Objective To determine the effective volume of 1.5％ lidocaine for obturator nerve block (ONB) in 50％ of patients (EV50) undergoing transurethral resection of bladder tumor (TURBT).Methods Thirty-six ASA physical status Ⅰ or Ⅱ patients with bladder tumor,aged 18-64 yr,with body mass index of 19-30 kg/m2,scheduled for elective TURBT and required ONB before TURBT,were enrolled in the study.ONB was performed with 1.5 ％ lidocaine using the pubic approach under the guidance of a nerve stimulator.The volume of 1.5％ lidocaine was determined by up-and-down sequential trial.The initial volume of hdocaine was 10 ml and the ratio between the two successive volumes was 1.1.Successful ONB was considered to be positive response.The EV50 and 95 ％ confidence interval (CI) of 1.5 ％ lidocaine for ONB were calculated.Results The EV50 of 1.5 ％ lidocaine for ONB was 5.53 rnl and the 95 ％ CI was 5.10-6.00 ml.Conclusion The EV50 of 1.5 ％ lidocaine is 5.53 ml when used for ONB in patients undergoing TURBT.

Objective To determine the median effective concentration (EC50) of lidocaine for obturator nerve block (ONB) guided by a nerve stimulator in patients undergoing transurethral resection of bladder tumor (TURBT).Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients with bladder tumor,scheduled for elective TURBT,required ONB according to the results of cystoscopy or CT examination performed before operation,with body mass index of 19-30 kg/m2,aged 18-64 yr,were enrolled in the study.ONB was performed with lidocaine using the suprainguinal approach under the guidance of a nerve stimulator.The concentration of lidocaine was determined by up-and-down sequential trial.The initial concentration of lidocaine was 1.5％,and the ratio between the two successive concentrations was 1.2.Successful ONB was considered to be positive response.The EC50 and 95％ confidence interval of lidocaine for ONB guided by a nerve stimulator was calculated.Results The EC50 of lidocaine was 0.57％,and the 95％ confidence interval was 0.55％-0.59％ when used for ONB guided by a nerve stimulator.Conclusion The EC50 of lidocaine is 0.57％ when used for ONB guided by a nerve stimulator in the patients undergoing TURBT.

Objective To investigate the changes of glucocorticoid receptor (GR) gene expression in the hippocampus of rats following scald burn stress and the role of N methyl D aspartate (NMDA) receptor in this change. Methods Adult male Wistar rats inflicted with 30% TBSA full thickness scalding were applied as severe scalding stress model. GR mRNA levels in the hippocampus were detected with RT PCR. Results A significant decrease of GR mRNA levels was observed in the hippocampus 2 h after the scalding stress. The decrease could be inhibited when MK 801, an NMDA receptor antagonist, was administered prior to stress, and be augmented with the administration of NMDA, an NMDA receptor agonist, but not be affected by normal saline. Conclusion NMDA receptors are involved in the scalding stress induced down regulation of GR gene expression in the rat hippocampus.

Aiming at the characteristics of biochemistry and the advantages of web-based courses and combining with teaching practice,a kind of web-based courses has been constructed which practices in the internet.The key of construction will be detailed from general design,page design and some design skills.

Objective Comparing the effects of ultrasound with nerve stimulation guided obtu-rator nerve block(ONB)with simple nerve stimulation guided ONB for transurethral resection of blad-der tumor(TURBT),so as to realize the validity and advantages of ultrasound with nerve stimulation guided ONB.Methods Sixty ASA Ⅰ or Ⅱ,male or female,age 39-77 years old,BMI 1 9-30 kg/m2 patients undergoing elective TURBT were randomly divided into two groups,nerve stimulation group (group S)and ultrasound and nerve stimulation group (group US).Success rate of the first puncture, visual analog scale (VAS)pain score,insertion-adductor contraction interval (ICI),puncture times corresponding to ICI,adductor strength,incidence of complications and validity were observed during and after ONB.Results There was no significant difference of the general validity,adductor strength and complication incidence between the two groups.The success rate of the first puncture was signifi-cantly higher in group US than that in group S (P < 0.01).VAS pain score,ICI and puncture times were significantly lower in group US than those in group S (P < 0.05).Conclusion Compared with simple nerve stimulation guided ONB,ultrasound with nerve stimulation guidance showed less punc-ture time,more accurate positioning and more comfort.

Objective To compare the efficacy of suprainguinal approach and pubic tubercle approach to obturator nerve block (ONB) in patients undergoing transurethral resection of bladder tumor.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 41-80 yr,with body mass index of 17.5-31.0 kg/m2,scheduled for elective transurethral resection of bladder tumor,were randomly divided into 2 groups (n =30 each) using a random number table:pubic tubercle approach group (group P) and suprainguinal approach group (group S).Nerve blocks were performed using a 100-mm insulated needle for ONB (21-gauge) under the guidance of a nerve stimulator.In group P,the insertion point of the needle was 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle.In S group,the insertion point of the needle was at the midpoint of the line drawn in the inguinal crease between the femoral artery and the inner border of the adductor longus tendon and the needle was advanced 3 cm cephalad in the major axis of thigh.The number of puncture eliciting contraction of adductor muscle,time taken to elicit contraction of adductor muscle starting from onset of puncture,depth of puncture,and highest visual analog scale (VAS) pain scores during application of the block were recorded.The myodynamia of adductor muscle was evaluated.The development of complications was also recorded.Results Compared with group P,the number of puncture,highest VAS scores,and myodynamia of adductor muscle at 4 and 6 min of blockade were significantly decreased,the time taken to elicit contraction of adductor muscle was shortened,and the success rate of puncture at first attempt was increased in group S (P ＜ 0.05 or 0.01).There was no significant difference in the incidence of puncture point bleedings between the two groups (P ＞ 0.05).Conclusion The suprainguinal approach for ONB offers more accurate location,faster onset,lighter degree of noxious stimulation and better safety than the pubic tubercle approach in patients undergoing transurethral resection of bladder tumor.

Objective To comparatively analyze serum levels of zinc , iron, magnesium, calcium, copper and phosphorus and their relationships with serum albumin and circulating HCV viral load in patients with chronic HCV infection , subjects with spontaneously resolved HCV infection and healthy subjects . Methods Serum levels of the six trace elements in patients with chronic HCV infection (n=59), subjects with spontaneously resolved HCV infection (n=65) and healthy subjects (n=48) were measured by a flame atomic absorption spectrophotometer and then a comparative analysis was performed to analyze the differences among the three groups .The relationships of the six trace elements with serum albumin and HCV viral load were analyzed among patients with chronic HCV infection .Results Compared with healthy subjects , the levels of serum zinc were significantly decreased , but serum levels of iron , copper , phosphorus were signifi-cantly increased in patients with chronic HCV infection .There was a significant positive correlation between the levels of zinc(r=0.4022, P=0.0016)and albumin in patients with chronic HCV infection with ALT no less than 40 IU/L, whereas negative correlations were presented between trace elements of iron ( r=-0.3001, P=0.0209), copper (r=-0.3856, P=0.0036), phosphorus (r=-0.3600, P=0.0075) and serum albumin.The circulating HCV viral load was negatively correlated with serum zinc (r=-0.4367, P=0.0005), but positively correlated with serum copper (r=0.3328, P=0.0139).The serum levels of six trace elements showed no significant differences between healthy subjects and spontaneous resolvers of HCV infection.Moreover, no significant differences of serum calcium and magnesium were found among the three groups.Conclusion Chronic HCV infection can induce abnormal serum levels of zinc , iron, copper and phosphorus and the abnormal serum levels of trace elements were closely related with liver function and HCV viral load.With the spontaneous clearance of HCV infection , the serum levels of trace elements could restore to normal .

OBJECTIVETo investigate the clinical effects of close reduction and minimally invasive percutaneous plate osteosynthesis in treating proximal humerus fractures in the aged.

METHODSFrom February 2012 to December 2013,39 patients with proximal humerus fractures were treated with minimally invasive percutaneous plate osteosynthesis (MIPPO group, 21 cases) and open reduction internal fixation (ORIF group, 18 cases). Including 17 males and 22 females in the study, and aged from 67 to 88 years old with an average of (71.8 ± 5.2) years old. In MIPPO group, there were 11 males and 10 females with an average age of (70.0 ± 5.3) years old;and in ORIF group, there were 10 males and 8 females with an average age of (72.0 ± 4.2) years old. Operation time, blood loss during operation, fracture healing time and postoperative complications were recorded. The functions of the shoulder joints were assessed according to Constant-Murley score at final follow-up.

RESULTSAll the patients were followed up from 11 to 27 months with an average of 18.1 months. The mean blood loss of the MIPPO group was (176.0 ± 57.4) ml,while the ORIF group was (356.0 ± 66.9) ml (t = 7.22,P = 0.01). The operation time of the MIPPO group was (47.4 ± 14.9) min, while the ORIF group was (92.7 ± 15.8) min (t = 0.79, P = 0.03). Fracture healing time in the MIPPO group and ORIF group was (17.6 ± 5.8), ( 21.7 ± 4.9) weeks, respectively (P < 0.05). The mean Constant-Murley score at final follow-up was 89.7 ± 14.5 in MIPPO group, and 81.8 ± 13.2 in ORIF group (P < 0.05).

CONCLUSIONMIPPO has advantages of little trauma, less blood loss, rapid recovery, less vascular damage and so on and can effectively treat the proximal humerus fracture in the aged.

Aged ; Aged, 80 and over ; Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Shoulder Fractures ; surgery

Objective To discuss clinical effects and indications of minimally invasive tension band technique in treatment of transverse patella fractures.Methods Thirty-eight patients with transverse patella fracture (close or slightly polluted open ones) were treated with minimally invasive tension band technique from July 1997 to June 2005 in our department.Twenty-six were fixated with percutaneous Kirschner wire tension hand and 12 with percutaneous cannulated screw tension band.The reduction,movement range and function of the knee were analyzed.Results Surgeries went on uneventfully.All the cases were followed up from six months to 6.5 years (average,32 months).Fracture healing time lasted from 6 to 12 weeks,averaging 7.7 weeks.No such compli- cations as traumatic arthritis occurred.Reduction was excellent in 21 cases,good in 11 and fair in six,with the good-to-excellent rate being 84.2%.All the affected knee joints could move in normal range.The functional re- covery was assessed as excellent in 34 cases and good in four.Conclusions Internal fixation with minimally invasive tension band technique is good for treatment of transverse patella fractures.It is chiefly fit for close or slightly polluted open fractures with limited wound,and can also be used for the comminuted fractures if the bone fragments are no more than three and the fracture site is suitable.

Carcinoma, Non-Small-Cell Lung ; metabolism ; pathology ; Cell Membrane ; metabolism ; Cell Nucleus ; metabolism ; Cytoplasm ; metabolism ; Humans ; Lung Neoplasms ; metabolism ; pathology ; Signal Transduction ; TCF Transcription Factors ; metabolism ; Transcription Factor 7-Like 2 Protein ; Wnt Proteins ; physiology ; beta Catenin ; metabolism