Objective To evaluate Effects of general anesthesia combined with thoracic paraver-tebral block(TPVB)on postoperative recovery after thoracoscopic pulmonary lobectomy. Methods Eighty patients were randomized into the general anesthesia group( G group)and general anesthesia combined TPVB group(GT group). Under the guidance of ultrasound,patients in the GT group received 20ml of 0. 5% ropivacaine for TPVB,and sevoflurane and propofol for combined anesthesia. Patients in the G group received sevoflurane,propofol and remifentanil for combined anesthesia. Extubation time,postoperative vis-ual analogue scale(VAS),quality of recovery(QoR)score,and adverse reaction were all recorded. Results Patients in the GT group had less extubation time and earlier ambulation time compared to the G group. Postoperatively,at the 1st,24th and 48th hour,patients in the G group had significantly higher VAS values both at rest and on movement than GT group(P < 0. 05). The opioid consumptions in GT group were lower than the G group(P < 0. 05). The QoR values of GT group at 24th and 48th hour[(152 ± 21)min and (175 ± 17)min]were significantly higher than the G group[(134 ± 25)min and(162 ± 20)min]respec-tively. There were significant differences in hospitalization expenses,the hospitalization stay and the inci-dence of complications between the two groups. Conclusion The ultrasound-guided paravertebral block can improve the quality of recovery in patients undergoing thoracoscopic pulmonary lobectomy.

Objective To explore the drug resistance diversity of pseufomonsd aeruginosa.Methods We did sensitivity experiments by 23 antibiotic of 1731 pseudomonad aeruginosa identified from clinic during 1997 to 2008,Results In 1 731 pseudomonad aeruginosa,the samples were main from phlegm,accounted for 58.5%.the second from secretion accounted for 24.7%.The drug resistance of pseudomonad aeruginosa for ampicillin、cefazolin and cefuroxime sodium were all higher than 90%,the second were trimethoprim/sulfamethoxazole 83.2%.The antibacterial medicines of drug resistance higher than 70%were netilmicn(75.2%)、ofloxacin(70.4%)、tetracycline(74.1%)、choramphenicol(72.0%).The antibacterial medicines of drug resistance Iower than 30%were Cefoperazone/Sulbactam、cefepime、imipenem、ceftazidme.In 12 years,the drug resistance diversity had enhanced prevalent trend.The enhanced speed of proportion drug was slow in 2004～2007,but it was fast again in 08 year.Conclusion The pseudomonad aeruginosa have become one of the most clinical routine nosogenetic germs.It showed single and anti muhiresistance of antibioties seriously.In order to improve antibacterial treating effect,we should inspect the drug resistance continuously in our area.We could select rationally antibacterial medicine according to the result of medicine sensitivity experiments.

Objective To investigate the effectiveness of the combination of general anesthesia ( GA) and single-shot bilateral thoracic paravertebral block ( TPVB) by ropivacaine in the patients undergoing off-pump coronary artery bypass surgery ( OPCAB) . Methods Forty patients with coronary heart disease scheduled for elective OPCAB surgery were randomly divided into two groups:general anesthesia group (group A, n=20) and general anesthesia combined with bilateral thoracic paravertebral block group (group B, n=20). The frequency of hemodynamic abnormalities and dosage of vasoactive drugs during the period of operation were recorded. Meanwhile, other reference data were recorded, such as the consumption of sufentanil during operation and postoperative analgesia, the time of endotracheal tube retention and intensive care unit ( ICU) stay. Results Two cases were excluded from the study in group B for failure block. Compared with group A, the frequency of hypertension and the amount of nicardipine was lower during operation in group B (P<0. 05), the consumption of sufentanil was less both during operation (P<0. 01) and postoperative analgesia (P<0. 05). Moreover, the time of tracheal tube retention and ICU stay were shorter in group B (P<0. 05). Conclusion The findings of this study indicate that GA combined with single-shot TPVB is superior to GA alone in improving haemodynamic stability in patients undergoing OPCAB surgery. The combination therapy can also reduce the use of opiates and shorten the time of recovery.

Objective To investigate the effect of ketamine on the mitochondrial function of rat neurons subjected to anoxia. Methods Primarily cultured rat hippocampal neurons were seeded in culture dishes (35 mm in diameter) at the density of 5×105-1×106 cells∕ml, and divided into 3 groups (n=11 each) using a random number table: control group, anoxia group and ketamine group. The neurons were exposed to 90% N2 plus 10% CO2 50 ml∕min for 5 min in anoxia group. In ketamine group, ketamine was added to the culture medium with the final concentration of 20 μmol∕L at 1 h before anoxia, and then the neurons were exposed to 90% N2 plus 10% CO2 50 ml∕min for 5 min. After the end of treatment in each group, the dead neurons were detected using trypan blue staining, the ATP content was determined by ATP bioluminescence assay, and mitochondrial membrane potential was measured by rhodamine 123 staining. Results Compared with control group, the mortality rate of hippocampal neurons was significantly in?creased, and the ATP content and mitochondrial membrane potential were significantly decreased in anoxia group and ketamine group ( P<0.05) . Compared with anoxia group, the mortality rate of hippocampal neu?rons was significantly decreased, and the ATP content and mitochondrial membrane potential were signifi?cantly increased in ketamine group (P<0.05). Conclusion The mechanism by which ketamine amelio?rates anoxia?induced damage to rat neurons is related to improved mitochondrial function.

Objective To evaluate the effect of different intravenous analgesia methods on postoperative incisional and uterine contraction pain after cesarean section.Methods Four hundred parturients (ASA Ⅱ-Ⅱ) undergoing cesarean section were randomly allocated into 4 groups,including sufentanil group (group S,96 cases),sufentanil combined with flurbiprofen axetil group (group SK,99 cases),butorphanol group (group N,106 cases) and butorphanol combined with llurbiprofen axetil group (group NK,99 cases).All the parturients received the operation under epidural combined with spinal anesthesia,and received patient-controlled intravenous analgesia (PCIA) after cesarean section.Numerical rating scale (NRS) of postoperative rest and dynamic incisional pain and uterine contraction pain,Ramsay sedation scale (RSS),and PCIA-related adverse events were recorded for 24 h after operation.Results All the parturients were finished this study.The age,body weight,gestational weeks and operative time in 4 groups had no significant difference (P ＞ 0.05).The NRS score of rest incisional pain was equivalent among the 4 groups (P ＞ 0.05).The NRS score of dynamic incisional pain after operative 13 h in group S was significantly lower than that in group N[(3.6 + 1.3) scores vs.(5.4 + 1.2) scores](P＜ 0.05).The NRS score of uterine contraction pain after operative 4,13 h in group N and group SK was lower than that in group S [(1.3 ± 1.0),(1.1 ± 0.9) scores vs.(2.5 ± 1.1) scores and (1.6 ± 1.0),(1.4 ± 0.9) scores vs.(2.9 ± 1.1) scores] (P ＜ 0.05).The RSS scores and incidence rate of dizziness were significantly higher in group N than those in group S (P ＜0.05).No abnormality of new-horn infant was recorded in 4 groups.Conclusion Sufentanil combined with nonsteroidal antiinflammatory drugs can perform effective and safe analgesia on postoperative incisional and uterine contraction pain after cesarean section.

Objective To investigate the phenotype, frequency of Th17 cells and the association between Th17 cells and viral clearance in patients with H1N1 influenza A. Methods Three groups including 70 confirmed patients with H1N1 influenza A, 30 patients with seasonal influenza as well as 68 healthy subjects as controls were enrolled in this study. The percentages of Th1, Th2, Treg and Th17 lymphocytes in the peripheral blood were determined by intracellular staining and flow cytometry. The levels of interferon-γ (IFN-γ), transforming growth factor-beta (TGF-β),interleukin-6 (IL-6) in plasma and supernatant of the peripheral blood mononuclear cell (PBMC)culture were quantified by enzyme-linked immunosorbent assay (ELISA). Viral load in nasopharyngeal swabs was detected by real time quantitative reverse transcription-polymerase chain reaction (RTPCR). Data were analyzed by one way ANOVA and liner correlation analysis. Results The percentage of Th17 cells in H1N1 influenza A patients was (2. 740±0. 210)%, which the percentage of was significantly decreased compared to healthy subjects (3. 443 ±0. 154)% and seasonal influenza patients (3. 443±0. 277) % (F=4. 242, P＜0. 05); while the percentage of Thl, Th2 and Treg cells were not significantly different among these groups. Moreover, the TGF-β level in plasma of H1N1 influenza A patients was (10±8) ng/mL, which was significantly lower than healthy subjects (43 ±32 ) ng/mL and seasonal influenza patient ( 18 ± 10) ng/mL ( F= 17.72, P＜0.01 ). The TGF-β level in the supernatant of PBMC culture of H1N1 influenza A patients was (782 ± 736) pg/mL, which was significantly lower than healthy subjects (1462±315) pg/mL and seasonal influenza patients (1481 ±348) pg/mL (F=5. 730, P＜0.01). Additionally, the viral clearance period was inversely correlated with the percentage of Th17 cells (r=-0.38, P=0.02). Conclusions The proportion of Th17 cells in patients with H1N1 influenza A is significantly decreased, which is closely correlated with the level of TGF-β. This decrease may results in the delayed viral clearance.

Objective To assess the validity of a newly developed in-house ELISPOT IFN-γ release assay (IGRA) for the detection of latent tuberculosis infection among HIV infected individuals. Methods In-house ELISPOT assay were performed, together with a tuberculin skin test in 205 health controls and 110 HIV infected individuals , who had no signs of active tuberculosis at time of enrolment . Results Using the ELISPOT assay, positivity rates for the 205 health controls, 110 HIV infected individuals and 47 AIDS patients on highly active antiretrovial therapy (HAART) were 7. 3% , 24.5% , 29. 8% , respectively. These results indicated that the positive rates obtained from HIV infected individuals (include patient on HAART) was significantly higher than health controls( P ＜ 0.001). We found no significant correlation between the CD4 cell count and positivity of ELISPOT assay (P ＞0.05 ). The proportion of subjects with a positive response to ELISPOT assay were higher than the proportion of tuberculin skin test(TST) responders(P＜0.0001) in HIV infected individuals. Conclusion Our study indicates that IGRA using M. tuberculosis specific antigens are likely to retain their validity for the diagnosis of LTBI among HIV positive individuals.

Objective To explore the resilience status and its influencing factors of rescue nurses in Wenchuan earthquake, so as to provide evidence for future psychological intervention and psychological rehabilitation. Methods Totally 736 nurses who took part in the rescue works of the great Wenchuan earthquake were selected as the research objects. They were surveyed by a self-designed general information questionnaire and the Connor-Davidson resilience scale (CD-RISC) in order to understand the psychological resilience factors of rescue nurses in Wenchuan earthquake. Results Total score of CD-RISC of 736 rescue nurses was (59.03±20.67) points, scores of tolerance, strength and optimism were (29.64±11.58), (20.55±6.70), (8.83±3.50) points, respectively. Univariate analysis showed that rescue nurses had different posttraumatic growth who had different gender, cultural level, household income monthly per capita, financial loss in the disaster, rescue place, physical health status, satisfaction with houses, satisfaction with leaders and colleagues, friends and relatives. Multiple linear regression analysis showed that household income monthly per capita, satisfaction with leaders and colleagues, title and physical health status could affect the total score of CD-RISC (adjust R2=0.157, F=12.163, P<0.01). Conclusions After 6 years of earthquake, the resilience of rescue nurses in disaster areas is at moderate level and needs to be improved. Household income monthly per capita, satisfaction with leaders and colleagues, title and physical health status are independent factors affecting rescue nurses' resilience. It is suggested to pay attention to such high-risk groups, and give them positive and effective psychological intervention to improve the resilience level of disaster relief nurses.

Purpose: Oligometastatic non–small cell lung cancer (NSCLC) patients have been increasingly regarded as a distinct group that could benefit from local treatment to achieve a better clinical outcome. However, current definitions of oligometastasis are solely numerical, which are imprecise because of ignoring the biological heterogeneity caused by genomic characteristics. Our study aimed to profile the molecular alterations of oligometastatic NSCLC and elucidate its potential difference from polymetastasis. Materials and Methods: We performed next-generation sequencing to analyze tumors and paired peripheral blood from 77 oligometastatic and 21 polymetastatic NSCLC patients to reveal their genomic characteristics and assess the genetic heterogeneity. Results: We found ERBB2, ALK, MLL4, PIK3CB, and TOP2A were mutated at a significantly lower frequency in oligometastasis compared with polymetastasis. EGFR and KEAP1 alterations were mutually exclusive in oligometastatic group. More importantly, oligometastasis has a unique significant enrichment of apoptosis signaling pathway. In contrast to polymetastasis, a highly enriched COSMIC signature 4 and a special mutational process, COSMIC signature 14, were observed in the oligometastatic cohort. According to OncoKB database, 74.03% of oligometastatic NSCLC patients harbored at least one actionable alteration. The median tumor mutation burden of oligometastasis was 5.00 mutations/Mb, which was significantly associated with smoking, DNA damage repair genes, TP53 mutation, SMARCA4 mutation, LRP1B mutation, ABL1 mutation. Conclusion Our results shall help redefine oligometastasis beyond simple lesion enumeration that will ultimately improve the selection of patients with real oligometastatic state and optimize personalized cancer therapy for oligometastatic NSCLC.