Objective To evaluate the efficacy and safety of postoperative analgesia in continuous Interscalene brachial plexus block by different strength ropivacaine mesylate combined with sufentanil.Methods Ninety cases of upper limb surgery in continuous peripheral nerve block (CPNB) were selected.The patients after the operation were divided randomly into three groups (A,B,and C):A group was treated with 0.158％ ropivacaine mesylate + 0.5 μg/ml sufentanil,B group with 0.238％ ropivacaine mesylate + 0.5 μg/ml sufentanil,and C group with 0.238％ ropivacaine mesylate.20 minutes before the end of surgery,controlled analgesia device was connected with infusion rate 0.05 ml/(kg · h),PCA 1 ml,and lock time 15 min.The pain visual analog score (VAS),Ramesay sedation score,and postoperative motor nerve block recovery ratings (modified Bromage classification) were recorded at the 4,8,16,32,48 h time point postoperatively.The times of using PCA and the frequency of the adverse reaction were also recorded.Results Three groups all got good analgesic effect at 4,8,16,32,48 h time point postoperatively (VAS 1.58 ± 9 ; 1.90 ± 0.8 ; 1.62 ± 0.6 ; 1.59 ± 0.7 ; 1.53 ± 0.7) (P ＞ 0.05) ; There were no significant difference among the three groups in Ramesay score,modified Bromage score,limb discomfort,nausea,vomiting,lethargy,pruritus and respiratory depression (P ＞ 0.05),but the time of using PCA in A group were significantly more than that in B or C group (P ＜ 0.05).Conclusions Sufentanil can enhance the analgesic effect significantly when the ropivacaine mesylate is in low concentrations (0.158％ ～0.238％),but when the ropivacaine mesylate concentration get up 0.238％,there will be similar analgesic efficacy and safety between ropivacaine mesylate only and ropivacaine mesylate combined with sufentanil.

Objective　To examinate the portal system hemo dynamics of portal hypertension in patients with cirrhosis and analysis the rela tionship between the changes of the portal system hemodynamics and the Child-Pu gh grade.Methods　The portal system hemodynamics of portal hypertension we re examined in 100 patients with cirrhosis and 24 normal subjects used colo r Doppler ultrasound and 100 cirrhosis patients were graded by the Child-Pugh g rade.Results　There were significant changes in the portal system hemo dynamics of portal hypertension between cirrhosis and 24 normal subjects,the di ame ter of the portal vein(Dpv),the splenic vein(Dsv) and the superior mesenteric vein(Dsmv), the speed of the portal vein(Vpv),the spleni c vein(Vsv) and the superior mesenteric vein(Vsmv) ,the flow of the portal vein(Qpv),the splenic vein(Qsv) and the superior mesenteric v ein(Qsmv) were significantly increased (P<0.01),respectively.The Dpv of Child grade C patients were wider than the those of Child grade A a nd B patients(P<0.05), the Vpv of Child grade C patients had mo re decrease than the those of Child grade A and B patients(P<0.05), but Qpv was were no significant difference between Child grade A,B and C gro ups patients(P>0.05). Conclusions　Examination of the portal system hemodynamics of por tal hypertension in patients with cirrhosis can be used to evaluate the degree o f liver function and the portal hypertension in cirrhosis patients.

Objective To investigate the possible role of intercellular adhesion molecule-1 (ICAM-1) in the lung injury induced by mechanical ventilationMethods Twenty-four normal healthy small pigs, ventilated with continuous different tidal volume, were randomly divided into control group, low tidal volume group (group A), middle tidal volume group (group B) and high tidal volume group (group C)The expression of ICAM-1 protein on pulmonary vascular endothelium cells, tumor necrosis factror-? (TNF-?) levels and myloperoxidase (MPO) activities in serum and lung were observed with immunohistochemisty, enzyme linked immunosorbent assay and MPO measurement 1d,3d and 7d following ventilation respectivelyResults The levels of TNF-? and MPO in serum and lung and the number of ICAM-1 protein expression were higher in group A, B and C than those in control group (P

Objective To investigate the characteristics of attentional control between Wenchuan earthquake anxious and normal children. Methods Using Screening Child Anxiety Related Emotional Disorders (SCARED), 18 earthquake anxious children were chosen as participants and 18 normal children were chosen as control group. They were asked to perform a visual search task. Results ( 1 ) The judgment accuracy of earthquake anxious children was lower than normal children's significantly ( ( 0.95 ± 0.01 ), ( 0. 98 ± 0. 01 ), P ＜0.01 ). ( 2 ) The reaction time of earthquake anxious children was significantly longer than normal children' s ((1664.5 ± 78.5 ) ms, ( 1110.7 ± 78.5 ) ms, P ＜ 0. 01 ). ( 3 ) There was significantly faster performance in the valid condition than in the neutral( ( 1304.7 ± 61.3 ) ms, ( 1382. 3 ± 47.4 ) ms, P ＜ 0. 05 ) and invalid condition ( ((1304.7 ± 61.3 )ms, (1475.8 ± 71.5 )ms; P ＜ 0. 05 ), as well as faster performance in the neutral than in the invalid condition ((1382.3 ± 47.4) ms, ( 1475.8 ± 71.5 ) ms, P ＜ 0.05 ) in all children. Conclusion The performance of earthquake anxious children on top-down attentional control task is less than normal children. It indicates that anxious emotion which is brought by traumatic incidents like earthquake influents earthquake anxious children' s cognitive processing ability.

Objective: To explore the application of extensive pterional approach combined with cutting of the zygomatic arch for the resection of large sphenoid ridge meningioma. Methods: Thirty-three patients with large sphenoid ridge meningioma underwent operation using the extensive pterional approach combined with cutting of the zygomatic arch. Twenty patients with large sphenoid ridge meningioma received operation with the traditional pterional approach as the control. The resection rate, operative time, intraoperative blood loss, and postoperative complications were compared between the groups. Results: Two groups of patients underwent craniotomy under microscope. The Simpon grade I resection and grade Ⅱ resection rate was 93.9％ in the cutting of the zygomatic arch approach group and 60.0％ in the control group (P<0.01). The operative time was (325.2±121.3) min in the cutting of the zygomatic arch approach group, which was significantly shorter than that in the control group with (406.4±182.9) min (P<0.05). The intraoperative blood loss was (502.5±101.8) mL and (697.7±115.4) mL in the two groups (P<0.05). In addition, postoperative complication rate was 15.2％ and 45.0％ in the cutting the zygomatic arch approach group and the control group, respectively (P<0.05). No death was reported in both groups. Conclusion: Extensive pterional approach combined with cutting of the zygomatic arch can fully expose the anatomical structures of the skull base and the sellar region to eliminate the influence of temporal muscle in the exposure of the surgical area. The operative field is exposed to reduce the stretch injury to only the frontotemporal brain tissue, which might be helpful for the complete resection of large sphenoid ridge meningioma, and is more conducive to neurovascular anatomy and relevant functional protection.

Objective To explore the clinical effect of traditional Chinese medicine (TCM) dialectical therapy for treatment of gastrointestinal dysfunction in patients with acute lung injury / acute respiratory distress syndrome(ALI/ARDS)undergoing mechanical ventilation. Methods A prospective,randomized controlled trial was conducted. Ninety-six ALI/ARDS patients admitted in intensive care unit(ICU)and treated with mechanical ventilation in Tianjin First Central Hospital were chosen and randomly divided into traditional Chinese medicine(TCM) group and conventional therapy group using a random number table,48 patients in each group. Conventional therapy alone was used in conventional therapy group,and TCM therapy of primarily using Dachengqi decoction combined with conventional therapy was applied in TCM group〔Dachengqi decoction was composed of mongolian milkvetch root 15 g, pilose asiabell toot 15 g,Chinese angelica 10 g,officinal magnolia bark 10 g,tangerine peel 10 g,immature tangerine fruit 10 g,peach seed 10 g,white peony root 12 g,red peony root 12 g,immature bitter orange 6 g,mongolian dandelion herb 30 g,radish seed(stir-fried)30 g,foxtail millet sprout 20 g,barley sprout 20 g,glauber salt 9 g (with water),rhubarb 10 g(added in water at last)〕,one dose orally taken daily for 28 days. The intra-abdominal pressure(IAP),gastrointestinal diseases in TCM symptom score and the incidence of gastrointestinal dysfunction were compared between the two groups before treatment and on the 3rd,6th and 8th day after treatment. Results There were no statistical significant differences in IAP and TCM symptom scores between the two groups before treatment (both P>0.05),but after treatment with the prolongation of therapeutic time the IAP and TCM symptom scores were decreased gradually compared with those before treatment,having reached the valley value on the 18th day and the changes in TCM group were more remarkable〔IAP(mmHg,1 mmHg=0.133 kPa):0.91±0.69 vs. 2.08±0.92, TCM symptom score:48.33±10.41 vs. 88.33±20.21,both P<0.05〕. In the TCM group,the incidences of the untoward symptoms and signs of gastrointestinal dysfunction such as bleeding of stress ulcer,toxic intestinal paralysis, abdominal distension,diarrhea and so on were lower than those in conventional therapy group〔stress ulcer bleeding:16.7%(8/48)vs. 39.6%(19/48),toxic intestinal paralysis:16.7%(8/48)vs. 43.8%(21/48),abdominal distension:10.4%(5/48)vs. 37.5%(18/48),diarrhea:6.3%(3/48)vs. 33.3%(16/48),all P<0.05〕. Conclusion Addition of TCM Dachengqi decoction on conventional treatment can effectively lower the incidence of gastrointestinal dysfunction in treatment of patients with ALI/ARDS undergoing mechanical ventilation.

Objective: To identify the differential proteins in the serum with anti-asthma activity of acupuncture to pinpoint the substance basis of anti-asthma activity of acupuncture by proteomics method. Methods: Two-dimensional electrophoresis of protein was employed to analyze the differential proteins in the serum with anti-asthma activity of acupuncture, and identify the differential proteins with mass spectrum technique. Results: In adrenalectomy (ADX)-asthma acupuncture group and asthma acupuncture group, two-dimensional electrophoresis showed that there was an obvious fuscous point (MW=44.1kD, PI=5.1), which was 60S ribosomal protein L13, or hypothetical protein FLJ32191 analyzed by mass spectrum technique, different from other groups. In ADX-asthma acupuncture group, there were two obviously fuscous points (MW=39.SkD, PI=4.9 and MW=39.SkD, PI=5.0), which were zinc finger protein 208, and thyroid hormone receptor-associated protein analyzed by mass spectrum technique, and two special proteins (MW=17.3kD, PI<4.5 and 16.9kD, PI<4.5), which were Cyclophilin A and zinc finger protein 91 analyzed by mass spectrum technique, different from other groups. Conclusion: There are multi-target effects regulating the whole body in acupuncture treating asthma relating to immunoloregulation, gene expression, and protein synthesization. The effects of acupuncture on the response proteins need further research.

Objective Training a few medical students as standardized patients to teach and test other medical students'physical examination skills is a good way to compensate the deficient teaching resources and improve the medical students'clinical capabilities.Methods We spent 12 class hours to train 6 students as standardized patients.Then we used these 6 students'standardized patients to help the teacher to educate medical students in experimental group,while students in the control group only had traditional class under the construction of the teachers as before.At last,we collected their final physical examination skills'score.Results The final physical examination skill score of experimental group(85.78?5.89)is higher than that of control group(84.53?4.64)(P

ObjectiveTo identify the value of walking speed at the evaluation of motor function recovery in hemiparetic patients after stroke.MethodsFifty-five cases were assessed in the study. The walking speed, motor function, strengths of the paretic lower limb,balance and ambulation of ADL function were evaluated with the 10m Maximum Walking Speed Test,Fugl-Meyer Assessment, Motricity Index, Berg Balance Scale and ambulation item of Functional Independence Measure. The level of association between walking speed and the clinical variables were examined with Pearson's correlation coefficients.ResultsIn the slow group, the gait-related clinical scores were related to walking speed (Pearson's r=0.581-0.770,P<0.05),while that in the moderate group and fast group were not (Pearson's r=0.016-0.380,P>0.05).The correlation between the gait-related clinical scores and walking speed was weakened when walking speed above 44.8m/min(or 41.3% of normal values).ConclusionWalking speed plays an independent role as an indicator of improved performance.