Objective To examine the differences in the level of sedation and adverse effects produced by equivalent analgesic doses of remifentanil,sufentanil and fentanyl.Methods Eighty ASA Ⅰ female patients aged 18-39 yr with BMI of 18-25 kg/m2 scheduled for laparoscopic surgery under general anesthesia were randomly divided into 4 groups ( n =20 each):group control (group C) ; group remifentanil ( group R) ; group sufentanil (group S) and group fentanyl (group F).Remifentanil 2 μg/kg,sufentanil 0.2 μg/kg and fentanyl 2 μg/kg in normal saline 10 ml were infused iv over 2 min in groups R,S and F respectively.Depth of sedation was assessed and scored using OAA/S scale (5 =alert,1 =no response to prodding) and wavele index (WLI),before (baseline) and at 2,4,6,8 and 10 min after drug administration.Besides RR,pulse oxygen saturation,BP,HR were also monitored.The incidences of apnea,muscle rigidity,nausea and vomiting,pruritus,vertigo,bradycardia,profuse sweating and skin rash were measured and calculated.Results The 4 groups were comparable with respect to age,BMI and height.The lowest values of OAA/S scores,WLI and RR were significantly lower in groups R,S and F than in group C.Sufentanil produced the deepest sedation among the 3 opioids.Remifentanil produced strongest respiratory depression and nausea and vomiting.Conclusion The equivalent analgesic dose of sufentanil produces deeper sedation than that of remifentanil and fentanyl while remifentanil has the greatest impact on RR.

Objective To investigate the pulmonary morphologic changes and pulmonary surfactant protein A (SP-A) mRNA expression in fetal rats with maternal intrahepatic cholestasis of pregnancy (ICP).Methods Animal models of intrahepatic cholestasis of pregnancy were induced by 17-α-ethinylestradiol and progesterone.Histopathologic examination of the fetal lungs was performed under light and electronic microscopes.The expression of SP-A mRNA in the fetal lungs was measured by reverse transcription-polymerase chain reaction technique.Results (1) Compared with the control group,histopathologic examination showed that fetal pulmonary tissues had dilated and congested interstitial lung capillaries,thickened alveolar septum,mild focal inflammatory exudation and focal hemorrhage in alveolus.Furthermore,reduced microvilli,mitochondrion vacuolization,cytoplasm disintegration and increased lamellar body evacuation were observed in alveolar epithelial cell II in ICP group under light and electronic microscopes.(2) Expression of SP-A mRNA in fetal lungs of ICP group (0.71 + 0.10) was significantly lower than that in control group (1.00±0.27),t=3.093,P＜0.05.Conclusions Hyperbileacidemia in ICP maternal rat might lead to pathological changes in fetal pulmonary tissues.Low expression of SP-A mRNA might contribute to lesions of fetal lung with ICP.

Objective To understand the quality of life of elders in the community of Shangqiu and analyze the affecting factors to provide a scientific evidence which could improve their quality of life.Methods The general questionnaire and World Health Organization Quality of Life Brief Evaluation From were used among 116 elders in two communities of Shangqiu.Results The quality of life of elders was in low level.The mainly factors that influencing the quality of life of elders in the community of Zhengzhou were age,education status,economic income,hobbies and interest,family relation,physical exercise.Conclusions The factors that influence the elders in community are various.To improve quality of life of elders,community workers should take relevant measures and encourage family members to participate in caring elders.

Gallstone disease is highly prevalent in clinic,particularly in women and some specific ethnic groups.The formation of water-insoluble cholesterol crystals is due to a misbalance between the three major lipids present in the bile:cholesterol,bile salts,and phospholipids.Many proteins implicated in biliary lipid secretion in the liver are regulated by several transcription factors,including nuclear receptors LXR and FXR.Human and murine genetic,pathophysiological evidence is consistent with the relevance of these nuclear receptors in gallstone formation.In addition,there is emerging data that also suggests a role for estrogen receptor ESR1 in abnormal cholesterol metabolism leading to gallstone disease.A better comprehension of the role of nuclear receptor function in gallstone formation may help doctors to design new and more effective therapeutic strategies for this highly prevalent disease condition.

Objective To investigate the influence of intrahepatic cholestasis of pregnancy (ICP) on the pulmonary morphologic changes of fetal rats.Methods Twenty pregnant SD rats at 15 days of gestations were randomly divided into ICP and control group.Rats in the ICP group were subcutaneously injected with 17-α-ethinylestradiol and progesterone for 5 consecutive days to establish the rat ICP model, and those of the control group received subcutaneous injection of sirasimeyu also for 5 days.The levels of serum alanine aminotransferases (ALT), aspartate transamlnase (AST), and total bile salt (TBA) were measured before and after the treatment, respectively.Maternal rats were sacrificed on 21 days of gestations and hysterotomies were performed immediately.Histopathologic changes of mammal rats' livers and fetal lungs were observed under light and electron microscopes.Results (1) The maternal serum levels of ALT, AST, and TBA showed no significant difference between the ICP and control group [ALT: (55 ± 15) vs (49 ±12) U/L; AST:(146±16)vs (145±20) U/L; TBA: (13±4) vs (14 ±4) μmol/L, P>0.05, respectively]before the ICP models were established, but higher levels were shown in the ICP group after [ALT: (94±12) vs (59±17) U/L; AST: (245±26) vs (163±27) U/L; TBA: (44±16) vs (17± 3) μmol/L, P <0.05, respectively].(2) The livers of maternal rats' in the ICP group were gloomy with blurred margins, however those of the control group were normal.Microscopic observed swollen and degenerated hepatocytes with narrowed hepatic sinusoid, dilated bile duct and necrosis of hepatocytes occasionally in the ICP group, while the morphology of hepatocytes and structures of lobuli hepatis in the control group were normal.(3) The fetal pulmonary tissues in the ICP group were dark, and normal in the control group.Histopathologic examination showed matured fetal pulmonary tissues with dilated and congested interstitial lung capillaries, thickened alveolar septum, mild focal inflammatory exudation and focal hemorrhage in alveolus.Furthermore, reduced microvilli, mitochondrion vacuolization, cytoplasm disintegration and increased lamellar body evacuation were observed in type Ⅱ pneumonocytes in ICP group under light and electron microscopes.While fetal pulmonary tissues of the control group did not show any significant lesions.Conclusions Rat model of ICP can be established with the combination of estrogen and progestin.Hyperbileacidemia in ICP rat may lead to pathological changes in fetal pulmonary tissues.

Objective To explore the clinical effect of pulmonary infection control window for sequence ven-tilation on treatment of severe pneumonia with respiratory failure,and to observe and analyze the prognosis.Methods 102 severe pneumonia patients complicated with respiratory failure were selected.They were divided into the observation group and the control group by the random number table method.The patients of the observation group were treated with pulmonary infection control window for sequence ventilation treatment,the control group were treated with conven-tional sequence ventilation treatment.The change of blood oxygen partial pressure(PaO2 ),carbon dioxide partial pres-sure(PaCO2 )and blood oxygen saturation (SaO2 )before and after ventilation,and the treatment time and symptoms improve time and the complications such as ventilator associated pneumonia(VAP)of the two groups were observed. Results PaO2 and SaO2 of the observation group after the ventilation were (75.60 ±2.89)mmHg and (0.78 ± 0.09),which were higher than control group after the ventilation (70.48 ±3.16)mmHg and (0.71 ±0.11),and data of two groups after ventilation were higher than those before the treatment,differences were statistically significant (t =11.30,10.92,13.26,14.08,all P <0.05).PaCO2 of the observation group after the ventilation was 49.21 ±3.22 mmHg, which was lower than that of control group after the ventilation of 54.35 ±3.82 mmHg,and data of two groups after treatment was lower than before treatment,the differences were statistically significant(t =12.44,11.85,14.16, 13.42,all P <0.05).The total mechanical ventilation time of the observation group,respiratory difficulty relief time, lung then disappear time and hospital stay time were (5.24 ±1.83)d,(38.13 ±2.91 )h,(6.72 ±0.40)d and (15.33 ±3.18)d,which were lower than those of control group,the differences were statistically significant (t =9.87,10.21,10.46,11.08,all P <0.05).The general adverse reaction and the death rate of the observation group was 9.80% (5 /51),which was lower than 19.61% of the control group(χ2 =9.85,P <0.05).Conclusion There was effect of pulmonary infection control window for sequence ventilation treatment of severe pneumonia with respirato-ry failure,and it could improve effectively lung function and the prognosis and reduce the incidence of complications.

Objective To systematically evaluate the effectiveness of using gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU.Methods The randomized controlled trials (RCTs) on the application of gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU were collected through the databases such as the China National Knowledge Infrastructure (CNKI),China Scientific Journal Database by VIP (VIP) and Wanfang Database.The quality of studies was critically appraised and data were extracted by two reviewers independently.Meta-analysis was conducted for the included studies.Results Eleven RCTs involving 1 337 patients were included.Meta-analysis showed that the application of gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU could reduce ventilator-associated pneumonia (VAP) incidence rate[RR=0.54,95％CI(0.44-0.65),P ＜ 0.01],shorten the duration of mechanical ventilation [mean differences(MD)=-2.38,95％CI(-2.69--2.07),P ＜ 0.01] and length of ICU [MD=-3.66,95％CI (-5.45--1.87),P ＜ 0.01],but the mortality rate was not statistically significant [RR=0.37,95％CI (0.11-1.26),P ＞ 0.05].Conclusions The application of gargle solution Chlorhexidine Gluconate for patients with mechanical ventilation in ICU is safe and effective.

Objective:To investigate the cardiac magnetic resonance technique in the diagnosis and treatment of unstable angina application value. Methods:The hospital diagnosed patients with unstable angina as research subjects, were given coronary angiography in patients (CAG) examination, ECG, echocardiography and cardiac MRI examination, recording the results and statistical analysis. Results:Cardiac MRI for>90%stenos is detected heart rate, and coronary angiography (CAG) showed no significant difference (x2=3.257, P>0.05), for<90%stenos is detection rate, and coronary angiography (CAG) was statistically significant between test results (x2=17.267, x2=25.714;P<0.05);cardiac magnetic resonance for the degree of stenos is of myocardial ischemia in patients with high detection rate and electrocardiogram detection rates were significantly different(x2=4.65, P<0.05), but the total no significant difference between the detection rate(x2=0.251, P>0.05);cardiac MRI for cardiac function and cardiac structure determination is better than conventional echocardiography. Conclusion: Cardiac MRI technology to more accurately reflect changes in cardiac structure and function of the stenos is and effort ischemia detection rate with conventional inspection methods have better consistency.

HDL or apolipoprotein A-Ⅰ,the major protein of HDL particles,protect host against vascular endothelial dysfunction.HDL binding to scavenger receptor-BI activates eNOS for increasing NO.SR-BI and Endothelial lipase(EL) play a critical role in the regulation of plasma HDL.Incubation of HDL with vascular endothelial cells promotes prostacyclin synthesis.Some proteins such as paraoxonase that cotransport with HDL in plasma,have antioxidant properties.HDL inhibits TNF-? dependent expression of adhesion molecules in vascular endothelial cells and interferes with apoptosis,proliferation and migration of vascular endothelial cells.

Objective To explore the feasibility of laparoscopical left hepatectomy with the method of Glis-son pedicle transsection.Methods Clinical data of anatomical left hepatectomy patients with the method of Glisson pedicle transsection from February 2012 to April 2012 in our hospital were retrospectively analyzed.Results All patients were completely suffered laparoscopical left hepatectomy with the method of Glisson pedicle transsection. Operation time form 2-4 hours,postoperative hospitalization for 6-7 days,all these patients were cured and discharged, without any complication of bile leakage, hemorrhage, peritonitis, intestinal obstruction, postoperative liver function recovered rapidly.There was no death case.Conclusion It is safe and feasible of laparoscopical left hepatectomy with the method of Glisson pedicle transsection and should be worth to popularize.