Successful pain management of perioperative shoulder arthroscopy may allow patients to go home earlier, improve the quality of life in perioperative period, and facilitate rehabilitation. A comprehensive method to perioperative pain control has three stages including preoperative, intraoperative and postoperative phase. Successful pain reduction should begin preoperatively because of an excellent communication between patient and physician, moreover, preoperative analgesia also should be administered. Intraoperative efforts should include local wound infiltration and the administration of anesthetic medication intra-articularly. Postoperative management should include oral analgesics, constant infusion devices, Patient Controlled Analgesia (PCA), sedative-hypnotic drug, continuous cryotherapy and vicarious treatment.
Acupuncture Analgesia ; Analgesia ; methods ; Analgesia, Patient-Controlled ; Arthroscopy ; Humans ; Pain, Postoperative ; therapy ; Perioperative Period ; Shoulder Joint ; surgery ; Transcutaneous Electric Nerve Stimulation

Objective To analyze the distribution of class 1,2 and 3 integrons and their gene cassettes,and to explore its relationship with drug resistance in Shigella.Methods Antimicrobial susceptibility was detected by minimal inhibitory concentration (MIC) method.All the genes of integrons and gene cassettes were amplified by polymerase chain reaction (PCR).The amplicons were identified by amplified fragment length polymorphism (AFLP) and sequencing.Results Fifty seven multi-drug resistant strains were identified from a total of 62 Shigella strains (91.9％).Among multi drug resistant strains,52 strains carried integrons of class 1 (91.2 ％) and 55 strains carried integrons of class 2 (96.5％).Only 2 strains carried class 1 integrons alone,5 strains carried class 2 integrons alone and 50 strains had both class 1 and class 2 integrons.Class 3 integrons were not detected.The gene cassettes of typical class 1 integrons,dfrV and dfrA17-aadA5,were detected in 6 strains and 2 strains,respectively.Atypical class 1 integrons with gene cassettes blaOxA30 aadA1 were detected in 44 strains.The typical and atypical class 1 integrons coexisted in 6 Shigella flexneri strains.Gene cassettes for class 2 integrons were dfrA1 sat1-aadA1.Conclusions The multi-drug resistant Shigella strains are widely distributed in Ji'nan,and the atypical class 1 integrons and class 2 integrons are common in these strains.Coexistence of the two integrons is observed in some of the strains.

ObjectiveTo look into the distribution of “iodine suitable” region in iodine-deficient areas in Shandong province and to provide a scientific basis for guiding the redesignate of iodine-deficient areas and launch scientific supply of iodine.Methods One to 3 copies of water source samples were collected in 105 existing iodine-deficient counties by village.Water iodine content was detected by arsenic-cerium catalytic spectrophotometry.The areas with water iodine content below 10 μg/L was defined as iodine-deficient areas and among 10 - 150 μg/L were “iodine suitable areas” and greater than 150 μg/L were high iodine areas.Results The research was carried out in 14 cities,105 counties,and 1337 towns.We collected 65 716 water samples.Sample recovery efficiency reached 99.8％.The median of water iodine was 5.57 μg/L.In the 1337 towns surveyed,there were 82.05％(1097/1337) of the township with water iodine median ＜ 10 μg/L,17.43％(233/1337) between 10 - 150 μg/L,and 0.52％(7/1337) ＞ 150 μg/L.Conclusions In Shandong province,the water “iodine suitable” regions are distributed scattered with considerable proportion.In iodine-deficient areas,there are areas with high water iodine,and iodine-deficient regions should be redrawn.Emphasis should be put on iodine nutritional status of residents in “high iodine and iodine suitable” regions,and iodine supplementation should be carries out scientifically.

Objective To survey the highly risk iodine deficiency regions of Shandong Province and to provide reference basis for further executing urgent iodine supply. Methods The annual document of cretinism in Licheng District in Jinan City and Shouguang City, the two iodine deficiency regions, were referred. Forty children aged 8-10 years of 2 targeted schools from 3 towns out of every targeted region underwent palpation, ultrasonography and As3+-Ce4+catalyzing speetrophotometry for ultra iodine examination. Twenty women aged 18-40 years from 2 villages sampled from every targeted town received ultra iodine examination and edible salt examination of iodine with direct titration. Results No new cretinism and suspected cretinism was found since 1995 in the regions. The goiter rates of children of the two regions detected with palpation and ultrasonography were 7.5% (18/241),6.2% (15/241) and 5.0% (13/259), 1.2% (3/259), respectively. Two hundred forty and 249 urine samples were respectively collected in school children, in which the median urinary iodine was 226.3,282.7 μg/L. One hundred twenty urine samples were respectively collected from the two group of women, resulting a median urinary iodine of 187.2,321.7 μg/L. Eight and 2 salt samples were free of iodine in 120 salt samples collected each region, respectively. The rate of qualified iodized salt was 100%. Conclusions It is not necessary to urgently implement iodine supply in Shouguang City and Licheng District. However, reinforcement of supervise on salt industry and eliminating the hazard from non-iodized and disqualified iodized salt remains in need.

Objective To investigate the danger of iodine excess for people in the downstream area of Yellow River in Shandong Province by describing the distribution of iodine excess water and the gorer of children Methods Water samples were collected from 5 villages of every town of Yuncheng,Jiaxiang and Dongchangfu Counties to determine the iodine of the water using arsenic cerium oxidation reduction method.In the 5 towns having water iodine in the range of 150～300μg/L,200 students aged from 8～10 years received the paJpation of thyroid,half of them were also measured of urinary iodine with As3+-Ce4+ catalytic spectrophotometry using ammonium persulfate digestion method,and 50 of the 100 students further underwent thyroid B-ultrasound.Results Three counties all have high iodine towns.The medium of urinary iodine of 30 town8 in 56 towns was higher than 150μg/L Urinary iodine and sign detection were performed in 13 towns,where water iodine was between 150～ 300μg/L;the medium ofurinary iodine of 11 towns were higherthan 400μg/L,and 3 of the 11 towns were higher than 800μg/L.In all 13 towns,the goiter rate of the students aged 8 to 10 years exceeded 5%by palpation in 11 towns:exceeded 5% by B-ultrasound method in 9 towns.Conclusions There are areas of iodine excess in drinking water and iodine-excess endemic goiter prevails in downstream area of the Yellow River in Shandong Province.It indicates that iodine excess in drinking water has done severe harm in these areas. Active management should be taken to control this endemic disease.

Objective To look into the current distribution of iodine deficiency area in Shandong province and to guide the re-defined iodine deficiency area and to supplement iodine scientifically. Methods In 2008, 100 iodine deficiency counties(cities, districts), designated in Shandong province's "to supplement iodized salt to eliminate the hazard of iodine deficiency management regulations", were selected in the study. One to three samples were collected from water source which was used by the majority of local residents in the 100 iodine deficiency places and iodine concentration was tested by As3+-Ce4+ catalyzing spectrophotometry. Results A total of 65 716 water samples were collected. Sample recovery efficiency reached 99.8%(65 572/65 716). The median water iodine was 5.57 μg/L, with 82.05%( 1097/1337 ) of the township(town) met criteria for the classification of iodine deficiency areas(water iodine ＜ 10 μg/L), 17.43%(233/1337) of the township (town) water iodine moderate(water iodine 10 - 150 μg/L), and 0.52%(7/1337)of the township(town) should be defined high iodine areas(water iodine ＞ 150 - 300 μg/L). Conclusions The iodine deficiency areas should be redefined because water iodine concentrations of iodine deficiency areas have changed. We suggest that the smallest place to supply salt with different range of iodine content is set to the township(town).

Objective To learn the iodine nutritional status of the vulnerable population with different iodine level under the current level of iodized salt in Shandong province and to offer prevention and cure measures.Methods Five groups of vulnerable population including school children aged 8 - 10, pregnant, lactation women, infants and women of childbearing age from mountain areas ( Daiyue, Mengyin counties ) , plain ( Luxian,Gaomi counties ) and coastal (Zhaoyuan county ) of five different iodine deficient areas were investigated in 2007.The thyroids of children aged 8 - 10 were checked by palpation and B ultrasound, their edible salt iodine level was detected by direct titration. The lever of urinary iodine of vulnerable population was examined by arsenic and cerium speetrophotometry. Results The goiter rates of 8 - 10 year-old were 1.8%(9/514) and 1.2%(6/514), respectively by palpation and B-ultrasonic. The mean iodine of 501 edible salt samples was 30.95 mg/kg. The coverage rate of iodized salt was 94.6% (474/501). The rate of qualified iodized salt was 90.4% (453/501). The median of urinary iodine was 216.7 μg,/L. The urinary iodine of school children aged 8 - 10, pregnant, lactation women, infants and women of childbearing age were 234.0, 165.5, 162.4, 257.5, 233.0 μg/L, respectively. Conclusions Current iodine nutritional level is basically appropriate in all groups of vulnerable people. The current iodine content of iodized salt could meet the needs of population from different iodine deficient areas of Shandong province.

OBJECTIVE To detect the reversal effect of Guizhi Fuling Wan on cisplatin-resistant ovarian cancer SKOV3/DDP cells and its relationship with protein expression of phosphatase and tensin homolog (PTEN) and metadherin (MTDH). METHODS Guizhi Fuling Wan (GFW) concentrated solution was prepared according to the Chinese Pharmacopoeia 2015 edition, Wistar rats were given GFW viagavage at 4 g·kg-1·d-1,8 g·kg-1·d-1,16 g·kg-1·d-1,or given saline as blank control for 5 days.Blood samples were taken and the corresponding drug-containing low-dose sera, medium-dose sear, high-dose sera and blank sera were prepared.The XCELLigence RTCA S16 real-time label-free cell analyzer was used to detect the reversal effect by the sera combined with cisplatin or paclitaxel in SKOV3/DDP cells. Annexin V-FITC and PI double-staining were used to detect the apoptosis-inducing effect of the sera in the cells. RT-qPCR and western blot were used to detect the mRNA and protein expression of PTEN and MTDH after the cells treated with the sera. RESULTS The inhibition rate of low-dose sera against SKOV3/DDP cells was less than 5%.After the low-dose sera combined with cisplatin or pacli-taxel, the IC50 of SKOV3/DDP cells against cisplatin and paclitaxel decreased by 3.01 and 1.79-fold, respectively.The total apoptosis rates induced by the low-dose sera,medium-dose sear,high-dose sera and blank sera in SKOV3/DDP cells were 11.08±0.13,19.42±0.30,24.23±0.31,and 3.21±0.24,respec-tively; there was a significant difference between the groups (P<0.01). RT-qPCR results showed that, compared with the blank serum, the sera can up-regulate the expression of PTEN mRNA and down-regulate the expression of MTDH mRNA in a dose-dependent manner. Western blot results showed that the induction effect to PTEN protein and the inhibition effect to MTDH protein by the sera were gradually enhanced with thesera dose increasement. CONCLUSION The resistance reversal effect of Guizhi Fuling Wan on ovarian cancer SKOV3/DDP cells may be related to the inhibition of MTDH, up-regulation of PTEN and induction of apoptosis, providing with an experiment basis for the applica-tion of Guizhi Fuling Wan as a reversal agent for chemotherapy resistance of ovarian cancer.

The aim of this study was to investigate the effect of integripetal rhodiola herb on pulmonary arterial remodeling and expression of vascular endothelial growth factor (VEGF) in high altitude pulmonary hypertension in rats. Fifty healthy male Wistar rats were divided into five groups randomly: Plain control group (LC group), 10-day plateau group (H(10) group), 30-day plateau group (H(30) group), 10-day rhodiola-treated plateau group (R(10) group), and 30-day rhodiola-treated plateau group (R(30) group). Each group included 10 rats. The rats in LC group were kept in Chengdu (500 meters above sea level), and rats in H and R groups were kept in Lhasa (3 700 meters above sea level). The rats in R group were daily treated with integripetal rhodiola herb extract (24%, 10 mL/kg) intragastrically for 10 d or 30 d, while rats in LC and H groups were treated with the same volume of saline. Mean pulmonary arterial pressure (mPAP) was detected via a catheter in the pulmonary artery by pressure waveform monitoring. The ratio value of right ventricle weight to left ventricle plus septum weight [RV/(LV + S)] was measured. The microstructure of pulmonary arterioles was examined by electron microscopy. The expression of VEGF in the lung was investigated using immunohistochemistry. The results showed that mPAP and [RV/(LV + S)] in H(10) group and H(30) group were higher than those in LC group (P < 0.05); but there was no significant difference between H(10) group and R(10) group (P < 0.05); and mPAP and [RV/(LV + S)] in H(30) group were lower than those in H(30) group (P < 0.05). Electron microscopy showed that compared to LC group, arteriolar endothelial cells were arranged in a columnar or palisading form, protruding into the lumen, accompanied with luminal stenosis, irregular internal elastic membrane, and proliferation of vascular smooth muscle cells in H groups, which was more obvious in H(30) group than in H(10) group; while these pathological changes were attenuated in the R groups compared to H groups. The levels of VEGF protein in H groups were also higher than those in LC group (P < 0.05); while the expression of VEGF in R(30) group was lower than that in H(30) group. In summary, the results show that the integripetal rhodiola herb can attenuate high altitude-induced pulmonary arterial remodeling in rats, and the inhibition of VEGF protein expression by rhodiola may be one of the mechanisms.
Altitude ; Altitude Sickness ; prevention & control ; Animals ; Arterioles ; metabolism ; pathology ; Drugs, Chinese Herbal ; pharmacology ; Hypertension, Pulmonary ; metabolism ; pathology ; physiopathology ; Male ; Pulmonary Artery ; metabolism ; pathology ; RNA, Messenger ; metabolism ; Rats ; Rats, Wistar ; Rhodiola ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVETo detect the spatial distribution characteristics of iodine in drinking water of residents in Shandong province with spatial autocorrelation analysis.

METHODSThe county-based study set Shandong province as a research site. A total of 108 164 water samples from 140 counties were collected. The drinking water iodine data in county-level city between 2008 to 2010 were obtained from Shandong Institute of Prevention and Control for Endemic Disease and was merged with an electronic map to build a spatial database. Global and local Moran's I index were calculated, respectively, and spatial autocorrelation and cluster range of iodine distribution in drinking water in Shandong province were studied by SaTScan software.

RESULTSAll counties were further grouped according to the "criteria of delimitation for IDD endemic areas" and "determination and classification of the areas of high water iodine and the endemic areas of iodine excess goiter", and 90 counties were iodine deficiency (< 10 µg/L), 31 were iodine suitable (10 - 150 µg/L), and 19 (> 150 µg/L) were high iodine. For the overall study area, the iodine distribution in drinking water in Shandong province existed spatial autocorrelation (Moran's I = 0.52, Z = 7.4, P < 0.01). For the local scale, the drinking water iodine in 18 counties of Dezhou, Liaocheng and Heze city in western Shandong province was clustered, the local Moran's I were between 0.22 - 1.00 (P < 0.01), which were all high-high clusters, indicating the positive spatial correlation. Spatial analysis using SaTScan software detected two cluster areas including 20 counties, which the centers located in Xiajin and Dingtao county, the cluster radiuses were 57.47 km and 65.58 km respectively. The analysis results were consistent with the results of local spatial autocorrelation.

CONCLUSIONThere are apparent spatial autocorrelation and strong spatial heterogeneity existed in the iodine distribution in drink water in Shandong province.