Spinal opioids have been widely used in clinical anesthesia and analgesia. In this article, we reviews the characteristics about the clinical applications of spinal opioids, including the opioid selection, drug dosage, administration route, effects of different opioids, drug combination, associated adverse effects and so on.

Objective To study the expression of Fos gene and GFAP in medullary visceral zone (MVZ) of rats under stress with their gastric mucosa protected by acupuncture. Methods 24 male SD rats were randomly divided into 3 groups: control, stress and acupuncture group, with 8 for each group. Immunohistochemical methods were employed to detect the expression of Fos and GFAP in the nucleus of solitary tract (NTS) and dorsal motor nucleus of vagus (DMV) of medullary visceral zone. The extent of gastric mucosal damage was evaluated by ulcer index (UI). Results Fos-positive neurons and GFAP-positive stellar microgliocytes were found mainly in NTS and DMV of the medullary visceral zone. Compared with control group, the expression of Fos and GFAP was greatly up-regulated in the stress group, and UI increased obviously (P

Objective To observe the effect of gastric motility and gastric electric activity on sleep deprivation and the changes of calcitonin gene-related peptide(CGRP) and nitro oxygen(NO). Methods The 192 SD rats were divided into three groups randomly. Gastric emptying was analyzed with radioimmunoassay, using nuclide 99m Tc and gastric emptying of liquids and EGG with the serosa method .By using the immuno-chemistry and chemistry analysis methods, we observed the changes of some connective factors, for example, CGRP and NO. Results The acute deprivation can cause the change of gastric emptying and which is decreased with the time of deprivation, in the meantime, we found the gastric electric activity would be decreased before food, otherwise, the gastric electric activity is irregulary and the gut hormone, for example, CGRP and NO have been changed in the plastic of rats after acute deprivation. In the study we found the gastric emptying have a change obviously in the short time. But with the time of deprivation the gastric empting no have change. And the gastric similar to this, the gut hormone no any change. Conclusions The acute sleep deprivation caused the change of gastric emptying and the change of gastric electric activity obviously. In plastic, the level of CGRP and NO have a change after sleep deprivation. The chronic sleep deprivation caused the change of gastric emptying and the change of gastric electric activity, and caused the function of gastric motility disturbing, and the effect is prolong after chronic sleep deprivation.

Objective To discuss the relationship between clinical pathway management and semi-structured electronic medical record(EMR),and explore the effects of EMR on hospital information system and its management quality.Methods EMR was used in combination with quality management and clinical pathway management.The relationship between clinical pathway management and semi-structured electronic medical record(EMR) was researched.Results Semi-structured EMR can increase the clinical pathway managerment and improve the clinical quality of management,the competitiveness of hospital can be upgraded.Conclusion Hospital should widely develop semi-structured EMR and promote the clinical pathway managerment in the future.

OBJECTIVETo investigate the therapeutic effect of reconstruction of facial defects with frontal expanded flaps bipedicled by superficial temple vessels and supraorbital/supratrochlear neurovascular bundles.

METHODSFrom June 2006 to Mar. 2013, the patients with mostly unilateral facial defects which affected temple area and crossed the facial midline, were treated with frontal expanded flaps. The expanders were implanted at first stage and the expanded frontal flaps were transferred at second stage. At third stage, pedicle division was performed and the pedicle skin tissue was used to repair the residue defect.

RESULTAll the 18 flaps survived completely with satisfactory color and texture. Good results were achieved during the follow-up period of one year.

CONCLUSIONThe bipedicled frontal expanded flap has a reliable blood supply which is very suitable for large facial defect.

Adolescent ; Adult ; Child ; Face ; surgery ; Female ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; Treatment Outcome ; Young Adult

Objective To investigate the effects of electro-acupuncture on gastric emptying and Fos expression in the neuron of vagal-solitary complex (VSC) of rat bulbus after lipopolysaccharide (LPS) intraperitoneal injection (i.p.). Methods 40 male SD rats were randomly assigned to 4 groups: control group, LPS i.p. group, LPS i.p. plus electro-acupuncture at Tsusanli point group and LPS i.p. plus electro-acupuncture at non-meridian-non-acupoint group, 10 rats for each group. Immunohistochemical techniques were used to detect the Fos expression in VSC. The animal's gastric emptying was measured by phenol red method. Results The rats with gastric emptying decreased greatly to (20.7±4.5)% 2.5 hours after LPS injection, and Fos-positive neurons were significantly found in VSC (83.2±6.6) compared with control group. However, in the group of LPS i.p. plus electro-acupuncture at Tsusanli point, the gastric emptying was up-regulated to (44.1±6.2)%, and the expression of Fos -positive neurons were down-regulated to (37.9±3.8) compared with LPS i.p. group. No significant difference was found between the group of LPS i.p. plus electro-acupuncture at non-meridian-non-acupoint and the group of LPS i.p. Conclusion LPS i.p. can retard the gastric motility in rats, electro-acupuncture at Tsusanli point may well regulate the function in LPS model rats. This function may be connected with its protective effects on Fos immunoreactive neurons activity in VSC of rat bulbus.

[Objective]To investigate the relationship of baseline antimullerian hormone(AMH)and live birth rate of IVF/ICSI and further explore the prognostic effect of AMH on live birth rate.[Methods]All non-polycystic ovary patients who underwent their first embryo transfers in our unit and had basal serum AMH evaluated between 2010 and 2015 were evaluated in this retrospective study. Patients were grouped according to their AMH level,i.e. low AMH group with AMH less than 1.1 ng/mL(n = 485),middle AMH group with AMH between 1.1 ng/mL and 7.0 ng/mL (n = 1 989),and high AMH group with AMH higher than 7.0 ng/mL (n=468). For age subgroup analysis,patients were stratified as follow:group A(age≤29 years),group B(30~34 years),group C(35~39 years)and group D(over 40 years). We compared clinical outcomes between AMH groups in different age groups usingunivariate and multivariate analysis. ROC analysis was utilized to assess predictive value of AMH on live birth rate.[Results](1)In both fresh and frozen embryo transfers,baseline AMH was significantly related to clinical outcomes. The lower AMH was,the lower implantation rate,clinical pregnancy rate,and live birth rate. However,higher miscarriage rate was observed. All difference reached statistically significant.(2)In age subgroup analysis,we demonstrated AMH was related to live birth rate in patients in group A,B, and C,regardless of fresh or frozen embryo transferred. In those over 40 years,AMH was related to live birth rate in frozen cycles (P < 0.05)but not fresh cycles(P = 0.092). The further multivariate analysis confirmed the above results after controlling po?tential confounding variables.(3)The AUC of ROC analysis for AMH predicting live birth rate were 0.647,0.633 for fresh and fro?zen cycles respectively.[Conclusion]Baseline AMH as one of excellent ovarian reserve markers ,was significantly related to live birth rate in fresh or frozen cycles. Baseline AMH was an independent prognostic factor of live birth rate,but its predictive value on live birth rate was of limited clinical value.

Respiratory dysfunction is a significant part of disorders associated with stroke. Stroke could impair respiratory center or motor pathway, leading to alter breath pattern or reduced respiratory muscle strength. Pneumonia secondary to stroke and stroke-associated sleep apnea are common respiratory disorder, which are adverse to the prognosis of stroke. Clinical routine physical examination is basic evaluation of respiratory function. Attention should be paid especially in breath pattern, respiratory muscle volume and muscle tone. Multiple quantitative assessments include arterial blood gas analysis, sleep apnea monitoring, dynamical, imaging and electrophysiological tests. Rehabilitation can be used to improve the inspiratory muscle strength, endurance and cough effectiveness, reduce sleep apnea hypoventilation, enhance the cardiorespiratory fitness, finally improve the quality of life in stroke patients.

Objective To evaluate the application of propfol?remifentanil closed?loop and opened?loop anesthesia in children otorhinolaryngologic operation under BIS monitoring. Methods Fourty children underwent elective children tonsillectomy and adenoidectomy were recruited for the study and randomly divided into two groups:closed?loop group(group T)and opened?loop group(group C),with 20 children each. The two groups all received total intravenous induction,then the subjects of closed?loop group were administrated with a method of system automatic regulation of plasma target control and the opened?group cases underwent manual adjustment of plasma target control method according to the BIS value during op?eration. The variables of non?invasive blood pressure(BP),heart rate(HR),pulse oxygen saturation(SpO2),electrocardiogram(ECG),bispec?tral index(BIS),the number of times the manual adjustment of propfol target control applied,and recovery time,were recorded respectively at the time points of before anesthesia(T0),immediately after intubation(T1),5 min after intubation(T2),10 min after(T3),15 min after(T4),30 min after(T5)and the removal of endotracheal intubation(T6). Results The total dosage of propfol in group T was less than the dosage in group C with dosage decrease of 9.83%;there was no significant statistical difference of the total dosage of remifentanil. Conclusion The use of propfol?remi?fentanil closed?loop anesthesia in children otorhinolaryngologic operation is safe,easy,and of strong controllability,which should be widely promoted.

Objective To investigate the role of calpain in the spinal dorsal horn in development of paw inflammatory pain in rats.Methods Forty-eight male SD rats,aged 6 weeks,weighing 160-200 g,were randomly divided into three groups:normal control group(group C,n =8),PBS group( n =16),zymosan-induced paw inflammatory pain group (group Z,n =24).Inflammatory pain was induced by injection of zymosan 1.25 mg into the plantar surface of left hindpaw.Group PBS received the equal volume of PBS 100 μl.The mechanical paw withdrawal threshold (MWT),paw withdrawal thermal latency (PWTL) and maximum thickness of the plantar surface of left hindpaw were measured before (T0 ) and at 30 min,1,2,4,8,24 and 48 h(T1-7 ) after zymosan or PBS injection.Eight rats were sacrificed at T4 in group PBS and at T4.6,7 in group Z respectively.The left lumbar segment (L4-6) was removed to determination of spectrin α Ⅱ breakdown products,IκBα,cyclooxygenase-2 (COX-2)expression and NF-κB activity in the spinal dorsal horn by Western blot.Results Compared with group C,MWT and PWTL were significantly decreased,maximum thickness of paw and NF-κB activity in the spinal dorsal horn were significantly increased,spectrin α Ⅱ breakdown products and COX-2 expression in the spinal dorsal horn were upregulated,while IκBα expression was down-regulated in group Z( P ＜ 0.05 or 0.01 ),but no significant change was found in group PBS( P ＞ 0.05).Conclusion The activation of calpain in the spinal dorsal horn is involved in the development of paw inflammatory pain in rats through activating NF-κB and up-regulating the expression of COX-2.