Objective To investigate the effects of parecoxib and morphine on remifentanil-induced postoperative hyperalgesia in patients undergoing orthopedic operation. Methods Sixty ASA Ⅰ or Ⅱ patients,aged 20-62 yr, weighing 45-100 kg, undergoing orthopedic surgery, were randomly divided into 3 groups ( n = 20 each). Anesthesia was induced with midazolam, propofol, remifentanil and rocuronium. The patients were mechanically ventilated after tracheal intubation. Group Ⅰ received iv injection of morphine 0.15 mg/kg, group Ⅱ received iv injection of parecoxib 20 mg and morphine 0.075 mg/kg and group Ⅲ received iv injection of parecoxib 40 mg and morphine 0.075 mg/kg. Anesthesia was maintained with infusion of propofol and remifentanil and intermittent iv boluses of vecuronium. The emergence time, consciousness recovery time, extubation time,incidence of agitation and shivering, and VRS score at 5 min after recovery of consciousness were recorded. Pain at rest and at movement was evaluated using VAS score at 1,2, 4, 8, 12 and 24 h (T1-6) after surgery and MAP andHR were recorded simultaneously. The incidence of nausea and vomiting during 24 h after surgery was also recorded. Blood samples were taken before induction of anesthesia, at the end of operation and 24 h after operation for determination of plasma concentrations of PGE2 and TNF-α. Results There was no significant difference in emergence time, consciousness recovery time, extubation time, VRS scores, MAP, HR, incidence of agitation,shivering, nausea and vomiting among the 3 groups. Compared with group Ⅰ , VAS scores at rest at T1-2 and at movement at T1-6 were significantly increased in group Ⅱ , while VAS scores at rest and at movement decreased at T1-5 in group Ⅲ (P＜0.05). VAS scores at rest at T1-6 and at movement at T1-5 were significantly lower in group Ⅲ than in group Ⅱ (P＜ 0.05). There was no significant difference in the plasma concentrations of PGE2 and TNF-α at different time points between group Ⅰ and Ⅱ (P＞0.05). The plasma concentrations of PGE2 and TNF-α were significantly lower at the end of surgery in group Ⅲ than in group Ⅰ and Ⅱ (P＜0.05). Conclusion Preoperative iv parecoxib 40 mg and morphine 0.075 mg/kg can reduce remifentanil-induced postoperative hyperalgesia in patients undergoing orthopedic operation, and the efficacy is better than that of morphine alone.

Objective To discuss the postoperative complications of hypertensive intracerebral hemorrhage treated with freehand drilling skull minimally invasive puncture drainage therapy .Methods The clinical data of 158 patients with hypertensive intracerebral hemorrhage were retrospectively analyzed .The incidence rate ,causes and preventative measures of the postoperative complications of hypertensive intracerebral hemorrhage treated with free -hand drilling skull minimally invasive puncture drainage therapy were analyzed .Results 10 cases of scalp bleeding , 4 cases of epidural hemorrhage , 9 cases of puncture pathway bleeding , 24 cases of secondary bleeding , 1 case of intracranial infection,3 cases of low intracranial pressure ,5 cases of pneumoencephalos and 2 cases died.Conclusion Freehand drilling skull minimally invasive puncture drainage leads to less complications and so far it is a safe and effective therapy for hypertensive intracerebral hemorrhage .

Objective To investigate the risks of operative contamination of surgical gear by exfoliated cancer in 78 patients who received surgery for hepatocellular carcinoma.Methods Surgical gear from 78 patients who were operated for primary hepatocellular carcinoma were divided into four groups:A.surgical instruments; B.surgeon gloves; C.gauze and gloves used for cleaning equipment; D.gauze and gauze pad used for cleaning operation area.Saline was used to soak the surgical gear followed by low speed centrifugation.The precipitate was stained and then observed for cancer cells.Results The positive rates of cancer cell on surgical gear were significantly associated with the TNM stage,tumor location,tumor size,and surgical approach.The positive rate of liver cancer cell on surgical gear in TNM stage Ⅲ was higher than TNM stage Ⅰ / Ⅱ (56.3％ vs 21.7％,P=0.002).The positive rate of cancer cell on surgical gear was significantly related to tumor size and location (P=0.006,P=0.001).The positive cancer cell detection rate of non-anatomical liver resection was significantly higher than anatomical resection (53.8 ％ vs 26.9 ％,P =0.019).The positive cancer cell detection rate was significantly associated with different types of surgical gear (P=0.008),in which group C showed the highest cancer cell detection rate.Conclusion The risks of cancer cell contamination of surgical gear were significantly associated with progression of hepatocellular carcinoma,tumor size,location and surgical approach,and also associated with the frequency in the use of surgical gear,the operation scope of contact and the nature of surgical gear.

Objective To investigate the relationship between positive peritoneal exfoliated cancer cells and the clinicopathological features of patients with hepatocellular carcinoma before any invasive treatment.Methods Of the 92 patients with hepatocellular carcinoma who underwent laparotomy,ascites fluid was collected in the patients with peritoneal ascites; and peritoneal lavage fluid was collected in those patients without peritoneal ascites.Then,shedded cancer cells in these fluid samples were detected.Results The positive rates of peritoneal cancer cells were associated with the TNM stage,tumor location and tumor size.The positive detection rate of cancer cells in TNM stage Ⅲ and Ⅳ was significantly higher than stage Ⅰ and Ⅱ (38.1％ vs 8.0％ ; P =0.0005).The positive detection rate was higher in tumors located closer to the surface (P =0.0 002),and with larger diameter (P =0.00 007).Conclusion Peritoneal cancer cells were significantly correlated with tumor stage,tumor location and size in hepatocellular carcinoma.

Objective This study investigated a method to rapidly inactivate tumor cells on surgical instruments intraoperatively.Methods Tumor cells were collected by immersing and washing the surgical instruments in 37 ℃ saline.The precipitation was collected by low speed centrifugation and then was cultured to harvest the tumor cells.The tumor cells were immersed in saline and distilled water of different temperatures for different duration of time.Inverted microscopy was used to investigate the changes in morphology.Results After immersion in 55 ℃ distilled water for 60 seconds,the tumor cells were swollen,the cell membranes disappeared,the sizes of the nuclei were reduced,the chromatin was condensed,and some cells lysed and separated from each other.Additionally,these tumor cells floated in the culture medium and lacked any living cells adhering to the walls of the bottle.In the group of tumor cells treated with 55 ℃ saline for 60 seconds,there were no obvious morphological changes of the tumor cell or nucleus.Conclusion The intraoperative immersion of surgical instruments in 55 ℃ distilled water for 60 seconds could completely inactivate tumor cells.

Objective To evaluate the performance of high-fluorescence body fluid cell (HF-BF)mode on the platform Sysmex XE-5000 automated blood analyzer,and analyse its clinical application value in diagnosis of meningeal carcinomatosis.Methods E-valuated the performance of HF-BF by using precision test and methodology comparison test.Retrospectively analyzed 295 test re-sults of cerebrospinal fluid in Zhongshan Hospital Affiliated to Xiamen University from June 2010 to September 2012.Results HF-BF on the platform Sysmex XE-5000 automated blood analyzer had high precision,and exhibited a good consistency with cytolgical examination.The percentage of high-fluorescence body fluid cell(HF-BF%)in the meningeal carcinomatosis group was higher than that in other cerebral diseases groups,had statistically significant differences (P < 0.05 ).The cut-off value for HF-BF% was 4.3%,while the area under a receiver operating characteristic (ROC)curve (AUC)was 0.933,the sensitivity was 95.2%,and the specificity was 92.7%.When HF-BF% was over 4.3%,it was more likely to detect tumor cell in cerebrospinal fluid cytology.Con-clusion HF-BF is an effective reference index for the early diagnosis of meningeal carcinomatosis and has significant clinical appli-cation value.

Objective To observe the usage of antiasthmatic drugs and seek problems of following the guidelines of asthma and COPD prevention & treatment in community hospitals.Methods The prescribed quantity in 2013 of antiasthmatic drugs was recorded for 5 community hospitals in a district of Shanghai.Basing on the defined daily dose (DDD),the dosing frequency of drugs (DDDs) and the percentages of each category of drugs were calculated.Then comparisons were made with the data of a grade Ⅱ hospital and a grade Ⅲ hospital in the same district.Results Among three level hospitals,no significant difference existed in the percentages of oral antiasthmatic drugs.But the major category of oral drugs at grades Ⅱ-Ⅲ hospitals was leukotriene receptor antagonist whereas only oral theophylline and oral β2-receptor agonists were available at community hospitals.Among inhaled drugs,inhaled corticosteroids (ICS) dominated at grades Ⅱ-Ⅲ hospitals.But at community hospitals,inhaled short-acting beta-agonists (SABA) predominated.Among inhalants,dry powder inhaler (DPI) dominated at grades Ⅱ-Ⅲ hospitals and metered dose inhaler (MDI) at community hospitals.Conclusions The usage of antiasthmatics at community hospitals is not consistent with the guidelines.Optimizing drug purchasing at hospitals,strengthening continued medical education,modifying the medication concept of patients and boosting the production of domestic inhalants should be urgently undertaken.

Objective To explore the application of Oxybuprocaine Hydrochloride Gel in colonoscopy examination. Methods 1000 patients received colonoscopy examination were randomly divided into experimental group and control group, 500 cases in each. Oxybuprocaine Hydrochloride Gel was applied on anal region in the experimental group before endoscopy for perianal anesthesia and lubrication. Paraffin oil was used in the control group to lubricate perianal and enteroscopy. The success rate of primary insertion, visual analogue pain score (VAS) score, examination time and postoperative complications were compared between the two groups. Results In the experimental group, the success rate of primary insertion (95%) was higher than that of the control group (76%), and the pain score was lower than that of the control group.The examination time was shortened, and the difference was statistically significant (P < 0.05). Conclusions Oxybuprocaine Hydrochloride Gel applied to colonoscopy can effectively reduce the patient's pain and discomfort, improve the success rate of primary insertion, shorten the examination time. And the method is worthy of clinical popularization and application.

Objective To evaluate the effects of limb ischemic preconditioning on myocardial ischemiareperfusion injury in a rat model of severe hemorrhagic shock and resuscitation.Methods Twenty-four male Sprague-Dawley rats,weighing 300-350 g,were randomized into 3 groups (n =8 each) using a random number table:control group (group C); severe hemorrhagic shock and resuscitation group (HSR group); limb ischemic preconditioning group (group LIP).Hemorrhagic shock and resuscitation was induced by withdrawing blood (50％ of the total blood volume) from the left common carotid artery over an interval of 1 h,and 30 min later the animals were then resuscitated by infusion of the shed blood via the jugular vein over 30 min.Limb ischemic preconditioning was induced by 4 cycles of 5 min limb ischemia followed by 5 min reperfusion at 40 min before ischemia in LIP group.Before withdrawing blood (T0),immediately after the end of withdrawing blood (T1),before infusion of the shed blood (T2),and at 0,1 and 2 h after infusion of the shed blood (T3-5),mean artery pressure (MAP) was measured,the cardiac output (CO),left ventricular ejection fraction (LVEF) and myocardial performance index (MPI) were detected using color Vivid flow imaging,and total vessel density (TVD),perfusing vessel density (PVD),proportion of perfused vessels (PPV),microvascular flow index (MFI) of sublingual microcirculation were measured using sidestream dark-field imaging.The survival rates within 72 h after hemorrhagic shock and resuscitation were recorded.Results Compared with C group,MAP,CO,LVEF,TVD,PVD,PPV and MFI were significantly decreased and MPI was increased at T1-5 in HSR group and at T1 and T2 in LIP group (P ＜ 0.01).Compared with HSR group,MAP,CO,LVEF,TVD,PVD,PPV and MFI were significantly increased and MPI was decreased at T3-5,and the survival rate within 72 h was increased in LIP group (P ＜ 0.01).Conclusion Limb ischemic preconditioning can significantly attenuate myocardial ischemiareperfusion injury induced by severe hemorrhagic shock and resuscitation in rats and is helpful for prognosis.

Objective To compare the contents and features of licensed pharmacist qualification examination papers between those in abroad and domestic in order to provide the informations for the reforming the examination in our country.Method The characteristics of licensed pharmacist qualification examination among USA、UK、Australia and China were analysed and compared with classified statistic by using excel software.Results The scene questions are the main type in the three examination papers(＞50％).There were fewer questions examining the memory ability of examinees in abroad examinations,than that of ours.There were one question just had objects of pharmaceutical care (0.18％) in our examination.In the inspection of pharmaceutical knowledge application ability for the practice test(＞60％),covering all aspects of pharmaceutical care; And Chinese licensed pharmacists exam basic no object and pharmaceutical care link information feedback(＞60％),and the others are theoretical knowledge(＞20％).And in the three abroad examinations other common questions were about clinical drug therapy (＞90％),while they were the knowledge of pharmaceutical analysis and pharmaceutics in domestic examination papers (41.97％).Conclusion Licensed pharmacist qualification examination in our country ignored the ability of employing pharmaceutical knowledge and developing pharmaceutical care.The reformation of the licensed pharmacist qualification examination in our country is extremely urgent.