Objective To observe the recovery efficiency of sufentanil and oxycodone hydrochloride in neurosurgical operation.Methods Total of 120 patients scheduled for microvascular decompression under general anesthesia were randomly divided into 4 groups to receive 0.03 mg·kg-1 oxycodone (group H1), 0.05 mg·kg-1 oxycodone (group H2), 0.08 mg·kg-1 oxycodone (group H3), and 0.08 μg·kg-1 sufentanil (group S).Each patient accepted 4 ng·mL-1 of remifentanil and 5-6 mg·kg-1·h-1 of propofol after induction to maintain bispectral index (BIS) value at 40-60.On starting to suture dura mater, oxycodone or sufentanil was given in various doses through intravenous route.The BIS value, the amount consumption of propofol, anesthesia and operation duration, and the drug delivery time of each group were recorded.The time of spontaneous breath recovery, awaking and extubation, verbal rating score (VRS) and sedation score (SS) at 10 min, 20 min, 30 min after operation as well as side-effects were also recorded.Results The VRS scores had no statistic difference among the groups at 10 min after operation, while the average scores of H1 were higher than those of H2 and H3 at 20, 30 min after operation.No statistic difference of the SS scores was showed among 4 groups at 10 min after operation, but it was lower in group H1 than those in group H3, and lower in group S than those in H2 at 20 min after operation;group H3 had a significantly higher SS scores than H1, H2 and S at 30 min after operation.Conclusion Oycodone hydrochloride 0.05 mg·kg-1 or sufentanil 0.08 μg·kg-1 can both provide satisfactory recovery quality in neurosurgical operation.

Objective To assess the effects of different doses of oxycodone hydrochloride on spontaneous breathing and consciousness level of patients,so as to provide theoretical basis for its clinical application.Sixty patients undergoing elective surgery were randomly divided into 3 groups:0.05 mg · kg-1 oxycodone group (group P1),0.1 mg· kg-1 oxycodone group (group P2),0.2 mg· kg-1 oxycodone group (group P3).Changes of respiratory rate (RR),end tidal carbon dioxide partial pressure (PETCO2),saturation of blood oxygen (SpO2) and bispectral index (BIS) were recorded in patients before injection (t0) and 1-15 min after injection (once per min);the Observer's Assessment of Alertness/Sedation Scale (OAA/S) were recorded.At the same time,the adverse reactions were observed after drug injection in each group.Results In 10 min after injection there were no significant differences in the RR,SpO2,PETCO2,BIS and OAA/S in group P1 as compared with those before injection (P＞0.05).The patients had no respiratory depression in group P1.In group P2,RR had a significant decrease (P＜0.05),BIS had decreased but were greater than 85;there were no significant differences in the SpO2,PETCO2 and OAA/S (P＞0.05).The P2 group had 3 cases with respiratory frequency＜10 per min,but SpO2 were all greater than 94％.In group P3,There were significant differences in the RR,SpO2,PETCO2,BIS and OAA/S (P＜0.05).The P3 group had 12 cases of respiratory frequency ＜10 per min,at the same time there were 8 patients with SpO2 less than 94％.With the increasing dose,the frequency of respiratory inhibition increased,and there were statistical differences (P＜ 0.05).In 15 min after injection,RR,SpO2,PETCO2,BIS and OAA/S were not significantly different in group P1 and P2 as compared with those before injection (P＞0.05).In group P3,RR was significantly different after injection (P＜0.05).There were no significant differences in the SpO2,PETCO2,BIS and OAA/S in group P3 after injection (P＞0.05).No patients complained with chest wall stiffness,nausea and vomiting,cough and other adverse reactions in group P 1 and P2.In group P3,three patients had nausea 5 min after injection,two patients complained of chest skin itching but no skin flushing.Conclusion With the increasing dose,effect of oxycodone hydrochloride on breathing and consciousness level of patients gradually increased.Injection of oxycodone hydrochloride 0.05 mg · kg-1 had no obvious effect on breathing and consciousness.After injection of oxycodone hydrochloride 0.1 and 0.2 mg · kg-1 for 5 to 10 min,respiration inhibition and sedative effect were the most obvious.Fifteen min after injection,the 0.1 mg · kg-1 dose group recovered to the level before,the respiratory rate of the 0.2 mg · kg-1 dose group was still lower than that before the injection.

ObjectiveTo investigate the effect of preoperative sleep disturbance on the efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery.MethodsNinety-six ASA Ⅰ or Ⅱ patients of both sexes aged 20-60 yr weighing 50-80 kg undergoing endoscopic nasal surgery were enrolled in this study.Pittsburg sleep quality index was used to evaluate long-term sleep quality before hospitalization and Athens sleep quality index was used to evaluate short-term sleep quality in hospital.The patients were divided into 4 groups according to the types of preoperative sleep disturbance ( n =24 each):group Ⅰ no sleep disturbance;group Ⅱ long-term sleep disturbance; group Ⅲ acute short-term sleep disturbance; group Ⅳ long-term + acute short-term sleep disturbance.Anesthesia was induced with sufentanil,propofol and cis-atracurium and maintained with iv infusion of remifentanil and propofol.The patients were intubated and mechanically ventilated.PETCO2 was maintained at 30-35 nun Hg.Controlled hypoteasion was performed with nicardipine,MAP was maintained at 50-70 mm Hg and HR at 60-90 bpm during operation.The patients received iv flurbiprofen 50 mg at 15 min before the end of operation for postoperative analgesia.When VAS score was more than 3 during the fnrst 6 h after operation,flurbiprofen 50 mg was given iv as rescue analgesic.ResultsThe incidence of rescue analgesic administered after operation was significantly larger in groups Ⅱ,Ⅲ and Ⅳ than in group Ⅰ,and in group Ⅳ than in groups Ⅱ and Ⅲ.There was no significant difference in the incidence of rescue analgesic administered during the first 6 h after operation between groups Ⅱ and Ⅲ.ConclusionPreoperative sleep disturbance has adverse effect on the efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery.

With the burgeoning of continuing medical education, grass-roots hospitals are confronted with quite a number of problems in the implementation of the task, such as a general rush into action with each department going its own way, incontrollable educational expenses that are beyond the hospitals, difficulties in developing programs at the hospital level because of the limitation of academic disciplines, and the buying and selling of credits. In view of the above problems, the authors put forward some suggestions for formulating a series of continuing medical education management strategies that both conform to the situation in our country and suit the needs of health professionals at grass-roots institutions.

Objective To investigate the effects of preoperative sleep disturbance on the efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery.Methods Ninety-six ASA Ⅰ or Ⅱ patients of both sexes (aged 20-60 years and weighing 50-80 kg) undergoing endoscopic nasal surgery were enrolled in this study.Pittsburg sleep quality index was used to evaluate the long-term sleep quality before hospitalization and Athens sleep quality index was used to evaluate the short-term sleep quality in hospital.The patients were divided into four groups according to the types of preoperative sleep disturbance (n =24 each):no sleep disturbance (group Ⅰ),long-term sleep disturbance (group Ⅱ),acute short-term sleep disturbance (group Ⅲ),and long-term + acute short-term sleep disturbance (group Ⅳ).Anesthesia was induced with sufentanil,propofol and cis-atracurium and maintained with intravenous infusion of remifentanil and propofol.Then the patients received endotracheal intubation and mechanical ventilation.The end-tidal pressure of carbon dioxide was maintained at 30-35 mm Hg.Controlled hypotension was performed with nicardipine,and the mean arterial blood pressure was maintained at 50-70 mm Hg and heart rate at 60-90 bpm during operation.The patients received intravenous injection of flurbiprofen 50 mg 15 minutes before the end of operation for postoperative analgesia.When the visual analogue scale score was more than 3 during the first 6 hours after operation,flurbiprofen 50 mg was given intravenously as rescue analgesia.Results The incidence of rescue analgesia administered after operation was significantly greater in groups Ⅱ,Ⅲ and Ⅳ than in group Ⅰ,and greater in group Ⅳ than in groups Ⅱ and Ⅲ.There was no significant difference in the incidence of rescue analgesia administered during the first 6 hours after operation between groups Ⅱ and Ⅲ.Conclusion Preoperative sleep disturbance has adverse effects on the efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery.

BACKGROUND: Research has shown that the vascular endothelial growth factor (VEGF) of the ends of the fractured bone is heavily expressed 72 hours to 3 weeks after the fracture and it is supposed that it has a promoting effect on fracture healing. Inducing angiogenesis through VEGF gene transfection has gradually attracted the attention of the researches.OBJECTIVE: To find an efficient way of exogenous VEGF gene in vivo transfection through injecting the mixture of positive ion liposome transfection agent and plasmid and to study the promoting effect of extra VEGF gene expression on bone fracture healing.DESIGN: A randomly grouping, blank control trial.SETTING: Animal Laboratory of Huaxi Medical Center of Sichuan University MATERIALS: Totally 40 adult male SD rats, weighing 230 to 250 g,were involved. All the animals were randomly divided into the experiment group and the control group with 20 rats in each group.METHODS: The experiment was conducted at the Animal Laboratory of Huaxi Medical Center of Sichuan University from April to December 2003.Altogether 40 rats were involved to establish fractured models of right shaft of femur. Cut the bone in the middle of bone stem, retroplanted a Kirsh' nail with 1 mm diameter through intercondylar part and the fractured bone was fixed. In the experimental group, a mixture of 100 μL of liposome transfection agent and 100 μg of pBLAST49-mVEGF plasmid was injected in multiple points into the subperiosteum of the both sides of the ends of the fractured bone. The same volume of normal saline was injected into the rats in the control group. Then, 2 rats in each group were put to death 3,7,14,28,42,56,70 days after the operation and femoral bone specimen was collected.MAIN OUTCOME MEASURES: Observation of right femoral fractured staining results of VEGF, with the apperance of brown granules as positive.RESULTS: Two rats were selected at 7 time points separately, and altogether 28 rats entered the stage of result analysis. The other 12 rats were fracture at different time points: For the experimental group, 28 days after the operation, cartilage callus appeared and replaced fibrocallus gradually,and the fracture line disappeared. Fifty-six days after the operation, the bone healed completely. For the control group, 28 days after the operation , fibrocallus was observed, and the fracture line was still clear. 56days after the operation, much callus appeared, and the fracture line beof fractured bone was stained with hemotoxylin eosin (HE). In the experiment group, 56 days after the operation, the bone healed completely and trabecular like bones were rebuilt. The bone marrow cavity of the fractured region was open again. In the control group, Fifty-six days after the operation, no mature bone was formed, and the bone marrow cavity was not different time points: The expression in the two group reached to the peak on day 14 and began to decrease on day 28. The expression of VEGF in the experimental group was obviously higher than that in the control group.CONCLUSION: Injection of the mixture of positive ion liposome transfection agent into the subperiosteum of rats is an effective approach for in vivo transfection and pBLAST49-mVEGF gene transfection can effectively facilitate the bone fracture healing of rats.

BACKGROUND: Ectogenesis vascular endothelial growth factor (VEGF) could enhance the activity of alkaline phosphatase (AKP) and concentration of cycli adenosine monophosphate (cAMP) fivefolds in cultured osteoblast cell. What' s the effect of ectogenesis VEGF gene transfection on osteoblasts is still by no means clear.OBJECTIVE: To investigate the effect of gene transfection and expression of ectogenesis VEGF on the osteogenesis activities of osteoblast cell.DEDIGN: A completely randomized controlled study.SETTING: Laboratory of Transplantation and Immunity, West China Hospital, Sichuan University MATERIALS: Cranial osteoblasts of newborn two or three-day male SD rat.METHODS: The experiment was conducted in the Laboratory of Transplantation and Immunology of Huaxi Hospital, Sichuan University from April to December 2003 The cranial osteolasts of newborn rat were separated and cultured with enzyme digestion method then were identified by teoblasts cultured in vitro with cation liposomes transfection as gene transations, immunohistochemical staining was performed on VEGF and collagen type I and osteocalcium were detected.collagen I and secretion of osteocalcium of osteoblasts.RESULTS: The concentration of osteocalcium and expression of type I collagen of the 1- 5 generation osteoblast cell in pBLAST49-mVEGF gene transfer group were significantly higher than that in the control group (P ＜0.05).CONCLUSION : It is found in this experiment that the synthesis of collagen I was enhanced obviously after sussceful transfection of pBLAST49-mVEGF plasmid. Compared with the control group, the diffence of intergrated optical density gained by Mias image analysis system was significant( P ＜ 0.05),indicating that pBLAST49-mVEGF plasmid transfection can improve the synthesis of type I collagen and secretion of osteocalcium of osteoblasts.

The 13 nm gold nanoparticles ( AuNPs ) were synthesized through the reduction of HAuCl4 by sodium citrate and the glutathione was assembled on the AuNPs. Under the experiment conditions, glutathione-modified AuNPs ( GSH-AuNPs ) with negative charge presented a wine red color owing to the electrostatic repulsion between nanoparticals. Upon the addition of neurogenin 3 ( ngn3 ) peptide, the aggregation of GSH-AuNPs was induced by ngn3 peptide under a certain concentration of salt. The color of AuNPs solution changed from red to blue as a function of the ngn3 peptide concentration. Thus, a rapid detection method for ngn3 peptide using GSH-AuNPs as colorimetric probe was established. The optimal experiment conditions were equilibrium time=10 min, pH=6. 0, CNaCl=100 mmol/L. Under the optimum conditions, the assay showed a linear response range of 20-300 μg/L for the peptide with a detection limit being 8 μg/L and exhibited excellent selectivity for ngn3 peptide.

OBJECTIVE To understand the epidemic condition on the resistant plasmids and their homology of the Staphylococcus aureus obtained from two hospitals in Gansu Province.METHODS The antibiotic sensitivity test,plasmid elimination,plasmid profile,and restriction endonuclease profile were used in analyzing the S.aureus resistant plasmids.RESULTS We isolated 15 strains of S.aureus from 196 samples in two different hospitals,the isolation rate was 7.7%.From them 86.7% isolates were resistant to the seven commonly used antibiotics in different degree.Only 13.3% strains were just resistant to one antimicrobial,the multi-resistant strains amounted for 46.7%.There were 12 isolates carried plasmids(80.0%).The results of plasmid elimination showed 11 strains carried resistant plasmids,and the one with 38 kb was a popular plasmid.The endonuclease profiles revealed that the same source strains had certain homology,there were similiar endonuclease profiles among strains in different wards.CONCLUSIONS The popular plasmids in different wards have certain homology,and they can be transferred among different strains of bacteria.

Objective To report the treatment outcomes and repair methods for soft tissue defects at thumb using miniature flaps. Methods Six different kinds of surgical flaps were used for the repair on different thumb injuries. They were radial lateral thumb reverse island flap, dorsal ulnar thumb revers flap, first metacarpal dorsal reverse flap, first digital dorsal island flap, neurovessel pedicled V-Y advanced island flap, free nail flap first foot digital, and so on. The emergency repair using miniature flaps were studied on 132 different cases, all 137 flaps. Results The flaps survived expect 5 flaps had partial epidermis necorsis in the 137 flaps. But the 5 flaps survived too after disinfecting and changing dressing. The appearances and functions of thumbs were satisfactory for the 1 to 2 years post-operation follow-up. Conclusion It will gain better results if choosing appropriate emergency repair methods using miniature flaps on different cases.