Objective To systematically review the changes in the intensity of postoperative pain under ketamine anesthesia in children.Methods We searched the Cochrane Library,PubMed,OVID,EMBASE,and Chinese Biomedical Database for prospective randomized controlled trials involving the changes in the intensity of postoperative pain under ketamine anesthesia in children.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included pain score and analgesic consumption during 6 h after operation,pain score and analgesic consumption during 6-24 h after operation,duration of sensory block (caudal block),side effects during 24 h after operation (postoperative nausea and vomiting and psycho-mimetic manifestations).Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software.Results Fifteen prospective randomized controlled trials involving 955 patients were included in our Meta-analysis.The patients were divided into 2 groups:control group ( n =455) and ketamine group ( n =500).The pain score and analgesic consumption during 6 h after operation were significantly decreased after general anesthesia with ketamine.The pain score during 6-24 h after operation and analgesic consumption during 6 h after operation were significantly decreased after local anesthesia with ketamine.The duration of sensory block was prolonged and the analgesic consumption during 6 h after operation was significantly reduced after caudal block with ketamine.There was no significant difference in the incidence of postoperative nausea and vomiting and psycho-mimetic manifestations between the two groups.Conclusion The intensity of pain and analgesic requirement during 6 h after operation are significantly reduced under ketamine anesthesia in children.

Objective To investigate the incidence of renal injury caused by strong intensity military training in the navy.Methods One thousand three hundred and twenty servicemen of the navy were enrolled in the present study including 568 recruits and 752 veterans.Urine protein and hemoglobin were determined using the dry chemistry method after a five-kilometer armed field race.Urine samples were collected and centrifuged for erythrocyte count under microscope after training.Retinol binding protein(RBP) and N-acetyl-?-D-glucosaminidase(NAG) were measured by enzyme linked immunosorbent assay(ELISA).Detection of creatine kinase(CK) above 950U/L was assumed to be rhabdomyolysis positive.Results The average incidence of hematuria,hemoglobinuria and proteinuria was 2.1%,7.4% and 44 %,respectively,and the incidence of abnormal RBP and NAG was 57.3% and 57.1%,respectively.Significant difference in each of the indexes existed between the recruits and veterans(P

BACKGROUND: Hypertension is one of the most important risk factors for stroke, and brain focal renin-angiotensin system has been proved to play a vital role in the development of hypertension and stroke.OBJECTIVE: To observe the influence of long-term administration of losartan, an angiotensin-1 receptor antagonist, on the incidence of strokeprone spontaneous hypertension in rats.DESIGN: Randomized controlled experiment.SETTING: Renmin Hospital Affiliated to Wuhan University.MATERIALS: This experiment was carried out in Wuhan University between July 1999 and March 2001. Totally 26 six-week-old male rats with stroke-prone spontaneous hypertension and 8 Kyoto male Wistar rats were recruited in this experiment with the body mass of 144.5-182.1 g.METHODS: Totally 26 six-week-old male rats with spontaneous hypertension were randomized into stroke-Rrone spontaneous hypertension group (n=9) which received gastric perfusion of physiological saline at a dosage of 5 mL/d; losartan 10 mg/(kg·d) group of 9 rats which received gastric perfusion of losartan at a dosage of 10 mg/(kg ·d) and losartan 30 mg/(kg ·d)group of 8 rats which received gastric perfusion of losartan at a dosage of 30 mg/(kg·d). Rats in the three groups were provided with high-protein feed when entering the group, and drank 15 g/L salty water (5 mL/d) from the onset of week 2. At the same time, 8 six-week-old male Wistar rats were taken as normal controls to receive gastric perfusion of physiological saline at a dosage of 5 mL/d once a day; they took ordinary feed and drank running water. All rats lived with 12 hours' day-night alternation at room temperature of 18-20 ℃ and with humidity of 40%-50%. Totally 18weeks later, the incidence of stroke and BP changes were observed. The clinical manifestation of stroke was scored 1 if rats appeared few activities,with movements slightly reduced or excited; 2 score referred to very few activities, with movements obviously reduced or violently stimulated; 3score referred to inability to walk, lying motionless with melancholy symptoms; score 4 referred to paralysis and inability to stand, lateral or bilateral limb paralysis. Transmission electron microscope was used for histological observation of cell apoptosis in the brain.MAIN OUTCOME MEASURES: ① Observation of brain structure at week 18 when rats were decapitated. ② Results of nerve cell apoptosis detected with TUNEL technique. ③ Rat body mass, BP, as well as the incidence and changes of stroke were recorded.RESULTS: Totally 34 rats entered the result analysis. ① The incidence of stroke in the three groups: It was 100%, 22%, and 13%, respectively, in stroke-prone spontaneous hypertension group, losartan 10 mg/(kg·d) group,and losartan 30 mg/(kg·d) group. ② Score for stroke: The score was remarkably higher in stroke-prone spontaneous hypertension group than in losartan 10 mg/(kg·d) group and losartan 30 mg/(kg·d) group [(3.50±0.55,0.67±1.12, 0.38±0.74) minutes]. ③ Electron-microscopic observation: In stroke-prone spontaneous hypertension group, electron density was found increased in necrotic neurons; moreover, some nuclear membrane lost double-layer structure with ridges broken, even reduced or disappeared, displaying vacuolated changes. In losartan 30 mg/(kg·d) group and losartan 10 mg/(kg·d) group, most of neurons displayed basically normal morphology, with neuron chromatin evenly distributed and nuclear envelops regular, but there were still some neurons that had dense chromatin, with ridges broken and reduced. ④ Nerve cell apoptosis in the three groups: It was found obviously lower in normal group than in losartan 30 mg/(kg ·d)group, losartan 10 mg/(kg·d) group, and stroke-prone spontaneous hypertension group [(2.5±0.8, 13.9±4.3, 14.0±4.4, 52.0±16.7)%, P ＜ 0.05]. ⑤ BP changes: At week 18, BP was obviously lower in normal group than in losartan 30 mg/(kg·d) group, losartan 10 mg/(kg·d) group and strokeprone spontaneous hypertension group [(120.1±7.9, 169.4±10.1,216.7±8.3,225.5±6.8) mmHg (1 mm Hg=0.133 kPa), P ＜ 0.05]. ⑥ Changes of body mass: At week 18, body mass was obviously higher in normal group than in losartan 30 mg/(kg·d) group, losartan 10 mg/(kg·d) group, and stroke-prone spontaneous hypertension group [(313.3 ±10.1, 270.8 ± 10.4,258.7±12.7, 231.0±6.5) g, P ＜ 0.05].CONCLUSION: Losartan can obviously reduce the incidence of stroke and nerve cell apoptosis in rats with spontaneous hypertension, suggesting that losartan as an angiotensin-1 receptor antagonist may prevent and delay the onset of stroke through antagonizing angiotensin I receptor, thus exerting brain-protecting function.

Humans ; Lichen Planus, Oral ; psychology

This study was aimed to assess the proportion and causes of misdiagnosis of pancreatic cancer (PC), and the effects of misdiagnosis on and treatment of PC, so as to sum up experiences and improve the diagnosis and treatment. 1027 cases with confirmed diagnosis of PC were retrospectively analyzed in detail. The patients were divided into misdiagnosed group and a group with correct diagnosis. The relevant data of the two groups were analyzed by stastical methods, and the differences between them were assessed. It was found that 586 cases (57 1%) were misdiagnosed.Fifty five diseases were involved in misdiagnosis, among them gastritis and duodenitis, peptic ulcer, virus hepatitis, cholecystitis and cholelithiasis, chronic pancreatitis wese the commonest. The differences of duration of diagnosis, main symptoms, resection rate, and half year survival rate between misdiagnosed group and correct diagnosis group were significant. It is concluded that PC is often misdiagnosed as other diseases. Early diagnosis and treatment is critical to the prognosis. The physician should be aware that PC may present a veriety of clinical manifestations, and therefore he or she should analyze comprehensively the symptoms and signs in order to improve diagnosis and treatment.

To study the relationship between the occurrence of pancreatic cancer with diabetes mellitus, other medical conditions and familial history in Chinese population. A case control study comprising 493 histologically confirmed pancreatic cancer patients and 1031 hospital non neoplastic controls matched with age, sex and economical income was conducted. The value of odds ratio (OR) and its 95% confidence interval (CI) to estimate the relative risk of diabetes mellitus, other medical conditions and familial history were calculated. The results showed that ORs and 95%CIs of diabeties diagnosed 2 years prior to the diagnosis of pancreatic cancer, cholelithiasis, chronic pancreatitis, cancer history, pulmonary tuberculosis, Helicobacter pylori infection, family history of cancer and family history of diabetes mellitus were 4 64(2 05～10 49),4 12(2 81～6 04),18 38(6 33～53 35),9 47(4 97～18 06),4 21(2 30～7 72),1 14(0 45～2 89),2 01(1 29～3 14), 0 83(0 15～4 56) respectively. The p values of diabeties and cholelithiasis in logistic regression analysis were less than 0 05. The analysis suggested that diabetes mellitus, cholelithiasis, chronic pancreatitis, cancer history, pulmonary tuberculosis, and family history of cancer were risk factors of pancreatic cancer, whereas diabetes mellitus and cholelithiasis were the independent factors.

Smoking is presently the only generally accepted risk factor for pancreatic cancer. In recent studies, reproductive history has been associated with pancreatic cancer, but with contradictory results. In order to evaluate a possible association between age of first parturition and the number of births and pancreatic cancer, we conducted a case control study with a hospital background. Association between age of first parturition and the number of births and pancreatic cancer was found, and it remained after adjustment for cigarettes smoking, alcohol consumption, body mass index, cholelithiasis, cholecystectomy, diabetes mellitus, chronic pancreatitis and partial gastrectomy. Young age of first parturition and high reproductive history, such as 3 or more births were risk factors for pancreatic cancer.

The study was to analyze the correlation between pancreatic cancer and appendectomy, partial gastrectomy, cholecystectomy and tonsillectomy in Chinese population. Case control study was made comprising 493 pancreatic cancer patients confirmed by histology and 1031 hospitalized non neoplastic controls matched with age, sex, residing district, and economical income. The value of odds ratio (OR) and its 95% confidence interval (CI) were calaclated to estimate the relative risk of appendectomy, partial gastrectomy, cholecystectomy and tonsillectomy to the occurrence of pancreatic cancer, and logistic regression was conducted. The results showed that the risk of pancreatic cancer increased in patients who had had appendectomy, partial gastrectomy and cholecystectomy, and all the p values of trend test were

To study the clinical features of the pancreatic cancer (PC), clinical symptoms of 1027 diagnosed cases of PC were retrospectively analyzed in detail, including their dynamic changes with regards to the patients'sexes, ages, blood types, and tumor locations in the pancreas. The results showed that abdominal pain, jaundice and epigastric discomfort were the prevailing initial symptoms in these 1027 cases. Abdominal pain, jaundice, weight loss, and anorexia were the main symptoms. Unusual symptoms were seemed to be different in different patients. The clinical symptoms could be dramatically different with difference in patients′ age and tumor location. The blood type might also infhluence the clinical symptoms in certain degree. It is concluded that the clinical symptoms of the PC were atypical in general, but still there were some characteristics.The physician should grasp these characteristic symptoms in order to make an early diagnosis.

Diabetic cardiomyopathy(DCM) is a disease independently related with coronary artery atherosclerotic heart disease, hypertensive heart disease, valvular heart disease, congenital heart disease and other heart diseases that are uniquely associated with diabetes mellitus, and the pathological manifestations of DCM are mainly myocardial hypertrophy, interstitial fibrosis, necrosis and apoptosis.Endoplasmic reticulum is the central location of many important cellular functions, and endoplasmic reticulum swelling and functional disorder in diabetic cardiomyocytes, high blood sugar can cause endoplasmic reticulum stress, suggesting that endoplasmic reticulum stress(ERS) may be involved in the pathogenesis of diabetic cardiomyopathy and development.Based on this, this paper summarizes the progress of ERS in diabetic cardiomyopathy from the pathogenesis of diabetic cardiomyopathy, unfolding protein reaction and the related role of ERS in DCM.