Objective To explore the safety of different doses of bupivacaine combined with epidural anes-thesia for delivery women undergoing cesarean operation.Methods A total of 120 cases of parturient women with cesarean section surgery were randomly divided into A,B,C three groups (40 cases in each group).A group was subarachnoidly given 0.5% levobupivacaine 1.5mL(7.5mg),B group was given 0.5% levobupivacaine 2.0mL (10.0mg),C group was given 0.5% levobupivacaine 2.5mL(12.5mg).The anesthesia effect in three groups was recorded.Results 5 min after anesthesia,the central venous pressure,heart rate,blood oxygen saturation in A group were (79.47 ±10.65)mmHg,(83.94 ±8.21)times/min,(98.16 ±1.17)%,which in B group were (76.38 ± 10.15)mmHg,(84.03 ±8.19)times/min,(98.48 ±1.06)%,which in C group were (66.28 ±18.49)mmHg, (76.38 ±5.68)times/min,(95.03 ±0.45)%.10 min after anesthesia,the central venous pressure,heart rate,blood oxygen saturation in A group were (83.54 ±10.03)mmHg,(84.03 ±8.34)times/min,(98.25 ±1.19)%,which in B group were (82.46 ±10.11 )mmHg,(83.95 ±8.24)times/min,(98.04 ±1.15 )%,which in C group were (69.06 ±17.03)mmHg,(74.19 ±5.48)times/min,(94.85 ±0.41 )%,the changes of heart function index in A group and B group had statistically significant differences compared with those in C group(F =5.165,6.487,7.125, 6.145,5.378,6.145,all P <0.05 ).In A group,excellent anesthesia in 9 cases,good in 17 cases,and poor in 14 cases;those in B group were 24 cases,13 cases,3 cases;those in C group were 28 cases,11 cases and 1 case.The anesthesia effect of B group and C group was significantly higher than A group(χ2 =4.887,P <0.05).In A group, hypotension occurred in 1 case,bradycardia in 2 cases,2 cases had nausea and vomiting,shortness of breath 0 case.In B group,hypotension occurred in 2 cases,2 cases of bradycardia,nausea and vomiting 3 cases,difficulty in breathing in 1 case.In C group,15 cases of hypotension,bradycardia in 11 cases,14 cases had nausea and vomiting,dyspnea in 7 cases.The incidence rate of adverse reactions of C group was higher than A group and B group(χ2 =4.168,5.122, 4.784,5.122,all P <0.05).Conclusion The anesthesia effects of levobupivacaine combined spinal and epidural anesthesia in cesarean section surgery is related with dosage,the greater the dosage,the anesthesia effect is stronger, but the circulation disturbance,the greater the use the share such as 10mg dose of levobupivacaine is more suitable, worthy of popularization and application in clinic.

Objective To discuss the value of MRI in diagnosis of complications related to pregnancy.Methods MRI were per-formed in 22 cases of late pregnancy,7 cases of postpartum with vagina bleeding,and 1 case with eight weeks of gestation following irregular vagina bleeding,respectively.The position of placenta and umbilical cord were observed in the cases of late pregnancy.The shape and signal features of embryo were evaluated in the case of eight weeks gestation following irregular vagina bleeding.Residual placenta and its relationship with the wall of uterus were analyzed in the cases of postpartum with vagina bleeding.Results Among the 22 cases of late pregnancy,normal position of placenta were in 4 cases,placenta previa were in 18 cases,umbilical cord winding around fetal neck in 8 cases.9 cases of placenta previa complicated with placenta accreta were comfirmed by cesarean delivery,how-ever,only 6 cases of placenta accreta were detected on MRI.The residual placenta with placenta accreta was found in all 7 cases of postpartum patients.Hydatidiform mole was proved by pathology in the case of eight weeks gestation following irregular vagina bleeding,and it was showed as a mass with hypointensity on T1 WI and hyperintensity on T2 WI in uterine cavity.Conclusion The complications related to pregnancy such as placenta previa,umbilical cord winding around fetal neck,residual placenta,placenta ac-creta could be correctly displayed on MRI.Hydatidiform mole also could be diagnosed by combining the clinical symptoms with MR images.

ObjectiveTo compare the recovery rates calculated according to different criteriain patients with urogenital Chlamydia trachomatis (Ct) infection after treatment with azithromycin. Methods Clinical data on outpatients who were diagnosed with urogenital Ct infection and treated with azithromycin in the sexually transmitted disease(STD) outpatient clinic of Tianjin Medical University General Hospital were retrospectively reviewed. Recovery rates were calculated according to the improvement of symptom and (or) reexamination results of Ct at 1,5 and 9 weeks after the end of treatment.ResultsSignificant differences were observed between the recovery rates calculated according to symptom improvement and those according to laboratory reexamination results.No obvious correlation existed between the presence of symptom and positive reexamination results.The recovery rates calculated according to the second reexamination result differed significantly from those according to the first reexamination result,but were similar to those according to the third reexamination result. ConclusionsThe cure of Ct infection should be determined according to laboratory test results,and two times of reexamination at 1 and 5 weeks after the final treatment are recommended.

Bipolar disorder (BD) is a chronic mental illness with high recurrence rate and disability. As one of the core symptoms, cognitive impairment may occurs at every stage of the disease. Evidence from the neuroimaging studies revealed that the abnormal brain volumes, the blood flow and oxygen saturation of key brain areas are related to executive impairment in patients with bipolar disorder. This article reviews current structural and functional neuroimaging studies about the executive impairment of patients with euthymic bipolar disorder and research progresses.

Objective To investigate the relationship between cognitive function of first-episode schizophrenic patients and dopamine D1 receptor gene. Methods A total of 112 first-episode schizophrenic patients and 60 healthy controls were evaluated with Wechsler adult intelligence scale ( WAIS-R), Wechsler memory scale (WMS) and Wisconsin card sort test (WCST) ,and genotyped one polymorphism (rs4532) within DRD1 gene using TaqMan SNP genotyping assay. Results There were no significant differences on the frequencies of the genotypes and alleles of rs4532 polymorphism between patients with schizophrenia and normal controls ( x2 =2.90, P=0.35; x2 = 0.01, P= 0. 93 ). There were significant differences in all index of WCST between two groups (P ＜0.01 ). Patients with rs4532G allele had worse WCST performance than those without G allele ((60.9 ± 13.2)%vs (44.9 ±21.3)%, t=4.79, P=0.00002). Conclusion Rs4532 polymorphism of DRD1 gene may be associated with executive function impairment in schizophrenic patients.

Objective To better understand the role of CREB signaling pathway in chronic mild stress (CMS), we investigated the alteration of CREB and p-CREB in CMS rats with and without fluoxetine hydrochloride. Methods Fifty adult male Sprague-Dawley rats were randomly divided into three groups:CMS group (26), fluoxtine group (12) and con-trol group (12). The rats in CMS group and fluoxtine group received 8 weeks of chronic mild stress. Rats in fluoxtine group were administered daily injections of fluoxetine 10mg/kg I.P. Sucrose preference tests and open-field test were car-ried out after the 8th week. Based on endpoint sucrose-intake, animals were further divided into 4 groups:CMS sensitive group, CMS resilient group, fluoxtine group and control group. Western blot was used to detect the expression levels of CREB and p-CREB in the hippocampus and prefrontal cortex. Results The sucrose consumption was significantly de-creased in CMS resilience group compared to sensitive group, control group and fluoxetine-intervention group (all P<0.05). Similarly, the numbers in total arm entries, percentage of entries into open arms and time spent in open arms was significantly lower in CMS resilience group compared to control group(all P<0.05), but not different compared to CMS sensitive group(all P<0.05). The p-CREB in the hippocampus was significantly lower in CMS sensitive rat compared to CMS resilience group, control group and fluoxetine-intervention group(all P<0.05), but CREB was not dfferent among the four groups(all P<0.05). Conclusions The elevated phosphorylation of CREB in the hippocampus and prefrontal cortex of resilience CMS rats may contribute to the mood alteration induced by stress.

Objective To investigate the feasibility of online and offline cone-beam CT (CBCT) guided radiotherapy for lung cancer. Methods Fourteen patients with lung tumor treated by three-dimen-sional conformal radiotherapy were investigated. Online kV CBCT scan,image registration and setup correc-tion were performed before and immediately after radiotherapy. CBCT online-guided correction data were used to calculate the population-based CTV-PTV margins under the condition of non-correction and correction in every fraction respectively. The numbers of initial images and the population-based CTV-PTV margins af-ter the offline compensation of the system setup error were evaluated with the permission of 0.5 mm and 1.5 mm maximal residue error,respectively. Results Under the condition of non-correction,the required mar-gins for total error were 5.7 mm,8.0 mm and 7.8 mm in the left-right(x axis) ,cranio-caudal(y axis) and anterior-posterior(z axis) directions, respectively. When the tumor was corrected in every fraction, the re-quired margins for intra-fraction error were 2.4 mm,2.4 mm and 2.3 mm in x,y and z axes, respectively. To correct the systematic setup error,9 sets of CBCT images for 3.3 mm,3.7 mm and 3.6 mm PTV margins, and 7 sets of CBCT images for 3.9 mm,4.3 mm and 4.3 mm PTV margins in x,y and z axes were necessary when 0. 5 mm and 1.5 mm maximal residue errosr were permited respectively. Conclusions Both of the online CBCT correction and the offline adaptive correction can markedly reduce the impact of setup error and reduce the required PTV margins accordingly. It is feasible to deliver the online and offline image guided ra-diation for patients with lung tumor.

Objective To investigate the radiosensitizing effect of 17AAG-cypate micelles on human non-small cell lung cancer A549 cells and its possible mechanism.Methods (1) A single-hit multi-target model formula was used to analyze the radiosensitizing effects of 17AAG-M and 17AAG-cypate-M.(2) The effects of 17AAG-cypate-M on the viability of A549 cells under laser and X-ray irradiation were analyzed by MTT assay.(3) The effect of the drugs on the cell senescence was observed by β-galactosidase staining assay.(4) The effects of different treatment conditions on DNA damage repair were analyzed by γ-H2AX immunofluorescence staining assay.(5) The expression of p-Erk1/2 and p-Akt was measured by Western blot.The paired t test was used for analyzing the differences between groups.Results Compared with the X-ray irradiation group,the X-ray+17AAG-cypate-M group had a lower mean lethal dose and a sensitization enhancement ratio greater than 1,indicating that 17AAG-cypate-M had a radiosensitizing effect.Compared with the 17AAG-M group,the 17AAG-cypate-M group showed significantly lower cell viability (P<0.01),a significantly higher percentage of aging cells (P<0.01),and significantly further delayed DNA damage repair (P<0.01).And the 17AAG-cypate-M group had lower expression of p-Erk1/2 and p-Akt than the 17AAG-M group.Conclusions Compared with 17AAG-M,17AAG-cypate-M has a higher radiosensitizing effect on A549 cells.The mechanism might be inducing the cell senescence,delaying DNA damage repair,and inhibiting the expression of p-Erk1/2 and p-Akt.

Objective To compare the cost-effectiveness and cost-utility of venlafaxine and mirtazapine in patients with treatment-resistant major depression (TRD).Methods One hundred and five patients with TRD were enrolled in this study and grouped into venlafaxine treatment (n=50) and mirtazapine treatment (n=55) based on the double-blind randomization scheme generated by computer.The treatment costs of antidepressants during 8 weeks were calculated,the rates of clinical response and remission were taken as treatment effectiveness,and the quality-adjusted life years (QALYs) as treatment utility.The descriptive analysis and nonparametric test were used to compare the cost-effectiveness and cost-utility of different groups.Results During 8 weeks,the treatment cost of antidepressant was ￥ 1 396.44 for venlafaxine and ￥ 1 206.90 mirtazapine,and the difference between two groups was ￥ 189.54.The cost-effectiveness ratios between venlafaxine and mirtazapine were very close (differed ￥ 0.06 for remission rate and ￥ 1.08 for response rate respectively).There was no significant difference for cost-utility ratios between two groups (physical functioning Z=-0.15,P＞0.05 ; mental health Z=-0.54,P＞0.05).Conclusion Both cost-effectiveness and cost-utility of venlafaxine in patients with TRD are close between venlafaxine and mirtazapine.

Objective To explore the relationship between ERG4 gene overexpression and azole resistance in clinical Candida albicans strains. Methods The National Committee for Clinical Laboratory Standards (NCCLS)M27-A2 broth microdilution method was conducted to evaluate antifungal susceptibility of 34 clinical Candida albicans isolates in vitro. Total RNA was extracted from these Candida albicans strains and transcribed into cDNA. Real-time fluorescence-based quantitative PCR was performed to determine the mRNA expression of ERG4 gene. Statistical analysis was carried out by a two-sample t-test. Results The expression level of ERG4 mRNA was significantly higher in fluconazole-resistant than in -sensitive Candida albicans strains (4.20 ± 2.56 vs. 1.72 ± 1.33, t = 3.99, P < 0.05), higher in itraconazole-resistant than in -sensitive Candida albicans strains (3.60 ± 2.47 vs. 1.66 ± 1.61, t = 3.71, P < 0.05), and higher in voriconazole-resistant than in -sensitive Candida albicans strains (3.99 ± 2.72 vs. 2.07 ± 1.58, t = 2.91, P <0.05). Further more, increased ERG4 mRNA expression was also observed in isolates cross-resistant to all the three azole antifungal agents compared with those susceptible to all of them (4.49 ± 2.73 vs. 1.69 ± 1.82, t = 3.81, P < 0.05). Conclusions The overexpression of ERG4 gene may be associated with cross resistance to fluconazole, itraconazole and voriconazole in clinical Candida albicans strains, but its exact role is expected to be investigated through downregulation of the ERG4 gene.