ObjectiveTo selected the safe dosage of intrathecal injection of sufentanil for preemptive analgesia in lower limb orthopaedic surgery.MethodsSelected 96 patients who ASA classification Ⅰ - Ⅱ grades undergoing elective lower limb orthopaedic surgery with subarachnoid epidural block down,they were divided into six groups by random number table and double blind method,each group of 16 cases.Group Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ received 0.05,0.10,0.15,0.20,0.25,0 μ g/kg of intrathecal sufentanil and 2.5 ml of 0.5％ levobupivacaine.Observed and recorded the duration of block level of pain to T10,visual analog score (VAS)postoperative at 2,4,6,8,12,24,48 h,and side effects.ResultsThe duration of block level of pain to T10 of group Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ was (245.6 ± 34.2),(259.3 ± 36.7),(268.9 ± 37.8),(286.6 ± 38.8),(287.7 ± 39.1 ),(228.6 ± 31.4) min.There was no significant difference between group Ⅳ and group Ⅴ (P ＞ 0.05 ),the differences of other groups were statistically significant (P ＜ 0.05 ).Compared with group Ⅴ,VAS of group Ⅲ and group Ⅳ at 6,8,12,24,48 h after operation was not statistically significant (P ＞ 0.05),and they were lower than the other three groups(P ＜ 0.05 ).There were no respiratory depression occurred after operation in group Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅵ,4 cases occurred in group Ⅴ.ConclusionThe best of effective dose of intrathecal injection of sufentanil for preemptive analgesia in lower limb orthopaedic surgery is 0.20 μ g/kg.

Objective To evaluate the information of head injury caused by the major earthquake of Wenehuan and the diagnostic value of muhi-slice spiral CT(MSCT). Methods A total of 1557 earthquake victims were hospitalized, of which head CT scan was performed in 292 eases, and abnormalities were found in 225 of them. The composition, type of injury and MSCT findings of head injury were retrospectively analyzed. Results CT abnormalities were found in 225 victims, including 66 cases of skull fracture,50 eases of cerebral contusion and laceration, 55 eases of intracranial hematoma, 16 cases of subaraehnoid hemorrhage, 16 eases of subdural collection of fluid,20 eases of foreign substance of scalp,and 2 eases of traumatic cerebral infarction. Operation was performed in 22 of them. Conclusion The incidence of head injury in earthquake was high, and most of them were not severe. The examination of MSCT was rapid, MPR and 3D images can clearly show the lesion of craniocerebral trauma. MSCT can provide more valuable information for clinical therapy in craniecerebral trauma caused by earthquake.

Objective To compare the efficacy of selective laser trabeculoplasty (SLT) on the intraocular pressure (IOP) reduction in the treatment of ocular hypertension (OHT),early and moderate primary open angle glaucoma (POAG).Methods Non-randomized controlled study was conducted in 120 patients (120 eyes),who were divided into 3 groups according to the patients' condition,including OHT group with 40 eyes of 40 patients,early-stage POAG group (40 eyes of 40 patients) and medium-stage POAG group (40 eyes of 40 patients),aged rang from 16 to 79 years.SLT was performed on the 360° trabecular meshwork using 532 nm frequency-double Q-switched Nd:YAG laser (Selecta duet),with the pulse of 3 ns and spot diameter of 400 nm.The initial energy was 0.6 m J,which decreased at 0.1 mJ interval till champagne bubble appeared.The following-up was postoperative 1 day,1 week,1 month,3 months and 6 months,respectively,and changes in IOP before and after SLT was recorded and analyzed statistically.Resuits Postoperative IOP at different time points was significantly lower than that of preoperation in the three groups,with significant difference (all P ＜ 0.05).There was also significant difference in IOP of the each group at different time points after the operation (all P ＜ 0.05).The preoperative baseline IOP of OHT group,early-stage POAG group and medium-stage POAG group was (25.95 ± 1.80) nmHg (1 kPa =7.5 mmHg),(24.66 ± 1.55) mmHg and (25.62 ± 2.67) mmHg,respectively,approaching significant difference (P ＜0.05).After eliminating the influence of baseline IOP,intergroup differences of postoperative IOP at each time point in the three groups were statistically significant (all P ＜ 0.05),and intragroup differences were also significant (all P ＜ 0.05).When compared with corrected baseline IOP,the reduction of IOP was the largest in OHT group after SLT,followed by the early-stage POAG group,and the lowest was in the medium-stage POAG group.Conclusion SLT has a good effect on IOP reduction for OHT and POAG,and the treatment effect of SLT declines successively according to the severity of POAG.

A series of valproic acid salicylanilide esters were designed and synthesized based on the principle of prodrug. The structures of the target compounds were confirmed by MS, 1H NMR and 13C NMR. Anti-tumor activities of these compounds against K562, A549, A431 cells in vitro were investigated by MTT assay and SRB assay. The results indicated that the compounds 6h-6j were found to have stronger cell growth inhibitory action than gefitinib, and comparable to niclosamide, which are worth to be intensively studied further.

Objective To observe the value of virtual tough tissue imaging quantification (VTIQ) in differential diagnosis of thyroid imaging reporting and data system(TI-RADS) 4 thyroid nodules.Methods A total of 185 patients with 192 TI-RADS 4 nodules were included in this study.The nodules were divided into three groups according to the maximum size as follows:Group Ⅰ,the maximum size≤0.6 cm;Group Ⅱ,0.6 cm＜ the maximum size≤ 1.0 cm;Group Ⅲ,the maximum size ＞ 1.0 cm.Shear wave velocities (SWV) of nodules were measured by means of VTIQ technique.With pathological diagnosis as the gold standard,SWV value of benign and malignant nodules were analyzed and ROC curve was drawn to assess the diagnostic efficiency.Results By the ROC curve test,at SWV cut-off values of 2.44 m/s for group Ⅰ and group Ⅱ,2.49 m/s for group Ⅲ,the sensitivity were 79.0 ％,76.0 ％,88.6％,specificity were 88.6％,89.5 ％,93.7 ％,accuracy were 83.5 ％,81.8 ％,90.1％,Youden index were 0.68,0.66,0.82,respectively.Conclusions VTIQ can reflect the hardness of TI-RADS 4 nodules,the value of the differential diagnosis of such nodules is high,convenient,noninvasive and not limited by the size of nodules.

OBJECTIVE:To evaluate the effects of propofol in relieving pain during fibrobronchoscopy when it is used in general intravenous anesthesia.METHODS:160patients undergoing fibrobronchoscopy were randomly divided into propofol group and control group.90patients in the propofol group were anesthetized intravenously by injection of propofol at the dosage of1.5mg/kg and speed of30mg/10s and then underwent fibrobronchoscopy;While70patients in the control group underwent regular fibrobronchoscopy.RESULTS:The lash reflex disappeared within(40.73?7.91)seconds after propofol injection,and patients became conscious within(5.39?1.85)minutes after stopping injection,full consciousness occurred at(10.82?2.73)minutes.Electrocardiogram did not show any signs of change in blood pressure,myocardial ischemia and cardiac dysrhythmia,the post-operative satisfaction rate was96%as compared with81%in the control group.The patients in the propofol group showed extensive willingness for second fibrobronchoscopy,while the patients in the control group presented cough,struggle,and20%of them refused the second fibrobronchoscopy.CONCLUSION:It is safe and effective to apply propofol in painless fibrobronchoscopy.

Objective To evaluate the effect of mini-abdominal incision for choledochoscopy via cystic duct in exploration of the common bile duct(CBD).Methods The right subcostal incision was 4-6 cm in length.Choledochoscopy via cystic duct stump for exploration and extraction of CBD stones was done in 135 cases.Results The CBD stone was removed in 109 of 135 patients(80.7%).The CBD exploration was negative in 26 cases(19.3%)and retained CBD stones occurred in 4 cases(3.0%).One case(0.7%)had intraoperative injury of common bile duct,2 cases(1.5%)had tear of cystic duct stump,and 2 cases(1.5%)had biliary leakage,all the 5 cases were recovered after treatment.Conclusions The mini-abdominal incision with choledochoscopy via cystic duct for exploration of the CBD is safe and feasible.

Objective To analyze the related immune parameters in liver transplantation recipients to help guide adjusting future immunosuppressants.Methods Fifty-three tolerant recipients after liver transplantation were included in this study.They had normal liver functions and took only one immunosuppressive drug.They were divided into the 3 ～5 years tolerance group (3Y group,n =21) (including 5 years) after transplantation,and the 5 ～ 11 years tolerance group (5Y group,n =32).Another 15 liver transplantation recipients who had twice or more recurrent acute rejections were enrolled as the RJ group and 32 age-matched healthy donors served as the HC group.The natural killer (NK) cells,B cells,memory T cells,regulatory T cells (Tregs) and the subsets were detected by flow cytometry.The plasma TGF-β level was evaluated using ELISA.Results The percentages of NK cells (3Y group 19.00 ± 0.09,5Y group 20.00 ±0.09,HC group 14.00 ±0.07,RJ group 9.00 ±0.03) and total Tregs within the CD4+ cells (3Y group 6.26 ±2.33,5Y group 4.80 ±2.21,HC group 3.04 ± 1.25,RJ group 1.09 ±0.81) in the 3Y,5Y and HC groups were significantly higher than those in the RJ group (P ＜ 0.05).The proportions of resting Tregs (3Y group 0.23 ±0.07,5Y group 0.16 ±0.02,HC group 0.07 ±0.02,RJ group 0.05 ±0.01),active Tregs (3Y group 0.56 ± 0.11,5Y group 0.42 ± 0.15,HC group 0.08 ± 0.02,RJ group 0.05 ± 0.01) and non-suppressive Tregs (3Y group 3.51 ±0.80,5Y group 3.71 ±0.41,HC group 1.44 ±0.14,RJ group 2.15 ± 0.62) increased significantly in the tolerant recipients after liver transplantation when compared with those in the HC and RJ groups (all P ＜ 0.05).No significant differences on B cells,memory T cells and TGF-β level were detected among in four groups.Conclusions The NK cells,total Tregs,resting Tregs,active Tregs and non-suppressive Tregs increased significantly in the tolerant recipients after liver transplantation.These might serve as potential biomarkers for immune tolerance.

Objective To carry out the current status of internal quality control by statistical analysis of the Internal Quality Control (IQC)data of homocysteine in 2014 March.Methods Web-based External Quality Assessment (EQA)system was used to collect IQC data of homocysteine from 292 EQA participant laboratories nationwide.The data include thecoefficient of variation (CV)of IQC data under control in March 2014 and long-term cumulative data.Acceptable rates of CVs of two-lot internal quality controls in homocysteine were calculated according to 5 criteria,that were 1/3TEa,1/4TEa and the speci-fications based on biological variation including the minimal,appropriate and optimal allowable imprecision.The instrument the participant laboratories used were sorted into 6 groups and the passing rate of each group were calculated by the 5 crite-ria.Results 292 laboratories reported the data of level 1 IQC for homocysteine,106 of which reported the data of level 2 IQC.The passing rate was different according to different criteria.The passing rate had few difference by the criteria of 1/3TEa and the minimal allowable imprecision based on biological variation,which were from 63.36% to 76.42%.It was also true for 1/4TEa and the appropriate allowable imprecision based on biological variation,which were from 34.25% to 57.55. The passing rate was only 10.62%~16.98% by the criteria of appropriate allowable imprecision based on biological varia-tion.Statistical results showed that instruments the participant mainly used were HITACHI (77/292),Olympus (61/292), Roche (19/292),Beckman (14/292),Abbott (10/292)and Simens (10/292).The passing rates of all the instrument group had few difference except Simens group.Conclusion Most of the laboratories could meet the criteria of 1/3TEa and the min-imal allowable imprecision based on biological variation.But less than half of the laboratories could meet the criteria of 1/4TEa and the appropriate and optimal allowable imprecision based on biological variation.The precision performance of ho-mocysteine among laboratories needs further improvement.

Objective Discussthe reference intervals and their sources of lymphocyte subsets by flow cytometry tests by all Chinese clinical laboratories at 2014 with a comparison of difference between different test systems.Methods Questionnaires about reference intervals were distributed to 212 clinical laboratories participating in October 2014 national external quality assessment scheme of lymphocyte subsets by flow cytometry tests of National Center for Clinical Laboratory.Relevant information about reference intervals of 5 relative counting items CD3 + (％),CD3 + CD4 + (％),CD3 + CD8 + (％),CD3-CD16 + CD56 + (％) and CD3-CD19 + (％) was collected by a internet-based external quality assessment software systems.Microsoft Excel 2010 and SPSS 19.0 were used to sort out raw data,eliminate unreasonable or incorrect data,and only analyze source distribution,arithmetic average,median,minimum value,maximum value and percentiles (P2.5 and P97.5) of upper and lower limits about healthy adults' reference intervals.Laboratories derived from the highest percentage of source distribution whose reagent and instrument were matching with each other were grouped according to the test systems used and the differences of reference intervals between different systems were compared with Mann-Whitney test.Results For five items collected,in the clinical laboratories who accepted statistical analysis,respectively 39.32％ (81/ 206),37.44％ (79/211),37.68％ (78/207),37.11％ (72/194),36.98％ (71/192) of them had verified the reference intervals they used.The top three sources of reference intervals were instructions of reagent and instrument manufactures (49.70％-52.54％),calculations by laboratories themselves (18.64％-20.00％),and calculations by other laboratories (14.12％-15.43％).The arithmetic averages and medians of upper and lower limits about every item were relatively close.But the minimum and maximum values of upper and lower limits of certain items had moderate differences.As Mann-Whitney test later showed,all items with the P values of upper and lower limits between different test systems,except for the lower limit of CD3 + CD4 + (％) (P value is 0.052) and the upper limit of CD3-CD19 + (％) (P value is 0.117),were lower than 0.05 which meant an existing statistical difference.Conclusions The sources of lymphocyte subsets by flow cytometry tests in all Chinese clinical laboratories were different and the instructions of reagent and instrument had the highest percentage,but the reference intervals among differenttest systems had statistically significance.