Nausea and vomiting are among the most common complications after surgery. Postoperative nausea and vomiting(PONV) may cause wound dehiscence, pulmonary aspiration, dehydration, and electrolyte disturbances. Despite the new classes of antiemetics and research published, PONV remains high incidence still. This article covers the different pharmacologic strategies taken introduced with multimodal approach by using antiemetic drugs for prevention and treatment of PONV.

It is increasingly evident that sepsis triggers a complex host reaction, which is responsible for a variety of pathophysiologic changes during the inflammatory process. Pentoxifylline (PTX) is a methyxanthine with selective anti inflammatory activity. The effects and mechanisms of PTX in human and animal models of sepsis are reviewed, for providing new information in treatment of sepsis.

Accumulation and infiltration of polymorphonuclear leukocytes are pivotal factors in accelerating cell apoptosis and death in ischemia/reperfusion(I/R) injury, however, adhesion molecules play an important role in its rolling，latching and infiltrating. The goal of the review is to explore the effect and significance of intercellular adhesion molecule-1(ICAM-1) in ischemia/reperfusion.

BACKGROUND:The regional gene therapy of bone defect is to transfer genes capable of accelerating bone healing into target cells, which will transcript the genes into mRNA and translate them into proteins, then the target cells will be stimulated to differentiate under the role of protein, and finally reach the purpose of accelerating bone healing by means of autocrine or paracrine. With the development of cell recombination technique, more and more genes of growth factors involved in the bone repairing have been successfully cloned, which make it possible to treat bone defect with gene therapy. The present status for the regional gene therapy of bone defect is summarized.DATA SOURCES: An online search in Pubmed database was undertaken to identify articles about the regional gene therapy of bone defect published in English from January 1965 to January 2006 by using keywords of "gene therapy,bone defect". Meanwhile, Chinese relevant articles published from January 2000 to January 2006 were searched in Wanfang database by using the same keywords in Chinese.STUDY SELECTION: The data were primarily checked, and the references of each article were looked up. Inclusive criteria: related to the regional gene therapy of bone defect. Exclusive criteria: repetitive study or Meta analysis.DATA EXTRACTrON: Totally 237 articles were collected, 32 of them were in accordance with the inclusive criteria, and the other 205 were old or repetitive ones. Of the 32 articles, 4 were about the selection of destination genes, 3 about the selection of target cells, 7 about the selection of gene expression vector, 3 about the methods of gene transfer, 4 about gene therapy combined with tissue engineering in treating bone defect, 5 about polygenes in treating bone defects, and 2 about the problems and prospects in the gene therapy of bone defect.DATA SYNTHESIS: The regional gene therapy of bone defect is a new technique developed base on the basic theoretical cognition of bone regeneration and gene recombination technique, and provides ideal solving program for the treatment of bone defect caused by various reasons. The basic problems mainly include the selection of destination genes, selection of target cells, selection of gene expression vectors and the selection of the methods of gene transfer.The studies about the selection of target cells and methods of gene transfer become mature day by day, bone marrow stromal cells have become the target cells should be selected firstly, and it has been generally acknowledged that ex vivo gene transfer has more obvious advantages than in vivo one. The key problem at present is how to further explain the natural process of the repair of bone defect, and select the most effective component from the signal molecules involved in the process to apply in the gene therapy of bone defect, and further improve the gene expression vector, so as to ensure the safety of gene therapy. It is believed that with the continuously deepened theoretical cognition of bone regeneration and the continuous perfection of gene recombinant technique, the gene therapy of bone defect will finally go out of laboratory, and really serve the patients with bone defect.CONCLUSION: The regional gene therapy of bone defect can effectively activate the activity of bone regeneration at the site of bone defect, also can avoid the problems of immunologic rejection and systematic toxicity caused by the direct application of cytokines, and has good prospects of clinical application. At present, this technique is not completely perfect, and there are many problems to be deeply investigated in destination genes, gene vectors and transfection technique, etc.

Different preparations of Hydroxyethyl starch (HES) each have unique molecular weight, degree of substitution and manner of substitution, which are responsible for their intravascular volume expansion and half-life. HES solutions have notable effects on ameliorating hemodynamic and hemorrheological parameters, as well as unique capacity to prevent and reduce capillary leak. Compared with other colloid solutions, HES is more effective, safe and economical. It is an ideal volume expander.

Ischemia-reperfusion of the heart leads to the opening of mitochondrial permeability transition pore(MPTP).Transient opening and subsequent closure of the MPTP may lead to the release of cytochrome c and other proapoptotic molecules.If unrestrained,this will lead to the loss of ionic homeostasis and initiate the cascade of necrotic cell death.Direct or indirect inhibition of MPTP provides protection against ischemia-reperfusion injury.Recent researches have shown that transient low-conductance pore opening also provides protection against reperfusion injury.This review gives summarization of the components,molecular mechanism of MPTP,permeability transition in myocardial ischemia-reperfusion and the relationship between MPTP and ischemic preconditioning.This may lead to better protective strategies against myocardial ischemia-reperfusion injury in the future.

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.

Glucocorticoids(GC) play definite and effective roles in the management of chronic pain,but their toxic and side effects also make them controversial agents.This review discusses various aspects of glucocorticoids including their action mechanism,toxic and side effects,different types of pharmaceuticals and ways of administration.It also ventures some suggestions on rational medication of steroids.

With the development of our understanding of the physiology,pathophysiology and pharmacology of pain,preemptive analgesia has been widely introduced into clinical treatment.This review focuses on the mechanism and application of preemptive analgesia in acute pain therapy.

Neuropathic pain and cancer pain are two difficult types of chronic pain to be controlled by currently available analgesics.Animal models can provide pivotal systems for preclinical study of pain.This article reviews some new models of chronic pain,such as those of cancer pain,central nerve pain,and the pain caused by peripheral nerve injury and disease-induced peripheral neuropathy.