Objective To esplore the effecf and the practical utility of the postoperative nausea and vomiting intensity scale for Chinese patients with laparoscopic operation .Methods Ninety patients with ASA I-II,Apfel≥2 were enrolled .Interviews were carried out at 6 and 24 hours postoperatively .Measurements included the PONV Inten-sity Scale,nausea and pain visual analogue scale .Quality of Recovery Score and antiemetic were used .The patients whose PONV intensity score ≥50 were assessed by PONV intensity scale and PONV VAS .Results There was signif-icant difference of the occurrence of clinical PONV between the patients with Apfel ≥3 and those with Apfel=2(P<0.05).The PONV Intensity Scale had a stronger correlation with PONV VAS ,r=0.946(P<0.01).The PONV In-tensity Scale had a stronger correlation with QOR,r=-0.937(P<0.01).Patients with clinically important PONV at 24 hours required more antiemetic therapy (P=0.024).PONV rate of the patients with a clinically significant score VS those without a clinically significant score was 80%VS 18%(P<0.05).Conclusion PONV intensity scale can distinguish trivial from clinically important PONV availably in Chinese Laparoscopic operation .It is more reliable than PONV VAS.Patients with clinically important PONV required more antiemetic therapy .Clinically important PONV ,as determined by the PONV Intensity Scale ,was associated with a poor quality of recovery .

Objective To analyse the effect of progesterone on peripheral blood corticotropin releasing hormone ( CRH ) and delivery time in women with premature rupture of membranes ( PROM ) .Methods 80 patients who were diagnosed with PROM in Department of Obstetrics and Gynecology, China Medical University were collected.Randomly divided into dexamethasone (DEX) group, dexamethasone plus progesterone (DEX+P) group, progesterone ( P) group and control group, three groups were detected on admission, admission 24 h, 48 h on peripheral white blood cell count, C-reaction protein, CRH level and time of delivery, neonatal weight, and analysis of CRH the level of the correlation and delivery time.Results Compared with the other three groups, the level of CRH in peripheral blood of DEX group were higher (P<0.05);CRH (P<0.05) increased faster;shorter delivery time (P<0.05); the level of CRH was negatively correlated with delivery time (r=-0.832, P<0.05).The results were statistically significant.Conclusion Dexamethasone treatment can make the premature rupture of fetal membranes of peripheral blood CRH levels rise, shorten the delivery time, progesterone can inhibit this process.

Objective To observe the effect of plasma exchange (PE)therapy for removing serum interleukin-6 (IL-6),tumor necrosis factor alpha (TNFα),and interferon gamma (IFNγ)in patients with liver failure,and to assess the value of artificial liver support system in the treatment of liver failure.Methods The study included 36 patients with liver failure who were hospitalized in the First Affiliated Hospi-tal of Bengbu Medical College from February 2012 to February 2013.Blood samples were collected before PE and the next morning after mul-tiple treatments.Plasma TNFα,IL-6,and IFNγlevels were measured by ELISA.Between-group comparison of measurement data before and after treatment was made by independent-samples t test,and comparison of mean values between groups was made by analysis of vari-ance.Results All the 36 liver failure patients had significantly lower levels of TNFα(381.23 ±190.57 ng/L vs 274.12 ±212.30 ng/L,P<0.05),IL-6 (77.9 ±83.09 ng/L vs 54.8 ±63.32 ng/L,P<0.05),and IFNγ(534.65 ±471.19 ng/L vs 259.65 ±312.26 ng/L,P<0.05)after treatment than before treatment.According to the severity of clinical manifestations,the patients with subacute or acute-on-chronic (subacute)liver failure were divided into early stage,middle stage,and advanced stage groups.There were significant differ-ences in IL-6 and TNFαdecreases between the early stage,middle stage,and advanced stage groups (P<0.05).IFNγdecrease signifi-cantly differed between the early stage or middle stage group and advanced stage group (P<0.05),but not between the former two groups (P>0.05).After PE therapy,29 out of 36 liver failure patients recovered well,while the remaining 7 patients deteriorated.The recovered group had significantly greater decreases in TNFα(122.58 ±57.64 ng/L vs 42.45 ±19.86 ng/L,P<0.05),IL-6 (26.93 ±7.25 ng/L vs 6.71 ±3.55 ng/L,P<0.05),and IFNγ(284.06 ±94.31 ng/L vs 217.47 ±45.76 ng/L,P<0.05)than the deteriorated group.The response rates of patients with acute,subacute,acute -on -chronic,and chronic liver failure were 66.67%,85.71%,86.36%,and 50%,respectively.Conclusion Continuous artificial liver PE therapy can effectively remove pro-inflammatory cytokines from plasma and thus improve the clinical outcomes of patients with liver failure.

To raise clinical curative effect through quantitative and synthesize analysis of Traditional Chinese Medicine (TCM). According to Zhongjing’s medicine usage regulation and the author’s clinical fulfillment, a generalization, contrast and synthesize analysis among the same kind medicines is carried on in the text. It put forward the conception of "First-line medicine" for the first time and carried on detailed treatise of its nature, effect, classification, application and regulation. Meanwhile, the important role and function of "First-line medicine" is conf irmed in the text, and hope it is wished to helpful to the usage of TCM in clinical practice.

Objective To study the changes rule of serum procalcitonin (PCT) and PCT clearance rate (PCTc) in patients with severe craniocerebral injury complicated with pulmonary infection and analyze the values of PCT and PCTc in the patients' therapeutic effect and prognosis.Methods A retrospective controlled analysis was conducted, the clinical data of 58 patients with severe craniocerebral injury complicated with pulmonary infection admitted into the Department of Neurology of the Forth Hospital of Tianjin from December 2012 to December 2016 were collected, and within 24 hours after definite diagnosis (before treatment) and after treatment for 1, 3, 7 days, the levels of PCT and percentages of PCTc were measured by rapid semi quantitative method. According to the therapeutic results of treatments, including antibiotics, airway management, nutritional support, etc., the patients were divided into an effective group and a deteriorative group. The changes rule of levels of serum PCT and percentages of PCTc before treatment and 1, 3, 7 days after treatment were dynamically evaluated. The receiver operating characteristic curve (ROC curve) was drawn and the area under the ROC curve (AUC) was calculated, and the sensitivity, specificity and diagnostic accordance rate of the combined treatment were assessed.Results Of 58 cases 32 (55.2%) after active treatment had promising therapeutic results or better prognosis (effective group), and the disease situations in 26 patients (44.8%) were deteriorating(deteriorative group). With prolonged treatment in effective group, the serum level of PCT was decreased gradually, while the deteriorative group showed a tendency firstly decreased and then increased, reaching to the valley on the 1st day after treatment, on the 3rd day beginning to increase and reaching the peak on the 7th day; the levels of PCT in effective group were significantly lower than those in deteriorative group at each time point after treatment on 1, 3, 7 days (μg/L: 1 day was 2.67±0.77 vs. 3.24±0.90, 3 days was 1.38±0.63 vs. 3.31±0.85, 7 days was 0.61±0.16 vs. 3.82±1.05, allP < 0.05); The PCTc rates in the effective group were significantly higher than those in the deteriorative group at each time point on 1, 3 and 7 d [1 day was (17.53±9.94)% vs. (12.31±7.55)%, 3 days was (60.34±13.55)% vs. (8.31±4.69)%, 7 days was (82.47±15.11)% vs. (-5.82±9.60)%, allP < 0.05]. After treatment for 3 days, 7 days, the AUC of PCT were 0.532 and 0.688, and the diagnosis cut-off values were 2.42 and 1.86 respectively; on 1, 3, 7 days after treatment, the AUC of PCTc were 0.529, 0.547, 0.775, and the diagnostic cut-off values were 15.67, 35.94 and 70.55 respectively. Further the final outcome was recognized as the gold standard: after treatment for 7 days, the PCT sensitivity was 80.1%, specificity 75%, the coincidence rate 77.6%; 7 days after treatment, the sensitivity of PCTc was 92.3%, the specificity 87.5%, the coincidencerate 89.7%.Conclusion The dynamic observations on serum PCT and PCTc have relatively good evaluation values on the therapeutic effect and prognosis of patients with severe craniocerebral injury complicated with pulmonary infection.

Objective To explore the security of spinal anesthesia by observing the pefioperation serum troponin T in the elderly patients with coronary heart disease who underwent spinal anesthesia.Methods 40 case8 were divided into two groups according to the elderly patients with or without the history of coronary heart disease.Group Ⅰ 0f 20 cases were the patients with the history of coronary heart disease.Group Ⅱ of 20 cases were the patients without the history of coronary heart disease.Both groups were undertaken single spinal anesthesia combined with epidural anesthesia.The blood samples were collected at the time of perioperation,the end of the operation and 24 hours after surgery.The serum troponin T Was tested by Roche fully automated ehemiluminescent analyzer E170.The symptoms and signs of the coronary heart disease in the patient were observed.And the age,operation time,anesthesia lever,the amount of bleeding and transfusion were recorded,and at the same time,electrocardiogram,heart rate,pulse,cerebral oxygen saturation were monitored.Results There was no significant difference between two groups in age,operation time,anesthesia lever,the amount of bleeding and transfusion,heart rate,pulse,cerebral oxygen saturation.There was no significant difference between two groups in seram troponin T.No symptoms and signs of the coronary heart disease were observed in two groups.There Was no significant difference between two groups in constituent ratio of positive rate of serum troponin T.There was one case in each group that serum lroponin T was more than reference value (0.010μg/L)during the perioperation while the patient was no discomfort.Conclusion Spinal anesthesia has no impact on the change of perioperative 8ertlm troponin T in the elderly patients with coronary heart disease.

Objective To observe the treatment effect of nicardipine for the presence of hypertension responses during thyroidectomy under cervical plexus nerve block.Methods Patient without hypertension before the operation was brought into if he received thyroidectomy under cervical plexus nerve block,and with the presence of hypertension responses during the operation,and without effect after injected innovar one dose or dolantin 50mg by vein when the blood pressure was over 160/90mmHg.20 patients according to the criterion mention above were dripped nicardipine 20?g/kg by vein.The SBP,DBP,MAP,HR,SpO_2 and ECG were recorded at 3min,5min,15min,30min,45min after injection and the side effects were also recorded.Results The SBP,DBP,MAP of all patients were fallen distinctly at 3min after injection,and reached lowest at 5min.The blood pressures were steady at other points.There was significantly difference between the point before and after injection(P

Objective To observe the therapeutic effect of tramadol combined with fentanyl in patient controlled intravenous analgesia after nucleotomy of intervertebral disc.Methods 60 patients under general anesthesia,scheduled for nucleotomy of intervertebral disc,were randomly divided into three group(n=20):group tramadol(group T),group fentanyl(group F) and group tramadol+fentanyl(group TF).All patients were received patient controlled intravenous analgesia by loading dose+background dose+PCA bolus dose.The BP,HR,RR,VAS at 6,12,24,48h of postoperation were observed.The sedation score in 24h,average effective-press times and drug dose in 48h of postoperation were recorded.The incidence of nausea and vomiting during 24h of postoperation were observed.Results It had no significantly difference of BP,HR,RR,VAS among three groups.The average effective-press times of group TF (8?2) were significantly less than those of group T (14?3) and group F (12?3).The drug dose of 48h was tramadol (17.9?1.5)mg/kg(group T),fentanyl (16.8?1.5)?g/kg(group F) and tramadol (11.5?0.7)mg/kg+fentanyl (9.1?0.7)?g/kg(group TF).The drug dose of group TF showed significant difference compared with others.The sedation score in group F was the highest,it had significant difference compared with the other two group.The frequency of nausea and vomiting in group T was significantly more than that in others.Conclusion Tramadol or fentanyl gived alone can afford the same satisfied analgesic effect on nucleotomy of intervertebral disc.But there is high nausea-vomiting frequency in tramadol and strong sedation frequency in fentanyl.Tramadol combined with a little opioid fentanyl can afford more satisfying analgesic effect,and is provided with advantage in less drug and side-effect.

BACKGROUND:Perioperative hypothermia may lead to coagulation function for patients undergoing total knee arthroplasty,and an increase in blood loss.OBJECTIVE:To compare the influence of temperature protection with non-temperature protection on coagulation function in patients undergoing total knee arthroplasty.METHODS:Forty ASA Ⅰ-Ⅱ patients scheduled for total knee arthroplasty were randomly divided into temperature protection and non-temperature protection groups (n=20 per group).The patients in the temperature protection group underwent heat-preservation including preheating room temperature,actively blanket warmer,were infused or flushed with fluids of 37 ℃ by heating apparatus;the patients in the non-temperature protection group received full-body-covered cotton quilt only.The nasopharyngeal temperature were detected at postoperative 10 minutes,intraoperative 1 hour and postoperative 1 hour,and 1.25 mL of venous blood were collected to detect the fibrin formation time,blood clot formation time,and maximum amplitude using thrombelastography.Additionally,the intraoperative blood loss and volume of drainage at postoperative 24 hours were recorded.RESULTS AND CONCLUSION:(1) The nasopharyngeal temperature in the non-temperature protection group was significantly lower than that in the temperature protection group at postoperative 1 hour (P ＜ 0.05).(2) The intraoperative blood loss and volume of drainage at postoperative 24 hours in the temperature protection group were significantly less than those in the non-temperature protection group (P ＜ 0.05).(3) Compared with the temperature protection group,fibrin formation time and blood clot formation time at intraoperative and postoperative 1 hour were significantly lengthened,and maximum amplitude at postoperative 1 hour was significantly shortened in the non-temperature protection group (P ＜ 0.05).(4) These findings show that intraoperative hypothermia can weaken platelet function,inhibit coagulation factor activity,and increase the amount of blood loss and drainage.In the meanwhile,heat-preservation is able to reduce the loss of body heat,improve coagulation function and reduce blood loss for patients undergoing knee replacement.

Objective To investigate the effects of TLR4 on the radiosensitivity of tumor cells.Methods The cell lines of RAW264.7,Lewis,MFC,Hepal-6,Bl6,and NIH3T3 were irradiated with 5 Gy X-rays or sham-irradiated.24 h after irradiation,the expression of TLR4 was detected by flow cytometry.According to the TKR4 level,cells were divided into three groups:without treatment,LPS stimulation and TAK242 block.CCK-8 kit and Annexin-V Apoptosis Kit were used to detect cell proliferation,apoptosis and cell cycle distribution of each group.Results After 24 h of 5 Gy ionizing radiation,TLR4 was significantly increased in Lewis cells (t =-8.68,P ＜0.01) but decreased in MFC cells (t =25.8,P ＜ 0.01) and had no significant changes in Hepal-6,B16 and RAW264.7 cells.In addition,the proliferation vitality (t =57.62,-6.23,P ＜ 0.01) and survival fraction (t =13.37,19.24,P ＜ 0.01) of the Lewis and MFC cells were reduced especially for the TLR4-blocked cells,and the apoptosis rates of both Lewis (t=-167.85,P＜0.01) and MFC cells (t=-26.45,P＜0.01) were elevated.The percentages of G0/G1 phase and S phase Lewis cells were significant increased (t =8.68,14.89,P ＜ 0.01) but its G2/M phase were reduced (t =-37.48,P ＜ 0.01).However,the percentages of G0/G1 phase and S phase MFC cells were obviously reduced (t =20.31,4.48,P ＜ 0.01) and G2/M phase increased (t =-13.06,P ＜ 0.01).For both cell lines of Lewis and MFC,the cycle distribution of TAK242 and LPS groups didn't change significantly.Conclusions High expression TLR4 in the Lewis cells is related to cell proliferation and apoptosis but not cell cycle distribution,and hence TLR4 could influence the radiosensitivity of tumor cells.