Objective:To research the influence of thoracic epidural block on blood dynamics、neural endocrine hormone and the expression of AQP4 mRNA in the lung of rabbit with heart failure models.Methods:60 rabbits which were punctured and cannulated at the thoracic epidural cavity of T5～6 were randomly divided into three groups(n=20):sham operation group(group s),in which the anterior descending branches of left coronary artery were threaded by suture but not tied;heart failure group(groupHF),in which the anterior descending branches of left coronary artery were ligated,0.9%normal sodium 0.5ml/kg was injected to epidural space twice a bay for 4 weeks separately in group S and group HF.TEB group(group TEB),in which 0.1%ropivacaine 0.5ml/kg was injected to epidural space twice a day for 4 weeks after the anterior descending branches of left coronary artery were ligated.After 4 weeks,blood dynamics were monitored directly by insertion through common carotid artery and femoral artery;the level of ANP and ET-1 were mensurated by radioimmunoassay(RIA)and the expression of AQP4 in the lung was quantified by reverse transcription-polymerase chain reaction(RT-PCR).Results:(1)At 4 weeks after ligated LAD,LVEDP was increased significantly and MAP、LVSP、?dp/dt max were decreased significantly in group HF compared with group S.Therapy of TEB was significantly decreased LVEDP and were increased significantly MAP、LVSP、?dp/dt max.(2)Therapy of TEB decreased the level of ANP、ET-1 and increased the expression of AQP4mRNA of the rabbit with heart failure models.Conclusion:Thoracic epidural block have exert anti-heart failure effects by improving blood dynamics parameters,decreased secretion of ANP、ET-1and increased the expression of AQP4mRNA in the lung of rabbits.

OBJECTIVE:To investigate the protective effects of adjunctive general anesthesia of dexmedetomidine on cardiac and cerebral ischemia-perfusion injury. METHODS:50 patients,ASA physical status Ⅰ-Ⅱ,undergoing selective tracheal intuba-tion,were randomly divided into dexmedetomidine group (group D) and control group (group C) with 25 cases in each group. The patients in group D received a loading dose of 1 μg/kg of dexmedetomidine by infusion pump before anaesthesia,10 min lat-er by a maintenance dose of 0.5 μg/(kg·h)till the end of surgery;whereas patients in group C received normal saline and same induction. HR,SBP and DBP of 2 groups were monitored at the beginning of operation,10 min after incision,30 min after inci-sion,at the end of operation. Blood samples of vena jugularis interna were taken to determine the plasma levels of cardiac tropo-ninⅠ(cTnⅠ) ,adrenaline and norepinephrine before anesthesia induction (T0),at the end of surgery (T1),6 h after surgery (T2),12 h after surgery(T3),24 h after surgery(T4),48 h after surgery(T5). RESULTS:There was no statistical significance in the levels of HR,SBP and DBP in group D between during operation and at the beginning of operation(P>0.05);those in-dex were significantly lower than those of group C at corresponding time points,with statistical significance(P<0.05). The lev-els of cTnⅠ in group D at T2-T5 were significantly lower than in group C,with statistical significance(P<0.05). The levels of adrenaline and norepinephrine at T1-T5 were significantly lower than group C,with statistical significance (P<0.05). CONCLU-SIONS:Adjunctive general anesthesia of dexmedetomidline can improve cardiac and cerebral ischemia-perfusion injury to certain extent.

Objective To investigate the effects of polysaccharide sulfate(PSS)on lipopolysaccharide(LPS)-induced mice pulmonary microvascular endothelial cell(PMVEC) injury in vitro .Methods PMVEC were divided into the blank control group (C) ,LPS stimulation group (L) and PSS+ LPS group (LP) .The effect of PSS on the viability of LPS-induced PMVEC was ob-served by MTT assay .The influence of polymorphonuclear(PMN) on the PMVEC adhesion number was measured by the rose Ben-gal staining .The concentrations of TNF-αand ICAM-1 in culture supernatant of PMVEC were detected by ELISA assay .Results PSS could inhibit the decrease of PMVEC viability caused by LPS(P=0 .001) ,compared with the group C ,the adhesion number of PMVEC and PMN in the group L was significantly increased(P=0 .000) ,the expression of TNF-αand ICAM-1 was significantly increased(P=0 .000);compared with the group L ,PSS pretreatment for 1 h could significantly decrease the LPS caused adhesion of PMVEC and PMN(P=0 .000) ,the expression of TNF-αand ICAM in the group LP was significantly decreased (P<0 .05) .Con-clusion PSS can inhibit LPS-induced PMVEC injury and adhesion of PMVEC and PMN ,its mechanism may be related with the de-crease of ICAM-1 and TNF-αexpression .

INTRODUCTION: Patients with chronic diseases face difficulties when navigating the healthcare system. Using the Healthcare System Hassles Questionnaire (HSHQ) developed by Parchman et al, this study aimed to explore the degree of hassles faced by patients in primary care in Singapore and identify the characteristics associated with greater hassles. METHODS: A cross-sectional study was conducted on patients with chronic diseases at Hougang Polyclinic, Singapore, using the interviewer-administered HSHQ. The mean HSHQ score was compared with that reported by Parchman et al. The associations between the number of chronic diseases, demographic variables and healthcare hassles were assessed using multivariate linear logistic regression analysis. RESULTS: In total, 217 outpatients aged 21 years and above were enrolled. Their overall mean HSHQ score (4.77 ± 6.18) was significantly lower than that of patients in the study by Parchman et al (15.94 ± 14.23, p < 0.001). Patients with five or more chronic diseases scored 3.38 (95% confidence interval [CI] 0.11-6.65, p = 0.043) points higher than those with one chronic disease did. With each increasing year of age, the mean HSHQ score decreased by 0.17 (95% CI -0.26 to -0.08, p = 0.001) points. Patients with polytechnic/diploma/university education and higher scored 2.65 (95% CI 0.19-5.11, p = 0.035) points higher than those with primary education and lower did. CONCLUSION Patients in our population reported less hassles than those in the study by Parchman et al did. Increasing age and lower education level were associated with less hassles. Further analysis of the types of chronic diseases may yield new information about the association of healthcare hassles with the number and types of chronic diseases.