Objective To investigate the effect and side effects of flurbiprofen axetil combined with fentanyl in postoperative patient-controlled analgesia (PCA) after craniotomy.Methods 60 patients undergoing scheduled craniotomy were randomly divided into the treatment group and control group with 30 cases in each group, and received flurbiprofen axetil combined with fentanyl and only fentanyl respectively in PCA after craniotomy. The visual analogue scale (VAS), sedation score (SS) and the side effects were evaluated in 24 h after craniotomy.Results There was no significant difference in VAS between the two groups ( P>0.05). The SS, side effects such as nausea and vomiting in the treatment group were significantly less than that in the control group ( P<0.05).Conclusion Flurbiprofen axetil combined with fentanyl in PCA can reduce the side effects of fentanyl and offers overall favorable analgesic responses.

Objective To evaluate the clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and pcrcutaneous transhcpatic insertion of biliary stent (PTIBS) for malignant biliary obstruction.Methods PTBD or PTIBS were performed in 56 patients with malignant biliary obstruction, which were aused by hepatic carcinoma (n = 14), biliary duct carcinoma (n = 11), gallbladder carcinoma (n = 5),stomach carcinoma accompanied with metastasis of lymph node (n = 14), carcinoma of ampulla (n = 1 ) or carcinoma of pancreatic head (n = 11 ). The diagnosis was confirmed by ultrasonography, CT or MRI in all patients. The obstructed site was well identified, including high obstruction in 19 patients and lower obstruction in 37 patients. Based on the imaging findings, suitable interventional procedure was employed.Results PTBD or PTIBS were performed successfully in all 56 patients, of them PTBD was adopted in 11,PTIBS in 40 and both PTBD and PTIBS in 5. The serum total bilirubin decreased from (295.65±152.86)μmol/L before the procedure to (151.05 ± 107.36) μmol/L after the procedure, (P < 0.01 ). Postoperative infection could affect the fading of jaundice (P < 0.01 ), but the location of the obstruction carried no relationship with the fading of jaundice (P = 0.063). Conclusion Both PTBD and PTIBS are safe and effective palliative therapies for malignant biliary obstruction, which can markedly relieve patient of jaundice,improve the quality of life and elongate the survival period.

Animals ; Arginine ; pharmacology ; Blood Pressure ; drug effects ; Hypertension ; etiology ; metabolism ; physiopathology ; Male ; Oxidative Stress ; drug effects ; Rats ; Rats, Sprague-Dawley

Objective To investigate the brain magnetic resonance imaging (MRI) features and clinical manifesta-tions of the patients with citrullinemia, and to promote awareness of, early diagnosis of and better treatment for the disease.Methods One case with citrullinemia was reported, and other eight cases reported in the literature in nearly 14 years were reviewed.Results The case was a 15-month-old girl with type I citrullinemia diagnosed by the mutation analysis of the ASS1 gene performed in local hospital after birth. The patient was admitted to our hospital for recurrent lethargy for a year and the high level of blood ammonia (311 μmol/L, normal range 9-33 μmol/L). The blood ammonia reduced to normal on the 11th day after arginine treatment. On MRI scans, the diffusion weighted imaging (DWI) showed diffuse hyperintensity on bilateral frontal, parietal and temporal cortex, which indicated restricted diffusion due to cytotoxic edema. On the follow-up MRI after 10 day's treatment, the affected regions was similar but the intensity decreased compared to the previous scan,which accompanied by cere-bral atrophy. Eight cases in the literature were reviewed, and the clinical manifestations in these patients were lack of speciifcity, the most common features included feeding dififculties, lethargy, and vomiting. Brain MRI was performed on 7 cases, computed tomography (CT) was performed on 1 case, with the result of cytotoxic edema in 3 cases and atrophy in 2 cases.Conclusions Citrullinemia often lacks of speciifc symptoms in the early phase. Brain MRI could provide the clinician a valuable help for early diagnosis and treatment of this disease.

Objective To investigate the correlation between the D-dimer level and the acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods The changes of D-dimer levels in 156 patients (AECOPD group) before and after treatment were measured and compared with the D-dimer levels of 156 healthy subjects(control group).Results The concentration of plasma D-dimer in the AECOPD group was (1.35 ± 1.46) mg/L,which was significantly higher than (0.25 ± 0.16)mg/L in the control group,and the difference was statistically significant(t =9.354,P ＜0.05).The level of plasma D-dimer in the AECOPD group was (0.69 ± 0.87)mg/L,and compared with (1.35 ± 1.46)mg/L before treatment,the difference was statistically significant(t =4.850,P ＜ 0.05).Conclusion D-dimer level is correlated to the condition of patients with chronic obstructive pulmonary disease,it can be used as one of the indicators to diagnose whether a patient is in hypercoagnlable state or suffers thrombotic diseases.

OBJECTIVE: To investigate the expression of hyperpolarization-activated cyclic nucleotide-gated cation channel 4 (HCN4) and connexin43 (Cx43) in the sinoatrial node of electric shock death. METHODS: As experimental group, 34 cases of electric shock death who had definite current mark evidence were selected from pathology department of Xuzhou Medical College from 2010 to 2013. As the control group, 20 cases of fatal severe craniocerebral injury in traffic accidents were chosen. The expressions of HCN4 and Cx43 in the sinoatrial node were observed by immunohistochemical technology. RESULTS: HCN4 positive cells expressed in the cell membrane and cytoplasm of the sinoatrial node. Cx43 positive cells expressed in the cell membrane and cytoplasm of T cells and myocardial cells. The expression of HCN4 was significantly higher than that of the control group (P < 0.05) and the expression of Cx43 was significantly lower than that of the control group (P < 0.05). CONCLUSION The changes of HCN4 and Cx43 expressions in the sinoatrial node illustrate electric shock death might be related to the abnormalities of cardiac electrophysiology and conduction.
Connexin 43/metabolism* ; Cyclic Nucleotide-Gated Cation Channels ; Heart Rate ; Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels/metabolism* ; Immunohistochemistry/methods* ; Myocardium/metabolism* ; Myocytes, Cardiac ; Sinoatrial Node/physiopathology*

Objective To explore a new model of medical humanity education in new situation. Methods Extensive survey was carried out among medical students,and discussion and consultation were hold to faculty and education administers.A new teaching model was established. Results A curriculum system with 1 or 2 core courses supported by some elective courses and social practice is under the process of implementation and achieved preliminary success.Conclusion The medical humanity education should pay attention to the development of connotation instead of pursuing the extension of quantity blindly,which means that students' school work must be eased by focusing on self-study and self-education.Medical students'life path with high-minded personality training should be strengthened.

Background:Resistance of Helicobacter pylori(Hp)to antibiotics is the primary reason for failure of Hp eradication therapies. It has been reported that there are regional differences in the resistance rate of Hp to commonly used antibiotics. Monitoring the regional Hp resistance status is helpful for improving the eradication rate in local area. Aims:To investigate the resistant spectrum of clinical Hp strains to commonly used antibiotics in Jiaxing Area,Zhejiang Province. Methods:A total of 17 402 patients who underwent gastroscopy from Jan. 2009 to Dec. 2013 at Jiaxing First Hospital were recruited for Hp culturing by using gastric antral biopsies. Then a drug sensitive test was performed for the Hp strains obtained from the culturing. Sensitivity of these Hp strains to metronidazole,amoxicillin,gentamicin,furazolidone,clarithromycin and levofloxacin was determined. Results:Among the 17 402 cases of gastric antral biopsies,5 898(33. 9% )were positive for Hp culturing. Drug sensitive test revealed that the resistance rate of metronidazole was extremely high in all year and age groups;the resistance rates of clarithromycin and levofloxacin were increasing by years;and the resistance rates of furazolidone,amoxicillin and gentamicin were considerably low in all year and age groups. When two antibiotics were combined,amoxicillin and gentamicin accounted for the lowest resistance rate,and the next were amoxicillin and furazolidone,and gentamicin and furazolidone,respectively. Conclusions:The clinical Hp strains isolated from all age groups in Jiaxing Area,Zhejiang Province are highly resistant to metronidazole,therefore it is not recommended to be used in first line eradication regimen. Amoxicillin combined with gentamicin/ furazolidone is an ideal antibiotic combination for patients with Hp infection in all age groups;and combination of gentamicin and furazolidone is recommended to patients who are allergic to penicillin.

A new method for the rapid determination of total phthalates (PAEs) in edible oils was developed. The PAEs in edible oils all were hydrolyzed to phthalic acid with tetrabutylammonium chloride (TBAC) as catalyst. Then phthalic acid was extracted by the supramolecular solvent ( SUPRAS) made up of octanol, tetrahydrofuran and aqueous solution, and detected by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS / MS). As a result, hydrolysis time was 10 min. The linear range of phthalic acid was 0. 05- 2. 0 mg / L with a good correlation coefficients ( r > 0. 999). The limits of detection ( LOD) and quantification (LOQ) were 5. 41 and 18. 05 μg / kg, respectively. The recoveries of target analyte at three spiked levels were in the range of 84. 6% - 104. 5% . The repeatability, expressed as relative standard deviation (RSD), was 2. 6% for intra-day and 3. 7% for inter-day. The total PAEs content of 12 edible oils was found in the range of 0. 30-1. 09 mg / kg.

Objective To explore the brain changes of electroacupuncturing (EA) different acupoints of peripheral facial paralysis (PFP) with functional magnetic resonance imaging (fMRI). Methods Eighteen patients with left PFP were randomly divided into three groups. Six of them received electroacupuncturing left Dicang, 6 received electroacupuncturing left Hegu, and 6 received electroacupuncturing left Houxi. fMRI data were obtained from scanning of the whole brain. Functional data were processed by SPM99 software and functional responses were established with t-test analysis (P<0.05). Results Electroacupuncturing Dicang and Hegu on the left induced decreasing of signal in bilateral middle frontal gyrus, left cingulate gyrus, signal increased of right precentral gyrus, bilateral postcentral gyrus, left superior temporal gyrus and right insular, while electroacupuncturing Houxi on the left induced decrease of signal in bilateral inferior frontal gyrus, left lentiform nucleus, right middle temporal gyrus, right cerebellar tonsil, signal increased of right caudate head, right cingulate gyrus, brainstem, cerebellar vermis and right parahippocampal gyrus. Conclusion Electroacupunctuing Hegu and Dicang can cause corresponding functional activation in cerebrum, while electroacupuncturing Houxi can not, suggesting that there is association between cerebral and acupoint of owned meridian.