Standardized pain assessment is a precondition of appropriate analgesia for mechanical ventilation patients. However, routine pain assessment rates remain very low in intensive care unit (ICU). Behavioral pain scale (BPS) and critical-care pain observation tool (CPOT) can be used to assess pain in mechanical ventilation patients who are unable to report pain by themselves. No matter what strategy we taken, analgesia-first sedation should be used in priority. Meanwhile, patient-centered and goal-directed sedation strategy should be adopted based on the individual condition.If condition permits, patients should be maintained in light states of sedation as long as possible, because this is associated with improved clinical outcomes. Humanistic care, multidisciplinary cooperation and comprehensive training are also important components of a perfect analgesia strategy.

Objective To explore the mechanism of the influence on mice brain of environmental tobacco smoke. Methods After the mice were placed into the bench for 8 weeks, the region of the mice brain was localized and the expression of neurotransmitters and neurotransmitters receptors were detected by immunohistochernistry.Results ( 1 ) The expression of GABA in the mice cerebral cortex ( CC ) ( 0. 25 ± 0. 06 ) and the hippocampus (Hip) (0. 19 ± 0. 07 ) were much higher in the ETS-exposed group than that in the control group(P＜ 0. 05 ). (2)The expression of nAChR on CC(0. 31 ±0. 10) was much more in the ETS-exposed group than that in control group(P＜0.05). (3) The expression of NMDAR( Glu receptors) on the CC and striate cortex were much higher in the ETS-exposed group(0.32 ±0. 10,0.38 ±0. 14), NIC-inhaling group(0.31 ±0. 08,0.31 ± 0. 11 ) than that in control group(P＜0. 05 ). Conclusions Long-term ETS-exposed and NiC-exposed environment could change the expression of neurotransmitter and its receptors.

Objective To study the surgical techniques and clinical experience of the total laparoscopic splenectomy .Methods Retrospective analysis 31 cases were performed laparoscopic splenectomy from January 2003 to April 2015 .Among them ,there were 12 cases with liver cirrhosis and hypersplenism ,5 cases with spleen hemangiomatosis ,3 cases with splenic lymphoma ,3 cases with splenic cyst ,2 cases with obsolete rupture of spleen hematoma ,6 cases with idiopathic thrombocytopenia .During surgery ,Li‐gaSure was used to deal with stomach ligament splenic artery .Using silk or endoscopic linear cutters to process splenic pedicle indi‐vidually .Results All operations were performed successfully without conversion to open surgery .13 patients were cutting off splenic pedicle by ligating of splenic portal blood vessel and 18 patients were using endoscopic linear cutters .The operation time was 80-240 min ,mean (130 ± 35)min ,the blood loss was 60-500 mL ,mean (150 ± 80)mL ,hospital stay was 8 .3 days .There was no mortality and pancreatic leakage complications .Conclusion On the basis of open surgery ,evaluating carefully before operation ,se‐lecting appropriate cases ,using different laparoscopic instruments ,handling splenic pedicle individually ,can make the laparoscopic splenectomy be a more safe and useful operation modality .

OBJECTIVE:To study the hemostatic effect of reptilase on abdominal operations in perioperative period.METH-ODS:The study was conducted in 66 patients.They were randomly divided into 2 groups:reptilase group(n=35) and control group(n=31).In reptilase group,the reptilase was given in pre-operative,post-operative and intraoperative period and in control group,other commonly-used hemostants were given in the same way as in reptilase group.The amount of bleeding,the content of D-D in venous blood,the quantity of postoperative bloody drainage were compared between 2 groups.RESULTS:The amount of intraoperative bleeding,postoperative contents of D-D in venous blood and the quantity of bloody drainage in reptilase and control group were(312.1?30.3)ml,(521.5?29.2)ml(P

Objective:To investigate the correlation between the expression of vascular endothelial growth factor receptor KDR ,somatostatin (SS) and angiogenesis in pancreatic carcinoma and their association with the clinicopathologic characterizations. Methods:Immunohistochemical SP technique was used to detect the expression of KDR and SS. Microvessel density was determined by immunostaining for factor CD34 related antigen. Results:MVD was higher in KDR high and middle expression cases than that in low expression cases(P

Most researchers consider that high exposure to heavy metals can result in hemorrhagic gastritis,hepatonecrosis,cancer,even death.There are many routes for heavy metals to get into human body,for instance absorption by gastrointestinal tract,cutaneous absorption etc.In this paper,the author reviewed the recent researches on brain function damage induced by heavy metals via olfactory pathway.Some heavy metals have especial affinity with brain tissue and cause functional disorder and death of nerve cells,and the mechanisms were discussed in detail.

In this paper, a carbon dioxide trans-critical refrigerating system which is different from a conventional subcritical refrigerating cycle was studied. The trans-critical carbon dioxide refrigerating systems are based on the Gustav Lorntzen cycle. Emphasis was focused on how to determine the optimal discharge pressure of compressor in CO2 trans-critical cycle. The factors related with the optimal discharge pressure were analyzed. A formula was developed based on cycle simulation, which could be used to predict the optimal discharge pressure of a basic CO2 trans-critical cycle. After further studies on CO2 trans-critical cycles with a regenerator or expander, two more formulas were also developed. These formulas could provide an access to improve the COP of CO2 trans-critical cycle.

Objective To investigate the inhibitory effect of melatonin on the proliferation activity of murine foregastic carcinomac ( MFC) cells via melatonin membrane receptors MT 2 and its relationship with the signaling pathways of mitogen-activated protein kinases ( MAPKs), phosphatidylinositol 3-kinase ( PI3K)-Akt.Methods Using siRNA technology to silence MT2 expression, we examined the ability of melatonin to inhibit the proliferation activity of MFC cells and its influence on the phosphorylation of ERK 1/2 and Akt.Results We found two interesting effects of SiRNA-mediated silencing of MT2 expression.Firstly, it significantly antagonized the inhibitory effect of melatonin on the proliferation activity of MFC cells .Secondly , it partially blocked the inhibitory effect of melatonin on the phosphorylation of ERK 1/2 and Akt.Conclusion Our results suggest that melatonin can inhibit the phosphorylation of ERK 1/2 and Akt via MT2 receptors , thereby inhibiting the proliferation of gastric cancer cells .

The major assessment is the key link of the applied undergraduate education quality guarantee system. According to the spirit of the Ministry of Education, The Qiqihar Medical University developed the internal major assessment study and founded 8 first grade indexes and 26 second level indexes including educational idea, teaching staff, major construction. The university also established the major evaluation system, monitor and improve the university's teaching quality. This system makes sense to the establishment and improvement of undergraduate teaching quality guarantee system and has attained great achievement in the building of teaching staff, major construction, teaching environ-ment and teaching idea. Also the school has rectified the problems, making the work more perfect and the teaching better and better.

Objective To investigate the efficacy and prognostic factors of transcatheter arterial chemoembolization (TACE),and radiofrequency ablation (RFA) combined with intensity modulated radiotherapy (IMRT) for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).Methods Sixtythree cases of HCC with PVTT were retrospectively analyzed.All of them received 1-3 time(s) of TACE therapy followed by RFA.IMRT was finally performed to PVTT.Both the therapeutic effects of HCC and PVTT were observed in 6 to 8 weeks after IMRT therapy.The long-run efficacy was observed by analyzing the 1-3 year(s) survival rate,and the hazards to prognosis were analyzed.Results The CR,PR,SD,PD numbers and rates in PVTT were 9 cases (15.0％),36 cases (60.0％),10 cases (16.6％),and 5 cases (8.3％).The effective rate in PVTT was 75.0％.Meanwhile the CR,PR,SD,PD numbers and rates in HCC were 19 cases (31.6％),30 cases (50.0％),6 cases (10.0％),and 5 cases (8.3％).The effective rate in HCC was 81.6％.The 1,2 and 3 year survival rates were 73.3％,45.0％ and 27.0％,respectively.ECOG score (x2 =53.046,P =0.000),history of hepatitis (x2 =6.472,P =0.030),tumor size (x2 =7.293,P =0.026),the number of tumor(x2 =24.382,P =0.000),the types of tumor thrombus (x2 =28.085,P =0.000) and Child-Pugh class (x2 =6.184,P =0.040) were independent hazardous factors for survivals.Conclusion TACE combined with RFA is effective treatment for HCC with PVTT patients with low frequency of severe complications and high rate of tumor response.ECOG score,history of hepatitis,the size and number of tumor,the types of tumor thrombus,Child-Pugh class are the factors that influence the long curative effect.