Objective To evaluate the effect of dexmedetomidine on the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.Methods Eighty patients of both sexes, aged 30-64 yr, weighing 45-80 kg, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective abdominal surgery, were randomly assigned into 2 groups (n =40 each) using a random number table: control group (group C) and dexmedetomidine group (group D).After routine induction of anesthesia, all the patients were tracheally intubated, and mechanically ventilated.Anesthesia was maintained with sevoflurane inhalation and intermittent iv boluses of sufentanil and cisatracurium besylate, and bispectral index values were maintained at 45-60.After induction of anesthesia, dexmedetomidine was infused in a dose of 1 μg/kg over 15 min, followed by a continuous infusion of 0.6 μg · kg-1 · h-1 until 30 min before the end of surgery in group D.Group C received normal saline instead.Heart rate (HR) and mean arterial pressure (MAP) were recorded at the end of surgery, and at 1 min before and after extubation.The emergence time, extubation time, and occurrence of bucking during extubation, and nausea and vomiting, respiratory depression, and agitation during recovery from anesthesia were recorded.Results Compared with group C, MAP and HR were significantly decreased at 1 min before and after extubation, the emergence time and extubation time were shortened, the incidence of bucking, nausea and vomiting, and agitation was decreased, and no significant change was found in the incidence of respiratory depression in group D.Conclusion Dexmedetomidine infused in a dose of 1 μg/kg after routine induction of anesthesia, followed by a continuous infusion of 0.6 μg · kg-1 · h-1 until 30 min before the end of surgery, can significantly increase the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.

Objective:To establish an analytical method for measuring the concentration of glucose in saliva by ion chromatography.Methods:The proteins in saliva were removed by thermal denaturation method, CarboPac PA20 (3×30 mm) was used as a protective column and CarboPac PA20 (3×150 mm) was used as an analytical column for ion chromatography analysis. Gradient elution was carried out with A: ultra-pure water, B: 250 mmol/L NaOH solution and C: 500 mmol/L NaAc solution. Pulsed ampere detector was used for detection.Results:This method had a good linear relationship in the range of 0.04 to 0.12 mg/L, with a linear relation coefficient of 0.9967. The detection limit of glucose was 2 μg/L, the mean value of the relative standard deviation (RSD) of the repeatability measurement was 0.75%, and the average spike recovery was 103.07%.Conclusion:This method is simple, sensitive, accurate and stable, and can be used for the determination of glucose concentration in saliva.

This paper introduced the necessity, background, principle, content, function of construction of teaching resource database of blood disease testing technology and its role played in teach-ing reform. Construction of teaching resource database made up for the insufficiency of blood disease test-ing technology in teaching time and resource, explored more scientific learning mode and teaching meth-ods and strengthened the cooperation between part-time teachers and professional teachers of blood dis-ease testing technology courses.

Objectives To evaluate the efficacy of rectally administered indomethacin for the prevention of post-ERCP pancreatitis(PEP).Methods All eligible patients without high risk factors such as heart,lung,liver and kidney,coagulation dysfunction,without malignant disease and contraindication for NSAIDs,and pre-operative imaging study and lab test suggesting no pancreatitis,aged from 18 ～ 75 who underwent ERCP and EST were enrolled.In a randomized prospective trial,patients were randomized to receive a suppository containing indomethacin,100 mg,or an identical placebo 30 minutes after ERCP.PEP was diagnosed when there was pancreatitis related clinical symptoms,and serum amylase was higher than 3 times of the normal values,and when the patient needed more than 1 day hospitalization.Patients with PEP were evaluated with APACHE Ⅱ score 72 hours after ERCP.Results During 2004 ～ 2010,a total of 348 patients were enrolled,of which 182 received indomethacin and 166 received placebo.Six patients developed pancreatitis in the indomethacin group and 14 in the placebo group (3.3％ vs.8.4％,P ＜0.05),and the difference between the two group was statistically significant ( P ＜ 0.05 ).In those patients with PEP,the APACHE Ⅱ scores in indomethacin group (4.3 ± 1.3 ) were lower than that in the placebo group (7.4 ±1.7),and the difference between the two groups was statistically significant ( P ＜ 0.05 ).The incidence of hyperamylasemia in both groups was not statistically significant (9.3％ vs.10.8％,P ＞ 0.05 ).Conclusions This trial shows that rectally administered indomethacin after ERCP and EST can effectively reduce the incidence and severity of PEP.

Objective To summarize the characteristics of low echo lesions by ultrasound findings in fat-ty liver,using real -time contrast -enhanced ultrasonography ( CEUS) for differential diagnosis .Methods The study was examed in 128 cases low echo lesions of fatty liver by using CEUS ,the malignant and the highly suspec-ted malignant and part of the benign lesions (in all the 52 cases)were punctured by ultrasound guided biopsy ,the rest of the 76 cases was confirmed benign by clinical comprehensive diagnosis ,were compared to the characteris-tics about ultrasound and contrast -enhanced ultrasound image and reviewed regular follow -up.We calculated the sensitivity,specificity,youden index and the area under the ROC curve by contrast -enhanced ultrasonography and ultrasound and apply for Kappa test for reliability analysis to contrast -enhanced ultrasonography and ultra-sound.Results There were 23 malignant lesions and 105 benign lesions in total of 128 patients.The sensitivity, specificity,youden index and the area under the ROC curve by contrast -enhanced ultrasonography and ultra-sound were 95.65%,98.10%,93.75% and 87.00%,91.43%,84.43%respectively.Compared contrast -en-hanced ultrasound examination diagnosis of low echo lesions in fatty liver with the clinical diagnosis performed good reliability(Kappa=0.922,P=0.045).Conclusion We should pay attention to low echo lesions in the fatty liver.contrast-enhanced ultrasound can effectively identify low echo lesions in the fatty liver ,and identify benign and malignant lesions in the liver ,and improve obviously the accuracy of diagnosis ,and reduce the misdi-agnosis rate.

Objective:To study the expression and clinical significance of neuron-specific enolase,chromogranin and synaptophysin in islet cell tumors.Methods:Twenty-one paraffin-embedded specimens with islet tumors and 3 cases cholangiocarcinoma and tissue nearby the tumor were recruited from Jan 1988 to Jun 2001.The S-P method was used for the detection of chromogranin,synaptophysin and neuron-specific enolase.Results:There were positive expressions of neuron-specific enolase,chromogranin and synaptophysin in 19,15 and 18 cases respectively,while negative results were observed in 3 cases of cholangiocarcinoma and the para-cancer tissue.Conclusion:CG,SYN and NSE may be specific tumor markers of islet cell tumors and combined detection can help to enhance the sensitivity.

The out-patient and emergency department is the window of a hospital open to the society,also is the most direct social image of the hospital.So,we must insist on the moral principle of the "ten needs" in the work of the out-patient and emergency department in order to establish a healthy and harmonious physician-patient relationship.The "Ten needs" includes a proper attitude,a sincere communication,a quick response,a correct diagnosis,a flexible treatment,a reasonable prescription,a steady action to the emergency,a well nursing,complex skills and a standard management.

Objective To investigate the efficacy and safety of hypertonie saline enhanced radiofrequency ablation (RFA) in the treatment of liver cancer. Methods The clinical data of 42 patients with primary liver cancer (n = 28) or metastatic liver eancer (n = 14) who had been admitted to First Affiliated Hospital of Nanjing Medical University from September 2001 to December 2007 were collected. Forty-eight lesions were detected with a diameter ranging from 1.2 cm to 7.5 cm. RFA electrode and 20G needle were pricked into the target lesion under the guidance of B ultrasound or computed tomography (CT) through percutaneoas puncture or open approaches. An amount of 5-10 ml hypertonie saline was infused through the needle at regular intervals during RFA. All patients were followed up for 3-79 months. Contrast-enhanced ultrasound and CT scanning were performed postoperatively to determine the efficacy of RFA. The levels of alpha-fetoprotein (AFP) before and after treatment were compared using t test, and the survival of the patients were analyzed using a Kaplan-Meier survival curve. Results The AFP expression changed to negative in 14 out of the 18 AFP-positive patients, with statistical difference (t =7.703, P <0.05). The complete necrosis rate of tumors was 94% (45/48), and the necrosis rate of tumors with diameter of ≤4.0 cm reached 100% (35/35). The incidence of complication was 5% (2/42). No perioperative mortality occurred. The 1-, 2-, 3-year survival rates were 91%, 85% and 70%, respectively. Conclusions Hypertonic saline enhanced RFA in the treatment of liver cancer was proved to be safe and effective.

Objective To investigate the clinical features, diagnosis and treatment of malignant pancreatic endocrine tumor. Methods The clinical data of 38 patients with malignant pancreatic endocrine tumor who had been admitted to First Affiliated Hospital of Nanjing Medical University from January 1969 to December 2008 were analyzed retrospectively. Of all patients, 6 were with insulinoma, 23 with pancreatic polypeptide tumor, 4 with glucagonoma and 5 with pancreatic carcinoid. Results All patients except 1 with insulinoma were found with pancreatic lesion by imaging examination. The resection rate was 87% (33/38). Pathological examination found 7 patients with liver metastasis, 5 with lymph node metastasis, 1 with tumor thrombus in vessels and lymphatic vessels, and 28 with local invasion. Twenty-four patients were followed up, and neither recurrence nor metastasis was found except 1 patient with insulinoma who received reoperation for local recurrence and 1 patient with pancreatic carcinoid who received radiofrequency ablation for liver metastasis. Conclusions The diagnosis of pancreatic endocrine tumor mainly depends on imaging examination. The malignancy of pancreatic endocrine tumor is determined after the comprehensive analysis of preoperative imaging findings, intraoperative examination, post-operative pathological examination and the data obtained during follow-up. The malignant pancreatic endocrine tumor should be managed actively by resection because of its relatively low malignancy, high operative resectability and relatively good prognosis.

Objective To investigate the diagnosis and surgical management of adult choledochal cyst.Methods The clinical data of 58 adult patients with congenital choledochal cyst who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 1997 to December 2010 were retrospectively analyzed.All patients were diangosed by the B ultrasonography,computed tomography (CT),Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Surgical procedures were selected according to the diagnosis and Todani classification.All data were analyzed using the t test or chi-square test.Results The accurate rates of B sonography,CT,MRCP and ERCP were 78％ (45/58),92％ (23/25),9/9 and 5/5,respectively.Forty-one patients underwent complete excision of the cyst + hepaticojejunostomy (2 patients were converted from laparotomy due to abdominal adhesions),2 underwent resection of the cyst and involed hepatic segments + hepaticojejunostomy,8 underwent laparoscopic excision of the cyst + hepaticojejunostomy,1 underwent left hemihepatectomy,3 underwent pancreaticoduodenectomy ( including partial hepatectomy in 1 patient),2 underwent common bile duct exploration + cholecystectomy due to acute obstructive suppurative cholangitis,1 underwent external drainage of choledochal cyst due to advanced malignance.The mean operation time and postoperative duration of hospital stay of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were (235 ± 70) minutes,(320 ± 50) minutes,and ( 10.0 ± 2.3 ) days,( 12.6 ±6.6) days,respectively,with significant differences between the 2 groups (t =3.157,2.162,P ＜ 0.05).The postoperative morbidities of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were 18％ (7/39) and 3/8,respectively,with no significant difference (x2 =1.515,P ＞ 0.05 ).Canceration of the choledochal cyst was observed in 6 patients( 10％ ).No perioperative mortality was observed,and the operative complication rate was 24％ (14/58).The duration of the follow up ranged from 1 to 15 years,no severe long-term complications were observed in patients with benign lesions.Four of the 6 patients with malignancy died in 1 year after operation,the other 2 patients survived for 3 years and 5 years,respectively.Conclusions Abdominal B ultrasonography should be the first choice for diagnosing adult congenital choledochal cyst,while MRCP is the gold standard.Surgical intervention should be timely considered once diagnosed. Complete excision of the cyst combined with Roux-en-Y hepaticojejunostomy is the first choice of treatment.