Objective: To determine if different methods of anesthesia and analgesia will influence the incidence of early postoperative cognitive dysfunction (POCD) after non-cardiac surgery in the elderly. Methods: One hundred and three elderly patients undergoing elective abdominal surgery were randomly allocated to receive either general anesthesia followed with postoperative intravenous analgesia (general anesthesia group, 53 cases) or combined general-epidural anesthesia followed with postoperative epidural analgesia (combined general-epidural anesthesia group, 50 cases). Cognitive function was assessed preoperatively and 7 days postoperatively using a battery of nine neuropsychological tests. A postoperative deficit in any test was defined when decline by more than or equal to 20% of the preoperative value of that test occurred. Any patient showing deficit in 2 or more tests was defined as having postoperative cognitive dysfunction. Results: Ninety-two patients completed both preoperative and postoperative neuropsychological tests. On day 7, POCD occurred in 20/45 patients (44.4%) in the general anesthesia group and in 23/47 patients (48.9%) in the combined general-epidural anesthesia group. No significant difference was found between the two groups. Logistic regression analysis showed that short duration of education and operation of general surgery were independent risk factors of the occurrence of early POCD. Conclusion: Early POCD occurred in 46.7% of the elderly patients undergoing abdominal surgery. However, there was no significant difference between the effects of two different methods of anesthesia and postoperative analgesia on the incidence of POCD. Short duration of education and operation of general surgery were risk factors of early POCD.

Objective To study the induction of IL-6 on expression and activity of tissue factor (TF)in peripheral blood monocytes(PBMCs).Methods rhIL-6 100 ng/L and rhIL-6 100 ng/L+ rhIL-6 MoAb 10?g/L were used respectively to stimulate the PBMCs for 24 h,PBMCs without any stimulation as control group,to study the changes of antigen content,mRNA expression and the ac- tivity of the TF.Results The antigen content,mRNA expression and activity of TF were increased significantly in 100 ng/L rhIL-6 group as compared with rhIL-6 100 ng/L+rhIL-6 MoAb 10?g/L and control groups(P＜0.01).Conclusions rhIL-6 can induce the increase of antigen expression,activity and mRNA expression in PBMCs,and these effects can be suppressed successfully by rhIL-6 MoAb. This study demonstrated that there was potential relations between cytokines and thrombogenesis, which may play an important role the pathogenesis of chronic rejection.

The relationship between vascular endothelial growth factor-C (VEGF-C)/vascular endothelial growth factor receptor 3 (VEGFR-3) expression and clinicopathologic features of the patients with non-small cell lung cancer (NSCLC) was investigated. The expression of VEGF-C and VEGFR-3 was assessed in 65 patients with NSCLC by immunohistochemistry. The significance of VEGF-C and VEGFR-3 expression was analyzed statistically. The results showed that VEGF-C and VEGFR-3 were highly expressed in cytoplasm and membrane in lung cancer tissues with the positive rate being 55.4 % and 52.3 % respectively, while there was no expression in the normal lung tissues. The expression of VEGF-C was significantly increased in adenocacinoma as compared to other types of NSCLC (P<0.05). The VEGFR-3 expression was closely related with lymph node metastasis (P<0.01) and TNM stage (P<0.05). There was a positive correlation between the VEGF-C and VEGFR-3 expression in NSCLC patients (r=0.658, P<0.01). It is suggested that VEGFR-3 plays an important role in the lymphatic metastasis of NSCLC. The interaction between VEGF-C and VEGFR-3 may be deeply involved in the mechanism of lung cancer metastasis.

Nuclear factor(NF)-κB is widely expressed in various types of tissue cells. Abnormal activation of NF-κB signaling pathway can lead to the initiation and progression of asthma,chronic ob?structive pulmonary disease(COPD)and other lung inflammatory diseases,but inhibition of its activity can effectively alleviate the occurrence and development of these diseases. In this paper ,we review biological characteristics of NF-κB,role of NF-κB signaling in asthma,COPD and other inflammatory lung diseases,and potential application of NF-κB inhibitors in clinical treatment of these inflammatory lung diseases. It will provide a valuable reference for further study on pathogenesis,prevention,and control of lung inflammatory diseases.

Female ; Humans ; Leukemia, Myeloid, Acute ; complications ; etiology ; Middle Aged ; Myelodysplastic Syndromes ; complications ; etiology ; Uterine Cervical Neoplasms ; complications ; drug therapy ; radiotherapy

Objective To investigate the clinical effect of loading dose of phenobarbital in neonatal hypoxic-ischemic encephalopathy(HIE).Methods Three hundred and fifty-six patients with neonatal HIE were randomly divided into treatment group and control group by systematic sampling,with 178 patients in each group.Two groups were given comprehensive therapy,with or without convalsions,early application of loading dose of phenobarbital in 20 mg/kg intramuscular injection,12 h beck to a maintenance dose 5 mg/(kg·d)in treatment group,while a conventional dose of phenobarbital in 5 mg/(kg·d)was used in control group after convulsion happened.Clinical effect of short-term and long-term were observed.Results The rates of eelampsia,choloplania and total effect was 11.2％(20/178),7.9％(14/178)and 87.1％(155/178)in treatment group,and 68.0％(121/178),50.6％(90/178)and 77.5％(138/178)in control group,there were significant differences between two groups(x2 =6.403,78.459 and 8.308,P ＜ 0.05).DQ score in treatment group was higher than that in control group(P＜ 0.05).The patients in two groups were followed up to age 18 months,the deformity rate in treatment group[7.9％(14/178)]was lower than that in control group[28.1％(50/178)],there was significant difference between two groups(x2 =29.085,P ＜ 0.05).Conclusion Loading dose of phenobarbital is very effective to treat neonatal HIE.

ObjectiveTo study exogenous surfactants disaturated phosphatidyl choline (DSPC) kinetics in full term infants with respiratory distress syndrome(RDS) who were treated with different dose of poractant alfa.MethodsOne hundred and twenty-two full term infants with RDS undergoing mechanical ventilation were divided into group A (80 cases) and group B (42 cases) by simple random method,who received 100 mg/kg or 200 mg/kg poractant alfa mixed with DSPC.Clinical manifestation and respiratory parameters were recorded,and DSPC half-life period and pool size and endogenous DSPC synthesis rate were calculated.ResultsFifty-six infants (70.0％) received a second dose after(25 ± 11) h and 18 infants (22.5％) received a third dose after(41 ± 11 ) h in group A.Twelve infants ( 28.6％ ) received a second dose after (33 ± 8) h and 2 infants (4.8％) received a third dose in group B.DSPC half-life period in group B was longer than that in group A[the fast:(32 ± 19) h vs.(15 ± 15) h;the second:(43 ±32) h vs.(21 ± 13) h],there was significant difference (P＜ 0.01 or ＜ 0.05).DSPC synthesis rate and pool size before the first and second doses had no difference between the two groups.But the oxygenation index at the first and the second dose in group B was less than that in group A,there were significant differences (P ＜ 0.01 or ＜ 0.05).ConclusionPoractant alfa given to full term infants with RDS at a dose of 200 mg/kg results in a longerDSPC half-life period,fewer retreatments,and better oxygenation index values.

Objective: To discuss the methods and items for clinical linear accelerator (Clinac) and 3D treatment planning system (TPS)/intensity modulated radiotherapy(IMRT) system based on 2D ionization chambers array(2D-ICA). Methods: The 2D-I-CA laid on the anthropomorphic phantom with five centimeters and which was put on another five centimeters same phantom.All data have gained as following conditions: the SAD is 100 cm and the SSD is 90 cm; the fields' size are 2 cm, 5 cm, 10 cm,15 cm ,20 cm respectively and 2 cm×10 cm ,5 cm×20 cm ,20 cm×5 cm, MU=100 cGy;the Clinae and TPS were verified by some special items for checking their dose accuracy, such as, square fields, rectangular fields, and rectangular fields with 600 wedge or 300 wedge, which were measured for verification their flatness and symmetry. And some measured items were only for checking multileaf collimator (MLC) and TPS calculated accuracy. So, we developed moveable MLC fields and IMRT plans and compound fields to evaluate leafs side effects and leafs end effects and transmission effects. Results: The flatness value of square and rectangular fields was 100.07%～102.66%,and their symmetry value was 0.10%～1.49%; and these irradiate fields' size were compared with light fields' sizes, which the X direction deviation was-1.5%～0.7% ,the Y direction deviation was-1.4%～1.0%,and their average value was-0.47%.To verify calculated data for TPS ,we developed Gamma value and ab-solute value (<4%)to evaluate their accuracy. For square and rect-angular fields, The Gamma value was 92.02%～96.35%.In com-pound fields Which were composed with two half fields (X1 = 5 cm, X2 =0 cm, Y= 10 cm and X1 = 0 cm,X2 = 5 cm, Y=10 cm),the maximum deviation was about 5%.And five fields (2 cm×10 cm) composed one fields (10 cm×10 cm),the maximum deviation was about 10% in the joint place. The Gamma value of one fields was 96.6%, another was 93.2% in the moveable fields. Conclusions: To dollop 2D ionization chambers array to verify the dose for Clinac and TPS, it was so quick and simple, and it was important that it bring more accurate dose evaluation and more clinical quality assurance and quality control methods.

Objective Carry out the reform of the online learning mode of prehospital training for refresher doctors , and evaluate the effect of reform in Peking Union Medical College Hospital .Methods An exploration was carried out on the refresher doctors prehospital training mode from traditional classroom teaching to online learning , Estab-lished the online learning system .Evaluated the effect of online learning by the way of questionnaire investigation andreexaminationamong289refresherdoctors.Results 289refresherdoctorshavecompletedthestructuredon-line courses of prehospital training , and the average pass rate of the first test was 42.2%.The questionnaire and retest was conducted , A total of 262 doctors completed the work , The recovery rate was 90.7%, and the average pass rate of retest was 74.9%, showing improvement by 32.7%.Conclusions Online learning mode is an effec-tive tool for knowledge dissemination , and has a better learning effect .

Objective To evaluate the efficacy of mid-axillary approach to transversus abdominis plane (TAP) block in each abdoninal and back region.Methods Twenty patients of both sexes,aged 18-64 yr,with body mass index of 20-27 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic cholecystectomy,who had expected operation time ＜1 h,were enrolled in the study.Ultrasound-guided TAP block was performed on the left side via the mid-axillary line with 0.25％ levobupivacaine 0.5 ml/kg.TAP block was assessed by cold stimulation (75％ alcohol) and acupuncture in each abdominal and back region (the left side of the body was divided into 19 regions using the anatomical landmarks on the body surface).The positive condition in each region at 20 min after administration was recorded.Results The regions in which the positive rate ≤5％ were 11,14,17 and 18 regions.The regions in which the positive rate ＞5％-20％ were 8,15 and 19 regions.The regions in which the positive rate ＞20％-50％ were 12,13 and 16 regions.The regions in which the positive rate ＞50％-70％ were 1 and 4 regions.The regions in which 70％ ＜ the positive rate ＜ 95％ were 7,9 and 10 regions.The regions in which the positive rate ≥ 95％ were 2,3,5 and 6 regions.Conclusion Mid-axillary approach to TAP block is effective in the left middle-lower regions of the anterior abdominal wall,however,it is ineffective in the left upper region between mid-axillary and posterior axillary lines and in the low back region.