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 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 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 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.

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 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.

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 .

Objective To explore the value of mast cell tryptase and brain natriuretic peptide(BNP)in the differential diagnostic of sudden death due to hypersensitivity and coronary atherosclerotic heart dis-ease.Methods Totally 30 myocardial samples were collected from the autopsy cases in the Department of Forensic Pathology, Shanxi Medical University during 2010—2015. All samples were divided into three groups:death of craniocerebral injury group, sudden death of hypersensitivity group and sudden death of coronary atherosclerotic heart disease group, 10 cases in each group. Mast cell tryptase and BNP in myocardium were detected by immunofluorescence staining and Western Blotting.Results Immunofluo-rescence staining showed that the positive staining mast cell tryptase appeared in myocardium of sudden death of hypersensitivity group and coronary atherosclerotic heart disease group. Among the three groups, the expression of mast cell tryptase showed significantly differences through pairwise comparison(P<0.05); The expression level of BNP in sudden death of coronary atherosclerotic heart disease group were significantly higher than the sudden death of hypersensitivity group and death of craniocerebral injury group(P<0.05). The difference of the expression level of BNP between the sudden death of hypersensitivity group and the death of craniocerebral injury group had no statistical significance(P>0.05).Conclusion The combined detection of the mast cell tryptase and BNP in myocardium is expected to provide help for the forensic differential diagnosis of sudden death due to hypersensitivity and coronary atherosclerotic heart disease.

Objective: To explore the clinical and echocardiography characteristics between noncompaction of ventricular myocardium (NVM) and dilated cardiomyopathy (DCM) combining hypertrabeculation in order to distinguish NVM from DCM.
Methods: Our research included 2 groups of patients: NVM group,n=31 and DCM combining hypertrabeculation group, n=50. The basic information as gender, age, family history, symptoms, ECG, plasma levels of BNP and echocardiography were recorded and examined in all patients; the size of cardiac chambers, myocardium, endocardium and hemodynamics were particularly focused. The trabeculation was analyzed by 17 segments method.
Results:①Compared with NVM group, the patients in DCM combining hypertrabeculation group had the worse cardiac classiifcation, higher plasma levels of BNP (P<0.05) and more obvious cardiac dilatation.②The patients in NVM group had the most trabeculation segments (9.82 ± 2.02) and the apical (17th segment) was involved, patients had the higher ratio of noncompacton/compaction (NC/C) as (2.84 ± 0.61), there were (4.12 ± 2.68) segments with NC/C > 2.③The patients in DCM combining hypertrabeculation group had the less trabeculation segments (5.56 ± 1.56) and the apical was seldom involved, patients had the lower ration of NC/C as (1.91± 0.42), there was at most 1 segment with NC/C > 2. All P<0.05.
Conclusion: Echocardiography is a simple, practical and noninvasive method to distinguish NVM from DCM. NVM could be diagnosed by obvious left ventricular apex involvement with NC/C >2 in at least 2 segments of free ventricular walls.

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