Objective To study the protective effect of removing inflammatory cytokines by hemoperfusion (HP)on acute kidney injury (AKI) in patients with sepsis. Method A total of 40 patients with sepsis and AKI were randomly divided into two croups: HP treatment group (n = 22) and control group (n = 18). Hemoperfusion carried out in patients of Hp group with HA330 filter once a day for 3 days and the procedure of each hemoperfusion was completed in 2 hours. The patients of control group were treated with routine treatment. Further, the hemodynamics, plasma IL-6, IL-10, C-reactive protein (CRP), serum creatinine (Scr), blood BUN and urine NAG, γ-GTP,α1-MG of patients in both groups were detected before treatment and 3 d,7 d and 14 days after treatment. Results Compared to control group, the levels of plasma interleukins-6, IL-10 and C-reactive protein were significantly lower (P ＜ 0.05), along with increase in urine output, lower levels of blood BUN and Scr, reduction in urine NAG,γ-GT and α1-MG (P ＜ 0.05). In addition, the patients at Ⅰ or Ⅱ stage of AKI treated with hemoperfusion had significantly lower level of Scr in 14 days and lower mortality in intensive care unit in comparison with control group (P ＜ 0.05). Conclusions Hemoperfusion employed in the earlier stage of AKI with the HA type filter may have protective effect on acute kidney injury by the removal of inflammatory cytokines in the setting of sepsis.

Objective To realize the hygienic state of drinking water in the rural areas in Yunnan Province,the scientific evidences would be provided for drawing the policies about improving the drinking water quality in the rural areas.Methods From August to October in 2006,30 counties were randomly chosen among the monitoring counties,in each county at least 10 sampling points were chosen randomly.The questionnaires were employed and the water samples were collected,the quality of drinking water was tested with the related standard methods.Results 8.94 million people were involved in the survey,48.60% of them used surface water as the source of water.52.18% of people were serviced by the central water supply.The eligible rate in 301 water samples in this survey was 36.88%,those of the samples of surface and underground water were 37.60% and 36.36% respectively.The eligible rate of samples from central water supply was 41.85%,higher than that from non-central water supply(P

Objective: To compare the clinical effects of postoperative patient controlled epidural analgesia (PCEA) with different combinations of tramadol and/or buprenorphine. Method:The 150 cases of surgical patients were ran domly divided into 6 groups: 0.6% tramadol (group T_1). mixture of 0.6% tramadol and 0.15% bupivacaine (group T_2), mixture of 0.0015% buprenorphine and bupivacaine (group B_1) , mixture of 0. 0015% buprenorphine, bupivacaine and 0.6% tramadol(group B_2). 0.15% bupivacaine(group C_1), 0.0015% buprenorphine(group C_2). With a Graseby- 9300 PCA pump in the loading-continuous-PCA model, the doses were 5mL-0.5ml-1ml respectively. Result: (1)In the first postoperative 24 hours the amount of drugs used in each group was similar; (2)1n these six groups, both visual analog scale scores and the ratios of tatol deliveries to demands were B_2

Objective To discuss clinical effects of transurethral electrovaporization of the prostate(TUVP) for the treatment of large benign prostatic hyperplasia(BPH).Methods A total of 126 cases of large BPH were treated with TUVP.Two longitudinal trenches were made at the position of 6 and 12 o'clock,respectively.Then the lateral lobe was retrogradely dissected from the proximal end of the seminal colliculus and was removed.Results The international prostate symptom scores(IPSS) decreased from 28.6?4.5 preoperatively to 10.7?2.6 postoperatively(t=38.661,P=0.000);the quality-of-life scores(QOL) decreased from 5.3?0.7 preoperatively to(2.0?)0.5 postoperatively(t=43.061,P=0.000);the maximum urinary flow rate(Qmax) increased from 5.7?3.6 ml/s preoperatively to 18.2?4.2 ml/s postoperatively(t=-25.365,P=0.000);the resident urine(RU) decreased from 312.4?56.6 ml preoperatively to 32.8?9.2 ml postoperatively(t=54.732,P=0.000).There were significant differences in all these parameters between preoperatively and postoperatively.Threatened transurethral resection syndrome(TURS) occurred during operation in 2 cases.Postoperatively,transient urinary incontinence was observed in 5 cases.Conclusions Transurethral electrovaporization of the prostate for the treatment of large BPH is effective and safe.

Objective To explore the protective effect of proliferator activated receptor-γ (PPAR-γ)activator pioglitazone on the expression of inflammatory cytokines in cultured cortical neurons after ischemia-reperfusion injury and its mechanism. Method The ischemie-reperfusion model was established by deprivating both glucose an oxygen in medium and then gave them back. Medium or that with pioglitazone was added at the beginning of reperfusion. The MTT values of neurons were determined in control or treatment groups, ANOVA was used to detect the expression of PPAR-γ. The expression of tumor necrosis factors-α(TNF-α) and interleukin-lβ(IL-lβ) were detected by Western Blotting. Results Compared to control group, the markedly reduction of MTT values and enhanced expression of PPAR-γ, TNF-a and IL-1β was observed in the ischemia-reperfusion neurons (P < 0.05). After they were treated by pioglitazone, the reduction of MTT values and enhanced expression of TNF-a and IL-1β were prominently reversed by the further activation of PPAR-γ ( P < 0.05). Conclusions Treatment of PPAR-γ activator pioglitazone has protective effect on neurons after ischemia-reperfusion injury. Its mechanism may be associated with the inhibition of inflammation after injury.

Objective: To evaluate the feasibility and safety of postoperative patient-controlled epidural analgesia (PCEA)in children. Methods: Forty postoperative pediatric patients(5-11 years old)were divided into two groups. A and B. Both wereinstituted with postoperative PCEA with LCP model (loading dose 2.05 + 0.13ml), continuos infusion rate 0.82 + 0.15mi/h, PCA dose 0.81 + 0.16ml)by Graseby-9300 PCA pump. The PCEA solution of group A was 0.075% bupivacaine plus0.0012 % buprenorphine, that of group B was same while 0. 005% droperidol was added as an adjuvant. Results:The volumeof PCEA sdution consumption in group B was significantly less than that in group A on the first and second postoperative day (P< 0.01-0.05). Good analgesic efficiency with little side effects was obtained, as evaluated by the VASF emasay or D/D score and complications in two groups, but the analgesic effect of group B was better than that of group A. Conclusion: Thepediatric PCEA with low concentration of bupivaeaine plus buprenorphine is feasible and safe. Droperidol may enhance theanalgesic effects of PCEA.

To determine the differences in analgesic, hemodynamic and ventilatory effects between epidural and intravenous midazolam (MID), 44 adult patients, ASA grade Ⅰ to Ⅱ, scheduled for elective upper abdominal surgery. were randomly allocated to receiving epidural MID 0.05 mg/kg (group E_1) or 0.1 mg/kg (group E_2). or intravenous MID 0.05 mg/kg (group V_1) or 0.1 mg/kg (group V_2), respectively, The analegic effect was evaluated by pin-prink test, following MID administration. The hemodynamie and ventilatory values were measured by impedance cardiogra phy and side stream spirometry, before and 1.3, 5, 10, 15 and 20 mins after MID administration. Tbe results showed that the segmental spinal analgesia occured with MID in group E_1 and E_2, but no analgesia was produced with WID in group V_1 and V_2. Following MID administration in four groups, HR increased during first 5 mins (P0.05); CI, SI. LVWI, MAP, RPP and indices of myocardial eonstraction, cardiae peak flow and blood ejection velocity decreased slightly(P0.05). After MID administration, SpO_2 and VT were reduced (P0.05), and the inspiratory end-tidal oxygen content difference was elevated transiently (P0.05) and went down in group E_2 and V2(P0.05).

Objective To compare the safety and efficacy of different doses of intrathecal sufentanil for labor analgesia in parturients. Methods One-hundred ASA I or II nulliparous parturients at 39-40 weeks of gestation who requested labor analgesia were included in this randomized double-blinded study. They were all in active labor with a 2-3 cm cervical dilatation. The subarachnoid block was performed at L2, 3 . The patients were randomized to received intrathecal sufentanil 1,3,5,7,or 10 ?g. An epidural cather was then placed for patient-controlled epidural analgesia (PCEA) . The PCEA solution contained 0.1% ropivacaine and sufentanil 0.4 ?g ? kg-1 .The PCEA settings were as follows: background infusion 5 ml?h-1 , demand bolus 3 ml and lock-time interval 10min. Pain relief was assessed by VAS scores, oxytocin dose, maternal satisfaction, hemodynamics and side effects. Apgar scores of the new-borns were recorded. Results Demographic data including age, sex, body weight and baseline VAS were similar among the five dose groups. There were significant differences in the onset , duration and efficacy of analgesia among the five dose groups. Significantly more patients who received 10 ?g sufentanil reported nausea and vomiting and pruritus than those who received 1 or 3 fig sufentanil. There was no significant difference in Apgar scores among the 5 dose groups. Conclusion Intrathecal sufentanil combined with PECA is safe and effective for labor analgesia. Intrathecal sufentanil 3-5 ?g is the dose of choice for labor pain relief.

Objective To observe the ultrasonic manifestation of metatarsal fatigue fractures and probe into the clinical values of ultrasonic diagnosis and follow-up to the disease.Methods The clinical data and sonographic features of 30 cases with metatarsal fatigue fracture confirmed by X-ray and CT were analyzed retrospectively.Results All the subjects in this study were metatarsals insufficiency fractures located in the second or third diaphysis.2D-ultrasound found microfracture in the cortex and the periosteal elevation by increased vascularity in the early stage.During the 3-month follow-up,thickened cortex and callus shown as the shape of mushroom or cauliflower and a great amount of neovascularisation were visualised with color Doppler flow imaging.Then,the cortex surface became gradually changing from rough to smooth and obvious posterior shadows were observed with the illness progression.Conclusions Ultrasonography could be used to detect the cortical continuity,callus characteristics and blood flow perfusion of fatigue fracture in the different damage stages.

Objective To investigate and compare the change of extravascular lung water (EVLW) and levels of cytokines in septic patients without clinical acute lung injury (ALI) /acute respiratory distress syndrome (ARDS) with those in spetic patients with sepsis-induced ALI/ARDS in order to determine the role of EVLW involved in the pathogenesis of lung injury in the patients by quantifying the relationship between EVLW and biomarkers of lung injury in patients with sepsis.Methods A total of 40 septic patients complicated either with or without clinical ALI/ARDS after sepsis. In each patient,transpulmonary thermodilution (PiCCO) was used to measure cardiovascular hemodynamics and EVLWI for 7 days via an arterial cannula indwelled within 72 hours after diagnosis of severe sepsis was made, and serial bronchoalveolar lavages (BAL) were carried out.Other examinations including blood gas analysis,ventilator parameters,chest X-ray and the levels of pro-inflammatory cytokines such as tumor necrosis factor (TNF-oα),interleukin-1 in the BAL were recorded.In-hospital and ICU mortalities were also observed.Results Of total 40 patients,29 were complicated with clinically defined septic ALI/ARDS ( ARDS n =15,and ALI n =14).The septic patients complicated with ALL/ARDS had significantly higher amount of EVLWI and higher levels of TNF-α and interleukin-1 in the BAL than patients without ALI/ARDS ( P ＜ 0.05).The arterial oxygen tension/fractional inspired oxygen ratio,lung injury score,and the levels of TNF-α,IL-1 in the BAL correlated with EVLWI.Moreover,in-hospital mortality,ICU mortality and the length of ICU stay of the patients with high amount of EVLWI were markedly increased than those of patients with low amount of EVLWI. Conclusions In septic patients complicated with ALI/ARDS, the extravascular lung water index correlates with oxygenation,lung injury severity and inflammatory cytokines in lung.Determination of EVLWI may be useful for evaluation of severity of lung injury and prognosis of septic patients.