Objective To compare the efficacy of anesthesia with dexmedetomidinc and midazolam combined with sufentanil in patients undergoing microwave coagulation therapy for liver cancer. Methods Forty ASA Ⅱ male patients, aged 35-62 yr, weighing 45-70 kg, scheduled for percutaneous microwave coagulation therapy,were randomly divided into 2 groups ( n = 20 each): midasolam group ( group Ⅰ ) and dexmedetomidine group ( group Ⅱ ). A loading dose of midazolam 40 μg/kg ( in normal saline 20 ml) was given intravenously over 10 min,followed by midasolam infusion at 40 μg·kg-1 ·h-1 in group Ⅰ . A loading dose of dexmedetomidine 1 μg/kg (in normal saline 20 ml ) was given intravenously over 10 min, followed by dexmedetomidine infusion at 0.5 loading dose of sufentanil 0.2 μg/kg was given, and then patient-controlled intravenous anesthesia with sufentsnil (background infusion 0.1 μg·kg-1 ·h-1 , bolus dose 0.1 μg/kg, lockout interval 3 min) was used. The operation was started 2 min after administration of the loading dose of sufentanil. Bradycardia, tachycardia, hypotension, hypertensinn and respiratory depression were recorded. The number of attempts and successfully delivered doses was also recorded. Results There was no significant difference in the incidence of bradycardia, tachycardia, hypotension and hypertension between the two groups ( P ＞ 0 .05). The incidence of respiratory depression was significantly lower, and the number of attempts and successfully delivered doses was smaller in group Ⅱ than in group Ⅰ ( P ＜ 0.05). Conclusion The efficacy of anesthesia with dexmedetomidine and sufentanil is better than that of anesthesia with midazolam and sufentanil in patients undergoing microwave coagulation therapy for liver cancer.

ObjectiveTo compare the efficacy of laryngeal tube-suction airway (LTSA) and SLIPA laryngeal mask airway (SLIPA) in obese patients undergoing laparoscopic cholecystectomy.MethodsSixty ASA Ⅰ or Ⅱ patients,aged 40-60 yr,with body mass index ＞ 30 kg/m2,undergoing laparoscopic cholecystectomy,were randomly into 2 groups ( n =30 each):group LTSA ( group Ⅰ ) and group SLI PA ( group Ⅱ ).Anesthesia was induced with target-controlled infusion (TCI) of propofol with the target plasma concentration (Cp) of 3-5 μg/ml and remifentanil (target Cp =4-6 ng/ml ).Rocuronium 0.6 mg/kg was injected intravenously as soon as the patients lost consciousness.LTSA and PLMA were inserted when BIS value was 50-60.HR,mean arterial pressure (MAP),SpO2,peak airway pressure(Ppeak) and PETCO2 were monitored during operation.Fiberoptic bronchoscopy was performed and the placement was scored.The placement time,the rate of successful placement at first attempt,airway sealing pressure,the failure of airway management and side effects were recorded.ResultsThere was no significant difference in HR,MAP,the fiberoptic bronchoscopy scores,the airway sealing pressure,and the incidence of side effects between the two groups.The placement time was significantly shorter in group Ⅰ than in group Ⅱ (P ＜ 0.05).The rate of successful placement at first attempt was more than 90％ and no failure was found in airway management in both groups.The SpO2,Ppeak,and PET CO2 were within the normal range during operation in both groups.ConclusionBoth LTSA and SLIPA can be safely and effectively used in obese patients undergoing laparoscopic cholecystectomy,however,LTSA placement is more easier.

Objective To research the effects of tianeptine and lithium on expression of pCREB in hippocampus of chronic stress depression rats. Methods All the experimental rats were divided by random into : Group of depression,Group of tianeptine,Group of lithium and Group of control. The rats of Group of depression, Group of tianeptine and Group of lithium were applied stress for 21 days,and meanwhile Group of control had no stress. The rats of Group of tianeptine were fed with tianeptine (50 mg/kg) , Group of lithium were fed with lithium (60 mg/kg) , while another groups were fed with normal sodium of the same volume. The ethology examination was performed by using method of open-field and experiment of fluid consumption. The expression of pCREB was detected by Western-blotting method. Results After the chronic stress,the horizontal crossing numbers,the erection times,the modification times and the percentage of sacchar-consumption of the rats of Group of depression were 23.2±23.0;8. 1 ±7.2; 3.6 ±3.5 and (55.4 ±11.7)% respectively, which were less than Group of control (46.0±18.9;20.3±11.3;8.4±2.7 and (68.5 ±8.2)% ; P＜0.01). The horizontal crossing numbers(28. 1 ±23.0) ,the erection times(12. 1 ± 9.4) and the modification times(5.5 ±3.2) of Group of tianeptine are less than those of Group of control (P ＜ 0. 05), but no significant difference compared with Group of depression; the percentage of sacchar-consumption(62.7 ± 10.6) % ,Group of tianeptine was more than Group of depression (P＜ 0.05 ) , but no obvious difference with Group of control. The horizontal crossing numbers, the erection times, the modification times and the percentage of sacchar-consumption of Group of lithium were less than those of Group of control (P ＜ 0.05), more than those of Group of depression but no significant difference (P ＞ 0.05). In Westernblotting method,the level of pCREB in the hippocampus of Group of depression was less than that of Group of control (P＜ 0.01); that of Group of tianeptine was more than that of Group of depression (P ＜ 0.01) but no obvious difference with Group of control; that of Group of lithium was less than that of Group of control (P＜0. 01) and more than Group of depression (P＜0.01). Conclusion Tianeptine could reverse the reduction of expression of pCREB in hippocampus of chronic stress depression rats and lithium partly did it.

AIM: To observe the effects of hypertriglyceridemia and fenofibrate on CD40L expression in platelets in vitro and in vivo. METHODS: In vivo experiments, according to its own strict standards, 20 patients were respectively selected for hypertriglyceridemia group and control group, before and after treatment of fenofibrate for hypertriglyceridemia patients. The CD40 ligand positive rates of platelets by flow cytometry and plasma soluble CD40 ligand by ELISA were examined under the same conditions as control group. The CD40L and sCD40L in each group were compared. In in vitro experiments, all 6 objects plasma was chosen in the same condition except for triglyceridemia, after the co-incubation of these plasma with the same healthy platelets was performed and the interference with wy14643, the CD40 ligand positive rate of platelets by flow cytometry and total platelets CD40 ligand protein content by Western blotting were examined under the same conditions in all objects. The CD40L positive rate and total CD40L content in each group were compared, respectively. RESULTS: The platelet CD40L positive rate and plasma sCD40L concentration in hypertriglyceridemia group were significant higher than those in control group (P<0.01). Followed the TG concentration decreased, the platelet CD40L positive rate and plasma sCD40L concentration decreased after the treatment of fenofibrate, the same as the total platelets CD40L content which was significant higher in hypertriglyceridemia group than that in control group in vitro (P<0.05). No effect of wy14643 on the total CD40L content expression was observed in vitro. CONCLUSION: Hypertriglyceridemia plasma stimulates immune-activation of platelets both in vitro and in vivo. sCD40L may mainly come from CD40L on platelet membrane. PPARα activator of fenofibrate may inhibit the immune-activation of platelets by reducing the concentration of plasma TG, but PPARα activator WY14643 cant inhibit the expression of CD40L and CD40L in vitro.

Objective To evaluate the efficacy of thracheal extubation-insertion of the nasopharyngeal airway for preventing the response to extubation under anesthesia in patients with hypertension. Methods Eighty ASA Ⅱ or Ⅲ patients with hypertension, scheduled for laparoscopic cholecystectomy under general anesthesia were randomly allocated into 2 groups with 40 patients in each group: tracheal tube group (group Ⅰ ) and tracheal tube-nasopharyngeal airway group (group Ⅱ). Anesthesia was induced with midazolam 0.05 mg/kg, sufentanil 0.4 μg/kg, cisatracurium besylate 0.15 mg/kg and propofol 2 mg/kg. The patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with TCI of propofol (target plasma concentration 3-4 μg/L) and sufentanil (target plasma concentration 0.2-0.4 μg/L). BIS was maintained at 40-50. Target plasma concentrations of propofol and sufentanil were adjusted to 1 μg/L and 0.1 ng/L respectively after operation and the infusion was stopped after recovery of breathing. In group Ⅱ, extubation was performed, and then the nasopharyngeal airway was inserted and oxygen was inhaled by mask, and the airway was removed after recovery of consciousness. In group Ⅰ , extubation was performed after recovery of cousciousness. The SP, DP, HR and SpO_2 were recorded immediately before anesthesia induction (T_0), immediately and 2 min after insertion of the nasopharyngeal airway (T_(1,2)), and immediately and 2 rain after removal of the tube or airway (T_(3,4)). The maximal value of SP (SP_(max)), DP (DP_(max)) and HR (HR_(max)) were also recorded during extubation. The differences in SP (△SP), DP (△DP) and HR (△HR) before and after extubation were calculated. The plasma concentrations of AD and NE were determined. The coughing and restlessness were observed. Results The SP, DP, HR and plasma concentrations of AD and NE were significantly higher at T_(3,4) in group Ⅰ and the SP, DP at T_(1,3,4) and HR at T_(2,3) were significantly lower in group Ⅱ than those at T_0 (P<0.05). The SP, DP, HR and plasma concentrations of AD and NE were significantly lower at T_(2-4) in group Ⅱ than in group Ⅰ (P<0.05). The SP_(max), DP_(max), HR_(max), △SP, ADP and △HR were significantly lower in group Ⅱ than in group Ⅰ (P<0.05). The incidence of coughing and restlessness was obviously lower in group Ⅱ than in group Ⅰ (P<0.05). Conclusion Thracheal extubation-insertion of the nasopharyngeal airway under anesthesia can effectively prevent the patients' response to extubation during emergence from anesthesia.

Objective To compare the anesthetic efficacy of dexmedetomidine and midazolam combined with sufentanil in patients undergoing microwave coagulation therapy for liver cancer.Methods Forty ASA Ⅱ male patients (aged 35-62 years and weighing 45-70 kg) scheduled for percutaneous microwave coagulation therapy were randomly divided into two groups (n =20 each):midazolam group (group Ⅰ) and dexmedetomidine group (group Ⅱ).A loading dose of midazolam 40 μg/kg (in normal saline 20 ml) was given intravenously over 10 minutes,followed by midazolam infusion at 40 μg·kg-1 · h-1 in group Ⅰ.And a loading dose of dexmedetomidine 1 μg/kg (in normal saline 20 ml) was given intravenously over 10 minutes,followed by dexmedetomidine at 0.5 μg· kg-1 · h-1 in group Ⅱ.At 5 minutes after administration of the loading dose of midazolam or dexmedetomidine,a loading dose of sufentanil 0.2 μg/kg was given,and then patient-controlled intravenous anesthesia (PCIA) with sufentanil (with the background infusion of 0.1 μg·kg-1 · h-1,bolus dose of 0.1 μg/kg and lockout interval of 3 minutes) was used.The operation was started 2 minutes after administration of the loading dose of sufentanil.The incidences of bradycardia,tachycardia,hypotension,hypertension and respiratory depression were recorded.The total attempts and effective pressing times of PCIA were also recorded.Results There was no significant difference in the incidences of bradycardia,tachycardia,hypotension,and hypertension between the two groups (P ＞ 0.05).The incidence of respiratory depression was significantly lower,and the total attempts and effective pressing times were smaller in group Ⅱ than in group Ⅰ (P ＜ 0.05).Conclusion The anesthetic efficacy of dexmedetomidine and sufentanil is better than that of midazolam and sufentanil in patients undergoing microwave coagulation therapy for liver cancer.

Objective To compare local infiltration anesthesia with different concentrations of ropivacaine for postoperative analgesia in pediatric patients undergoing tonsillectomy.Methods Sixty ASA physical status Ⅰ patients of both sexes,aged 6-12 yr,weighing 18-41 kg,scheduled for elective tonsillectomy,were randomly divided into 3 groups (n =20 each) using a random number table:control group (group C); 0.2％ ropivacaine group (group R1) ; 0.5 ％ ropivacaine group (group R2).Anesthesia was induced with inhalation of sevoflurane,injection of sufentanil and cisatracurium and maintained with inhalation of sevoflurane and iv infusion of remifentanil.The tonsil was locally infiltrated vith 0.2 ％ and 0.5％ ropivacaine (3-5 ml on each side of the tonsil) before surgery in R1 and R2 groups,respectively.Tonsillectomy was performed under general anesthesia.At 1,3,6,12,and 24 h after surgery,pain was assessed using faces pain scale-revised (FPS-R).Paracetamol 5 mg/kg was used as rescue analgesic when FPS-R scores ≥4.The interval between awake extubation and the first request for analgesic,requirement for postoperative analgesic and development of adverse effects were recorded.Results Compared with group C,the interval between awake extubation and the first request for analgesic was significantly prolonged,and the requirement for postoperative analgesic was decreased in R1 and R2 groups (P ＜ 0.05).Compared with group R1,the interval between awake extubation and the first request for analgesic was significantly prolonged,and the requirement for postoperative analgesic was decreased in R2 group (P ＜ 0.05).There was no significant difference in the incidence of adverse effects between the two groups (P ＞ 0.05).Conclusion The optinum concentration of locally infiltrated ropivacaine is 0.5 ％ for postoperative analgesia in pediatric patients undergoing tonsillectomy.

AIM:To observe the effect of immune-activated platelets and low-density lipoprotein cholesterol (LDL) on the expression and activity of cyclooxygenase-2 (COX-2) and peroxisome proliferator activated receptor ? (PPAR-?) in human umbilical vein endothelial cells (HUVECs) treated with activated platelets and LDL.METHODS:The platelets were activated by ADP.The co-culture system of HUVECs with immune activated platelets and/or LDL were established.The activity of COX-2 and expression of PPAR-? at mRNA and protein levels in HUVECs were detected by RT-PCR and Western blotting.The concentration of PGE2 was measured by ELISA for representing the COX-2 activity.The PPAR-? activity was determined by a nuclear factor assay kit.RESULTS:The COX-2 activity and mRNA expression of PPAR-?,the protein levels of COX-2 and PPAR-? and PGE2 concentration in activated platelets group were significant higher than those in un-activated platelets group (all P

Medical psychology and psychiatry is the obligatory courses for five-year and seven-year medical students. With the rapid changes of society and continuous improvement of medical services , it is necessary to adjust and integrate the teaching content of these two courses. Teaching order of some chapters in the teaching syllabus was not helpful for students to understand the teaching content. Some teaching content was repetitive. Part of the self-study content urgently needs to teach with the development of the society and changes in disease spectrum. After the adjustment , the teaching content of the curricu-lum with strong pertinence was clear and coherent. It improved the teaching efficiency and knowledge of students;therefore, the curriculum is widely praised by the students.

Objective To study the consistency among non-invasive and invasive brachial artery pressure,radial artery pressure and invasive central arterial pressure,and to explore the correlation between the severe degree of coronary artery disease and invasive central aortic pressure.Methods A total of 331 patients who underwent coronary angiography in our hospital were selected.The invasive central aortic pressure,invasive and non-invasive brachial arterial pressure,radial artery pressure in all patients were measured.The severe degrees of atherosclerosis were recorded.The differences among invasive brachial arterial pressure and invasive radial artery pressure,non-invasive brachial artery pressure and non-radial artery pressure and invasive central aortic pressure were compared.Results The systolic pressure values measured in invasive and non-invasive brachial artery and radial artery were higher than that measured by central aortic pressure,while the diastolic pressure values measured in the four peripheral artery were lower than that measured in central aorta.The pressure values measured by non-invasive brachial artery pressure were more close to that measured by invasive central aortic pressure (P＞0.05).The systolic pressure was increased and the diastolic pressure was reduced in central aortic pressure with the coronary vessel lession numbers increased.The values of systolic pressure in patients with single-vessel,double-vessel and triple-vessel lesions were (118.2± 19.5) mm Hg,(124.9 ± 19.7) mm Hg and (137.7 ± 20.6) mm Hg,respectively and the values of diastolic pressure were (86.8±8.4) mm Hg,(85.3± 10.3) mm Hg and (83.1± 9.4) mm Hg,respectively.There were significant differences in systolic and diastolic pressure values among patients with single-vessel lesions,double vessel lesions and triple-vessel lesions(F=3.93,4.31,both P＜ 0.05).Conclusions The blood pressure values measured by noninvasive brachial artery pressure are more close to that measured by invasive central aortic pressure.There is a significant correlation between the severe degree of coronary heart disease and invasive central aortic pressure.Non invasive brachial artery pressure can be used in the early detection of cardiovascular dysfunction.