Objective To explore the clinical effect of remifentanil and ketamine with sevoflurane in pediatric surgery. Methods 80 cases of ASAⅠ～Ⅱ grade line surgery in children, were randomly divided into remifentanil group(A group) and the ketamine group(B group). Intramuscular midazolam 0.3mg/kg basic anesthesia catheter later. A group 2min before skin incision to give 0. 5μg/kg remifentanil infusion pump micro pump remifentanil 30μg(kg/h) add sevoflurane inhalation 3MAC until surgery. B group 2min before skin incision 2mg/kg ketamine infusion then pump ketamine 3mg(kg/h) add sevoflurane inhalation 3MAC until surgery; Record separately the two groups before skin incision in children with 2 min(T0) ,atskin incision(T1),after skin incision 15min(T2) ,when surgery (T3) in children with the mean arterial pressure (MAP),heart rate(HR),respiratory frequency(R)and oxygen saturation (SpO2) ,and record the total number of children with secretions (sputum volume) , awake time and the availability of laryngeal spasm,restlessness,nausea, vomiting and other adverse reactions. Results A group sputum volume was less than B group(P＜0.01) and A Group awake time was shorter than B Group(P＜0.01) ;Two groups of patients R infants had no inter-group differences(P＞0.05) ,two groups of children during quiet sleep,analgesic perfect, no significant respiratory depression,no laryngeal spasm,restlessness and nausea,vomiting and other adverse reactions. Conclusion Remifentanil composite Sevoflurane for surgery in children than ketamine was more stable during the cycle, secretions less quickly after waking up was a safe and reliable method of anesthesia.

Objective To study the correlation between small intestinal bacterial overgrowth (SIBO) and plasma endotoxin,platelet-derived growth factor(PDGF)level,and levels of serum hyaluronic acid (HA),laminin(LN),N-terminal procollagen Ⅲ peptide(PⅢNP)and type Ⅳ collagen(Ⅳ.C). Methods Lactulose hydrogen breath test (LHBT) was performed in 64 patients with chronic liver disease. Plasma endotoxin was measured with Limulus test, plasma PDGF was tested with ABC-enzyme-linked immunosorbent assay,serum HA,LN,PⅢNP and Ⅳ.C were tested by radioimmunoassay(RIA) in the patients. The relationship between SIBO and plasma endotoxin, PDGF and HA,LN,PⅢNP and Ⅳ.C levels were analyzed. Results Positive LHBT suggesting the existence of SIBO were observed in 22 patients(34.4%). Plasma endotoxin[(62?19) pg/ml vs.(31?13) pg/ml] and PDGF [(211?77) pg/ml vs.(136?57) pg/ml] levels were significantly higher in patients with SIBO than those in patients without SIBO (P

Objective To evaluate the diagnostic value, patients' tolerance and complications of double-balloon enteroscopy (DBE) in the diagnosis of small intestinal diseases. Methods During May 2003 to July 2005, a total of 68 patients (36 men, 32 women; mean age of 52. 6 years, range 15-78 years) with suspected small intestinal diseases were performed double-balloon enteroscopy (36 via mouth, 25 via anus and 7 via both mouth and anus according to suspected lesion location). Among them, obscure recurrent gastrointestinal bleeding was found in 39 cases, incomplete small intestinal obstruction in 7 cases, chronic abdominal pain in 14 cases, and chronic diarrhea in 8 cases. Results Approximately one half to three-fourth of the entire small intestine was observed by each approach in all cases except for 3 cases of severe intestinal stricture. The observation of the whole small intestine was finished by the combination of both oral and anal approaches in 7 cases. The appropriate use of X-ray made the enteroscopy easier and more helpful to determine the extent and location of the lesions. The lesions were found in 41 of the 68 patients, with a total positive rate of 60. 3%. The diagnostics yields was 26/39(62. 6%) in obscure recurrent gastrointestinal bleeding, 5 in incomplete intestinal obstruction, 6/14(43%) in chronic abdominal pain and 4 in chronic diarrhea, respectively. Fifty-seven cases (83. 8%) tolerated well without anesthesia while 11 cases received propofol anesthesia. No procedure-related severe adverse events or severe complications such as hemorrhage or perforation occurred in all cases. Conclusion Double-balloon enteroscopy is a well-tolerated and safe diagnostic approach with a high diagnostic yield in small intestinal diseases.

A myxobacterial strain, So ce cpu-1, was isolated from a soil sample near the Huanghai beach. So ce cpu-1 had broad antimicrobial activity, active component has maxima] absorption at 210 nm. The effects of different culture conditions on the yield of the secondary metabolites were investigated. The results showed that, when cultivating the strain in the M, medium (containing 10% w/v D312 neutral absorber resin ), the air up to 70% of the whole flask volume, adding 5?L the secondary metabolites as the revulsant, at 30℃, 200r/min, for 6 days, the yield of the secondary metabolites achieved the maximum.

Objective To systematically assess the clinical efficacy of estrogen combined with antidepressants in the treatment of perimenopause-related depression in our country by meta analysis.Methods The electronic databases of CBMdisc,CNKI,VIP,Wanfang,PubMed,Cochrane Library and Google Scholar were retrieved by computer.The subject terms were set for retrieving the literatures on the effect evaluation of estrogen combined with antidepressants in treating perimenopause-related depression in our country published at home and abroad from January 1980 to February 2016.The study data and results of included literatures were performed the meta analysis by using the RevMan 5.1 software.Results Fifteen articles conforming to the inclusion standard were included.The data merged results showed that compared with single estrogen use group,in the aspects of the effective rate(RR=1.46,95%CI=1.29-1.66,P<0.004),HAMD score(WMD=-4.61,95%CI=-5.63——3.59,P<0.01)and KMI score(WMD=-5.83,95%CI=-11.12——0.53,P<0.01),the estrogen combined with antidepressants group had statistically significant difference.Conclusion The treatment and alleviating effect of estrogen substitution therapy combined with antidepressants for treating perimenopause symptoms and depression is superior to that of single estrogen use substitution therapy.

Objective To investigate the CT and MRI features of intraductal papillary neoplasm of the bile duct (IPNB).Methods Thirty eight patients with IPNB finally diagnosed by puncture biopsy or surgery were enrolled in this study.All the CT or MRI data were investigated retrospectively.Twenty one patients underwent CT examinations,17 patients underwent MRI examinations.The features of IPNB including the distribution features of the nodules or masses,CT and MRI features of cholangiectasis,mucus were analyzed.The accuracy differences of CT and MRI for the preoperatively diagnosing mucus and tumor growing along mucous were compared by nonparametric test.Results The lesions (including 5 patients with solitary lesions and 19 patients with multiple lesions) were located in intrahepatic bile duct in 24 patients,3 patients occurred simultaneously in intrahepatic and portal bile duct,2 lesions occurred in portal bile duct,8 lesions occurred in common bile duct,the lesions of 1 patient occurred simultaneously in common bile duct,cystic duct and gallbladder.Seventeen and 11 patients appeared nodules locating in dilated bile duct on CT and MRI,respectively.Four and 5 patients appeared cystic lesions with multiple nodules of the liver on CT and MRI,respectively.Higher contrast enhancement on CT and MRI in arterial phase than that in portal vein and equilibrium phase were observed in 18 and 12 patients,respectively.Excluding the patients undergoing puncture,CT was better than MRI in evaluating whether the mucus was present,with the accuracies of 30.0％ (6/20) and 6.3％ (1/16) for CT and M RI,respectively (Z =2.58,P ＜ 0.05).CT was worse than MRI in preoperatively evaluating the features of tumor growing along mucous,with the accuracies of 77.8％ (14/18) and 92.6％ (13/14) for CT and MRI,respectively (Z =4.23,P ＜ 0.01).Conclusion IPNB had the features of growing along mucous of the bile duct,nodule or mass in dilated bile duct and other features,CT and MRI are important in diagnosing the IPNB.

Objective To investigate the feasibility of magnetic resonance diffusion-weighted intravoxel incoherent motion (DW-IVIM)imaging and its reproducibility in normal liver.Methods Thirty-five young healthy volunteers underwent liver DW-IVIM ex-amination twice on a 1 .5 Tesla Philips MR scanner.Parameter maps of D,D* and f were generated by using a manufacturer-sup-plied software.Six Region-of-interests (ROIs)(3 ROIs in left and right liver lobe,respectively)were drawn on three consecutive middle slices,respectively.The average values of D,D* and f were measured and compared between the left and right liver lobe. The reproducibility of D,D* and f measurement were assessed with Bland-Altman method.Results The values of D,D* and f of left liver lobe [D(×10-3 mm2/s):1.250±0.210,D*(×10-3 mm2/s):101.906±15.063 ,f(%):22.954±5.268]were statistically higher than those of right liver lobe[D(×10-3 mm2/s):1.039±0.124,D*(×10-3 mm2/s):100.127±20.757,f(%),18.317± 3.671](D,f,P<0.001,D*,P<0.232-0.605),however ,their reproducibility of left liver lobe [limit of agreement(LOA):22.55%,51.05%,39.3%,respectively]were lower than those of right liver lobe (LOA:20.3%,39.25%,33.9%).The D values had the best reproducibility in both the left and right liver lobe.Conclusion The liver DW-IVIM is feasible.The values of D,D*and f in left liver lobe were higher that those in right liver lobe but with worse reproducibility of measurement.The D value was most reproducible in both liver lobes.

Purpose To investigate the effect of two different 1.5T MRI scanners on the apparent diffusion coefficient (ADC) measurement and its reproducibility in diffusion weighted imaging (DWI) of the liver. Materials and Methods Two groups of volunteers (33 people in each group) underwent liver DWI examination twice by using the same DWI sequence with b value of 0 and 800 s/mm2 on different MRI scanners (1.5T Siemens Espree and 1.5T Philips Achieva). On ADC maps, two region of interests were placed on three central slices of the left and right liver lobes, respectively. The ADC measurements of six region of interests on left and right liver lobes were averaged to represent the mean ADC values of the left and right liver lobe, respectively. The reproducibility of the ADC measurements was assessed by Bland-Altman method. Results The ADC values of the left and right liver lobes measured on Siemens MRI scanner were significantly higher than those on Philips MRI scanner (t=2.045-2.713, P<0.05); on both scanners, the ADC values of the left liver lobe were significantly higher than those of the right liver lobe (t=-10.561--7.263, P<0.001). The Bland-Altman results showed that the reproducibility of ADC measurement was similar on both MRI scanners, and both displayed higher reproducibility of right liver lobe than that of left liver lobe (on Siemens MRI scanner: the agreement were 16.65% and 7.55% for the left and right liver lobe, respectively;and on Philips MRI scanner:16.30%and 7.85%, respectively. Conclusion Different MRI scanners may have influence on ADC values, but does not affect its reproducibility. Therefore, when ADC values obtained on different MR scanners are compared in clinical analysis, this influence should be considered.

Objective To evaluate the correlation between MRI and X-Ray discography findings and pain response at provocative discography in patients with discogenic back pain. Methods Two hundred and fifty-six lumbar intervertebral discs in 93 patients who underwent MRI and X-Ray discography were included in this study. MR images were retrospectively evaluated regarding disc degeneration, endplate abnormalities and high intensity zone. Disc degeneration was graded according to the modified criteria of Pearce, et el. Evaluation of disc morphology was performed with X-Ray discography by using the classification of Adams, et al. Endplates and adjacent bone marrow abnormalities were classified according to Modic,et al. During discography concordant pain was regarded as positive, whereas discordant pain and no pain were regarded as negative. The data were analyzed using the Chi-squnre test. Results There were 116 discs with concordant pain and 140 discs with discordant pain or no pain. Of 256 discs on discography, 17 discs were type Ⅰ17(6.6%),type Ⅱ were 25(9.8%),type Ⅲ were 91(35.5%), type Ⅳ were 77(30.1%) and type Ⅴ were 46(18.0% ). On MR images, discs of grade Ⅰ were 23 (9.0%) ,grade Ⅱ were 34(13.3%), grade Ⅲ were 84(32.8%), grade Ⅳ were 85 (33.2%) and grade Ⅴ were 30(11.7%). There was positive correlation between Pearce graded of MRI and classification of Adams of discography (r=0.62, X2 =160.87,P <0.01).In 123 discs of type Ⅳ to type Ⅴ on discography, 104 discs were with concordant pain. There was positive correlation between type Ⅳ-Ⅴ and concordant pain( r=0.60, X2 = 144.08, P < 0.01). In 115 discs of Ⅳ-Ⅴ grade degeneration, 99 discs presented with concordant pain. There was positive correlation between Ⅳ-Ⅴ grade disc degeneration and concordant作者单位:510120 广州,中山大学附属第二医院放射科 pain(r = 0.59, X2 = 137.11, P <0.01 ). In 60 discs with high intensity zone(HIZ), 52 discs presented with concordant pain. There was positive correlation between HIZ and concordant pain ( r=0.41, X2= 51.93, P <0.01 ). In 58 discs with endplate degeneration, 51 presented with concordant pain. There was positive correlation between Modic degeneration and concordant pain ( r = 0.41, X2= 52.76, P < 0.01 ). Conclusion In patients with chronic low back pain, MR imaging may present moderate to severe disc degeneration, high intensity zone, endplates and adjacent bone marrow abnormalities. MR findings with concordant pain can raise the diagnostic possibility of discogenic lumbar pain. Typical discography findings, fissured or ruptured disc, with concordant pain are important diagnostic evidence for discogenic lumbar pain.

BACKGROUND: Differentiation of bone marrow mesenchymal stem calls(BMSCs) is associated with their microenvironment. After acute myocardial infarction (AMI), the necrosis of cardiomyocytes caused activation of complement, generation of free radical, and secretion of various cell factors. As a result, the ingredients of patients' serum also changed, so does the changes will influence the differentiation of BMSCs into cardiomyocytes? And what influence it will be? OBJECTIVE: To investigative effects of AMI rat serum on the differentiation of BMSCs into cardiomyocytes. DESIGN, TIME AND SETTING: The in vitro controlled cytology experiment was performed at the Laboratory of Center for Stem cells and Tissue Engineering, Sun Yat-sen University from September in 2005 to June in 2006. MATERIALS: SPF Sprague Dawley rats, weighing 50-80 g, aged 3-4 weeks, were used for culture of BMSCs, and SpragueDawley rats, weighing 200-300 g, aged 6-8 weeks, were used for making AMI models. METHODS: BMSCs were isolated and cultured with the adherent method. After making AMI rat models by deligating anterior descending of the left coronary artery, the serum were collected and centrifuged from AMI and normal rats. Then the passage 3 of BMSCs were divided into six groups, non-induction group, 5-azacytidine (5-aza) group, 5-aza plus serum from AMI rat group, 5-aza plus serum from normal rat group, serum from AMI rat group, and serum from normal rat group. MAIN OUTCOME MEASURES: Morphology changes in rat BMSCs after induction; Expression of cardiac troponin T of BMSCs after induction; Expression of GATA-4 and desmin mRNA of BMSCs after induction. RESULTS: After being induced by 5-aza and two kinds of serum, some cells became elongated and thinner. Two to three weeks after induction, some cells had a ball-like or rod-like appearance, and connection were formed between adjacent cells. It showed that some BMSC have differentiated into cardiac like cells. The expression of cardiac troponin T, GATA-4 and desmin were positive in cells differentiated from BMSCs. The troponin T expression in control group and simple serum induction group were negative, but GATA-4 and desmin expressed weakly. CONCLUSION: Serum from AMI rat cannot induce BMSCs to differentiate into cardiomyocytes alone, but it promotes BMSCs induced by 5-aza differentiating into cardiomyocytes and facilitates the differentiated calls into mature.