Objective To observe the effects of postoperative patient controlled epidural analgesia(PCEA) on plasma neuropeptide Y(NPY) Methods Fifty eight patients scheduled for thoracic surgery, were randomly divided into PCEA group(n=28) and control group(n=30) After operation, patient controlled epidural analgesia was applied in PCEA group and in control group pethidine I M was given intermittently The plasma NPY and serum cortisol concentrations were measured at pre anesthesia,the end of operation,and 24h and 48h after operation by radioimmunossay Results Compared with the baselines, plasma NPY and serum cortisol levels increased significantly at the end of operation in both groups ,without the obvious differences between both groups The plasma NPY level restored to the baseline in PCEA group 24h after operation, and in control group was significantly higher 24h after operation than the besaline and restored to the besaline 48h after operation The serum cortisol level was kept higher level 24h after operation and restored to the baseline 48h after operation in PCEA group, and in control group increased significantly 24h and 48h after operation as compared with the baseline The plasma NPY level 24h after operation and serum cortisol level 24h and 48h after operation were lower markedly in PCEA group than those in control group Conclusions The PCEA can effectively depress the increase of plasma NPY and serum cortisol induced by postoperative pain in patients undergoing thoracic surgery

OBJECTIVE: To study the optimum supercritical- fluid extraction technique for Xiangjiang Granula essential oil. METHODS: The orthogonal test was adopted to optimize the extraction process using the content of Ligustilide and the yield rate of essential oil as indicators, and 95% ethanol as co- solvents. The content of Ligustilide was determined by HPLC, using Phenomenex Luna C18( 250nm? 4. 6nm, 5? m) as column and methanol- 0. 5% glacial acetic acid( 30∶ 70) as mobile phase, with the detection wavelength set at 280 nm. RESULTS: The optimal extraction conditions were: temperature at 50℃ , pressure at 45MPa, extraction time for 3h, and 95% ethanol as co- solvents. The Ligustilide had a good linearty relationship between 5. 1～ 25. 5? g? mL- 1( r=0. 999 8) . CONCLUSIONS: This technique is easy, convenient and workable, and can provide theoretical support for production.

Objective To study the effects of community nursing interventions on stroke patients with attention disorders.Methods A total of 60 stroke patients fulfilling eligibility were divided randomly into two groups.Their data were collected between December 2010 and February 2012.The intervention group was treated by community nurses while the control group trained by family members.Attention was assessed by simple reaction time (SRT) and number cancellation test (NCT).Modified Barthel index was used to assess the activities of daily living (ADL).Both groups were evaluated before and after a 2-month intervention.Results Before treatment,the control group had(0.71 ± 0.25),(662.8 ± 152.7) and(31 ±8)scores at SRT,NCT and MBI respectively.And the intervention group yielded(0.69 ± 0.19),(652.7 ±131.0) and (30 ± 8)scores at SRT,NCT and MBI respectively.There were no significant differences in average value of SRT,NCT and MBI between training and control groups at pre-treatment (P ＞ 0.05).After 2 months,the control group had (0.68 ± 0.20),(637.4 ± 151.7) and (33 ± 8) scores at SRT,NCT and MBI respectively.And the intervention group yielded (0.56 ± 0.16),(540.3 ± 125.9) and(37 ± 8) scores at SRT,NCT and MBI respectively.Very significant difference existed in attention scale scores at Month 2 (P ＜ 0.01) and the difference in ADL scale scores was also significant (P ＜ 0.05).Conclusion For stroke patients with attention disorders,strengthening community nursing interventions may help to improve attention and boost activity of daily living.

A total of 60 brain injury patients with cognitive impairment were randomly divided into electro-acupuncture,computer and combination groups (n =20 each).The electro-acupuncture group received electroacupuncture,computer group cognitive rehabilitation training with specialized equipment and combination group both regimens.The treatment lasted for 2 months.Before training,Loewenstein occupational therapy cognitive assessment (LOTCA) test was not statistically significant among all groups (P 8 0.05).After 1 month,the combination group scored higher than pre-training (P ＜ 0.05).After 2 months,the scores of all groups were higher than pre-training(P ＜ 0.05).After 1 and 2-month training,the combination group scored higher than the other two groups in aspects of consciousness,optomotor tissue,attention,thinking and aggregate score (P ＜ 0.05).However,the orientation scores of all groups changed insignificantly after 1-month training (P 8 0.05),the combination group scored higher than the other two groups in improved orientation after 2 months (P ＜ 0.05).

Objective To assess the efficacy of postoperative adjuvant interferon (IFN) therapy on patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC).Methods An electronic search for articles published from January 2000 to January 2013 was conducted to identify English language comparative studies evaluating IFN therapy on recurrence and survival after surgical treatment of HCC.Results A total of five trials consisting of 694 patients were included in the Meta-analysis.The estimated odds ratios (OR) for the 1-,2-,3-,and 5-year overall survival rates of HBV-related HCC were 3.37 (95％CI:1.18-6.27,P=0.000),2.36 (95％ CI:1.45-3.83,P=0.001),1.81 (95％ CI:1.21-2.72,P=0.004),and 1.93 (95％ CI:1.35-2.75,P=0.000),respectively.The OR for the 1-,2-,3-,and 5-year recurrence rates were 0.63 (95％ CI:0.44-0.91,P=0.014),0.84 (95％ CI:0.60-1.18,P=0.322),0.88 (95％ CI:0.63-1.22,P=0.431),and 0.78 (95％ CI:0.56-1.07,P=0.120),respectively.Conclusion This Meta-analysis shows that IFN therapy had a significant clinical effect in improving overall survival rates but not in decreasing recurrence rates of HBV infected HCC patients postoperatively.

ObjectiveTostudy the value of color Doppler sonography in diagnosisof rhabdomyolysis.Methods The color Doppler sonography images of twenty-one patients with diagnosed rhabdomyolysis were retrospective analyzed.The pathological changes of the muscle were observed.Results The appearance of ultrasound was cloundness and rough-cast glass change in the diseased area of rhabdomyolysis.The diseased region can be found by ultrasound,and location and scope can be displayed clearly.There were major differences in the location of rhabdomyolysis because of etiological factor.The muscle volume and tension of rhabdomyolysis were increased for trauma,the individual patients will lead to the osteofascial compartment syndrome.There was no blood flow signal or little blood flow signal in the diseased area of rhabdomyolysis.Conclusions The color Doppler sonography is an efficient method for diagnosis of rhabdomyolysis.

Objective:To evaluate the short-term effect of robotic pancreaticoduodenectomy (RPD) and laparoscopic pancreaticoduodenectomy (LPD) in the treatment of ampullary and periampullary tumor systematically.Methods:A systematic search of the PubMed, Embase and Cochrane library database using the key words "pancreaticoduodenectomy, duodenopanreatectpmy, whipple, laparoscopic, robotic, Da Vinci" . A systematic search of the Sinomed, Wangfang, VIP and CNKI databases including the key words "胰十二指肠切除" , "腹腔镜" , "机器人" , "达芬奇" . To investigate the differences of the conversion rate of laparotomy, incidence of postoperative complications, and the postoperative hospital stay between the RPD group and the LPD group. The software RevMan5.3 was used in this meta-analysis.Results:A total of 4 retrospective cohort studies and 1 001 patients were included in this meta-analysis, including 451 patients in the RPD group and 550 patients in the LPD group. The results of the meta-analysis showed that there were significant differences between RPD group and LPD group for the conversion rate laparotomy ( OR=0.35, 95% CI: 0.24-0.50, P<0.05). There were no significant differences between RPD group and LPD group for the incidence rate of overall complication( OR=1.23, 95% CI: 0.95-1.58, P>0.05), hemorrhage ( OR=0.71, 95% CI: 0.50-1.00, P>0.05), pancreatic fistula ( OR=1.09, 95% CI: 0.80-1.49, P>0.05), delayed gastric empty ( OR=0.81, 95%CI: 0.57-1.14, P>0.05) and hospital stay after surgery ( WMD=-2.87, 95% CI: -1.44-1.70, P>0.05). Conclusions:RPD is as safe as LPD, with the same complication rate. Therefor it is worthy for further application in medical institutions with relevant conditions.

The high incidence of postoperative recurrence of hepatocellular carcinoma ( HCC) is a most difficult obstacle for improving the prognosis of patients.Several adjuvant modalities have been developed to prevent recurrence in patients after surgery; nevertheless , there is no consensus regarding the standardized adjuvant therapy in terms of indications , clinical efficacy and interactions.In this article we review the currently available evidence in the medical literature on adjuvant therapy in HCC after radical resection.

Objective To study the clinical value of high frequency ultrasonography in acute closed mallet finger.Methods The high frequency ultrasonographic images of thirty-six patients with diagnosed acute closed mallet finger were retrospective analyzed.The ultrasonographic features were analyzed.Results The position and internal structure of extensor tendon could be showed by high frequency ultrasound,the position and injury level of acute closed mallet finger were identified.In 36 patients of acute closed mallet finger,6 cases were complete tear combined avulsion fracture,the ultrasonography showed the disruption in the extensor tendon at the level of the distal interphalangeal joint,the hyperechoic fracture fragment were found in the distal end of extensor tendon.22 cases were complete tear and no avulsion fracture,the longitudinal imaging showed the disruption in the extensor tendon at the level of the distal interphalangeal joint and the retraction of the tendon end.8 cases were partial tear,the ultrasonography showed that extensor tendons were thickened and hypoechoic,the section of extensor tendons were still continuous.Conclusions High frequency ultrasonography is the preferred imaging method for diagnosis of acute closed mallet finger,it will be important value for clinical treatment method.

Objective To explore the therapeutic effect of lipid emulsion on acute organophosphorus poisoning and its consequence of acute lung injury. Methods A total of 48 sealant - grade Sprague-Dawley (SD) rats were randomly divided into four groups A,B,C,D,namely saline control group,lipid emulsion control group,the conventional therapy group and lipid emulsion administration group. After dichlorvos (DDVP) 11 mg/kg was given by intra-peritoneal injection,if there was no loss of DDVP during the injection process,the model of poisoning was considered to be made successfully.Then the rat models in four groups were respectively treated:with normal saline (5 ml/kg) intravenous injection in group A,lipid emulsion (5ml/kg) intravenous injection in group B,atropine (5 mg/kg) and pralidoxime chloride (40 mg/kg) intramuscular injection in group C,and combined use of lipid emulsion (5 ml/kg) with atropine and pralidoxime chloride in group D after administration of DDVP by intra-peritoneal injection.The activity of cholinesterase (CHE) in blood was detected before and 0.5 h,2 h and 4 h after DDVP poisoning. The clinical manifestations,the survival of rats,the wet weight of rat' s lung and the pathological changes of the lung tissue were observed within following 24 h. The rates of survival and symptoms of rats were compared between paired groups by using the x2 test,and the mean values of biomarkers were compared paired groups by using t test. Results In groups A and B,the intensity of muscular fasciculation and salivation were more severe and appeared sooner after DDVP exposure in comparison with groups C and D leading to lower survival rates in group A and B. Compared with group C,the rate of 24 h survival was higher and the intensity of muscular fasciculation was weaker in group D ( P ＜ 0.05 ).In group A and group B,the 24-hour survival rates were 1/12 and 2/12,respectively ( P ＜ 0.05 ).The levels of CHE in blood significantly decreased after DDVP poisoning ( P ＜ 0.05 ).There was no significant difference in activity of CHE between group B and group A,and in groups C and D,the levels of CHE in blood were not significantly higher than that in the group B 0.5 h after DDVP poisoning ( P ＜ O.05 ).In groups C and D,the activity of CHE in blood was significantly higher compared with group A and B,and that in group D was higher compared with C,and that in group B was higher compared with A 2 and 4 hours after DDVP poisoning ( P ＜ 0.05 ).In groups C and D,the wet weight of rat lung was significantly lighter compared with groups A and B,and that in group D was lighter compared with C,and that in group B was lighter compared with A 24 h after DDVP poisoning P ＜ 0.05 ).The electron microscopic findings showed the combined use of lipid emulsion with atropine and pralidoxime chloride obviously lessened the lung histopathologic changes after DDVP poisoning.Conclusions The lipid emulsion combined with atropine and pralidoxime chloride can be beneficial to controlling the toxic symptoms,reduce the death rate,accelerate the resume of the activity of CHE in blood,and relieve the lung injury induced by acute organophosphorus poisoning.