Objective To investigate the moist healing dressing nasal packing for epistaxis patients′physiological comfort and complications. Methods 70 patients of epistaxis patients with nasal packing by drawing lots were divided into A, B two groups of 35 cases. Group A used Vaseline gauze, and group B used moist healing dressings of composite fillings. Comparison of the two groups of pain, nasal odor, sleep disorders, hemostatic effect, nasal mucosa reaction, fever, nasal adhesions were conducted. Results Patients when nasal packing group A pain, sleep disorders and nasal odor scores were (9.80 ± 0.12), (7.10 ± 0.33) and (9.44 ± 0.25) points, group B were (3.82 ± 0.16), (3.22 ± 0.16) and (0.37 ± 0.09) points. Group A scored significantly higher than group B, the difference was statistically significant (t=-179.97,-7.22,-7.33, P <0.05). Group A fever and nasal adhesions were 33 cases and 6 cases respectively, while those figures in group B both were 0, the difference was statistically significant (χ2=62.43, 6.56, P<0.05). Conclusions Nasal packing varying degrees of discomfort in patients, the use of moist healing dressings for epistaxis targeted composite filling, can significantly increase the patients ’ physiological comfort and reduce the complications of nasal packing.

Healthcare delivery is transforming from hospital-centric episodic care to a more patient-centric comprehensive and continuing care that caters to the changing needs of an ageing population and finite healthcare resources. The transition period during which patients move between healthcare settings is a period of vulnerability that requires well-executed care transitions. The relatively less-developed primary, intermediate and long-term care sector further underlines the importance of good transitional care. This article serves to introduce Family Physicians to the importance of transitional care, its broad concepts and a simple framework to help manage complex patients comprehensively in any Family Medicine practice setting.

Objective To evaluate the effect of dexmedetomidine and small dose of ketamine on the expression of P2X4 receptor (P2X4 R) mRNA and P2X7 receptor (P2X7R) mRNA in the dorsal root ganglion of rats with neuropathic pain.Methods Ninety male Sprague-Dawley rats,aged 6-9 weeks,weighing 180-220 g,were randomly divided into 5 groups (n =18 each):sham group (group S),chronic constrictive injury group (group CCI),dexmedetomidine group (group D),ketamine group (group K) and dexmedetomidine + ketamine group (group DK).The animals were anesthetized with intraperitoneal 10％ chloral hydrate 400 mg/kg.Neuropathic pain was induced by CCI in CCI,D,K and DK groups.The sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1mmintervals with 4-0 silk thread.In group S,the sciatic nerves were only exposed but not ligated.In D,K and DK groups,dexmedetomidine 50μg/kg,ketamine 10 mg/kg and dexmedetomidine 25μg/kg + ketamine 5 mg/kg were injected intraperitoneally,respectively,while the equal volume of normal saline was injected in S and CCI groups,once a day for 14 consecutive days after CCI.Mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before CCI,and 3,7 and 14 days after CCI.Six animals were sacrificed after measurement of pain threshold at 3,7 and 14 days after CCI and the lumbar segments (L4-6) of the dorsal root ganglion were removed for determination of P2X4 R mRNA and P2X7 R mRNA expression by RT-PCR.Results Compared with group S,MWT and TWL were significantly decreased at 3,7 and 14 days after CCI in groups CCI,D,K and DK,the expression of P2X4R mRNA and P2X7R mRNA was up-regulated at 3,7 and 14 days after CCI in groups CCI,D and K,and the expression of P2X4 R mRNA and P2X7 R mRNA was up-regulated at 3 and 7 days after CCI in group DK (P ＜ 0.05).Compared with group CCI,TWL and MWT were significantly increased and the expression of P2X4 R mRNA and P2X7 R mRNA was down-regulated at 3,7 and 14 days after CCI in groups D,K and DK (P ＜ 0.05).Compared with D and K groups,TWL and MWT were significantly increased and the expression of P2X4 R mRNA and P2X7 R mRNA was down-regulated at 3,7 and 14 days after CCI in group DK (P ＜ 0.05).Conclusion The mechanism by which the combination of dexmedetomidine and small dose of ketamine produces a synergistic antinociception in rats with neuropathic pain may be related to down-regulation of the expression of P2X4 R mRNA and P2X7 R mRNA.

Objective To investigate the effects of Sulfotanshinone Sodium Injection (SSI) on neuropathic pain in rats.Methods One hundred and eight adult male Wistar rats,aged 6-8 weeks,weighing 180-220 g,were randomly divided into 3 groups (n =36 each):sham operation group (group S) ; chronic constrictive injury (CCI)group; group SSI.The animals were anesthetized with intraperitoneal 10% chloral hydrate 350 mg/kg.In groups CCI and SSI,4 ligatures were placed on the right sciatic nerve at 1 mm intervals with 4-0 silk thread according to the method described by Bennett et al.In group S,the right sciatic nerves were exposed,but not ligated.In group SSI,SSI 25 mg/kg was injected intraperitoneally once a day starting from the end of operation until one day before the animals were sacrificed,while the rats received the equal volume of normal saline (5 ml/kg) instead of SSI in groups S and CCI.Twelve animals in each group were chosen at 1 day before operation and 3,7 and 14 days after CCI (T1-4) to measure mechanical paw withdrawal threshold to yon Frey stimuli (MWT) and paw withdrawal latency to thermal nociceptive stimulus (TWL).Six rats in each group were sacrificed at T2-4 after measurement of pain threshold,and their lumbar segnents (L4-6) of the spinal cord were immediately removed for determination of Bcl2 and caspase-3 expression in spinal dorsal horn (by immune-histochemistry),and MDA content and SOD activity (by spectrophotometry) in spinal cord.Results Compared with group S,PWT was significantly decreased,PWL was shortened,the expression of Bcl-2 and caspase-3 was up-regulated,MDA content was increased and SOD activity was decreased at T2-4 in groups CCI and SSI (P ＜ 0.05).Compared with group CNP,PWT was significantly increased,PWL was prolonged,the expression of Bcl-2 was up-regulated,the expression of caspase-3 was downregulated,MDA content was decreased and SOD activity was increased at T2-4 in group SSI (P ＜ 0.05).Conclusion SSI can mitigate neuropathic pain in rats and inhibition of oxidative stress in spinal cord tissues and reduction of apoptosis in spinal dorsal horn neurons are involved in the mechanism.

Objective To evaluate the effect of dexmedetornidine on the expression of Toll-like receptor 4 (TLR4) and nuclear factor kappa B (NF-κB) in the spinal cord in rats with neuropathic pain (NP).Methods One hundred and eight male Wistar rats,aged 6-8 weeks,weighing 180-220 g,were randomly assigned into 3 groups (n =36 each):sham operation group (group S),NP group and dexmedetomidine group (group D).NP was induced by chronic constrictive injury in anesthetized rats.Sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1 mm intervals with 4-0 silk thread.In group S,the right sciatic nerves were exposed,but not ligated.Dexmedetomidine 50 μg/kg was injected intraperitoneally once a day from the onset of operation to one day before the rats were sacrificed in group D,while the equal volume of normal saline was injected in groups S and NP.Mechanical withdrawal threshold (MWT) and thermal pain threshold (TPT) were measured on the day before operation (T0) and 3,7,and 14 days after operation (T1-3).After measurement of pain threshold at T1,T2 and T3 after operation,the L4-6 segments of the spinal cord were removed for determination of the expres-sion of TLR4 and NF-κB mRNA (by RT-PCR) and the expression of TLR4 and NF-κB in spinal dorsal horn (by immuno-histochemistry).Results Compared with group S,MWT and TPT were significantly decreased and the expression of TLR4,NF-κB and TLR4 and NF-κB mRNA was up-regulated after operation in groups NP and D (P ＜ 0.05).Compared with group NP,TPT and MWT were significantly increased and the expression of TLR4,NF-κB,TLR4 mRNA and NF-κB mRNA was significantly down-regulated after operation in group D (P ＜ 0.05).Conclusion The mechanism by which dexmedetomidine attenuates NP in rats is related to inhibition of the expression of TLR4 and NF-κB in rat spinal cord.

Objective To evaluate the effects of dexmedetomidine on the activity of cAMP response element binding protein (CREB) and c-fos in the spinal dorsal horn in a rat model of neuropathic pain.Methods Fifty-four adult male Wistar rats,aged 6-8 weeks,weighing 180-220 g,were randomly divided into 3 groups (n =18 each):sham operation group (group S),chronic neuropathic pain group (group C) and dexmedetomidine group (group D).The animals were anesthetized with intraperitoneal 10％ chloral hydrate 350 mg/kg.The sciatic nerve was exposed and 4 ligatures were placed on the right sciatic nerve at 1 mm intervals with 4-0 silk thread in C and D groups.In group D,dexmedetomidine 50 μg/kg was injected intraperitoneally once a day starting from the end of operation until 1 day before the animals were sacrificed,while the equal volme of normal saline was injected instead of dexmedetomidine in S and C groups.Paw withdrawal threshold to mechanical stimulation with yon Frey filament (MWT) and paw withdrawal latency to thermal stimulation (TWL) were measured on 1 day before operation and 3,7 and 14 days after operation.The animals were sacrificed after measurement of MWT and TWL.Their lumbar segments (L4-6) of the spinal cord were removed for measurement of the expression of phosphorylated CREB (pCREB) and c-fos by immunohistochemistry.Results Compared with group S,MWT was significantly decreased,TWL was shortened,and the expression of pCREB and c-fos was up-regulated on 3,7 and 14 days after operation in C and D groups (P ＜ 0.05).Compared with group C,MWT was significantly increased,TWL was prolonged,and the expression of pCREB and c-fos was down-regulated on 3,7 and 14 days after operation in group D (P ＜ 0.05).MWT was significantly lower,and TWL was shorter on 3,7 and 14 days after operation than on 1 day before operation in C and D groups (P ＜ 0.05).MWT was significantly lower,TWL was shorter,and the expression of pCREB and c-fos was higher on 7 and 14 days after operation than on 3 days after operation in C and D groups (P ＜ 0.05).MWT was significantly higher,TWL was longer,and the expression of pCREB and c-fos was lower on 14 days after operation than on 7 days after operation in C and D groups (P ＜ 0.05).Conclusion The mechanism by which dexmedetomidine reduces neuropathic pain is related to inhibition of the activity of CREB and c-fos in the spinal dorsal horn of rats.

Objective To study the significance of pain symptoms and physical signs to diagnosis of deeply infiltrating endometriosis (DIE).Methods Totally 500 patients with laparoscopic diagnosis of endometriosis were studied retrospectively and divided into two groups depending on the existance of DIE.The pain symptoms and gynecological physical signs were recorded detail,and the correlation with diagnose of DIE were analyzed.Results (1) The significance of pain symptoms:the sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) and OR,95％ CI of each pain symptom were:dysmenorrhae (90.5％,37.2％,59.6％,79.3％,5.66,3.46-9.28),chronic pelvic pain (35.2％,82.6％,67.4％,55.4％,2.58,1.70-3.91),dyspareunia (46.2％,80.6％,70.7％,59.6％,3.56,2.39-5.32),dyschezia (51.0％,73.7％,66.5％,59.5％,2.91,2.00-4.24),respectively.(2) Pelvic physical examination:the sensitivity,specificity,PPV and NPV of each physical sign were:fixed uterine:73.6％,71.2％,79.5％,64.0％; fixed ovarian cyst:94.1％,20.3％,63.3％,70.0％; uterosacral ligaments nodule:47.1％,97.5％,96.6％,54.9％; uterosacral ligaments nodule with tenderness:81.7％,75.0％,83.1％,73.2％; rectovaginal septum nodule:32.2％,100.0％,100.0％,49.4％; rectovaginal septum nodule with tenderness:32.2％,100.0％,100.0％,49.4％; blue nodule in posterior vaginal forni:14.9％,100.0％,100.0％,43.7％.Conclusions In the symptoms,the dysmenorrheal has the highest sensitivity and NPV for the diagnosis.And chronic pelvic pain has the highest specificity,and dysparaunia has the highest PPV for the diagnosis.In pelvic vaginal examination,fixed uterine,fixed ovarian cyst and the nodule on uretosarcal ligment and rectovaginal septum with tenderness,the blue lesion on posterior fornix have the strong significance for DIE.So record the symptom detail and careful digital vaginal examination,especially the vaginal-recto-abdominal examination could improve the diagnosis DIE obviously before procedure.

BACKGROUND:Shape memory polyurethane has good physical and chemical properties and compatibility, but there are relatively few reports on the compatibility of osteoblasts before and after the deformation-complex of the shape memory polyurethane. OBJECTIVE:To observe the compatibility of osteoblasts with shape memory polyurethane before and after the deformation-complex. METHODS: Shape memory polyurethane membranes were prepared, and its stretching-solid-complex was conducted under the experimental environment, to obtain the membrane materials after the deformation-complex. The Sprague-Dawley neonatal rat osteoblasts were inoculated on the shape memory polyurethane membranes before and after the deformation-complex. After 2 hours of culture, the number of adherent cels was counted, and cel spreading was observed; cel proliferation was determined after 1-11 days of culture. RESULTS AND CONCLUSION:The adhesion amount and proliferation activity of osteoblasts on shape memory polyurethane membranes after the deformation-complex were significantly higher than those before the deformation-complex (P < 0.05). The osteoblasts presented fusiform appearance on the shape memory polyurethane membranes after deformation-complex, and cel arrangement showed a clear orientation, but a smal spreading area; while the osteoblasts presented polygonal shape on the shape memory polyurethane membranes before deformation-complex, arranged in no particular direction, and spread largely. These findings show the shape memory polyurethane has better osteoblast compatibility after the deformation-complex.

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.

Objective To investigate clinicopathological characteristics of recurrent endometriosis and outcomes of secondary surgery.Methods From Jan.2003 to Dec.2008,69 cases with recurrent endometriosis operated by the same senior gynecologist in Peking Union Medical College Hospital were studied retrospectively in order to summarize clinicopathological characteristics and clinical outcomes.In prior surgery,both ovaries were involved in 29 cases (42％,29/69),and unilateral ovarian endometriomas were found in 40 cases ( 58％,40/69),including 19 cases (48％,19/40) with left lesions and 21 cases (52％,21/40) with right lesions.After first surgery,57 cases presented recurrent pelvic cystic masses and 12 cases presented moderate to severe pain without pelvic mass.Results The median recurrence interval was 38 ( 1 - 144) months.Among 57 cases with recurrent pelvic masses,bilateral ovarian endometiomas recurred in 24 cases at median recurrence interval of 31 months.Unilateral ovarian endometrioma recurred in 33 cases at recurrence interval of 39 months.There was no significant different recurrence period between blilateral and unilateral recurrent ovarian mass ( P =0.452).The recurrent rate of left and right side ovarian lesion was 77％ (37/48) and 68％ (34/50 cases),respectively,which did not reach statistical difference (P=0.396).Among 12 recurrent cases with pure pelvic pain,10 cases were founded combined with adenomyosis ( AM),of which 4 cases had deep infiltrated endometriosis (DIE).Compared with the 40 cases of simple ovarian endometriomas,29 cases complicated by DIE and (or) AM had longer operation time (75.1 min vs.49.9 min,P=0.017) and more blood loss (114.9 ml vs.38.4 ml,P＜0.05).In those 69 recurrent endometriosis patients,the median period of following-up was 32 months (3 months to 8 years).Six cases showed recurrent disease again at median recurrence interval of 3 years ( 6 months 6 years).Thirty-eight cases had expecting childbearing,however,only 4 women underwent childbirth.Conclusions The rate of clinical diagnosis of recurrent endometriosis is quite high.Pain is mostly associated with AM.The major difficulty and challenge of secondary surgery was ovarian endometrioma combined with DIE or AM.Prognosis of recurrent endometriosis is not optimistic after secondary surgery.