Objective To compare the postoperative analgesic effect of the single dose of oxycodone and dezocine in patients who underwent gynecological laparoscopic operation. Methods Sixty patients who underwent elective gynecological laparoscopic operation were randomly divided into two groups (n=30): oxycodone group (group O) and dezocine group (group D). Fifteen minutes before the end of surgery, oxycodone 0.1 mg/kg was given in O group, and dezocine 5 mg was given to D group. Twenty minutes before the end of surgery, tropisetron 5 mg was given to both groups. Analgesia was maintained by propofol-remifentanil with TCI. The mean arterial pressure (MAP) and heart rate (HR) of T1, T2, T3 and T4 were recorded respectively in both two groups. After the operation, pain of visual analogue scale (VAS) was assessed in 2 h ,4 h , 6 h and 24 h, respectively. Results There were no significant differences in MAP and HR between two groups at T1, T2, T3 and T4 (P＞0.05). The VAS score was significantly lower in group O than that of group D (P＜0.05). There was significant difference in the incidence of nausea between the two groups (P＜0.05). Conclusion Single dose of oxycodone 0.1 mg/kg can be used for postoperative analgesia after gynecological laparoscopic operation, and which has better analgesia than that of dezocine, except for the adverse reaction of nausea.

Objective To evaluate the protective effects of different modes of ventilation on the lungs on the operated side during one-lung ventilation (OLV ) in patients undergoing thoracic surgery .Methods Forty-five ASA physical status Ⅰ or Ⅱ patients of both sexes ,aged 45-64 yr ,weighing 65-80 kg ,were randomly divided into 3 groups (n=15 each) using a random number table :group A ,group B and group C .After induction of anesthesia ,the patients were intubated with double-lumen tube and OLV was performed .During OLV ,the lung on the operated side was collapsed naturally in group A ,positive pressure ventilation (FGF 2 L/min) was applied in the lung on the operated side in group B ,and high-frequency jet ventilation (frequency 100 beats/min ,driving pressure 0.5 kg/cm2 ) was used in the lung on the operated side in group C .Immediately after intubation (T0 ) , and at 1.5 h (T1 ) and 2 h (T2 ) of OLV ,blood samples were taken from the central vein and radial artery for determination of the serum interleukin-6 (IL-6 ) and IL-8 concentrations .The net release of IL-6 and IL-8 was calculated .Blood samples were taken from the radial artery at T0-2 for blood gas analysis and for determination of surfactant protein A (SP-A) concentration in the serum .Respiratory index (RI) was calculated .The non-cancer tissues 1.0 cm × 1.0 cm × 1.0 cm which were extracted from the lung cancer specimens were used for microscopic examination of the pathological changes of lungs which were scored .Results Compared with group A ,the net release of IL-6 and IL-8 ,serum SP-A concentration ,RI and pathological scores were significantly decreased at T1 ,2 in B and C groups ( P<0.05) .Compared with group B ,the serum SP-A concentration and RI were significantly decreased at T1 ,2 , and the net release of IL-6 was increased at T2 in group C ( P< 0.05 ) .Conclusion Continuous positive ventilation and high-frequency jet ventilation both can effectively protect the lungs on the operated side during OLV in patients undergoing thoracic surgery ,and the efficacy of high-frequency jet ventilation is better .

Objective To evaluate the disease onset regions and spreading patterns in sporadic amyotrophic lateral sclerosis (ALS)patients and related influencing factors.Methods We performed a prospective analysis of 1 58 ALS patients.The disease-onset was confirmed according to the patients’self-reports,neurological examination results and electromyogram study.We followed up 1 5 1 patients with the second or other affected body regions during the disease progression.Data were analyzed according to the different groups of onset regions.Results 1.In 94.3% (149/1 58)of the patients,the early motor manifestations were focally in the bulbar,upper or lower limbs.2.The region of onset was associated with signs of lower motor neuron (LMN)and upper motor neuron (UMN)involvement (P = 0.000 ).The LMN involvement was more distinctive in patients with bulbar onset (65.4%,1 7/26 )group.Patients with cervical onset more frequently showed pure LMN (47.9%,45/94 )or concomitant UMN (52.1%,49/94)signs in the affected limbs.The highest proportion of UMN and LMN signs in the affected lower limb was found in the lumbar onset (83.8%,31/37 )group.3.Spreading patterns:Rostral to caudal spreading pattern was more frequent in bulbar onset patients.For patients with limb onset,there were significant differences between spreading patterns and disease-onset regions (P =0.04).Circular (31.5%,28/89),horizontal (30.3%,31/89)and vertical (21.3%,1 9/89)spreading patterns were more frequent in cervical onset patients whereas circular (47.2%,1 7/36)spreading patterns were more frequent in lumbar onset patients.4.There was a strong association between the rate of progression and age of disease onset (P =0.01 1).Patients aged over 60 had a faster progression.Conclusion ALS is a focal process at motor axis along the spinal cord and cerebral cortex.Different disease-onset can cause different distribution of UMN and LMN signs.Therefore,special attention should be paid to the signs of disease-onset clinically.ALS does start focally and spreads to adjacent regions.Elder patients have a faster disease progression.

Objective To evaluate the correlation between stroke volume variation (SVV) and blood volume during one-lung ventilation (OLV).Methods Forty ASA Ⅱ male patients,aged 50-60 yr,with body mass index 20-25 kg/m2,scheduled for elective resection of esophageal cancer,were studied.Anesthesia was induced with fentanyl 4 μg/kg,propofol 2 mg/kg,and rocuronium 0.6 mg/kg.Double-lumen tube was inserted.Correct position was verified by fiberoptic bronchoscopy.The patients were mechanically ventilated (VT 8 ml/kg,RR 15 bpm,Ⅰ ∶ E 1 ∶ 2).6％ hydroxyethyl statch (HES) 130/0.4 was infused intravenously at a rate of 0.67 ml· kg-1 · min-1 starting from 30 min of OLV.SVV,cardiac output (CO),SV and cardiac index (CI) were monitored and recorded using the FloTrac/Vigileo (Edwards Lifesciences,USA) system before HES was infused and when the dose of HES reached 2,4,6,8,10 and 12 ml/kg.Spearman rank sum correlation coefficient was used to analyze the data.Results SVV was negatively correlated with the blood volume during OLV and the correlation coefficient was rSVV =-0.249.CI,CO and SV were positively correlated with the blood volume during OLV and the correlation coefficients were rCO =0.570,rSV =0.552 and rCI =0.550,respectively.Conclusion SVV is poorly correlated with the blood volume during OLV and can not reflect the blood volume accurately.

Objective To observe the effects of vitamin E(VE) on the changes of the intercellular adhesion molecule-1(ICAM-1)and free radicals in ischemic-reperfused myocardium(MIR) of diabetic rats Method The diabetic rat model was established by i.p.streptozotocin injection.Four weeks later,MIR models were established,and 30 rats were divided into three groups with each group 10 rats(sham group,MIR group and VE group).The ICAM-1 protein expressions were evaluated by immunocytochemistry.The contents of malonialdehyde(MDA) in serum and myocardial tissues were detected.The activities of superoxide dismutase(SOD) and glutathione peroxidase(GSH-Px) in serum and myocardial tissues were measured.The activities of Na+,K+-ATPase,Mg++-ATPase,Ca++-ATPase in myocardial mitochondria were measured.Results Compared with sham group,the activities of Na+,K+-ATPase,Mg++-ATPase,Ca++-ATPase in myocardial mitochondria were decreased,the contents of MDA in serum and myocardium increased,the levels of SOD and GSH-Px in serum and myocardium decreased,and the levels of ICAM-1 in myocardium increased significantly in MIR group.Compared with MIR group,the activities of Na+,K+-ATPase,Mg++-ATPase in myocardial mitochondria were increased,the levels of MDA in serum andmyocardium decreased the activities of SOD and GSH-Px in serum and myocardium increased,and the levels of ICAM-1 in myocardium decreased significantly in VE group.Conclusion VE could relieve myocardial ischemic reperfusion injury and the damage of lipid peroxidation and free radical induced by MIR in diabetic rats,and this effect was mediated by reduction of the expression of ICAM-1 protein.

Objective To evaluate the correlation between stroke volume variation (SVV) and the blood volume. Methods Forty-eight ASA Ⅱ male patients, aged 50-60 yr, scheduled for elective radical operation for gastric cancer, were studied. Anesthesia was induced with fentanyl 4 μg/kg, propofol 2 mg/kg and cis-atracurium 0.15 mg/kg and maintained with inhalation of 2%-3% sevoflurane. 6% HES 130/0.4 was infused intravenously at a rate of 0.67 ml· kg - 1 · min - 1 30 min after induction. SVV,cardiac output (CO),SV and cardiac index (CI) were monitored and recorded using the FloTrac/Vigileo (Edwards Lifesciences, USA) system before HES was infused and when the dose of HES reached 2, 4, 6, 8, 10, 12, 14, 16 and 18 ml/kg. CVP was also recorded at the corresponding time points. Spearman's rank sum correlation coefficient was used to analyze the data. Results Correlation coefficients between the amount of HES infused and CO, SV, CI or CVP were rSVV = - 0.91 ± 0.06,rCO = 0.83 ± 0.04, rSV = 0.86 ± 0.09, rCI = 0.86 ± 0.09 and rCVP = 0.90 ± 0.03. Among the 5 correlation coefficients, rSVV was the highest, rCVP was significantly higher than rCO, rSV and rCI (P ＜ 0.05), and there was no significant difference among rCO, rSV and r CI (P ＞ 0. 05). Conclusion SVV is highly correlated with the blood volume and can be used to guide volume therapy.

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) for submucosal tumors in upper gastrointestinal tract, and its influence on choice of endoscopic therapies. Methods A total of 82 submucosal tumors from upper gastrointestinal tract were examined by EUS, and treated by various endoscopic therapeutic techniques including fulguration with high frequency current ( FHFC), endoscopic mucosal resection (EMR) and endoscopic band ligation according to orion, size and property of the lesion. The diagnoses of 58 reseeted samples were determined by routine pathological examination and immunohistochemistry. All patients were followed up with routine endoscopy and EUS. Results FHFC was applied in 26 lesions originated from muscularis mucosa, EMR was used in 17 flat lesions originated from muscularis mucosa, and endoscopic band ligation in 38 lesions from muscularis propria and 1 tumor from muscularis mucosa. The diagnostic accuracy of EUS was 91.4% (53/58). Except for post-operative bleeding in 1 patient, no other complications were observed. A total of 79 cases were followed up for 3-24 months, and no recurrence was found. Conclusion EUS can display the origin and property of submucosal tumors in upper gastrointestinal tract and guide the selection of endoscopic therapy, which is effective and safe in treatment of submucosal tumor in upper gastrointestinal tract.

Objective To evaluate the effects of different doses of dexmedetomidine on stress responses of the hypertensive patients undergoing thoracic surgery and find the uptimal infusion rate of dexmedetomidine in decreasing stress responses.Methods Sixty hypertensive patients of both sexes,aged 45-64 yr,weighing 65-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were divided into 4 groups (n =15 each) using a random number table:control group (group C) and 3 different doses of dexmedetomidine groups (D1-3 groups).In D1,D2 and D3 groups,dexmedetomidine 0.2,0.3 and 0.4 μg · kg 1 · h 1 were intravenously infused until 30 min before the end of surgery,respectively,starting from 15 min before induction of anesthesia.The equal volume of normal saline was given instead of dexmedetomidine in group C.Before administration of dexmedetomidine (T0),at 1 min after endotracheal intubation (T1),at skin incision (T2) and immediately after extubation (T3),venous blood samples were collected for determination of epinephrine and norepinephrine concentrations in plasma (using high-performance liquid chronatography) and blood glucose concentrations.The development of adverse effects such as bradycardia,hypotension and respiratory depression was recorded.Results Compared with group C,epinephrine and norepinephrine concentrations in plasma and blood glucose concentrations were significantly decreased at T1-3 in D1,D2 and D3 groups,the incidence of bradycardia and hypotension was significantly increased in group D3 (P＜0.05),and no significant change was found in the incidence of bradycardia or hypotension in D1 and D2 groups (P＞0.05).There were no significant differences in epinephrine and norepinephrine and concentrations in plasma and blood glucose concentrations at each time point between group D1,group D2 and group D3 (P ＞ 0.05).Conclusion The optimal infusion rates of dexmedetoinidine are 0.2 and 0.3μg · kg-1 · h-1 in decreasing stress responses of the hypertensive patients undergoing thoracic surgery.

Objective To determine the optimal dose of oxycodone for patient-controlled intravenous analgesia (PCIA) after gastrointestinal surgery when combined with dexmedetomidine in elderly patients.Methods Sixty patients of both sexes,aged 65-80 yr,weighing 50-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective open gastrointestinal surgery,were divided into 3 different doses of oxycodone groups (group O1,group O2 and group O3,n=20 each) using a random number table.At 15 min before the end of surgery,oxycodone 0.1 mg/kg was intravenously injected,and PCIA pump was connected simultaneously.In O1,O2 and O3 groups,the PCIA solution contained dexmedetomidine 2.0 μg/kg and oxycodone 0.3,0.5 and 0.7 mg/kg in 100 ml of 0.9％ normal saline,respectively.The PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Oxycodone 0.05 mg/kg was intravenously injected as a rescue analgesic after surgery,postoperative pain was assessed using a verbal rating scale,and the verbal rating scale score was maintained ≤4.The number of successfully delivered doses and requirement for rescue analgesics were recorded within 48 h after surgery,and the rate of rescue analgesia was calculated.The occurrence of adverse reactions such as nausea,vomiting,dizziness,respiratory depression,somnolence,bradycardia,hypotension and over-sedation was recorded.Patients' satisfaction with analgesia at postoperative 72 h and the length of postoperative hospital stay were also recorded.Results Compared with group O1,the rate of rescue analgesia after surgery and the number of successfully delivered doses were significantly decreased,and the degree of patients' satisfaction with analgesia was increased in O2 and O3 groups,and the incidence of nausea and somnolence was significantly increased in group O3 (P＜0.05).Compared with group O2,no significant change was found in the rate of rescue analgesia after surgery or the number of successfully delivered doses (P＞0.05),and the incidence of nausea and somnolence was increased in group O3 (P＜0.05).Conclusion When combined with dexmedetomidine 2.0 μg/kg,the optimal dose of oxycodone for PCIA is 0.5 mg/kg after gastrointestinal surgery in elderly patients.

Objective To explore the clinical phenotype, treatment and prognosis of immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome, and to improve pediatricians' knowledge of this disease. Methods Clinical data of a case of IPEX with congenital ichthyosiform skin lesions were retrospectively analyzed, and related literatures China were reviewed. Results The 2-month-11-day old boy came to our hospital due to ichthyosiform skin lesions accompanied by blood oozing in the head and feet exudatation, with severe sepsis and gastrointestinal perforation. He was died of multiple organ failure. DNA sequencing of whole-genome exon group showed a hemizygous mutation of c.1150G> A, p.A384> T in FOXP3 gene. His mother was a heterozygous mutation carrier, while his father was normal. Conclusions In addition to typical symptoms including early-onset refractory diarrhea, multiple endocrine disease and growth retardation, IPEX should be considered also in infants with ichthyosiform rash and severe infection. Gene sequencing will help diagnose the disease.