The paper stated several typical problems in the medical charges,such as be short of considerate service,low quality but high price, abuse expensence medicine etc. the author forther proposed some countermeasures including respection to patient's health and making facts, right,implement of standardization manag ement by Health Ministry,enhanuing moral eductation and marco-controlling the price of medicines, etc. Only through theoe counfermeasures,may health service have more full emotional and humanisium spirit.

Prophylactic cranial irradiation is an effective means of dealing with brain metastasis of cancer,which can reduce the incidence of brain metastasis by killing the micrometastasis and then improve the prognosis.The effectiveness has been verified in small cell lung cancer,but the application is still in the exploration in non-small cell lung cancer (NSCLC) and breast cancer.Prophylactic cranial irradiation is expected to become the conventional treatment for patients with NSCLC of ⅢA-N2 stage after operation and adjuvant chemotherapy or breast cancer of epithelial growth factor receptor-positive after receiving trastuzumab.

Objective To compare the effects of propofol intravenous balanced anesthesia with infusion of remifentanil combined with fentanyl to simple infusion of remifentanil or fentanyl during laparoscopic cholecystectomy(LC).Methods Sixty patients scheduled for LC were randomly divided into three groups(n=20): simple remifentanil group(R),remifentanil combined with fentanyl group(RF) and simple fentanyl group(F).Mean arterial pressure(MAP),heart rate(HR) and SpO2 during the anesthesia induction phage,maintenance phage and analepsia phage,the recovery time of spontaneously breathing and consciousness from withdrawal,extubation time,pain score(verbral report score,VRS) and conscious state score(observers assessment of alertness/sedation scale,OAAS) at instant,1 h,3 h,7 h,12 h after extubation and complications of analepsia phage were recorded.Results As compared with the RF Group,the F Group and pre-induction intro-group,the R Group showed lower MAP and quicker HR when induction intubation,higher MPA and quicker HR after operation,and no obvious difference in maintenance phage was found.MAP and HR showed no obvious difference between the RF and F Group as well as within groups in induction and maintenance phage.MAP increased and HR became quicker in the RF Group when extubating and leaving operating room.All observed index at every time showed no significant differences between the R and RF Group after operation,but it prolonged significantly in the F Group.Complications of the three groups showed no statistical difference.VRS of the R Group was significantly higher than that of RF and F groups after operation(P

Objective To investigate the effects of unilateral stellate ganglion block (SGB) on the expression of heat shock protein 70(HSP70) in bilateral hippocampus and temporal lobe induced by global cerebral ischemia-reperfusion in rabbits. Methods Twenty-eight healthy Japanese long-ear rabbits of either sex weighing 2.5-3.0 kg were anesthetized with intravenous 1.5% pentobarbital, intubated and mechanically ventilated. Global cerebral ischemia was produced by clamping bilateral external and internal carotid arteries and vertebral arteries for 10 min. Global cerebral ischemia was confirmed by blanching of lips and conjunctival, respiratory and EGG changes. The arteries were then declamped for reperfusion. The animals were randomly divided into 4 equal groups ( n = 7) : SGB group, NS control group, blank control group and sham operation group. In SGB group left stellate ganglion was blocked by 0.25% bupivacaine 0.5 ml injected through an epidural catheter with its tip placed close to left stellate ganglion when reperfusion was started followed by continuous infusion of 0.25 % bupivacaine at a rate of 0.5 ml ? h -1 . SGB was confirmed by ptosis and miosis. In NS control group normal saline was used instead of 0.25 % bupivacaine. In blank control group no medication was give. In sham operation group the six arteries were exposed but not occluded. The HSP70 expression in the neurons in hippocampus CA1 section and cortex of temporal lobe was detected by immunohistochemistry using an antibody specific for HSP70 30h after reperfusion was started. Results HSP 70 expression in bilateral hippocampus CA1 section and cortex of temporal lobe was significantly lower in SGB group compared with the two control groups ( P 0.05) . Conclusion Left SGB can depress the over-expression of HSP 70 in bilateral hippocampus and temporal lobe induced by global cerebral ischemia-reperfusion.

Objective To investigate formalin-induced nociceptive behavior and c-fos expression of interbrain following stellate ganglionic block (SGB) in rabbits. Methods Catheters were inserted closely to right stellate ganglia in rabbits by operation.One week later,twenty-four rabbits were randomly divided into three groups, each group containing 8 animals. groups A,B and C received 0.5ml of normal saline,3% formalin and 3% formalin stimulation by intraplantar injection , respectively. 10 minutes before stimulation,0.5 ml of 0.25% bupivacaine was administered via the catheter in group B, while in groups A and C 0.5 ml of normal saline was applied. Nociceptive behavior was observed for 1 hour using weighted pain score. 2 hours after stimulation, whole interbrain was removed to immunohistochemically detect the expression of c-fos. Results Formalin-induced nociceptive behavior in phase 2 was relieved following SGB, c-fos expression level of hypothalamus in group B was significantly lower than that in group C(P0.05). Conclusion SGB could relieve formalin-induced nociceptive behavior, and downregulate formalin-induced c-fos expression of hypothalamus, which may be related to the mechanisms of SGB for the treatment of inflammatory pain.

OBJECTIVE:To study the mechanism of Cassia obtusifolia L in decreasing blood-lipid.METHODS:Primary cultures of rat hepatocytes in vitro were used to determine the concentrations of proteins in hepatocytes by the method of Folin-phenol reagent and to assay the cholesterol synthesis from 14 C-acetate with liquid scintillation count.RESULTS:Ex?tract of Cassia obtusifolia L inhibited cholesterol synthesis from 14 C-acetate,but cassiaside B didn't affect cholesterol synthe?sis.CONCLUSION:The mechanism of extract of Cassia obtusifolia L in decreasing blood-lipid may result from inhibition of cholesterol synthesis,but inhibiting cholesterol synthesis may be not the main approach of cassiaside B in decreasing blood-lipid.

Objective: To investigate formalin-induced inflammatory nociceptive response and Fos expression of interbrain following stellate ganglion block (SGB) in rabbits. Methods: Catheters were inserted closely to right stellate ganglia in rabbits.One week later,twenty-four rabbits were randomly divided into three groups of 8 each:sham group,SGB group and control group,receiving 0.5ml of normal saline,3% formalin and 3% formalin stimulation by intraplantar injection into the right front paw, respectively. ten mins before stimulation,0.5ml of 0.25% bupivacaine was administered via the catheter in SGB group,while 0.5ml of normal saline in sham group and control group. Nociceptive response was observed for 60min using weighted pain score. Local inflammatory response was measured by histopathology, the expression of Fos of interbrain was measured with immunohistochemistry 2 hours after stimulation. Results: Formalin-induced nociceptive behavior in phase 2 and local inflammatory response were relieved following SGB; the average numbers of Fos-positive neurons of hypothalamus in SGB group was lower than that in control group( P 0.05). Conclusion: SGB suppresses formalin-induced Fos expression of hypothalamus.

Objective To develop a high performance liquid chromatography(HPLC) method to determine the concentration of ampicillin and probenecid in human plasma.Methods A Symmetry ShieldTM RP18 column(5 ?m,150 mm?3.9 mm)was used.The mobile phases were 0.068 mol/L KH_2PO_4(pH 3.0)∶acetonitre(92∶8,V/V)for ampicillin,H_2O∶acetonitrile∶1 mol/L KH_2PO_4∶1 mol/L acetic acid(59.5∶39.8∶0.62∶0.062,V/V,0.15% triethylamine added to reach pH 2.76) for probenecid.The detective wavelength were at 254 nm for probenecid and 210 nm for ampicillin.Results The calibration curves obtained were linear in the range of 0.625-20 ?g/ml (r=0.999 9) of probenecid and 1.25-40 ?g/ml of ampicillin.Conclusion This analysis method is simple,sensitive and rapid,suitable for studying pharmacokinetics of ampicillin and probenecid.

BACKGROUND: Ketamine is a kind of frequently used general venous anesthesia drug in clinic, and the medication in vein or epidural cavum has analgesic effect. It is N-methyl-D-aspartic acid (NMDA) receptor noncompetitive antagonist, which can inhibit toxic effect of excitatory amino acids.OBJECTIVE: To observe effect of ketamine on apoptosis of dorsal horn astrocytes of spinal cord of rats induced by NMDA receptor over activation and explore its possible mechanism of action.DESIGN: Randomized controlled observation.SETTING: Department of Anesthesiology, Taihe Hospital Affiliated to Yunyang Medical College.MATERIALS: The experiment was conducted at Cell Biology Laboratory,Institute of Basic Medical Sciences, Yunyang Medical College between September 2003 and January 2005. Neonatal Wistar rats of two or three days were provided by Animal Experimental Center of Wuhan University. METHODS: Primary astrocytes in dorsal horn of T11-L6 spinal cord of Wistar rats were purified and cultured. Astrocytes were used in the experiment when its purity coefficient reached 98% assessed by gial fibrillary acidic protein. The cultured cells in 24-well plates were divided randomly into 6 groups (9 portions in each group): ①50 μL Hanks liquor was added into the control group. ②Amount of 100μmol/L was added into the NMDA group. ③Amount of 1 mmol/L was added into the ketamine group. ④100μmol/L NMDA + 0.1 mmol/L ketamine group. ⑤100 μmol/L NMDA + 0.5 mmol/L ketamine group. ⑥100μmol/L NMDA + 1 mmol/L ke tamine group. 1 mmol/L ketamine was clinical antalgic dosage. Activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) were examined after 24-hour culture. Content of Bcl-2 protein and change of morphology were observed with immunocytochemistry. Apoptosis of astrocytes was measured with flow cytometry. MAIN OUTCOME MEASURES: ① Counterstain cell staining and changes of morphology of Bcl-2 protein with immunohistochemical method and hematoxylin-esoin staining (HE). ②Apoptosis of astrocytes was detected with flow cytometry. ③Content of MDA and activity of SOD.RESULTS: ①Mean absorbance (A) of Bcl-2 as expression of Bcl-2 protein measured semiquantitatively: It was lower in the 100μmoL/L NMDA group than the control group, which had significant difference [0.054±0.021,0.108±0.039, respectively, P＜0.01]. It was higher in the 100 μmol/L NMDA + 1 mmol/L ketamine group than the 100 μmol/L NMDA group,which had significant difference [0.148±0.045, 0.054±0.021, respectively,P ＜ 0.01]. ②Apoptosis of astrocytes detected with flow cytometry: It was higher in the 100μmol/L NMDA group than the control group, which had significant difference [(25.26±6.13)%, (5.66±2.24)%, respectively, P＜0.01].It was lower in the 100μmol/L NMDA + 1 mmol/L ketamine group than in the 100μmol/L NMDA group, which had significant difference[(24.41±4.82)%, (25.26±6.13)%, respectively, P＜0.01]. ③Content of MDA and activity of SOD: 100 μmol/L NMDA made the content of MDA in astrocytes obviously increase , while the activity of SOD markedly decrease. 1 mmol/L ketamine remarkably decreased the content of MDA, distinctly increased the activity of SOD. This effectiveness had evidently dosage-effect relationship in clinical antalgic dosage, which had obviously difference as compared with that of the NMDA group (P ＜ 0.01 ). The differences between the 1 mmol/L ketamine group and the control group as well as between the 100 μmol/L NMDA + 0.1 mmol/L ketamine group and the NMDA group had insignificant difference.CONCLUSION: NMDA receptor over activation can induce apoptosis of a great number of astrocytes in spinal dorsal horn of rats. Suitable ketamine dramatically inhibits apoptosis, and its mechanism can enhance the expressionof Bcl-2 protein of astrocytes, at the same time inhibit the production of free radical and reinforce the activity of SOD.

Objective To evaluate the clinical characteristics,treatment,outcome and complications of child and adolescent nasopharyngeal carcinoma (NPC). Methods From January 1970 to April 1997, the records of 145 NPC patients younger than 21 years of age were reviewed. The clinical stages according to 92'Chinese NPC Staging System were :stageⅠin 1, Ⅱin 8, Ⅲ in 79 and Ⅳ in 57. All patients were treated with external beam radiotherapy. Before 1988, parallel opposed lateral pre-auricular portals were chiefly used in 75 patients and after 1988, parallel opposed lateral facio-cervical portals were adopted in 70. The radiation dose to the primary tumor ranged 45-80?Gy: 70?Gy in 50 cases and 32 of them also received chemotherapy. Results Distant metastasis developed in 26 cases, while local and/or regional recurrence in 14. The actuarial overall survival rates of 1-, 3-, 5, and 10-years were 96.3%, 79.9%, 76.5% and 69.4%, respectively. Among 45 dead cases, 16 did so of metastasis, 11 of local and/or regional recurrence and 18 of other reasons. Univariate analysis suggested that clinical stage, size and site of involved lymph nodes, skull base involvement were significant prognostic factors of survival, whereas sex、age、dose、therapeutic method and chemotherapy were not. Conclusions 1. Even though the majority of pediatric and adolescent NPC were advanced, it signifies a relatively good survival. 2. As the normal tissue of pediatric and adolescent patients tolerates radiation poorly, prudence should be meticulously practiced in deciding the radiation dose and radiotherapeutic fields.