ObjectiveTo evaluate the effect and safety of dezocine and sufentanil in intravenous analgesia for postoperative pain. Methods60 patients with ASA Ⅰ～Ⅲ,underwent general anaesthesia operation were divided into two groups randomly,with 30 cases for each group:dezocine 0.6mg/kg and sufentanil 0.6mg/kg was applied to PCIA in group A and B.PCIA was administered with subsequent bolus of 1 ml with lockout time 15 minutes and background infusion of 2ml/h.The analgesic effect was evaluated by VAS,BCS and Ramsay at 1、2、4、12、24、48 hours after operation.The changes of vital sign were also assessed. ResultsThere was no significant difference between two groups in analgesia effect(all P＞0.05)and adverse reaction incidence rate(P＞0.05). ConclusionThe effect of dezocine in intravenous analgesia for postoperative pain could be as satisfaction as that of sufentainyl.

Objective To characterize composition and antibiotic resistance of the pathogens isolated from patients' deep sputum with ventilator-associated pneumonia(VAP) in PICU of our hospital,and give support to the administration of antibiotics early and reasonably in clinic.Methods The study was conducted during the period of January 2009 to December 2013 at PICU of the Children's Hospital of Zhejiang University School of Medicine.One hundred and twenty-one cases of children who conformed to the diagnostic criteria of VAP after treated with ventilator were the object,the endotracheal aspirates were collected and transported to microbiology laboratory within 15 minutes.The pathogens were routinely analyzed and identified with WITEK60 and used Kirby-Bauer method for drug sensitive test,and identified with the special drug-resistant bacteria.Results Among 121 VAP diagnosed patients,127 pathogenic strains isolated from sputum specimen.Gram negative,Gram positive bacteria and fungi accounted for 64.57％ (82/127),29.92％ (38/127)and 5.51％ (7/127) respectively.Acinetobacter baumannii (25.61％,21/127),Escherichia coli (20.27％,17/127),Stenotrophomonas maltophilia (20.27 ％,17/127),Klebsiella pneumoniae (16.22％,12/127) and Pseudomonas aeruginosa (9.46％,11/127) were frequently identified isolates among Gram negative bacteria.The resistant rate of Gram negative bacteria in β lactam antibiotics was 77.62％.Ten strains of Staphylococcus epidermis and 6 strains of Staphylococcus aureus were identified isolates among Gram positive bacteria.Except the sensitive to vancomycin and linezolid,Gram positive bacteria were resistance to cephalosporin and aminoglycosides.All fungi were sensitive to the anti-microbial agents.Conclusion The Gram negative bacteria were more prevalent than Gram positive bacteria and fungi in VAP and show high drug resistance.It is pivotal to administer anti-microbial agents early and reasonably for VAP children.To emphasize surveillance to the antibiotic resistance and grasp the characteristics of the drug resistance are much important to VAP therapy.

OBJECTIVE To report malignant hematologic patients suffered in fungal infections treated with voriconazole(VOR),compare them with other similar patients treated with aluphotericin B liposome(L-AMB) as control,and then review the references.METHODS Fifty patients were treated with VOR and 57 patients were treated with L-AMB.According to the clinical performance and the changes in the CT,we could find the difference of between them.RESULTS Forty cases were effective in VOR group and most of them were in good tolerance.In the control group,37 cases were effective,most of them were in poor tolerance,and some of them stopped the treatment.CONCLUSIONS Instead of L-AMB,VOR can be a useful drug in the treatment of hematologic malignancies patients suffered in fungal infections.

Objective To investigate the value of pathological examination in the diag-nosis of lethal cases due to acute poisoning.Methods The macroscopic and microscopic find-ings in 28 autopsy cases (10 cases of toxic gas,7 cases of pesticide,6 cases of drug,3 cases of alcohol and 2 cases of chinese herbal medicine) died of acute poisoning during the period from October,2001 to June,2012 were retrospectively reviewed.Results Gross Changes were found on gross examination in 22 of the 28 cases studied.Of them,7 cases died of acute carbon mono-xide poisoning had showed cherry red of Shiban,muscle,visceral organs and blood.In addition,11 and 8 cases had been found gastric mucosa hemorrhage and epicardium petechial hemorrhage respectively.Histologically,myocardial interstitial hemorrhage was observed in 9 cases,pulmonary hemorrhage in 18 cases,bronchospasm in 12 cases,cerebral hemorrhage in 4 cases,hepato-cyte necrosis in 11 cases,renal tubular necrosis in 7 cases and gastric mucosa hemorrhage in 11 cases.In 6 cases of oral pesticides poisoning,besides they had all gastric mucosa hemorrhage,the change of character of gastric contents was found in 3 cases and pesticide odor from stomach in 3 cases.In addition,acute inflammatory and necrosis of gastric wall in 6 cases of oral pesticides poisoning were observed under the light microscope.Drug addicts often suffered from chronic lesions in multiple organs,such as chronic liver disease,fatty infiltration of the myocardium with myocardial atrophy,interstitial lung disease and pulmonary foreign body granuloma.Conclusions Pathology examination is helpful in the diagnosis of some lethal cases due to acute ooisoning,and it can provide pathological basis to study on treatment of acute poisoning.

Purpose At present,morphological observation and CT value measurement were mainly used to evaluate ground-glass nodule (GGN),and there was no effective image feature-quantization evaluation method.Therefore,in this study,a follow-up quantization analysis was conducted on GGN within 2 years using texture feature analysis method to confirm reasonable GGN follow-up time.Materials and Methods Baseline and highresolution CT images of 100 GGN follow-up patients were retrospectively analyzed.They were assigned into three groups,3 months follow-up (group A),6 to 12 months follow-up (group B) and 2 years follow-up (group C).For each group,using firstly founded GGN image as baseline,GGN texture features (including energy,contrast,autocorrelation,inverse difference moment and entropy) were analyzed.Results There were 1 case of narrowed nodules in group A,1 case of increased nodules and 1 case of narrowed nodules in group B,and 4 cases of increased nodules in group C,2 of which showed density differences.There was no significant change in shape,density and size of the remaining nodules.There were no significant differences in texture features (energy,contrast,autocorrelation,deficit,entropy) among group A,group B and group C (P＞0.05).Conclusion Texture feature analysis can quantitatively evaluate the change of GGN attribute characteristics,and as a GGN follow-up quantitative tool,it can guide patients to choose reasonable follow-up mode.

OBJECTIVE: To investigate the expression of EBV-encoded latent membrane protein 2A (LMP2A) and epithelial-mesenchymal transformation(EMT) associated markers (E-cadherin and fibronectin) in nasopharyngeal carcinoma (NPC) and its clinical significance. METHOD: The expression of LMP2A, E-cad-herin and fibronectin proteins in 32 cases of chronic nasopharyngeal inflammation, 56 cases of NPC and 18 cases of NPC lymph node metastasis were examined byimmunohistochemical SP method. RESULT: (1)The positive rates of LMP2A in NPC and its lymph node metastasis were significantly higher than those of chronic nasopharyngeal inflammation (89. 3%vs 37. 5%o and 77. 8% vs 37. 5%) respectively (both P<0. 01); The normal expression rates of E-cadherin in NPC and its lymph node metastasis were significantly lower than those of chronic nasopharyngeal inflammation (33. 9% vs 90. 6% and 5. 6% vs 90. 6%) respectively (both P<0. 01); The positive rates of fibronectin in NPC and its lymph node metastasis were significantly higher than those of chronic nasopharyngeal inflammation (83. 9% vs 28. 1% and 72. 2% vs 28. 1%) respectively (both P<0. 01). (2) ZLMP2A expression were negatively correlated with normal expression of E-cadherin (r= -0. 387, P<0. 01), and were positively correlated with fibronectin (r= 0. 421, P<0. 01). (3)LMP2A, E-cadherin and fibronectin expression were significantly correlated with N stage and clinical stage (both P<0. 05), but the three proteins were not significantly correlated with M stage (both P> 0. 05). In addition, LMP2A and E-cadherin expression were significantly correlated with T stage (both P<0. 01). CONCLUSION LMP2A and fibronectin expressions were increased in NPC, but normal expression of E-cadherin were decreased. LMP2A may promote lymph node metastasis and malignant progression of NPC by induce EMT through downregulation of E-cadherin and upregulation of fibronectin.
Cadherins ; biosynthesis ; Carcinoma ; Epithelial-Mesenchymal Transition ; Fibronectins ; biosynthesis ; Humans ; Lymphatic Metastasis ; Membrane Proteins ; biosynthesis ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; metabolism ; pathology ; Nasopharynx

OBJECTIVE:To investigate the preparation technic of pantoprazole sodium freeze-dried injection.METHO_ DS:The kinds of auxiliary were screened based on the color and luster,external appearance,pH value,clarity and the compatible stability of pantoprazole sodium lyphilization injection with other infusion solutions;the content and other associated material of freeze-dried injection were determined by HPLC method.RESULTS:With Mannitol being freeze-dried powder supporting agent and disodium edetate being metal ion chelation agent and pH value at9.5～11.5adjusted by NaOH,the calibration curves of the prepared freeze-dried injection was linear within12.0～60.0?g/ml in concentration(r=0.9998),the average recovery rate of which at100.26%,RSD=1.14%(n=9),the labeled amount at98.6%.CONCLUSION:The preparation technics is appropriate and the quality control method is simple and feasible.And the prepared freeze-dried injection is able to meet both the pharmaceutical and clinical requirements.

Some questions like the hardship of treatment and lacking of standard on diagnosis are existing in steroid-resistant nephritic syndrome(SRNS).This article make an ethical analysis on these questions and assumes that we should persist in treating the patients carefully with humanism,carry on informed consent principle,implement the optimal treatment and perfect the standard of diagnosis and treatment,carry on clinical ethics education and promote the judgment level of clinical ethics.

Objective: To investigate the case-mix method by clinical pathway. Methods: K-MEANS cluster analysis was applied to case-mix classification and artificial neural network was used for case-mix prediction. Results: Five hundred and twenty three inpatient records constructed a case-mix classification scheme of 4 groups.Statistical significant difference of costs existed in 4 groups.The training error of artificial neural network was low(0.0 029) and the predicting result was accurate(98.91%). Conclusion: Case-mix result was more reasonable using records under clinical pathway.The existing models of case-mix depend on dividing individual variables, but artificial neural network does not.

Objective To investigate the effects of isehemic postconditioning (IPO) on the acute renal ischemia/reperfusion (I/R) injury in dogs. Methods Fifteen adult male mongrel dogs were randomly divided into three groups with 5 animals in each group. In sham operation group (S), after the dogs were anesthetized, the midline laparotomy was made and right nephrectomy was performed;In I/R group, animals were subjected to the similar surgical procedures, except that the left renal vessels were clamped; In IPO group, the IPO was induced by 6 cycles of reperfusion (30 s) and ischemia (30 s) after 60 min renal ischemia before reperfusion completely. Blood samples were obtained for determination of blood creatinine (Cr) and urea nitrogen (BUN) concentrations before operation and at 24, 48 and 72 h after operation. The dogs were killed at the thirdday after operation and left kidneys were removed for determination of SOD activity and MDA and MPO concentrations.The apoptosis in the nephridial tissue was assessed by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and apoptotic index (AI) was calculated. The changes of renal tissue were examined by a microscope. Results Blood Cr and BUN concentrations in I/R group, IPO group and S group were decreased in turn after operation (P<0. 05). MDA and MPO concentrations were decreased significantly, SOD activity was significantly increased and AI was decreased significantly in IPO group as compared with I/R group at 72 h after operation (P<0. 05). Microscopic examination showed that there was no renal injury in S group and renal I/R resulted in tubular necrosis, medullary hemorrhage congestion and proteinaceous casts in I/R group. The renal I/R injury was significantly attenuated by IPO. In S group, IPO group and I/R group the renal AI was 2. 7 ±1.3, 28. 4 ± 6. 2 and 15.4±4. 1 respectively (P<0. 05). Conclusion IPO can attenuate renal damage induced by I/R by inhibiting oxidative stress and apoptosis and decreasing inflammation.