Objective To evaluate the maternal age at delivery in Beijing and the effect of maternal age on pregnancy outcomes.Methods A retrospective analysis was conducted on 14 970 singleton pregnancies from 15 hospitals in Beijing from June 20th to November 30th in 2013.These hospitals were sorted by the numbers of delivery and chosen as clusters by systemic cluster sampling method.The data of age,diagnosis with gestational diabetes mellitus (GDM) and pre-eclampsia (PE),neonatal birth weight,gestational age at delivery,postpartum hemorrhage and infants admitted to the neonatal ICU (NICU) were collected.The 14 970 women were divided into 5 groups according to their ages at delivery:(1) less than 20 years (n=205),(2)20-＜30 years (n=9 228),(3)30-＜35 years (n=4 365),(4)35-＜40 years (n=1 017),and (5) 40 years and older (n=155).T-test and x2 test were used for between-group comparison,and logistic regression analysis was used to examine the association between age and the risk of adverse pregnancy outcomes.Results (1) The mean maternal age at delivery in 2013 in Beijing was (28±4) years old.Among them,205 (1.4％,205/14 970) delivered under 20 years of age;1 172 (7.8％,1 172/14 970) ≥35 years;and 155 (1.O％,155/14 970) at 40 years and older.(2) The prevalence of diabetes,hypertension,overweight and obesity increased with age,and the incidence of these conditions were 3.4％,4.3％ and 31.4％ in women with advanced age,respectively.(3) Compared with 20-＜30 years group,less than 20 years was associated with significantly lower incidence of GDM [adjust OR (aOR)=0.393,95％ CI:0.222-0.696] and cesarean section rate (aOR=0.549,95％CI:0.391-0.771),and higher incidence of preterm birth (aOR=2.144,95％CI:1.256-3.662).Moreover,30-＜35 years,35-＜40 years and 40 years and older groups all had significantly higher risk of GDM (30-34 years,aOR=1.513,95％CI:1.374-1.666;35-＜40 years,aOR=2.094,95％CI:1.786-2.455;≥40 years,aOR=2.174,95％CI:1.492-3.167),preterm birth (aOR=1.219,95％CI:1.021-1.455;aOR=1.644,95％CI:1.251-2.161;aOR=2.141,95％CI:1.209-3.792),cesarean section (aOR=1.373,95％ CI:1.268-1.486;aOR=2.960,95％ CI:2.550-3.435;aOR=4.332,95％CI:2.920-6.426) and NICU admission rate (aOR=1.236,95％CI:1.059-1.443;aOR=1.337,95％CI:1.018-1.756;aOR=2.389,95％CI:1.385-4.121),when compared to the 20-＜30 years of age group.Higher incidence of PE (aOR=1.292,95％CI:1.007-1.659) and postpartum hemorrhage (aOR=1.224,95％CI:1.048-1.429) were also noted in women of 30-＜35 years,compared to 20-＜30 years group respectively.Conclusion Both advanced maternal age and adolescent pregnancy are associated with increasing risk of adverse pregnancy outcomes.

Objective:To discuss the early diagnosis of malignant hyperthermia(MH) and its treatment regimen without dantrolene.Methods: A patient of American Society of Anesthesiologist class Ⅰhad sudden muscle spasms and masseter muscle spasm during induction of anesthesia for idiopathic scoliosis surgery,and was diagnosed as having MH.Without using dantrolene,the patient was treated promptly with removal of inducement,control of temperature,adequate oxygen supply,maintaining of pH,water and electrolyte balance,and protection of renal function.The dynamic changes of the myoglobin in the blood and urine,serum creatine kinase,the blood gas indicators,and EtCO2,together with the pathological changes of the quadriceps were observed.Our experience on diagnosis and treatment was summarized.Results: The patient fully recovered and was discharged without any complications.The myoglobin in the blood and urine,serum creatine kinase and its isoenzyme increased rapidly and reached the peak one hour after MH,and maintained for about ten hours,then returned gradually to normal level about five days later.The temperature and EtCO2 increased immediately after development of MH,arterial blood gas quickly showed hypercapnic acidosis,but pH maintained normal or partial alkali during the treatment due to sodium bicarbonate administration;the alkali maintained obviously higher.Some quadriceps muscle cell had vacuolar degeneration and lysis.Conclusion: Non-ventilation induced increase of EtCO2 is a reliable indicator for early diagnosis of MH.Anesthetics,such as succinylcholine,should be avoided in patients at high risk of MH,and EtCO2 should be monitored.Once MH is diagnosed,dantrolene is the first choice.When without dantrolene,satisfactory outcome can be achieved through early diagnosis,timely removal of incentives,control of temperature,adequate oxygen supply,maintaining of stable internal environment,control of arrhythmia and protection of renal function.

Objective: To observe the controlled hypotension effects of nicardipine in 2 different ways for spinal tumor operalion. Methods: Twenty-four adult patients, scheduled for selective spinal tumor operation, were randomly divided into 2 groups. In groupⅠ(n=12), the nicardipine was infused at a rate of 10 μg*kg-1*min-1 and the infusion continued until MAP was at the level of 7.33-8.66 kPa, and then the rate was decreased to 1 μg*kg-1*min-1. In Group Ⅱ(n=12), nicardipine was given 0.01-0.02 mg/kg as the load dose, then infused at 1-2 μg*kg-1*min-1. Results: During the period of controlled hypotension, cardiac index(CI) increased significantly, other hemodynamic variables were stable and no hypertension rebound occurred in both groups. Reaching time of target blood pressure in groupⅡ was shorter than that in groupⅠ（P＜0.05）. The dose required to obtain target blood pressure in group Ⅱwas less than that in group Ⅰ（P＜0.05）. BP recovery time from discontinuing nicardipine infusion to pre-hypotension level,bleeding volume and transfusion volume were similar between 2 groups（P＞0.05）.During mass bleeding,　serious arrhythmia and oliguria did not occur in any case. Conclusion: Controlled hypotension with nicardipine is rapid, stable and easily controlled without hypertension rebound. Nicardipine has considerable protective effects on heart and kidney during mass bleeding. The method of bolus injection followed with intravenous infusion is more suitable to clinical application.

Objective: To observe the inhibitory effect of scopolamine(Spm) and chlopromazine (Clo) on withdrawal syndromes in morphine dependent rats. Methods: The intensity of withdrawal syndromes on the model of morphine dependent rats was recorded after single or muiltiple subcutaneous administration(sc) of Spm and Clo at different doses. Results: Withdrawal syndromes were markedly decreased when single Spm 1 mg/kg and Clo 0.5 mg/kg combined with morphine were injected (P<0.05). Spm+Clo(sc) had much stronger effects on inhibiting withdrawal syndromes after intraperitoneal (ip) naloxone in morphine dependent rats (P<0.01). Conclusion: Spm can act on Ach-receptor and relieve morphine withdrawal syndromes. Clo may have a synergistic action with Spm via α2-receptor in the locus coeruleus of the rat brain stem.

Objective: To compare the effects of nicardipine and labetalol on hypertension during laparoscopic cholecystectomy.Methods:Thirty patients with hypertension undergoing selective laparoscopic cholecystectomy were randomly divided into 3 groups. The control group was only given anesthetic drugs; nicardipine group was given nicardipine 20 ?g?kg -1 ?min -1 before induction, followed by intravenous continuous infusion of nicardipine at the rate of 0.5 1.5 ?g?kg -1 ?min -1 ; labetalol group received labetalol 0.3 mg?kg -1 ?min -1 before induction followed by intravenous continuous infusion of labetalol at the rate of 10 20 ?g?kg -1 ?min -1 . Results: Statistical differences( P

It is an important way for interns to evaluate and test quality of teaching and results of practice by means of clinical check.Applying dynamic simulation of anesthesia in our university,we statistically analyzed check results for interns of anesthesia specialty from 1996 to 2003 to invest present problems,aiming at perfecting clinical practice and teaching work of anesthesia specialty and favoring to cultivating talents with high diathesis.

Preoperative anesthetic interview is not only an important part of clinical teaching,but also a vital tache of improvement for medical treatment quality.Unlike internal medicine and surgery,interview for anesthesiology department has its own characteristics.Anesthesiology department of Changzheng hospital has put great emphasis on preoperative anesthetic interview.Some experiences about preoperative anesthetic interview were introduced in our article.

Objective: To investigate jugular bulb venous oxyg en partial pressure(PjO2)， hemoglobin saturation (SjO2) and the arterial t o jugular bulb venous oxygen content difference(AjDO2) during anesthesia with desflurane and isoflurane in patients with brain tumor. Methods: Fifty-six patients with brain tumor were randomized into desflur ane or isoflurane for maintaining anesthesia. PjO2, SjO2 and AjDO2 in pati ents were measured during normoventilation, hyperventilation and hypoventilation . Results: During normoventilation， SjO2 and PjO2 in desflu rane group was significantly higer than those in isoflurane group（P<0.05 or P<0.01）, and AjDO2 in desflurane group was significantly lower than that in isoflurane group（P<0.05）.Except that PjO2 in desflurane group was si gnificantly higer than that in isoflurane group during hyperventilation （P< 0.01）, there were no differences in SjO2, PjO2 or AjDO2 between the 2 g roups during hyperventilation or hypoventilation. While anesthesia with desflura ne and isoflurane, there was a positive correlation between PaCO2 and SjO2. Conclusion: At the same anesthetic effect concentration, desflur ane can significantly increase SjO2 and PjO2 in comparison to isoflurane un der normoventilation, suggesting that desflurane may have stronger effect of rel axing cerebral vessel than isoflurane.

Objective To explore the effect of TNF related apoptosis inducing ligand (TRAIL) in apoptosis induced by LPS. Methods After LPS injected mice blocking TRAIL with soluble death receptor 5 (sDRS), detecting ALT, AST and LDH of mice serum at different times, apoptotic effects of LPS to mice hepatocyte were detected by HE and flow eytometry (FCM) with Annexin V-FITC/PI staining. The expres-sion of DR5 in mice hepatocyte was assayed with immunohistochemistry and FCM. Results Apoptotic effect was promoted by up-regulated DR5 expression on hepatocyte. Blocking TRAIL with sDR5 markedly amelio-rated the hepatocyte damage and reduced apoptosis. Conclusion These results establish a critical role for TRAIL in apoptosis during disease process of LPS.

Objective To investigate the protective effect of a COX inhibitor,flurbiprofen (Flurb) on hepatic ischemia/reperfusion (IR) injury in rats and the action mechanism.Method C57BL/6 mice were randomized into sham,IR and Flurb (4 different doses) groups.The model of segmental (70％) warm hepatic ischemia was established in IR and Flurb groups.Flurbiprofen of different doses (5,7.5,10 and 15 mg/kg) was injected via the tail vein 20 min before ischemia.At different time points after reperfusion,liver cell necrosis and apoptosis were evaluated by HE and TUNEL staining.The COX and inflammatory cytokine gene expression was detected by using realtime PCR.Liver mitochondria were separated and mitochondrial permeability transition (MPT) pore sensitivity was examined by using swelling assay and fluorescence spectrophotometry assay.Result In flurbiprofen groups of different doses,the serum AST and ALT levels were significantly decreased at 6 h after reperfusion as compared with IR group.Moreover,10 mg/kg Flurb pretreatment significantly inhibited the mitochondrial permeability transition (MPT) pore opening,and thus alleviated liver cell damage and prevented mitochondria-related cell death and apoptosis by inhibiting COX-2 and inflammatory factor genes expression such as IL-1β,IL-6 and TNF-α.Conclusion Flurbiprofen protects mice from hepatic I/R injury possibly by inhibiting mitochondrial permeability transition and IL-1β,IL-6 and TNF-α expression,which may provide experimental evidence for clinical use of flurbiprofen to protect liver function in surgical settings other than its conventional use for pain relief.