Objective To examine the differences in the level of sedation and adverse effects produced by equivalent analgesic doses of remifentanil,sufentanil and fentanyl.Methods Eighty ASA Ⅰ female patients aged 18-39 yr with BMI of 18-25 kg/m2 scheduled for laparoscopic surgery under general anesthesia were randomly divided into 4 groups ( n =20 each):group control (group C) ; group remifentanil ( group R) ; group sufentanil (group S) and group fentanyl (group F).Remifentanil 2 μg/kg,sufentanil 0.2 μg/kg and fentanyl 2 μg/kg in normal saline 10 ml were infused iv over 2 min in groups R,S and F respectively.Depth of sedation was assessed and scored using OAA/S scale (5 =alert,1 =no response to prodding) and wavele index (WLI),before (baseline) and at 2,4,6,8 and 10 min after drug administration.Besides RR,pulse oxygen saturation,BP,HR were also monitored.The incidences of apnea,muscle rigidity,nausea and vomiting,pruritus,vertigo,bradycardia,profuse sweating and skin rash were measured and calculated.Results The 4 groups were comparable with respect to age,BMI and height.The lowest values of OAA/S scores,WLI and RR were significantly lower in groups R,S and F than in group C.Sufentanil produced the deepest sedation among the 3 opioids.Remifentanil produced strongest respiratory depression and nausea and vomiting.Conclusion The equivalent analgesic dose of sufentanil produces deeper sedation than that of remifentanil and fentanyl while remifentanil has the greatest impact on RR.

Objective:To investigate the value of magnetic resonance imaging, CT and X ray radiography on preoperative diagnosis of osteoporotic vertebral compression fracture and post-operation follow up of percutaneous kyphoplasty.Methods: A retrospectively analysis was adopted for 41 patients of osteoporotic vertebral compression fracture, who were detected by X ray, MRI examination and CT analyze, respectively. And the values of 3 methods for preoperative diagnosis of osteoporotic vertebral fractures and X-ray in postoperative follow-up were analyzed. Results: For preoperative diagnosis of osteoporotic vertebral compression fractures, the accuracy rate of MRI, X-ray and CT were 100%(41/41), 65.85%(27/41) and 92.85%(13/14), respectively. Both of the accuracy rates of MRI and CT were higher than X-ray, and the differences were statistical significant (x2=16.882,x2=3.837;P<0.05); the difference of accuracy rate between MRI and CT was not significant (x2=2.983,P>0.05). After the third day of post-operative and during last follow up, anterior vertebral height and middle vertebral height were significantly higher than before operation (F=17.094,F=15.526,P<0.05); and the Cobb angle and the VAS score of lumbar back pain were lower than before operation, the difference was statistical significant (F=41.085,F=107.338;P<0.05).Conclusion: For preoperative diagnosis of osteoporotic vertebral compression fractures, the accuracy rate of MRI is the highest and X-ray is lowest. X-ray can be used to evaluate surgery effect during postoperative follow-up.

Objective To explore the clinical effect of pulmonary infection control window for sequence ven-tilation on treatment of severe pneumonia with respiratory failure,and to observe and analyze the prognosis.Methods 102 severe pneumonia patients complicated with respiratory failure were selected.They were divided into the observation group and the control group by the random number table method.The patients of the observation group were treated with pulmonary infection control window for sequence ventilation treatment,the control group were treated with conven-tional sequence ventilation treatment.The change of blood oxygen partial pressure(PaO2 ),carbon dioxide partial pres-sure(PaCO2 )and blood oxygen saturation (SaO2 )before and after ventilation,and the treatment time and symptoms improve time and the complications such as ventilator associated pneumonia(VAP)of the two groups were observed. Results PaO2 and SaO2 of the observation group after the ventilation were (75.60 ±2.89)mmHg and (0.78 ± 0.09),which were higher than control group after the ventilation (70.48 ±3.16)mmHg and (0.71 ±0.11),and data of two groups after ventilation were higher than those before the treatment,differences were statistically significant (t =11.30,10.92,13.26,14.08,all P <0.05).PaCO2 of the observation group after the ventilation was 49.21 ±3.22 mmHg, which was lower than that of control group after the ventilation of 54.35 ±3.82 mmHg,and data of two groups after treatment was lower than before treatment,the differences were statistically significant(t =12.44,11.85,14.16, 13.42,all P <0.05).The total mechanical ventilation time of the observation group,respiratory difficulty relief time, lung then disappear time and hospital stay time were (5.24 ±1.83)d,(38.13 ±2.91 )h,(6.72 ±0.40)d and (15.33 ±3.18)d,which were lower than those of control group,the differences were statistically significant (t =9.87,10.21,10.46,11.08,all P <0.05).The general adverse reaction and the death rate of the observation group was 9.80% (5 /51),which was lower than 19.61% of the control group(χ2 =9.85,P <0.05).Conclusion There was effect of pulmonary infection control window for sequence ventilation treatment of severe pneumonia with respirato-ry failure,and it could improve effectively lung function and the prognosis and reduce the incidence of complications.

Gallstone disease is highly prevalent in clinic,particularly in women and some specific ethnic groups.The formation of water-insoluble cholesterol crystals is due to a misbalance between the three major lipids present in the bile:cholesterol,bile salts,and phospholipids.Many proteins implicated in biliary lipid secretion in the liver are regulated by several transcription factors,including nuclear receptors LXR and FXR.Human and murine genetic,pathophysiological evidence is consistent with the relevance of these nuclear receptors in gallstone formation.In addition,there is emerging data that also suggests a role for estrogen receptor ESR1 in abnormal cholesterol metabolism leading to gallstone disease.A better comprehension of the role of nuclear receptor function in gallstone formation may help doctors to design new and more effective therapeutic strategies for this highly prevalent disease condition.

Studying of atherosclerosis is more than a hundred year.There are many theories about this disease,but now most of us seems to agree with the stress-reponse theory.Heat shock proteins are the products produced at the first stage of atherosclerosis.And someone think that it may have something to do with atherosclerosis.This paper discussed the heat shock proteins and atherosclerosis respectively,and emphasized the relationship between them.

Objective:To Study the molecular mechanism of Guizhi Fuling Bolus(GFW) controlling the tumor growth.Methods:Each of 30 mice received 0.2ml S180 tumor cell suspension subcutaneously in the right axilla.The mice were randomly divided into model group,GFW group and Cyclophosphane(CY) group and with 10 mice in each group.Another ten mice without cancer were used as control.The model group received intragastric normal saline,0.2ml?10g-1?d-1;the GFW group was given intragastric administration,0.2ml?10g-1?d-1 whilst the CY group received intraperitoneal injection of CY at 20mg?kg-1?d-1.The medicines were given to the mice in each group after they were inoculated,once a day for 10 days.The mice were sacrificed and the tumor removed,the S180 mice sarcoma model was used to detect the inhibiting effects of GFW.The protein expressions of P21waf/cip and mRNA expression of Survivin were evaluated by immunohistochemistry and in situ hybridization.Results:For S180 sarcoma,the inhibiting ratio of GFW was 38.93%.Survivin mRNA was markedly declined in the GFW group when compared with the model group(P

Objective To explore the feasibility of laparoscopical left hepatectomy with the method of Glis-son pedicle transsection.Methods Clinical data of anatomical left hepatectomy patients with the method of Glisson pedicle transsection from February 2012 to April 2012 in our hospital were retrospectively analyzed.Results All patients were completely suffered laparoscopical left hepatectomy with the method of Glisson pedicle transsection. Operation time form 2-4 hours,postoperative hospitalization for 6-7 days,all these patients were cured and discharged, without any complication of bile leakage, hemorrhage, peritonitis, intestinal obstruction, postoperative liver function recovered rapidly.There was no death case.Conclusion It is safe and feasible of laparoscopical left hepatectomy with the method of Glisson pedicle transsection and should be worth to popularize.

Although the symptom of stable bronchiectasis is not significant, the four pathological factors including qi stagnation, sputum obstruction, blood stasis and lung-spleen qi vacuity still exist inside patients' bodies, making them in the state of both healthy and ill. This article discussed the application of the idea of preventive treatment to intervene and treat, which could prevent the emergence of new diseases and the changing of existing diseases. It could prevent vacuity evil and bandit wind, depressed qi transforming into fire, phlegm depressed in the lung and channel obstruction caused by long-term diseases. It can effectively prevent the acute attack of bronchiectasis and improve the patients' lung function and life quality.

HDL or apolipoprotein A-Ⅰ,the major protein of HDL particles,protect host against vascular endothelial dysfunction.HDL binding to scavenger receptor-BI activates eNOS for increasing NO.SR-BI and Endothelial lipase(EL) play a critical role in the regulation of plasma HDL.Incubation of HDL with vascular endothelial cells promotes prostacyclin synthesis.Some proteins such as paraoxonase that cotransport with HDL in plasma,have antioxidant properties.HDL inhibits TNF-? dependent expression of adhesion molecules in vascular endothelial cells and interferes with apoptosis,proliferation and migration of vascular endothelial cells.

Objective To systematically evaluate the effectiveness of using gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU.Methods The randomized controlled trials (RCTs) on the application of gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU were collected through the databases such as the China National Knowledge Infrastructure (CNKI),China Scientific Journal Database by VIP (VIP) and Wanfang Database.The quality of studies was critically appraised and data were extracted by two reviewers independently.Meta-analysis was conducted for the included studies.Results Eleven RCTs involving 1 337 patients were included.Meta-analysis showed that the application of gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU could reduce ventilator-associated pneumonia (VAP) incidence rate[RR=0.54,95％CI(0.44-0.65),P ＜ 0.01],shorten the duration of mechanical ventilation [mean differences(MD)=-2.38,95％CI(-2.69--2.07),P ＜ 0.01] and length of ICU [MD=-3.66,95％CI (-5.45--1.87),P ＜ 0.01],but the mortality rate was not statistically significant [RR=0.37,95％CI (0.11-1.26),P ＞ 0.05].Conclusions The application of gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU is safe and effective.