The work that the reformation of worker's medical insurance system is being put into effect is both a oppotunity and a challenge for the development and reformation of our hospital. There is a lot of things to do in the hospital, but dealing seriously with medical moral standars formation of the hospital has a role of guiding and protecting for other works to do well. Therefore, the related sections of hospital have to regard it as a important thing.

Objective To determine the difference between target and measured concentration of remifentanil given by target-controlled infusion (TCI) and evaluate the performance of a new type Ⅰ TCI system for Chinese. Methods Thirty-six ASA Ⅰ or Ⅱ patients aged 40-60 yr weighing 50-70 kg undergoing elective lung resection were randomly divided into 2 groups according to target remifentanil concentration: group Ⅰ 6 ng ? ml-1 and group Ⅱ 8 ng?ml-1. The patients were premedicated with intramuscular midazolam 0.05 mg?kg-1 and atropine 0.5 mg. Anesthesia was induced with remifentanil and propofol both given by TCI. The target concentration of propofol (effect-site concentration) was set at 3 ?g?ml-1 and remifentanil (plasma concentration) at 6 or 8 ng? ml-1. When the patients lost consciousness, vecuronium 0.1 mg?kg-1 was given i. v. to facilitate intubation. The patients were mechanically ventilated and PETCO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with TCI of propofol and remifentanil and intermittent i. v. boluses of vecuronium. Target plasma concentration of remifentanil remained unchanged during anesthesia. BIS value was maintained at 45-55 by modifying target propofol concentration. Arterial blood samples were taken before and 5, 10, 20, 40, 60, 90 and 120 min after TCI remifentanil was started for determination of blood remifentanil concentration by high performance liquid chromatography.The performance error (PE) was determined for each measured blood remifentanil concentration. The performance in the population was determined by median absolute performance error (MDAPE), median performance error (MDPE) and the wobble (the median absolute deviation of each PE from the MDPE). Results The measured concentrations (Cm) of remifentanil were significantly lower than the target plasma concentration (Cp) at5, 10, 20 min of TCI in both groups ( P

Objective To study H.pylori infection and the changes of muco sal inflammation， atrophy and intestinal metaplasia in the different histolog ical types of gastric polyps. Methods Two hundred and seventy－ eight cases of gastric polyps(12.6％ ) from 2 203 gastric mucosal biopsy cases were histologic ally classified and examined for the presence of Helicobacter pylori,for degree and type of inflammation,mucosal atrophy and intestinal metaplasia. Results 53. 9％ gastric polyps were infected with H.pylori,in which faveolar polyp was the highest with an infective rate of 73.1％ .The changes of active inflammation,atr ophy and metaplaisa in gastric mucosa were frequently accompanied with H.pylori positive faveolar polyps almost as same as those in adenoma.The fundic gland pol yps were usually with low rate of H.pylori infection,and the changes of mucosal active inflammation,atrophy and metaplasia were seldom observed. Conclusions Fav eolar polyps,which are different from fundic gland polyp,may caused by H.pylori infection and are usually with the changes of mucosal active inflammation,atroph y and metaplasia.

OBJECTIVE:To develop a RP-HPLC method for determining serum concentration of propofol METHODS:Using ODS C18 column as fixed phase,a mixture of methanol and water(75∶25) as mobile phase,excitation wavelength 270nm,emission wavelength 295nm RESULTS:The linear range was 0 0 375～8 0?g/ml,r=0 9 996 The within-day and between-day RSDs were less than 5%,the average recovery was 83 98% CONCLUSION:This is a good method to monitor propofol serum concentration

Objective To compare the severity of kidney injury following liver transplantation performed under sevoflurane versus propofol combined anesthesia in patients.Methods Fifty ASA Ⅱ or Ⅲ patients of both sexes,aged 40-64 yr,weighing 47-85 kg,scheduled for elective orthotopic liver transplantation,were randomly divided into 2 groups (n =25 each) ∶ propofol combined anesthesia group (group P) and sevoflurane combined anesthesia group (group Se).During maintenance of anesthesia,propofol was given by target-controlled infusion and the target plasma concentration was 2-4 μg/ml in group P,and sevoflurane was continuously inhaled and the endtidal concentration was maintained at 1.0％-3.0％ in group Se.Venous blood samples and urine specimens were taken immediately before skin incision (T0),at 30 min after occlusion of the inferior vena cava (T1),at 30 min of neohepatic phase (T2),at the end of surgery (T3),and at 1,3 and 5 days after operation (T4-6) for determination of serum concentrations of creatinine (Cr),blood urea nitrogen (BUN),β2-microglobulin (β2-MG) and urinary β2-MG concentrations.Results Compared with group P,the serum concentrations of Cr,BUN and β2-MG and urinary β2-MG concentrations were significantly lower at T3,4 in group Se (P ＜ 0.05 or 0.01).Conclusion The severity of kidney injury is reduced in patients undergoing liver transplantation performed under sevoflurane combined anesthesia compared with that under propofol combined anesthesia.

Objective To investigate the effect of creatine phosphate on perioperative myocardial injury caused by living donor liver transplantation(LDLT)in adult patients.Methods Forty ASA Ⅱ -Ⅳ patients(liver function Child-Pugh grade B or C)aged 45-62 yr weighing 47-91 kg undergoing LDLT were randomly divided into 2 groups(n = 20 each): control group(group C)and creatine phosphate group(group CP).In group CP,creatine phosphate 30 mg/kg was injected intravenously at skin incision followed by creatine phosphate infusion at 4 mg· kg- 1 · h- 1 until the end of surgery.In group C,equal volume of normal saline was infused instead of creatine phosphate.HR,MAP,CVP,PCWP,CO and SvO2 were recorded immediately before skin incision,at 5 and 30 min of anhepatic phase,at 5 and 30 min of neohepatic phase and at the end of operation.Blood samples were taken from central vein immediately before skin incision(baseline,T0),at 30 min of anhepatic phase(T1),at 30min of neohepatic phase(T2),at the end of operation(T3)and at 4 and 24 h after operation(T4,5)for determination of serum cardiac troponin I(cTnI)and creatine kinase MB(CK-MB)concentrations and lactate dehydrogenase(LDH)activity.Postoperative adverse events were recorded.Results The serum cTnI and CK-MB concentrations and LDH activity were significantly increased at T2-5 as compared with the baseline value at T0 in both groups(P ＜0.05 or 0.01).MAP and CO were significantly higher from 5 min of neohepatic phase to the end of operation,the serum cTnI and CK-MB concentrations and LDH activity were significantly lower at T2-5,and the incidence of ventricular arrhythmia was significantly lower in group CP than in group C(P ＜ 0.05 or 0.01).Conclusion Creatine phosphate can attenuate perioperative myocardial injury caused by LDLT in adult patients.

Objective To confirm the protective effect of berberine (BBR) on cold ischemia reperfusion (I/R)-induced liver injury and to show whether the hepatic protection conferred by BBR involves the activation of phosphatidylinositol 3 kinase (PI3K) / protein kinase B (Akt)/mammalian target of rapamycin(mTOR) signal pathway.Method Adult male Sprague-Dawley rats were assigned randomly to four groups:BBR group (BBR was intragastrically administered at a dose of 100 mg·kg-1 · d-1 2 weeks before hepatic cold I/R treatment),dimethyl sulfoxide (DMSO) group (BBR was replaced by DMSO,and others were the same as BBR group),I/R group (BBR was replaced by normal saline,and others were the same as BBR group) and sham group (normal saline was administered 2 weeks before opening and closing abdomen treatment).Then the rats were sacrificed at 3,6,and 24 h after reperfusion.The liver function,oxidative stress level,apoptosis rate,and the expression of PI3K/Akt/mTOR related pathway proteins were assayed.Result As compared with sham group,the I/R-induced liver tissue displayed severe lobular distortion with widespread necrosis,high level of oxidative stress and apoptosis rate.As compared with I/R group,BBR dramatically attenuated the histopathologic damage,restored the liver function and decreased the oxidative stress level.Simultaneously,BBR significantly ameliorated the apoptosis by decreasing the apoptosis rate,increasing the Bcl-2/Bax ratio and inhibiting caspase-3 activity in rats subjected to hepatic I/R.The expression of p-Akt was effectively upregulated with the inhibited expression of p-mTOR.Conclusion Our result provides robust in vivo evidence that BBR can prevent I/R-induced oxidative stress and apoptosis.The mechanisms involved can be attributed to the activation of P]3K/Akt/mTOR signal pathway.

Kidney plays an important role in maintaining the homeostasis as an important excretory and endocrine organ.The occurrence and development of kidney disease is closely associated with glomerular filtration barrier dysfunction and renal interstitial remodeling.Matrix metalloproteinase-9 (MMP-9),a major enzyme in the extracellular matrix (ECM),plays an important role in the process of kidney disease by regulating the ECM components and its interaction with cytokines.The paper reviews the pathophysiology of MMP-9 in glomerular filtration barrier dysfunction and renal fibrosis to provide a theoretical basis for clinical treatment of kidney disease.

Objective To evaluate the effect of dexmedetomidine on myocardial injury in pediatric patients undergoing living-related liver transplantation. Methods Fifty-eight pediatric patients of both sexes,aged 5-20 months,weighing 4.5-15.0kg,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,scheduled for elective living-related liver transplantation,were divided into 2 groups(n=29 each)using a random number table:control group(group C)and dexmedetomidine group(group D).In group D,dexmedetomidine was intravenously infused at a dose of 0.5 μg/kg over 10min starting from the time point immediately before skin incision,followed by an infusion of 0.8 μg·kg-1·h-1 until the end of surgery. The equal volume of normal saline was given instead in group C. Immediately before skin incision(baseline,T0),at 10min of anhepatic phase(T1),at 30min of neohepatic phase(T2)and at the end of surgery(T3),blood samples were obtained from the central vein for determination of serum cardiac troponin I(cTnI),lactate dehydrogenase(LDH),alpha-hydroxybutyrate dehydrogenase(α-HBDH),interleukin-6(IL-6)and IL-10 concentrations. The changing rate of serum cTnI concentrations were calculated at T2. The occurrence of myocardial ischemia and ventricular premature beat and requirement for dopamine were recorded during surgery. Results Compared with the baseline at T0,the serum concentrations of cTnI,LDH and α-HBDH were significantly increased at T2,3,and the serum concentrations of IL-6 and IL-10 were increased at T1-3 in both groups(P<0.05).Compared with group C,the serum concentrations of cTnI,LDH,α-HBDH and IL-6 were significantly decreased at T2,3,the serum concentration of IL-10 was increased at T1-3,the changing rate of serum cTnI concentrations was decreased(P<0.05),and no significant change was found in the incidence of myocardial ischemia and ventricular premature beat and requirement for dopamine in group D(P>0.05).Conclusion Dexmedetomidine can attenuate the myocardial injury to some extent in pediatric patients undergoing living-related liver transplantation.

Objective To evaluate the role of silent information regulator fac tor 2-related enzyme 1 (SIRT1)/Forkhead Box O3 (FoxO3a) signaling pathway in berberine pretreatment-induced reduction of hypoxia/reoxygenation (H/R)-caused injury to hepatic parenchymnal cells.Methods Hepatic parenchymal cells obtained from AML12 mice were cultured and seeded in 6-well plates (2 ml/well) and in 96-well plates (200 μl/well) at the density of l×l06 cells/ml.The cells were divided into 4 groups (n=36 each)using a randomn number table:control group (group C),group H/R,berberine pretreatment group (group BP) and SIRT1-siRNA group (group SS).The cells were cultured in normal culture atmosphere (5％ CO2-21％ O2-74％ N2) in group C.In H/R,BP and SS groups,the cells were exposed to hypoxic air (5％ CO2-1％ O2-94％ N2) for 12 h,followed by 6 h reoxygenation in normal culture atmosphere (5％ CO2-21％ O2-74％ N2).In group SS,small interference RNA targeting SIRT1 (SIRT1-siRNA) was added to the culture medium at 24 h prior to hypoxia.Berberine (final concentration 5 μmol/L) was added at 2 h prior to hypoxia in BP and SS groups.At the end of reoxygenation,the cell viability was measured by methyl thiazolyl tetrazolium assay,the malondialdehyde (MDA) content and superoxide dismutase (SOD) activity were determined using enzyme-linked immunosorbent assay,cell apoptosis was detected by flow cytometry,the expression of SIRT1 and FoxO3α was detected by Western blot,and the acetylation of FoxO3α was measnred by using immunoprecipitation.Apoptotic rate was calculated.Results Compared with group C,the cell viability was significantly decreased,the MDA content was increased,the SOD activity was decreased,apoptotic rate was increased,the expression of SIRT1 and ratio of FoxO3α expression in nucleus/in cytoplasma were increased,and the acetylation of FoxO3α in the nucleus was increased in H/ R,BP and SS groups (P＜ 0.05).Compared with group H/R,the cell viability was significantly increased,the MDA content was decreased,the SOD activity was increased,apoptotic rate was decreased,the expression of SIRT1 and ratio of FoxO3α expression in nucleus/in cytoplasma were increased,and the acetylation of FoxO3α in the nucleus was increased in group BP (P＜0.05).Compared with group BP,the cell viability was significantly decreased,the MDA content was increased,the SOD activity was decreased,apoptotic rate was increased,the expression of SIRT1 and ratio of FoxO3α expression in nucleus/in cytoplasma were decreased,and the acetylation of FoxO3α in the nucleus was decreased in group SS (P＜O.05).Conclusion The mechanism by which berberine pretreatment attenuates H/R-caused injury to hepatic parenchymal cells is related to promotion of SIRT1 expression in cells and inhibition of FoxO3α acetylation in the nucleus.