Objective To observe the effects of peridural and general anesthesia on haemodynamics in gynecological laparoscopic operation.Methods 106 patients with gynecological laparoscopic operation were randomly divided into epidural anesthesia group(n=53)and general anesthesia group(n=53)respectively.The changes of heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),SPO_2 were monitored before anesthesia,at 20min after pneumoperitoneum(pp),end of operation.Results The sober time in epidural anesthrsia geoup(7.1 ±2.5)min was significantly faster than that in general anesthesia group(20.8 ± 6.3)min(t=2.068,P＜0.05).At 20min after pp,HR in general anesthesia group(91 ±17)was significantly faster than that in ppidural anesthesia group before anesthesia(t=2.593,P＜0.05),and it was significantly higher than epidural anesthesia group(t=3.417,P＜0.05).SBP in epidural anesthesia group was singnificantly lower than before anesthesia(t=2.806,P＜0.05),and it was significantly lower than general anesthesia group(t=3.917,P＜0.05).Conclusion General anesthesia does not significantly better than epidural anesthesia in gynecological laparoscopic operation,but they should enhance the clinical monitoring of hemodynamics.

Objective To analyze the clinical effect of the treatment of secretory otitis media with puncture combined with injection.MethodsThe control group was given tympanic membrane puncture combined with conventional drug treatment, and the experimental group was given combined with tympanic tympanic membrane puncture injection and conventional medicine for treatment.ResultsThe total effective rate of the experimental group (95.2%) was significantly lower than that of the control group (66.7%)(P<0.05);The incidence of complications in the experimental group (6.3%) was significantly lower than that in the control group(22.2%)(P<0.05).ConclusionClinical efficacy and safety of the treatment of secretory otitis media with puncture and injection.

100 g/d), hypernatremia and hyperglycemia were the three main risk factors resulting in plasma hyperosmolality. The 4-week survival rate of hyperosmolality group(47.1%) was significantly lower than that of non-hyperosmolality group(78.3%, P

Objective To evaluate RR,DCR,PFS,OS and toxicities in a population affected by NSCLC using gefitinib as maintenance therapy after the first line chemotherapy.Methods From January,2006 to January,2008,seventy-one patients were enrolled with stable disease or partial response after firstline chemotherapy.They were divided into the observing group and the control group.Gefitinib was administered at the dose of 250 mg in observing group;placebo was also administered everyday in control group.Results Of 71 assessable patients ,overall response rate was 36.1% (13/36) in observing group and 14.3 % (5/35) in control group respectively (x 2 = 4.633,P = 0.036),and one patient (2.8 %) was observed complete response (CR) in observing group.The disease control rate was 83.3 % (30/36) in observing group and 42.9 % (15/35) in control group,respectively,(x2 = 14.782,P ＜ 0.001).The median PFS (progression free survival time) was 13 weeks in observing group and 11 weeks in control group respectively (x2 = 10.401,P =0.001).The median overall survival time (OS) was 13.2 months in observing group and 10.4 months in control group respectively (x2 = 7.696,P= 0.006).The median OS was 18.5 months in women and 11.2 months in men(x2 =22.864,P=0.011) .The median OS was 15.3 months in non-smokers and 10.3 months in smokers (x2 =10.389,P =0.007).The median OS was 16.0 months in adenocarcinoma and alveolar cell carcinoma patients and 10.2 months in squamous cell carcinoma patients (x 2 = 4.638,P = 0.001).The most common toxicity was rash ,diarrhea,fatigue and dry skin itching,and most of them were 1 or 2 grade.Conclusion Maintenance therapy with gefitinib after first-line chemotherapy may improve overall survival time and progression free survival time in patients with NSCLC,and it is effective and safe.

Objective To explore the clinical value of application research in business process reengineering in transferring of inpatients for check-up. Methods We reorganized transferring of inpatients for check-up and service tache by introducing the Systematic Redesign method from the therory of Business Process Reengineering. The reengineered process was adopted and applied in the transferring processes. We randomly selected patients for check-up(126 cases for electrocardiogram,130 cases for Xrayand 128 cases for CT examination)and investigated the time cost for check-up and patients satisfaction rate. The above results were compared with those patients(112 cases for electrocardiogram,112 cases for Xrayand 120 cases for CT examination)before use of reengineered process. Results The time cost for the above mentioned check-up was shorter and patients satisfaction rate were alleviated compared with those before use of reengineered process(U=14.55,12.26,13.57;x2=17.37,14.65,10.75,P＜0.01).Conclusion Application of business process reengineering in the transferring process of inpatients for check-up proved pivotal important in that it could shorten time cost for transferring process and improve patients satisfaction rate.It possessed realistic significance for increasing benefit and competitions for hospitals.

Objective To investigate the effect of fluvastatin on the expressions of caspase-12,CCAAT/enhancer-binding protein homologous protein(CHOP), and c-Jun N-terminal kinases (JNK) in ischemia-reperfusion brain injury in rats.Methods Forty two rats were randomly divided into sham operation group (6 rats), ischemia-reperfusion (I/R) group (18 rats), and fluvastatin (Flu) group (18 rats).The rats of I/R and Flu groups were molded by modified Longa intraluminal thread, then put to death at 2 h occlusion and 24 h reperfusion point.Expressions of caspase-12, CHOP, and JNK were detected with immunohistochemistry and Western blot.Results Immunohistochemistry and Western blot showed that the expressions of caspase-12, CHOP, and JNK were increased at 24 h reperfusion.Compared to I/R group, the expressions of caspase-12 and CHOP in Flu group were decreased significantly (all P ＜0.01);and the expression of JNK had no difference between I/R and Flu groups(P ＞ 0.05).Conclusions The increased expression of caspase-12, CHOP, and JNK showed that endoplasmic reticulum stress was involved in the pathological process of ischemia-reperfusion brain injury.Fluvastatin could inhibit the expression of caspase12 and CHOP, and could delete endoplasmic reticulum stress (ERS) in ischemia-reperfusion brain injury.

Objective To observe the changes of CD31 and CD62p expressions in platelets of patients with acute cerebral infarction(ACI) and its significance.Methods The expression levels of CD31 and CD62p of 53 patients with ACI were measured with whole blood flow cytometry within 48h after onset,and were compared with those of 38 patients with vascular risk factors(hypertension,diabetes,current smoking and hyperlipidemia) of cerebral infarction and 30 normal controls.Results The expression levels of CD31 and CD62p in patients with ACI [((90.91?)15.39)%,((7.00?)2.96)% respectively] were higher than those of patients with risk factors and normal controls(all(P

Objective To observe the changes of PECAM-1,Bcl-2 and Bax expressed by ischemic cerebrum of adult rats after focal cerebral ischemia. Methods Middle cerebral artery occlusion (MCAO) models were made by operation with Longa suture method in Wistar rats. The expression levels of PECAM-1,Bcl-2 and Bax at the 6th,12th,18th,24th,48th,72nd hour after MCAO were detected by immunohistochemistry staining. Results The expression levels of PECAM-1,Bcl-2 and Bax in cerebrum were significantly increased after MCAO. The expression levels of Bcl-2 we、re up to the peak at the 12th hour after MCAO, while the levels of Bax and PECAM-1 were up to the peak at the 24th and 48th hour after MCAO. At the 72nd hour after MCAO, the expression levels of PECAM.1.Bcl-2 and Bax were still higher than that in the control group(all P＜0.001).Conclusions PECAM-1,Bcl-2 and Bax participate in the different pathological stages of focal cerebral ischemia.

Objective To explore nurses' experiences of ethics dilemma and coping strategies involed in caring dying patients. Methods Interviews were conducted with 25 nurses from four different levels of hospitals in Shanghai. Results The ethical dilemmas that participants encountered with were derived from different standpoint and ethics decision-making between "relieve pain" and "extend life span","life value" and "insufficient medical resources","agent execution for patients' rights of being informed consent" and"medical intervention rights". Nurses' coping strategies included patiently communicating with family members to achieve agreement,failing to change family's decision then passively accepting it by self-adjustment,and following hospital rules and regulation or relying on team decision-making. Conclusion The study analyzed and discussed the reasons behind ethical dilemmas,as well as providing some suggestions on how to improve the coping abilities for nurse staffs. It can provide reference and basis for ethical decision-making.

Objective To investigate the clinical features and the gene mutation of patients with spinocerebellar ataxia type3 and type7.Methods The trinucleotide repeat mutations were detected by polymerase chain reaction (PCR),agarose gel electrophoresis method,and DNA sequencing in 13 patients,4 related members and 4 common members from 3 spinocerebellar ataxia families.Results Among the 13 patients,four patients had SCA3/MJD(CAG) n expansion mutation(n = 65 ～ 74),nine patients had SCA7 allele expansion for 40 ～ 52 times.Patients with type 3 or 7 showed significant difference in nervous system injury.Conclusion The difference of clinical feature might be used in diagnosis of SCA3/MJD and SCA7,but genotype determination would be the only method of definite diagnosis.