Objective To evaluate the correlation between CYP3A4 enzyme and analgesia with fentanyl after gynecological operation. Methods One hundred and fifty-nine ASA Ⅰ or Ⅱ patients, aged 30-50 yr, scheduled for elective myomectomy or abdominal total hysterectomy, were enrolled in this study. Anesthesia was induced with midazolam, remifentanil, propofol and succinylcholine and maintained with iv infusion of propofol and remifentanil and intermitent iv injection of atracurium. Venous blood samples were obtained for determination of the plasma 1'-hydroxymidazolam and midazolam concentrations at 1 h after iv injection of midazolam. The ratio of the 1'-hydroxymidazolam concentration to the midazolam concentration was used to reflect the effect of CYP3A4 enzyme. Pain was assessed with visual analog scale (VAS) after consciousness was regained. When VAS score ＞ 4,the patients were given fentanyl 10 μg every 5 min until VAS score ≤ 4 and then PCIA with fentanyl was performed. VAS score was maintained ≤4. The times of successful delivery within 24 h after operation and during the period of 24-28 h after operation and fentanyl consumption within 48 h after operation were recorded. Pearson correlation was used to analyze the data. Results There was no correlation between the effect of CYP3 A4 enzyme and the times of successful delivery or fentanyl consumption, and the correlation coefficients were 0.16, 0.13 and 0.11 respectively ( P ＞ 0.05). Conclusion CYP3A4 enzyme is not the major enzyme metabolizing fentanyl.

Objective:To discuss the implementation and experience of the quality control circle ( QCC) activi-ty in shortening the interval time of consecutive operation and speeding up the turnover of operating table. Method:We formed a QCC team and explored the influential factors of the interval time of consecutive operation using quali-ty control technique. We found out the real reason, put forward corresponding countermeasures, and organized the implementation. Results: Before the implementation of QCC, the average interval time of consecutive operation was 24. 6 minutes, whereas it decreased to 16. 2 minutes after the implementation of QCC with the progress rate of 64. 87%. Through the QCC activities, the problem-solving ability, responsibility, communication and coordina-tion ability, motivation, confidence, team cohesion, and the use of quality control technique of the QCC members has improved significantly. Conclusion:Through the quality management tools of QCC, the interval time of con-secutive operation has greatly shorten, the turnover of operation table has improved, and doctors′ and operating room nurses′satisfaction has improved significantly.

Objective To investigate the association between body mass index (BMI) and exercise capacity in patients with chronic systolic heart failure.Methods The elderly patients with chronic systolic heart failure were consecutively recruited from 2008 to 2011 in cardiovascular clinic of Zhejiang Hospital.All the participants underwent height and weight measurements and BMI was calculated with these two parameters.Cardiopulmonary exercise test were performed to achieve peak oxygen uptake (PVO2),oxygen uptake to body mass ratio (PKVO2),oxygen uptake to heart ratio (VO2/HR) and ventilation/carbon dioxide production (VO2/VCO2).Results A total of the 273 patients with chronic systolic heart failure included 6 underweight patients (BMI ＜ 18.5 kg/m2),113 normal weight patients (BMI 18.5-＜ 24.0 kg/m2),116 overweight patients (BMI 24.0-＜ 28.0 kg/m2),and 38 obese patients (BMI ≥ 28 kg/m2).In both NYHA Ⅱ and Ⅲ/Ⅳ patients,unadjusted correlation analyses showed that BMI was positively related to PVO2 and VO2/HR,and was inversely related to PKVO2 and VE/VCO2 (P ＜ 0.05),respectively.Multiple stepwise regression analyses showed age,sex,BMI (P ＜ 0.05) and left ventricular ejection fraction (LVEF) were independent determinants of PKVO2,and age and BMI (P ＜ 0.05) were independent determinants of VE/VCO2.Conclusions BMI is significantly associated with exercise capacity in patients with chronic systolic heart failure,and also independent determinant for the PKVO2 and VE/VCO2,respectively.

Objective To investigate the effect of IL-1β-511 genetic polymorphism on postoperative analgesia with fentanyl. Methods Two hundred and fifty ASA Ⅰ or Ⅱ patients of Han nationality (native of Henan province) aged 20-50 yr undergoing elective abdominal total hysterectomy or myomectomy under general anesthesia were enrolled in this study. The polymorphic sites of the IL-1β-511 allele were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The patients were assigned into 3 groups according to their genotypes: group wild homozygote; group mutation hetorozygote and group mutation homozygote. Anesthesia was induced with midazolam, remifentanil, propofol and succinylcholine and maintained with propofol, remifentanil and atracurium. The patients were mechanically ventilated after tracheal intubation. The pain was assessed using VAS score after the patients recovered from anesthesia. When VAS score was ＞ 3 the patients were given fentany120 μg every 5 min until VAS score decreased to ≤ 3. PCIA with fentanyl was then started. The PCIA solution contained fentanyl 1.0 mg and droperidol 5mg in 100 ml of normal saline. The PCA pump was set to deliver a background infusion of 0.5 ml/h and a bolus dose of 2 ml at 5 min lockout interval. The VAS score was maintained at ≤3.The amount of fentanyl consumed during 24 h of PCIA was recorded. Results There was no significant difference in the amount of fentanyl consumed during the 24 h PCIA among the 3 groups. Conclusion IL-1β-511 genetic polymorphism is not the factor contributing to the individual variation in the patient' s response to postopertive analgesia with fentanyl, indicating that the pain within 24 h after operation is not related to the inflammatory factors.

Objective: To investigate the clinicopathological features, diagnosis, and differential diagnosis of gallbladder sarcomatoid carcinoma. Methods: The clinical manifestations and the microscopic and immunohistochemical characteristics of six patients with gallbladder sarcomatoid carcinoma were analyzed with a follow-up period. Related literature was reviewed. Results:Immunohistochemical markers of gallbladder sarcomatoid carcinoma with spindle cell morphology were epithelial and mesenchymal positivity. Conclusion: Gallbladder sarcomatoid carcinoma could be firmly diagnosed by microscopic morphology and immunohistochemistry. Radical resection is currently used to treat such patients. However, more cases with longer follow-up period are needed to discover better treatments and improve the survival of these patients.

Background and purpose:Cancer is a major public health issue in China and worldwide, which se-riously threatens human beings as well as social and economic development. This study explored the relationships between the cancer distribution characteristics and cancer prevalences in Chinese cancer surveillance regions to provide scientific evidence for cancer prevention and management.Methods:The data were obtained from the book named“Prevalence and Mortality of Cancer in China from 2003-2007” including incidence of 23 cancer types in 32 regions of China published by the Academy of Military Medical Sciences of the Chinese PLA in 2012. Correspondence analysis was used to gain the relation between the prevalence and area distribution. Cluster analysis was used to obtain the classifications with special significance by putting the cancers or regions with similar characteristics into a cluster.Results:Esophageal cancer, gastric cancer, liver cancer, lung cancer, colorectal and anal cancer have high incidence and mortality in both genders. The districts with high incidence of esophageal cancer and gastric cancer were grouped together. The counties or cities (Shexian, Yangcheng, Linzhou, Yanting, Yangzhong and Jianhu) with high incidence of esophageal cancer and gastric cancer were classified into same cluster frequently. Fusui was grouped along because of the lower incidence of various cancers than the national average except for liver cancer. Guangzhou, Sihui and Zhongshan were the districts with high incidence of nasopharyngeal carcinoma in both genders. Rural areas in Qidong and Haimen were classified into a cluster in male and total data for the high incidence of liver cancer. Colorectal cancer, anal cancer and breast cancer in women also had high incidence in urban areas. Cervical cancer had the second level high incidence in women following diseases of digestive system, breast cancer and lung cancer.Conclusion:Similar pathogenic factors may exist in counties or cities of Shexian, Cixian, Yangcheng,etc, because of the high prevalence of esophageal cancer. Similar pathogenic factors may also exist in other districts or cancers that were classified into the same cluster.

Objective To investigate the effect of PXR* 1B polymorphism on postoperative analgesia with fentanyl in the patients undergoing gynecological operation.Methods A total of 102 female patients from Henan province, of Han nationality, aged 20-50 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , with body mass index of 14.8-30.0 kg/m2, scheduled for elective abdominal total hysterectomy or myomectomy under general anesthesia, were enrolled in this study.PXR genetic polymorphic sites were analyzed by polymerase chain reaction (PCR)-direct DNA sequencing.PXR* 1B haplotype was analyzed by the PHASE V.2.1 software.The patients were assigned into 3 groups according to their genotypes: PXR* 1B haplotype group (group PXR* 1B), non-PXR* 1B haplotype group (group n-PXR* 1B) and PXR* 1B/PXR * 1B group (group PXR* 1B/PXR* 1B).Postoperative pain was assessed with visual analogue scale (VAS) score.When VAS ＞ 3, fentanyl 20 μg was injected intermittently until VAS ≤ 3, and then a pump was connected to perform patient-controlled intravenous analgesia (PCIA) with fentanyl.PCIA solution contained fentanyl 1.0 mg and droperidol 5 mg in 100 ml of normal saline.The PCA pump was set up with a 2 ml bolus dose, a 5 min lockout interval and background infusion at a rate of 0.5 ml/h.The number of successfully delivered doses was set at 7 times, and the maximal amount of fentanyl was 145 μg.If exceeding the maximal dose, the VAS score was still more than 3, nonsteroidal anti-inflammatory drugs were given as rescue medication.VAS score immediately after the end of operation, and the consumption of fentanyl within 24 h after operation were recorded.Midazolam 0.1 mg/kg was injected intravenously during induction of general anesthesia, and 1 h later venous blood samples were collected for determination of plasma 1'-hydroxymidazolam and midazolam concentrations.The ratio of 1'-hydroxymidazolam concentration to midazolam concentration was calculated to reflect the activity of CYP3A4.Results No patients required rescue anesthetics in the three groups.There were 27 cases in group PXR * 1B, 53 cases in group n-PXR* 1B, and 22 cases in group PXR* 1B/PXR* 1B.PXR* 1B allele frequency was 37.2％.There was no significant difference in VAS score immediately after the end of operation, consumption of fentanyl within 24 h after operation, and activity of CYP3A4 between the three groups (P＞0.05).Conclusion PXR* 1B polymorphism has no effect on postoperative analgesia with fentanyl in the patients undergoing gynecological operation, and is not one of the genetic factors producing individual variation in postoperative analgesia.

Objective To explore the application effect of prospective nursing in patients with hip replacement operation.Methods 80 patients with hip replacement operation were ran-domly divided into observation group and control group with 40 patients in each group.The control group was received routine nursing while the observation group was given prospective nursing based on the treatment in the control group.Rehabilitation enthusiasm,complications,hospitalization time,life quality and nursing satisfaction were compared between the two groups.Results Reha-bilitation enthusiasm score in the observation group was higher than that in the control group,com-plications and hospitalization time were less than those in the control group,nursing satisfaction was higher than that in the control group ,thus ,the difference was statistical significant (P <0.05).Life quality score in physical function,social function,mental function in the observation group were higher than that in the control group ,the difference was statistical significant (P <0.05).Conclusion Prospective nursing is preventive and targeted nursing.And it can effectively improve the rehabilitation enthusiasm of hip replacement operation patients and enhance the life quality.

Objective To explore the application effect of prospective nursing in patients with hip replacement operation.Methods 80 patients with hip replacement operation were ran-domly divided into observation group and control group with 40 patients in each group.The control group was received routine nursing while the observation group was given prospective nursing based on the treatment in the control group.Rehabilitation enthusiasm,complications,hospitalization time,life quality and nursing satisfaction were compared between the two groups.Results Reha-bilitation enthusiasm score in the observation group was higher than that in the control group,com-plications and hospitalization time were less than those in the control group,nursing satisfaction was higher than that in the control group ,thus ,the difference was statistical significant (P <0.05).Life quality score in physical function,social function,mental function in the observation group were higher than that in the control group ,the difference was statistical significant (P <0.05).Conclusion Prospective nursing is preventive and targeted nursing.And it can effectively improve the rehabilitation enthusiasm of hip replacement operation patients and enhance the life quality.