Objective To evaluate the effect of the expression of P-glycoprotein (P-gp) in tumor tissue on analgesic efficacy of morphine and buprenorphine in advanced cancer patients with pain. Methods One hundred and fifty advanced cancer patients with pain aged 51-64 yr weighing 54-65 kg were included in this study. The expression of P-gp was negative in the tumor tissue in 50 patients (group M1 and B1, n = 25 each) and positive in 100 patients (group M2 ,M3 ,and B2 ,B3, n =25 each). The PCA regimen for the 6 groups were listed in the table .Pain was assessed with VAS scores (0 = no pain, 10 = worst pain) and venous blood samples were taken for determination of blood morphine/buprenorphine concentrations at 4, 12, 24 and 48 h of PCIA. Results The six groups were comparable with respect to age, body weight, M/F sex ratio, types of cancer, baseline pain level and education. The analgesic efficacy of morphine and buprenorphine was better ( VAS scores were significantly lower)in P-gp expression negative patients (group M1 and B1 ) than in P-gp expression positive patients (group M2 and B2 ). Higher doses of morphine and buprenorphine provided better analgesic efficacy in P-gp expression positive patients in group M3 and B3 than in group M2 and B2. Plasma morphine and buprenorphine concentrations were comparable between group M1 , B1 and M2, B2 and were significantly higher in group M3 and B3 at each time point. Conclusion Positive P-gp expression in the tumor tissue can decrease the analgesic efficacy of morphine and buprenorphine in advanced cancer patients with pain.

The computerized imitating system constructed by the Second Affiliated Hospital of Guangzhou Medical University contains four blocks:administration of student infomation,administration of question bank,on-line tests and administration of score inquiry.It's designed to imitate typical pediatric cases,so that the medical students may put themselves into the practical clinical scenario and solve the challenges step by step in one-direction procedure.Teaching with computerized clinical scenario imitating patients can improve students' test resuhs and activate students' learning enthusiasm significantly.It not only helps to solve the contradiction between increasing number of medical students and clinical typical teaching case shortage but also improves the clinical thinking ability of the medical students.This system can also be used as a test bank for pediatric technical skills examination.

Objective To compare the efficacy and safety of topical anesthesia,conscious sedation and intravenous anesthesia during endoscopic varices ligation(EVL).Methods Patients underwent EVL were divided into 3 groups to receive different anesthetic methods,namely topical anesthesia,conscious sedation and intravenous anesthesia,with 50 subjects in each group.The changes of vital signs,the tolerance to stimulation of the procedure,the time of operation,the rate of complication were recorded and compared between 3 groups.Results The procedure of EVL were completed in all patients.In topical anesthesia group,40(80%)patients had nausea and vomiting,9 cases(1 8%)tried to pull out the endoscopy.The mucosa at the entrance of the esophagus were injured in 10 cases(20%).Massive bleeding occurred in 4 patients(8%)during operation because of nausea and vomiting.In conscious sedation group,only 7 patients(14%)had mild nausea and vomiting,and no complication of variceal bleeding occurred.The mucosa at the entrance of the esophagus was injured in 5 cases(10%).In intravenous anesthesia group,no patient had nausea or vomiting.The respiratory rate,heart rate and mean artery pressure decreased during the procedure,but without significant difference(P＞0.05).The operation time in intravenous anesthesia group WaS shorter than that in other two groups,but without significant difference(P＞0.05).Conclusion EVL can be completed under 3 different anesthetic methods,while EVL under conscious sedation is more effective and safe.

Five known compounds have been isolated from the culture of an endophytic fungus Fusarium sp., which was originated in a seagrass Spartina alterniflora. Their structures have elucidated by TLC comparision with standard and spectral methods as ergosterol (Ⅰ), ergosterol peroxide (Ⅱ) cinnamic acid (Ⅲ), para-hydroxyphenylpropionic acid (Ⅳ) and beauvericin (Ⅴ), respectively.

Objective To investigate the clinical curative effects and side effects of concurrent radiotherapy combined with interventional artery infusion chemotherapy in advanced cervical carcinoma.Methods 48 patients with advanced cervical carcinoma were randomly divided into two groups including concurrent radiotherapy combied with interventional artery.infusion ehemotherapy group (25 patients) and radiotherapy group (23 patients).Each patient in the concurrent radiotherapy combined with interventional artery infusion chemotherapy group was given THP,DDP and 5-Fu,repeatedly every 28 days,total 3-4 cycles.Radiotherapy was given at the same time.Results The effective rates of the concurrent radiotherapy combined with interventional artery infusion chemotherapy group and radiotherapy group were 92.0 ％ (23/25)and 69.6 ％ (16/23),respectively.The overall 3 year survival rates for the patients in concurrent radiotherapy eombined with interventional artery infusion chemotherapy group and radiotherapy group were 80.0 ％ (20/25)and 52.2 ％ (12/23),respectively,and there was statistically significant between the 2 groups (all P ＜ 0.05).No more side effects were found in the concurrent radiotherapy combined interventional artery infusion chemotherapy group (P ＞ 0.05).Conclusion Concurrent radiotherapy combined with interventional artery infusion chemotherapy in advanced cervical carcinoma can increase short term therapeutic effect and improve the survival rate of the patients without more side effects.

Objective To know the indication for patients with spinal cord injury during the course of intermittent urethral catheterization.Methods Divided 33 patients with spinal cord injury into the experimental group(18 cases)and control group(15 cases)randomly.The indication of beginning in the experiment group was less than 500 ml transfusion per day,without press ulcer,more than 150 ml bladder capacity.The indication in the control group was＞28 cm H2O pressure of bladder.Compared the effects between the two groups.Results The incidence rate of infection in the experiment group was lower than control group,all the indexes of uretharal catheterization were better in the experiment group than those of in the control group.Conclusions The indication of less than 500ml transfusion per day,without press ulcer,more than 150 ml bladder capacity are proper.

Objective To construct and analyze the model of the sleeve gastrectomy with modified jejunoileal bypass (SG/MJIB) on non-obese Goto - kakizaki (GK) rats. Methods GK rats were randomly divided into SG/MJIB, sham-SG/MJIB, pair-fed (PF) and controls group. Before and after surgery, the changes of weight, food intake, fasting glucose, oral glucose tolerance test (OGTT), insulin tolerance test (ITT), fasting plasma Insulin and the histological changes in islet were dynamically observed for 16 weeks. Results From the 4th week postoperative, the weight changes of SG/MJIB significantly decreased compared with sham-SG/MJIB and PF group (P＜0.01). Fasting glucose concentration of SG/MJIB animals was lower than sham-SG/MJIB, PF and controls group (P＜0.05). The OGTT of SG/MJIB rats was obviously improved compared with the sham-SG/MJIB, PF and controls group （P＜0.01). Two weeks after operation, glucose tolerance was better improved in SG/MJIB than preoperative, the area under the curve (AUC) of blood glucose concentration decreased by about 38.9% (P＜0.01). Postoperative insulin levels in SG/MJIB group were obviously lower than sham-SG/MJIB group throughout the experiment(P＜0.05). In the 16th week, the morph of pancreatic islet of SG/MJIB was obviously improved. In the SG/MJIB group, the number of positive β-cell and mature acinus was significantly increased, while sham surgery groups had no obvious changes as mentioned above. Conclusions SG/MJIB was directly linked to the reduction in glucose levels in GK rats, independently weight loss and caloric intake, and it can be served asa stable long-lasting hypoglycemic surgery model to research the mechanism for the treatment of type 2 diabetes.

ObjectiveTo evaluate the value of serum galactomannan platelia aspergillus kit in the diagnosis and treatment of invasive fungal infection(IFI) patients. MethodsA total of 178 serum samples from 74 high risk patients were collected. ELISA assay was used to detect the level of GM antigen. Refer to domestic IFI diagnostic criteria, 16 patients include the proven cases and probable cases were defined as study group, while 29 patients of improbable cases defined as control group. Fourflod table was founded,by which the sensitivity,specificity,positive predictive value, negative predictive value of this GM test were calculated. Meanwhile, a total of 53 patients received antifungal therapy which divided into GM-positive group(21 patients with I≥0. 5) and GM-negative group(32 patients with I ＜0. 5). The therapeutic effect comparison of two groups was made according to curative effect criterion. ResultsAccording to the certainty level of IFI diagnosis, 1,9,10 and 4 patients were identified as GM positive in proven, probable,possible and improbable IFI groups respectively. The prevalence of GM in these 4 groups was 50％ ,64％ ,34％ and 14％ ,respectively. The sensitivity and specificity of galactomannan ELISA assay were 63％ ,86％ respectively. The positive and negative predictive values were 71％ and 81％ respectively. The diagnose accordance rate was 78％, the Younden index was 0. 49. The efficacy of fluconazole in GM-positive patients was significant lower than in GMnegative patients( x2 =4. 95 ,P ＜0. 05) ,while The efficacy of non-fluconazole drug was superior to that in GM-negative patients( x2 =4. 88,P ＜ 0. 05). After antifungal therapy, the GM value of GM-positive patients decreased significantly( t =2. 13 ,P ＜0. 05). ConclusionThe galactomannan ELISA assay with high specificity, could be helpful in diagnosis and choicing effective anti-fungi drug in clinic.

Objective To assess the effectiveness and safety of vitamin D in preventing and treating bone loss in renal transplant patients.Methods Methods recommended by the Cochrane Collaboration were used.MEDLINE,EMBase,Cochrane Library and CNKI were searched from Jan.1990 to Nov.2009 to locate all the randomized controlled trials (RCT) concerning preventing and treating bone loss by vitamin D in renal transplant patients.The qualities of included trials were evaluated by two independent reviewers.Trails consistent with criteria wereanalyzed by Revman 4.2 software.Results Nine RCTs involving 658 post transplant patients were included.The qualities of included trials were graded as grade A in 4,grade B in 2 and grade C in 3.Meta-analysis showed that after being treated with vitamin D for one year,the difference of BMD,Z-score and T-score between the two groups was statistically significant (P＜ 0.05); the difference of PTH concentration was also statistically significant (P＜0.01),but there was no significant difference in concentrations of serum calcium and phosphorus,and the incidence of hypercalcemia (P＞0.05).Conclusion Current available evidence demonstrates that vitamin D is effective and safe in preventing and treating bone loss in renal transplant patients.

Aim To investigate the effect of sphingo-sine kinase 1 (SphK1 )on unilateral ureteral obstruc-tion(UUO)-induced tubulointerstitial fibrosis and ex-plore the possible mechanism.Methods The CD-1 mice were randomly divided into four groups:sham-op-eration group(Sham),PF-543 treatment control group (Sham +PF-543),model group(UUO)and PF-543 treatment group(UUO +PF-543).On 1 ,3,7 and 1 4 d after operation,eight mice were selected randomly from each group and sacrificed.The protein expressions of SphK1 ,mature TGF-β1 ,FN,ColⅠ,LC3,Beclin1 ,Atg5 and Atg1 2 were observed by Western blot.The histo-logical changes were examined by Masson′s trichrome stain.Immunhistochemistry was performed to measure the levels of expression of SphK1 ,FN and Col Ⅰ. Transmission electron microscope was used to observe the autophagic body.Results SphK1 expression and autophagy were both upregulated in a mouse model of kidney fibrosis induced by UUO. Meanwhile, in-creased mature TGF-β1 and deposition of extracellular matrix(ECM)were observed in tubulointerstitial areas compared with sham-operated mice.After intraperito-neal injection with the SphK1 specific inhibitor PF-543 in UUO mice,enhanced expression of SphK1 and acti-vated autophagy were significantly abrogated.Howev-er,aggravation of renal fibrosis was detected when SphK1 inhibitor PF-543 was applied to suppress SphK1 expression in UUO mice.Conclusion SphK1 activa-tion is renoprotective through the induction of autoph-agy in the pathogenesis of kidney fibrosis.