Objective To investigate the effects of caudal block with lidocaine plus drugs on postoperative analgesia in children. Methods Eighty children aged 1 to 4 years old received caudal block with 1% lidocaine 1 ml/kg and were randomly allocated to 4 groups with 20 cases each. The local anesthetic solution was added fentanyl 2 μg/kg in group Ⅱ , neostigmine 2 μg/kg in group Ⅲ, tramadol 2 mg/kg in group Ⅳ or nothing in group Ⅰ. Postoperative analgesia with fentanyl (nurse controlled analgesia, NCA) was given in all patients. Pain and sedation scores were evaluated at 1, 2, 4, 6 and 24 h after surgery. The duration of caudal analgesia, fentanyl requirements, sicle effects,and discharge time were recorded. Results Duration of caudal analgesia in group Ⅳ was (510. 7±64. 9)rain, which was longer than (174.5±39. 3) rain in roup Ⅰ , (291.7 ± 50. 8) min in group Ⅱ , or (242.0±62. 8) min in group Ⅲ. The incidence of postoperative nausea and vomiting was more [requent in group Ⅳ than that in the other groups(P<0. 05). Conclusion Combined 1 % lidocaine 1 ml/kg with tramadol 2 mg/kg for caudal block can provide better and longer postoperative analgesia, but with a higher incidence of postoperative nausea and vomiting.

Objective To explore clinical nursing pathway(CNP) teaching method for nursing practice students.Methods Nursing practice students ( n =120 ) were randomly divided into two groups:experimental group and control group.CNP teaching method was applied in experimental group while traditional teaching method was used in control group.The test results of theory,operational skill,comprehensive quality,patient's satisfaction degree and nursing mistake between the two groups were compared.Results The results of theory,operational skill,comprehensive quality,patient's satisfaction degree in experimental group were obviously better than those in control group(P ＜0.05),the result of nursing mistake in experimental group was greatly decreased compared with that in control group(P ＜ 0.05).Conclusion CNP teaching method is superior to traditional teaching method and it greatly improve the teaching quality.

ObjectiveTo evaluate the effects of various surgical procedures on liver carcinoma accompanied by portal hypertension. MethodsOne stage surgical procedure was performed in 28 cases of liver carcinoma accompanied by portal hypertension in our department from January 1992 to June 2000. ResultsThere was no operative mortality. The postoperative complications developed in 39%(11/28). The postoperative survival rates of 1?2 and 3 years were respectively 91%, 61%, and 48%. Postoperative upper digestive tract hemorrhage developed in 9 cases, 13 cases died during follow-up period, of whom 6 cases died of the recurrence of liver carcinoma, 2 cases died of liver failure, 5 cases died of upper digestive tract hemorrhage.Conclusions The survival time can be prolonged and the postoperative complications reduced through prudent selection of surgical procedures in patients suffering from concurrent liver cancer and portal hypertension. Postoperative recurrent bleeding can be prevented by pericardial devascularization. In poor risk cases with huge carcinoma, simple surgical procedure should be applied,and with a discreet application of chemoembolization.

Objective To observe the effects of electro-acupuncture on the expression and inhibition of DNA binding protein 2 (Id2) and myelin basic protein (MBP),and to explore the mechanism of remyelinization after compressive spinal cord injury (CSCI) in rats.Methods Fifty-four SD rats were randomly divided into a control group and a treatment group,and each was further subdivided into 3 time point subgroups:3,7 and 14 days.There were 9 rats in each subgroup.The CSCI models were made with a self-designed method.The acupuncture points Jiaji (EX-B2),bilateral Zusanli (ST36) and Taixi (KI3) were selected for treatment.Electro-acupuncture (continuous wave,2 Hz,1.5 V)was applied to the bilateral Zusanli (ST36) and Taixi (KI3) points.The control group received the injury but no treatment.The changes in the ultrastucture of the nerve fibers＇ white matter were de-termined by transmission electron microscopy (TEM).The alterations in the expression of MBP and Id2 were observed by double labeled immunofluorescence and Western blotting on the 3rd,7th and 14th day after the injury.Results TEM showed that the myelin sheaths in the control group had degenerated,swollen,and even broken down after CSCI.Changes to the myelin sheaths in the treatment group were milder than those in the control group.The immunofluorescence results showed the amount of Id2-immunoreactive oligodendrocytes in the control group to be (20 ±2) on the 3rd day after CSCI,becoming (16 ± 1) on the 14th day.The differences among the 3 control subgroups were not statistically significant.The amount of Id2-immunoreactive oligodendrocytes in the treatment group was (13 ± 1) on the 3rd day,reaching a minimum the 14th day.The differences among the 3 treatment groups were statistically significant.The differences compared with the control group at the same time points were also statistically significant.Western blotting showed that the expression of Id2 in the contrast and treatment groups was (1.12 ±0.12) and (0.67 ±0.01) respectively on the 3rd day after CSCI,and both decreased with time.The expression of Id2 in both groups reached their minima ((0.86 ±0.02) and (0.25 ±0.01) respectively) on the 14th day.The difference between the treatment groups and the contrast group was statistically significant at each time point.The expression of MBP in the contrast and treatment groups at day 3 was (0.44 ± 0.02) and (0.67 ± 0.04) respectively,and these increased with time.The expression of MBP in both groups peaked at the 14th day (at (0.95 ± 0.04) and (1.74 ± 0.09) respectively).These differences were again statistically significant.Conclusion Electro-acupuncture can regulate the expression of Id2 and MBP after CSCI.The down-regulation of Id2 which controls MBP negatively and the up-regulation of MBP may contribute to remyelination in the injured spinal cord.

Objective To construct and implement theSTARnurse training model, and discuss its application effect and the problems that should be paid attention to, and to provide operational cases and practical basis for nursing clinical education. Methods Through literature review and expert consultation, the framework and content of STAR nurse training model were set up and implemented. The questionnaire survey and semi structured in-depth interviews were conducted among the nurses in the hospital to evaluate the effect of improving the nurses′self-directed learning ability. Results After the implementation of the project, the scores of the three dimensions of self-management, desire for study and self-control were (3.67±0.57), (4.05±0.54), (3.99±0.50) points, which were higher than (3.55±0.49), (3.71± 0.52), (3.53±0.42) points before implementation. The difference was statistically significant (P<0.05 or 0.01). The semi structured in-depth interviews showed that all the nurses believed that STAR nurse training model could promote independent learning and stimulate interest in learning. 14 nurses thought it was beneficial for the nurses to find the problems. Conclusions STAR nurse training model can create a favorable learning environment for nurses, and stimulate the learning motivation. It plays a positive role in improving nurses′ability of self-directed learning.

Objective To investigate the relationship between body fat distribution and pulse wave velocity (PWV) in middle-aged and aged population. Methods Two hundred patients received health examination were enrolled into the male group (103 cases) and the female group (97 cases). Visceral fat volume (VFV), subcutaneous fat volume (SFV) and ba-PWV were determined. Results Compared to patients in the female group, patients in the male group had significantly higher VFV values [(3.17 ± 0.84) kg vs (2.30 ± 0.94) kg], and lower SFV values [(15.56 ± 3.49) kg vs (17.69 ± 4.82) kg], In the male group, there existed a positive correlation between ba-PWV and age, VFV, fasting blood glucose,SBP and DBP. In the female group, a positive correlation was found between ba-PWV and age, SFV, TG, BUN, SBP and DBP, while a negative correlation was observed for HDL-C and Apo A1. Conclusion There was gender differences in body fat distribution in middle-aged and aged healthy population. In the male group , age, VFV, SBP, and DBP were the only independent and significant risk factors for ba-PWV. In the female group , age, SBP and Apo A1 were the independent risk factors for ba-PWV.

Objective To investigate the expression and clinical significance of thyroid transcription factor-1(TTF-1)and chromogranin A(CgA)in small cell lung cancer(SCLC). Methods The expressions of TTF-1 and CgA protein in 68 cases of SCLC tissues and 20 cases of normal lung tissues were examined by immunohistochemistry method,and their correlations with clinical features of SCLC were analyzed. Results The positive rates of TTF-1 and CgA protein in SCLC were 88. 2%(60 / 68)and 70. 6%(48 / 68),respec-tively,and they were higher than those in normal lung tissue[10. 0%(2 / 20)and 5. 0%(1 / 20);χ2 = 45. 442, P = 0. 000;χ2 = 26. 941,P = 0. 000]. The expression of TTF-1 protein was not related to the patients' age,sex and tumor size,while closely related to smoking index(χ2 = 4. 131,P = 0. 042),lymph node metastasis(χ2 =5. 488,P = 0. 019)and clinical stage(χ2 = 6. 011,P = 0. 014). The expression of CgA protein was not related to the patients' age,sex,tumor size and smoking index,while closely related to lymph node metastasis(χ2 =9. 895,P = 0. 002)and clinical stage(χ2 = 4. 145,P = 0. 042). Conclusion TTF-1 and CgA protein are highly expressed in SCLC,especially in the patients with lymph node metastasis and extensive disease.

Objective To investigate the role of demyelination and the alteration of chondrotin sulfate proteoglycan (CSPG,NG2) expression after compression injury of the spinal cord (CSCI).Methods Seventy-five adult Sprague-Dawley rats were randomly divided into a normal group,a sham-operation group,a CSCI 1 day group,a CSCI 3 day group,and a CSCI 7 day group.There were 15 rats in each group.The injuries in the CSCI groups were inflicted using a technique devised in our laboratory.Basso-Beattie-Bresnahan (BBB) neurological function assessment was used to assess the rats' motor function,osmic acid staining and transmission electronic microscopy (TEM)were used to observe any pathological changes of myelinated nerve fibers in the white matter at 1,3 and 7 days after CSCI.The amount of myelinated nerve fibers in the posterior funiculus of the spinal cord and the ratio of myelin sheath thickness to axon diameter (the G-ratio) were calculated.Any alteration in NG2 expression was observed by Western blotting.Results The average neurological function assessment scores in the CSCI groups were (1.23 ±0.45),(0.65 ± 0.35) and (0.00 ± 0.00) respectively.Compared with the normal group (21.00 ± 0.00) and the sham operation group (21.00 ± 0.00),the differences were all statistically significant.The rats' motor function deteriorated gradually with time after the CSCI.Osmic acid staining showed that the white matter was intact in the normal and sham groups.After being compressed the myelinated nerve fibers became swollen,degenerated and broke down.The amount of myelinated nerve fibers in the normal group,the sham operation group and the three CSCI groups was (2771 ± 108),(2675 ± 199),(2403 ± 161),(1708 ± 70) and (8 10 ± 95) respectively.The amount of myelinated nerve fibers decreased in the CSCI groups and reached a minimum on the 7th day.The difference was statistically significant.The TEM quantity analysis showed that the G-ratios in the normal,sham operation,and CSCI 1 day,3 day and7 day groups were (18.10±0.4),(17.70±1.0),(6.69 ±0.8),(5.73 ±0.4) and (4.95 ±0.5) respectively.Compared with the normal and sham operation groups,the G-ratios in the 3 CSCI groups were lower and reached their minimum on the 7th day after injury.The difference was statistically significant.TEM observation showed that the axons and myelin sheaths were intact in the normal and sham groups.After CSCI the axons became swollen and cell organelles in the axoplasm degenerated and decreased.The layers of myelin sheath shrank,folded and even wrinkled,which had an onion-like appearance.The oligodendrocytes exhibited chromatin condensation.Macrophages showed infiltration.Western blotting showed that the expression of NG2 in the CSCI groups reached a maximum on the 1st day after injury and then decreased with time.The expression of NG2 in the CSCI groups was higher than in the normal and sham groups,and the difference was statistically significant.Conclusion Demyelination occurs after CSCI-the amount of myelinated nerve fibers decreases and neurological deficits increase with time.The expression of NG2 was associated with changes in the myelin sheaths after CSCI and contributed to recovery of the myelin sheath through proliferation and differentiation to oligodendrocytes and perhaps other kinds of cells.

The TCM acupuncture education for foreign students is complicated and technical work.The writer discusses the modern teaching methods recently to aim directly at the problems in the traditional teaching methods in foreign students education,analyzes and compares the connotation and teaching mode of these teaching methods,and at last puts forward that we should choose correct teaching method according to the actuality to improve the teaching quality for foreign students in TCM acupuncture.

Objective To investigate correlation between demyelination and caspase-12 expression alteration after compressed spinal cord injury (CSCI) so as to discuss mechanism of demyelinating lesion after CSCI.Methods Seventy-five adult SD rats were randomly divided into five groups,ie,normal group,control group,compression 1 d,3 d and 7 d groups,with 15 rats per group.Models of spinal cord compression were established with a self-made device.Ultrastructure of the demyelinated nerve fibers was observed by electronic microscope and oligodendrocyte apoptosis was detected by TUNEL staining and double labeling immunofluorescence.Immunoblotting was used to defect caspase-12 that was related to cell apoptosis.Results Demyelination of nerve fiber occurred after CSCI and was aggravated with time.Apoptosis of oligodendrocytes was found after CSCI,and showed significant difference between compression 7 d group and normal group (P ＜ 0.05).Caspase-12 was also upregulated with extension of compression time.Conclusion Caspase-12 mediating oligodendrocyte apoptosis is one of the mechanisms of nerve fiber demyelination after CSCI.