Objective To investigate the changes in cerebral cAMP and PKA levels during development of acute opioid tolerance induced by remifentanil and to determine whether post-receptor cAMP/PKA signaling pathway is involved in the process. Methods Fifty-six male Kunming mice weighing 25-35 g were randomly divided into 5 groups: group Ⅰ control (C) (n=8); group Ⅱ received morphine infused intraperitoneally (IP) at 0.6 μg'kg-1·min-1 for 120min(M) (n=8); group Ⅲ,Ⅳ,Ⅴ received remifentnil infused IP at 0.4, 0.8 and 1.6 μg·kg-1·min-1 for 120 min(R1=8, R2n=8; R3 n=24).Control group received IP infusion of normal saline. Tail-flick test was performed td measure the response of animals to a thermal nociceptive stimulus before IP infusion, at 30, 60, 90 and 120 min after beginning of IP infusion and at 15, 30, 45 and 60 min after termination of IP infusion. Eight animals were decapitated at 60 min after termination of IP infusion in all 5 groups and the other 16 animals in group R3 were decapitated at 30 and 45 min after termination of IP infusion (n=8 each) for determination of intracellular contents of cAMP and activities of PKA in cerebral cortex and inferior colliculus-striatum by ELISA or radioactive isotope [32p,] ATP-catalyzing assay. Results The tail-flick latency was significantly prolonged during IP infusion as compared with the baseline before infusion in group M, R1 , R2 and R3 but became significantly shorter at 30 and 45 min after infusion than the baseline values in group R1, R2 and R3indicating hyperalgesia after remifentauil infusion. The cerebral contents of cAMP and PKA activities at 60 min after termination of infusion were comparable or decreased in group M, R1, R2 and R3 as compared with group C. There was no significant difference in cerebral cAMP contents and PKA activities at 30, 60 and 45 min after IP remifentanil infusion in group R3. Conclusion Remifentanil can induce acute hyperalgesic effect on mice, and there is no up-regulation of post-receptor cAMP/PKA signaling pathway in the acute opioid tolerance, which is not similar to that chronic opioid tolerance.

Objective To study the sedation efficacy of propofol combined with midazolam and /or fentanyl in fibreoptic choledochoscope. Methods Ninty outpatients were randomly divided into three groups. Group PF (n=31)was given fentanyl 0. 05 m.g plus propofol 1 mg/kg intravenously, group PM (n=29) midazolam 2 mg plus propofol 1 mg/kg, and group PMF(n=30) fentanyl 0. 05 mg, midazolam 2 mg and propofol 1 mg/kg. Propofol 20 mg was used when needed. HR,MAP,SpO_2,sedation scores and amnesia were recorded. Results All patients were awakened in 20 minutes after procedures. The recovery time was shorter in group PF than that in the other two groups. There were 21(67. 70%) patients in group PF, who were aware of surgery. Fifteen(48. 4%) patients were satisfied in group PF. Conclusion Propofol combined with midazolam and /or fentanyl in fibreoptic choledochoscope has better sedation without any obvious side effects.

Objective: To study the effects of the different doses of midazolam in fibreoptic gastroscopy on sedation, respiratory and circulatory function. Method: One hundred and four outpatients undergoing fibreoptic gastroscopy were randomly divided into four groups. The control group(N)was not given drugs, the other groups were intravenously given midazolam 0.07mg/kg(MS),0.05mg/kg(M),diazepam 10mg(D)respectively. The sedative scores, symptom, amnesia,HR,MAP and blood gases were observed. Result: The sedative scores of MS,M and D groups were much better than that of control group. There were significant differences in sedative scores,amnesia and sedative period between MS group and D group or M group. MAP decreased one minute after administering the drugs in MS,D and M groups significantly. The results of blood gases analysis of all groups were in normal ranges. Conclusion: Midazolam 0.07mg/kg can produce safe and effective sedation for fibreoptic gastroscopy.

Laparoscopic anatomical hepatectomy of segment 7 is recognized as one of the most difficult hepatectomies. Because of its location and anatomic characteristics, the resection of hepatic segment 7 has the difficulties of poor surgical view, instrumental accessibility, hepatic pedicle anatomy, confirmation of dividing line and secure hemostasis. When performing laparoscopic anatomical hepatectomy of segment 7, the authors routinely put patient at left semi-decubitus position, set all trocars at the right upper quadrant of the abdomen, and select proper approach for hepatic pedicle anatomy according to the results of individualized preoperative three-dimensional reconstruction. The authors use to transect the liver parenchyma at the plane between hepatic segment 6 and segment 7, with the direction perpendicular to the right hepatic vein, and then finish parenchymal dissection using right hepatic vein as the intrahepatic landmark. According to the authors experiences, choosing appropriate tactics can effectively reduce the difficulty of laparoscopic anatomical hepatectomy of segment 7, improve the safety and controllability of operation, and ensure the oncological radical effects.

Objective To investigate the effect of operation timing on patients with rheumatic mitral stenosis underwent valve replacement during perioperative period.Methods Retrospective analysis were performed on 122 cases diagnosed as rheumatic mitral stenosis (mitral stenosis,MS) underwent valve replacement,during January 2012 through December 2013 in the Department of Cardiovascular Surgery,General Hospital of Shenyang military region.According to the mitral valve area (mitral valve area,MVA) measured by echocardiography before operation,patients were respectively divided into three groups,mild stenosis (＞ 1.5 cm2),moderate stenosis (1.0 ～ 1.5 cm2),and severe stenosis (＜ 1.0 cm2).Through the single factor and multi-factor logistic regression analysis on all clinical data collected from patients,the effects of operation timing on patients were confirmed in perioperative period in each group.Results The results were satisfied in the group.Heart function was significantly raised compared to that before surgery,and the life quality of the patients was improved.Two cases died during hospitalization,New York Heart Association Functional Class (NYHA) reached between Ⅰ ～ Ⅱ,Ⅱ,perhaps Ⅰ for survival.Single factor analysis showed that the pulmonary arterial systolic pressure (pulmonary arterial systolic pressure,PASP),left ventricular end diastolic volume,mitral valve area,cardiothoracic ratio,intensive care unit (ICU) staying,ventilator-assistant during hospitalization were influence factors on surgical opportunity of patients with rheumatic mitral stenosis and perioperative outcomes.Multivariate logistic regression analysis showed that pulmonary artery pressure and mitral valve orifice area were the independent influence factors on surgical timing by collecting perioperative outcomes in the groups.Conclusions Mitral valve replacement (mitral valve replacement,MVR) is an effective method in the treatment of rheumatic mitral stenosis.Timely operation can improve the prognosis of patients in the perioperative period,and help to improve the quality of life.Early treatment should be an important factor affecting the perioperative prognosis.Timely operation,early treatment may improve the patient's survival during perioperative period.

Objective To explore the diagnostic value of helical CT in superior mesenteric vein(SMV) thrombosis.Methods Characteristic CT appearances of SMV thrombosis verified by clinic in 13 patients were retrospectively analysed.Precontrast and postcontrast CT scan were performed in all patients.After the data were acquired,they were transferred to workstation for maximum intensity projection of muti-plane.Results Hyperaemia and edema of the mesentery could be seen in all patients.After administration of contrast material,the filling defects of SMV could be showed in 8 cases,and the distal SMV was occluded in other patients.The thrombi could be directively showed by CT,but distended bowel loops,bowel wall thicking with or without the target sign,absent or poor enhancement of the bowel wall,and the pneumatosis at interbowel were showed by CT,the later two findings were more important and specific signs of ischemic bowel.There was not directively relation between bowel necrosis and the thrombus was whether or not localized at main SMV.Conclusion Helical CT is a important modality for the diagnosis of SMV thrombosis.

[Objective]To investigate the biomechanical effect of mid-upper fibular fracture on ankle joint.[Method]From January 2005 to June 2006,20 cases of mid-upper fibular fracture were collected.Normal anterior film of bilateral ankle joint was photographed,ankle mortise width and distal fibula upper shift were measured to observe the effect on stability of ankle joint.Foot-scan pressure analyzer was used to detect the central track of footplate pressue,subtalar joint angle,in order to compare the difference between normal ankle and the sick.[Result]Dislocated mid-upper fibular fracture could lead to ankle mortise widening,lateral malleolus up shift ( averaged,1.260?0.339mm,1.045?0.276mm).the central track of footplate pressure offset and the fracture sides subtalar joint angle were larger than those in normal feet(P

Objective To investigate the mechanism of the protective effects of olanzapine against apoptosis of PC12 cells induced by ?-amyloid peptide 25-35 (A?_ 25-35 ). Methods Based on the model of apoptosis of PC12 cells induced by A?_ 25-35 , cell viability was determined by MTT assay. The expressions of Bax, Caspase-3 of PC12 cells induced by A?_ 25-35 and olanzapine were assessed by Western blot. Results 10 -14 -10 -5 mol/L A?_ 25-35 lowered the cell viability of PC12 cells, 50?mol/L and 100?mol/L olanzapine pretreatment enhanced the cell viability of PC12 cells, and there was significant difference compared with olanzapine non-pretreated groups (P

Objective To evaluate the therapeutic effect of Yin-Huang pills combined with Banlangen granule therapy on upper respiratory infection.Methods 120 cases of acute upper respiratory infection were randomly separated into an experiment group and a control group.The experiment group was treated by Yin-Huang pills combined with Banlangen granule;while the control group was treated by Yin-Huang pills.Results There was significant difference of cure rate between the experiment group(75%)and the control group(51.6%),with P＜0.01.There was no significant difference of total effective rate between the experiment group(96.6%)and the control group(88.3%),with P＞0.05.Conclusion Yin-Huang pills combined with Banlangen granule therapy was more effective in controlling acute upper respiratory infection,and this therapy caused few adverse effects.

Objective To evaluate the correlation between the dynamic enhanced CT signs of hepatocellual carcinoma(HCC),MVD and VEGF expressions in hepatocellular carcinoma.Methods The MVD and VEGF expression were examined by means of SP immunohistochemical technique in 45 cases of HCC proved by pathology.All patients were examined by plain and contrast-enhanced CT.Results(1)The relation of pathologic grade,MVD and VEGF:the MVD in HCC of grade Ⅰ,Ⅱ,Ⅲ,Ⅳ were 22.9 ± 12.6,36.7 ±16.2,51.1±17.3,67.8±21.4,VEGF positive rates in HCC of grade Ⅰ,Ⅱ,Ⅲ and Ⅳ were 28.6%(2/7),53.3%(8/15),90.9%(10/11)and 100.0%(12/12).The pathologic grading of HCC was positively correlated with MVD and VEGF expression,in grade Ⅰ and grade Ⅲ～Ⅳ,Ⅱ and grade Ⅳ(P＜0.05).There were no statistical correlation between Ⅰ and Ⅱ,Ⅱ and Ⅲ or between Ⅲ and Ⅳ(P＞0.05).(2)There were three blood supply types in HCC at contrast-enhanced CT,the MVD ad VEGF positive rates were 70.6±22.9 and 85.l%(23/27)in tumors with arterial blood,65.7±21.6 and 63.6%(7/11)in those with double blood supply,and 25.1±13.5 and 28.6%(2/7)in those with poor blood supply.There was statistical difference(P＞0.05)in VEGF expression between the tumors with arterial blood,arterial combining with double blood supply and poorly blood supply.In HCC with arterial and double blood supply,MVD expression level was higher than that with poor blood supplies(P＜0.01).Conclusion MVD and VEGF expression can reflect the tumor's cell differentiation of HCC in a certain degree.