Objective To analyze the application effect on gynecological laparoscopic surgery patients by different dexmedetomidine doses.Methods One hundred gynecological laparoscopic surgery patients were divided into control group and observation group by random digits table method with 50 cases each.The patients in observation group were given dexmedetomidine 0.5 μ g/kg intravenous injection 15 min before induction of anesthesia intubate,the patients in control group were given dexmedetomidine 1.0 μ g/kg,then 0.4 μ g/(kg· min) continuing venous pumping.The induction of anesthesia program in the 2 groups was midazolam,fentanyl citrate,propofol,cisatracurium besilate intravenous injection,maintaining intraoperative depth of anesthesia program was remifentanil and propofol by continuing venous pumping,and the maintaining muscle relaxation program was cisatracurium besilate interruptable injection.The patients in the 2 groups were given dezocine 0.1 mg/kg intravenous injection 30 min before the end of operation.The man-machine system engineering (MMSE) score,restlessness degree (using restlessness score),sedation effect (using Ramsay sedation score),analepsia time,extubation time and drug adverse reaction were compared.Results The rates of postoperative cognitive dysfunction and drug adverse reaction in observation group were significantly lower than those in control group [10％(5/50) vs.32％(16/50),10％(5/50) vs.40％(20/50)],Ramsay sedation score,analepsia time and extubation time were significantly lower than those in control group [(1.04 ± 0.59) scores vs.(4.84 ± 0.63) scores,(20.14 ± 4.32) min vs.(26.57 ± 4.28) min,(20.17 ± 4.23) min vs.(27.26 ± 4.34) min],there were statistical differences (P ＜ 0.05).There was no statistical difference in MMSE score before anesthesia and 24 h after anesthesia between the 2 groups (P ＞ 0.05),but MMSE score 1,6,12 h after anesthesia in observation group was significantly higher than that in control group [(23.93 ±3.51) scores vs.(20.34 ±3.45) scores,(25.87 ±4.46)scores vs.(21.34 ±4.63) scores,(27.53 ± 4.22) scores vs.(23.49 ± 4.31) scores],there was statistical difference (P ＜ 0.05).Conclusions Dexmedetomidine in accordance with 0.5 μ g/kg can reduce the incidence of postoperative drug cognitive dysfunction in the patients after gynecological laparoscopic surgery,it has good calming effect and less adverse reactions.It is worthy of popularization and application in the clinical work.

Helicobacter pylori (H.pylori) infection rate is increasing these years.The incidence of related diseases subsequently rose.Hp infection can not only cause digestive diseases,but also lead to idiopathic thrombocytopenic purpura (ITP),iron deficiency anemia,and indigestion etc.which can affect the growth and nutritional health of children.H.pylori has become a global issue,both international and domestic colleagues have reached a consensus on treatment for adults.According to the new conscnsus,the aim of this article is to study the diagnosis and treatment options for children with Hp infection.

BACKGROUND: The application of biological response modifiers (BRMs) has become the fourth cancer treatment following surgery, chemotherapy and radiotherapy. Polysaccharide-peptide (PSP) is a biological response modifier substance playing a special role in cancer treatment, which has been used in the treatment of gastric cancer, lung cancer, esophagual can cer, etc. With good results. OBJECTIVE: To observe the effect of PSP on the immune function and quality of life (QOL) in patients receiving chemotherapy for gynecological malignancies. DESIGN: A comparative observation. SETTING: Department of Obstetrics and Gynecology, Shanghai Jiaotong University Affiliated First People's Hospital. PARTICIPANTS: Forty patients who had been operated on for gyneco logical malignancies were selected from the Department of Obstetrics and Gynecology, Shanghai Jiaotong University Affiliated First People's Hospital from June 1999 to December 2002, including 36 cases of ovarian cancer with an average age of 52 years and 4 cases of endometrial cancer with an average age of 54 years. Patients with ovarian or endometrial cancer suffered from no contraindication in chemotherapy postoperatively were enrolled, otherwise were excluded.METHODS: The 40 patients were divided into study group (n=20) and control group (n=20) by matching according to stage and age. In the study group, the patients were treated with PSP capsules in addition to chemotherapy, whereas those in the control group were treated with chemotherapy only. PAC (phenacetin, spirin, caffeine) and MFP (melphalan, 5-fluorouracil, medroxyprogesterone acetate) regimens were adopted for the ovarian cancers and endometrial cancer respectively. The experiment lasted for two months from the beginning of the second course of chemotherapy to the beginning of the fourth one.MAIN OUTCOME MEASURES: The indexes of blood immune function and QOL were observed before and after treatment.RESULTS: All the 40 patients were involved in the analysis of results. ①The average Karnofkky's scores before and after treatment were (84±9.6)and (90±8.6) in the study group (P ＜ 0.05), and (83±9.2), (80±12.8) in the control group (P ＞ 0.05). The average Karnofkky's score was 10 credits higher in the study group than in the control group (P ＜ 0.05). ② The CD4+,CD4+/CD8+ and natural killer cells after treatment in the study group were all obviously higher than those in the control group (28.14±4.10, 0.96±0.17,23.80±4.90; 23.12±3.97, 0.75±0.21, 5.32±3.90) (P ＜ 0.05, 0.01).CONCLUSION: PSP can improve the cellular immunity and QOL of patients with ovarian or endometrial cancers.

Objective To illustrate the different levels of fundamental nursing skills of undergradu ate nursing students,and explore the characteristics of the assessment method.Methods With descriptive statistics,one-way analysis of variance after rank transformation,and multiple comparison (Scheffe),we made an analysis of 1 340 assessment records of fundamental nursing skills.Results The score distributions of all the skills,but the skill of measuring vital signs,conformed to Gaussian distribution.The overall distribution shaped in peak state and was negative skewness,showing bias towards 70 to 90 score levels.The score levels of 60 and 70 were significantly higher than that of their surrounding levels.The scores of aspiration of sputum,oxygenic therapy and aseptic technique were the lowest,while the scores of closed bed making and intramuscular injection were the highest.Conclusions The score distribution of fundamental nursing skills is rational,which shows the methods of teaching and assessment are generally believable.But the individual bias cannot be ignored.The majority of students get high grades.Different levels do exist among different skills because of abstract or concrete characteristics and principal matters.

Objective To study the therapeutic effect of pinaverium bromid and oryz-aspergillus enzyme and pancreatin tablet on patients with bile duct Ⅲ of sphincter of Oddi dysfunction (SOD) after cholecystectomy.Methods 72 patients who had a diagnosis consistent with bile duct Ⅲ of SOD seen from February 2010 to February 2013 in our hospital were randomly divided into the control group and the treatment group.Patients in the control group were given pinaverium bromid for 3 months while patients in the treatment group were,in addition to pinaverium bromid,given oryz-aspergillus enzyme and pancreatin tablet.Relief of abdominal pain,abdominal distention and recurrence of the above symptoms after drug withdrawal were studied.Results The scores on abdominal pain in the treatment group before and after treatment were 7.5 ± 1.1 and 3.0 ± 1.6 (P ＜ 0.05) while the scores in the control group were 7.4 ± 1.1 and 5.0 ± 1.4 (P ＜ 0.05),respectively.Alleviation of abdominal pain in the treatment group was superior to the control group (P ＜ 0.05).The scores on abdominal distention in the treatment group before and after treatment were 5.4 ± 0.6 and 1.6 ± 0.5 (P ＜ 0.05) while the scores in the control group were 5.2 ± 0.5 and 4.7 ± 0.8 (P ＞ 0.05),respectively.Alleviation of abdominal distention in the treatment group was superior to the control group (P ＜0.05).The scores of abdominal pain and distention in half year after 3 months' therapy in the treatment group were 3.1 ± 1.7 and 1.7 ± 1.1,respectively,which obviously were lower than the control group (5.4 ± 1.4 and 5.0 ± 0.6,P ＜ 0.05).Conclusions Pinaverium bromid and oryz-aspergillus enzyme and pancreatin tablet could effectively alleviate abdominal pain and distention in patients with bile duct Ⅲ of SOD after cholecystectomy and the recurrence rates of symptoms were significantly lower.

Objective To evaluate the reliability and validity of Short-form Arthritis Impact Measurement Scales 2(AIMS2-SF).Method AIMS2-SF not including the role component was used to evaluate Quality of Life(QOL) of 51 arthritis patients,then its test-retest reliability and the internal consistency reliability were tested,and factor analysis was applied to determine its construct validity.Results The Intra-class correlation coefficients(ICCs) of test-retest reliability of AIMS2-SF ranged from 0.60 to 0.80,and the Cronbach's ? coefficient for internal consistency reliability ranged from 0.65 to 0.83.Furthermore,the factor analysis confirmed the construct validity for AIMS2-SF.Conclusions The study suggested that the AIMS2-SF had satisfactory reliability and validity,then it is applicable for the evaluation of QOLs of Chinese patients with arthritis.

[Objective]To analyze the character of the complex proximal humeral fracture,study their operative methods and evluate the efficiency of treatment for complex proximal humeral fracture in elder patients with LCP plate.[Method]From(Oct 2004 to June 2006,16 elder patients with complex proximal humeral fracture were admitted and treated with open reduction and LCP plate internal fixation,regular clinical follow-up was executed by our medical team,the postoperative results were observed and the efficiency were evaluated by us.[Result]Sixteen cases obtained postoperative clinical results from 6 to 18 months(average 12.3 months),the fracture were healed in all cases,the shoulder function were evaluated with Neer shoulder functoin scoring systerm,the execellent result were 11,good 2,normal 2 and poor 1,the execellent and good results were 81.3% in all cases,6 cases got anatomic reduction,6 cases got nearly anatomic reduction,3 normal and 1 poor which were certified by radiographic examination.[Conclusion]The treatment for complex proximal humeral fracture in elder with LCP plate has less invasive,firm internal fixation and satisfactory shoulder function recovery.It is a very satisfactory internal fixtion for complex proximal humeral fracture in elder patients.

[Objective]To evaluate the long term effect of the short incision and tenocutaneous relaxing suture to treat the acute closed rupture of the Achilles tendon.[Method]28 cases were treated by short incision and tenocutaneous relaxing suture from 1996-2005,The scar tissue and blood blocks between the ends of ruptured Achilles tendon were first debrided completely,then treated with percutanneous decmpression suture,the duration of follow up ranged from 2 years to 10 years.The treatment outcome were evaluated by Arner-Lindholm evaluation system and the MRI of post operation.2 cases were lost.[Result]According to the Arner-Lindholm evaluation system and the MRI of post operation,the treatment outcome were excellent in 18,and good in 6,with excellent rate of 92%,No complication including nerve injury and infection were found after operation,except 1 rerupture of Achilles tendon was found during the follow up period.The MRI showed the rupture Achilles tendon were repaired and remodeled very well in all cases.[Conclusion]The short incision and tenocutaneous relaxing suture is an ideal surgical technique,with good Clinical result and less Significant complication.

[Objective] To examine the specific gene and protein expression of primary and passaged chondrocytes in normal oxygen tension and hypoxia.[Methods]Articular chondrocytes were isolated from limb joint cartilage of C57BL/6 mice(3~5 days).Primary chondrocytes(P0)and passaled chondrocytes(P1,P2)were cultured in normal oxygen tension and hypoxia respectively for two days.The mRNA levels of collagen II,aggrecan,sox9,Indian hedgehog(ihh),parathyroid hormone-related protein(PTHrP),bone morphogenetic protein(BMP)-4 and wnt5a were examined with RT-PCR,and protein levels of collagen II,aggrecan were examined with immunohistochemistry and toluidine blue staining.[Results]During the culture of primary chondrocyte,the expression of collagen II and aggrecan increased under hypoxia,mRNA levels of collagen II,wnt5a increased and ihh decreased at the same time.The mRNA levels of special genes and differentiation related genes of passaged chondrocytes were not altered under hypoxia.[Conclusion]Protein and mRNA level of Collagen II of primary chondrocyte under hypoxia increased.It may be regulated by chondrocyte differentiation gene ihh,and wnt5a.The chondrocyte phenotype could not be resumed under hypoxia through short-term monolayer culture in vitro.