BACKGROUND:Dural elderly knee arthroplasty anesthesia is a common mode of anesthesia. Dexmedetomidine, because of good analgesic effects, is widely applied to epidural anesthesia in elderly knee replacement, but different applied dose of dexmedetomidine may lead to different results. OBJECTIVE:To explore the effects of different doses of dexmedetomidine for epidural anesthesia in elderly knee arthroplasty. METHODS:A total of 75 cases of older patients undergoing knee replacement surgery were selected and randomly divided into dexmedetomidine loading and maintenance group (25 cases), dexmedetomidine group (25 cases), and the normal saline group (25 cases), and then they were given smal doses of dexmedetomidine loading and maintenance, dexmedetomidine maintenance, intravenous infusion of normal saline. Blood pressure, heart rate, Calm/Alert Standard Score and the operation degree of forgetting were observed and compared in the three groups. The time points included T0 (after epidural anesthesia), T1 (3 minutes after medication), T2 (5 minutes after medication), T3 (10 minutes after medication), T4 (15 minutes after medication), and T5 (30 minutes after medication). RESULTS AND CONCLUSION:After the use of drugs, blood pressure and heart rate were decreased in the dexmedetomidine loading and maintenance group and dexmedetomidine group. Blood pressure and heart rate were significantly lower in the dexmedetomidine loading and maintenance group than that of dexmedetomidine maintenance group (P < 0.05). Moreover, it was slowest in T3 phase and in T4 phase in the dexmedetomidine group (P < 0.05). After 5 minutes of medication, Calm/Alert Standard Score was decreased in the dexmedetomidine loading and maintenance group and dexmedetomidine group. In T3 phase, deep sedation and heart rate decreased significantly in the dexmedetomidine loading and maintenance group; above symptoms could be improved by giving atropine. In T4 phase, score was lowest in the dexmedetomidine group (P < 0.05), but deep sedation was not found; the decreased degree of blood pressure and heart rate was lighter in the dexmedetomidine group than in the dexmedetomidine loading and maintenance group. The complete oblivion extents of the operation-related procedures were respectively 72%, 68% and 0% in the dexmedetomidine loading and maintenance group, dexmedetomidine group and normal saline group. Above extent was significantly greater in the dexmedetomidine loading and maintenance group and dexmedetomidine group than in the normal saline group (P < 0.05). No significant difference was detected between groups (P > 0.05). These findings suggest that in elderly patients undergoing knee replacement, smal dose of dexmedetomidine continuous infusion for epidural anesthesia can achieve good effects on analgesia and sedation, can eliminate the bad memories for patients with operation, and is a scientific mode of anesthesia.

Objective To study the genetic diversity of rDNA ITS sequences in the root tuber of Polygonum multiflorum from various habitats and to analyze the utility of ITS sequences in molecular authenticating the genuineness, identifying the varieties of wild resources, and studying the germplasm resources. Methods Firstly, total DNA in the root tuber of P. multiflorum from various habitats was extracted. Secondly, the ITS sequence was amplified by PCR with universal primer of ITS and sequenced after purification. Results The total length of ITS sequence is 648 bp in the different samples, such as 5.8S, 18S, and 26S rDNA. The lengths of three fragments, ITS1, 5.8S, and ITS2, are 195 bp, 164 bp, and 189 bp, respectively. There are seventeen variable sites among the sequences. Conclusion ITS Sequence can be used to authenticate the genuineness and identify the varieties of wild resources in the root tuber of P. multiflorum.

Using chemotherapy (DA or HA and ATRA) to treat 22 cases of acute promyelocytic leukemia following to give PSS (100mg/d X 7d) ,the patients complicated with DIC were treated then were given the chemotherapy,combined with PSS to end. The results showed that the complete remission rate of the therapy of APL with PSS was increased to

BACKGROUND: A long-term follow-up indicates that orthotopic ileal neobladder can cause acid-base balance and nutritional metabolic disorder. Otherwise, a long mesenterium is necessary to balance the tension of bladder at pelvic cavity and urinary inosculation due to a high position of ileum. On the contrary, sigmoid neobladder is near by urinary canal, and orthotopic sigmoid neobladder as a bladder substitute after radical cystectomy has few effects on acid-base balance of electrolytes, nutritional metabolism and secretion of mucus.OBJECTIVE: To compare the clinical results of these two operations basis on long-term follow-up. DESIGN: Retrospective analysis.SETTING: Department of Urinary Surgery, the Second Affiliated Hospital of Kunming Medical College.PARTICIPANTS: 164 patients with carcinoma of bladder were selected from Department of Urinary Surgery, the Second Affiliated Hospital of Kunming Medical College form January 1995 to March 2005. Ninety-six of them, including 74 males and 22 females, with age of 43-74 years and the average age of 65 years, accepted the operation of orthotopic ileal neobladder were regarded as the ileal neobladder group, and the other 68, including 64 males and 4 females, with age of 51-72 years and the average age of 62 years, accepted the operation of orthotopic sigmoid neobladder were regarded as the sigmoid neobladder group. All patients were finally diagnosed as pathological examination, and informed consent was provided by all patients. Treatment plan was approved by the local ethical committee.METHODS: ① Orthotopic ileal neobladder: Once the bladder was removed, a segment of ileum about 40-60 cm in length was isolated. In the operative procedure, the distal part of ileum which connected to the caecum often kept, the length of which was 15-20 cm. Both distal ends of the ureters were anastomosed to the homolateral not been split end of the isolated bowel. A perforation was constructed at the bottom of the pouch which served as the outlet, this outlet was then anastomosed to the proximal portion of the remaining urethra. ② Orthotopic sigmoid neobladder: After surgically removing the bladder, a part of the sigmoid colon, the length of which was 30-40 cm was isolated. Other operations were as the same as those mentioned above. MAIN OUTCOME MEASURES: Time of operation, blood loss during the procedure, length of time confined to bed, time of indwelling catheter, the ability to maintain continence and urinate, the results of urodynamic studies, and pouch related complications after operation.RESULTS: In 164 patients, 12 (7.3%) were lost to follow-up. The mean follow-up times were 46 months in the group of orthotopic ileal neobladder and 42 months in the group of orthotopic sigmoid neobladder, respectively. Blood loss during the procedure and the ability to maintain continence and urinate were similar in the two groups (P > 0.05). Compared with sigmoid neobladder group, the ileal neobladder group spent more time on operation, keeping the bed and indwelling catheter. The max volume of ileal pouch was higher than that of sigmoid pouch, and the difference was significant in statistic analysis (t=2.56-3.08, P < 0.05-0.01). Incidence of complication of ileal pouch (16.7%, 29.2%) was higher than that of sigmoid pouch (9%, 16%). The incidence in the early phase was not significantly different, but that in the late phase was significantly different (x2=5.426, P < 0.05).CONCLUSION: Compared with orthotopic ileal neobladder, sigmoid neobladder is worthy of being preferred for its shorter operative time, faster recovery and lower rate of pouch related complications.

Objective To evaluate the effect of technical improvement of radical retropubic prostatectomy(RRP) for patients and reduction of complications.Methods 22 patients with clinically prostate cancer(mean age 67 years,stage B 19 cases,stage C 3 cases) underwent radical retropubic prostatectomy.During operation the dorsal vein complex,puboprostatic ligament,puborectalis sling,the neurovascular bundle,external urethral sphincter,reconstruction of the bladder neck were carefully managed.Results All the patients recovered uneventful except 2 deaths,and they survived and were followed up for a mean time of 16 months(range 1～4 years).The mean operative time was 140 minutes(range 90～220minutes) and the mean blood loss was 600mL(range 250～1500mL).16 cases received blood transfusion for 300～1200mL and no ureteral or rectal injury occurred.The urinary catheters were removed 2～3 weeks after operation.2 cases had stress incontinence 3 months later,1 case encountered urethral stricture and became well after urethral dilation,15 cases had satisfactory erectile function after operation and 3 patients had biochemical failure and endured continually chemotherapy during follow-up.Conclusions Accurate maneuver is handled according to correct anatomy can protect the apex of prostate and its surrounding tissue and reconstructing the bladder neck is helpful to reduce complications and achieve better outcome.

Objective To observe the damage of liver cells and to investigate the distribution and expression of glu-cose-regulated protein 78 (Glucose regulated protein78, GRP78/Bip) in liver tissue under the positive acceleration (+Gz) exposure.Methods Totally 24 wistar rats were randomly assigned to four groups:blank control,+6Gz,+9Gz and +12Gz.Each rat was clamped to the centrifuge arm , prone position, with the head of the rat facing the axis of the centrifuge for +Gz orientation.The onset rate was +0.5 Gz/s, which was used trapezoidal acceleration curve effect and controlled by computer .Blank control group rats were placed on the arm of centrifuge and under-went a process similar to that described above , but they were not exposed to acceleration .+6Gz group,+9Gz group and +12Gz group were subjected at peak time 3 min in animal centrifuge , acceleration rate 0.5 G/s, five times with interval 30 min between times.In addition, liver tissue of rats were respectively observed by H .E.staining.Mean while, plasma aspartate aminotransferase ( AST) and alanine aminotransferase ( ALT) were tested determine the damageofliverfunction.Results +GzaccelerationstressinjuryincreasedserumASTandALTlevel.Compared with the stress control, +9Gz group and +12Gz group significantly increased in plasma ALT and AST as compared with control group ( P<0.05 ) .+12 Gz stress induced the highest level in these groups .The level of ALT in+2 Gz group was higher than that in +6 Gz group ( P<0.05 ) .HE staining showed derangement of liver cells , irregular shape, the cell gap is not clear, vacuolar changes in +Gz groups, and with the increase of G value.Compared with the control group, the expression of GRP78/Bip was focused in the cytoplasm;the expression of GRP78 in the experimental group is higher than that in the control group ( P<0.05 ) .+12 Gz group was significantly higher than+6Gz group and the control group (P<0.05).The expression of GRP78/Bip in liver tissue increased with the in-creasing of G value levels;the expression level of GRP78/Bip in +12Gz and +9Gz groups were higher than that in +6Gz and control group (P<0.05).Conclusions There is positively related expression of GRP78/Bip, which was associated with exposure of increasing G values .

Objective To evaluate the safety and clinical efficacy of the treatment for symptomatic uterine fibroids with MR guided focused ultrasound surgery(MRgFUS)in China. Methods Twenty five selected patients with symptomatic uterine fibroids underwent MRgFUS treatment in our perspective clinical study. Immediately after treatment the patients accepted pelvic enhanced MRI scans, and recorded the non-perfused volume(NPV)and calculated the non-perfused volume ratio(NPV%). We recorded the symptom severity score(SSS) and standard SSS change(ΔSSS)of the patients before, during and 1 week after treatment together with 1, 3, 6, 12 months and several years follow-up. The patients accepted pelvic enhanced MRI scans in the follow-up of 12 months after treatment,and recorded the volume and the volume change(ΔV) of fibroids. We observed the adverse reactions during the treatment and the follow-ups. Wilcoxon test or t test and Pearson or Spearman correlation analysis were used to analyze the data. Results Totally 31 fibroids of 25 patients were completed the treatment. Twenty two patients completed the 12 months follow-up and 15 patients completed the long-term follow-up which was during 34 to 66 months, median follow-up duration was(55 ± 11)months. The NPV was 4.5 to 295.0 cm3, median was 37.0 cm3. The NPV%was 6%to 94%, average was(64 ± 23)%. According to our follow up, the standard SSS continued to decline. Compared with screening standard SSS, all the follow-up standard SSS had significant difference(P<0.05), except for that of the first week. Among all the follow up, only the standard SSS change of 1 week after the treatment had a correlation with NPV%(r=0.552,P=0.005), and the others had no significant correlation with NPV%(P>0.05). The uterine fibroids volume decreased in the 12 months follow-up, which had a significant difference with the volume before treatment(P<0.05). And there was also correlation between the fibroids volume change and NPV(r=0.587,P=0.017). There was no correlation between the volume or volume change and standard SSS or standard SSS change(all P>0.05). None serious adverse effects occurred in all cases. Conclusion MRgFUS is a safe and effective way to treat uterine fibroids.

Objective The study is designed to evaluate the difference in identification for depression and clinical effectiveness of its treatment between psychiatrists and non-psychiatric Dhysieians at out-patient departments of general hospitals and to analyze its related factors.Methods Totally,680 patients who visited psychiatric clinics in nine general hospitals of Shanghai at first time were screened by psychiatrists using Composite International Diagnostic Interview(CIDI)for depression and the screening resuhs were compared to the diagnosis made by non-psychiatric physicians as goal-keepers there.Altogether 297 patients with depression were recruited and assessed using Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA).A self-made questionnaire for basic information was used to assess the ability for identification of depression in non-psychiatric physicians of general hospitals.Results Psychiatrists identified depression correctly in 337 of 680 patients who visited psychiatric clinics in general hospitals at their first visit,but non-psychiatric physicians only identified 216 patients,with statistically significant difference(χ2=30.73,P=0.000).A consistent agreement on depression diagnosis between the findings by psychiatrists and by CIDI was reached with Kappa of 0.774,but Kappa for that between the findings by non-psychiatric physicians and CIDI was 0.439.Effectiveness of treatment for depression by psychiatrists was better than that by non-psychiatric physicians,with higher total score and scores for each item of HAMD four,eight and 12 weeks after treatment,respectively(P＜0.05 or P＜0.01).Length of professional work of non-psychiatric physicians and annual time for professional training in management of mental disorders associated with their ability of identification for depression(P＜0.05).Conclusion Ability of non-psychiatric physicians to identify alQd cope with depression in the psychiatric department of general hospitals was insufficient,suggesting that more importance should be attached to the management of service quality at psychiatric department of general hospitals.

Objective To discuss the long term clinical effect of ileal orthotropic neobladder.Methods From 1991 to 1998,79 patients,mean age 55(41～75)years,male 74,female 6,were followed up.The serum creatinine and urea,electrolytes,blood routine,B ultrasonic scan of the neobladder residual urine and IVU or MRU of the patients were followed up.The max transverse diameter of renal pelvis and the max verticaI/level diameter of neobladder were measured in 5,10 to 14,15 years of postoperative when IVU or MRU.All results of different time were compared by the multiple comparisons.The local or distant cancer recurrence and the complications of the operation Were evaluated. Results Sixty-four cases,58 male,6 famle,were long term followed up:mean time was 167 (range,121～216)months.Seven cases died of other diseases.Seven cases had pelvic recarrence.Two cases had urethral recurrence.Three cases died of tumor metastasis.One case had ureter recurrence.Forty-eight patients were alive more than 10 years.The value of the serum creatinine,urea,electrolytes and bloods routine of the patients were normal after 5,10 to 14 and 15 vears postoperative (P＞0.05).The max transverse diameter of the renal pelvis in 5,10 to 14 and 15 years Dostoperative were 14.0 mm,14.1 mm and 13.7 mm,respectively,P＞0.05.The max vertical/level diameter of the neobladder in 5,10 to 14,15 years of postoperative were 110.4 mm/90.4 mm,111.5 mm/95.3mm and 127.0 mm/97.0 mm,respectively,P＞0.05.The residual urine of 5 cases was more than 50 ml and had not increased during follow up.Eight cases with neobladder stone were cured by the intracavitary lithothrypsis.Two cases with uretheral stricture were cured by the intracavitary therapy.Twelve cases of 14 cases with inguinal hernia were cured by reoperation,2 cases accepted conservative treatment.Only 17 cases had no complication involve of the cancer and the operation. Conclusion The upper urinary tract and neobladder of the ileal orthotopic neobladder could be stable for long time,the cure rate of tumor is satisfactory and the lifetime follow up is necessary.

Objective:To investigate the value of multi-slice spiral CT (MSCT) combined with three myocardial markers in the diagnosis of acute chest pain etiology.Methods:A retrospective study was conducted on 120 patients with acute chest pain admitted to the Affiliated Hospital of Jining Medical University from January 2020 to December 2020. All patients underwent MSCT imaging examination upon admission, and serum creatine kinase isoenzyme MB (CK-MB), troponin I (cTnI), and myoglobin (MYO) levels were also tested. The final clinical diagnosis was used as the judgment standard to draw a 2×2 four-square table, and calculate the value of MSCT, CK-MB, cTnI, and MYO in the diagnosis of acute chest pain etiology.Resultsl:Among the 120 acute chest pain patients included, 75 were diagnosed with acute coronary syndrome (62.50%), 16 with aortic dissection (13.33%), and 29 with pulmonary embolism (24.17%). The coincidence rate of MSCT diagnosis of coronary heart disease was 86.67%(65/75), the diagnosis of aortic dissection coincidence rate was 12/16, and the diagnosis of pulmonary embolism coincidence rate was 75.86%(22/29). The serum CK-MB, cTnI, and MYO levels in the coronary heart disease group were significantly higher than those in the aortic dissection group and pulmonary embolism group, and the differences were statistically significant (all P<0.05). There was no significant difference in serum CK-MB, cTnI, and MYO levels between the aortic dissection group and pulmonary embolism group (all P>0.05). The sensitivity of CK-MB, cTnI, and MYO in the differential diagnosis of acute chest pain patients with coronary heart disease and non-coronary heart disease were 93.33%, 85.33%, and 89.33%, respectively, and the specificity were 73.33%, 80.00%, and 77.78%, respectively. The areas under the receiver operating characteristic (ROC) curve were 0.833, 0.826, and 0.836, respectively. Conclusions:MSCT can better identify coronary heart disease, aortic dissection, and pulmonary embolism in patients with acute chest pain, while the three myocardial markers can better distinguish patients with coronary heart disease and non-coronary heart disease. Therefore, MSCT combined with myocardial markers should be used for the diagnosis of acute chest pain patients in clinical practice to facilitate early clinical diagnosis.