Objective To investigate the relationship between the doses of epidural morphine administered for postoperative analgesia and postoperative urinary retention (POUR). Methods Sixty ASA Ⅰ patients aged < 20-56 yr undergoing atthroscopic knee operation under epidural anesthesia were randomly divided into 3 groups ( n = 20 each) : group Ⅰ and Ⅱ received epidural morphine 1 and 3 mg in 5 ml of normal saline (NS) respectively at the end of operation (group M1, M2 ); group Ⅲ received NS 5 ml instead of morphine (group C). Urinary retention was defined as the patient could not void, when bladder volume was ≥ 600 ml measured using ultrasound. Bladder urine volume was measured before anesthesia and at 4, 6, 8, 10 and 12 h after operation. The occurrence of urinary retention, the first postoperative voiding time, VAS scores and the incidences of vomiting and pruritus were recorded. Results The 3 groups were comparable with respect to age, M/F sex ratio, preoperative bladder urine volume, the amount of local anesthetic used during operation and duration. The incidences of urinary retention, vomiting and pruritus were 65%, 60% and 90% respectively in group M2 and significantly higher than those in the other 2 groups. The first postoperative voiding time was significantly longer in group M2 than in the other 2 groups. VAS scores were significantly lower in group M1 and M2 than in group C. There was no significant difference in VAS scores between group M1 and M2. Conclusion Epidural morphine increases the incidence of POUR in a dose-dependent manner, and 1 mg is the recommended dose.

The McAb 2H3 to different target cells was investigated by using an indirect ELISA meth-ods. The result showed that the 2H3 could bind to the ConA actiuated mouse T lymphoblastsand CTLL-2 cells (an IL-2 dependent T cell line)but not to the resting mouse splenocytes,lymph node cells and thymocytes. The binding of FITC-anti-IL-2R to the activated mouse spleencells and CTLL-2 cells was seen as tested by immunofluorescence analysis. This binding reactionwas blocked when the target cells were previously treated with 2H3, but the binding reaction ofFITC-anti-Ia McAb to these target cells couldn't be blocded by 2H3. Further analysis of the tar-get antigen by using Western-Blotting technigue showed the molecular weight of this antihenrecognized by 2H3 was of 50～60KD in reducing condition. According to these data, target anti-gen recognized by the McAb 2H3 may be the IL-2R molecule(P_(55) mole cule)on the cell surface.

Objective To investigate the value of interleukin-6 (IL-6) level as a prognostic indicator in diabetic ketoacidosis (DKA) patients.Methods Data of 88 cases of DKA in Sir Run Run Shaw Hospital collected from June 1,2010 to December 31,2012 were analyzed prospectively.They were divided into two groups according to the survival of patients followed up for 28 days:non-survival group (n =12) and survival group (n =76).Serum levels of IL-6,lactate,base excess and APACHE Ⅱ score in 24 hours after admission were compared between two groups by independent t test.The receiver operating characteristic (ROC) curve was plotted to analyze the performance of IL-6 as a prognostic indicator in the early stage of DKA.Correlations between IL-6 value and lactate,base excess,APACHE Ⅱ score were analyzed.Results The IL-6 values were elevated obviously in non-survival group.The ROC of IL-6 had an area under curve (AUC) of 0.783,and the cut-off value of IL-6 for the death followed up for 28 days was 448.9 ng/L.In all patients,IL-6 values and APACHE Ⅱ score showed a positive correlation between them (r =0.919,P =0.005),and also positive correlations existed between IL-6 and lactate as well as base excess (r=0.922,P=0.003; r=0.887,P=0.015)in24 hours.Conclusions IL-6 value is a reliable prognostic indicator in the early stage of DKA.

Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty.

Objective To discuss the relative importance of the 5 English skills and to compare medical majors' main purposes of English listening and medical majors' actual usage of English listening.Methods A questionnaire survey was conducted among medical sophomores in the Second Military Medical University who had finished the college English course.Data were processed by Excel 2007 and statistical results were described by percentage.Results Participants paid enough attention to five English skills,especially the listening ability; a total of 98.4％ of the participants recognized the importance of listening skills.Students' learning needs and course arrangements are mainly about examinations,graduations future study.Medical English course arrangements cannot satisfy the learning needs.Conclusions Students recognized the importance of five English skills,especially the listening skills.Students' learning needs are basically examination-oriented and the medical English course is not enough for the students.Suggestions on the English teaching,course design and the integration of college English and medical English are put forward in the paper.

Based on the theory of self-access learning,this paper makes an investigation into some factors which have great influence on the fostering of learner autonomy by the case study of the online English writing course.

Graduates are generally weak in oral English. Some measures have been taken in graduate oral English course since 2005 in SMMU and proved effective by the questionnaire completed later.

Objective To determine the factors contributing to the development of deep vein thrombosis (DVT) in the lower extremity in patients after hip or knee arthroplasty and hip fracture internal fixation.Methods One hundred and forty-seven consecutive patients receiving hip or knee arthroplasty and hip fracture internal fixation from 2004 to 2005 were included in this study. Their age ranged from 33 to 92 years. Duplex color ultrasonic inspection was performed on veins of the bilateral lower extremities before operation and 2 weeks after operation for detection of DVT. The patients were divided into a DVT group and a DVT-free group based on the development of DVT after operation. Detailed perioperative clinical information about the patients, surgery and anesthesia was collected.Results Lower extremity DVT was found in 42.2% of the patients after operation, while the incidence of proximal DVT was 2.7%. Compared with the DVT-free group, the usage rate and dosage of ephedrine increased significantly, the duration of anesthesia was significantly longer, and the white blood cell count (WBC) on the 1st postoperative day and the highest WBC count were significantly higher in the DVT group(P＜0.05). Logistic regression analysis indicated that the above factors were closely related to DVT.Conclusion Duration of anesthesia ＞ 3 h, ephedrine administration and a marked increase in WBC count after operation are the risk factors for DVT in the lower extremities in patients after hip or knee arthroplasty and hip fracture internal fixation.

Objective To investigate the effect of recombinant intestinal trefoil factor(rITF)on the intestinal mucosa of acute necrotizing pancreatitis(ANP)rats and explore the mechanism.Methods 60 male SD rats were randomly divided into control group(n=20),ANP group(n=20),rITF group(n=20).ANP was induced by retrograde injection of 5%sodium taurocholate(100μl/100 g)into biliopancreatic duct.Rats in rITF group were injected with rITF(0.5 mg/100 g)before and after ANP induction.The rats in ANP group and control group received same amount of normal sailne.Each group were sacrificed 12 h or 24 h later.respectively.Blood sample was taken to determine the serum level of amylase.Terminal ileum was resected to observe the pathologic changes;immunohistochemistry method was applied to detect the activity of NF-κB;the expression of TNF-α mRNA,ICAM-1 mRNA in intestinal mucosa was measured by RT-PCR.Results Intestinal injury score of ANP group was higher than that ofcontrol group(P＜0.05),intestinal injury score of ANP 12 h group was higher than that of rITF 12 h group(P＜0.05),but there was no significant difference between ANP 24 h group and rITF 24 h group.The number of positive NF-κB cells was 26±4,55±8,49±4,respectively;the relatively expression of TNF-α mRNA in terminal ileum was 0.050±0.005,1.040±0.031 and 0.792±0.0256,respectively;the relatively expression of ICAM-1 mBNA was 0.045±0.010,0.795±0.037 and 0.400±0.031,respectively,in control group,ANP group and rITF 12 h group.The corresponding values in the ANP group were significantly increased compared with those values in the control group (P＜0.05 or P＜0.01).Conclusions rITF may protect the intestinal mucosa.the mechanism may include inhibit NF-κB activation,down-regulate TiNF-α mBNA,ICAM-1 mRNA expression.

ObjectiveTo explore the effects and underlying mechanisms of acid sensing ion channels (ASICs) on pain behavior in a rat model of post-incision pain.MethodsFifty-eight adult male Sprague Dawley rats were used in this study,four rats were used for immunofluorescence test,thirty rats were employed for pain behavior test,and twenty-four rats were used for Western blot.Rats used for pain behavior test and Western blot were randomly divided into 3 groups:control group ( C group),incision pain model group ( I group) and amiloride group (A group).Plantar skin of rats in A group were infiltrated with 20 μl(200 μg)amiloride solution.Paw withdrawal mechanical threshold(PWMT) and paw withdrawal thermal latency(PWTL) of all rats in pain behavior test was tested at 24 h preoperative,2 h,4 h,8 h,12 h,24 h postoperative.Western blot was tested at 4 h postoperative.ResultsImmunofluorescence test displayed ASIC3 was expressed in plantar skin of all rats.The basal level of PWMT and PWTL of all rats in three groups was C group( (23.15 ± 5.10) g,( 11.32 ± 1.21 ) s),I group ( (23.26 ± 5.69) g,( 11.75 ± 2.01 ) s),A group ( (23.63 ± 4.96 ) g,( 11.47 ± 1.96) s) respectively,which was no significantly difference (P ＞ 0.05 ).PWMT and PWTL of I group and A group was significantly lower than that of C group at all time points postoperative (P ＜ 0.05) ; PWMT and PWTL of A group was at 2 h( ( 13.75 ±3.25)g,(9.96±1.32)s),4h((14.05±3.75)g,(9.17±2.11)s),8 h((9.75 ±2.74)g,(8.11 ±1.22)s)postoperative,which was significantly higher than that of I group (P ＜ 0.05 ).Compared with that of C group,the level of pERK1/2 expression was significantly increased in I group at 4 h postoperative (P ＜ 0.05 ),which could be inhibited by amiloride local infiltration (P ＜ 0.05 ).ConclusionASIC3 can mediate incision pain in a rat model of post-incision pain,through pERK1/2 signaling pathway,which can be inhibited by amiloride.