Objective To compare the influences of combined spinal-epidural anesthesia(CSEA)and general anesthesia(GA)on patients who underwent laparoscopic gynecological operation.Methods A total of 60 patients of ASA Ⅰ～Ⅱ,were divided into two groups:the CSEA group and the general anesthesia group.Each group consisted of 30 patients.Glucose and cortisol levels were determined before anesthesia,10 minutes after anesthesia,10 minutes after pneumoperironeum and 10 minutes after abdominal deflation.Results No significant differences existed between the two groups on age,weight,operation time,pneumoperitoneum time,time to regain consciousness after operation,HR,SpO2,ECG and MABP(P＞0.05)No significant difference was found in cortisol level between two groups at various time points(P＞0.05).In the general anesthesia group,glucose level at 10 minutes after pneumoperitoneum was significantly lower than that before anesthesia(P＜0.05),but no significant difference was found in glucose level between the two groups at other time points(P＞0 05).At the same time,significant difference was found in postoperative complication rate between two groups(P＜0.01).Conclusion Both CSEA and general anesthesia can effectively inhibit the patients'stress response in laparoscopic gynecological operation.

Trospium chloride is an anticholinergic agent with predominantly peripheral nonselective antimuscarinic activity and water solubility. It has potential therapeutic value in decreasing detrusor contracivity and tonity, so as to increase predominantly mean maximal bladder capacity and compliance. Multicenter studys showed that the tolerability and efficacy of trospium chloride was as same as oxybutynin and better than toterodine. Adverse events of trospium chloride is the same as other anticholinergic agents, however its specially constitutional feature so as not to have toxicity to central nervous system. Trospium chloride has potential therapeutic value in the neurourological rehabilitation.

Objective To investigate the prevention of the antelocation of nursing intervention to constipation in patients with acute myocardial infarction(AMI).Methods 70 AMI patients were divided randomly into the test group and control group with 35 patients in each group.The control group received the AMI usual care and drugs;the test group received the antelocation of nursing intervention to constipation besides the usual care and drugs.Results The death rate and the incidence of abdominal distension,abdominal pain,anxiety,and complication of the patients in the test group were lower than those of the patients in the control group(P<0.05).Conclusion The antelocation of nursing intervention to constipation can decrease the death rate of AMI patients.

Goiter, Nodular ; Humans ; Thyroid Neoplasms

Objective:To investigate the structure of alveolar bone around incisors in patients with verical facial type of skeletal ClassⅡ by CBCT.Methods:60 skeletal Class Ⅱ patients were divided into low angle,average angle and high angle cases(n =20)by FMA.CBCT scanning was made and the thickness of the labial and lingual alveolar bone around the incisors in each subject was meas-ured.The measurements were analyzed using ANOVA.Results:The total width of alveolar bone at the root apical level of maxillary and mandibular incisors,the lingual thickness of alveolar bone at the root midpoint of maxillary incisors and labial thickness of alveolar bone at the root midpoint of mandibular incisors in the high angle cases were thinner than that in the average and low angle cases(P <0.05),but there was no significant difference in labial thickness of alveolar bone at the crest among 3 groups.Conclusion:The alveo-lar bone thickness around incisors of high angle patients is thinner,more attention should be paid for the alveolar bone absorpation and tooth root exposure in these patients.

Objective:To analyze the craniofacial morphology characeristics of patients with peg-shaped upper lateral incisors. Methods:1 13 patients,aged 12 ~28 years,with peg-shaped upper lateral incisors were included,lateral cephalograms were taken and analyzed cephalometrically.Data were statistically analysed.Results:The sagittal facial patterns were skeletal Class Ⅰ(40.71%),skeletal Class Ⅱ(9.73%)and skeletal Class Ⅲ(49.56%).The vertical skeletal patterns were average vertical type (41.59%),high vertical type(18.58%)and low vertical type(39.82%).SNA,ANB,Ptm-A(mm),U1-SN,L1-NB,UL-EP were smaller(P<0.05)and SNB,PP-GoGn,SN-MP,Y axis,U1-L1,U1-NA,L1-MP and Z angles were increased(P<0.05).Conclu-sion:Patients with peg-shaped upper lateral incisors show Class Ⅲ skeletal pattern with maxillary retrognathia and mandibular prog-nathism.

Objective To study effect of TCM-based syndrome differentiation combined with diet nursing and point massage on insomnia.Methods Five hundred and twelve patients with insomnia were randomized into control group(n=85)and intervention group (n=67).The patients in both groups received treatment by TCM-based syndrome differentiation.Besides,the control group was given conventional nursing while those in the intervention group received diet nursing and point massage.The two groups were compared in three months in terms of sleep quality and curative effect.Results In comparisons of sleep quality index,the two groups both had statistically significant improvements respectively(both P<0.05).In terms of time to sleep, duration of sleep an sleep efficacy and Pittsburg sleep quality index,the intervention group scored significantly lower than the control group(all P<0.05).In terms of curative effect,the intervention group was significantly higher than the control group(P<0.05).Conclusion The method of TCM-based syndrome differentiation combined with diet nursing and point massage is effective in improving the sleep quality of those with insomnia.

A wide range of computer and internet applications impact on people's lifestyles andways of thinking profoundly, Internet acculturation is an important research issue in the information age.By the literature review,this paper summed up the themes of medical students' internet acculturation:in-ternet addiction disorder research,internet morality anomie research and internet learning adaptation re-search.Some suggestions for future research were put forward at last.

Objective To investigate the effect of deltaNp63(ΔNp63) silencing on the proliferation of pancreatic cancer PANC1 cells.Methods ΔNp63 mRNA level in 23 pairs of pancreatic cancer and adjacent tissue specimen was detected by real-time PCR, andΔNp63 protein in human normal pancreatic ductal cell line HPDE6-C7 and pancreatic cancer cell line PANC1, CFPAC1 and BXPC3 was detected by Western blot. PANC1 cells were transfectedΔNp63 specific siRNA (ΔNp63-siRNA ) and scramble siRNA ( Con-siRNA ) using liposome, and untransfected cells served as control.ΔNp63 mRNA and protein was detected by real-time PCR and Western blot to validate the silencing ofΔNp63 expression.MTT assay and BrdU method were used to detect the proliferation and DNA synthesis of transfected PANC1 cells.Results TheΔNp63 mRNA expression in pancreatic cancer tissues and matched adjacent normal tissues was 0.99 ± 0.07 and 0.70 ±0.07, respectively.ΔNp63 mRNA expression in pancreatic cancer tissue was significantly up-regulated compared with that in the normal tissue (P=0.0034).TheΔNp63 protein expression in HPDE6-C7, PANC1, CFPAC-1 and BxPC3 cells was 0.97 ±0.09,3.06 ±0.16,2.57 ±0.11 and 2.45 ±0.08, respectively.TheΔNp63 protein level in pancreatic cancer cells were higher than that in HPDE6-C7 cells (P<0.001).ΔNp63 mRNA level in control, Con-siRNA and ΔNp63-siRNA group was 0.97 ±0.07,0.97 ±0.07 and 0.28 ±0.03, respectively, andΔNp63 protein expression level was 0.97 ±0.06,1.00 ±0.10 and 0.26 ±0.03.The expression ofΔNp63 mRNA and protein inΔNp63-siRNA group were significantly down-regulated comparing with those in Con-siRNA group (P<0.01).Significant inhibition on cell proliferation was observed in ΔNp63-siRNA group, which was statistically different from that in control and Con-siRNA group.The A490 value (DNA synthesis) of control, Con-siRNA andΔNp63-siRNA group was 0.55 ±0.04, 0.56 ±0.01 and 0.55 ±0.00 at 24 h after transfection, and 0.84 ±0.05,0.87 ±0.07 and 0.71 ±0.05 at 48 h after transfection.The DNA synthesis inΔNp63-siRNA group was significantly down-regulated compared with that in control and Con-siRNA group (P<0.05).Conclusions Knockdown ofΔNp63 could greatly inhibit the proliferation and DNA synthesis of pancreatic cancer PANC1 cells.

Objective To assess the clinical efficacy of vitrectomy with intravitreal ranibizumab (IVR) at different injection time for proliferative diabeticretinopathy (PDR).Methods This was a prospective,comparative,and randomized study.Ninety-seven eyes of 97 patients were enrolled and randomly assigned to three different treatment groups:30 eyes (30 patients) in the preoperative IVR group,32 eyes (32 patients) in the intraoperative IVR group and 35 eyes (35 patients) in the no IVR injection group.The best corrected visual acuity (BCVA) (F=0.18) and the grading of vitreous hemorrhage (x2 =1.39) before surgery did not differ significantly among the 3 groups,respectively (P ＞ 0.05).All eyes enrolled underwent conventional 23-gauge pars plana vitrectomy (PPV).The preoperative IVR group received intravitreal 0.5 mg/0.05 ml ranibizumab injection 3 to 7 days before PPV,intraoperative IVR group received intravitreal 0.5 mg/0.05 ml ranibizumab injection at the end of PPV and non-drug injection group received PPV only.Postoperative BCVA,fundus color photography,optical coherence tomography examination was performed in all eyes at 1 week and 1,3,6,9,12 months after surgery.Early RVH was defined as RVH occurred within 1 week to 1 month postoperatively;while late RVH was defined as RVH occurred 1 month later after the operation.Results The mean BCVA were all improved among the 3 groups compared with the preoperative vision at 1 month after operation.At the beginning of 3 months after surgery,the average BCVA of the preoperative injection group and the intraoperative injection group tended to stable;while 3 eyes in the non-drug injection group began to decreased.There was no significant difference in average BCVA at 1,3 and 12 months of follow-up periods among the 3 groups (F=1.42,1.17,0.26;P＞0.05).The incidences of early RVH were 16.7％,9.4％,28.6％ in the preoperative injection group,intraoperative injection group,and non-drug injection group,respectively (x2 =5.12,P＜0.05).The incidence of early RVH in the intraoperative injection group reduced compared to preoperative injection group and non-drug injection group (x2 =4.04,4.93;P＜0.05).The incidences of late RVH were 13.3％,9.4％,14.3％ in preoperative injection group,intraoperative injection group,and non-drug injection group,respectively (x2 =0.47,P＞0.05).The average centeral foveal thickness (CFT) decreased among the 3 groups in different degrees at 1 month when compared with that of 1 week after operation and the decreasing was statistically significant (F=59.50,P＜0.05).A subgroup pairwise analysis showed no significant difference of decreasing CFT in preoperative injection group compared with that of intraoperative injection group (t=0.23,P＞0.05).The average CFT of the 3 groups had different degrees of thickening at 3,6,9,12 months after surgery,and the increasingof CFT among the 3 groups were not differ significantly (F=2.92,2.86,3.07,3.12;P＞0.05).Conclusions The adjunctive use of IVR can reduce the incidence of early postoperative RVH in vitrectomy for PDR,decrease in macular thickness and obtain favorable visual recovery.The effect of preoperative IVR injection was slightly better than that of the intraoperative IVR injection.