Objective To investigate the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine mixed with sufentanil on the sleep quality after spinal surgery.Methods Eighty patients of both sexes, aged 21-72 yr, weighing 48-100 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective spinal surgery, were randomly assigned into sufentanil group (group S) and dexmedetomidine mixed with sufentanil group (group DS) with 40 cases in each group.In group S, PCIA solution contained sufentanil 2 μg/kg and tropisetron 6 mg in 100 ml of normal saline.In group DS, PCIA solution contained sufentanil 2 μg/kg, dexmedetomidine 3 μg/kg and tropisetron 6 mg in 100 ml of normal saline.The PCA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h.Sufentanil 5 μg injected intravenously and celecoxib 200 mg given orally were used as rescue analgesics, and numeric rating scale (NRS) score at rest was maintained ≤4 within 48 h after surgery.Ramsay sedation scores were recorded at 1, 2, 6, 12, 24 and 48 h after surgery.Sleep quality was evaluated using the Medical Outcomes Study Sleep Scale (MOS-SS), and the average time of daily sleep and Sleep Problems Index (SPI) were recorded at week 1 before and after surgery.Patient's satisfaction with sleep was assessed on the night of surgery and 1st day after surgery.The requirement for rescue analgesics was recorded.Results There was no significant difference in the requirement for rescue analgesics between group S and group DS (P＞0.05).Compared with the value before surgery, the average time of daily sleep was significantly shortened, and SPI was increased at week 1 after surgery in group S (P＜0.05 or 0.01), and no significant change was found in group DS (P＞0.05).Compared with group S, the Ramsay sedation scores were significantly increased at 1, 2, and 6 h after surgery, the average time of daily sleep was prolonged at week 1 after surgery, the SPI was decreased at week 1 after surgery, and the degree of satisfaction with sleep was increased on 1st day after surgery in group DS (P＜0.05 or 0.01).Conclusion PCIA with dexmedetomidine mixed with sufentanil is helpful in improving the sleep quality after spinal surgery in the patients.

Purpose Protein is the main influencing factors for diffusion weighted imaging (DWI) signals and apparent diffusion coefficient (ADC), it results in hyperintensity on DWI and low ADC, but not fully matched in clinic. This paper aims to investigate the effect of protein type and concentration on the signal intensity (SI) and ADC of DWI. Materials and Methods Different concentrations of albumin, globulin solution and the mixed solution were created in vitro. DWI was performed on GE 1.5T superconducting nuclear MRI system. Results ① There was a linear negative correlation between the ADC value and the concentrations of protein solution (at 37℃, ra= - 0.849, Pa<0.05; rg= - 0.843, Pg<0.05; at 40℃, ra= - 0.894, Pa<0.05; rg= - 0.819, Pg<0.05);there was a linear positive correlation between the SI of DWI and the concentrations of the albumin solution (at 37℃, r=0.753, P<0.05; at 40℃, r=0.845, P<0.05). There was no correlation between the SI of DWI and the concentrations of the globulin solution (at 37℃, r= - 0.222, P>0.05; at 40℃ , r= - 0.270, P>0.05). ② SI of the albumin solution was significantly higher than the globulin solution at the same concentration and temperature (t=3.96, P<0.001); the ADC values were not statistically different between the albumin and the globulin solution (t=0.61, P>0.05). Conclusion The nature of the cystic fluid can be understood preliminarily through quantitative analysis of the cystic fluid DWI and ADC values, so as to provide theoretical basis for the qualitative diagnosis of cystic lesions in vivo.

Antibodies, Monoclonal ; administration & dosage ; Antibodies, Monoclonal, Humanized ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; drug therapy ; metabolism ; Drug Administration Schedule ; Female ; Humans ; Neoadjuvant Therapy ; Paclitaxel ; administration & dosage ; Receptor, ErbB-2 ; metabolism ; Trastuzumab

Androstadienes ; therapeutic use ; Antineoplastic Agents, Hormonal ; administration & dosage ; Aromatase Inhibitors ; administration & dosage ; Breast Neoplasms ; drug therapy ; Drug Administration Schedule ; Female ; Humans ; Nitriles ; administration & dosage ; Postmenopause ; Triazoles ; administration & dosage

Background The main cause of filtering surgery failure is over proliferation of fibroblasts in filtering channels,leading to excessive fibrosis and scar formation.Researches determined that p38 mitogen-activated protein kinase(MAPK) signaling pathway plays an important role in fibroblast phenotype transition. Objective The present study was to investigate the inhibitory effect of p38 MAPK inhibitor on myofibroblasts transdifferentiation and the extracellular matrix synthesis after filtration surgery in rabbit eyes. Methods Trabeculectomy was performed on 24 eyes of 12 clean New Zealand white rabbits to establish the filtering operative models.The models were randomized into model group,SB203580 group and mitomycin C ( MMC ) group.1 ml SB203580 ( 0.2 g/L) was conjunctively injected at the end of operation in the rabbits of the SB203580 group,and the cotton piece with 0.2 g/L MMC solution was placed on the operative area for 3 minutes intraoperatively in the rabbits of the MMC group.The bleb appearances were examined under the slit lamp microscope,and intraocular pressure(IOP) was measured with Icare tonometer I,3,7,10,14 days after operation.0.2 ml aqueous humor was extracted and the conjunctive tissue at the filtering area was obtained 14 days after operation for the detection of α-smooth muscle actin (α-SMA) and fibronectin protein by ELISA.Expression of ACTA2 mRNA,connective tissue growth factor(CTGF) mRNA and alpha2 chain of type Ⅰ collagen( COL1A2 )mRNA in conjunctive tissue was assayed with fluorescence real-time PCR. Results Vascularization of fibrosis of filtering bleb were obvious in the eyes of the model group,and the bleb was flat and diffuse in the eyes of the SB203580 group and MMC group on 14 days following operation.No significant difference was seen in IOP before trabeculectomy among these three groups( F=0.065,P=0.937 ).IOP was gradually elevated with the increase of time after operation ( F =32.873,P =0.030 ).ELISA assay showed that α-SMA level in conjunctiva was lower in the SB203580 group and MMC group compared with the model group,and that of MMC group was significant lower than the SB203580 group( P＜0.05 ).Fibronectin level in conjunctiva was lower in the SB203580 group and MMC group compared with the model group,and that of MMC group was significant lower than the SB203580 group (P＜0.05).Fluorescence real-time PCR showed that expressions of the ACTA2 mRNA,CTGF mRNA and COL1A2 mRNA were significantly different among the three groups( P＜0.01 ),with the highest expression in model group and the lowest expression in the MMC group ( P ＜ 0.05 ). Conclusions Fibrotic reaction after trabeculectomy can be suppressed by inhibiting p38 MAPK signal pathway.The mechanism of SB203580 is to reduce the synthesis of myofibroblasts transdiffercntiation and extracellular matrix.

To explore the binocular disparity information for children with a normal vision based on computer-assisted evaluation system.We examined the random dot zero-order disparity,line zero-order disparity,2nd-order disparity and random dot motion parallax for 97 children with normal vision.And 94 children reached 100″ vision disparity both in random dot zero-order disparity and line zero-order disparity (pass rate of 96.9％) ; all 94 cases passed the 2nd-order disparity and random dot motion parallax.Thus children with a normal vision develop their stereopsis.

Objective:To explore the correlation between serum level of matrix metalloproteinase 2 (MMP-2)and se-verity of coronary artery disease in aged patients with acute coronary syndrome (ACS)complicated hyperhomocys-teinemia (HHCY).Methods:According to serum level of homocysteine (Hcy),a total of 105 aged ACS patients were selected and divided into ACS+HHCY group (n=56)and pure ACS patients (n=49),another 65 healthy in-dividuals were enrolled as healthy control group.The severity of coronary artery disease was showed by Gensini score ;enzyme linked immunosorbent assay was used to measure serum MMP-2 level in each group.Results:Com-pared with healthy control group,there were significant rise in MMP-2 level [(140.8±50.1)ng/ml vs.(442.5± 98.2)ng/ml,(297.9±86.3)ng/ml]in ACS+HHCY group and pure ACS group,P <0.01. Gensini score in ACS+HHCY group was significantly higher than that of pure ACS group [(1.9±0.2)scores vs.(1.1±0.3)scores,P<0.01].Pearson correlation analysis indicated that Gensini score was positively correlated with MMP-2 level in ACS+HHCY group (r =0.424,P <0.05).Conclusion:The serum MMP-2 level is significantly positively correla-ted with severity of coronary artery disease in aged patients with ACS complicated HHCY.

ObjectiveTo evaluate the effectiveness of the interventional treatment for portal vein stenosis in patients who had undergone liver transplantation.MethodsFromApr.2004 to Oct.2011,30 patients with portal vein stenosis after liver transplantation were referred for angiographic analysis and interventional treatment. All patients had typical clinical signs and symptoms or surveillance by imaging.After percutaneous transhepatic portography and balloon angioplasty,stents were deployed.Embolization was performed on patients with varices or portal vein flow changes.The therapeutic results were monitored by the follow-up on clinical symptoms,laboratory tests and imaging examinations.ResultsAngiography was performed successfully on all patients.Twenty-four patients received balloon dilation and 26 stents were deployed subsequently.The guide-wire cannot pass through the lesion of portal trunk in 1patient.Four patients received balloon angioplasty only.The technical success rate was 96.7％ (29/30).Stainless steel coils were applied in 7 patients for varices embolization.The complication related to interventional treatment was bleeding in thoracic cavity which happened in 2 patients.Portal vein patency was maintained in all the patients who received interventional treatment for 1-72 months (mean 21.5 months).No re-stenosis was identified.ConclusionInterventional therapy is an effective method for the treatment of portal vein stenosis after liver transplantation and excellent patency can be achieved by this method.

Objective To investigate the distribution and drug resistance of pathogens for hospital-acquired urinary tract infections between patients in internal medicine wards and in surgical wards .Methods A total of 586 midstream urine samples were collected from patients in the First Municipal Hospital of Qinhuangdao during January 2012 and December 2014.Vitek 2 Compact system was applied in bacteria identification and drug sensitivity tests .Excel and SPSS 11.5 software were applied for data analysis . Results A total of 661 strains were isolated , in which 404 strains were from internal medicine wards and 257 strains were from surgical wards .Escherichia coli (44.6%vs.33.1%) and Enterococcus (23.0%vs. 16.3%) infections were more common in the internal medicine wards (χ2 =8.620 and 4.309, P<0.05), while the occurrence of Pseudomonas aeruginosa infection (4.0%vs.24.5%) was higher in surgical wards (χ2 =63.056, P <0.01).Escherichia coli and Klebsiella pneumonia strains were highly sensitive to piperacillin/tazobactam, cefptetan, amikacin, imipenem, and meropenem, and the sensitivity rates were from 85% to 100.0%.The sensitivity rates of Escherichia coli to ampicillin/sulbactam, levofloxacin and ciprofloxacin were <30%, and strains from surgical wards had lower sensitivity rates to these drug than those isolated from internal medicine wards (χ2 =4.987, 4.575 and 5.359, P<0.05).The sensitivity rates of Klebsiella pneumonia isolated from internal medicine wards to ceftazidime , gentamicin and aztreonam were 68.8%, 60.6% and 69.7%, which were higher than those isolated from surgical wards (36.0%, 32.0%, and 40.0%), and the differences were of statistical significance (χ2 =6.068,4.661 and 5.115, P<0.05).Pseudomonas aeruginosa strains were highly sensitive to piperacillin/tazobactam and amikacin, and the susceptibilities of strains isolated from surgical wards (98.4%and 96.8%) were higher than those isolated from internal medicine wards (75.0% and 81.3%) (χ2 =11.797 and 5.221, P <0.05). Pseudomonas aeruginosa strains isolated from surgical wards were also highly sensitive to cefepime (92.1%), but the sensitive rate of strains from internal medicine wards was only 37.5%, and the difference was of statistical significance (χ2 =24.696, P<0.01).Enterococcus faecium and Enterococcus faecalis were sensitive to tigecycline , vancomycin and linezolid with the sensitivity rates over 95%.Except quinupristin/dalfopristin and tetracycline , the sensitivities of Enterococcus faecalis to other antibiotics were higher than Enterococcus faecium.Susceptibility of Enterococcus faecium from surgical wards (33.3%) to moxifloxacin was lower than those from internal medicine wards (70.8%), and the difference was of statistical significance (χ2 =4.629, P <0.05).Conclusion There are differences in distribution and antimicrobial susceptibility of pathogens isolated from internal medicine wards and from surgical wards .

Objective To compare the contrast-enhanced ultrasonography (CEUS) manifestations of pNENs with the pathological changes and to explore the clinical value of CEUS in diagnosis of pNENs. Methods The CEUS of sixteen pathologically diagnosed pNENsfrom April,2012 to February,2014 were retrospectively observed.The CEUS of thirty pathologically diagnosed pancreatic carcinomas during the same period were taken as the control group.The enhancement extent and enhancement patterns of CEUS in pancreatic tumors were analyzed. The specimens of pNENs were stained with HE and CD34 immunochemistry.The grading of interstitial content and Ki-67 index were obtained on HE-stained slices and microvascular density(MVD) were obtained on CD34 immunochemistry stained slices.Spearman rank test analysis was employed to analyze the correlation.Results Among the 16 cases of pNENs,12 cases (75.0%) demonstrated hyper-or iso-enhancement,which included 6 cases (37.5%) showing homogeneous enhancement and 6 cases (37.5%) showing inhomogeneousen hancement,and the other 4 cases demonstrated hypo-enhancement. Among 30 cases of pancreatic carcinomas,25 cases (83.3%) demonstrated hypo-enhancement and 5 cases (16.7%) hyper- or iso-enhancement,and 21 cases (70.0%) demonstrated homogenous enhancement,and 9 cases(30.0%)inhomogeneous enhancement.Taking hyper-or iso-enhancement on CEUS as the diagnostic criteria,its diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 75.0%,83.3%,70.6%,86.2%,80.4%respectively.Negative and positive correlation of the enhancement extent of pNENs with the interstitial content(r =-0.880,P < 0.001) and MVD (r =0.658,P =0.003) were observed,respectively.Six tumors with inhomogeneous enhancement contained cystic degradation or necrosis under microscope. Conclusions CEUS is an effective and non-invasive diagnostic approach for pNENs and can reflect the pathological changes.Hyper-or iso-enhancement of CEUS is typical appearance of pNENs.