Epidural analgesia is the most effective form of pain relief available to labouring women.In this review,the author highlights the latest progress in the researches on the mechanism of epidural analgesia for labour,the choice of administration mode,the choice of local anaesthetics and opioids,and the impact of epidural analgesia on the parturient and fetus.

Objective To study the role of survivin in the incidence of pulmonary hypertension secondary to congenital heart disease (CHD) of left-to-right shunt. Methods Forty-nine cases were divided into 4 groups according to mean pulmonary artery pressure (mPAP), that is, non-hypertension group, mild hypertension group, medium hypertension group, and severe hypertension group. Their lung tissue samples were collected during heart surgery. TUNEL technique and immunohistochemical analysis were respectively used to detect nuclear DNA fragment of apoptotic cells and the expression of survivin, bcl-2 and bax. Western blotting also was conducted to detect survivin expression. Results The pulmonary wall of CHD patients with medium or severe pulmonary hypertension became significant incrassate. The apoptotic index and expression level of bax were significantly decreased but surviving and bcl-2 expressions were significantly increased in CHD with medium or severe pulmonary hypertension. Survivin expression was significant correlation with percentage media wall thickness and apoptotic index. Conclusion Apoptosis associated with survivin plays an important role in pulmonary artery remodeling after pulmonary hypertension of CHD.

Objective To discuss the clinical manifestations and imaging diagnostic value of tuberous sclerosis accompanied by multi-organ injuries.Methods 2 cases in our hospital and 27 cases of tuberous sclerosis from the published reports were collected.The clinical manifestations and imaging features as well as the extent and type of multi-organ lesion were analyzed.Results Among the 29 patients,17 were male and 12 were female.The averaged age was 16.8.The clinical manifestations included:with family history in 6 , epilepsies in 25 (15 with mental retardation),symmetric angiofibroma in the face in 22 (3 with similar changes in the else body surface),fibromas beneath toenail or fingernail in 4, hyperdactylia of thumb in 2 and abdominal masses in 7 (4 with hematuria), tuberous scleroses beneath ependymal layer in 27,17 patients with kidney diseases,9 involved liver,5 involved spleen.Conclusion Multiple organs can be involved by tuberous sclerosis.The calcification of ependymal lyer and harmatoma of kidney are the most valuable in imaging diagnosis of the disease.

Aim To investigate HPA axis change relation with glucose and lipid metabolism.Methods Wistar rats were injected intraperitoneally with STZ (30 mg·kg~(-1)) after fed with high lipid food for two months, then rats with blood glucose of over 15 mmol·L~(-1) were used in the experiment. Animals were divided into four groups: normal group, diabetic model group, treatment group (ROS 200 mg·kg~(-1) ·d~(-1) ig), and metformin group (200 mg·kg~(-1)·d~(-1) ig).Rats were decapitated after they had been administered ig for four weeks and were 24 hour urine collected.Plasma CRH, ACTH, corticosterone, hypothalamic CRH, ACTH of pituitary gland, 24 hour urinary corticosterone and plasma insulin were determined by ELISA and radio immunity kit respectively.Results In diabetic rat model induced by high lipid food and STZ, plasma and urinary glucose level and plasma TC, TG levels were increased, plasma HDL-C and hepatic glycogen content were reduced, which was synchronized with changes of higher pituitary ACTH, plasma and total 24 hour urine corticosterone excretion.Conclusion The disorder of glucose and lipid metabolism of model induced by high lipid food and low dose STZ may be linked to the change of HPA axis.The improvement of ROS on glucose and lipid metabolism in diabetic rats may be linked to the decrease of HPA axis activity.

Object The influence of producing area and plant age on oxymatrine levels in the dried root of Sophora flavescens Ait. has been investigated to provide useful information to optimize the areas for mass scale propagation, proper management and species conservation. Methods The oxymatrine was quantified by HPLC and various statistical treatments were carried out following SPSS 9.0 and Microsoft Excel. Results The oxymatrine concentrations in the root samples collected from 17 provinces and regions differed from 0.494% to 4.127% and the maximum oxymatrine content (3.493%) was recorded in the root sample collected from Heilongjiang Province. Analysis of variance indicates a highly significant difference in the oxymatrine content of roots collected from different provinces, and the samples from the cold arid northern high-latitude areas had higher oxymatrine than those from warm humid southern low-latitude areas in the mainland China. Plant age is positively related to the total root biomass and oxymatrine content. Conclusion The oxymatrine content in the roots of S. flavescens is quite different between different areas and plant ages. The S. flavescens growing in the cold arid northern high-latitude areas had higher oxymatrine concentration.

Objective To review and summarize the effects of interventional treatment of hand arteriovenous malformation in 5 cases.Methods Through catheterization of brachial artery ipsilaterally the blood-supply artery of arteriovenous malformation was embolized,using high-temperaure managed gelatin sponge,silk thread,pingyangmycine and spring coil.Results Total 13 blood-supply arteries in 5 cases were embolized with successful rate of 100%,including 1 case of complex malformation under effectively controlled,3 cases cured clinically and 1 case still awaiting observation.Conclusions Transcatheter arterial embolization for the treatment of hand arteriovenous malformation is safe,effective and high successful.(J Intervent Radiol,2007,16:277-279)

0.05)was found in the2groups.The costs of the2groups were1059.73yuan(RMB)?2304.26yuan(RMB)respectively;the cost-effectiveness ratios of the2groups were11.62?25.70respectively;the total cost in the course of treatment for the pantoprazole group was1244.53yuan(RMB)less than the omeprazole group.In the sensitivity analysis,the cost-effectiveness ratios of the2groups were10.51?23.22respectively.CONCLUSION:Pantoprazole is an economical and effective drug for the prevention of stress ulcer in ICU patients.

Objective To provide useful suggestion for the prevention and treatment of osteoporosis by analyzing the density of the lumbar vertibra of normal Uygar and Han people in Xinjiang.Methods Normal Uygar males were 104,Uygar females were 85, Han males were 230,Han females were 182,the age ranged from 20 to 69 and was divided into five groups.Cann-Genant method was adopted to make human skeleton model,by which the density of bone was worked out.Results (1)The bone density was obviously negatively interrelated to age (?

Objective To investigate the energy expenditure of mechanically ventilated patients,compare the measured energy expenditure (MREE) with the energy expenditure expected from the Harris-Benedict equation adjusted with correction factors (PREE). Methods Twenty-four critically ill adult patients who were mechanically ventilated in the intensive care unit were enrolled in this study. Data during the 72 hours of mechanical ventilation were collected for computation of severity of illness. Resting energy expenditures were derived at 72hours after mechanical ventilation by indirect calorimetry. Predicted basal energy expenditure was obtained at the same time using the Harris-Benedict equation and predicted resting energy expenditure was calculated using the Harris-Benedict value adjusted with correction factors for illness. Results The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ)scores and Marshall scores were 14 ± 5 and 6 ± 3, respectively. MREE and PREE were (6 793.64 ± 1 197.15) and (8 041.02 ± 1 971.54) kJ/day, respectively. There was no correlation between MREE and PREE (r2 = 0. 28, P = 0. 07), and the difference between MREE and PREE was statistically significant (t = 7.62, P = 0.04). No statistically significant correlations were observed between both MREE or PREE and APACHE Ⅱ score or Marshall score (r2 = 0. 14, P = 0. 08; r2= 0. 08, P = 0. 63; r2 = 0. 05, P =0. 65; r2 = 0.03, P = 0. 87, respectively). Conclusions In mechanically ventilated patients, the energy expenditure is not correlated with the severity of illness. The Harris-Benedict prediction modified with correction factors for severity of illness systematically overestimates the total energy expenditure.

event and treat circular,respiratory and renal insufficiency.