Objective To study the effect of sevoflurane or propofol/remifentanil general anesthesia undergoing gynecological surgery.Methods A total of 80 patients scheduled for selected gynecological surgery were divided into sevoflurane group or propofol/remifentanil group by random digits table method and 40 cases in each group.The induction of anesthesia was conducted with midazolam,propofol,sulfentanil,and rocuronium.After tracheal intubation,anesthesia was maintained with sevoflurane in sevoflurane group,and with propofol/remifentanyl target-controlled infusion in propofol/remifentanil group.Bispectral index was monitored in each group,and which was maintained 40-60.Blood pressure and heart rate was observed.At the end of operation,all anesthetics were discontinued,and the time of consciousness recovery,tracheal extubation,orientation was recorded.The incidence of agitation,nausea and vomiting within 24 h after surgery and the use of rescue drugs such as epinephrine,atropine or urapidil was recorded.Results No statistically significant difference was observed with respect to the time of consciousness recovery,tracheal extubation,orientation between two groups (P ＞ 0.05).The use of atropine and epinephrine in sevoflurane group was lower than that in propofol/remifentanil group [7.5％(3/40) vs.22.5％(9/40),20.0％(8/40) vs.32.5％(13/40)],and there was significant difference(P ＜ 0.05),and the use of urapidil in sevoflurane group was higher than that in pmpofol/remifentanil group [22.5％ (9/40) vs.2.5％ (1/40)],and there was significant difference (P ＜ 0.01).There was no statistically significant differences with respect to the incidence of agitation,nausea and vomiting within 24 h after surgery between two groups (P ＞0.05).Conclusion Propofol/remifcntanil and sevoflurane both provide satisfactory anesthesia for gynecological surgery.

Maxillary first molar with twin-root canal in palatal side is rare. This article described two cases of maxillary first molar with twin-root canal. A properly designed and prepared access of the cavity is helpful for the diagnosis and negotiation of the root canal morphology.
Dental Pulp Cavity ; Humans ; Maxilla ; Molar ; Root Canal Therapy

Microcalcifications are among the most common imaging findings of breast cancer. This article reviews the recent liter-ature regarding the foci of microcalcifications in breast cancer. In particular, we summarize the composition, formation mechanism, and biopsy method of the microcalcifications;the relationship between the foci and clinicopathologic indicators;and the influence of neoad-juvant chemotherapy on the foci.

OBJECTIVE:TO summarize the newest clinical application of permanent cardiac pacemaker, and introduce the relationship between the therapy efficacy and mechanism.DATA SOURCES: Related papers were searched in Pubmed from January 2000 to December 2006 with the terms of "pacemaker,application",and the language of paper was limited to English,at the same time,related papers were searched in WangFang Database with the same terms and the language of paper was limited to Chinese.STUDY SELECTION:The papers relevant to the newest large-scale clinical trial about the cardiac pacemaker were primarily collected.Exclusion criteria:repetitive studies.DATA EXTRACTION:A total of 203 pieces of papers related to the newest clinical application of cardiac pacemaker were collected,among which,30 pieces accorded with the inclusion criteria.DATA SYNTHESIS:The pacemaker can simulate the normal myocardium cell's function pacing and conducting the rhythm. Consequently it can substitute the abnormal myocardium cell to ensure the sequence and completeness of the cardiac pacing and conducting system,the natural electrophysiological activity,and the efficiency of the cardiac ejection and blood supply.The clinical application is not only for single bradycardia, but also for cardiac electric failure, cardiac electric turbulence,and some heart diseases without cardiac electric abnormity.With pacemaker miniaturization,digital signal processing, improved diagnostics and endocardial electrograms, modern pacemakers are able to offer a sophisticated therapeutic and diagnostic platform for the patients with refractory symptoms.CONCLUSION:The pacemaker can simulate the normal myocardium cell's function pacing and conducting the rhythm.It therapy for congenital heart disease.

Liver transplantation is a valid treatment option for select patients with Hepatocellular Carcinoma HCC and end-stage liver disease. However, in approximately 20% of patients, recurrent HCC is the rate-limiting factor for longterm survival. Despite identification of clinical parameters that may stratify patients at high risk and exhaustive preoperative staging, cancer recurrence is likely the result of microscopic extrahepatic disease. With a desperate donor organ shortage, locoregional ablation techniques and resection are being employed in patients on the waiting list to serve as a bridge to OLT. Further more, some have advocated aggressive surgical resection of isolated metastasis in both the liver and extrahepatic viscera. Whether these creative strategies confer a survival advantage is unknown, requiring longterm follow-up to determine their efficacy.

Objective To investigate the feature of pathogen distribution and antibiotic resistance of venti-lator associated pneumonia from Jan.to Dec,2007 in our ICU in order to provide a reference data guiding the appro-priate use of clinical antibiotics.Methods The 148 VAP cases of pathogen and drug sensitive tests were retrospec-tively analyzed.Results The incidence rate of VAP was 70.81%.Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli,Acinetobacter sp were the top pathogen of Gram negative bacillus.Staphylococcus aureus (MBSA)was the major pathogen of Gram positive coccus.The resistance rates of Klebsiella pneumonia and Pseudomonas aeruginosa were very high.The effect rates of frequently used antibiotics were not satisfactory.The fungus infection rate was 6.76% among all the cases.Conclusion MRSA,Klebsiella pneumoniae and Pseudomonas aerugmosa are the major pathogens of VAP in our ICU with a high drug resistance rate.Gram negative bacillus is the major Pathogen of VAP with a faidy high drug resistance rate.

OBJECTIVE: To investigate the effects of O-carboxymethyl chitosan (O-CMC) multi-hemostatic sponge on the immobilization of thrombin. METHODS: The formulation of O-CMC multi-hemostatic sponge was optimized by using central composite design-response surface methodology (CCD-RSM), in which the O-CMC, glutaraldehyde and thrombin were used as enzyme immobilization carrier, crosslink agent and coagulant, respectively. The crosslinked conditions of thrombin were studied by determining the enzymatic activity yield. RESULTS: The optimized concentrations of O-CMC, thrombin and glutaraldehyde were 2.49%, 49.87 U · mL-1, 0.49%, respectively. CONCLUSION: O-CMC multi-hemostatic sponge has the positive immobilization effect on thrombin.

Objective To evaluate the protective effect of curcumin against reperfusion injury of mouse renaltubular epithelial cells in vitro and the related mechanisms. Methods The renal tubular epithelial cells(TECs)were isolated by an improved Percoll density gradient centrifugation method. The cultured TECs were divided into blank group, hypoxia reperfusion group, low-concentration curcumin (5μmol/L) and high? Concentration curcumin (25μmol/L) groups. Apoptoticrate of TECs was examined with FACS, and them RNA and protein levels of TLR4 were detected with RT-PCR and Westernblotting analysis, respectively. Meanwhile, expression of IL-6, IL-1ß, TNF-α and MCP-1 mRNA in TECs was examined by RT-PCR, and their contents in the supernatants of TECs were measured by ELISA. Results The purity of the isolated TECs washigher than 95%, and the cell viability was higher than 93%. Compared with hypoxia reperfusion group, the two curcumin groups exhibited significantly lower apoptotic rates (P<0.01) and lower levels of TLR 4m RNA and protein (P<0.01), inhibited P65 phosphorylation, and significantly decreased levels of IL-6, IL-1ß, TNF-α and MCP-1 in the TECs (at both mRNA and protein levels) and their supernatant (P<0.05orP<0.01). Conclusion Curcumin can protect TECs from reperfusion injury in vitro, which might be associated with the inhibition of TLR4 expression and the consequent attenuation of TLR4- triggered inflammatory damages.

OBJECTIVE To ensure safe operation of medical equipment through raising procurement staffs′ awareness of safety and quality control in the process of purchasing medical equipment and exerting fine control of safety and quality throughout procurement. METHODS To sum up regulations,rules and ways on the safety and quality control at all links in the process of purchasing.RESULTS The acceptance rate of quality inspection of introduced medical equipment was 100% and the operating rate of equipment for the annual working hours was 95%.In 2002,our work together with other departments work in our hospital passed the proof of ISO9000. CONCLUSIONS They can not keep hidden safety perils of medical equipment outside the gate of the purchasing and can not ensure the safe operation of medical equipment and its vital role in every medical activity,unless purchasing staffs observe all purchasing regulations and rules and exert fine control of safety and quality of the purchasing.

OBJECTIVE To evaluate the prevention of antibiotic-associated diarrhea(AAD) in surgical critical illness patients and strengthen the usage of antibacterials to AAD in hospital.METHODS Using prediction and retrospection to analyze the factors of AAD.RESULTS The main factors for AAD are changing antibiotics frequently,the age of patient,complicated disease of patient.CONCLUSIONS Rational use and rigorous control of antibiotics are the keys to prevent AAD in hospital.