Objective To investigate the effect of dexmedetomidine (Dex) on postoperative sufentanil consumption in patient-controlled intravenous analgesia (PCIA).Methods Eighty patients (ASA Ⅰ or Ⅱ) undergoing abdominal hysterectomy and general anesthesia were divided into 2 groups with 40 cases each by random digits table.Patients in experiment group were received Dex 0.6 μg/kg (in 10 minutes).Patients in control group were recieved normal saline respectively by pumped infusion one hour before the operation finishing.All patients received a standadized sufentanil PCIA one hour before the operation finishing,sufentanil 2 μg/kg in 100 ml saline with tropisetron 5 mg,the loading dose was 4 ml,the backgroud dose was 1 ml/h,the controlled dose was 1 ml/h,the lock time was 10 minutes.The scores of VAS and RSS were recorded 1,2,6,12 and 24 hours after PCIA,and the incidence rate of the nausea,vomiting and shivering were recorded too for 24 hours.Results There was no statistical significance between the two groups in the scores of VAS and RSS after PCIA.The sufentanil consumption 1,2,6,12 and 24 hours after PCIA in experiment group [(4.5 ± 0.6),(7.4 ± 1.2),(14.2 ± 2.2),(25.4 ± 3.1),(40.1 ± 5.3) μg] was less than that in control group [(8.9 ± 0.9),(13.8 ± 2.9),(27.2 ± 4.1),(40.2 ± 5.2),(62.3 ± 7.1) μg] (P ＜0.05).The incidence of postoperative nausea,vomiting and shivering in experiment group [7.5％(3/40),2.5％(1/40),2.5％(1/40)] was less than that in control group [15.0％(6/40),7.5％(3/40),10.0％(4/40)](P ＜ 0.05).Conclusion The patients receive Dex 0.6 μg/kg one hour before the operation finishing,need less consumption of sufentanil and occur less postoperative nausea,vomiting and shivering.

Objective: To study the status and identify the determinants of outpatient service utilization of rural floating population in Beijing who have different accumulated residence time.Methods: The survey data of rural floating population health and health care services in Beijing in 2014 were used, and the migrant population aged 18 years and above were taken as the research object.Whether to use outpatient service within two weeks was taken as dependent variable, gender, age, education level, self-assessment score of socioeconomic status, accumulated residence time in Beijing, health insurance, average household income, suffering from high blood pressure or diabetes as independent variables.Logistic regression model was used to analyze the influencing factors.Results: The average age of the research object was 36.7 years, with mostly secondary education.The average accumulated residence time in Beijing was 8.4 years.The two-week prevalence rate was 10.3%, the two-week visiting rate calculated by person-time was 6.0%.The Logistic regression model suggested that, socioeconomic status, accumulated residence time and suffering from high blood pressure or diabetes were statistically significant determinants of outpatient service utilization.Conclusion: The research object is a younger and less educated population, their health status is better and outpatient service utilization is lower.It is found that people who have longer accumulated residence time in Beijing have lower outpatient service utilization.This is because people with longer residence time have lower age-adjusted two-week prevalence rate.This is also because people with longer residence time have larger proportion of taking continuous measures under doctor's advice.It does not mean people with longer residence time have lower utilization of medical service.The residence time variable plays the role of proxy variable.It can solve the problem of variables' endoge-neity.At the same time, it can reflect the influence to outpatient services utilization of some determinants,which are not included in the model but varies with residence time.

Blood stasis is one of the main pathogenesis of geriatrics.The main traits of geriatrics blood stasis are: blood stasis mainly induced by def iciency,def iciency and stasis is concomitant,stasis builds up gradually,symptoms of blood stasis aren’t mandatory in clinic practice,the range and severity of blood stasis is so wide and severe that it’s hard to be dissipated.Activating circulation to dissipate stasis is followed through the whole therapeutic process,and often used with replenishing qi,invigorating the kidney,and nourishing blood in order to dissipate stasis without hurting vital qi as well as reinforcing vital energy to dissipate stasis.

Objective To analyze and investigate endoscopic and pathological characteristics in the diagnosis of early esophageal carcinoma. Methods The clinical data of 62 patients with early esophageal carcinoma who had been admitted to Southwest Hospital from January 2003 to December 2007 were retrospectively analyzed. Results Of all patients, 8 had upper esophageal carcinoma, 42 had middle esophageal carcinoma and 12 had lower esophageal carcinoma. The tumor growth patterns included surface diffusion growth (n = 30), bidirectional growth (n = 11), intracavitary growth (n = 9), intra-esophageal wall growth (n = 7) and mixed growth (n = 5). The diameter of lesions ranged from 1.0 cm to 2.9 cm in majority. Surgical resection was done in 38 patients, endoscopic mucosal resection in 23 patients and endoscopic submucosal dissection in 1 patient. Postoperative pathological examination showed that 13 patients had in situ carcinoma, 22 had intramucosal carcinoma and 27 had submucosal carcinoma. The lymph node metastatic rate of intramucosal carcinoma and submucosal carcinoma were 5% (1/22) and 15% (4/27), respectively. The numbers of squamous cell carcinoma, adenocarcinoma, small cell carcinoma, sarcoma carcinoma and spindle carcinoma were 57, 2, 1, 1, 1, respectively. ConelusionsEarly esophageal carcinoma tends to appear in the middle part of esophagus, and with surface diffusion growth type. Most of the early esophageal carcinoma are squamous cell carcinoma. Endoscopy combined with lugol's iodine and methyleneblue staining is effective in detecting early esophageal carcinoma.

AIM: To determine the effects of NF-?B on the development of rat pancreatic fibrosis mediated by angiotensin II. METHODS: Spraque-Dawley rats (200-300g) were randomly divided into normal group, control group and losartan-treatment group. Pancreatic fibrosis was induced by injection of 2% TNBS into biliopancreatic duct. Rats in losartan-treatment group and control group were respectively treated with losartan (10 mg?kg~(-1)?d~(-1)) by gavage and the same volume of saline vehicle. The expression, distribution, and activation of NF-?B were studied by Western blot, immunohistochemistry and TransAM~(TM). Toluidine blue staining and transmission electron microscopy were also used to observe the number, distribution and degranulation of mast cells. In addition, RT-PCR was performed to detect the intrapancreatic ICAM-1 mRNA expression. RESULTS: The expression and activity of intrapancreatic NF-?B p65 protein were significantly increased on day 3 after operation, reaching peak on day 7 [(0.406?0.086) mg/g total protein]. Mast cell activation was observed and ICAM-1 mRNA levels on day 3 and 7 were up-regulated in control group. Losartan treatment inhibited NF-?B expression and activation, reduced mast cell infiltration and degranulation and decreased ICAM-1 mRNA expression compared with control rats. CONCLUSION: It might be associated with the expression and activation of NF-?B that angiotensin II mediates inflammation and fibrosis in the early stage of pancreatic fibrosis. [

AIM: To examine the effects of PPAR? activation on the growth of human pancreatic carcinoma in vitro and to explore the role of NF-?B and activator protein-1 (AP-1) in this process. METHODS: SW-1990 pancreatic cancer cells were treated with ligand of RXR?, 9-cis-RA, ligand of PPAR?, 15d-PGJ_2, and both. Antiproliferative effect was evaluated by using MTT assay; the expression of NF-?B p65 active protein was assayed by using TransAM~TM technique. Expression of c-jun and c-fos by SW1990 cells, which were treated with 15d-PGJ_2, 9-cis-RA and both at varying concentrations, were detected by RT-PCR. RESULTS: MTT assay demonstrated that 15d-PGJ_2, 9-cis-RA and the combination of both had a potent inhibitory effect on the growth of SW1990 cells in a dose-dependent manner. 9-cis-RA had a synergic action with 15d-PGJ_2 on the growth inhibition of pancreatic carcinoma. TransAM~TM showed a down-regulation trend of P65 active protein in SW1990 cells treated with 15d-PGJ_2, 9-cis-RA and both. RT-PCR demonstrated that the expression of c-jun mRNA in 15d-PGJ_2, 9-cis-RA and the combination of both-treated cells were firstly increased and then decreased, the expression of c-fos was decreased in 15d-PGJ_2 or 9-cis-RA treated SW1990 cells, but increased in cells treated with both 15d-PGJ_2 and 9-cis-RA. CONCLUSION: Activation of PPAR? exerts a negative regulatory effect on the growth of pancreatic carcinoma in vitro. Activation of RXR? has a synergic action with PPAR? agonist. The mechanism is probably associated with down-regulating the expression of NF-?B and AP-1. [

Objective To prepare in-house calibrator of apolipoprotein A1 and apolipoprotein B with the values are traceable to the WHO-International reference materials SP1-01 and SP3-07.Methods We participated in the Northwest lipid research laboratory (NWLRL) protocol for target value transfer of WHO-IFCC apo A1 and apoB reference materials, and evaluated of comparability of the measurement.The analyses were performed on a Olympus AU 400, apo A1 and apoB were determined by immunoturbidimetric endpoint method.Results Through 3-step study, the precision and accuracy of apo A1 and apoB determination of our company met the NWLRL criteria.Correlation coefficients between obtained and assigned values of NWLRL on 40 individual serum samples were 0.983 for apo A1, 0.987 for apoB, the average absolute bias were 2.7 % for apo A1, 3.0 % for apoB, respectively.Conclusion NWLRL issued the certificate to Zhongsheng Beikong Bio-Technology and Science Inc.for the in-house apo A1 and apoB calibrator values are traceable to the WHO- International reference materials.

Objective To screen the risk factors for postoperative residual neuromuscular blockade (RNMB) in the patients undergoing thoracic surgery.Methods A total of 733 patients undergoing elective thoracic surgery with general anesthesia,without neuromuscular disease,skin temperature ≥32 ℃,were transferred to the postanesthesia care unit (PACU) after surgery and given synchronized intermittent mandatory ventilation.Neuromuscular blockade was monitored immediately after admission to the PACU,and the occurrence of postoperative RNMB was defined as a train of four (TOF) ratio ＜90％ at the time of extubation.The patients were divided into RNMB group and nonRNMB group according to whether or not postoperative RNMB occurred.Each parameter of baseline patient characteristics,complications,sites and methods of surgery,anesthesia time,requirement for muscle relaxants during surgery,TOF ratio on arrival to the PACU,requirement for muscle relaxant antagonists in the PACU,and extubation time were recorded.The risk factors of which P values were less than 0.05 would enter the multivariable logistic regression analysis to stratify the risk factors for postoperative RNMB.Results A total of 385 patients developed postoperative RNMB,and the incidence was 52.5％.The results of multivariate logistic regression analysis showed that complications such as diabetes,intraoperative application of two kinds of muscle relaxants,average intraoperative consumption of cisatracurium ≥ 0.14 mg · kg-1 · h-1,TOF ratio on arrival to the PACU ≤ 0.5,and extubation time ≤ 30 min were independent risk factors for postoperative RNMB (P＜0.05).Conclusion Complications such as diabetes,intraoperative application of two kinds of muscle relaxants,average intraoperative consumption of cisatracurium 0.14 mg · kg-1 · h-1,TOF ratio on arrival to the PACU ≤ 0.5,and extubation time ≤ 30 min are independent risk factors for postoperative RNMB in the patients undergoing thoracic surgery.

Objective To investigate the clinical effect of gastric bypass operation on treating type 2diabetes,and analyze the management status.Methods Fifty-seven patients wiith type 2 diabetes treated by gastric bypass operation were divided by different body mass index(BMI) into 4 groups:group A( BMI ＜ 20kg/m2) with 8 cases,group B (20 kg/m2≤BMI ＜24 kg/m2) with 21 cases,group C (24 kg/m2≤BMI ＜27kg/m2) with 17 cases and group D (BMI ≥27 kg/m2) with 11 cases.The control of blood glucose and glycosylated hemoglobin,changes of diets and body weight,diabetes complications,adverse reactions after operation and postoperative management were followed up or reviewed.The clinical data were analyzed comprehensively.Results The cure rate of group C was the highest [ 70.6％( 12/17 ) ],while the cure rate of group A was the lowest (0).The overall cure rate was 43.9％(25/57) and the overall improvement rate was 28.1％(16/57).The overall efficient rate was 71.9％(41/57) and the overall inefficient rate was 28.1％(16/57).Apart from a few patients had malnutrition,amenorrhea,bad stomach,diarrhea and poor diet after leaving the hospital,other patients had no surgery complications and no patients died.There was no clinician to follow up and did education to these patients after operation.Conchusions Gastric bypass operation is safe and effective for obese and non-obese patients with type 2 diabetes.It is a new method to weat type 2diabetes at present,but the indications should be grasped and operation enlargement must he prevented.The management of teams of physicians,surgeons,dietitians,nurses should be established afler operation.

Objective To explore the role of peroxisome proliferator activated receptor ?(PPAR ?) in angiogenesis in human pancreatic carcinoma with reference to the regulation of vascular endothelial growth factor (VEGF). Methods Expression of PPAR ? in SW1990 pancreatic carcinoma cells was examined by RT PCR and immunocytochemical staining. Secretion of VEGF by SW1990 cells, treated by 15 deoxy delta(12,14) prostaglandin J 2(15d PGJ 2), the ligand of PPAR ? and, 9 cis retinoic acid(9 cis RA) the ligand of retinoic X receptor(RXR)?, at different concentrations and durations, was detected by semi quantitative RT PCR. Effects of Rosiglitazone, a selective PPAR ? activator, on the changes of microvascular density (MVD) and VEGF expression were investigated in 30 SW1990 cell xenografted nude mice, among which 15 were in the treatment group (drank a solution of Rosiglitazone at the dose of 10 ?mol?kg -1 ?d -1 ) and 15 in the control group. Neovasculature was detected using immunohistochemistry staining labeled with anti Ⅳ collagen antibody and indicated by MVD. Results RT PCR and immunocytochemical staining showed that PPAR ? mRNA and protein were expressed in the SW1990 cell line. Semi quantitative RT PCR demonstrated that the combination of 15d PGJ 2 and 9 cis RA had a potent inhibitory effect on the expression of VEGF in SW1990 cells in both dose and time dependent manners. In vivo study, the MVD was statistically decreased in Rosiglitazone treated mice (10.67?3.07) compared with that in the control group (31.44?6.06) ( P