Objective To investigate the effects of remifentanil patient controlled intravenous analgesia (PCIA) as a labour analgesic and the effects of neonate.Methods One hundred and thirty-five vaginal delivery primiparas were randomly divided into 3 groups: natural labor group, remifentanil l(RI) group and remifentanil Ⅱ(R Ⅱ) group,each group of 45 cases.RⅠ group and R Ⅱ group were treated with remifentanil at initial dose of 0.5 μg/kg and background dose of 0.05 μg/(kg? min) respectively.Patients in RⅠ group were treated with bolus dose of 0.2 μg/kg.Patients in R Ⅱ group were treated with bolus dose of 0.5 μg/kg.The lock time was 2 minutes.The analgesic effect of before analgesia immediate, and 5,30,60 min after analgesia were evaluated by visual analogue scale (VAS).And the oxytocin usage rate, cesarean section rate, neonatal Apgar score were assessed.The adverse drug reactions were recorded.Results After 5,30,60 min used drug , compared with natural labor group((9.52±0.32) sore, (9.58±0.27) sore, (9.53±0.28) sore) ,the VAS were decreased in the group of RⅠ((7.19±0.53) sore, (5.82±0.48) sore, (5.25±0.54) sore) and R Ⅱ (P＜0.05).Compared with RⅠ group,the VAS were decreased in the group of R Ⅱ (P＜0.05).There were no differences of oxytocin usage rate,cesarean section rate,neonatal Apgar score.In the remifentani] group, there were 2 cases of pruritus and 1 cases of vomiting;the systolic blood pressure and heart rate were in the normal physiological range after analgesia.Abnormal fetal heart rate was not found during the routine fetal heart monitoring during analgesia.Conclusion Patient-controlled intravenous analgesia with remifentanil is effective in labour analgesia and at initial dose of 0.5 μg/kg,background dose of 0.05 μg/(kg? min) and bolus dose of 0.5 μg/kg for 2 min.

Objective To explore the effect of traditional Chinese medicine direction inductive therapeutical instrument combined with golden bifid in the treatment of infantile diarrhea .Methods 188 infants aged from 1 month to 3 years who suffered from acute diarrhea were randomly divided into the treatment group and the control group ,94 cases in each group .All the patients were treated with continued diet ,prevention and correct water and electrolyte bal-ance and other treatment ,the treatment group received traditional Chinese medicine direction inductive therapeutical instrument combined with oral golden bifid based on the above treatment .The time of temperature returned to normal , stop vomiting and diarrhea and stool frequency were recorded and analyzed .Results The time of symptoms disap-peared,obvious effective rate and total effective rate of the treatment group were better than those of the control group . Conclusion It is safe and effective to treat infantile diarrhea by traditional Chinese medicine direction inductive therapeutical instrument combined with golden bifid .

Objective To study the teaching effects of using case discussing-analysis method in the teaching course of Nursing Research among nursing students,and then make suggestion for relative teaching improvement. Methods Nursing students of Grade 2003 in main school and Grade 2004 in the affiliated WUZHOU school were divided into the trial group and control group at random. Part of teaching contents of nursing research were taught to the trial group students by case discussing-analysis method,and to the control group students by the methods of lecture-based learning. The teaching effect was evaluated after the course end. Results The ability of design to scientific research,recognition of Nursing research,learning attitude and learning interest,etc,in the trial group students were obviosly better than those in the control group students,and there was significant by statistical test. Conclusions Case discussing-analysis method can effectively excite the interest and the potential of students,and improve the ability of discovering and solving problems.

It is a trend that clinical researchers overemphasize on hypothesis testing and the P value. However, P value has some limitations in the presentation of study results. Power is a tool for study design and results explanation, especially for negative results. Confidence interval contains more information for clinical results than P value. P value, power, and 95% confidence interval should be provided in the clinical reports to facilitate the interpretation of the results.

Objective To evaluate the therapeutic approach for patients with periampullary carcinoma (complicated) with acute cholangitis. Methods A comparative analysis of the clinical data of cases of (periampullary) carcinoma with acute cholangitis who were admitted and treated in our hospital during a 12-year period.They included 25 cases who underwent primary resection, and 12 cases who underwent a two-stage resection with initial bile duct drainge. Results After conservative procedures, the preoperative temperature and WBC of patients in primary resection group were much lower than when admitted(P0.05). Total bilirubin and albumin levels showed no significant changes. Compared with the two-stage resection group,the primary resection group had shorter preoperative preparation time, shorter operation time, lesser intra-operative blood loss, but higher postoperative infection complication rate and prolonged length of hospital stay(P0.05). Conclusions Patients with periampullary carcinoma complicated with acute cholangitis can initially be treated conservatively . After biliary infection is controlled, primary (pancreatoduodenectomy) is performed.

ObjectiveTo evaluate the effects of anterior sagittal anorectoplasty(ASARP) on treating imperforate anus with rectovestibular fistula(IAFR).MethodsThe clinical data of 16 cases of IAFR treated by ASARP were analysed retrospectively.ResultsSixteen cases were followed-up for 2 months to 5 years.The anus function was assessed according to the Clinical Scoring Systems of LI Zheng.Excellent scores were obtained in 13 cases and good in 3 cases;1 patient suffered from incision infection postoperatively.ConclusionsASARP is a feasible therapy for imperforate anus with IAFR.

Objective To investigate the clinical and pathological characteristics of renal involvement in Beh(c)et's disease (BD).Methods A retrospective analysis was carried out in BD patients complicated with renal damage who were admitted to Peking Union Medical College Hospital from June 1998 to July 2012.Results Twenty patients with renal involvement constituted 3.2％ of all the 618 hospitalized BD patients.The presentation of renal disease was chronic glomerulonephritis in 6 patients (1 with nephrotic syndrome),renal tubular acidosis in 1 patient,renal artery stenosis in 7 patients,renal vein thrombosis in 1 patient,and chronic renal failure of unknown etiology in 5 patients.Kidney biopsy was performed in 5 patients,3 of them revealed glomerular minor lesion,mild mesangial proliferative glomerulonephritis and chronic tubularinterstitial nephropathy,respectively.The other 2 patients underwent a second biopsy,one with glomerular minor lesion transforming into IgA nephropathy of grade Ⅲ on Lee's glomerular grading system after 6 years,and the other with IgA nephropathy of grade Ⅱ progressing to grade Ⅳ after 2 years.After the diagnosis of renal BD,one patient with uremia underwent peritoneal dialysis,while the remaining 19 patients received immunosuppressant (or with combination of glucocorticoid,angiotensin converting enzyme inhibitors and angiotensin Ⅱ receptor blockers.etc.) therapy.Among the 8 patients with renal vascular involvement,2 underwent surgery,and several received anticoagulant therapy.During the follow-up of 13 patients,the urine protein quantifications were reduced,and renal functions remained relatively stable.Conclusion Renal damage is relatively uncommon in BD patients.There are various clinical spectrums for renal BD.Routine screening with urinalysis,serum creatinine and imaging studies should be carried out for the early diagnosis of renal BD.

The fine structure of the biomembrane of the sinus node cells in the dog wasstudied with the replicas of freezecleaved specimens.The intramembranous particles.(IMP)in the PF and EF faces of the plasma mcmbrane of the sinus node cells,were present.The density of the IMP on the PF faces was more dense than those ofEF faces,In general,the shape of the IMP of the plasma membrane(PF and EFfaces)exhibited spherical or spheroidal.The IMP of PF faces may be divided into,three groups,i.e.the larger,medium and small size.Numerous endocytotic vesicles.found on the PF faces appeared as circular depressions and as small walled craterson EF faces.No regular array of the vesicles had been observed on both faces,TheIMP of the mitochondrial cristae were more dense than those of the depression.TheIMP of PF face of the nuclear membrane were observed.Their size and shapepresent a uniform appearance.There were many nuclear pores in the surface of thenuclear membrance.In the cytoplasm,longitudinal and transverse sections of the myofibrils werefound.On the transverse section,the myofilaments of A and I band werepresent.The intercalated disk was observed.The gap junctions present between thesinus node cells were proved by Masson-Pevet et al in the rabbits but were notfound in our specimens.

Objective To develop the quality standard for evaluating Huangdi cataplasm. Methods Thin layer chromatography (TLC) was used to qualitatively identify Astragalus membranaceus (Fisch.) Bunge,Rheum palmatum Linn,Rhizoma Chuanxiong,Angelica sinensis and Resina Draconis in Huangdi cataplasm.HPLC method was used to determine astragaloside A and loureirin B in Huangdi cataplasm. Results The Astragalus membranaceus (Fisch.) Bunge,Rheum palmatum Linn,Rhizoma Chuanxiong,Angelica sinensis and Resina Draconis were well separated by TLC without interference in the negative control.content of Astragaloside A and loureirin B showed good liner relationships with respective peak area within the range of 6.96-23.2 μg,and 0.072-0.648 μg,with r = 0.999 5,r = 0.999 9, respectively;and the average recovery was 97.18%,and 96.93%,RSD was 1.21%(n= 6),1.53% (n = 6 ), respectively. Conclusion The established qualitative and quantitative detection method is simple, specific, reproducible, accurate and reliable, which can be used for quality control of Huangdi cataplasm.

Objective To observe functional changes of renal tubular epithelial cells stimulated by high mobility group protein box 1 (HMGB1) and associated mechanism.Methods Renal tubular epithelial cells (NRK52E) were divided into control group,HMGB1 group and HMGB1+ lipopolysaccharide from Rhodobactersphaeroides (LPS RS) group.Toll-like receptor 4 (TLR4) expression was detected by immunofluorescence and Western blotting.Apoptosis rate and cell cycle arrest were identified with flow cytometry.The activation of MAPK signaling pathway and NF-κB were detected by Western blotting.The IL-1,IL-6 and tissue inhibitor of metalloproteinases 2 (TIMP2) mRNA levels were measured by real-time PCR.The secretion levels of IL-1,IL-6 and TIMP2 were measured by protein chips assay.Results TLR4 was expressed by NRK52E cells.Compared with the control group,there were increased cell cycle G1 arrest,MAPK signaling pathway and NF-κB activation in HMGB1 group.Furthermore,IL-1,IL-6 and TIMP2 mRNA levels were increased and IL-1,IL-6 and TIMP2 were secreted by NRK52E when stimulated with HMGB1 (all P ＜0.05).However,effects mediated by HMGB1 stimulation could be inhibited by LPS RS (all P＜0.05).Conclusions Inflammatory activation of NRK52E cells can be mediated by the interaction of HMGB1 and TLR4.