Epidural analgesia is the most effective form of pain relief available to labouring women.In this review,the author highlights the latest progress in the researches on the mechanism of epidural analgesia for labour,the choice of administration mode,the choice of local anaesthetics and opioids,and the impact of epidural analgesia on the parturient and fetus.

Objective To compare the clinical characteristics and the outcomes of severe hyperlipidemic pancreatitis (SHLP) and severe acute gallstone pancreatitis (SAGP).Methods The clinical data of 22 patients with SHLP and 91 patients with SAGP admitted from January 2009 to December 2015 were retrospectively reviewed.The clinical manifestations,laboratory tests,organ dysfunction,medical treatment,complications and outcomes in 30 d after admission were analyzed and compared between two groups of patients.Results There were 16 males and 6 females with a mean age of (60.5 ± 9.1) years in SHLP group;while 32 males and 59 females with a mean age of (54.3 ± 5.4) years in SAGP group.The blood and urine amylase levels in SHLP group were significantly lower than those in SAGP group [(715 ±99) U/L vs.(1 551 ± 107) U/L,t =4.65,P =0.00;(382 ±56) U/L vs.(773 ± 66) U/L,t =4.52,P =0.00,respectively].The incidence of circulation insufficiency,respiratory insufficiency,renal dysfunction,and long-term puhnonary infection in SHAP patients was significantly higher than that in SAGP patients [36 ％ (8/22) vs.14 ％ (13/91),x2 =5.22,P =0.01;41％ (9/22) vs.7 ％ (6/91),x2 =9.46,P =0.01;23％(51/22) vs.5％ (5/91),x2 =4.20,P=0.03;55％(12/22) vs.32％ (29/91),x2 =7.02,P =0.01].Two cases died in the SHLP group and 9 cases died in SAGP group due to critical infection,cardiac events and bleeding.Conclusion Compared to SAGP patients,the blood and urine amylase levels are usually not remarkably high in SHLP patients,and the prevention and management of multi-organ failure and lung infection are more important for SHLP patients.

Objective To investigate the relative factors of insulin resistance(IR)during elective abdominal surgery and the mechanism of IR induced by surgery.Methods Fourteen patients underging elective abdominal surgery were studied.Fasting blood glucose(FBG),fasting plasma insulin(FPI),plasma TNF-α,IL-6 and CRP were tested for elective surgery patients on the day before,during operation and on one day after surgery.Insulin resistance index(HOMA-IR)and the index of insulin secretion(HOMA-β)were ealculated with homeostasis model assessment(HOMA).Insulin receptor and GLUT4 mRNA expression in skeletal muscle were assessed before operation and at the end of operation by use of RT-PCR.Results Significant differences were found in fasting blood glucose (5.95±1.08)mmol/L vs(8.92±2.41)mmol/L,fasting plasma insulin(19.95±3.33)mU/L vs(25.44±5.36)mU/L,IL-6(33.98±5.01)ng/L vs(45.29±7.81)ng/L and plasma TNF-α(86.70±9.27)ng/L vs(114.46±15.33)ng/L during and after operation(P＜0.01).A significant elevation of HOMA-IR levels was found after operation compared with that before operation[(9.59±2.89)vs(4.111.86)](P＜0.001).However there wag no significant difference in HOMA-β among three points(groups)of time(P=0.103).The result of RT-PCR showed that the expression of GLUT4 in muscle of patients at the end of operation reduced significantly compared with preoperation(t=12.488,P＜0.001)but there was no significance in INSR mRNA expression(P=0.165).ISI showed negative correlation with opermive time(r=-0.736、P＜0.001),blooding during operating (r=-0.594、P=0.032)and post-operative TNF-α(r=-0.641、P=0.018).Conclusion Insulin resistance occurs in elective abdominal surgery patients.The defective site is at postreceptor.To shorten the operation time,control the intensity of surgery and reduce the bleeding is helpful for decreasing IR.

Objective To summarize clinical characteristics and experiences in treatment of severe hyperlipidemic pancreatitis (SHLP). Methods A retrospective analysis for 22 cases of SHLP and 91 cases of severe acute biliary pancreatitis (SABP) hospitalized during January 1, 2000 to December 31, 2006 was carried out to compare their clinical characteristics and treatment outcomes. Results Activities of serum and urine amylase in SHLP patients at admission were (715 ± 99) and (382 ± 56) U/L, respectively, significantly lower than those in SABP patients (1551 ± 107) and (773 ± 66) U/L, respectively (P < 0.01). About 55% (12/22) of SHLP patients had pulmonary infection, 36% (8/22) with circulatory failure, 41% (9/22) with respiratory failure and 23 % (5/22) with renal failure, all significantly higher than those in SABP patients SABP [32% (29/91), 14% (13/91), 7% (6/91) and 5% (5/91), respectively, P < 0.01]. Two died of SHLP and 11 of SABP, respectively. Conclusions In diagnosis of SHLP, it should be noticed that no remarkable elevation of activities in serum and urine amylase usually, so during the course of treatment for SHLP, it is important to prevent and treat multi-organ failure, respiratory failure and renal failure in an active way.

Objective To investigate the energy expenditure of mechanically ventilated patients,compare the measured energy expenditure (MREE) with the energy expenditure expected from the Harris-Benedict equation adjusted with correction factors (PREE). Methods Twenty-four critically ill adult patients who were mechanically ventilated in the intensive care unit were enrolled in this study. Data during the 72 hours of mechanical ventilation were collected for computation of severity of illness. Resting energy expenditures were derived at 72hours after mechanical ventilation by indirect calorimetry. Predicted basal energy expenditure was obtained at the same time using the Harris-Benedict equation and predicted resting energy expenditure was calculated using the Harris-Benedict value adjusted with correction factors for illness. Results The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ)scores and Marshall scores were 14 ± 5 and 6 ± 3, respectively. MREE and PREE were (6 793.64 ± 1 197.15) and (8 041.02 ± 1 971.54) kJ/day, respectively. There was no correlation between MREE and PREE (r2 = 0. 28, P = 0. 07), and the difference between MREE and PREE was statistically significant (t = 7.62, P = 0.04). No statistically significant correlations were observed between both MREE or PREE and APACHE Ⅱ score or Marshall score (r2 = 0. 14, P = 0. 08; r2= 0. 08, P = 0. 63; r2 = 0. 05, P =0. 65; r2 = 0.03, P = 0. 87, respectively). Conclusions In mechanically ventilated patients, the energy expenditure is not correlated with the severity of illness. The Harris-Benedict prediction modified with correction factors for severity of illness systematically overestimates the total energy expenditure.

Aim To investigate HPA axis change relation with glucose and lipid metabolism.Methods Wistar rats were injected intraperitoneally with STZ (30 mg·kg~(-1)) after fed with high lipid food for two months, then rats with blood glucose of over 15 mmol·L~(-1) were used in the experiment. Animals were divided into four groups: normal group, diabetic model group, treatment group (ROS 200 mg·kg~(-1) ·d~(-1) ig), and metformin group (200 mg·kg~(-1)·d~(-1) ig).Rats were decapitated after they had been administered ig for four weeks and were 24 hour urine collected.Plasma CRH, ACTH, corticosterone, hypothalamic CRH, ACTH of pituitary gland, 24 hour urinary corticosterone and plasma insulin were determined by ELISA and radio immunity kit respectively.Results In diabetic rat model induced by high lipid food and STZ, plasma and urinary glucose level and plasma TC, TG levels were increased, plasma HDL-C and hepatic glycogen content were reduced, which was synchronized with changes of higher pituitary ACTH, plasma and total 24 hour urine corticosterone excretion.Conclusion The disorder of glucose and lipid metabolism of model induced by high lipid food and low dose STZ may be linked to the change of HPA axis.The improvement of ROS on glucose and lipid metabolism in diabetic rats may be linked to the decrease of HPA axis activity.

event and treat circular,respiratory and renal insufficiency.

Object The influence of producing area and plant age on oxymatrine levels in the dried root of Sophora flavescens Ait. has been investigated to provide useful information to optimize the areas for mass scale propagation, proper management and species conservation. Methods The oxymatrine was quantified by HPLC and various statistical treatments were carried out following SPSS 9.0 and Microsoft Excel. Results The oxymatrine concentrations in the root samples collected from 17 provinces and regions differed from 0.494% to 4.127% and the maximum oxymatrine content (3.493%) was recorded in the root sample collected from Heilongjiang Province. Analysis of variance indicates a highly significant difference in the oxymatrine content of roots collected from different provinces, and the samples from the cold arid northern high-latitude areas had higher oxymatrine than those from warm humid southern low-latitude areas in the mainland China. Plant age is positively related to the total root biomass and oxymatrine content. Conclusion The oxymatrine content in the roots of S. flavescens is quite different between different areas and plant ages. The S. flavescens growing in the cold arid northern high-latitude areas had higher oxymatrine concentration.

Objective To study the role of survivin in the incidence of pulmonary hypertension secondary to congenital heart disease (CHD) of left-to-right shunt. Methods Forty-nine cases were divided into 4 groups according to mean pulmonary artery pressure (mPAP), that is, non-hypertension group, mild hypertension group, medium hypertension group, and severe hypertension group. Their lung tissue samples were collected during heart surgery. TUNEL technique and immunohistochemical analysis were respectively used to detect nuclear DNA fragment of apoptotic cells and the expression of survivin, bcl-2 and bax. Western blotting also was conducted to detect survivin expression. Results The pulmonary wall of CHD patients with medium or severe pulmonary hypertension became significant incrassate. The apoptotic index and expression level of bax were significantly decreased but surviving and bcl-2 expressions were significantly increased in CHD with medium or severe pulmonary hypertension. Survivin expression was significant correlation with percentage media wall thickness and apoptotic index. Conclusion Apoptosis associated with survivin plays an important role in pulmonary artery remodeling after pulmonary hypertension of CHD.

Objective To review and summarize the effects of interventional treatment of hand arteriovenous malformation in 5 cases.Methods Through catheterization of brachial artery ipsilaterally the blood-supply artery of arteriovenous malformation was embolized,using high-temperaure managed gelatin sponge,silk thread,pingyangmycine and spring coil.Results Total 13 blood-supply arteries in 5 cases were embolized with successful rate of 100%,including 1 case of complex malformation under effectively controlled,3 cases cured clinically and 1 case still awaiting observation.Conclusions Transcatheter arterial embolization for the treatment of hand arteriovenous malformation is safe,effective and high successful.(J Intervent Radiol,2007,16:277-279)