sedation is the necessary measure in critically ill patients. For implementation of an-algesia and sedation treatment, we should respect the patients′ and family members′rights to be informed. Under the premiseof profit maximization and priority to life,we should optimize the analgesic and sedative treatment, and avoid the adverse effects and complications as far as possible. At the same time, we should pay attention to protec-ting patients′privacy and strengthening the cooperation of physicians and nurses. Analgesia sedation management mode formulated and guided by physicians and nurses-led should be promoted.

Aim to solve the common problems in the chronic non-cancer therapy,the author proposed that the medical professional ethics should be strengthened,and both the right and obligation of patient and doctor should be respected.The ethical issues in the psychological treatment as well as the use of opium drug and advanced technique are analyzed in the paper.

Background Retinal flatmount of oxygen-induced retinopathy (OIR) animal models is a useful tool in the study of ischemic retinopathy.The retinas of OIR of rat or mouse pups were small and thick and difficult in operating of conventional preparation and quantitative analysis of retinal flatmounts.Objective This study was to explore an easy and stable operating method of retinal flatmount combined with immunofluorescence staining in rodent.Methods Forty ＜6-hour-old SD rat pups were randomly assigned to OIR model group and normal control group.The pups were raised with nursing mothers in hyperoxia environment (80％) and normal oxygen environment (21％) alternately at a 24-hour interval for 14 days in the OIR model group,and the pups were raised in the room air for 14 days in the normal control group.The eyeballs of the rats were extracted to isolate the retinas intactly.The retinas were stained with glutamine synthetase (GS)-isolectin B4 firstly and then expanded into flatmounted and cut into 4 petals radially.Adobe Photoshop CS3 imaging analysis system was used to match the pictures into entire retinal vascular images and analyzed under the fluorescence microscope.The pixel values of retinal avascular areas and the entire retina were quantified by this system.The percentage of avascular areas to the entire retina was calculated to analyze the severity of non-perfusion areas.The use and care of the animals complied with the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission.Results An intact and smooth retinal flatmount could be obtained by firstly staining method.Ora serrata structure was seen surrounding the whole retina.Strong green fluorescence was exhibited in retinal vessel net with clearly visible vascular branches;while the background fluorescence was weaker.Fully developed blood vessels were displayed in the retinas of the normal control group.Non-capillary areas around the central optic disk and large peripheral avascular areas could be seen in the retinal flatmounts of OIR models.Conclusions The preparation of retinal flatmount is easy and feasible by first immunofluorescence staining for retinal vessels followed by radially cutting of retina.This method of retinal flatmount can ensure the integrity of retinal vascular system and it is available for the observation and evaluation of retinal vascular structure in OIR models.

Objective To investigate urine levels of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule 1(KIM-1), and its relevant influencing factors in young patients with hyperuricemia.Methods Sixty young subjects with hyperuricemia were randomly selected from physical check-up examination population (the hyperuricemic group), and 60 young subjects with normouricemia were randomly selected at the same time from physical check populationexamination (the control group).Urine NGAL and KIM-1, and other biochemical indicators were evaluated.Clinical data, iab tests, testing items and biochemical indicators between the two groups were analyzed by using t test or analysis of variance test.Regression analysis between the above indicators and urinary NGAL/creatinine (cr) and urine KIM-1/cr ratios were carried by using single regression analysis.Analyzed relevant Relevant influencing factors of urinary NGAL/cr and urine KIM-1/cr ratios were analyzed by using multiple linear regression.Results Urine NGAL/cr and urine KIM-1/cr ratios in the hyperuricemic group were higher than the control group (t=22.152 5, t=24.725 5, P＜0.01).Single regression analysis showed that serum uric acid level and urine NGAL/cr ratio, KIM-1/cr ratio was positively correlations correlated (r=0.63, P＜0.01;r=0.41, P＜0.01).Multiple linear regression analysises showed that serum uric acid,systolic blood pressure, HbA1c, serum creatinin and cholesterol level were the independent factors of urine NGAI/cr ratio.Age, blood uric acid level, systolic blood pressure, HbA1c and serum creatinin levels were independent factors of KIM-1/cr ratio.Conclusion There are high levels in of urine NGAL/cr and KIM-1/cr ratios in population with hyperuricemia.Hyperuricemia, high systolic pressure, diabetes mellitus, declined kidney function and hypercholesterolemia are independent factors of urine high NGAL/creatinin ratio.Oldage,hyperuricemia, high systolic pressure, diabetes mellitus and declined kidney function are independent factors of high urine KIM-1/cr ratio.

Aninductivelycoupledplasmamassspectrometric(ICP-MS)methodbasedonquadrupole reaction/collision ( DRC) was developed for the determination of K,Na,Ca,Mg,Al,Cu,Zn,Pb,As and Mn in food. Samples were digested with HNO3 and H2 O2 followed by dilution with ultrapure water and then analyzed directly by ICP-MS. The signal sensitivity of high concentration element ( K, Na, Ca, Mg and Al ) was suppressed easily by adjusting the voltage parameters of DRC quadrupole ( Rpa) , and the food samples could be online diluted any multiples ( i. e. from one time to million times) according to the actual need. In order to eliminate mass spectral interferences of 40 Ar35 Cl+, the operational conditions of the DRC, working with CH4 as reaction gas, were optimized for 75 As. The limits of detection for the K, Na, Ca, Mg, Al varied from 0. 013-0. 027 mg/L, and Cu, Pb, Zn, As, Mnvaried from 0. 12-0. 61 μg/L. The accurate and reliable results were obtained for validation of the ICP-MS method with food reference material according to the national standard GBW10023 , GBW10015 , GBW10018 , GBW10017 , GBW10019 and GBW10024 . As the routine method in our laboratory, the satisfactory results indicate that it has great potential for the determination of low and high concentration level elements by one single analysis in various samples.

To investigate the influence of pressures change in gastric fundus in patients with reflux esophagitis (RE) to lower esophageal sphincter (LES) and motor function of lower esophagus. With gastro esophageal manometric catheter designed by the authors,the LESP and function of lower esophagus were synchronously measured,while the pressure in the gastric fundus was continuously increased, in 13 patients with RE and 8 healthy volunteers. The results showed that LESP and lower esophagus motor function of the RE group was significantly lower than that of the healthy group when the stomach was empty or when the pressure in the gastric fundus was increased.Whereas in the RE group, LES showed continuous relaxation,and frequent and transient lower esophageal sphincter relaxation (TLESR) were observed. It suggested that RE is an upper digestive tract motor disorder disease caused by various factors,the main mechanisms underlying RE are lower basic LES pressure and lower esophagus motor function. The LES showed continuous relaxafion and frequent and transient TLESR when the stomach is inflated.

To investigate the character of esophageal manometry in reflux esophagitis(RE) with or without sliding hiatus hernia(SHH). Ambulatory 24 hours esophageal pH metry and esophageal manometry were studied in 50 patients with RE, and 50 RE patients with SHH. Lower esophageal sphincter(LES) competence was significantly boorer in SHH groups as compared with RE group, esophageal sphincter length(LESL) was (1 31?0 33)cm in SHH groups and (2 10?0 86)cm in RE group, and lower esophageal sphincter pressure(LESP) was (1 17?0 53) kPa in SHH groups and (2 16?0 65) kPa in RE groups( P

To compare the diagnostic value of X ray and endoscopy in reflux esophagitis (RE) in patients with hiatus hernia(HH) and their option in clinical practice. Correlative data of X ray and endoscopic findings in 50 cases of RE with HH were analysed.The radiography showed that there was 78 57% with the reflux type of suck and 64 29% with the clearance type of passivity in HH1 group, 81 82% with the reflux type of dumpage and 90 91% with the clearance type of delay in HH2 group. X ray and endoscopic diagnoses were corresponded 60% identically. Both examination methods are suitable for diagnosis of RE with hiatus hernia, X ray is the modality of first choice. Endoscopic exemination is indicated in cases of reflux esophagitis or other complications.

Gastroesophageal reflux(G), duodenoesophageal reflux(D) and duodeno gastroesophageal reflux(DG) model and control group(C) were reproduced by operations in rats. Their esophagi were harvested at 1, 2, and 4 weeks after operation. Epithelial cells were stained by PI and assessed with flow cytometry(FCM).The results of FCM were compared in terms of DNA index (DI, the ratio of the G0/G1 peak of the sample cells to that of the spleen lymphocyte of normal rat), proliferating index (PI, the percent of cells in S and G 2 /M in all cells) and aneuploidy (a distinct additional G0/G1peak).PI of D group increased at 2 weeks, and PIs of D and DG group were greater than G group and C group at 4 weeks.DIs and the rates of aneuploidy of all groups were similar at all time points. The results were in accord with the morphological changes. It is concluded that gastric and duodenal contents can induce abnormal proliferation of esophageal epithelium. This effect is obvious in groups with reflux of duodenal contents. Excessive proliferation of the esophageal epithelium might be one of the pathogenetic factors of reflux esophagitis or other relevant complications.

The aim is to study proliferation of esophageal epitheliun with reflux of different gastrointestin secretions to the esophagus and its role in carcinogenesis of esophagus. Gastroesophageal reflux(G), duodenoesophageal reflux(D) and duodenogastroesophageal reflux(DG) model and control group(C) were reproduced by operations. All rats were given carcinogen (methyl n amyl nitrosamine). Then their esophagi were harvested at 20, 26,and 40 weeks after the operation. With immunohistochemical staining of SABC method, PCNA labeling indexes(LI) were compared. Epithelial cells were stained with PI and assessed with flow cytometry(FCM).The results of FCM were compared in terms of DNA index(DI), proliferating index(PI) and aneuploidy. LIs increased with time of reflux and the administration of MANA. LIs in reflux groups, especially in D and DG group, were significantly greater than that in the C group with the same time interval. 3 indexes of FCM showed obvious changes in G, D and DG group, and they were greater than C group.The changes ware most marked in D and DG groups.It is concluded that all kinds of reflux into the esophagus can induce abnormal proliferation of esophageal epithelium and enhance carcinogenesis of the esophagus. The role of duodenoesophageal reflux may be more important than gastroesophageal reflux.