Objective To investigate the effect of positive end expiratory pressure (PEEP) on thermo-regulatory function during general anesthesia in patients addicted to smoking. Methods Twenty adult male ASA Ⅰ or Ⅱ patients who had been smoking more than or equal to 10 cigarettes per day for more than or equal to 6 years were studied. The patients underwent intra-abdominal surgery under general anesthesia and were randomly divided into 2 groups ( n = 10 each): control group (group C) and PEEP group (group P). Anesthesia was induced with propofol, fentanyl and vecuronium and maintained with inhalation of 1%-2% isoflurane and continuous iv infusion of remifentanil and vecuronium. The patients were mechanically ventilated after tracheal intubation. In group P PEEP of 10 cm H2O was added. Temperature probe was inserted into the lower segment of esophagus and placed on the anterior chest wall, medial surface of thigh anterior surface of forearm and palmar surface of the tip of index finger. Mean skin temperature (TMSK) was calculated according to Roberts. MAP, HR, TES, TMSK and the difference between TES and TMSK (TES-MSK) were recorded before induction of anesthesia (T0 ,baseline) and every 30 min after tracheal intubation. Esophageal temperature was taken as threshold of thermo-regulatory peripheral vasoconstriction when the difference between forearm and finger tip temperature = 0 ℃. The gain in the threshold was calculated according to Sessler. Results TES and TES-MSK significantly decreased,while TMsK increased after tracheal intubation in both groups ( P ＜ 0.05). There was no signifieant difference in TES, TMSK, TES-MSK, MAP, HR, the threshold of vasoconstriction and gain between the 2 gronps ( P ＞ 0.05). Conclusion PEEP cannot improve thermo-regulatory function during general anesthesia in smoking-addicted patients.

Three ASA Ⅱ patients, aged 24-32 yr, weighing 56-74 kg, undergoing caesarean section with nitroglycerine for uterine smooth muscle relaxation, from May 2005 to April 2007 in our hospital, were studied. Among the 3 cases, 2 cases (39 or 40 weeks of gestation) were singleton pregnancy and 1 case (34 weeks of gestation) was twin pregnancy.Combined spinal-epidural block with an injection was used in the 3 patients and the block level was at T4-6-S3-5. The excess contraction of uterine occurred in the patient at 40 week gestation about 140 s after uterus incision and it was difficult in delivery of the fetus, trananasal administration was then performed with nitroglycerine 0.5 nag, but it was inefficient after 60 s observation. Nitroglycerine 0.2 nag was injected intravenously, 32 s later the uterine smooth muscle relaxation was good and the fetus was delivered smoothly. In the patients at 39 and 34 week gestation, nitroglycerine 0.2 mg was injected intravenously when the excess contraction of uterine occurred about 140 s after uterus incision and the 2rid fetus started to be. delivered respectively. The uterine smooth muscle relaxation was good 45 or 35 s after injection and the fetuses were delivered smoothly. Apgar score was 6-8 and 10 at 1 and 5 min after delivery in the 3 patients. The duration from hysterotomy to delivery was 195-240 s. Intravenous drip of oxytocin 20 U was given immediately after delivery, and then uterus contracted. No obvious adverse reactions were found.

Objective To investigate the incidence of drug resistance among new and retreatment TB patients from special hospital.Methods Totally 500 smear positive TB patients from June 2013 to December 2014 in Beijing Chest Hospital were enrolled.Phenotypic susceptibilities to cultured isolates were analyzed in 15 anti tuberculosis drugs by MGIT 960,include Isoniazid (INH),Rifampicin (RFP),Streptomycin (STR),Ethambuto (EMB),Kanamycin (Km),Amikacin (Am),Capreomycin (Cm),Ofloxacin (Ofx),Levofloxacin (Lfx),Moxifloxacin (Mfx),Paza-aminosalicylate (PAS),Protionamide (Pto),Linezolid (Lzd),Ethionamide (Eto),Pyrazinamide (PZA).Results A total of 500 TB cases were enrolled.71 samples among these were NTM infection and 12 samples were contaminted.The rest of 417 of cases infected with Mycobacteriuma,and the rate of drug resistance was 47.2％ (192/417) and the MDR rate was 28.2％ (120/417).The retreatment was significantly higher than that of the new in any drug resistance rate and MDR rate (P =0.000).100 of the retreatment isolates and 50 of the new isolates with Mycobacteriuma were selected to do the drug susceptibility test in 11 subsequent anti tuberculosis drugs (include:PZA,Am,Km,Cm,Ofx,Lfx,Mfx,PAS,Pto,Lzd,Eto).Five cases were contaminated,and in the rest of the cases,48 was the new and 97was the retreatment.The rate of the drug resistance to PZA,Am,Km,Cm,Ofx,Lfx,Mfx for the retreatment were significantly higher than the new (P ＜ 0.05).The rate of drug resistance to PAS,Pto,Lzd and Eto for the new and reteartment were no markedly differential in statistics.Conclusion This study further confirmed the rate of drug resistance in retreatment cases is higher,and the management of tuberculosis patients should be further strengthened.

ve To investigate the effect of ischemic preconditioning (IPC) on apoptosis induced by acute myocardial ischemia/reperfusion and expressions of Bcl-2 and Bax protein which were known to modulate apoptosis. Methods Twenty-four healthy SD rats of either sex, weighing (200()20)g were anesthetized with intraperitoneal pentobarbital 4.5mg?100g-1. The animals were tracheotomized and mechanically ventilated. Respiratory rate was 20 bpm and tidal volume 2 ml?100g-1. Myocardial ischemia/ reperfusion(I/R) model was established by ligation and untying of the anterior descending branch of left coronary artery. The animals were randomly divided into three equal groups with eight animals each. Group I : (control group) anterior descending branch was exposed and dissected but not ligated and was exposed for 50 min. Group II (I/R group): anterior descending branch was double ligated for 30 min and then untied for reperfusion which lasted 2h. Group III (IPC group): The anterior descending branch was tied for 5 min then untied for 5 min and the process was repeated 4 times according to Murray's method, then I/R was produced as in group II. A piece of myocardium of 2 mm thick was cut from ischemia-infarct area. Apoptotic myocardial cells were detected by TdT-mediated dUTP-biotin nick end labeling (TUNEL) and the expressions of Bcl-2 and Bax protein were measured by immunohistochemical technique. Results I/R increased the percentage of apoptotic myocardial cells and the optical density (OD) value of Bax protein and decreased the OD value of Bcl-2 protein as compared with those in the control group. IPC reduced the increased percentage of apoptotic myocardial cells and OD value of Bax protein induced by I/R and increased the OD value of Bcl-2 protein as compared with those in the I/R group. Conclusions IPC can inhibit the apoptosis induced by myocardial I/R by modulating the expression of Bcl-2 and Bax protein.

Objective To investigate the effect of ondansetron on the analgesic efficacy of tramadol for postoperative patient-controlled intravenous analgesia (PCIA). Methods Forty ASA I - II patients aged 22-74 years, weighing 40-90 kg scheduled for radical mastectomy were randomly allocated to one of two groups : control group ( n = 20) and ondansetron group ( n = 20) . The patients were premedicated with intramuscular atropine 0.01 mg?kg-1 and diazepam 0.2 mg?kg-1. Anesthesia was induced with midazolam 0.1-0.2 mg (total dose was limited to 15 mg), fentanyl 2.4?g?kg-1 , propofol 1.5-2.0 mg?kg-1 and vecuronium 0.12-0.15 mg?kg-1 . The patients were mechanically ventilated after tracheal intubation (VT 8-10 ml?kg-1 , RR 13 bpm). Anesthesia was maintained with enflurane inhalation and continuous infusion of vecuronium. The patients were attached to a PCIA pump after operation and received PCIA with 1 % tramadol (background infusion 2 ml?h-1 , bolus dose 2 ml, lockout interval 10min) in both groups. In ondansetron group the patients received ondansetron 6 mg iv during operation and a loading dose of tramadol 1 mg?kg-1 and ondansetron 2 mg after operation before PCIA. Pain score (VAS 0-10), sedation score (0-3), tramadol consumption and the incidence of nausea and vomiting were recorded at 4, 8, 12 and 24 h after operation. Results There was no significant difference in pain and sedation scores and the incidence of vomiting between the two groups. Significantly more tramadol was consumed at 4, 8 and 12 h after operation in the ondansetron group as compared with control group (P

BACKGROUND:Dihydroartmisinin can promote apoptosis of glioma cels GL261, but its effect on glioma stem cels is stil unknown. OBJECTIVE:To investigate the preliminary mechanism that dihydroartemisinin inhibits migration and invasion of glioma stem cels. METHODS: Glioma stem cels were isolated from mouse malignant glioma cel lines GL261. Immunofluorescence analysis was conducted to identify the characteristics of glioma stem cels. Migration and invasion abilities of glioma stem cels were analyzed by Transwel assay. The mRNA expressions of Tol-like receptor 2, matrix metaloproteinase-2 and matrix metaloproteinase-9 were examined by real-time fluorescence quantitative PCR. RESULTS AND CONCLUSION:The characteristics of glioma stem cels were identified by CD133 and Nestin staining. The migration and invasion of glioma stem cels were attenuated by dihydroartemisinin dose-dependently. Moreover, the mRNA expression of Tol-like receptor 2, matrix metaloproteinase-2 and matrix metaloproteinase-9 was also decreased by dihydroartemisinin in a dose dependent manner. These results suggest that dihydroartemisinin inhibits the migration and invasion of glioma stem cels probably through attenuation of Tol-like receptor signaling pathway.

Diabetic retinopathy is a series of typical pathological changes in retinal microvasculature caused by diabetes,which seriously affects the visual acuity and quality of life of patients.The development of spectral-domain optical coherence tomography provides a new approach to elucidate the pathogenesis of diabetic retinopathy,and this paper will give a brief review on the latest progress in the relationship between choroidal thickness measured by optical coherence tomography and diagnosis-treatment of diabetic retinopathy.

Through an introduction to the importance of medical ethics education and the status quo, this paper discusses how to better combine the medical ethics education with medical students′medical practices. It puts for-ward some suggestions from the institutional arrangements, personnel allocation, and publicitymethods. The ulti-mate goal is that the medical students could get more effective, continue and integration medical ethics education in the process of medical practice.

Objective To evaluate the effects of dexmedetomidine or dezocine alone or the combination of the two agents on the emergence agitation in patients undergoing thoracic surgery.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,weighing 48-75 kg,scheduled for elective thoracic surgery under general anesthesia,were randomly divided into 4 groups (n =20 each):control group (group C),dexmedetomidine group (group DEX),dezocine group (group DEZ) and dexmedetomidine + dezocine group (group DEX + DEZ).In group DEX,dexmedetomidine 0.5 μg/kg was injected intravenously at 15 min before induction of anesthesia,followed by continuous infusion of dexmedetomidine at 0.4 μg· kg-1 · h-1 until beginning of chest closure.Dezocine 0.1 mg/kg was injected intravenously after beginning of chest closure in group DEZ.In group DEX + DEZ,dexmedetomidine 0.5 μg/kg was injected intravenously at 15 min before induction of anesthesia,followed by continuous infusion of dexmedetomidine at 0.4 μg·kg-1 ·h-1 until beginning of chest closure and then dezocine 0.1 mg/kg was injected intravenously.While the equal volume of normal saline was given instead in group C.Flurbiprofen axetil 50 mg was injected intravenously at beginning of skin closure in each group.Venous blood samples were collected for determination of plasma C-reactive protein (CRP),TNF-α and IL-10 levels at 10 min before induction of anesthesia (T1),before skin closure (T2),immediately after extubation (T3) and 15 min after extubation (T4).Side effects such as agitation during emergence from anesthesia were recorded.Sedation was assessed using Ramsay score.Results Compared with group C,the levels of plasma CRP and TNF-α at T2-4 and ratio of TNF-α/IL-10 were significantly decreased,the levels of IL-10 were increased at T2-4,the degree and incidence of agitation were decreased,and Ramsay score was increased in the other three groups (P ＜ 0.05).Compared with groups DEX and DEZ,the levels of plasma CRP and TNF-α at T2_4 and ratio of TNF-α/IL-10 were significantly decreased,the levels of IL-10 were increased at T2-4,and the degree and incidence of agitation were decreased in group DEX + DEZ (P ＜0.05).No side effects such as hypotension,bradycardia,respiratory depression,nausea and vomiting were observed in the four groups.Conclusion Dexmedetomidine or dezocine alone or combination of the two agents can decrease the degree and occurrence of emergence agitation and inhibit the inflammatory response simultaneously,and the combination of the two agents provides better efficacy than either alone in patients undergoing thoracic surgery.

Objective The purpose of this study was to assess the imaging features of newly diagnosed high-grade glioma and the effect of relevant factors such as postoperative radiotherapy and chemotherapy on progression-free sur-vival (PFS) time. Methods A total of 54 patients with recurrent high-grade glioma confirmed by pathology or progressive malignant glioma proved by clinical follow-up were included in this retrospective study from 4 clinical centers. The prog-nostic factors selected included MR image features at initial diagnosis (including the maximum diameter of tumor, peritu-moral edema, degree of enhancement, degree of necrosis and presence of cystic or satellite), postoperative radiotherapy and chemotherapy. Kaplan-Meier method and Cox’s proportion-hazards model were used to analyse the factors influenc-ing the progression free survival (PFS) time. Results The univariate Kaplan-Meier analysis revealed that the degree of peritumoral edema (PTE, P=0.001), degree of necrosis (P<0.001) , degree of enhancement (P<0.001), postoperative radio-therapy (P=0.008) and chemotherapy(P=0.035) were significant factors for PFS. Cox multivariate analysis also showed that the degree of PTE(P=0.019),degree of necrosis (P<0.001) were all significantly correlated with PFS. The less edema or necrosis was associated with the longer PFS. In addition, postoperative radiotherapy (P=0.035) and chemotherapy (P=0.049) were also significantly correlated with PFS. The normative chemotherapy and radiotherapy were associated with longer PFS. Conclusions The PTE and necrosis on preoperative MR images can be used to predict the PFS of glioma af-ter total resection. Adjuvant normative chemotherapy and radiotherapy should be recommend for supratentorial high-grade glioma including those even with MRI confirmed total resection.