Objective To systematically review the effects of air or liquid in a loss of resistance technique for identification of the epidural space. Methods We searched the Cochrane Library, PubMed, EMBASE, Chinese Biomedical Database (CBM), CNKI, VIP and ChinaInfo for studies on the effects of air versus liquid in a loss of resistance technique for identification of the epidural space. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0.1 software. Results Seven prospective randomized controlled trials involving 5183 patients were included in our meta-analysis. The patients were randomly allocated into 2 groups according to the technique by which the epidural space was identified: loss of resistance with air group (group air, n = 2534) and loss of resistance with liquid group (group lidocaine, n = 2649). The results showed that the incidences of difficult catheterization, intravascular catheter insertion, incomplete block and post-operative headache were significantly lower in group liquid than in group air (P ＜ 0.05). There were no significant differences in the incidences of transient abnormal sense and accidental dural puncture between group liquid and air. Conclusion Loss of resistance with liquid can identify the epidural space more correctly than with air, with fewer complications and better analgesic efficacy.

Filial piety and fraternal love ethics is the nucleus of tradition ethics and the base of a person's moral.Reinforcing filial piety and fraternal love education is beneficial to raising the medical students'morality and qualities,consummating their personality,raising their brotherhood life,easing up doctor-patient relationship and promoting the development of medical health.

Low-density lipoprotein receptor-related protein-1 (LRP-1) is a transmembrane receptor protein locatedon the plasma membrane of the cells and involved in receptor-mediated endocytosis.LRP-1 binds to distinct ligandsthat are structurally and functionally unrelated, which makes it not only mediates endocytosis, but also regulates cell surfaceproteolytic activity and specific intracellular signaling pathways related to multiple links in the process of developmentof atherosclerosis.Moreover, LRP-1 plays an important role in maintaining vascular stability.This review focuses on theprogress in LRP-1-regulated vascular integrity, and provides new insights to the target of the blood vessel diseases.

Objective The aim of this study was to compare hypophosphatemia between the sepsis patients and the non-sepsis patients,and between within the subgroups of sepsis patients.Methods We collected 312 sepsis cases and 300 non-sepsis cases by stratified random sampling method yearly.In the sepsis cases,the number infected by gram-negative bacteria was 170,and by gram-positive bacteria was 142,containing 4 different bacteria infected cases in each one.Serum phosphorus of cases in each group were collected.The data were statistically processed to compare the incidence rates of hypophosphatemia,mean serum phosphorus levels and relative risk among groups.Results There was a statistical difference between the sepsis cases and the non-sepsis cases in incidence rate of hypophosphatemia (P ＜ 0.05,and RR ＞ 1.2).There were statistical differences between the cases infected by gram-negative bacteria and the cases infected by the gram-positive bacteria,also among cases infected by 4 different gram-positive bacteria in both incidence rate of hypophosphatemia and average serum phosphorus level (all P ＜ 0.05),and both RR ＞ 1.2.There were no statistical differences among cases infected by 4 different gram-negative bacteria in both incidence rate of hypophosphatemia and average serum phosphorus level (both P ＞ 0.05),and RR ＜ 1.2.Conclusions The sepsis patients were susceptible to hypophosphatemia,especially the ones infected by the 4 gram-negative bacteria,staphylococcus aureus and enterococcus in this study.We should pay attention to the serum phosphorus level seriously and prevent the occurrence of serious complications.

Objective To know the pollution situation by microcystin MC in Tai Lake in Wuxi. Methods The MC content in 12 water samples and 28 fish samples in the Tai Lake were determined by ELISA. Results The positive rates of MC in water samples and fish samples were 100%. The mean content of MC in water samples was higher in July 9 874.8 pg/ml than in November 142.8 pg/ml. The mean content of MC in the livers was 27.84 ng/g, in the muscle it was 3.97 ng/g. Conclusion The Tai Lake has been contaminated by microcystin and it can be detected in the fish living in the lake.

Objective To compare the efficacy of rcmifentanil combined anesthesia and fentanyl or sufentanil combined anesthesia in patients undergoing cardiac surgery.Methods We searched the Coehrane library,PubMed,EMBASE,OVID and Chinese Biomedical Database for prospective randomized controlled trials involving the comparison of the efficacy of remifentanil combined anesthesia and fentanyl or sufentanil combined anesthesia in patients undergoing cardiac surgery.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included the mechanical ventilation time after operation,duration of stay in hospital,and level of cardiac troponin,mortality,requirement for positive inotropic drugs and incidence of hyperalgesia and myocardial infarction during perioperative period.Meta-analysis was conducted using the RevMan 5.0 software.Results Sixteen prospective randomized controlled trials involving 1473 patients were included in our Meta-analysis.The patients were divided into 2 groups:fentanyl or sufentanil group ( n =644) and remifentanil group ( n =573).Compared with fentanyl or sufentanil group,the mechanical ventilation time after operation and duration of stay in hospital were significantly shortened,the level of cardiac troponin during the perioperative period was significantly decreased and the requirement for positive inotropic drugs during the perioperative period was significantly reduced ( P ＜ 0.05),and no significant change was found in the incidence of hyperalgesia or mortality of myocardial infarction during the perioperative period in remifentanil group ( P ＞ 0.05 ).Conclusion The efficacy of remifentanil combined anesthesia is better than that of fentanyl or sufentanil combined anesthesia in patients undergoing cardiac surgery.

Objective To explore current status of health-related productivity loss and its risk factors among nurses.Methods Stanford presenteeism scale (SPS-6) and self-designed questionnaire were used to investigate current status of health-related productivity loss and its risk factors among 1122 nurses working in a tertiary hospital in Changchun city.Results Compared with hired nurses,age and work seniority of permanent nurses were significantly higher(Z =-19.49,-19.28 ;P ＜0.05).The average score of SPS-6 of all the participants was 20.05 ± 4.37.The score of SPS-6 of married nurses was significantly lower than other nurses (Z =-3.52,P ＜ 0.05) ; and the score of SPS-6 of nurses less than 30 years old was significantly higher than those above 30 years old (Z =-2.49,P ＜ 0.05).There were no significant differences between the SPS-6 score of education degree and department.(Z =-1.37,x2 =0.58 ; P ＞0.05).The result of GLM showed that employment status and work seniority were independent risk factors of health-related productivity loss among nurses.The scores of SPS-6 of permanent nurses was significantly lower than hired nursed (x2 =4.48,P ＜ 0.05),and those who had worked for less than 3 years showed significantly higher score of SPS-6 than those who had worked longer (x2 =12.89,P ＜ 0.05).Conclusions Health-related productivity loss do exist among nurses.Improving health management may help to reduce this loss of productivity.

AIM To evaluate whether l glutamine monofluorophosphate(MFP) together with Alendronate sodium may further increase bone mass in ovariectomized rats. METHODS Forty two 3 month old Sprague Dawley female rats were randomized into six groups:group 1 rats were sham operated(Sham),group 2 rats were ovariectomized controls(Ovx),and groups 3～6 were ovariectomized and received either 1 mg?kg -1 ?d -1 of alendronate sodium ,270 mg?kg -1 ?d -1 of calcium gluconate,5 6 mg?kg -1 ?d -1 of MFP or combination of 5 6 mg?kg -1 ?d -1 of MFP and 1 mg?kg -1 ?d -1 of alendronate sodium for 3 months. All animals received double bone fluorochrome labeling prior to sacrifice. At the end of experiment,the left tibiae were havested for histomorphometrical evaluations. RESULTS Alendronate sodium increased trabecular bone volume significantly with suppressed bone resorption and bone formation. Administrated calcium gluconate had no influence on the bone mass. MFP also could not restore cancellous bone of ovariectomized rats. Administration of both MFP and alendronate sodium increased bone mass significantly but did not increase bone mass compared with alendronate sodium. CONCLUSIONS The results indicated administration of both alendronate sodium and MFP could not further increase bone mass of ovariectomized rats.

Objective To investigate the application of dual volume reconstruction translucent imaging in performing stent- assisted coil embolization for intracranial aneurysm embolization treatment. Methods During the period from Nov. 2011 to Sep. 2012, a total of 30 patients with intracranial aneurysm were admitted to authors’ hospital. Stent-assisted coil embolization was carried out in all patients. The number of all the stent point-marks visualized on routine 2D-DSA, on rotational angiography (3D-RA) and on dual volume reconstruction translucent images were determined, and the results were compared between each other of the three imaging methods. Results A total of 34 stents (206 stent point-marks in total) were implanted in the 30 patients. Of the 206 stent point-marks, 2D-DSA, 3D-RA and dual volume reconstruction translucent image could clearly display 146 (70.8%), 123 (59.7%) and 190 (92.2%), respectively. Statistically significant difference in the displaying rate of the stent point-marks existed between each other among the three imaging methods (P < 0.05). Conclusion Dual volume reconstruction translucent imaging can distinctly display the location of the stent marks, which is of great value in guiding the performance of intracranial stent implantation surgery.

Objective:To evaluate the short-term effect of robotic pancreaticoduodenectomy (RPD) and laparoscopic pancreaticoduodenectomy (LPD) in the treatment of ampullary and periampullary tumor systematically.Methods:A systematic search of the PubMed, Embase and Cochrane library database using the key words "pancreaticoduodenectomy, duodenopanreatectpmy, whipple, laparoscopic, robotic, Da Vinci" . A systematic search of the Sinomed, Wangfang, VIP and CNKI databases including the key words "胰十二指肠切除" , "腹腔镜" , "机器人" , "达芬奇" . To investigate the differences of the conversion rate of laparotomy, incidence of postoperative complications, and the postoperative hospital stay between the RPD group and the LPD group. The software RevMan5.3 was used in this meta-analysis.Results:A total of 4 retrospective cohort studies and 1 001 patients were included in this meta-analysis, including 451 patients in the RPD group and 550 patients in the LPD group. The results of the meta-analysis showed that there were significant differences between RPD group and LPD group for the conversion rate laparotomy ( OR=0.35, 95% CI: 0.24-0.50, P<0.05). There were no significant differences between RPD group and LPD group for the incidence rate of overall complication( OR=1.23, 95% CI: 0.95-1.58, P>0.05), hemorrhage ( OR=0.71, 95% CI: 0.50-1.00, P>0.05), pancreatic fistula ( OR=1.09, 95% CI: 0.80-1.49, P>0.05), delayed gastric empty ( OR=0.81, 95%CI: 0.57-1.14, P>0.05) and hospital stay after surgery ( WMD=-2.87, 95% CI: -1.44-1.70, P>0.05). Conclusions:RPD is as safe as LPD, with the same complication rate. Therefor it is worthy for further application in medical institutions with relevant conditions.