Objective To investigate the changes in cerebral cAMP and PKA levels during development of acute opioid tolerance induced by remifentanil and to determine whether post-receptor cAMP/PKA signaling pathway is involved in the process. Methods Fifty-six male Kunming mice weighing 25-35 g were randomly divided into 5 groups: group Ⅰ control (C) (n=8); group Ⅱ received morphine infused intraperitoneally (IP) at 0.6 μg'kg-1·min-1 for 120min(M) (n=8); group Ⅲ,Ⅳ,Ⅴ received remifentnil infused IP at 0.4, 0.8 and 1.6 μg·kg-1·min-1 for 120 min(R1=8, R2n=8; R3 n=24).Control group received IP infusion of normal saline. Tail-flick test was performed td measure the response of animals to a thermal nociceptive stimulus before IP infusion, at 30, 60, 90 and 120 min after beginning of IP infusion and at 15, 30, 45 and 60 min after termination of IP infusion. Eight animals were decapitated at 60 min after termination of IP infusion in all 5 groups and the other 16 animals in group R3 were decapitated at 30 and 45 min after termination of IP infusion (n=8 each) for determination of intracellular contents of cAMP and activities of PKA in cerebral cortex and inferior colliculus-striatum by ELISA or radioactive isotope [32p,] ATP-catalyzing assay. Results The tail-flick latency was significantly prolonged during IP infusion as compared with the baseline before infusion in group M, R1 , R2 and R3 but became significantly shorter at 30 and 45 min after infusion than the baseline values in group R1, R2 and R3indicating hyperalgesia after remifentauil infusion. The cerebral contents of cAMP and PKA activities at 60 min after termination of infusion were comparable or decreased in group M, R1, R2 and R3 as compared with group C. There was no significant difference in cerebral cAMP contents and PKA activities at 30, 60 and 45 min after IP remifentanil infusion in group R3. Conclusion Remifentanil can induce acute hyperalgesic effect on mice, and there is no up-regulation of post-receptor cAMP/PKA signaling pathway in the acute opioid tolerance, which is not similar to that chronic opioid tolerance.

Objective To explore hospice home care method of dying children.Methods In 58 cases of dying children at home were given personalized hospice care plan,then the questionnaire were adopted to investigate the related indexes and the results were analyzed.Results In home hospice care,parents had a high recognition and satisfaction to children's pain management and symptom care.The parents with different education background had significant difference in recognition extent of psychological support,games support and death education.The parents anxiety and depression mood got effective mitigation through hospice home care of dying children.Conclusions Implementation of personalized home hospice care can increase life quality of dying children and improve adverse mood of their parents.

Objective To explore the clinical curative effect of irinotecan HCL trihydrate combination with cisplatin in treatment of non.small-cell carcinoma(NSCC)by observing the clinical curative effect,adverse reactions and the improvement of the quality of life post therapy.Methods 120 patients with NSCC were divided into two groups.60 cases in control group were treated with cisplatin and topotecan while ifinotecan HCL tfihydrate combination with cisplatin chemotherapy for 60 case of patients in observation group.The curative effect and Kamtfsky point were observed.Results The effective rate of observation group was 56.7%,which was significantly higher than that of the control group(41.7%),and differences between the two groupswas statistically significant(P＜0.05).Average survival time for treatment group was(9.3±4.2)months that was longer than that of the control group[(7.2±3.2)months](P＜0.05).The result of Kamofsky classification standard after chemotherapy also indicated the same situation(P＜0.05).Conclusion Irinotecan HCL trihydrate combining with cisplatin in treatment of non-small cell lung cancer had a effective therapy result and could reduce the toxicity.as well as improving the quality of life of the patients.

Objective To discuss the cleaning effect of biofilm cleaners for the endoscopic equipment,in order to clean the endoscopic equipment in the operation room thoroughly,improve the cleaning quality of surgical instruments in hospital and prevent nosocomial infection.Methods 300 polluted endoscopic equipments were selected in the operation room and were divided into the experimental group and the control group randomly.Then the two groups were dealt with biofilm cleaners and multi-enzyme detergent respectively.At the end of the cleaning step,the cleaning effect were compared between the two groups.Results The passing rate of cleaning in the experimental group was 96.8％,significantly better than that of the control group,which was 78.0％.The difference between two groups had statistical significance.Conclusions Cleaning endoscopic equipment with biofilm cleaners can improve the cleaning effect of the surgical instruments,ensure the cleaning quality of the surgical instruments.

Non-muscle invasive bladder cancer (NMIBC) represents the malignant tumor of urinary bladder which is limited to mucosa and submucosal.NMIBC has high recurrence,and can progress to muscle invasive bladder cancer.Adjuvant intracavitary perfusion is beneficial for patients after surgery.There are many drugs for intravesical instillation in clinic.However,the new bladder perfusion drug which is safer and more effective,is always a research hotspot.

Objective To investigate the circulatory levels of hormones and cytokines in the patients with the chronic heart failure(CHF)and the effect of naftopidil.Methods The levels of tumor necrosis factor-?(TNF-?),interleukin-1(IL-1),interleukin-6(IL-6),endothelin-1(ET-1),adrenomedullin(Adm),neuropeptide Y(NPY),calcitonin gene-related peptide(CGRP),atrial natriuretic peptide(ANP),brain natriuretic peptide(BNP)and C-type natriuretic peptide(CNP),and left ventricular fraction(LVEF)of 47 patients with CHF(CHF group)and 24 healthy subjects(control group)were measured by radioimmunoassay or echocardiography respectively.The patients were randomized to receive naftopidil(50mg Bid)in addition to routine therapy(B group,n=23)or routine therapy only(A group,n=24)for one-month.Results (1)The levels of TNF-?,IL-1,IL-6,ET-1,Adm,NPY,ANP,BNP and CNP of the CHF group were higher(P 0.05)in the levels of IL-1,IL-6,Adm,CNP and LVEF.(4)There were significantly inverse correlations between LVEF and TNF-?,ET-1,IL-6 or BNP(P

Objective To investigate the insulin injection-related knowledge of the registered nurses in first-class general hospitals in Shanghai and look into its influence factors. Methods Totally 331 nurses in the hospitals were enrolled in this study. Univariate and multivariate stepwise regression were used to analyze the factors which influenced the insulin injection-related . Results The aggregate score of insulin injection-related knowledge was 54.20 ± 7.64, and the score index was 67.75%. Multiple linear regression analysis showed that such factors as professional title and nursing experience and training in the endocrinology department were the main factors of insulin injection-related knowledge (all P<0.05). Conclusion We should enhance the training to promote the injection skills so that they can assist the patients to effectively control blood sugar and improve the quality of life.

Amyotrophic lateral sclerosis(ALS)is a rare progressive motor neuron disease.Sialorrhoea is one of the common symptoms which influenced the patient's quality of life.This paper reviewed the treatments for sialorrhoea in ALS patients.

Objective To evalute the effects of subcutaneous transfection of human beta-nerve growth factor (Ad-hNGFβ) gene on the function of sensory nerve in a rat model of diabetic neuropathic pain (DNP).Methods Healthy male Sprague-Dawley rats,weighing 180-220 g,were used in this study.Ten rats were randomly collected as normal control without DNP (group C).DNP model was established by intraperitoneal injection of streptozocin (STZ) 75 mg/kg.Seventy-five rats with DNP were randomly divided into 3 groups (n =25 each):DNP group; Ad-hNGF group and Ad-LacZ group.Groups Ad-NGF and Ad-LacZ received subcutaneous transfection of 1.12 × 1011 PFU Ad-hNGFβ 10 ul and 1.12 × 1011 PFU Ad-LacZ 10 ul respectively after pain thresholds were measured on 21 days after STZ injection.The mechanical and thermal pain thresholds were measured before STZ injection (baseline) and at 21,35 and 49 days after STZ injection.The conduction velocity and latency of the sensory nerve and the expression of substance P (SP) in dorsal root ganglion (by immmuno-histpchemistry) were determined after measurement of pain threshold on 49 days after STZ injection.Results Compared with group C,the mechanical and thermal pain thresholds were significantly increased at each time point after STZ injection in groups DNP,Ad-NGF and Ad-Lacz,the conduction velocity of the sensory nerve was significantly decreased,the latency of the sensory nerve was prolonged,and the expression of SP in dorsal root ganglion was down-regulated in groups DNP and Ad-LacZ,the conduction velocity of the sensory nerve was significantly decreased (P ＜ 0.05),and no significant change was found in the latency of the sensory nerve and expression of SP in dorsal root ganglion in group Ad-NGF (P ＞ 0.05).Compared with group DNP,the thermal pain threshold was significantly increased at 49 days after STZ injection,the conduction velocity of the sensory nerve was decreased,the latency of the sensory nerve was shortened,and the expression of SP in dorsal root ganglion was down-regulated (P ＜ 0.05 or 0.01),while no significant change was found in the mechanical pain threshold in group Ad-NGF,and no significant change was found in the parameters mentioned above in group Ad-LacZ (P ＞ 0.05).Conclusion Subcutaneous transfection of Ad-hNGFβ can improve the function of sensory nerve in a rat model of DNP through up-regulat-ing of the SP expression in dorsal root ganglion.

AIM： To give some information for rational administration of oral antiepileptic drugs to epileptic patients in clinic METHODS： The serum concentrations of oral phenytoin sodium， phenobarbital and carbamazepine were determined in 88,63 and 63 epileptic patients（ total 214 times） by fluorescence polarization immunoassay， respectively The individualized drugs administration schemes were provided RESULTS： The sensitivity to the three kinds of antiepileptic drugs varied in different patients CONCLUSIONS： The administration of oral antiepileptic drugs to epileptic patients must be based on the data of drug concentration in serum We must comprehensively consider the other factors