Objective To evaluate the effect of small dose ketamine on the efficacy of intravenous PCA (POA) with sufentanil after intra-abdominal surgery in aged patients.Methods Sixty ASA Ⅰ orⅡpatienm aged 65-82 yr undergoing elective intra-abdominal surgery under general anesthesia were randomized into 3 groups (n=20 each)according to the composition of PCIA solution:group I sufentanil 200 μg in 200 ml of noilnal saline (group S);group μ sufentanil 200μh+ketmine 100 mg in NS 200 ml(group K1)and group Ⅲ sufentannil 200 μg+ketmine 200 mg in NS 200 ml(group K2).A loading dose of 5 ml wag given at the end of operation.The PCIA setting was as follows:backgound infusion 1 ml/h,bolus dose 2 ml,lockout interval 5 min and 4-hour maximum dose 30 m1.If VAS score(0=no pain,10=womt pain)was≥7,pethidine 25 mg was given iv.The total amount of pethidine given within 48 h after operation and postoperative complications including nausea and vomiting and respiratory depression were recorded.Results Small dose ketamine added to the PCIA solution can significantly reduce the amount of pethidine administered after operation in a dose-dependent manner.Conclusion Small dose ketamine can improve the efficacy of PCIA with sufentanil after intra-abdominal surgery in aged patients with no significant adverse effect.

Objective To investigate the effect of Biglycan and FAK signal pathway on the proliferation of colon cancer cells in vitro and its possible mechanisms.Methods Biglycan expression vector was constructed and transfected into the colon cancer cell line HCT116.FAK inhibitor was used for cell treatment as well.Cells were divided into 5 groups:control group(HCT116),control group transfected with empty plasmid(Vector),con-trol group with empty plasmid transfected and inhibitor treatment(Vector+PF-562271),group transfected with Biglycan expression vector(Biglycan),group with Biglycan expression vector transfected and inhibitor treatment ( Biglycan+PF-562271) .Treatment duration was 24 hours.The expressions of FAK,p-FAK,PCNA and p53 were detected by Western Blot.The proliferation of cells was detected by MTT.Results The overexpression of Biglycan significantly promoted the proliferation of HCT116 and the phosphorylation of FAK(P<0.01).It signif-icantly up-regulated PCNA and down-regulated p53(P<0.01).The FAK inhibitor PF-562271 treatment could obviously inhibit the proliferation of HCT116,and the regulation of Biglycan on the expression of p-FAK, PCNA.p53 proteins was reversed(P<0.01).Conclusion Biglycan regulates the proliferation of colon cancer cells by promoting the activation of FAK signal pathway.

Objective To observe the influence of Biglycan on the focal adhesion kinase( FAK) activa-tion and to explore whether it regulates the invasion and metastasis of colon cancer through FAK signaling path-way.Methods The overexpressive plasmid of Biglycan was constructed and then transfected into the colon canc-er cell line HCT116.Meanwhile,FAK inhibitor was used to treat cells.Control group(HCT116),empty plasmid group(Vector),empty plasmid and inhibitor treatment group(Vector +PF -562271),Biglycan overexpression group( Biglycan) ,Biglycan overexpression and inhibitor treatment group( Biglycan+PF-562271) were set.Twen-ty four hours after exposure to inhibitor,the expression of FAK and p-FAK in each group was detected by West-ern Blot.The invasion and metastasis of colon cancer cells was detected by transwell assay.Results Overexpres-sion of Biglycan significantly enhanced the phosphorylation level of FAK and promoted the invasion and metastasis of HCT116(P<0.01).The inhibitor of FAK PF-562271 could significantly reduce the expression of p-FAK and reverse the effect of Biglycan on the invasion and metastasis of colon cancer cells.Conclusion Biglycan reg-ulates the invasion and metastasis of colon cancer cells through activation FAK signaling pathway.

Objective To explore the influential factors of hospital management teaching and to apply new plans to improve quality of teaching. Methods Questionnaire survey was conducted among 94 students majored in health management in Xuzhou Medical College to investigate student' learning behavior as well as contents, applying value, procedures, and teaching effects of the course. Data was put in by Epidata 3.02, described and analyzed by SPSS 18.0. Continous variables were ana-lyzed by t test and classified variables were analyzed by X2 test. Results 25.6%(24/94) students were not interested in this course. 61.7%(58/94) students thought that the course was highly correlated with profession. 56.4%(53/94) students thought that the course was valuable. 35.1%(33/94) students thought that the course was not good in combining theory with practice in teaching. 19.1%(18/94) stu-dents thought that the course was deficient in interactive teaching and teaching methods. 62.8%(59/94) students were satisfied with the teaching effect. Conclusions Main influential factors of hospital man-agement teaching are learning interest, curriculum evaluation and teaching evaluation. To improve quality of hospital management teaching, it is necessary to communicate the importance of the course and to apply new teaching plans to arouse the interests of students.

Objective To explore the clinical application of adaptive support ventilation (ASV) in elderly patients with acute respiratory failure.Methods A total of 46 mechanically ventilated patients aged over 65 years with acute respiratory failure admitted from January 2013 to June 2015 were enrolled.Comparison between the ASV mode and synchronized intermittent mandatory ventilation (SIMV) mode was carried out in respects of the impacts of both modes on respiratory mechanics, hemodynamics, oxygen availability and comfort rate.Results Difference between ASV and SIMV in respiratory rate was [(20.84 ±4.04) vs.(24.50 ±4.60) cycles/min, t =4.04, P ＜0.05], in inspiratory resistance was [(13.24 ±4.76) vs.(16.54±5.25) cmH2O/ (L·s), t=3.16, P＜0.05], in mean airway pressure was [(13.58±2.58) vs.(16.63 ±1.57) mmHg, t =6.84, P＜0.05], in peak airway pressure was [(25.96 ± 3.69) vs.(27.87 ± 2.45) mmHg, t =2.92, P ＜ 0.05], and tidal volume was [(378.41 ± 85.61) vs.(341.52 ± 86.84) mL, t =2.05, P ＜ 0.05], and comfort rate of patients was increased in ASV mode.There were no statistically significant differences in arterial oxygen partial pressure, carbon dioxide partial pressure, lactate, heart rate, mean arterial pressure and central venous pressure between the two modes (PP ＞ 0.05).Conclusions Compared with the synchronized intermittent mandatory ventilation mode, the adaptive support ventilation mode can improve the respiratory mechanics and can increase the comfort rate in the elderly patients with mechanical ventilation.

Objective: To investigate the differences of biochemical markers between the patients with pulmonary hypertension related to left heart disease (PH-LHD) and LHD; to explore the sensitive bio markers which may predict PH in LHD patients. Methods: A total of 355 LHD patients admitted to our hospital from 2014-01 to 2015-05 were enrolled. According to 2009 ESC/ERS guidelines, PH was deifned by pulmonary artery systolic pressure (PASP)>50 mmHg and patients were divided into 2 groups: LHD group,n=224 and PH-LHD group,n=131. The basic information with blood levels of biomarkers was recorded and their accuracy for predicting PH was analyzed. Results: The pathogenesis of LHD included 184 (51.83%) patients of coronary heart disease, 90 (25.35%) of dilated cardiomyopathy and 81 (22.81%) of cardiac valve heart disease. Compared with LHD group, PH-LHD group had increased ratio of NYHA III and IV degree (89.31% vs 45.54%), decreased LVEF [42.0 (33.0, 59.0) % vs 60.0 (42.0, 65.0) %], all P<0.001; PH-LHD group presented elevated blood levels of BNP, bilirubin, red cell distribution width (RDW), uric acid and cystatin C, while reduced lipoprotein (HDL), allP<0.001. PASP was positively related to biomarkers as BNP, bilirubin, RDW, uric acid and cystatin C, while negatively related to HDL. With the combination of BNP, direct bilirubin and RDW, the predictive value for PH-LHD under ROC curve was 0.828 with the sensitivity at 0.813, speciifcity at 0.708. Conclusion: Blood levels of biochemical markers were statistically different between the patients of PH-LHD and LHD; the combination of BNP, direct bilirubin and RDW showed the higher accuracy for predicting PH occurrence in LHD patients.

Objective To discuss the clinical application of CT-guided percutaneous puncture biopsy in diagnosing thyroid nodes. Methods A total of 65 patients with thyroid nodes were enrolled in this study. CT-guided percutaneous puncture biopsy of thyroid nodes was carried out in all 65 patients. The puncture biopsy results were compared with the postoperative pathologic findings. Results Successful puncturing of thyroid node was accomplished in all 65 patients. One patient developed subcutaneous hematoma. The coincidence rate between puncture biopsy results and postoperative pathologic findings was 93.8%(61/65). Five of 6 cases with thyroid cancer agreed with the pathologic diagnosis. Conclusion For the diagnosis of thyroid diseases, CT-guided percutaneous puncture biopsy is simple, safe and reliable, with higher success rate.

BACKGROUND: The graft versus host disease (GVHD) is the main reason for allogeneic hematopeic stem cell transplantation (allo-HSCT) failure, and oral tolerization is a newly developed treating method.OBJECTIVE: To evaluate the inhibition effect of acute GVHD induced by feeding donors with recipient splenocytes orally before allo-HSCT in a murine model and to compare the immune tolerance with immunosupression agents currently used in clinical treatment.DESIGN, TIME AND SETTING: A randomized grouping design of contrast observation was performed at the Center Laboratory of School of Medicine, Southeast University in December 2008.MATERIALS: The male C57BL/6J(H-2~b) mice were served as donors, and the female (BALB/C) mice (H-2~d) were served as recipients.METHODS: The mice were prepared allo-HSCT/GVHD models, and divided into 5 groups, which received prevent scheme. ①Oral tolerization group: C57BL/6J mice were fed with BALB/C (H-2~d) splenocytes before the transplantation, with dose of 10 μg per time, 1 day interval, for 3 times. ②Rapamycin group: mice were intragastric administrated rapamycin from the 1st after transplantation with dose of 1.5 mg/(kg·d). ③Ciclosporin A+ methotrexate group: mice were intragastric administrated ciclosporin A with 1.5 mg/(kg·d), increased to 5 mg/(kg·d) when mice were recovered the gastrointestinal function, and received intragastric administrated 0.4 mg/(kg·d) methotrexate at days 1, 3, 6 and 11 after transplantation. ④Blank control group: no medication after transplantation. ⑤Irradiation group: mice were received no transplantation.MAIN OUTCOME MEASURES: The presence of GVHD after allo-HSCT, and the difference of immune tolerance index.RESULTS: Typical GVHD symptoms occurred in all mice after transplantation. In the blank control group, most mice dead at days 14-18 and the mortality was nearly 100%. Compared to the blank control group, the symptoms were significantly ameliorated and the median survival times were extended in the other 3 transplantation groups (P < 0.05). The pathological structures in liver, intestine and skin tissue in the oral tolerization group were significantly decreased. Flow cytometry assay showed that oral tolerization significantly increased the CD4~+/CD8~+ lymphocyte ratio and the percentage of the CD4~+CD25~+ cells.Oral tolerization also induced the decrease of GVHD-related cytokine level. The MTT results also showed that the immunologic tolerance in the oral tolerization group was significantly enhanced and the proliferation of lymphocyte was suppressed.CONCLUSION: Oral tolerization has obviously inhibitory effect towards GVHD after allo-HSCT, its exact mechanism may be due to the suppressing the proliferation of lymphocyte and increase the immunologic tolerance in recipients. Compared to the widely used immunosuppressive drugs, oral tolerization exhibits strong ability in ameliorating GVHD.

The multidisciplinary synthetic therapy for the colorectal liver metastases has been a hot spot in clinical research,which includes operative therapy,tumor local therapy,conversion therapy,chemotherapy, molecular targeted therapy and so on. It is need to choose multiple therapies for the patients and make the whole treatment strategy in accordance with the condition of patients to maximize the survival benefit in clinical prac-tice. So,it is important to comprehend the newest research process of the clinical therapy to make a good choice for the colorectal liver metastases patients.