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.

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 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

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 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.

Objective To study the apheresis procedure of collecting mononuclear cells from bone marrow for clinical treatment.Methods Bone marrow mononuclear cells were separated from bone marrow using COBE Spectra apheresis system.Cell morphology,cell counts,positive expression of CD34+,CD133+,CD271+ were detected,and the recovery rate of nucleated cell and mononuclear cell were also calculated.And the main parameters of the procedure with upper efficiency were set via data analysis.Results The efficiency of collection line with colourimetric card of 3% was higher than that of 5% and of 7%.The recovery rate of mononuclear cell is 75% when the cycle times ranged from 7 to 9.The positive expression of CD34+,CD133+ and CD271+ were 1.17%,0.63%,and 0.53%,respectively.Conclution This mononuclear apheresis procedure is safety,pollution-free and efficient,and remaming the bone marrow could be retransfused to the donor.

Objective To assess the clinical use of anti-Parkinson's disease(PD)drugs in the patients with PD,and provide a basis to formulate an effective clinical drug program.Methods 190 PD patients were interviewed by questionnaires about resources,dosage and costs of anti-PD drugs from April,2004 to March,2005.Results By retrospective analysis,number of drugs used in per patient per year was 2.88;levodopa dosage and Levodopa Equivalents(LDE)per patient were 323.0 mg/d and 318.6 mg/d respectively,and LDE increased significantly following by scores of Hoehn-Yahr(H&Y)class increasing(P

Now medical undergraduates are faced with a series of problems in the clinical practice.Instructors should work well on students' education work to improve the effect and quality of clinical practice.

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.

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.