Objective Through the effect comprison of analgesic calm and side-effect on postoperative analgesia under different concentration dexmedetomidine with butorphanol,to research the best concentration of dexmedetomidine on postoperative analgesia.Methods Ninety patients with lower abdominal surgery with general anesthesia,ASA Ⅰ-Ⅱ grade,were divided into 3 groups by random digits table:group A,group B and group C,each group with 30 cases.The group A received 0.2 μg/ (kg·h) dexmedetomidine.The group B received 0.3 μg/ (kg ·h) dexmedetomidine,both added 0.15 mg/kg butorphanol and 8 mg ondansetron.The group C only received 0.15 mg/kg butorphanol and 8 mg ondansetron.Applied patient controlled intravenous analgesia (PCIA) pump continuous infusion gave total 100 ml,background infusion 2 ml/h,patient controlled analgesia (PCA) 2 ml,lock time 30 min,analgesia was continued 48 h.Below were recorded at 2,6,12,24 and 48 h after the beginning of PCIA:analgesia VAS score,ramsay sedation scale (RSS),adverse reaction.The total number of button pressing of PCA and the consumption of patient controlled liqnid analgesia (PCLA) solution were also recorded.Results There was no statistically significant difference in VAS score after each time point between group A and group B (P＞ 0.05).The VAS scores after each time point in group A and group B were significantly lower than those in group C [(2.7 ±0.8),(2.6 ± 0.8) scores vs.(3.2 ± 0.9) scores; (1.8 ± 0.6),(1.7 ± 0.6) scores vs.(2.5 ± 0.6) scores; (1.0 ±0.6),(0.9 ±0.7) scores vs.(1.8 ±0.6) scores; (1.0 ±0.5),(0.8 ±0.5) scores vs.(1.4 ±0.5) scores; (0.7 ±0.5),(0.7 ±0.4) scores vs.(1.0 ±0.5) scores,P ＜0.05].There was no statistically significant difference in RSS score among 3 groups (P ＞ 0.05).The RSS scores after 6,12,24 and 48 h in group A and group B were significantly higher than those in group C [(2.6 ±0.5),(3.5 ±0.6) scores vs.(2.0 ±0.3) scores; (2.9 ± 0.6),(3.8 ± 1.2) scores vs.(2.4 ± 0.3) scores; (2.8 ± 0.7),(3.9 ± 0.7) scores vs.(2.5 ± 0.4)scores; (2.8 ± 0.6),(3.9 ± 0.6) scores vs.(2.5 ± 0.5) scores,P ＜ 0.05],group A was significantly higher than those in group B (P＜ 0.05).There was no statistically significant difference in rate of hypoxemia among 3 groups (P ＞ 0.05).The rates of nausea and vomit,deliration in group A and group B were significantly lower than those in group C [3.3％(1/30),0 vs.10.0％(3/30) ;0,0 vs.10.0％(3/30),P＜ 0.05].The rates of hypotension and bradycardia in group B were significantly lower than those in group A and group C[16.7％ (5/30) vs.3.3％(1/30),0;20.0％(6/30) vs.3.3％(1/30),0,P＜ 0.05].The total number of button pressing of PCA 24 h and the consumption of PCLA solution in group C were significantly higher than those in group A and group B [(13.9 ±2.4) times vs.(9.7 ±2.2),(7.4 ± 1.5) times; (60.9 ± 1.8) ml vs.(54.5 ± 1.2),(50.7 ± 0.7) ml,P ＜ 0.05].Conclusion Concentration 0.2 μ g/(kg· h) dexmedetomidine with butorphanol has better effects on postoperative analgesia and calm,less side-effect.

Objective To evaluate the optimal surgical approach for huge liver neopiasms in the caudate lobe.Methods Thirty-three patients with huge liver neplasms（≥10cm) underwent caudate lobectomy at a single tertiary referral center between January 2001 and June 2007.The surgical out-comes of pateints who underwent isolated caudate lobectomy or caudate lobectomy combined with partial hepatectomy were compared.Result Fifteen（45.5％）of 33 patients underwent isolated total or partial caudate lobectomy（group A）,whereas 18（54.5％) had total or partial caudate lobectomy cellular carcinoma (HCC) (51.5％),followed by hemangioma(21.2％),intrahepatic cholangiocarcinoma(9.1％),angiomyolipoma(6.1％),hepatic adenoma (3％),focal nodular hyperplasia(3％),colorectal liver metastases(3％)and sarcoma(3％).The median diameter of the tumour was 12.3 (range,10.2-21)cm.Patients in group A had significantly longer operative time (280 minutes vs.170 minutes),longer length of hospital stay (17 days vs.12 days)and more blood loss(1250 ml vs.670 ml) than patients in group B.There was no perioperative death in the 2 groups of pateints.Complication rates in group A and group B were 26.7％ and 16.7％ respectively.There was no disease-related death in patients with benign lesions.The1-,3- and 5-year disease-free survivals of patients with malignant lesions in group A and group B were 25.9％,0％,0％and 74.3％,46.7％,31.2％,respectively.The 1-,3- and 5-year overrall survivals were 68.6％,19.7％,0％ and 100％,66.5％,41.8％,respecively.Conclusion The approach to caudate lobectomy depends on the size and location of the lesion and the liver functional reserve.For patients with sufficient liver functional reserve,caudate lobectomy combined with partial hepatectomy is preferred because it is technically less demanding.For patienls with marginal liver functional reserve,isolated caudate lobectomy is the only viable surgical option.

Objective To evaluate the effects of electrocautery assisted uvalopalatopharyngoplasty (UPPP) for obstructive sleep apnea and hyponea syndrome(OSAHS) .Methods Patients with OSAHS were randomly divided into two groups ,with 14 cases in each group .Group A was operated on with electrocautery ,while group B was operated on with the traditional method .The operative blood loss ,the operation time ,the tunica albuginea off time ,post operative pain ,surgical outcomes and complications were compared between two groups .Results The operative blood loss and the operation time of group A were much less than in group B (all P<0 .05) ,while no difference in the tunica albuginea off time ,post operative pain and surgical outcomes was found (P>0 .05) .Two groups of patients both had no serious complications .Conclusion The advantages of electrocautery assisted UPPP consists of less operative blood loss and less operation time .It deserves to generalize and apply in the future clinical treatments .

BACKGROUND: There have been some foreign studies on the general anatomy of meniscus, while domestic materials about adult normal meniscus are few.OBJECTIVE: To measure the various data of adult meniscus, so as to provide anatomical basis for clinical meniscal sport injury.DESIGN: Repetitive measurement design.SETTING: Department of Scientific Research, Chengdu Medical College.MATERIALS: This experiment was carried out in the Laboratory of Local Anatomy, Department of Human Anatomy, Chengdu Medical College during September 2003 to September 2005. Totally 94 adult knee joint samples, without any diseases were harvested from 94 patients, including 48 male and 46 female.METHODS: Skin of knee joint, subcutaneous tissue and muscle were removed. Tendon of musculus quadriceps fexoris was cut above the whirbone. Articular capsule was open, and incisions were made and prolonged to the posterior wall of articular capsule. Anterior and posterior cruciate ligaments were exposed and cut near the starting point of anterior cruciate ligaments. Fat pad of articular capsule was carefully cleaned. Various data of adult medial and lateral meniscus before and after ex vivo were measured up and down.MAIN OUTCOME MEASURES: Measurement before ex vivo: ① The largest sagittal diameter, the length of outer arc, the width of anterior angle, caudomedial part and posterior angel of medial meniscus. ②The largest sagittal diameter, the length of outer arc, the largest transverse diameter, aperture length ( distance between anterior and posterior angel border of lateral meniscus), the width of anterior angle, caudomedial part and posterior angle of the lateral meniscus. Measurement after exvivo: ①The largest sagittal diameter, the length of outer arc, the width of anterior angle, caudomedial part and posterior angel as well as the thickness of lateral border, center and free edge of anterior angle, caudomedial part and posterior angel of medial meniscus. ② The largest sagittal diameter, the length of outer arc, the largest transverse diameter,aperture length, the width of anterior angle, caudomedial part and posterior angel as well as the thickness of lateral border, center and free edge of anterior angle, caudomedial part and posterior angel of lateral meniscus. RESULTS: ①The measuring data of medial and lateral meniscus of female samples were a little smaller than those of male samples. The measuring results of medial and lateral meniscus of male samples were basically consistent with the observed results. ②The anterior angle, caudomedial part and posterior angle of medial and lateral meniscus were gradually thinned from lateral border to interior free edge, and they were filled in the plateau between medial or lateral condyles and tibia in wedge shape. ③ Medial meniscus presented "C" or crescent shape. An terior angle adhered to the anterior intercondylar fossa of tibia which located in the front of the attachment point of anterior cruciate ligament, and posterior angle adhered to posterior intercondylar fossa of tibia which located in the rear of posterior angle of lateral meniscus and in the anteriomedialis of the attachment point of posterior cruciate ligament; There was no obvious changes in the length of outer arc of medial meniscus be- fore ex vivo (t=1.98,P ＞ 0.05). ④The lateral meniscus presented "0" shape a little , and anterior angle adhered to the front part of nodus among condyles of tibia and the rear of anterior cruciate ligament, and the posterior angle adhered to the rear of lateral intercondylar tubercle which located in the front of attachment point of posterior angle of medial menisus; There were no obvious changes in the length of outer arc of lateral meniscus before and after ex vivo (t=0.61,P ＞ 0.05), but ob vious changes existed in the width of anterior angle, caudomedial part and posterior angel of medial meniscus (t=2.49,P ＜ 0.05). CONCLUSION: The obtained measuring data of meniscus provide referencing basis for clinical meniscal sport injury.

Objective To evaluate the techniques and the effects of resection of giant hepatic tumors in the caudate lobe of the liver. Methods The clinical data of 33 patients with primary liver carcinoma or benign tumor (>10 cm) in the caudate lobe of the liver surgically treated in our hospital from January 2000 to January 2007 were retrospectively analyzed. Results The total of 33 huge liver tumors with a median diameter of 12.3 cm (10.2-15.3cm) were successfully resected. The types of the hepatectomies conducted were as follows:isolated total caudate lobectomy in 7cases, partial cau-date lobectomy in 8, caudate lobectomy plus other extended hepatectomy in 18. The median operative time was 218 min (120-360 min) and the median intraoperative blood loss 958 ml (400-7000 ml),with operative mortality and morbidity being 0 and 27%, respectively. The postoperative 1-, 3- and 5-year survival rates for the patients with primary liver cancer were 76 %,52% and 24%, respectively. Con-clusion The hepatic tumors of caudate lobe, when larger than 10 cm in diameter, frequently involves all the hepatic portal,hepatocaval confluence and retrohepatic IVC. Though it is sophisticated in tech-nique, surgical resection of this kind of tumor is safe, effective and of the first choice.

Objective To clinically observe and verificate the advantages of treating infantile anorexia of spleen-dysfunction in transportation with infantile massage and Chinese medicine based on the thought of “invigo-rating spleen and nourishing qi”. Methods Multi-central large-sample randomized controlled trial was carried out in Guangzhou, Shenzhen, and Foshan. Five hundreds cases of infantile anorexia of spleen-dysfunction in transportation were randomized into infantile massage group, Chinese medicine group, infantile massage combined with Chinese medicine group and Western medicine group and two sessions of treatment were required in each group. Separately, during the enrollment, after 2 sessions of treatment, infantile anorexia signs and symptoms scale , the related therapeutic effect criterion from clinical guideline of new drugs for traditional Chinese medicine, the expression level of hemoglobin and blood zinc were adopted for efficacy assessment. Results A mong 4 groups , the recovery rate and the total effective rate of infantile massage combined with Chinese medicine group were better than those of other groups (P < 0.05). The expression level of hemoglobin and blood zinc of 4 groups both increased obviously (all P < 0.01), but more improvement was found in infantile massage combined with Chinese medicine group (both P < 0.05). Conclusion The treatment of infantile anorexia with infantile massage and Chinese medicine based on the thought of invigorating spleen and nourishing qi has a significant effect.

Objective To investigate effectiveness of meta-cognitive intervention on aged people with middle depression. Methods Geriatrist Depression Scale(GDS) and Hamilton's Depression Scale ( HAMD-17 ) were used to screen out 70 aged people with middle depression from 850 retired soldier cadres dwelling in cpla dalian sanitarium. They were randomly divided into study group( n = 35 ) and control group( n = 35 ). The experimental group received meta-cognitive intervening and general nursing care for 8 weeks, while the control group only received general nursing care for 8 weeks. HAMD-17, GDS, global assessment scale(GAS) and the Metacognitions Questionnaire(MCQ-30) were administered both at the start and the end of the 8th week. Results The total scores in HAMD and GDS were decreased significantly in study group ( HAMD: ( 1 1.54 ± 2.50 ) vs ( 13.06 ±2.82),t= -2.378, P=0. 020;GDS:(12.51 ±2.43) vs (16.06 ±2.48), t= -6. 031, P=0. 000;GAS:(77.71 ±3.03) vs (75.63 ± 3.24), t = 2. 785, P = 0. 007 ). At the end of 8th week, the MCQ total score was significantly decreased in study group (38.69 ± 4. 17,81.37 ± 5.98, t = 34. 652, P ＜ 0. 01 ). Conclusion For aged people with middle depression,good effects are got by the meta-cognitive intervening technique and meta-cognitive intervening technique improve the meta-cognitive level of aged people with middle depressive mood.

Objective:To investigate the efficiency and pharmacoeconomics of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) for mobilization of peripheral blood stem cells (PBSCM) in patients with multiple myeloma (MM).Methods:The data of 91 patients with newly treated MM who were hospitalized in the First Hospital of Jilin University and Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College from January 2015 to October 2017 were retrospectively analyzed. According to the patient's wishes, a high-dose chemotherapy combined with subcutaneous injection of PEG-rhG-CSF or recombinant human granulocyte colony-stimulating factor (rhG-CSF) was used for stem cell mobilization in 42 and 49 patients, respectively. The number of mononuclear cells (MNC) and CD34 + cells collected after mobilization, the maximum absolute neutrophil count (mANC), the cost of mobilization, and the engraftment time of white blood cells and platelets after transplantation were compared between the two groups. Results:The median number of MNC collected after mobilization in the PEG-rhG-CSF group and rhG-CSF group were 5.86×10 8/kg [(1.08-24.54)×10 8/kg] and 6.61×10 8/kg [(0.83-33.80)×10 8/kg], and the difference was not statistically significant ( U = 883.00, P = 0.245); while the median number of CD34 + cells collected after mobilization in the PEG-rhG-CSF group was higher than that in the rhG-CSF group [5.56×10 6/kg (0.94-19.90)×10 6/kg and 4.82×10 6/kg (1.12-14.61)×10 6/kg], and the difference was statistically significant ( U = 732.00, P = 0.038). The median number of mANC during mobilization in the PEG-rhG-CSF group was lower than that in the rhG-CSF group [20.50×10 9/L (7.26-61.30)×10 9/L and 32.08×10 9/L (6.92-69.99)×10 9/L], and the difference was statistically significant ( U = 490.00, P = 0.001). After autologous stem cell transplantation (ASCT), the time-to-recovery of white blood cell count (WBC) to 1.0×10 9/L in the PEG-rhG-CSF group was shorter than that in the rhG-CSF group [(11.59±1.98) d vs. (12.93±2.83) d], and the difference was statistically significant ( t = -2.395, P = 0.019), and the time-to-recovery of platelet count (Plt) to 20.0×10 9/L in the PEG-rhG-CSF group was also shorter than that in the rhG-CSF group [(12.86±2.62) d vs. (14.80±5.47) d], but the difference was not statistically significant ( t = -1.749, P = 0.085). The total mobilization cost of the PEG-rhG-CSF group was not statistically different from that of the rhG-CSF group [(21 405.47±7 365.98) yuan vs. (22 976.83±10 264.34) yuan, t = -0.721, P = 0.474]. Conclusions:PEG-rhG-CSF combined with high-dose chemotherapy is an effective option for PBSCM in MM patients, and its mobilization cost is equivalent to rhG-CSF. Therefore, PEG-rhG-CSF may be a better choice for PBSCM in MM patients.

Objective The aim of this study was to investigate whether the addition of neoadjuvant chemoradiotherapy ( NACRT ) to surgery can improve outcomes better than neoadjuvant chemotherapy in terms of rate of R0 resection, pathological complete response ( pCR ) and side effects. Methods This exploratory study included primary gastric adenocarcinoma patients staged as clinical T4N0 or anyTN1-3. Intensity modulated radiotherapy was delivered of 40 to 50 Gy in 22 to 25 fractions,5 days/week.Concurrent chemotherapy regimens included S-1 or Capecitabine or a combination of Paclitaxel plus Carboplatin.Results Eleven eligible patients were enrolled. R0 and R2 resections were performed in 9 ( 9/11) and 1 patients, respectively.Peritoneal metastasis was found in 1 case during exploratory laparotomy.The pCR was observed in 1 patient with R0 resection ( 1/10 ) . Ten cases completed radiotherapy and 8 cases completed chemotherapy. Nausea ( 3/11 ) , vomit ( 2/11 ) and anorexia ( 2/11 ) were the most common Grade 3 toxicities. Conclusions NACRT showed an acceptable toxicity and promising activity in locally advanced gastric adenocarcinoma.

Objective To investigate the effects of different irradiation techniques on dose distribution in target volume and normal tissues after the radical surgery for gastroesophageal junction adenocarcinoma,and to provide the optimal regimen for clinical treatment.Methods A total of 9 patients with gastroesophageal junction adenocarcinoma who underwent radical esophagus-proximal gastrectomy or total gastrectomy were enrolled.The therapeutic regimens of five-field static intensity-modulated radiotherapy (IMRT),volumetric-modulated arc therapy (VMAT),and helical tomotherapy (HT) were designed for each patient,and the dose-volume histogram was used to evaluate the effects of different irradiation techniques on the conformity index (CI) and homogeneity index (HI) of target volume and the surrounding normal tissues. The prescribed dose was 45 Gy at 1.8 Gy/fraction.The patients received oral S-1 as concurrent chemotherapy at a dose of 80 mg/(m 2? d) twice a day during radiotherapy.Results Compared with IMRT and VMAT,HT had better CI and HI of the target volume,as well as a better protective effect on the intestinal tract and bone marrow.Compared with IMRT and HT,VMAT had a lower V20 and V30 for the left kidney and a lower V30 for the heart,while IMRT had lower V5 and V10 for both lungs;V20 and mean dose showed no significant differences between the three techniques.HT had the highest mean sub-field hop count,followed by IMRT and VMAT.Conclusions IMRT, VMAT, and HT can meet the clinical requirements,but besides ensuring the best CI and HI of the target volume,HT has a good protective effect on the intestine and spinal cord and can help to reduce the incidence of adverse events in patients.