Objective To research the different protective effects of general anesthesia combined with thoracic epidural anesthesia on experimental myocardial infarctionMethods Rabbits of experimental group were anesthesitized with 1% sodium pentobarbitone (30 mg/kg, iv) Following tracheal intubation, epidural catheter was put into at T_ 6-7 with the anterior end of the catheter reaching at T_ 2-3 After the epidural anesthesia was made sure to be effective, the anterior descending branches of left coronary artery were ligated Blood samples were collected before ligation, 15, 30, 60, 120, 180 and 240 min after ligation All procedures of control group were similar to those of experimental group except for thoracic epidural anesthesia Nitric oxide (NO), creatine kinase(CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), superoxide dismutase (SOD) were detected The changes of the activities of CK and LDH, and NO level during the research course in both groups were analyzed with liner regression Results The regression coefficients of CK, LDH and NO in the experimental group were significantly lower than those in control group In the experimental group the activities of CK and LDH decreased markedly, NO level increased significantly as compared with those in control groupConclusions General anesthesia combined with thoracic epidural anesthesia produces the protective effects on the myocardial infarction and the stress-induced injury

Objective To research the stress to experimental myocardial infarction under general anesthesia combined with thoracic epidural anesthesia(TEA) Methods Nine rabbits in experimental group were anesthetized with 1% sodium pentobarbitone with tracheal intubation after sectioned, and after the epidural catheters was put into to make sure that the epidural anesthesia was effective, the anterior descending branches of their left coronary artery were ligated All procedures in control group were similar to those of experimental group except for thoracic epidural anesthesia The blood samples from left common carotid artery before ligation were taken 15,30,60,120,180 and 240min after ligation, to measure the plasma levels of monoamine neurotransmitters with high performence liquid chromatography, the Ag Ⅱ and cortisol levels with radioimmunoassay TNFa content in non infarction myocardium was assessed with immunohistochemistry Results There were no differences in NE and 5 HT levels between both groups before ligation Thirty min after the ligation, NE level in experimental group remained unchanged, but in control group increased markedly(P

Objective To evaluate the effect of thoracic epidural block combined with general anesthesia on c-fos and heat shock protein(HEP) 70 gene expression of myocardium from non-infarct area in rabbits with acute myocardial infarction. Methods Twenty-eight New Zealand white rabbits of either sex (12 male, 16 female), weighing 2.5-3. 8kg were randomly divided into two groups with 14 animals in each group: general anesthesia group and combined general-epidural anesthesia group. The rabbits were anesthetized with 1 % pentobarbital and tracheotomized and intubated. Spontaneous breathing was maintained. Epidural catheter was placed with one of the tips reaching T2-3. 2% lidocaine was injected and the effectiveness of epidural block was confirmed by decrease in MAP. Left common carotid artery was cannulated for intra-arterial pressure monitoring. Chest was then opened, and anterior descending branch of left coronary artery was ligated. Myocardial infarction was confirmed by changes in ECG. 4 hours after ligation the animals were sacrificed and a piece of myocardium from non-infarct area was taken for measurement of the concentration, OD and ratio of total RNA in 100 mg of myocardium. 0.7 ?g of total RNA was used for determination of c-fos and HPS 70 expression relative to ?-actin gene(c-fos/ ?-actin, HSP70/ ?-actin) by using one-step RT-PCR. Results c-fos/ ?-actin and HSP70/ ?-actin were significantly lower in combined general-epidural anesthesia group than those in control group(P

Student evaluation is an important part of the teaching process.The Children's Hos-pital of Chongqing Medical University focused on the characteristics of individual child's growth and overall development according to the own condition and integrated formative assessment and summa-tive evaluation in the classroom teaching and clinical internship process. All the measures mentioned above not only help promote students' learning interests,master of knowledge and clinical skills but also exert positive effect on the improvement of teaching level.

Objective To evaluate the radical effect and prognosis of laparoscopic resection for colorectal cancer in China.Methods Articles of non.randomized comparative studies(NRCs)of laparoscopic resection and open Burgery for colorectal cancer which were published before October 2007 were retrieved,and correlated indexeswere extraeted for meta.analysis.Results The mean quality score of the 14 articles selected was 18.92±1.27.The basic characteristics of patients in laparoscopic resection group were similar to those in open surgery group.Compared with open surgery group,the incised length of the intestine in the laparoscopic resection group was shorter by 0.66 cm.and the distance between distal margin of resection and tumor was farther by 0.26 cm.The 2-year survival rate of patients in laparoscopic group Was 1.67 times higher than that of open surgery group.There was no significant difference upon follow-up rate,tumor diameter,number of resected lymph nodes,local recurrence rate and distal metastasis rate between the 2 groups.Conclusions The results of meta-analysis show that laparoscopic resection has the sanle radical effect as open surgery for colorectal cancer.but the 2-year survival rate of patients treated by laparoscopic resection is comparatively higher.

ObjectiveEvidence-based medicine was used to make an individualized treatment plan for rare solitary splenic metastasis of an ovarian carcinoma in a female patient. MethodsAfter clinical problems were discovered, evidence was collected from the Cochrane Library, PubMed, EMBASE, ScienceDirect, CNKI and Wanfang databases according to our predefined search strategy. The search was done until October, 2009. The validity of the evidence was assessed. The evidence, combined with the doctor experience and the patient value, was applied to the patient. ResultsA total of 15 English literature and 11 Chinese literature were identified. A rational treatment plan was made upon a critical evaluation of the data. There were 5 review articles in PubMed, EMBASE and ScienceDirect databases and no RCT in the Cochrane Library. And there was one retrospective cohort study inCNKI and Wanfang databases. The others were all case reports. After 20 month follow-up, the treatment protocol was proven correct. Conclusion The patient has rare disease, and the evidence intension for the evidence-based medicine was low. It can not present the efficacy of the evidence-based medicine treatment sufficiently, though it could provide some suggestion for rare disease which was lack of large RCT for evidence-based Methods .

Objective To evaluate the effects of compound glycyrrhizin on the percentage of Th17 cells and expression of interleukin(IL)-17A in peripheral blood of patients with psoriasis vulgaris, and to explore their relationship with therapeutic effects. Methods A total of 30 patients with mild to moderate progressive psoriasis vulgaris were randomly and equally divided into two groups:group 1 treated with compound glycyrrhizin injection, antihistamines and topical drugs, group 2 treated with antihistamines and topical drugs. Twelve healthy human subjects served as the control group. Blood samples were collected from the patients 1 day before start of treatment and after 3 weeks of treatment, and from the control group. Flow cytometry and enzyme-linked immunosorbent assay (ELISA)were performed to determine the percentage of Th17 cells and expression level of IL-17A respectively in the peripheral blood samples. Results Before the treatment, the percentage of Th17 cells and expression level of IL-17A were both significantly higher in the two patient groups than in the control group (all P<0.05). After the treatment, group 1 showed significant decreases in the percentage of Th17 cells and expression level of IL-17A compared with those before the treatment (both P<0.05), while no significant differences were observed in group 2 between pre-and posttreatment IL-17A expression level or Th17 cell percentage (both P>0.05). Furthermore, both Th17 cell percentage and IL-17A expression were significantly different between the two patient groups after the treatment (both P< 0.05). Conclusion Compound glycyrrhizin may treat psoriasis vulgaris by regulating Th17 cell percentage and IL-17A expression in peripheral blood.

Objective To study the academic level of randomized control trials(RCTs)published from 2004 to 2009 in Chinese Journal of Hepatobiliary Surgery.Methods Published work about RCTs in 72 issues of Chinese Journal of Hepatobiliary Surgery was searched by finding relevant articles published during 2004-2009.Correlated indexes including literature received time, literature publishing time, the total number of citations, number of citations in Chinese, number of citations in English, research funding situations, the number of authors, article affiliations in all RCTs, together with single(or multiple)center study situation, positive conclusions, the starting time, the end time,and number of patients recruited in clinical RCTs were extracted for aggregate analysis.Results During the past six years, a total of 135 articles of RCT were published in Chinese Journal of Hepatobiliary Surgery, accounting for 8.7% in all clinical studies.The average number of RCTs in each issue was 1.88.The average time for publishing time delay was 450 days.The total number of citations in RCTs was 1252 and the average number of RCTs for citations was 9.3.53 RCT studies were financed, accounting for 39% of the total number of research papers.Beijing Friendship Hospital attached to the Capital University of Medical Sciences had published 8 papers of RCT and it is the institution of publishing the largest number of such papers in the journal.The number of multi-center study for RCTs was one and all RCT studies had significant conclusions.The average research duraton in RCTs was 45 months.The total number of patients in 33 clinical RCTs was 2705 and the average number of patients recruited in each RCT was 82.Conclusion Chinese Journal of Hepatobiliary Surgery put emphasis on the strongest evidence and the most valuable RCT researches that have great significance in the field of domestic hepatobiliary surgery for clinical treatment and experimental research.

Objective To construct a nomogram to predict the prognosis of patients with gallbladder cancer(GBC).Methods The clinicopathological data of GBC patients were extracted from the SEER database,and the independent prognostic factors of GBC patients were analyzed by Cox regression,and a nomogram was constructed.Finally,the column diagrams in the training queue and validation queue are verified.Results Age,T stage,M stage,histological grade,radiotherapy,surgery and tumor size were independent prognostic factors in GBC patients,and the differences were statistically significant(P＜0.05).In the training cohort,the C index was 0.735(95％CI=0.721～0.749),and the AUC values at 1,3 and 5 years were 0.821,0.820 and 0.833,respectively.In the verification group,the C index was 0.733(95％CI=0.711～0.755),and the AUC values for 1,3 and 5 years were 0.816,0.807 and 0.827,respectively.The calibration curve shows that the predicted values of the nomogram are in good agreement with the observed values.The decision curve shows that the nomogram model has better prediction ability than TNM staging system.Conclusion The constructed dynamic prognosis nomogram of GBC patients has high accuracy and reliability.

Objective To evaluate the value of endorectal ultrasonography (ERUS) in assessment of mesorectal fascia (MRF) invasion in rectal cancer.Methods Data of 44 patients who accepted preoperative ERUS and total mesorectal excision surgery within a week were retrospective analyzed.There were 18 patients who accepted preoperative neoadjuvant chemotherapy and 26 patients didn't acceped.Taking the pathological diagnosis of circumferential resection margin (CRM) as the gold standard,the diagnostic efficiency of ERUS for the MRF invasion in rectal cancer was evaluated.Results The final pathological T staging was T1 in 2 cases,T2 in 17 cases and T3 in 25 cases.There were 2 cases of CRM positive results,and 42 cases of CRM negative results.With regard to the location of tumor,there were 16 cases located in low,and 28 cases in mid rectum.There were 26 cases located in anterior or antero-lateral wall of rectum,13 cases in posterior or postero-lateral wall,and 5 cases with a circle of rectum.The diagnostic accuracy were 83.33 ％ (15/18) and 92.31％ (24/26) for cases of accepting and not accepting the preoperative neoadjuvant chemotherapy;80.77％ (21/26) for cases located in anterior or antero-lateral wall,and 100％ (13/13) for cases located in posterior or postero-lateral wall;75.00％ (12/16)and 96.43 ％ (27/28) for low position and mid position tumors.The total diagnostic accuracy was 88.64％ (39/44).Conclusion ERUS can be an effective method in preoperative assessment of the MRF invasion in rectal cancer.