Objective The purpose of this study was to investigate the preventive effect of flurbiprofen axetil or small-dose ketamine for remifentanil-induced postoperative hyperalgesia. Methods 120 anesthetized patients with ASA ⅠorⅡwere randomly divided into three groups. Group A (40 cases) was given 0.5 mg/kg of ketamine by intravenous injection,and 5μg/(kg.min) vein to maintain,group B (40 cases) was given 100 mg of preoperative flurbiprofen axetil by intravenous injection and group C (40 cases) had no flurbiprofen axetil or ketamine which was served as controls. After the treatment, all groups were given continuous intravenous tramadol controlled analgesia (PCIA) . Results After 1 h, 2 h, 4 h and 8 h, the visual analog scale (VAS) of group C was significantly higher than that of group A and group B ( <0.05);after 24 h, there was no statistically significant difference among the three groups in VAS scores ( > 0.05) . The number of fentanyl analgesia were 25 cases and postoperative 24 h PCIA self-control were (8.6 ±4.2) times, which were more than 7 cases and (3.3 ±2.8) times of group A, and 6 cases and (3.2 ± 2.2) times of group B ( <0.05) . Conclusion The preoperative administration of flurbiprofen axetil or intraoperative continuously administered ketamine is able to prevent the occurrence of remifentanil-induced postoperative hyperalgesia, and it will not affect the patient regained consciousness. The method is safe and reliable,so it is worth promoting and popularizing.

Objective To evaluate the efficacy of remifentanil combined with propofol in children of different age undergoing short-term ophthalmologic operation.Methods Forty-eight children aged 4-12 yr undergoing elective short-term ophthalmologic operation were divided into 4 groups(n=12 each)according to age and anesthetics:group ⅠPK aged 4-7 yr and group ⅡPK aged 8-12 yr received ketamine and propofol combined anesthesia;group ⅠPR aged 4-7 yr and group ⅡPR aged 8-12 yr received remifentanil and propefol combined anesthesia.In group ⅠPK and ⅡPK the anesthesia was induced with intravenous bolus of ketamine 2 ms/kg and ketamine 1-2 ms/kg.In group ⅠPR and ⅡPR the anesthesia was induced with intravenous remifentanil 1 μg/kg and respiratory rate(RR),cerebral state index(CSI)and SpO2 were recorded before anesthesia induction(baseline),2 min after induction,at the initiation of the operation,15 min after the initiation of operation and at emergence from anesthesia.Adverse effects during and after the operation,induction time,analepsia time,conscious recovery time and total sedation time were recorded.The mean infusion rate of remifentanil was calculated.Results Compared with the baesline,SP,DP,HR,RR and CSI were significantly decreased in 4 groups(P＜0.05).RR,CSI and incidence rates of adverse effects were significantly lower,and the emergence time and the recovery time of consciousness were significantly shorter in group ⅠPR and ⅡPR than in group ⅠPK and ⅡPK(P＜0.05).The average infusion rate of remifentanil was lower in group ⅡPR than in group ⅠPR(P＜0.05).Conclusion Remifentanil combined with propofol can produce good anesthetic effect in children undergoing short-term ophthalmologic operation,with less adverse effects,stable hemodynamics and rapid emergence from anesthesia.The dosage of remifentanil is difierent in children at different ages.

BACKGROUND:Early clinical application of non-biological materials (bone cement) for treatment of hip joint is ineffective, due to the large fixed range, long fixation time, as wel as aging and rupture of bone cement interface causing complications such as prosthetic loosening. Thus, postoperative range of motion of the hip joint can be affected to some degree.
OBJECTIVE:To investigate the methods and progress of biological and non-biological materials for total hip replacement and to assess the features and clinical application of different hip prostheses.
METHODS:A computer-based search of PubMed and CNKI was performed by the first author to retrieve articles related to biological materials and tissue-engineered hip joint using the keywords of“carpal bone, fracture ununited”in the title and abstract. The keywords were limited to Chinese and English.
RESULTS AND CONCLUSION:Biological materials for internal fixation have good wear resistance, corrosion resistance and biocompatibility. Currently, the combination of metal joint head and polyethylene acetabulum with ultrahigh molecular weight is the most commonly used in hip replacement. However, the metal joint head exhibits an elastic modulus far from the human skeleton, resulting in stress shielding effects which are easy to cause prosthetic loosening and instability. Bio-inert ceramics has high in vivo stability and good mechanical strength;and bioactive ceramics has bone conduction characteristics and performance of the living bone integration. Composite prosthesis, because of adjustable elastic modulus and sufficient mechanical strength, shows the mechanical properties close to the human bone and has been gradual y noticed. However, there is a lack of ideal prostheses with good biocompatibility and biomechanics. Therefore, hip design and manufacturing processes should be improved to elevate wear resistance and mechanical properties, to enhance the binding between prosthesis and the host bone, and to reduce stress shielding in order to improve the biocompatibility of the implant with the host, and extend the prosthetic life.

ObjectiveTo investigate the effect of controlled low perfusion pressure on expression of phosphor-Akt (p-Akt) and phosphor-ERK1/2 (p-ERK1/2) following spinal ischemia-reperfusion (1/R) in rabbits.MethodsThirty-six Japanese long-ear white rabbits aged 3 months weighing 2.0-2.5 kg were randomly divided into 3 groups ( n ＝ 12 each):group sham operation (group S) ; group spinal I/R (group I/R) and group controlled low perfusion pressure (group LP).Auricular artery and femoral artery were carnulated for proximal and distal BP monitoring.A 4F catheter with a balloon at the tip was inserted into abdominal aorta.The tip was positioned 1 cm below left renal artery.Spinal ischemia was induced by inflating the balloon until the distal MAP < 20 mm Hg,and maintained for 25 min.During the first 10 min of reperfusion the distal MAP was increased to 45-55 mm Hg by partially deflating the balloon.Then the balloon was fully deflated to allow complete reperfusion.The function of lower limbs was assessed with Tarlov score (0 ＝ no detectable movement,4 ＝ normal function) at 1,3,7,28 d of reperfusion.Au the animals were sacrificed at 1 d of reperfusion in each group.The lumbar segment L3-5 of the spinal cord was removed for microscopic examination and determination of expression of p-Akt and p-ERK1/2 by immuno-histochemistry) and detection of neuronal apoptosis in dorsal horn (by TUNEL).ResultsSpinal I/R significantly decreased Tarlov scores,and increased the number of apoptotic cells and expression of p-Akt and pERK1/2 in group I/R as compared with group S.Low perfusion pressure during the 10 min at the beginning of reperfusion significantly increased Tarlov scores,decreased apoptotic index and further increased p-Akt and pERK1/2 expression in group LP compared with group I/R.The histopathological damage in the spinal cord was attenuated in group LP.ConclusionControlled low pcrfusion pressure can reduce the spinal cord I/R injury by activating Akt and ERK1/2 and decreasing neuronal apoptosis.

Objective To investigate the risk factors for postoperative cognitive dysfunction (POCD)induced by patient-controlled intravenous analgesia(PCIA)in elderly patients. Methods 95 patients with POCD and 97 cognitive normal controls were included in the study. The cases and controls were matched for gender, type of operation and PCIA volume dose. Cognitive function was assessed by Mini-Mental-State test and the relationship between POCD and various factors was analyzed by univariate and multivariate analysis. Results Univariate analysis revealed that the education level and visual analog scale (VAS) score had significant differences between the two groups. Multivariate analysis showed that the VAS score and education level were significantly related to POCD induced by PCIA, with the odds ratios of 2. 379 (95%CI:1.205～4.698) and 0. 292 (95%CI:0.157～0.543), respectively. Conclusions Lower VAS score is an independent risk factor and higher education level seems to be a protective factor for POCD induced by PCIA.

Objective To evaluate the effects of dexmedetomidine with different-dose on the hemodynamics during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting. Methods Sixty patients undergoing off-pump coronary artery bypass grafting were selected, with ASA grade Ⅱ - Ⅲ, NYHA cardiac functional grading Ⅱ - Ⅲ, and left ventricles ejection fraction >45%. The patients were divided into D1 group, D2 group and control group by table of random digit method with 20 cases each. In D1 group, intravenous infusion dexmedetomidine 0.3μg/kg was given for 20 min before anesthesia induction;in D2 group, intravenous infusion dexmedetomidine 0.6μg/kg was given for 20 min before anesthesia induction;in control group, intravenous infusion the same volume of 0.9% sodium chloride was given before anesthesia induction. The mean arterial pressure (MAP), heart rate, cardiac output and stroke volume variation (SVV) were recorded before infusion dexmedetomidine (T0), before anesthesia induction (T1), 3 min after anesthesia induction (T2), trachea cannula (T3) and 5 min after trachea cannula (T4). The adverse cardiovascular events and drug intervention were recorded during anesthesia induction. Results There were no statistical differences in MAP, heart rate, cardiac output and SVV at T0 among 3 groups (P>0.05). Compared with that in control group, the heart rate at T1, T2, T3 and T4 in D1 group were decreased, the MAP, heart rate, cardiac output and SVV at T1, T2, T3 and T4 in D2 group were decreased, and there were statistical differences (P<0.05). Compared with that at T0, the heart rate at T1, T2, T3 and T4 in D1 group were decreased, the MAP, heart rate, cardiac output and SVV at T3 in control group were increased, the MAP, heart rate, cardiac output and SVV at T1, T2, T3, T4 in D2 group were decreased, and there were statistical differences (P<0.05). Compared with that in D1 group, the MAP, heart rate, cardiac output and SVV at T2, T3 and T4 in D2 group were decreased, and there were statistical differences (P<0.05). The rates of adverse cardiovascular events in D1 group and D2 group were significantly lower than those in control group:35%(7/20) and 40%(8/20) vs. 95%(19/20), the rate of drug intervention in D1 group was significantly lower than that in control group and D2 group:10% (2/20) vs. 45% (9/20) and 35% (7/20), and there were statistical differences (P<0.05). Conclusions Dexmedetomidine (0.3 μg/kg) is beneficial for the stability of hemodynamics before anesthesia induction in patient undergoing off-pump coronary artery bypass grafting.

OBJECTIVE:To investigate the characteristics and regularity of lornoxicam related ADR,and to provide reference for rational and safe use of lornoxicam. METHODS:From Jan. 1,2006 to Dec. 31,2013,lornoxicam related ADR reports collect-ed by National ADR Monitoring System in Beijing were analyzed retrospectively about their characteristics and related factors. RE-SULTS:In the statistical period,there were 48 ADR reports related to lornoxicam. The people over 40 years age accounted for 62.5%. 38 patients used lornoxicam by intravenous infusion or intramuscular injection ,accounting for 79.17%. The clinical mani-festations were diverse and complex,in which skin(32.96%)and gastrointestinal damage(25.00%)were more common ADR oc-curred within 30 min,accounting for 35.42%,and it would be better after stopping drug or 1-3 days symptomatic treatment. CON-CLUSIONS:The rational use of lornoxicam can reduce the occurrence of ADR. Suggestion on the use of the drug,is that the pa-tient should be monitored for security,in order to reduce the risk of ADR.

OBJECTIVE:To investigate the curative effect and economics of prostaglandins drugs in the treatment of glauco-ma,and to provide reference for clinical medication. METHODS:In retrospective study,a total of 790 glaucoma patients were di-vided into latanoprost group(62 cases),travoprost group(356 cases)and bimatoprost group(372 cases)according to therapy regi-men. They were given relevant medicine. Total effective rate of 3 groups were calculated,and the cost-minimization method was used for pharmacoeconomics evaluation. RESULTS:The total effective rate of 3 groups were 87.10%,84.27%,76.08% respective-ly,without statistical significance(P>0.05). The cost of them were 208.00 yuan,225.00 yuan and 173.00 yuan,and that of bima-toprost group was the lowest. The results of sensitivity analysis was in line with that of cost-minimization analysis. CONCLU-SIONS:For glaucoma,bimatoprost is more economical than latanoprost and travoprost.

Objective To understand the prevalence of physical activity deficiency and its association with depressive, anxiety symptoms and dissatisfaction of school life among adolescents in Shaoxing, Zhejiang province. Method A total of 3 397 valid questionnaires from adolescents from 80 classes of 2 middle schools (including 1 420 urban and 1 977 town adolescents) were investigated for the study, their average age was (13.73±1.01) years. The Depression Self-rating Scale for Children (DSRSC) and Screen for Child Anxiety Related Emotional Disorders (SCARED) were used to assess the mental health status, while the dissatisfaction of school life was evaluated by the School Life Satisfaction Rating Questionnaire for Adolescent (SLRQA), and the data were analyzed by descriptive statistics and multivariate logistic regression models. Result The self-reported proportion of 3 397 adolescents with physical activity deficiency reached 78.5%, and the prevalence rate of depressive, anxiety symptoms and school life dissatisfaction were 55.2%, 18.9% and 31.1%, respectively. Adjusting on other potential confounders, the result of multivariate logistic regression showed that girls engaged in less physical activities, the OR value (95%CI) was 1.597 (1.348-1.892), while the adolescents with town census register and adolescents having six or more close friends participated in more physical activities, their OR values were 0.785 (0.661-0.931) and 0.565 (0.355-0.900), and insufficient physical activity was positively associated with depressive, anxiety and dissatisfaction of their school lives, their OR values were respectively 1.783 (1.506-2.105), 2.141 (1.664-2.755) and 1.337 (1.101-1.621). Conclusion High prevalence of physical activity deficiency appeared among adolescents in Shaoxing and was closely related to the presence of depressive, anxiety symptoms and school life dissatisfaction.

Objective To observe the hypoglycemic mechanism of total saponins of Momordica charantia (MC) in type 2 diabetes mellitus (DM) rats. Methods Among the selected 60 male Specific Pathogen Free (SPF)rats, 8 were random- ly chosen as control group, while others were fed with high fat and high glucose diet following streptozotocin injection from caudal vein 8 weeks after to construct type 2 DM models. After the DM models were successfully built, rats were then ran- domized into five groups: DM control group (n=8), the metformin group (n=8) and three groups of total saponins of MC with different dosage (n=8 in each group). The total saponins of MC groups include DM rats administrated with total saponins of MC 100, 200, 400 mg/(kg·d) for 8 weeks, the metformin group include DM rats administrated with metformin 50 mg/(kg·d) for 8 weeks. At the end of the experiment, the fasting blood glucose and insulin were examed. At the same time, a part of pan- creas islet, liver and skeletal muscle were preserved. The pancreas islet structure, the hepatic glycogen and Glucose trans- porter 4 (GLUT4) expression were observed by electron microscope, glycogen dyeing and immunoblot respectively. Results After 8 weeks treatment, compared to type 2 DM control group, fasting blood glucose and insulin values in MC groups were reduced more obviously. However, skeletal muscle GLUT4 expression level, insulin granules and hepatic glycogen increased obviously in MC groups. Conclusion Total saponins of MC has hypoglycemic effect. It’s mechanisms maybe include pro- moting the hepatic glycogen synthesis, inhibiting the hepatic glycogen decomposition and promoting insulin sensitivity by in- creasing peripheral tissue’s GLUT4 expression.