Objective To evaluate the effects of 6% hydroxyethyl starch (HES)130/0.4 and 6% HES 200/0.5 on blood coagulation in patients undergoing major operation under general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing major operation under general anesthesia during which the blood loss was expected to be＞20%of blood volume were allocated randomly into 3 groups(n=20 each):Ⅰ control group(C);Ⅱ6% HES200/0.5 group (H) and Ⅲ HES130/0.4 group (V).In group H and V the patients Arterial blood samples were taken before(T1),immediately(T2)and 1 h after the end of fluid infusion(T3)for determination of hematocrit(Hct),platelet count(PLT)and prothrombin time(PT),platelet maximum aggregation test induced by 5 μmol/L ADP,and Sonoclot coagulation and platelet function analysis(gbACT,CR,PF,TP).Activated partial thromboplastin time(Am),coagulation factor Ⅷ (FⅧ)activity and von Willebrand factor(vWF)were measured only in group H and V.Results (1) PT and APTT were significantly prolonged after fluid infusion at T2 and T3 as compared with the baseline values at T1 in group H and V.(2)FⅧ activity and platelet maximum aggregation induced by ADP were significantly decreased at the end of fluid infusion at T2 as compared with the baseline at T1 but increased again at T3 in group H and V.(3)There was no significant change in Sonoclot coagulation parameters after fluid infusion as compared with the baseline except clot formation rate (CR)in group H and V.Conclusion Acute hypervolemic hemodilution with 6% HES130/0.4 or 200/0.5 has minimal effect on blood coagulation and there is no significant difference in blood coagulation changes induced by 6%HES130/0.4 and 200/0.5.

OBJECTIVE:To develop a simple but practical evaluation system of pharmacoeconomics.METHODS:The data base of this system was built up using the SQL Server 2000.Delphi was used as programming tool to develop an evaluation system of pharmacoeconomics.RESULTS:This system has good human-computer interfaces,including the interfaces of data input,cost-effectiveness analysis,cost-benefit analysis and cost-utility analysis.The sensitivity analytic results consisted of the computed results of simple analysis,bootstrap analysis and rank-order stability analysis.CONCLUSION:System testing indicates the system is simple in operation and reliable in analytical results,which thus deserves to be popularized.

[Objective]To evaluate the incidence of postoperative residual numbness and the factors that influenced numbness in lumbar canal stenosis(LCS).[Method]Eighty patients with LCS including 24 males and 32 females,who were 27～78 years of age with an average age of 61.3,were operated by posterior decompression,and followed 10 days,1 month,3 months,1 year and 2 years after operation.All patients were examined by neurological findings and residual symptoms.[Result]In LCS,there were 82.1% of patients who complained numbness preoperativety.The incidence of residual numbness was 43.6%,39.1%,36.6%,35.3% and 35.7% after 10 days,1 month,3 months,12 months and 24 months,respectively.The factors that influenced residual numbness were related to stenosis types;JOA score before operation and the type of spinal canal stenosis were independent of age and nerve root diameter.[Conclusion]The lower limbs numbness recovered within 1 month postoperatlvely.The incidence of postoperative residual numbness was 35.3% and 35.7% in LCS after 1 year and 2 years.It is speculated that the potential of recovery of neural tissue is important for lower limbs residual numbness.

Objective To analyze the CT, especially HRCT appearance of localized organizing pneumonia. Methods The CT scans of nine patients with histologically proved localized organizing pneumonia were studied retrospectively. Results The size of the lesions in nine cases varied from 2 to 4 cm( average 2.5 cm). Eight lesions were located in the peripheral lung parenchyma near the pleural surface. The lesions were detected as round in four, anomaly in five. The margin of six lesions had inward bow indentation. Infiltrating lesions in surrounding structures were found in four cases. Conclusion The CT, especially HRCT appearance of localized organizing pneumonia shows some features that can make most of them to be differentiated from other lesions.

Opioids can activate the pro-nociceptive channel by which the sensitivity to pain has been increased, which is called opioids induced hyperalgesia (OIH). The mechanism of OIH has not been identified, but it is possibly involved in the increased activity of central glutamatergic system, changed function of opioid receptors, roles of peripheral receptors, effects of endogenous neuropeptides, decreased function of inhibitory neurotransmission system, and changed elements in signal transduction pathway, etc.

BACKGROUND: Pathogenesis and pathophysiological changes of chronic compressive cervical myelopathy havenotbeen completely clarified.OBJECTIVE: To establish an animal model of experimental chronic compressive cervical myelopathy for the exploration of the pathological and electrophysiological changes after chronic spinal compression.DESIGN: A randomized and controlled observatory study using experimental animals as subjects.SETTING: An Animal Experimental Center of a University and an Orthopaedic Laboratory of Affiliated Hospital of a Military Medical University MATERIALS: The study was conducted in the Animal Experimental Center of Nantong Medical University and the Orthopaedic Laboratory of Shanghai Changzheng Hospital from June 2002 to April 2003. Sixty 12-week healthy Chinese rabbits of either gender with a bodymass between 2.5 kg and 3.0 kg were randomly divided into control group( n = 6) and study group( n = 54).METHODS: Titanic metal screw was put into C5 vertebra through cervical anterior approach for progressive compression to establish chronic cervical myelopathy model.MAIN OUTCOME MEASURES:Principal consequences: ①histological examination ;②electrophysiological examination. Secondary consequence:neural function evaluation.RESULTS: Totally 48 rabbits entered into result analysis, in which 6 rabbits from control group and 42 rabbits from study group. Modified Tarlov's motor function evaluation was 3 in 31 rabbits with compression signs, and 4 in 11rabbits without compression signs. The latency of N1 wave in cortical somatosensory evoked potentials (CSEP) was (9.11 ± 1.61 ), ( 11.36 ± 2.17)and (17.55 ± 3.73) ms respectively in animals of control group, animals of study group without compression signs and animals of study group with compression signs. The lantency of CSEP N1 wave was significantly longer in animals of study group with compression signs than that of the animals in the control group and study group without compression signs (P＜0.05).CONCLUSION: This animal model can simulate clinical invasion process of chronic compressive cervical myelopathy. The severer the spinal compression is, the more often the compression signs appear, the longer the lantency of CSEP N1 wave is, and the more serious the spinal pathological damages are.

Objective To explore imaging features of the lateral atlanto-dental interval (LADI) of atlanto-axial joint and its value in the diagnosis of atlanto-axial joint dislocation/subluxation. Methods Two hurdred and forty healthy volunteers without atlanto-axial joint dysfunction and 32 patients with torticollis and/or functional impairment at atlanto-axial joint were enrolled into this study. All subjects were examined with multi-slice CT in both neutral and max rotation positions to the left/right. Clinical endpoints including VBLADI, variance range of the VBLADI and asymmetric conditions were evaluated. x2 test is used to evaluate the variance of incidence of bilateral LADI asymmetry in different age groups, Pearson-test(2-tailed) is used to evaluate the correlation between VBLADI and rotary function of atlanto-axial joint,precise test of fourfold table is used to compare normal group with patient groups. Results ( 1 ) In the normal control group: asymmetry of bilateral LADI were observed in 204 among 240 (85.00%) healthy volunteers including 60 youngsters( ＜ 15 years) and 180 adults( ≥ 15 years). The median and P95% of |VBLADI| were 0.850 mm,2.450 mm in the young ( ＜ 15 years) and 0.700 mm,2.051 mm in the adult(≥15 years),there were 2 and 10 volunteers whose |VBLADI| ≥P95% in the young and in the adult respectively. There was no correlation between VBLADI( -2.146 to 2.114 mm,Median 0.000 mm) and LA(22.949° to 44.649°, Median 34.500°), RA (25.284° to 45.334°, Median 35.300° ), VLRA ( - 11.643°to 8.623 °, median 0.000 ° ) respectively in normal people ( r = - 0.030, - 0.005,0.026, P ＞ 0.05 ). ( 2 ) In the study with 32 patients including 25 youngsters( ＜ 15 years) and 7 adults( ≥ 15 years). Seventeen of 32 had atlanto-axial lateral subdislocation (AALSD),in 16 youngsters( ＜ 15 years), the median of the |VBLADI| was 3.350 mm and 14 cases |VBLADI| ≥2.450 mm;1 adult patient(≥ 15 years) had |VBLADI| ≥ 2.051 mm; 7 of 32 patients had atlanto-axial rotatory dislocation (AARD) including 4 youngsters |VBLADI| ＜2.450 mm,median 1.200 mm,3 adults |VBLADI| ＜2.051 mm,all of the 7 patients with AARD had unilateral parasol LADI in neutral position;8 of 32 patients had atlanto-axial complicated dislocation(AACD) including 5 youngsters |VBLADI| ≥2.450 mm,3 adults |VBLADI| ≥2.051 mm. There are more cases whose |VBLADI| ≥P95% in group AALSD and group AACD than in abnormal group( P<0.01 ), but there is no difference between group AARD and normal group( P = 0.738 ).Conclusion The imaging finding of "asymmetry of bilateral LADI" may be either a physiological variation or a pathological condition, clinical manifestations and other imaging findings should be evaluated to make a diagnosis.

Objective To elucidate the efficacy and safety of transcatheter closure of secondary atrial septal defect (ASD) with Amplatzer septal occluder (ASO) in people over 50 years of age. Methods Retrospective comparison of 41 patients (14 males, 27 females) with ASD over 50 years of age ranging from 50 to 75(mean age 55.5?7.6, elder group) was conducted with 132 patients younger than 50 years(control group). After diagnosis of ASDs and evaluation of pulmonary artery systolic pressure and right atrial and ventricular dimensions by transthoracic echocardiography (TTE), all patients underwent transesophageal echocardiography (TEE) for complete assessment of ASD size, margins and anatomic relationship of the defect before closure of ASD. Each case was treated with ASO through the percutaneous transcatheter procedure under fluoroscopy and TTE or TEE. Early follow up(3 months) by echo was taken after the intervention. Results There was no difference of mean defect diameter measured by TEE and the balloon-stretched defect diameter of the ASDs between 2 groups. Pulmonary artery pressures in elder group were higher than those in younger group(P

Objective To investigate the clinicopathological characteristics and prognosis in patients with node-negative gastric cancer.Methods Between January 2004 and December 2013,clinicopathological characteristics of 300 patients with node-negative gastric cancer who underwent radical gastrectomy in Tianjin Medical University General Hospital were retrospectively analyzed.Results The 1-,3-,and 5-year overall survival rates for patients with node-negative gastric cancer was 80％,69％ and 63％ respectively.The univariate analysis showed that tumor size,histologic type and depth of invasion had significant effects on the survival (P ＜ 0.05).Multivariate analysis for these factors showed that tumor size (RR:1.800,95 ％ CI:1.120-2.891,P =0.015),histologic type (RR:1.982,95 ％ CI:1.291-3.042,P =0.002) and depth of invasion (RR:1.464,95％ CI:1.213-1.767,P =0.000) were independent prognostic survival factors.Conclusions Tumor size,histologic type and depth of invasion are important prognostic factors of patients with node-negative gastric cancer.

Objective To compare the accuracy of jugular venous oxygen saturation (SjvO2),somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) in estimation of the occurrence of intraoperative cerebral ischemia in patients undergoing clipping of intracranial aneurysm.Methods Forty-three ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with a body mass index of 20-25 kg/m2,undergoing clipping of intracranial aneurysm,were studied.Anesthesia was induced with sufentanil,rocuronium and propofol.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with remifentanil and propofol.Blood samples were taken from the jugular bulb for detection of SjvO2 before aneurysm clipping or temporary occlusion of parent artery and at 1,3,10,20 and 30 min after clipping aneurysm or temporary occlusion of parent artery.The amplitude and latency of SSEPs and MEPs were recorded simultaneously.The occurrence of cerebral ischemia estimated by SjvO2,SSEPs and MEPs was recorded.The condition of nerve defect was recorded within 3 days after operation and the gold standard of cerebral ischemia was defined as the occurrence of nerve defect.Results Among 43 patients,14 cases were diagnosed as having brain ischemia.The sensitivity and specificity of SjvO2 in estimation of the occurrence of intraoperative brain ischemia were 71％ and 93％,respectively (P ＜ 0.01).The sensitivity and specificity of SSEPs in estimation of the occurrence of intraoperative brain ischemia were 71％ and 62％,respectively (P ＜ 0.05).When the diagnostic criterion of cerebral ischemia was defincd as a decrease in the amplitude of MEPs or prolongation of the latency MEPs,the sensitivity and specificity of MEPs in estimation of the occurrence of intraoperative brain ischemia were 79 ％ and 52 ％,respectively (P ＞ 0.05).When the diagnostic criterion of cerebral ischemia was defined as a loss of the amplitude of MEPs,the sensitivity and specificity of MEPs in estimation of the occurrence of intraoperative brain ischemia were 57％ and 93％,respectively (P ＜0.05).Conclusion The sensitivity of SjvO2 and SSEPs in estimation of the occurrence of intraoperative brain ischemia is higher,however,the specificity of SjvO2 and MEPs is higher,indicating that SjvO2 is a reliable criteria for estimation of the occurrence of intraoperative brain ischemia in patients undergoing clipping of intracranial aneurysm.