Objective To compare the effects of pre-emptive epidural analgesia and postoperative epiclural analgesia on stress response to upper abdominal surgery. Methods Thirty ASA Ⅰ or Ⅱ patients undergoing elective upper abdominal surgery performed under general anesthesia were randomly divided into 2 groups (n = 15 each): Ⅰ pre-emptive epidural analgesia group (group P) and Ⅱ postoperative epidural analgesia group (group C). A mixture of 0.5 μg/ml sufentanil and 0.15% ropivacaine 250 ml was used for epidural analgesia in both groups. The epidural catheter was placed at T_(10-11) interspace. The epidural regimen included a loading dose of 15 ml followed after 30 min by continuous epidurai infusion at 5 ml/h for 50 h. In group P the epidural analgesia was started at 20 min before skin incision, while in group C after operation when the patients emerged from general anesthesia and were extubated. The depth of general anesthesia was monitored using CSI and maintained at 45-55. Vcnoas blood samples were taken before epidnral catheter was placed (T_0, baseline), at 2 h (T_1) and at 18 h (T_2) after operation for determination the concentrations of ACTH and cortisol (Cor) and C reaction protein (CLIP). Results Blood Cor, ACTH and CRP concentrations were significantly increased after operation as compared with the baseline values at T0 and were significantly lower at T_1 and T_1 in group P than in group C. Conclusion Pre-emptive epidural analgesia can more effectively inhibit stress response than postoperative epidural analgesia to upper abdominal surgery.

Objective To detect the mutations in coding region of the guanosine triphosphate cyclohydrolase Ⅰ (GCH1) gene in Chinese patients with dopa-responsive dystonia (DRD).Methods Two families with five affected family members and six patients with sporadic DRD were examined, as well as their eighteen relatives and twenty normal members. Mutation screening was performed using single-strand conformation polymorphism analysis followed by direct sequencing of the presumably mutated exons; in patients whose results showed a normal pattern on single-strand conformation polymorphism analysis, the entire coding region of the GCH1 gene was sequenced. To confirm the mutation, a pair of primers was designed, which produced a restrictive site for SphI.Results DNA sequencing revealed a new heterozygous A224G missense mutation (Tyr75Cys) located within exon 1 in one family with autosomal-dominant inheritance. The mutation was confirmed with restriction enzyme analysis; it was not present in 20 control alleles. Restriction enzyme analysis also detects two systematic gene mutation carriers. In patients from the other family and patients with sporadic DRD, no alterations in the translated portion of the GCH1 gene were observed. Direct sequencing also showed that there existed gene polymorphisms in intron 1 and intron 3 which neared the exon2 and exon3 respectively in Chinese.Conclusions We describe a new missense mutation (Tyr75Cys) in the GCH1 gene. Mutation in the coding region of the gene might be accounted for a part of patients with DRD.

Zhou Jianren's thinking on sexual morality at the late "May 4th" is profound and prospective.It is of great theoretical significance and practical value to dredge up the spirit of Zhou's thinking on sexual morality to establish a scientific concept of sexual morality and to train students of good character of sexual morality in contemporary university.

Objective To investigate the influence of laparoscopic resection of colorectal cancer on (postoperative) micrometastasis of tumor cells.Methods Using cytokeratin,CK-20 mRNA as target gene,the RT-PCR method was used to examine the pre-and post-operative changes in the number of tumor cells in the peripheral blood of 48 cases of colorectal cancer.Results After operation,the number of tumor cells in(peripheral) blood was significantly higher in the laparoscopic surgery group as compared to that of traditional(laparotomy) operation group(P0.05),but was significantly related to positive rate of proliferating cell nuclear antigen(PCNA)(P

Medical charts of tuberculotic patients with secondary autoimmune hemolytic anemia (AIHA) admitted to Peking Union Medical College Hospital (PUMCH)from 2006 to 2015 were retrospectively reviewed.Four cases with complete information of laboratory tests,imaging findings and bone marrow results were included.Therapy regimens and outcomes of survival were followed by phone call if needed.Ages at diagnosis of AIHA were 58-80 years old,hemoglobin levels were 31-73 g/L,Coomb tests were negative in all cascs.Thcrapy of cortical steroid did not work,while anti-TB therapy (including isoniazid,rifampicin,ethambutol) significantly improved hemoglobin to normal level in three cases during six to nine months.One case died within one week,for progressive TB to central neurological system.As one of rarc complications of TB,AIHA may be fatal.Early diagnosis and appropriately anti-TB therapy is helpful for good outcomes.

Objective To evaluate the role of protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathway in ulinastatin-induced reduction of oxidative stress injury to cardiomyocytes of rats.Methods H9c2 cells were inoculated in 96-well plates at a density of 104 cells/well.The cells were divided into 5 groups using a random nomber table:control group (group C,n =12),H2O2 group (n=12),H2O2 plus ulinastatin group (group HU,n=12),H2O2 plus ulinastatin plus LY294002 group (group HUL,n=9) and H2O2 plus LY294002 group (group HL,n=9).In group H2O2,H2O2 (final concentration 200 μ mol/L) was added,and the cells were incubated for 12 h in the incubator.In HU,HL and HUL groups,ulinastatin (final concentration 50 U/ml),LY294002 (final concentration 10 μmol/L),and ulinastatin (final concentration 50 U/ml) plus LY294002 (final concentration 10 μmol/L)were added,respectively,the cells were incubated for 2 h,H2O2 (final concentration 200 μmol/L) was then added,and the cells were incubated for 12 h in the incubator.The cell survival rate was measured by methyl thiazolyl tetrazolium assay.The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were determined by using water soluble tetrazolium-1 and thiobarbituric acid colorimetric assays.Cell apoptosis was measured by flow cytometry,and apoptosis rate (AR) was calculated.The expression of Akt,phosphorylated Akt (p-Akt),mTOR,phosphorylated mTOR (p-mTOR),activated caspase-3 and activated poty-ADP-ribose polymerase (PARP) was detected by Western blot.The p-Akt/AKT and pmTOR/mTOR ratios were calculated.Results Compared with group C,the cell survival rate was significantly decreased,AR was increased,the SOD activity was decreased,the MDA content was increased,the expression of activated caspase-3 and PARP was up-regulated (P＜0.05),and no significant change was found in p-Akt/AKT ratio or p-mTOR/mTOR ratio in group H2O2 (P＞0.05).Compared with group H2O2,the cell survival rate was significantly increased,AR was decreased,the SOD activity was increased,the MDA content was decreased,the p-Akt/AKT and p-mTOR/oTOR ratios were increased,and the expression of activated caspase-3 and PARP was down-regulated in group HU (P＜0.05).Compared with group HU,the cell survival rate was significantly decreased,AR was increased,and the expression of activated caspase-3 and PARP was up-regulated in group HUL (P＜0.05).Conclusion The mechanism by which ulinastatin reduces oxidative stress injury to cardiomyocytes is related to activation of Akt/mTOR signaling pathway in rats.

Objective To investigate the cataract patients' awareness on the cataract diseases, treatment and major obstacles for patients to seek eye care. Design Prospective cross-sectional study. Participants All 251 patients in Jiangyan county were screened by the group of eye diseases selection in 6 months for cataract treatment performed by prevention blind surgery group. Methods Patients accepted surveys before operation. The patient's awareness questionnaire was developed in Aravind Eye Hospital, India. Main outcome measures Awareness of eye disease, awareness of treatment, obstacles of therapy and false treatment. Results 89.6% of patients were aware of the occurrence of eye disease for more than 1 year. However, it was only 0.12% of patients when they realized that their eye diseases could be treated more than 1 year,the time less than 6 months was 31.9%,and the time less than 1 month was 65.7%. The major obstacles for seeking eye care were still able to see a little, economic reason, no demand for operation, short of belief for the operation, etc. Conclusions It's high necessary and imperative to educate patient the knowledge of eye health and care. Developing economy is the radical measure in a long run to improve the cataract surgical rate (CSR) in our country. Low price service and high quality surgery is the key of improving CSR at present.

Objective To assess the importance of initial resuscitation, prevention and management of the early complication in acute cervical spine injury. Methods Initial resuscitation of 715 early complications of 10 types and their prevention and management in 194 cases with acute cervical spinal cord injury admitted from 1996 to 1998 were reviewed. Results Mortality in early stage could be markedly reduced with routine and normal initial resuscitation, pulmonary complications were the main cause of death. Early complications delayed the possible surgical treatment, affected the treatment results, increased the cost and duration of hospitalization and difficulty of rehabilitation. Conclusions Early complications of cervical spine injury mostly occur in the first few days and can be predicted. Proper prevention and treatment of it will benefit the recovery of the neural lesion and following rehabilitation.

Objective:To explore the closed fog mirror in evaluation of velopharyngeal incompetence. Methods:A self-developed closed fog mirror was and used to evaluate for the velopharyngeal compentence and to determine the extent of velopharyngeal compentence according to the map on the fog mirror from nasal air emission and to grade the velopharyngeal compentence from the shape and size of the fog on the mirror. Then choose the right treatment method: speech therapy or pharyngoplasty. Results:The closed-fog-mirror determined different types of velopharyngeal compentence. Conclusion:The closed fog mirror is simple and objective in evaluation of velopharyngeal incompetence.

Objective To investigate the levels of complement and activated complement factors in peripheral blood and skin in patients with psoriasis and their significance in the development of psoriatic lesion.Methods Enzyme linked immunosorbent assay (ELISA) and immuno turbidi metric analysis were used to determine the levels of C3d, sC5b-9, C3 and C4 in sera from 57 patients with psoriasis vulgaris.Immunohistochemistry was employed to assess in situ expression of SC5b-9 in lesional and non lesional skin of 37 patients.Results There was a significant decrease of C3 and C4, and increase of C3d and sC5b-9 in patients with psoriasis in comparison with those of normal controls (t=10.88～ 24.80, P<0.01).The levels of C3 and C4 were significantly lower, while the levels of C3d and sC5b-9 were significantly higher in progressive stage than those in static stage (t=4.55～ 6.77,P< 0.01).In situ expression of sC5b-9 was significantly higher in stratum corneum and dermo epidermal junction of lesional skin than that in non lesional skin and normal controls (χ2=62.90,45.45;P< 0.01).There was no significant difference of C5b-9 expression in stratum corneum and dermoepidermal junction of lesional skin between progressive and static stage.Conclusions There is significant correlation between the development of psoriatic lesion and local deposit of activated complement factors.