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 compare the clinical characteristics and the outcomes of severe hyperlipidemic pancreatitis (SHLP) and severe acute gallstone pancreatitis (SAGP).Methods The clinical data of 22 patients with SHLP and 91 patients with SAGP admitted from January 2009 to December 2015 were retrospectively reviewed.The clinical manifestations,laboratory tests,organ dysfunction,medical treatment,complications and outcomes in 30 d after admission were analyzed and compared between two groups of patients.Results There were 16 males and 6 females with a mean age of (60.5 ± 9.1) years in SHLP group;while 32 males and 59 females with a mean age of (54.3 ± 5.4) years in SAGP group.The blood and urine amylase levels in SHLP group were significantly lower than those in SAGP group [(715 ±99) U/L vs.(1 551 ± 107) U/L,t =4.65,P =0.00;(382 ±56) U/L vs.(773 ± 66) U/L,t =4.52,P =0.00,respectively].The incidence of circulation insufficiency,respiratory insufficiency,renal dysfunction,and long-term puhnonary infection in SHAP patients was significantly higher than that in SAGP patients [36 ％ (8/22) vs.14 ％ (13/91),x2 =5.22,P =0.01;41％ (9/22) vs.7 ％ (6/91),x2 =9.46,P =0.01;23％(51/22) vs.5％ (5/91),x2 =4.20,P=0.03;55％(12/22) vs.32％ (29/91),x2 =7.02,P =0.01].Two cases died in the SHLP group and 9 cases died in SAGP group due to critical infection,cardiac events and bleeding.Conclusion Compared to SAGP patients,the blood and urine amylase levels are usually not remarkably high in SHLP patients,and the prevention and management of multi-organ failure and lung infection are more important for SHLP patients.

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.

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 (?

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.

To explore the necessity of teaching of elective course:Flow Cytometry and its application to clinical medicine in medical students,sixty nine medical students including sevenyear program undergraduate,master and Ph.D candidates were surveyed with a community questionnaire. More than 95% students thought it was very necessary to set up the course because they knew little about the course and it would be very helpful in their future clinical and research work.

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.

Objective To summarize clinical characteristics and experiences in treatment of severe hyperlipidemic pancreatitis (SHLP). Methods A retrospective analysis for 22 cases of SHLP and 91 cases of severe acute biliary pancreatitis (SABP) hospitalized during January 1, 2000 to December 31, 2006 was carried out to compare their clinical characteristics and treatment outcomes. Results Activities of serum and urine amylase in SHLP patients at admission were (715 ± 99) and (382 ± 56) U/L, respectively, significantly lower than those in SABP patients (1551 ± 107) and (773 ± 66) U/L, respectively (P < 0.01). About 55% (12/22) of SHLP patients had pulmonary infection, 36% (8/22) with circulatory failure, 41% (9/22) with respiratory failure and 23 % (5/22) with renal failure, all significantly higher than those in SABP patients SABP [32% (29/91), 14% (13/91), 7% (6/91) and 5% (5/91), respectively, P < 0.01]. Two died of SHLP and 11 of SABP, respectively. Conclusions In diagnosis of SHLP, it should be noticed that no remarkable elevation of activities in serum and urine amylase usually, so during the course of treatment for SHLP, it is important to prevent and treat multi-organ failure, respiratory failure and renal failure in an active way.

event and treat circular,respiratory and renal insufficiency.