Objective To investigate the relationship between the doses of epidural morphine administered for postoperative analgesia and postoperative urinary retention (POUR). Methods Sixty ASA Ⅰ patients aged < 20-56 yr undergoing atthroscopic knee operation under epidural anesthesia were randomly divided into 3 groups ( n = 20 each) : group Ⅰ and Ⅱ received epidural morphine 1 and 3 mg in 5 ml of normal saline (NS) respectively at the end of operation (group M1, M2 ); group Ⅲ received NS 5 ml instead of morphine (group C). Urinary retention was defined as the patient could not void, when bladder volume was ≥ 600 ml measured using ultrasound. Bladder urine volume was measured before anesthesia and at 4, 6, 8, 10 and 12 h after operation. The occurrence of urinary retention, the first postoperative voiding time, VAS scores and the incidences of vomiting and pruritus were recorded. Results The 3 groups were comparable with respect to age, M/F sex ratio, preoperative bladder urine volume, the amount of local anesthetic used during operation and duration. The incidences of urinary retention, vomiting and pruritus were 65%, 60% and 90% respectively in group M2 and significantly higher than those in the other 2 groups. The first postoperative voiding time was significantly longer in group M2 than in the other 2 groups. VAS scores were significantly lower in group M1 and M2 than in group C. There was no significant difference in VAS scores between group M1 and M2. Conclusion Epidural morphine increases the incidence of POUR in a dose-dependent manner, and 1 mg is the recommended dose.

Malignant colon cells require angiogenesis and optimal tumor microenvironment for proliferation, invasion and metastasis. The non-receptor tyrosine kinase signal transducer and activator of transcription (JAK-STAT) pathway are involved in multiple processes, including chronic inflammation-associated tumorigenesis, cancer proliferation, tumor angiogenesis, immune evasion and facilitating tumor metastasis, making JAK-STAT a new target in molecular target therapy. In this review, advances on JAK-STAT pathway as a new target in colon tumorigenesis are updated, and a preliminary estimation of JAK-STAT in prognosis and target therapy will be mentioned to show a potential future of JAK-STAT in colon cancer.

Objective To explore the diagnostic value of gram-stained sputum smears in elderly patients with ventilator-associated lower respiratory infection (VALRI).Methods 368 elderly patients undergoing mechanical ventilation over 48 hours in ICU were retrospectiely analyzed from Jun 2009 to Jun 2011.42 patients fulfilled the inclusion criteria (with good-quality sputa and presence of the same microorganism in sputum and blood cultures).58 gram-stained smears and sputum cultures were obtained and analyzed.Results The diagnostic sensitivity and specificity of Gram-positive bacteria and Gram-negative bacteria by gram-stained smears were 82.35％ and 78.05％,80.49％ and 82.35％,respectively.The positive and negative predictive value of Gram-positive bacteria and Gramnegative bacteria were 63.64％ and 91.43％,91.67％ and 60.87％,respectively.The coincidence rates in diagnosing Gram-positive bacteria and Gram-negative bacteria were 81.03％ and 79.31％,respectively.Conclusions Gram-stained sputum smear is reliable in diagnosing ventilator-associated lower respiratory infection in elderly patients,and has a certain clinical significance in guiding to the selection of antibiotics.

ObjectiveTo evaluate the therapeutic efficiency and outcomes of vertical condensation of warm gutta-percha obturation using the four-handed technique.MethodsA split-tooth model constructed with lateral grooves and depressions was used to compare vertical condensation of warm gutta-percha obturation with and without the four-handed technique.Respectively 10 times of obturation were done in the four-handed group and the independent operation group.The operation time and defect replication quality were recorded.Evaluation of defect replication quality was on an ordinal scale 0 to 2 grade based on how much each defect was replicated.The results were statistically analyzed.ResultsThere were signiticant differences in treatment time between the four-handed group and theindependent operation group,as well as in treatment outcomes between two groups.ConclusionsUse of the four-handed technique can improve therapeutic efficiency and outcomes of vertical condensation of warm gutta-percha obturation.

Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty.

Objective To investigate the clinical characteristic and prognosis of nonsteroidal antiinflammatory drugs( NSAIDs)and aspirin associated peptic ulcer bleeding. Method All patients with peptic ulcer bleeding were studied by the same researcher after admission and discharge. Results Fifty-one cases with NSAIDs and aspirin medication of the total peptic ulcer bleeding patients ( 147 cases) were included (34. 7% ). Compared with patients not associated with NSAIDs and aspirin medication, they are older [(41.2 ± 1. 9 ) years vs ( 59.4 ± 2. 2 ) years, P ＜ 0. 001], more commonly associated with hypertension ( 10. 4% vs 39. 2% ,P ＜0. 001 ), coronary heart disease ( 10. 4% vs 17.6% ,P ＜0. 001 ) ,diabetes (4. 2%vs 19. 6%, P = 0. 005 ); and had more severe anemia (7. 3% vs 23. 5%, P = 0. 008 ). Fewer patients in NSAIDs group had epigastric pain (61.5% vs 27.5%, P ＜ 0. 001 ), while there was more re-bleeding (9.4% vs 15.7%, P = 0.034). In all bleeding patients, factors associated with re-bleeding, surgical intervention and death included NSAIDs and aspirin medication, and low platelet count. In patients with NSAIDs and aspirin medication, re-bleeding was associated with previous ulcer history ( P ＜ 0. 05 ).Conclusion Peptic ulcer bleeding patients with NSAIDs and aspirin medication were more severe ill, and less likely to present with epigastric pain.

Objective To investigate anti-inflammatory effect of recombinant human erythropoietin(rhEPO) on bronchopulmonary dysplasia in newborn rats exposed to hyperoxia.Methods Ninety-six Wistar newborn rats were randomly divided into 4 groups after birth:room air-exposed control group,room air-exposed rhEPO treated group,hyperoxia-exposed group,and the hyperoxia-exposed rhEPO treated group.The last two groups were exposed to oxygen,FiO2 =850 mL/L,room air-exposed rhEPO treated and hyperoxia-exposed rhEPO treated group received rhEPO 2 400 IU/kg subcutaneously at birth,30 minutes' before oxygen exposure and 2 d after birth.The isodose of 9 g/L saline was given in the same way in room air-exposed controls and hyperoxia-exposed pups.Rats from each group were sacrificed on day 3,7 and 10.Lung histology was observed under microscope,and mRNA expression of monocyte chemoattractant protein-1 (MCP-1) and cytokine-induced neutrophil hemoattractant-1 (CINC-1) were determined with reverse transcriotion-polymerase chain reaction(RT-PCR).Results Under microscope,in the hyperoxia-exposed group,inflammatory cell influx was detected in the lungs on the 3rd day and there was marked neutrophlic infiltrate on the 7th day.Alveolar enlargement and fibrosis were evident on the 10th day.At the same time,the histopathological changes were improved greatly in the lungs of hyperoxia-exposed rhEPO treated pups compared with the hyperoxia-exposed pups.MCP-1 and CINC-1 mRNA expression increased in hyperoxia-exposed pups,compared with room air-exposed controls especially on the 7th day [(0.94 ± 0.45) vs (0.21 ± 0.03),P ＜ 0.001 ; (1.26 ± 0.29) vs (0.26 ± 0.06),P ＜ 0.001].MCP-1 and CINC-1 mRNA expression were greatly depressed in the hyperoxia-exposed rhEPO treated pups compared with the hyperoxia-exposed pups especially on the 7th day.[(0.65 ± 0.07) vs (0.94 ± 0.45),P＜0.05;(0.83±0.07) vs (1.26±0.29),P＜0.05].Conclusions The therapy of rhEPO (2 400 IU/kg) therapy can reduce lung inflammatory cell infiltration and alveolar fibrin deposition in newborn rats with hyperoxic lung injury,and it can restrain MCP-1 and CINC-1 mRNA expression.The anti-inflammatory mechanism of rhEPO is related to inhibition of MCP-l and CINC-1 mRNA expression.

Hypoxia and hypoxia-induced factors (HIFs) are main regulators for tumor stem cells, metastasis-initiating cells and their differentiated progenies to adapt to the environment which lacks oxygen and nutrient in the process of cancer development. HIFs are up-regulated in many tumors, including leukemia, glioblastoma, melanoma, prostate cancer, breast cancer and pancreatic cancer, in where they are especially highly expressed in hypoxic regions. HIFs activation can induce expression of numerous stem cell related genes and multidrug resistance genes, which may play important roles in tumour and stem cell-mediated self-renewing, energy metabolism alternation, invasion, metastasis, angiogenesis and treatment resis?tance of neoplastic cells. Consequently, it will provide new clues for cancer therapy after investigating the role of HIFs in tar?geted regulation and metabolic pathway modulation in various stem cell-mediated tumor cells.

Objective To study the content of isorhynchophylline from different regions and different harvest time.Methods The content of isorhynchophylline in Uncaria rhynchophylla from different regions and different harvest time was tested by HPLC. The Waters Symmetry C18 color (4.6 mm× 250 mm, 5 μm), mobile phase of methanol - 0.01 mol/L ammonium acetate buffer (pH 8.0) (60:40), column temperature 25℃, 20 μl sample volume, velocity of 1.0 ml/min, detection wavelength of 246 nm were setted.Results The isorhynchophylline can be detected in different regions and different harvest time, with the highest content was found in Ningming county and from September to February of the next year.Conclusion The content of isorhynchophylline in Uncaria rhynchophylla varied from different regions and harvest times. The best harvest time is during September to February of the next year.

Objective To investigate ultrasonographic features,clinical and histopathologic characteristics of hydrometra in the elderly women.Methods Hysteroscopy endometrial biopsy,dilation and curettage (D&C) and Tao Brush were selectively performed for the endometrial cytologic and histopathologic diagnosis according to the depth of the hydrometra investigated by transvaginal sonography,endometrial thickness and high-risk factors of carcinoma of endometrium in 72 elderly women with hydrometra.Results Among 72 elderly women with hydrometra,9 cases (12.5％) were examined by hysteroscopy,51 cases (70.8％) by D&C and 12 cases (16.7％) by endometrial cytology along with D&C.Histopathologic examination revealed that there were 7 (9.72％) cases with endometrial carcinoma,2 cases (2.8％) with atypical endometrial hyperplasia,6 cases (5.6％) with endometrial benign lesion,14 cases(19.4％)with pyometra and the other 43 cases (59.7％) with normal and simple hydrometra.Conclusions Transvaginal sonography in combination with endometrial cytology are beneficial for screening of endometrial disorders or for drainage of hydrometra in elderly women,decreasing invasive examinations such as D&C.