Objective To investigate the effects of continuous wound infusion of ropivacaine for postoperative analgesia on local inflammation.Methods Forty ASA Ⅰ or Ⅱ patients,aged 45-64 yr,weighing 45-80 kg,undergoing simple nephrectomy,were randomized into either continusous wound infusion of local anesthetic group ( group CWI ) or control group ( group C),with 20 cases each.Group CWI were treated with continuous wound infusion of 0.25％ ropivacaine for postoperative analgesia,while group C were infused with the same volume of normal saline.All patients received patient-controlled analgesia with intravenous morphine.At 6,12,24 and 48 h after operation,the accumulated consumption of morphine was documented,and the concentration of prostaglandinE2 (PGE2) of drainage was determined using ELISA.Results Compared with group C,the accumulated consumption of morphine was decreased,and the PGE2 concentration was decreased in group CWI at each time points.Conclusion The mechanism of postoperative analgesic effect of continuous wound infusion of ropivacaine is related to the suppression of local inflammation in wound sites.

Objective:To explore the solutions to enhance the professional skills and humanistic quality of neurosurgery in theprimary hospitals, and to improve the neurosurgery medical care level.Methods: a comprehensive analysis of the literature retrieval as well as information collected in practice the first hospital of Zhangjiakou in, extract the problems of neurosurgeon training in primary hospital, to carry out grading treatment requirements, explore the basic path to improve the clinical ability of primary hospital neurosurgeon, and through the establishment of standard clinical operating procedures and systems to ensure the quality of medical service.Results: from Wanfang database retrieved from 2006 to 2015 research journals in Chinese on improving grassroots doctors ability of 819 papers, bibliometric analysis shows that the trend is increasing year by year, in 2015 issued a number is 5.21 times in 2006. There are 28 papers including neurosurgery area, accounting for 3.42% of the total number of papers; the hot topics focus in the mode of training neurosurgery doctors in primary hospitals,transfer the technology of minimally invasive neurosurgery and spreadmodern neurosurgery theory and knowledge.Conclusion: to improve the ability of doctorsof primary hospitals should be combined with the characteristics of local diseasesand primary hospital neurosurgeon status, from making training plan, appropriate to establish the corresponding clinical standard, promote the essential neurosurgery technology, in order to ensure implementation of the tiered diagnosis and treatment .

Objective To observe the thickness and histologic changes of cartilage -perichondrium complex (CP) and vascular density changes in perichondrium after repairing perforated eardrum .Methods Forty -five male guinea pigs were randomly divided into three groups ,and were used to create left TM perforation .The left cavum conchae cartilage-perichondrium was immediately used to repair the perforation .The observation time for group A was two weeks ,group B was six weeks and group C was twelve weeks .The thickness of the composite was meas-ured before and after the implantation .The histologic changes of implants and the vascular change in perichondri were observed .Results The healing time for the left ear was 3 .8 ± 0 .84 ,and the right ear 7 .2 ± 0 .84 .The thick-ness of the composite for group A increased by 14 .4% (P<0 .05) .There was no significant change in the thickness of group B after implantation(P>0 .05) .Group C decrease by 14 .2% (P<0 .05) .After implantation ,the thickness of cartilage in group C was decreased by 34 .2% compared to that in group A (P<0 .05) .At the 2nd week in post -implantation ,the number of vessels within the unit area of fiber -perichondrium was up to 13 .28 ± 2 .49 ,while the above number reached to 7 .71 ± 2 .49 at the 6th week after implantation .The final histological structure of recon-structed tympanic membrane at the 2nd week and 6th week was composed of squamous epithelial layer ,fibrous -perichondrium layer ,cartilaginous layer and mucous layer .The above histological structure at 12th week was com-posed of squamous epithelial layer ,cartilaginous layer and mucous layer .Conclusion The healing time of the recon-structed tympanic membrane is shorter than the time spent on healing on its own .The thickness of the composite in post-implantation in three groups first increased and then decreased compared to that in pre -implantation .The number of blood vessels of fiber -perichondrium in the reconstructed tympanic membrane first increased and then re-duced .The layers of final histological structure of reconstructed tympanic membrane are similar to those of normal tympanic membrane .From the perspective of histology ,the cartilage-perichondrium composite is the suitable ma-terial for repairing tympanic membrane .

Objective To investigate the risk factors for postoperative delirium in patients undergoing noncardiac surgery. Methods From September-December 2009, 480 patients undergoing elective noncardiac surgery were included in this study. The criteria for enrolment of the patients in this study were (1) age ≥ 65 yr,(2) age ＜ 65 yr if associated with coronary artery disease, hypertension, diabetes mellitus, brain injury, cerebral hemorrhage, cerebral infarct, emphysema, chronic bronchitis; duration of operation ≥ 3 h and intraoperative blood loss was expected to exceed 20% of blood volume. The diagnosis of delirium was based on Confusion Assessment Method (CAM). Multivariate logistic regression was used to analyze the risk factors for postoperative delirium.Results Postoperative delirium developed in 79 patients during the first three postoperative days. The incidence of postoperative delirium was 16.5%. The logistic stepwise regression analysis indicated that the risk factors for delirium included advanced age, method of anesthesia, long operation, postoperative pain, emphysema and alcholic. Conclusion Age, method of anesthesia, long operation, postoperative pain, emphysema and alcholic are risk factors for postoperative delirium in patients undergoing noncardiac surgery.

Objective To investigate the safety and effectiveness of thoracic paravertebral nerve block on radiofrequency ablation of liver tumors. Methods A total of 40 patients underwent radiofrequency ablation of liver tumor, were ran-domly divided into target-controlled infusion group(group G,n=20)and paravertebral nerve block group (group P,n=20). The intraoperative vital signs, anesthesia effects,anesthesia work time, total operation time,postanesthesia care unit stay time, major adverse clinical events and postoperative VAS scores of two groups were recorded and compared. Results The anesthesia satisfactory rate of G group was 95% and P group was 100%. After anesthesia induction MAP,HR,SPO2 and R declined significantly in group G. Compared with group G,intraoperative vital signs were more stable in group P. Major adverse clinical events in group P were less than group G (P<0.05). The effecting time in group P was longer than group G. The postanesthesia care unit stay time was longer in group G than group P(P<0.05). The post-operative VAS scores in group P declined much more than those in group G before 24 hours postoperatively(P<0.05). Conclusion Thoracic paravertebral nerve block for anesthesia in liver tumors underwent radiofrequency ablation is safe and effective.

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.