Spinal opioids have been widely used in clinical anesthesia and analgesia. In this article, we reviews the characteristics about the clinical applications of spinal opioids, including the opioid selection, drug dosage, administration route, effects of different opioids, drug combination, associated adverse effects and so on.

Objective: To investigate the expression and distribution of G protein and protein kinase C (PKC) under the mechanical pressure in rabbit mandibular condylar chondrocytes (MCCs) and to study the role of G protein in PKC signalling pathway. Methods:MCCs from two-week-old New Zealand rabbits were cultured. After treatment under continuous pressure of 90 kPa for 60 min or 360 min by hydraulic pressure controlled cellular strain unit, the expression of G?q/11 protein was examined by Western Blot. The expression and distribution of PKC was observed by immunocytochemical staining. Results:Gaq/11 protein in MCCs treated by 90 kPa for 60 min and 360 min was increased by 163.7% and 65.8% respectively(P0.05). PKC in control cells distributed uniformly in the cytoplasm. After been pressed under 90 kPa for 60 min,PKC translocated to the membrane and, partly,into nuclei. When the pressure prolonged to 360 min, PKC distributed uniformly again in cytoplasm. By treatment of G protein inhibitor, the translocation of PKC under 90 kPa of 60 min was not observed. Conclusion:Feasible pressure may promote G protein expression and activate PKC. The activation of PKC signalling pathway is mediated by G protein.

Objective To evaluate the applicative value of fiberoptic ductoscopy(FDS)in abnormal nipple discharge.Methods A total of 104 patients with nipple discharge were examined by fiberoptic ductoscopy(Germany Scholly Fiberoptic Gmbh 42.0500).The results were compared with postoperative pathological diagnosis.Results All the 104 cases were successfully diagnosed with FDS.The detectable rate for intraductal mass by ductoscopy is 94 %(49/52).The sensitivity and specificity of ductoscopy for mammary duct cancer is 50%(1/2)and 91%(43/47)respectively;the negative predictive value is 98%(43/44),positive predictive value is 20%(1/5),and accuracy is 90%(44/49).Five cases of papillomatosis were diagnosed by ductoscopy,in which 3 cases were consistent with postoperative pathological findings,therefore the diagnose accordance rate is 60%;the other 2 cases were proven to be multiple papilloma.Thirty-eight cases of papilloma were detected by ductoscopy and received lobectomy of bresat;55 cases of inflammatory duct disease did not receive any operation;and 3 cases(3%,3/104)were diagnosed papilloma by re-examination with ductoscopy due to persistent nipple discharge,and were confirmed after operation.Conclusions Fiberoptic ductoscopy is the first choice for examination of nipple discharge for its accuracy in finding pathogenic cause and locating lesion,and surgery can thereby be avoided for galactophoritis and mammarv duct ectasia patients.

Objective To observe the effect of electric activity in the nucleus of solitary tract and the expression of NMDAR2 and GLAST in the zone of hippocampal gyrus after sleep deprivation in younger rats, in order to provide some theoretical basis for clinical therapeutie strategy. Methods Synchronous experiment was conducted with electrophysiological method. The changes in electric-activity of nucleus of solitary tract (NTS) were determined. Immunohistochemical method was employed to detected the expression of NMDAR2 and Glast in the zone of hippocampal gyrus in younger rats with sleep deprivation. Results The electric activity in nucleus of solitary tract (NTS) increased gradually along with sleep deprivation for 3 days, and the electric activity was much increased on the 7th day of sleep deprivation. In the second week of sleep deprivation, the electric activity in NTS was restrained. In the zone of hippocampal gyrus, the expression of both NMDAR2 and GLAST was increased significantly with 3-day sleep deprivation, and on the 5th day, the expression was much increased, while on the 7th day the expression decreased gradually. However, the expression of both NMDAR2 and GLAST in the zone of hippocampal gyrus in the second week of sleep deprivation was similar to that of the control group. Conclusion Sleep deprivation can exert a marked influence on the electric activity of the nucleus of solitary tract (NTS), and may interfere with the ability of study and memory in younger rats.

Objective To investigate the clinical effectiveness of autologous platelet-rich-plasma (PRP) combined with iliac autograft in reconstruction of bony defective nonunion of humeral condyle.Methods The 27 patients who had been admitted to our department from January 2004 to June 2015 for bony defective nonunion of humeral condyle were analyzed retrospectively.Of them,15 underwent reconstruction with PRP combined with iliac autograft (experimental group) and 12 reconstruction with only iliac autograft (control group).The preoperative demographic data of the 2 groups were not significantly different (P ＞ 0.05).The 2 groups were compared in terms of operation time,hospital stay,bony union time,range of motion of the elbow,and modified Cassebaum scoring.Results The patients were followed up for 12 to 90 months (average,24.6 months).No such complications were observed as displacement of bone blocks,loosening or breakage of implants,re-nonunion,malunion,delayed ulnar neuritis,or olecranon nonunion.There were no statistic differences between the 2 groups regarding operation time,hospital stay,range of motion of the elbow and modified Cassebaum scoring (P ＞ 0.05).The clinical healing time (4.2 ± 1.3 months) and bony healing time (4.8 ± 1.4 months) for the experimental group were significantly shorter than for the control group (6.0 ± 1.1 months and 6.2 ± 1.0 months,respectively) (P ＜ 0.05).Conclusion Autologous PRP combined with iliac autograft can speed up the healing of bony defective nonunion of humeral condyle,promoting functional recovery of the elbow.

砄bjective: To study the mineralization and related differential phenotype of human dental papilla cells in vitro . Methods: Human dental papilla cells were primarily cultured with explant technique, the cells of third passage were incubated for a long term in the presence of 10 mmol/L ? glycerophosphate(? GP)and 50 ?g/ml of ascorbic acid (L AA) in DMEM containing 5% FBS. Alkaline phosphatase (ALP) and osteocalcin(OC) were measured at different culture time. Cell growth was observed under inverted microscope and mineralization was tested with Von Kossa stainning. Results: Cultured papilla cells were growing in multilayer. Cells exposed to ? GP and L AA exhibited higher ALP activity in 14 days and increased OC in 21 days with certain amount of secreted matrix. After 35 days of culture, mineralized tubercles were formed. ALP activity and synthesized OC began to decrease after 42 days of culture. Conclusion: Human dental papilla cells may show odontoblast phenotype in vitro .

Objective To evaluate the value of breast duct endoscopy and breast localization needle for the diagnosis and microinvasive treatment of intraductal lesions. Methods A total of 103 patients with nipple discharge without breast lumps were examined by breast duct endoscopy in our hospital. Of them, 63 cases of intraductal lesions were localized with breast localization needle and received arc incision of the areola of the breast and excision of the localized breast duct with 1-cm adjacent tissues, which were sent for intraoperative frozen. After the frozen pathological examination, the operation was ended for the patients with intraductal papilloma; simple mastectomy was performed on those with duct papillomatosis; and simple mastectomy combined with DIEP reconstruction was carried out for the patients with intraductal carcinoma. Results Frozen and postoperative pathological examinations showed single intraductal papilloma in 59 of the patients (59/63, 93.6%), duct papillomatosis in 2 (2/63, 3.2%) , and intraductal carcinoma in 2 (2/63, 3.2%). The 59 patients with single intraductal papilloma were reexamined in 3 months after the operation, none of them had nipple discharge or other symptoms. Conclusions Resection of intraductal lesions under the guidance of breast localization needle is less traumatic with good cosmetic outcomes. By using the method, high rates of complete resection and accuracy of pathological examination can be achieved.

The traditional independent methods can not solve the prominent problems of long waiting time in registration , paying and drug obtaining and short time in diagnosis and treatment .After the application of the mobile internet technology , it′s highly possible that outpatients′queuing congestion can be drastically alleviated .The paper investigates the outpatient registration and queuing data of our hospital over 9 weeks, and presents key requirements and system architecture of an outpatient service system based on mo -bile internet.To achieve the target, the hospital must make great efforts to improve online experience , optimize offline outpatient process, promote mobile internet service , and cultivate outpatient internet habits .

Objective Traditional outpatient process has been blamed for its complexity and inconvenience .The ariticle was to evaluate the effects of incorporating mobile internet into our hospital's queuing system . Methods The outpatient queuing data of Nanjing General Hospital of Nanjing Military Region were collected .Four indexes are proposed to evaluate the quality of medical serv-ice in the hospital , including the average outpatient wait time , the average outpatient interview time , the ratio of interview time to wait time, and the number of outpatient stayers . Results These indexes predicted that approximately 38.08%of outpatients would ben-efit from the application of mobile internet to queuing service , the average outpatient wait time would reduce by 42.31% and that 25.60%of the outpatient stayers would decrease . Conclusion The system can shorten the wait time , decrease the number of stayers, improve the outpatient process and raise the utilization rate of medical resources .

Objective To observe the effect of gastric motility and gastric electric activity on sleep deprivation and the changes of calcitonin gene-related peptide(CGRP) and nitro oxygen(NO). Methods The 192 SD rats were divided into three groups randomly. Gastric emptying was analyzed with radioimmunoassay, using nuclide 99m Tc and gastric emptying of liquids and EGG with the serosa method .By using the immuno-chemistry and chemistry analysis methods, we observed the changes of some connective factors, for example, CGRP and NO. Results The acute deprivation can cause the change of gastric emptying and which is decreased with the time of deprivation, in the meantime, we found the gastric electric activity would be decreased before food, otherwise, the gastric electric activity is irregulary and the gut hormone, for example, CGRP and NO have been changed in the plastic of rats after acute deprivation. In the study we found the gastric emptying have a change obviously in the short time. But with the time of deprivation the gastric empting no have change. And the gastric similar to this, the gut hormone no any change. Conclusions The acute sleep deprivation caused the change of gastric emptying and the change of gastric electric activity obviously. In plastic, the level of CGRP and NO have a change after sleep deprivation. The chronic sleep deprivation caused the change of gastric emptying and the change of gastric electric activity, and caused the function of gastric motility disturbing, and the effect is prolong after chronic sleep deprivation.