Objective To evaluate the effect of small dose ketamine on the efficacy of intravenous PCA (POA) with sufentanil after intra-abdominal surgery in aged patients.Methods Sixty ASA Ⅰ orⅡpatienm aged 65-82 yr undergoing elective intra-abdominal surgery under general anesthesia were randomized into 3 groups (n=20 each)according to the composition of PCIA solution:group I sufentanil 200 μg in 200 ml of noilnal saline (group S);group μ sufentanil 200μh+ketmine 100 mg in NS 200 ml(group K1)and group Ⅲ sufentannil 200 μg+ketmine 200 mg in NS 200 ml(group K2).A loading dose of 5 ml wag given at the end of operation.The PCIA setting was as follows:backgound infusion 1 ml/h,bolus dose 2 ml,lockout interval 5 min and 4-hour maximum dose 30 m1.If VAS score(0=no pain,10=womt pain)was≥7,pethidine 25 mg was given iv.The total amount of pethidine given within 48 h after operation and postoperative complications including nausea and vomiting and respiratory depression were recorded.Results Small dose ketamine added to the PCIA solution can significantly reduce the amount of pethidine administered after operation in a dose-dependent manner.Conclusion Small dose ketamine can improve the efficacy of PCIA with sufentanil after intra-abdominal surgery in aged patients with no significant adverse effect.

Objective To investigate the effect of Biglycan and FAK signal pathway on the proliferation of colon cancer cells in vitro and its possible mechanisms.Methods Biglycan expression vector was constructed and transfected into the colon cancer cell line HCT116.FAK inhibitor was used for cell treatment as well.Cells were divided into 5 groups:control group(HCT116),control group transfected with empty plasmid(Vector),con-trol group with empty plasmid transfected and inhibitor treatment(Vector+PF-562271),group transfected with Biglycan expression vector(Biglycan),group with Biglycan expression vector transfected and inhibitor treatment ( Biglycan+PF-562271) .Treatment duration was 24 hours.The expressions of FAK,p-FAK,PCNA and p53 were detected by Western Blot.The proliferation of cells was detected by MTT.Results The overexpression of Biglycan significantly promoted the proliferation of HCT116 and the phosphorylation of FAK(P<0.01).It signif-icantly up-regulated PCNA and down-regulated p53(P<0.01).The FAK inhibitor PF-562271 treatment could obviously inhibit the proliferation of HCT116,and the regulation of Biglycan on the expression of p-FAK, PCNA.p53 proteins was reversed(P<0.01).Conclusion Biglycan regulates the proliferation of colon cancer cells by promoting the activation of FAK signal pathway.

Objective To observe the influence of Biglycan on the focal adhesion kinase( FAK) activa-tion and to explore whether it regulates the invasion and metastasis of colon cancer through FAK signaling path-way.Methods The overexpressive plasmid of Biglycan was constructed and then transfected into the colon canc-er cell line HCT116.Meanwhile,FAK inhibitor was used to treat cells.Control group(HCT116),empty plasmid group(Vector),empty plasmid and inhibitor treatment group(Vector +PF -562271),Biglycan overexpression group( Biglycan) ,Biglycan overexpression and inhibitor treatment group( Biglycan+PF-562271) were set.Twen-ty four hours after exposure to inhibitor,the expression of FAK and p-FAK in each group was detected by West-ern Blot.The invasion and metastasis of colon cancer cells was detected by transwell assay.Results Overexpres-sion of Biglycan significantly enhanced the phosphorylation level of FAK and promoted the invasion and metastasis of HCT116(P<0.01).The inhibitor of FAK PF-562271 could significantly reduce the expression of p-FAK and reverse the effect of Biglycan on the invasion and metastasis of colon cancer cells.Conclusion Biglycan reg-ulates the invasion and metastasis of colon cancer cells through activation FAK signaling pathway.

Objective To explore the influential factors of hospital management teaching and to apply new plans to improve quality of teaching. Methods Questionnaire survey was conducted among 94 students majored in health management in Xuzhou Medical College to investigate student' learning behavior as well as contents, applying value, procedures, and teaching effects of the course. Data was put in by Epidata 3.02, described and analyzed by SPSS 18.0. Continous variables were ana-lyzed by t test and classified variables were analyzed by X2 test. Results 25.6%(24/94) students were not interested in this course. 61.7%(58/94) students thought that the course was highly correlated with profession. 56.4%(53/94) students thought that the course was valuable. 35.1%(33/94) students thought that the course was not good in combining theory with practice in teaching. 19.1%(18/94) stu-dents thought that the course was deficient in interactive teaching and teaching methods. 62.8%(59/94) students were satisfied with the teaching effect. Conclusions Main influential factors of hospital man-agement teaching are learning interest, curriculum evaluation and teaching evaluation. To improve quality of hospital management teaching, it is necessary to communicate the importance of the course and to apply new teaching plans to arouse the interests of students.

Objective: To investigate the differences of biochemical markers between the patients with pulmonary hypertension related to left heart disease (PH-LHD) and LHD; to explore the sensitive bio markers which may predict PH in LHD patients. Methods: A total of 355 LHD patients admitted to our hospital from 2014-01 to 2015-05 were enrolled. According to 2009 ESC/ERS guidelines, PH was deifned by pulmonary artery systolic pressure (PASP)>50 mmHg and patients were divided into 2 groups: LHD group,n=224 and PH-LHD group,n=131. The basic information with blood levels of biomarkers was recorded and their accuracy for predicting PH was analyzed. Results: The pathogenesis of LHD included 184 (51.83%) patients of coronary heart disease, 90 (25.35%) of dilated cardiomyopathy and 81 (22.81%) of cardiac valve heart disease. Compared with LHD group, PH-LHD group had increased ratio of NYHA III and IV degree (89.31% vs 45.54%), decreased LVEF [42.0 (33.0, 59.0) % vs 60.0 (42.0, 65.0) %], all P<0.001; PH-LHD group presented elevated blood levels of BNP, bilirubin, red cell distribution width (RDW), uric acid and cystatin C, while reduced lipoprotein (HDL), allP<0.001. PASP was positively related to biomarkers as BNP, bilirubin, RDW, uric acid and cystatin C, while negatively related to HDL. With the combination of BNP, direct bilirubin and RDW, the predictive value for PH-LHD under ROC curve was 0.828 with the sensitivity at 0.813, speciifcity at 0.708. Conclusion: Blood levels of biochemical markers were statistically different between the patients of PH-LHD and LHD; the combination of BNP, direct bilirubin and RDW showed the higher accuracy for predicting PH occurrence in LHD patients.

Objective To explore the clinical application of adaptive support ventilation (ASV) in elderly patients with acute respiratory failure.Methods A total of 46 mechanically ventilated patients aged over 65 years with acute respiratory failure admitted from January 2013 to June 2015 were enrolled.Comparison between the ASV mode and synchronized intermittent mandatory ventilation (SIMV) mode was carried out in respects of the impacts of both modes on respiratory mechanics, hemodynamics, oxygen availability and comfort rate.Results Difference between ASV and SIMV in respiratory rate was [(20.84 ±4.04) vs.(24.50 ±4.60) cycles/min, t =4.04, P ＜0.05], in inspiratory resistance was [(13.24 ±4.76) vs.(16.54±5.25) cmH2O/ (L·s), t=3.16, P＜0.05], in mean airway pressure was [(13.58±2.58) vs.(16.63 ±1.57) mmHg, t =6.84, P＜0.05], in peak airway pressure was [(25.96 ± 3.69) vs.(27.87 ± 2.45) mmHg, t =2.92, P ＜ 0.05], and tidal volume was [(378.41 ± 85.61) vs.(341.52 ± 86.84) mL, t =2.05, P ＜ 0.05], and comfort rate of patients was increased in ASV mode.There were no statistically significant differences in arterial oxygen partial pressure, carbon dioxide partial pressure, lactate, heart rate, mean arterial pressure and central venous pressure between the two modes (PP ＞ 0.05).Conclusions Compared with the synchronized intermittent mandatory ventilation mode, the adaptive support ventilation mode can improve the respiratory mechanics and can increase the comfort rate in the elderly patients with mechanical ventilation.

Objective To explore the matrix effect on cyclosporine A (CsA) test by fluorescence polarization immunoassay (FPIA) and enzyme-multiplied immunoassay technique (EMIT), explain the discrepancy of external quality control results between these two methods and find the corrective action.Methods One hundred whole blood samples with various concentrations were adopted and CsA levels were detected by FPIA and EMIT.The results were compared with each other.Moreover, the influence of residual metal ions upon immunoreactions was assessed by adding Cu2+ and Zn2+.The effect of non-whole blood matrix on extraction efficiency for quality control materials and CsA calibrator was evaluated by adding identical volume of Hb-rich reagents followed with re-extraction.Results There is good correlation between results measured with FPIA(X) and EMIT(Y) methods ( Y=0.926 8X -8.115,R2 =0.996 9).Neither FPIA nor EMIT was affected by residual metal ions ( P ＞ 0.05 ). Non-whole blood matrix decreased the extraction efficiency of two methods, but it could be corrected by supplementation of the Hb-rich reagents (≥30 g/L).Conclusions Non-whole blood matrix may be the main reason for the inconsistent results measured by FPIA and EMIT methods.It could be corrected by using Hb-rich reagents.In addition,we should consider the influence of low lib on CsA test,espocially for organ transplant patients with lower Hb ( ＜30 g/L).

BACKGROUND: The graft versus host disease (GVHD) is the main reason for allogeneic hematopeic stem cell transplantation (allo-HSCT) failure, and oral tolerization is a newly developed treating method.OBJECTIVE: To evaluate the inhibition effect of acute GVHD induced by feeding donors with recipient splenocytes orally before allo-HSCT in a murine model and to compare the immune tolerance with immunosupression agents currently used in clinical treatment.DESIGN, TIME AND SETTING: A randomized grouping design of contrast observation was performed at the Center Laboratory of School of Medicine, Southeast University in December 2008.MATERIALS: The male C57BL/6J(H-2~b) mice were served as donors, and the female (BALB/C) mice (H-2~d) were served as recipients.METHODS: The mice were prepared allo-HSCT/GVHD models, and divided into 5 groups, which received prevent scheme. ①Oral tolerization group: C57BL/6J mice were fed with BALB/C (H-2~d) splenocytes before the transplantation, with dose of 10 μg per time, 1 day interval, for 3 times. ②Rapamycin group: mice were intragastric administrated rapamycin from the 1st after transplantation with dose of 1.5 mg/(kg·d). ③Ciclosporin A+ methotrexate group: mice were intragastric administrated ciclosporin A with 1.5 mg/(kg·d), increased to 5 mg/(kg·d) when mice were recovered the gastrointestinal function, and received intragastric administrated 0.4 mg/(kg·d) methotrexate at days 1, 3, 6 and 11 after transplantation. ④Blank control group: no medication after transplantation. ⑤Irradiation group: mice were received no transplantation.MAIN OUTCOME MEASURES: The presence of GVHD after allo-HSCT, and the difference of immune tolerance index.RESULTS: Typical GVHD symptoms occurred in all mice after transplantation. In the blank control group, most mice dead at days 14-18 and the mortality was nearly 100%. Compared to the blank control group, the symptoms were significantly ameliorated and the median survival times were extended in the other 3 transplantation groups (P < 0.05). The pathological structures in liver, intestine and skin tissue in the oral tolerization group were significantly decreased. Flow cytometry assay showed that oral tolerization significantly increased the CD4~+/CD8~+ lymphocyte ratio and the percentage of the CD4~+CD25~+ cells.Oral tolerization also induced the decrease of GVHD-related cytokine level. The MTT results also showed that the immunologic tolerance in the oral tolerization group was significantly enhanced and the proliferation of lymphocyte was suppressed.CONCLUSION: Oral tolerization has obviously inhibitory effect towards GVHD after allo-HSCT, its exact mechanism may be due to the suppressing the proliferation of lymphocyte and increase the immunologic tolerance in recipients. Compared to the widely used immunosuppressive drugs, oral tolerization exhibits strong ability in ameliorating GVHD.

Objective To evaluate the correlations between the cerebral hemodynamic changes of severe acute encephalopathy with the clinical features from emergency periods to stable periods and the value of transcranial Doppler ultrasonography( TCD)in cerebral function assess. Methods Thirty patients with acute brain diseases by assisted mechanical ventilator from Jun 2014 to May 2015 in PICU were included and followed up to Nov 2015,then grouped by Glasgow Coma Scale( GCS),MRI,prognosis( mental sequelae after half a year). Each subject was examined through the temporal bone window by TCD at emergency peri-ods and stable periods. The systolic cerebral blood flow velocity( sCBFV),and pulsatility index( PI)of bilat-eral middle cerebral artery( MCA),anterior cerebral artery,posterior cerebral artery were analyzed. Multivari-ant analysis of variance,repeated measures analysis of variance was conducted to compare sCBFV and PI of MCA among groups in different clinical periods. The variants included sex,disease diagnosis,prognosis, MRI,GCS,and the first abnormal TCD. The variation within groups was tested via a Hotelling T2 test. All sCBFV and PI of each artery and the D-value of sCBFV between the different periods were compared accord-ing to the prognosis groups. Results (1)Five patients could be lateralized,and their lateralization of MRI focus was consistent with the abnormal sides of sCBFV in the stable periods.(2)The D-value of sCBFV in left MCA between the different periods in the poor prognosis group was significantly higher than that in the good prognosis group[(71. 93 ± 58. 21)cm/s vs.(33. 20 ± 30. 23)cm/s,t = -2. 287,P =0. 033].(3) Multivariant analysis of variance showed that GCS classification and disease diagnosis were significantly cor-related with the cerebral hemodynamic changes respectively(P =0. 042,0. 005,respectively).(4)sCBFV and PI of left MCA reduced significantly in the stable periods than those in the emergency periods( P =0. 002,0. 003,respectivly). Conclusion The cerebral hemodynamic changes by TCD from emergency peri-ods to stable periods are consistent with the clinical status,dynamic evaluation by TCD may facilitate the evaluation of brain dysfunction in the severe acute encephalopathy.