Objective To investigate the impact of propofol and midazolam on the time course of extubation in patients with mechanical ventilation.Methods The patients were randomly divided into the propofol group(n=37)and the midazolam group(n=52),which were further divided into three sedation stratums.The administration of two drugs were stoped immediately while weaning from the ventilator.The awakening time and extubation time of the two groups were recorded and compared with each other.Results Both awakening time and extubation time of the propofol groups were shorter than those of the midazolam group(P

Objective To explore the relationship between phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt)/mammals target protein rapamycin (mTOR) signal transduction pathway and Barrett esophagus genesis.Methods A total of 140 rats were divided into sham operated group (n=10),iron group (n =10),esophageal duodenal side anastomosis group (n =30),esophageal duodenal side anastomosis plus iron group (n-30),esophageal gastric duodenal side anastomosis group (n=30) and esophageal gastric duodenal anastomosis plus iron group (n=30).In the end,10 normal esophagus tissue specimens,62 reflux esophagitis tissue specimens and 34 Barrett's esophagus tissue specimens were obtained.The expression levels of epidermal growth factor receptor (EGFR),Akt,phospho Akt (p-Akt),phospho-mTOR (p-mTOR) protein were detected by immunohistochemistry.Single factor analysis of variance,SNK between two groups and nonparametric correlation analysis were performed for statistical analysis.Results The protein expression levels of EGFR,Akt,p-Akt,p-mTOR in Barret(s esophagus tissues were higher than those in reflux esophagitis tissues and normal esophagus tissues (EGFR 0.1799±0.0367 vs 0.0438±0.0025 and 0.0277±0.0069,q=6.79,4.13; Akt 0.1874±0.0250 vs 0.0986±0.0093 and 0.0383±0.0048,q=6.51,3.56; p-Akt 0.1418±0.0130 vs 0.0592±0.0027 and 0.0281 ±0.0017,q=7.68,3.99; p-mTOR 0.1591±0.0275 vs 0.0674 ±0.0059 and 0.0112±0.0017,q=5.62,4.11; all P＜0.05).The protein expression levels of EGFR,Akt,p-Akt,and p-mTORin reflux esophagitis tissues were higher than those in normal esophagus tissues(q=4.67,4.29,4.27,4.03; all P＜0.05).Conclusion PI3K/Akt/mTOR signal transduction pathway were activated in reflux esophagitis and Barrett's esophagus,which provided theoretical basis for clinical multi-target treatment for diseases.

BACKGROUND:Gait analysis enable to convert qualitative analysis and description used for a long time in orthopedic examination and rehabilitative treatment into objective and precise quantitative assessment. At the present, with the development of science and technology, three-dimensional (3D) gait analysis is more and more widely, extensively used in orthopedic surgery and rehabilitation medicine abroad, while much less in China.OBJECTIVE: To study the parameters of time-distance, kinematics, kinetic and electromyography (EMG) in healthy subjects and patients with backbone, hip, knee or ankle joint diseases.DESIGN: Comparative observation and control study.PARTICIPANTS: From December 2004 to July 2005, 40 healthy subjects and 112 patients suffering from backbone and hip, knee, ankle joint disease were selected from the Department of Rehabilitative Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University and analyzed by three dimensional gait analysis system (VICON 612 system made by Britain VICON Company). 112 patients including 42 males with the mean age of (46.2 ± 2.3) years and 70 females with the mean age (41.2 ± 3.5) years were screened by skilled clinicians after surgical and rehabilitative treatment.Among them there were 21 patients with cervical vertebra, 26 patients with prolapse of lumbar intervertebral disc and lumbar spinal stenosis. The number of hip, knee, ankle joint disease was 12, 34, 19 respectively. Total hip replacement was included in hip joint disease, anterior cruciate ligament (ACL) reconstruction was included in knee joint disease, talipes equinovarus was included in ankle joint disease. Meanwhile, 40 healthy subjects who were 20-40 years old, male or female, without any clinical symptom of backbone and limbs volunteered in the study.METHODS :Gait analysis were carried out on 40 healthy volunteers and 112 operational and rehabilitative treatment patients with spinal and lower limb diseases using VICON 612 system made by Britain VICON Company.MAIN OUTCOME MEASURES: The time-distance parameters (cadence, step length, walking speed), kinematics parameters (knee flexion/extension degree, hip flexion/extension degree, ankle dorsi/plantar degree), kinetic parameters (knee force in Z axis, hip force in Z axis, normalized force in Z axis) and EMG parameters (vastus lateralis SEMG) of lower limbs were examined.RESULTS: A total of 40 healthy subjects and 112 patients were involved in the analysis of results. ① Time-distance parameter: Cadence, as well as step length and walking speed of patients with backbone disease, patients with hip joint disease, patients with knee joint disease, and patients with ankle joint disease were lower than those of healthy subjects,and the difference between two groups was significant (P ＜ 0.05-0.01). ② Kinematic and kinetic parameters of all joints in upper limbs: One year after left ACL knee reconstruction, the extension of left knee in initial contact phase was 9° less than that of right one and the stress in Z axis of left knee was much less than that of right one; One year after left THA,the flexion of left hip in initial contact phase was 8.5° less than that of right one, the extension of left hip in terminal stance phase was 3° less than that of right one, during stance phase the stress in Z axis of left hip was much less than that of right one; As to an infantile paralysis patient with talipes equinovarus, the dorsiflexion of left ankle in initial contact phase was 12° less than that of right one, the plantar flexion of left ankle in terminal stance phase was 5° less than that of right one. The stress in Z axis of left ankle during stance phase was much less than that of right one. However, the difference in range of motion and stress in Z axis was not significant between the left and right knee joint in healthy people. ③ One year after left total knee arthroplasty, the dynamic surface electromyogram signals of left vastus lateralis is much lower than that of right vastus lateralis in a gait cycle.CONCLUSION: 3D gait analysis enables tprovide objective basis for making operation scheme for orthopedic surgery and after-operation rehabilitation therapy, and assessing curative effect of rehabilitation therapy.

Objective To study the value of detection of C- reactive protein(CRP), serum glucose concen-tration and APACHE Ⅱ grade for estimating inflammation, pathogenetic condition and prognosis of systemic inflam-matory response syndrome (SIRS) patients.Methods 50 SIRS patients in ICU were selected and were divided into S1 and S2 subgroup according to SIRS diagnosis standard, and 18 patients developed MOBS.30 patients without SIRS, were selected as control group.Detection of CRP, serum glucose concentration and APACHE Ⅱ grade were per-formed.Results CRP(76.19±11.98 mg/L vs.14.04±5.70 mg/L) ,serum glucose concentration(7.10±1.30 mmol/L vs.5.32±1.09 mmol/L) and APACHE Ⅱ grade (20.06±6.39 vs.7.90±3.54) of SIRS group were higher than that of non-SIRs group (P<0.01).CRP, serum glucose concentration and APACHE Ⅱ grade all are higher in group S2 than that of group S1 (91.25±9.89 mg/L vs.62.29±10.38 mg/L,8.32±2.40 mmol/L vs.7.10±1.69 mmol/L,26.72±5.14 vs.18.37±5.70).MOBS incidence and case fatality in S2 subgroup (12/15 and 6/35) were higher than that of S1 subgroup(10/15 and 3/35 ) (P<0.01 ).Conclusion CRP, serum glucose concentration and APACHE Ⅱ grade are increased in SIRS patients and with their increasing, MOBS incidence and case fatality were also increasing.CRP, serum glucose concentration and APACHE Ⅱ grade are significant factors in estimating SIRS patients pathogenetic condition and their prognosis.

BACKGROUND:Evaluation plan for the neuro-musculo-skeletal system model and motor function was little.However,the three-dimensional gait analysis can transfer qualitative analysis and object description which widely used in orthopedics and rehabilitation medicine to quantitative evaluation with more objective and precise.OBJECTIVE:To evaluate gait kinematics and kinetic changes after total knee replacement based on 12 months follow up using three-dimensional gait analysis.DESIGN,TIME AND SETTING:The comparative observation and case-control study was performed in the Gait Analysis Room of the Department of Rehabilitation Medicine in the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University from January 2007 to May 2008.PARTICIPANTS:Ten patients with knee osteoarthritis following total knee replacement were chosen as treatment group;concurrently,ten patients whose baseline data were matched with the treatment group without problems in nerve,muscle,skeletal system and equilibrium were selected as the control group.METHODS:Ten patients in the treatment group underwent rehabilitation training,then compared time-distance,kinematic,and mechanical parameters which were measured at 3,6,12 months after total knee replacement with the control group.MAIN OUTCOME MEASURES:Time-distance parameter,kinematic parameter,mechanical parameter and knee functional scores.RESULTS:Pace,step frequency,gait speed,and time of injured leg standing were notably decreased,while time of uninjured leg standing,duration of gait cycle were obvious prolonged compared with the control group(P

AIM: To establish the quality standard for Jieeryin Effervescent Tablets (Fructus Cnidii, Folium Artemisiae Argyi, Radix Sophorae Flavescentis, Cortex Phellodendri, etc.). METHODS: Radix Sophorae Flavescentis、Cortex Phellodendri、Radix Scutellariae and Fructus Gardeniae in Jieeryin Effervescent Tablets were identified by TLC. The content of geniposide was determined by HPLC. RESULTS: The average recovery was 99% and relative standard deviation was 1.6%. CONCLUSION: The precision and reproducibility of the method are good. The method can be used for quality control of Jieeryin Effervescent Tablets.

Objective To evaluate the value of MRI in diagnosing the bucket handle tear (BHT) of the knee meniscus.Methods Eighty four knees which underwent both MRI and arthroscopy (AS) examinations were analyzed. Results of AS were used as golden standard to evaluate the results of MRI. The evaluating criteria included primary reports, central displaced fragments of meniscus (CDFM), double posterior cruciate ligament sign (DPCLS) and the absent bow tie sign (ABTS). Results For MRI diagnosing BHT, the sensitivity and specificity of primary reports were 43% and 87%, respectively; the sensitivity and specificity of CDFM were 72% and 87%, respectively; the sensitivity and specificity of the DPCLF were 31% and 97%, respectively; and the sensitivity and specificity of the ABTS were 71% and 69%, respectively.Conclusions When MRI was applied to diagnose BHT, the CDFM had higher sensitivity and specificity, while the ABTS had higher sensitivity and lower specificity. The DPCLF had the highest specificity and the lowest sensitivity.

Objective The purpose of this study was to investigate the value of chest CT in the evaluation ofchildren with suspected foreign body aspiration. Methods Chest CT was performed in 45consecutive children with suspected foreign body aspiration. The patients were examined with 16-slice Multidetector CT (MDCT) using 100 ～ 150 kV,30 ～ 50 mA, 1 mm section thickness. 1.2 pitch ratio, and 0.6 ～1.0 mm reconstruction interval. multiplanar reformatted (MPR) imaging were carried out after MDCT examinations. Results Chest CT revealed all foreign bodies in 42 of the 45 patients. Three patients with suspected foreign body aspiration did not show evidence of foreign body on CT,and they were treated with antibiotics for one week. These patients avoided unnecessary operations and recovered completely. The other 42 patients had evidence of foreign bodies in their bronchi. We designed the surgerical plan and selected appropriate foreign body forceps based on the CT scans. All of the foreign bodies were removed successfully, and no severe complications were observed. The location, shape, and volume of the foreign bodies found at surgery were consistent with the CT images. Conclusion The diagnosis of foreign body aspiration of the airwayin children can be accomplished by using chest CT. It is often useful in delineating the exact shape, location, volume and form of a bronchial foreign body and can help the surgeon plan for operative bronchoscopy and safe removal of the foreign body.

AIM: The synthesis of sarmentosin. METHODS: Condensation of butane-1,2,4-triol-1,2-acetonide(3) with α-D-glucopyranosyl bromide tetraacetate in the presence of Ag2O and molecular sieves gave the desired β-glucoside 4,which was transformed into sarmentosin via a reaction sequence of 7 steps. RESULTS: The overall yield is 5.8%. CONCLUSION: The first synthesis of sarmentosin(1),a potent natural GPT lowering agent,was achieved.

In order to explore the effect of glial cell line derived neurotrophic factor (GDNF) on the motor neurons of the spinal cord, the present study investigated the localization of GDNF in the lumbar segment of the spinal cord on postnatal 1、3、7、10、14 and 28 days in rats with immunohistochemical staining method. The results showed that the positive GDNF immunoreactivity was present in the motor neurons of the ventral horn on postnatal 1、7 and 28 days, the motor neurons on postnatal 3 days were also weakly stained in rats,and some neurons of the dorsal horn and some glial cells had positive immunoreactivity. Furthermore, GDNF was found in the glial cell of the dorsal root in all groups of the postnatal spinal cord. The present results suggested that GDNF might play important roles in the development and function of the motor neurons of the spinal cord. More experiments should be done to explain why there is no positive immunoreactivity in the motor neurons between postnatal 7 and 28 days.