Background and purpose:It is important to control acute pain after gynecological oncologic surgery effectively.This study was to compare the clinical effects of butorphanol and flurbiprofen axetil(FA) combined with sufentanil on patient controlled intravenous analgesia(PCIA) after surgery.Methods:Forty ASA Ⅰ-Ⅱ patients scheduled for elective gynecological oncologic surgery under general anesthesia were randomly divided into two groups of twenty each,butorphanol group(Group B) and flurbiprofen axetil(FA) combined with sufentanil group(Group FS).After induction Group B received a loading dose of butorphanol 1 mg,and Group FS received that of FA 50 mg.Before the operation was over,Group B received intravenous infusion of butorphanol 13 mg in 100 mL saline,whereas Group FS received that of FA 150 mg combined with sufentanil 200 ?g in 100 mL saline.In the postoperative period,visual analogue scale(VAS),Ramsay sedative scores and side effects were recorded at 6,12,24 and 48 h.Results:There were not any signifi cant differences in VAS and the demanding times for supplemental bolus between the two groups.All VAS were below 4.Ramsay sedative scores of Group B before 12 h were signifi cantly higher than those in group FS(P0.05).The incidence of nausea and vomiting in Group FS was signif icantly higher than that in Group B(P

OBJECTIVE:To investigate the improvement effects of andrographolide dripping pills combined with Danxi yup-ingfeng granules on immunologic function of children with allergic rhinitis(AR). METHODS:Two hundred and eight AR children were randomly divided into control group,observation groupⅠ,observation groupⅡ,observation groupⅢ,with 52 cases in each group. Control group was given Loratadine syrup 10 mL,qd;observation groupⅠwas given Danxi yupingfeng granules 15 g,bid+Andrographolide dripping pills 0.6 g,tid;observation groupⅡwas given constant dose of Andrographolide dripping pills;observa-tion groupⅢwas given constant dose of Danxi yupingfeng granules. Four groups were treated for 2 weeks. 2 weeks later,they were given Loratadine syrup orally if the symptom appeared again. The levels of IgE and Th1/Th2 were compared among 4 groups be-fore treatment,1,2 weeks after treatment,3 months after the end of treatment. The children receiving Loratadine syrup orally due to the recurrence of AR 3 months after the end of treatment were observed. RESULTS:Before treatment,there was no statistical significance in serum levels of IgE and Th1/Th2 among groups(P>0.05). One week after treatment,serum levels of IgE and Th1/Th2 were improved significantly,with statistical significance (P<0.05);but there was no statistical significance among 4 groups (P>0.05). 2 weeks after treatment,serum levels of IgE and Th1/Th2 were improved significantly,and the observation groups were significantly better than the control group,with statistical significance(P<0.05). Three months afterthe end of treatment,serum lev-els of IgE and Th1/Th2 in observation group were improved significantly and better than control group,with statistical significance (P<0.05);there was no statistical significance in control group,compared to before treatment(P>0.05). The recurrence rate of ob-servation groupⅠwas significantly lower than that of observation groupⅡ,observation group Ⅲ and control group,with statistical significance(P<0.05). No obvious ADR was found in 4 groups. CONCLUSIONS:Andrographolidume dripping pills combined with Danxi yupingfeng granules can effectively improve immunologic function of AR children and reduce recurrence rate with good safety.

ObjectiveTo investigate the therapeutic effect of Xiaoqinglong decoction for supplementary treatment of patients with ventilator-associated pneumonia (VAP).Methods Thirty-three VAP patients with syndrome of traditional Chinese medicine (TCM) as interior retention of phlegm and exopathic cold admitted to Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine (TCM) from July 2011 to December 2014 were enrolled, and their historical data were retrospectively analyzed. According to the difference in treatment methods, the patients were divided into TCM treatment Xiaoqinglong decoction group (observation group, 18 cases) and general treatment group (control group, 15 cases). The patients in both groups were given conventional western medicine treatment, including anti-infection, phlegm elimination and cough relieve, protection of gastric mucosa and organ function, nutritional support, prevention of bedsore and thrombosis, etc. Additionally, the patients in TCM treatment group were given Xiaoqinglong decoction (drug composition: herba ephedrae 15 g, ramulus cinnamomi 15 g, herba asari 15 g, rhizoma zingiberis 15 g, chinese peony 15 g, rhizoma pinelliae 15 g, fructus schisandrae 15 g, radix glycyrrhizae preparata 10 g) for nasal feeding, once 150 mL, twice a day, once every 7 days. The changes in body temperature were observed before and 3 days and 7 days after treatment, and peripheral blood was collected for determination of white blood cell count (WBC) and C-reactive protein (CRP) level in the two groups. Comprehensive therapeutic effects of the patients in both groups were recorded.Results There were no significant differences in body temperature, WBC and CRP before treatment between the two groups. After treatment, the above parameters in both groups were significantly lower than those before treatment, and they showed a decrease tendency with time prolongation. The decrease in body temperature and WBC in observation group was more obvious than those of control group, and the comparisons showed statistical significant differences on 7 days after treatment [body temperature (℃): 36.5±0.6 vs. 37.0±0.8, WBC (×109/L):6.7±3.0 vs. 8.9±2.5, bothP < 0.05], but there was no significant difference in CRP between the observation group and control group (mg/L: 3 d was 73.7±20.5 vs. 61.5±18.4; 7 d was 27.2±10.5 vs. 23.5±9.1, bothP > 0.05). The total effective rate on the 7th day after treatment in observation group was higher than that of control group [83.3% (15/18) vs. 80.0% (12/15)], but no statistical significant difference was seen (P > 0.05).Conclusions The Xiaoqinglong decoction can reduce the inflammatory reaction of patients with VAP, and improve their symptoms.

Objective To explore the clinical effects of S-1 single agent chemotherapy for the patients undergoing radical resection of cholangiocarcinoma.Methods The clinical data of 51 patients receiving radical resection of cholangiocarcinoma who were admitted to the Second Affiliated Hospital of Zhejiang University from November 2011 to December 2013 were retrospectively analyzed.After radical resection of cholangiocarcinoma,25 patients receiving non-special treatment and 26 patients receiving S-1 single agent chemotherapy were divided into the operation group and chemotherapy group,respectively.S-1 was taken orally twice per day.Forty mg/once of S-1 was applied to patients with the body surface area ＜ 1.25 m2,50 mg/once of S-1 was applied to patients with the body surface area ≥ 1.25 m2 and ＜ 1.50 m2,and 60 mg/once of S-1 was applied to patients with the body surface area ≥ 1.50 m2.The 14 days usage and 7 days withdrawal of S-1 were used as one course of treatment.The standard usage of S-1 was 6-8 courses of treatment.All the patients were followed up by outpatient examination and telephone interview till December 1,2014.Count data were analyzed using the chi-square test.Measurement data with normal distribution were presented as (x) ± s and analyzed using the t test.Survival curve was drawn by the Kaplan-Meier method,and survival analysis was done using the Log-rank test.Results Twenty-six patients in the chemotherapy group finished the courses of chemotherapy without chemotherapy-related death,and 14 patients had chemotherapy adverse reactions with remission after discontinuation of S-1.All the 51 patients were followed up for 5-37 months with a median time of 19 months.The median overall survival time,1-,3-year overall survival rates,tumor-free median survival time and 1-,3-year tumor-free survival rates were 22 months (range,18-27 months),72.3％,42.9％,21 months (range,16-26 months),60.0％,55.0％ in the operation group and 32 months (range,29-35 months),84.6％,44.4％,26 months (range,21-31 months),76.9％,61.9％ in the chemotherapy group,respectively.There was a significant difference in the overall survival between the 2 groups (x2=6.032,P ＜ 0.05).There was no significant difference in the tumor-free survival between the 2 groups (x2=0.498,P ＞ 0.05).Conclusion S-1 single agent chemotherapy after radical resection of cholangiocarcinoma could improve the survival of patients,while no obvious advantages of inhibiting tumor recurrence is observed.

Objective To evaluate the clinical value and efficacy of transcatheter preoperative superselective arterial embolization in sacral or ilium tumors.Methods The procedures of superselective arterial embolization with gelfoam were performed in 15 cases. The lesions included giant cell tumor of bone (n = 5) , aneurysmal bone cyst (n = 2) ,chordoma (n = 2) , metastatic tumor (n = 4)and chondrosarcoma (n = 3) . The operations of resection were done 1 to 5 days after superselective arterial embolization.Results Angiograms showed marked reduction (80% or more) of the tumor's staining after embolization. In this series ,the average blood loss was 1100 ml ,during operations(aranged from 500 ml to 2600 ml),and all tumors were completely resected.Conclusion Preoperative transcatheter selective arterial embolization is an effective and safe method in reducing blood loss during operations and improving therapeutic effect for sacroiliac tumors.

ObjectiveTo investigate the effect of jin’s three-needle scalp electroacupuncture on Cyt-c and Caspase-3 expressions in the cerebral cortex in Intrauterine distress-induced HIBD rats and reveal the mechanism of its protective action on the brain. MethodThe abdomen was incised in a female SD rat at 21 days of pregnancy. Bilateral uterine horn blood vessels were tightly clamped with a hemostat for five minutes. An infant rat was then taken out by a cesarean section. A rat model of hypoxic-ischemic brain damage was confirmed by the use of a behavior test and braintissue sections. The rats were randomized into model and acupuncture groups. The model group was not needled. Acupuncture groups 1, 2, 3 and 4 began to be needled at 3, 5, 7 and 14 days after birth, respectively. Acupuncture treatment was given for seven consecutive days. The normal control group was naturally delivered, not used to make a model and not needled. All groups of rats were decapitated to take the brain tissue at 21 daysafter birth. Cyt-c and Caspase-3 expressions in the cerebral cortex were detected.ResultCyt-c optical density value decreased somewhat in the four acupuncture groups; there was a statistically significant difference between acupuncture group 1 or 2 and the modelgroup (P<0.05). Caspase-3 expression was significantly down-regulated in acupuncture group 1; there was a statistically significant difference compared with the model group (P<0.05).ConclusionThe protective effect of acupuncture beginning at 3 days after birthon the brain is related to the down-regulation of Cyt-c and Caspase-3 expressions in intrauterine distress-induced HIBD rats.

Objective To establish a numerical model of the shear module of alginate beads stimulated by ultrasonic sound.Methods The compression ratio and force of alginate beads were recorded with the compression test .The shear module of beads was measured with a Hertz model .When to alginate beads were stimulated ultrasonically for different durations , the ultrasonic stimulation power , ultrasonic pulse ratio , and changes in the shear module and solution temperature were measured.Results Temperatures in the solution and shear module of alginate beads increased under different ultrasonic stimulation conditions .Modeling analysis revealed the relationship between the shear module of alginate beads and the corresponding temperature .The shear module of beads was in a quadratic equation with temperature (20℃

Objective:To compare the dose distribution among CyberKnife, Tomotherapy, Edge, Triology and γ-knife in stereotactic body radiation therapy (SBRT) for pancreatic cancer.Methods:Clinical data of 10 panreatic cancer patients receiving CyberKinife treatment were retrospectively analyzed. The treatment plans were designed by five apparatuses from five centers according to the uniform requirement. All plans were transferred to MIM system for the extraction of parameters, which mainly included D min, D mean and D max of PTV, conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI), coverage, D max and dose-volume of the stomach and bowel. Results:The best CI and nCI were obtained in Triology ( P<0.001), and the worst HI was found in γ-knife ( P<0.001). The best GI was found in CyberKnife, followed by γ-knife and Tomotherapy, and Edge showed the worst GI ( P<0.001). The highest D min of PTV was found in both Edge and Triology, while lower D min of PTV was found in CyberKnife and Tomotherapy ( P<0.001). Additionally, γ-knife provided the highest D mean and D max of PTV ( P<0.001). Regarding the organs at risk, the lowest D max and D 5cm 3 of the bowel ( P<0.001), D max of the stomach ( P=0.003), D max( P=0.001), D 5cm 3 ( P<0.001) and D 10cm 3 ( P=0.005) of the duodenum, D max( P<0.001) and D 0.35cm 3 ( P<0.001) of the spinal cord were found in CyberKnife. The highest D max of the bowel was found in γ-knife. Furthermore, the highest D 5cm 3 of the duodenum was demonstrated in Edge ( P<0.001) and Tomotherapy provided the highest D max( P<0.001) and D 0.35cm 3 of the spinal cord ( P<0.001). Conclusions:All five radiotherapy apparatuses can meet the requirement of SBRT for pancreatic cancer. More rapid dose fall-off could be obtained via CyberKnife and γ-knife. Triology and Edge provide better target conformity. CyberKnife can better protect the gastrointestinal tract.

Objective: To analyze the risk factors of high-risk pregnancy, the change factor conversion rate and pregnancy outcomes, summarize the experience of high-risk pregnancy management, make it rationalized and standardized, improve the health of pregnant women and perinatal children, and guarantee the safety of mother and baby. Methods: The 6 472 pregnant women who were admitted to the hospital from January 2016 to March 2017 were screened for high-risk factors according to the relevant management methods and implementation rules of high-risk pregnancies, and systematic management of high-risk pregnant women was conducted. Results: Among 6 472 pregnant women, 1 610 pregnant women were high-risk pregnancies, and the incidence rate was 24.88%. Three or more high-risk factors accounted for 163 cases (10.12%), two high risk factors accounted for 391 (24.29%) , one risk factors accounted for 1056 cases (65.59%). The top five risk factors were abortion history, age, gestationathe or mild pre-eclampsia, preterm prematurity, and premature rupture of fetal membranes at more than 34 weeks. Among pregnant women with high risk, 249 cases (11.29%) were between 19 and 25 years old; 441 cases (18.27%) of 26-30 years old; 536 cases (36.49%) of 31-34 years old; 384 cases (100.00%) of the 35-year old. The incidence of high-risk pregnancy was closely related to age, and the incidence of high-risk pregnancy was 100% in patients over 35 years old, with the increase of age. The risk factors of hypertension, preterm birth, endocrine disease and prenatal hemorrhage could be change normal rates were 32.77% (58/177), 83.21% (109/131), 46.88% (45/96) and 83.13% (69/83) respectively. The age group with the highest cesarean section rate was ≥35 years old. The c-section rate gradually decreased with age. The age group with the highest vaginal assist rate was 31-34 years old high-risk pregnant women without obviously differences between groups; the highest perinatal mortality rate was ≥35 years old (P <0.05). The risk of eclampsia, puerperal infection and postpartum hemorrhage was significantly higher in maternal ≥35 years old than in other age groups (P <0.05). Conclusions There are many influencing factors of high risk pregnancy, screening, identification and management of the influence factors, attention to health education, to promote the hospital management and community management cooperation, strengthen the management of high-risk pregnancies, helps to reduce the risk of maternal severe adverse pregnancy outcomes, and improve maternal and infant prognosis.

Objective To explore the effect of warming yang for diuresis method combined with blood purification on the clinical therapeutic effect of patients with acute renocardiac syndrome (ARCS).Methods Sixty ARCS patients admitted to the Department of Intensive Care Unit (ICU) of Affiliated Hospital of Tianjin Institute of Chinese Medicine from May 2013 to October 2016 were enrolled, they were divided into an observation group and a control group by random number table, 30 cases in each group, one case died of multiple organ failure due to aggravation of infection, thus the actual observation number was 29 patients in the control group. The continuous vein-vein hemofiltration (CVVH) was applied in the two groups, 6-13 hours each time, and according to the disease situation, the continuous ultrafiltration time was determined, generally about 3-7 days; the observation group was additionally treated with warming yang for diuresis oral herbal decoction, 1 dose daily, 2 times a day, once 100 mL orally taken. The changes of cardiac and renal function indexes, traditional Chinese medicine (TCM) syndrome score and clinical efficacy were observed before and after treatment in the two groups.Results After treatment, the heart and renal function indexes were significantly improved, serum creatinine (SCr), urea nitrogen (BUN), N-terminal pro-brain nitric peptide (NT-proBNP) were all significantly lower than those before treatment in both groups, glomerular filtration rate (GFR), urine output, left ventricular ejection fraction (LVEF), cardiac output index (CI) were all significantly higher than those before treatment in both group; 7 days after treatment, BUN was significantly lower in observation group than that in control group (mmol/L:10.38±1.02 vs. 13.68±2.67), GFR, urine output, CI were significantly higher in observation group than those in control group [GFR (mL/min): 62.02±4.47 vs. 52.95±1. 92, urine output (mL/24 h): 875.41±44.26 vs. 537.82±79.65, CI (L·min-1·m-2): 3.12±0.51 vs. 3.07±0.17, allP < 0.05]; the effective rate of TCM syndrome score and clinical efficacy were significantly higher in observation group than those in control group [total effective rate of TCM syndrome score: 80.0% (24/30) vs. 55.17% (16/29), total effective rate: 93.33% (28/30) vs. 72.41% (21/29), both P < 0.05].Conclusions The warming yang for diuresis TCM decoction intake combined with CVVH can improve the cardiac and renal functions and clinical symptoms, and increase urine output for patients with ARCS.