Objective To explore the value of carbox dioxide(CO2 )for the upper gastrointestinal endoscopic mucosal dissection(ESD).Methods A total of 158 patients who underwent ESD from January 2012 to May 2014 at Endoscopy Center of Dongguan Hospital were enrolled in the study.The patients were randomly divided into air group and CO2 group.The arterial partial pressure of CO2 (PaCO2 ),the monitering results of SpO2 before,during,afte operation,abdominal pain after operation and postoperative complications were assessed.The safety and advantage of CO2 of the upper gastrointestinal ESD were comparative ana-lyzed.Results PaCO2 of air group and CO2 group during the ESD procedures [(47.8 ±5.4)mmHg, (45.1 ±5.5)mmHg]was significantly higher than that before[(37.2 ±4.6)mmHg,(36.3 ±3.9)mmHg] (P <0.05)and after the operation[(39.9 ±4.0)mmHg,(39.4 ±4.2)mmHg](P <0.05).Preoperative, intraoperative and postoperative PaCO2 were not significantly different between the two groups(P >0.05);all the SpO2 were greater than 90%,and it was not significantly different between the two groups(P >0.05). The abdominal pain score of CO2 group was significantly lower than that of air group less than 2 h after wake-up (P <0.05),but there was no difference between the two groups at 12 h and 24 h after operation(P >0.05).The bleeding rate of air group and CO2 group during and after operation was not significantly different (P >0.05),and there were no other serious complications.Conclusion CO2 is safe in the upper gastroin-testinal ESD,and it can reduce postoperative abdominal pain,so it is suitable for clinical application.

Objective To compare the effects of pre-emptive epidural analgesia and postoperative epiclural analgesia on stress response to upper abdominal surgery. Methods Thirty ASA Ⅰ or Ⅱ patients undergoing elective upper abdominal surgery performed under general anesthesia were randomly divided into 2 groups (n = 15 each): Ⅰ pre-emptive epidural analgesia group (group P) and Ⅱ postoperative epidural analgesia group (group C). A mixture of 0.5 μg/ml sufentanil and 0.15% ropivacaine 250 ml was used for epidural analgesia in both groups. The epidural catheter was placed at T_(10-11) interspace. The epidural regimen included a loading dose of 15 ml followed after 30 min by continuous epidurai infusion at 5 ml/h for 50 h. In group P the epidural analgesia was started at 20 min before skin incision, while in group C after operation when the patients emerged from general anesthesia and were extubated. The depth of general anesthesia was monitored using CSI and maintained at 45-55. Vcnoas blood samples were taken before epidnral catheter was placed (T_0, baseline), at 2 h (T_1) and at 18 h (T_2) after operation for determination the concentrations of ACTH and cortisol (Cor) and C reaction protein (CLIP). Results Blood Cor, ACTH and CRP concentrations were significantly increased after operation as compared with the baseline values at T0 and were significantly lower at T_1 and T_1 in group P than in group C. Conclusion Pre-emptive epidural analgesia can more effectively inhibit stress response than postoperative epidural analgesia to upper abdominal surgery.

Objective To investigate the effects of hyaluronan (HA) and CD44 on airway mucous hypersecretion,and explore the molecular mechanism of activation of epidermal growth factor(EGF)/epidermal growth factor receptor(EGFR) signal transduction pathway by signal factors. Methods BEAS-2 B airway epithelial cells were cultured in vitro,and were stimulated by neutrophil elastase(NE).Reactive oxygen species(ROS)scavenger(DMTU),hyaluronidase(Hase),CD44 antibody and tissue kallikrein(TK)inhibitor(PI)were served as interventional factors,and control group(serum free culture),NE stimulation group(50 nmol/L NE),DMTU+NE group(20μmol/L DMTU+50 nmol/L NE),DMTU+Hase+NE group(20 μmol/L DMTU+10μg/mL Hase+50 nmol/L NE),CD44Ab+NE group(5 μg/mL CD44Ab+50 nmol/LNE)and PI+NE group(1 00μg/mL PI+50 nmol/L NE)were established.The expression of mucin(MUC)5AC mRNA was detected by RT-PCR,the expression of MUC5AC and EGF protein was determined by ELISA,and the expression of phosphorylated epidermal growth factor receptor(p-EGFR)protein was analysed by Western blotting. Results The expression of MUC5AC,EGF and p-EGFR protein and MUC5AC mRNA in NE stimulation group was significantly higher than that in control group(P<0.01),the expression in DMTU+NE group was significantly lower than that in NE stimulation group(P<0.01),the expression in MTU+Hase+NE group was significantly higher than that in DMTU+NE group(P<0.05 for MUC5AC and p-EGFR protein and MUC5AC mRNA,and P<0.01 for EGF protein),the expression in CD44Ab+NE group and PI+NE group was significantly higher than that in NE stimulation group(P<0.05 for MUC5AC and p-EGFR protein and MUC5AC mRNA,and P<0.01 for EGF protein). Conclusion NE up-regulates the expression of MUC5AC gene via ROS/HA/CD44/TK/EGF/EGFR signal transduction pathway in airway epithelial cells.

ObjectiveTo investigate the efficacy of intravenous parecoxib combined with femoral nerve block on postoperative analgesia and knee functional rehabilitation in elderly patients following total knee replacement.MethodsForty elderly patients with osteoarthritis schedu[ed for total knee arthroplasty under general anesthesia,aged 65-74 years,weighing 45-90 kg,ASA [Ⅱ,were randomly divided into two groups( n ＝ 20 each).FNB group received femoral nerve blockade for postoperative analgesia ( local injection of 0.25 ％ ropivacaine 25 ml at the end of surgery,repeated every 8 h up to 72 h after surgery).FNB-Pa group received the femoral nerve blockade plus the parecoxib (administered Ⅳ bolus of 40 mg 30 min before the end of surgery,12,24,and 48 h after surgery respectively).Pain was scored at rest or during continuous passive motion using Visual Analog Scale (VAS).The Hospital for Special Surgery (HSS) knee score was determinated before surgery,at 24,48 and 72 h after surgery respectively.Side effects were also recorded in both groups.Results VAS score was significantly lower at rest and during continuous passive motion in FNB-Pa group than in FNB group ( P < 0.05).Compared with baseline value,HSS score increased significantly during postoperative analgesia in both groups( P < 0.05 or 0.01 ).HSS score were significantly higher at 48 h and 72 h after surgery in FNB-Pa group than in FNB group ( P < 0.05).No severe related side effects occured in both groups.ConclusionFemoral nerve block in combination with intravenous parecoxib can safely and effectively relieve the static and dynamic pain after total knee replacement and is helpful for rehabilitation of the prosthesis knee joint function after surgery.

For many reasons,the size of jointed implement for central oxygen supply are different in some small and mediate hospitals,and some equipments can not used in other departments.In order to share mutual resource and make good use of all important equipments,we design a fast jointed implement for respirator joint.In the application of 24 cases,it shows convenient and effective for saving patients.

OBJECTIVE To discuss the risk factors of nosocomial infection in burn patients in order to raise their treatment level.METHODS Picked out the nosocomial infection and the risk factors in burn patients during recent three years,we then made the review analysis.RESULTS From 234 cases 46 patients were with nosocomial infection,the infection rate was 19.66%,the most common location was wound infection,accounted for 63.04%,followed by respiratory tract for 23.91%.The main risk factors were age(≥ 60 years),severe degree burns,a long stay in hospital,and the large-scale application of antibiotics.CONCLUSIONS As for the high incidence of nosocomial infection among burn patients,we must pay close attention to and strengthen prevention.

Objective:To study the effect of cervical canal mucosa dng excision on cervical columnar eversion in Loop electrosurgical excision procedure(LEEP).Methods:A prospective randomized control trail was performed in 125 cervical intraepithelial neoplasia(CIN)patients.Cervix and cervical canal were conically excised with triangle electrode in 62 patients in the control group;in the study group,a small ring electrode was put into the cervical canal and the cervical canal mucosa was excised about 0.5～0.8cm,after excision as the control group.Follow-up was performed postoperatively in 1,3,6 months respectively.The operation time,the bleeding volume,the rate of cervical columnar eversion and cervical adhesion or stenosis were compared between the two groups.Results:The rate of cervical columnar eversion in the study group (1/63,1.59%)was lower than that in the control group(9/62,14.52%).There was significantly statistical difference between them(P=0.008).There was no statistical differences between them in the operation time,the bleeding volume,and the rate of cervical adhesion or stenosis (P>0.05).Conclusions:The cervical canal mucosa ring excision in LEEP can effectively prevent postoperative cervical columnar eversion.

Objective To study the brain development in infants of diabetic mother. Methods The development of cerebral grey matters and white matters was evaluated in 64 infants of pregnant diabetic mother by echoencephalography and medical image analysis system. The parameters were compared with 101 infants of non-diabetic mother. The early brain response function of newborns was assessed. The neurodevelopment after neonatal period was also evaluated. Results The brain in infants of diabetic mathers was immature.The average values of grey density in thalami (76.92?6.60) were significantly lower in full term infants of diabetic mathers than that of the infants of non-diabetic mathers (84.72?6.35). These were also obvious in white matters of frontal lobe [(62.68?5.21) vs (67.60?4.09)] and occipital lobe [(73.39?5.67) vs (78.61?2.95)] (P

Objective To investigate the influence of lidocaine on systemic inflammatory response to cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting (CABG) .Methods Twenty ASA Ⅱ or Ⅲ patients of both sexes (13 males, 7 females) aged 47-67 yrs weighing 62-82 kg undergoing CABG were randomly divided into 2 groups of 10 each: control group (C) and lidocaine group (L). In group L lidocaine infusion was started as soon as the pericardium was cut open and maintained at 4 mg?min-1 until the end of the surgery. Another dose of lidocaine (4 mg?kg-1) was added to the prime. In control group normal saline (NS) was given instead of lidocaine in the same volume and at the same speed. Blood samples were taken from radial artery before CPB (T0, baseline) and at 1, 10 and 60 min after release of the aortic cross-clamp (T1,2,3) for determination of plasma concentration of TNF-?, IL-6, IL-10 and PMN count. Plasma lidocaine concentration was determined at 10 and 60 min after initiation of CPB and at the end of surgery in 5 patients in group L. Results The two groups were comparable with respect to age, sex ratio (M/F), body weight, CPB time and aortic cross-clamping time. The mean plasma lidocaine concentration was (4.1?0.5)?g?ml-1, (4.6?0.7) ?g?ml-1 and (5.9?0.9)?g?ml-1 at 10, 60 min of CPB and end of surgery respectively in group L. Plasma concentrations of TNF-?, IL-6, IL-10 and PMN count were significantly increased at T1,2,3 as compared to the baseline values at T0 in both groups. The plasma concentrations of TNF-? and IL-6 were significantly lower while those of IL-10 were significantly higher at T1-3 in group L than in group C. Conclusion Lidocaine can inhibit the inflammatory response induced by CPB in patients undergoing CABG.

Objective To detect water iodine content,urinary iodine content and thyroid volume of children aged 6-12 in high water-iodine areas and to explore the relationship between thyroid volume and the three factors (water iodine content,urinary iodine content and age).Methods In July 2011 to March 2012,four provinces of Shandong,Shanxi,Henan and Hebei were investigated,and water iodine content were divided into 4 levels,which were 50-99,100-149,150-299,and ≥300 μg/L,respectively.For each water iodine content level,three villages were analyzed.School children aged 6-12 were recruited,family salt iodine was determined to exclude those children who had intaken iodized salt.After that,water iodine content,urinary iodine content and thyroid volume of children were measured.Finally,relationships between thyroid volume and water iodine content,urinary iodine content and age were analyzed.Salt iodine was detected by semi-quantitative method;urinary iodine was detected by arsenic cerium catalytic spectrophotometry;thyroid volume was detected by B-scan ultrasonography.Results The medians of thyroid volume in each age group from 6 to 12 years were 2.00,2.21,2.54,2.94,3.30,3.44,and 3.72 ml,respectively;the medians of urinary iodine content in each age group were 252.3,319.4,345.2,350.9,371.2,384.4,and 409.6 μg/L,respectively.Under the condition of water iodine content ＞ 100 μg/L,the median of urinary iodine content of children aged 6 in 100-149 μg/L water iodine content group was 274.0 μg/L,while other groups with different ages got the median of urinary iodine content more than 300 μg/L.Water iodine content,urinary iodine content and age were all positively correlated with thyroid volume (r =0.154,0.148,0.381,all P ＜ 0.01).In addition,water iodine content and urinary iodine content were positively correlated (r =0.399,P ＜ 0.05).With the same water iodine content level,the urinary iodine content and thyroid volume showed a significant dispersion with increasing age,which meant different individual responses to higher iodine.Conclusions In higher water-iodine areas,the iodine level of children is excessive,although they have intaken non-iodized salt.Furthermore,thyroid volume is associated with water iodine content,urinary iodine content and age.