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Objective To analyze the epidemiological characteristics and influencing factors of pulmonary infection in the elderly, and to construct a risk prediction model. Methods Stratified cluster sampling was used to randomly select 683 elderly patients in Zhangjiakou First Hospital as the investigation subjects. Sputum specimens were collected and sent for bacterial isolation, culture, identification, and drug sensitivity test. According to whether the patients had pulmonary infection, they were divided into pulmonary infection group (n=315) and non-pulmonary infection group (n=368). The clinical data of the two groups such as age, sex, COPD, and ICU admission were analyzed. Univariate analysis and logistic regression analysis were used to analyze the influencing factors of pulmonary infection in elderly patients, and a risk prediction model was established. Results A total of 331 strains of pathogenic bacteria were detected in 315 patients with pulmonary infection, and there were 207 strains (62.54%) of gram-negative bacteria detected, mainly including 95 strains (28.70%) of Acinetobacter baumannii and 71 strains (21.45%) of Klebsiella pneumoniae. There were 169 strains (26.28%) of gram-positive bacteria detected, mainly 68 strains (20.54%) of Staphylococcus aureus. In addition, there were 25 strains of fungi (7.55%). There were no significant differences in gender, smoking history, history of COPD, asthma, and stroke between the two groups (P>0.05). The proportion of patients aged≥70, mechanical ventilation, admission to ICU and recent respiratory tract infection in the experimental group was significantly higher than that in the control group (P<0.05). Multivariate logistic regression analysis showed that age, smoking history, mechanical ventilation, and ICU admission were independent risk factors for pulmonary infection in elderly patients (P<0.05). According to the above four independent influencing factors and corresponding regression coefficient of each factor, the prediction model of pulmonary infection in elderly patients was constructed, Z=-5.948+1.198× (age) +1.281×(smoking history) +2.029×(mechanical ventilation) +1.211×(ICU admission). Conclusion Lung infection in elderly patients in our hospital is dominated by gram-negative bacilli. Antibiotics should be rationally selected according to drug sensitivity results. Age≥70 years old and COPD can increase the risk of pulmonary infection in elderly patients, and the prediction model constructed can effectively predict the occurrence of pulmonary infection in elderly patients.
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Objective:To investigate the adherence of patients with chronic airway disease with inhalation therapy and to explore the influencing factors.Methods:A total of 180 outpatients with chronic airway disease were selected by convenient sampling. The general information, adherence of inhalation therapyquestionnaire, asthma knowledge questionnaire, chronic obstructive pulmonary disease (COPD) health literacy questionnaire (COPD-Q) were used to evaluate the general information, adherence of inhalation therapy and disease knowledge level of the patients. The severity of the disease was evaluated by asthma control test (ACT) score and COPD assessment test (CAT) score. ANOVA and t-test were used to analyze the adherence of patients with chronic airway disease, and multivariate linear regression was used to analyze the adherence. Results:The adherence score of asthma patients was 89.74 ± 7.27 and the adherence score of COPD patients was 86.80 ± 9.16, which were in the middle level. The risk factors of non-adherence of inhalation therapy were retirement, living alone and smoking. The effect of inhaled treatment time on the adherence of inhaled therapy is not linear, and the turning point of adherence decline occurs one year after the patients received inhaled therapy. The results of multiple linear regression showed that the effect of course and employment on the adherence of inhalation therapy was statistically significant.Conclusions:The adherence of chronic airway disease patients with inhalation therapy is not ideal, especially for the patients with long course, smoking, retirement and living alone, the medical staff should pay more attention, take appropriate intervention measures to improve the adherence of inhalation therapy.
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Objective To detect the diffusional kurtosis imaging (DKI) parameters of patients with Alzheimer's disease (AD),and evaluate the inner link of DKI parameters with cognitive function and serum nerve injury index.Methods 78 patients who were first diagnosed with AD in our hospital between December 2015 and January 2018 were enrolled in AD group,and 50 healthy volunteers who had physical examination in our hospital during the same period were enrolled in normal control group.The corpus callosum DKI parameters [mean kurtosis (MK),axial kurtosis (AK) and radial kurtosis (RK)] values,Mini-Mental State Examination (MMSE) score as well as serum nerve damage indexes [β amyloid 1-42 (Aβ1-422),S100B protein (S100B) and brain-derived neurotrophic factor (BDNF)] were compared between the two groups of subjects.Pearson test was used to evaluate the correlation of DKI parameters with MMSE score as well as serum nerve injury index in patients with AD.Results MK,AK and RK levels in AD group were lower than those in normal control group;MMSE score was lower than that of normal control group;serum Aβ1-42 and S100B contents were higher than those of normal control group while BDNF content was lower than that of normal control group (P ＜ 0.05).Correlation analysis revealed that the MK,AK and RK values in AD patients were directly correlated with the MMSE score as well as Aβ1-42,S100B and BDNF levels (P ＜ 0.05).Conclusions The corpus callosum DKI parameter levels decrease in AD patients,and the specific levels are closely related to the severity of cognitive function and nerve injury,which may be one of the effective methods for early assessment of AD condition.
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Objective@#To detect the diffusional kurtosis imaging (DKI) parameters of patients with Alzheimer's disease (AD), and evaluate the inner link of DKI parameters with cognitive function and serum nerve injury index.@*Methods@#78 patients who were first diagnosed with AD in our hospital between December 2015 and January 2018 were enrolled in AD group, and 50 healthy volunteers who had physical examination in our hospital during the same period were enrolled in normal control group. The corpus callosum DKI parameters [mean kurtosis (MK), axial kurtosis (AK) and radial kurtosis (RK)] values, Mini-Mental State Examination (MMSE) score as well as serum nerve damage indexes [β amyloid 1-42 (Aβ1-422), S100B protein (S100B) and brain-derived neurotrophic factor (BDNF)] were compared between the two groups of subjects. Pearson test was used to evaluate the correlation of DKI parameters with MMSE score as well as serum nerve injury index in patients with AD.@*Results@#MK, AK and RK levels in AD group were lower than those in normal control group; MMSE score was lower than that of normal control group; serum Aβ1-42 and S100B contents were higher than those of normal control group while BDNF content was lower than that of normal control group (P<0.05). Correlation analysis revealed that the MK, AK and RK values in AD patients were directly correlated with the MMSE score as well as Aβ1-42, S100B and BDNF levels (P<0.05).@*Conclusions@#The corpus callosum DKI parameter levels decrease in AD patients, and the specific levels are closely related to the severity of cognitive function and nerve injury, which may be one of the effective methods for early assessment of AD condition.
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Objective To study the correlation of whole brain apparent diffusion coefficient (ADC) with neurological impairment,homocysteine (Hcy) metabolism and oxygen free radical generation in patients with Alzheimer's disease (AD).Methods The patients diagnosed as AD in Xuanwu Hospital of Capital Medical University from March 2014 to December 2017 were selected as AD group and healthy persons as control group.The ADC of whole brain was calculated after magnetic resonance scanning.The degree of neurological impairment was evaluated by Montreal Cognitive Function Assessment Scale (MoCA).The levels of Hcy metabolic index and oxygen free radical production were measured after collecting serum.Results ADC values of AD group in parietal lobe,frontal lobe,temporal lobe and occipital lobe were not significantly different from those of control group (P ＞ 0.05).The ADC value of hippocampus as well as serum Hcy,malondialdehyde (MDA) and nitric oxide (NO) contents were significantly higher than those of control group,while MoCA score as well as folic acid (FA),vitamin B12 (VitB12),superoxide dismutase (SOD) and glutathione peroxidase (GSH) contents in serum were significantly lower than those of control group (P ＜ 0.05);ADC value of hippocampus in AD patients was negatively correlated with MoCA score as well as serum FA,VitB12,SOD and GSH contents,and positively correlated with serum Hcy,MDA and NO contents.Conclusions The increased ADC value of hippocampus in AD patients was related to the cognitive function injury,Hcy metabolism disorder and excessive generation of oxygen free radicals.
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Aberrant regulation of miRNA genes contributes to pathogenesis of a wide range of human diseases, including cancer. The TAR DNA binding protein 43 (TDP-43), a RNA/DNA binding protein associated with neurodegeneration, is involved in miRNA biogenesis. Here, we systematically examined miRNAs regulated by TDP-43 using RNA-Seq coupled with an siRNA-mediated knockdown approach. TDP-43 knockdown affected the expression of a number of miRNAs. In addition, TDP-43 down-regulation led to alterations in the patterns of different isoforms of miRNAs (isomiRs) and miRNA arm selection, suggesting a previously unknown role of TDP-43 in miRNA processing. A number of TDP-43 associated miRNAs, and their candidate target genes, are associated with human cancers. Our data reveal highly complex roles of TDP-43 in regulating different miRNAs and their target genes. Our results suggest that TDP-43 may promote migration of lung cancer cells by regulating miR-423-3p. In contrast, TDP-43 increases miR-500a-3p expression and binds to the mature miR-500a-3p sequence. Reduced expression of miR-500a-3p is associated with poor survival of lung cancer patients, suggesting that TDP-43 may have a suppressive role in cancer by regulating miR-500a-3p. Cancer-associated genes LIF and PAPPA are possible targets of miR-500a-3p. Our work suggests that TDP-43-regulated miRNAs may play multifaceted roles in the pathogenesis of cancer.
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Animals , Humans , Mice , Cells, Cultured , DNA-Binding Proteins , Metabolism , Electrophoretic Mobility Shift Assay , Immunoprecipitation , MicroRNAs , Genetics , Metabolism , Neoplasms , Genetics , MetabolismABSTRACT
Objective: To explore the clinical characteristics, imaging feature, surgical outcomes, and prognosis of recurrent aneurysmal bone cysts (RABC) of the extremities. Methods: Between January 2008 and January 2016, 29 patients histopathologically diagnosed with RABC were treated at our hospital. These patients included 15 males and 14 females. The mean age at the time of diagnosis was 17.4 years(range 4-42 years). The most common site of the RABC was the proximal tibia (12 cases), followed by the distal femur (11 cases), and 3 cases each with involvement of the proximal humerus and the proximal femur. Recurrence was most commonly ob-served within 24 months following the initial treatment. Intralesional re-curettage was performed in 24 patients and en bloc resection of the tumor and reconstruction in 5 patients. The medial tibial stress syndrome (MTSS) score was used to evaluate postoperative func-tion of the affected limb, and the comprehensive clinical efficacy was evaluated on the basis of the Mankin criteria. Results: The mean follow-up duration was 64 months (range 24-90 months). Re-recurrence occurred in 1 patient with a total re-recurrence rate of 3.4%. The postoperative MTSS score was 26-30 points (mean 29.1 points) in the intralesional re-curettage group and 21-27 points (mean 23.0 points) in the tumor resection group. Based on the Mankin criteria, excellent and good clinical outcomes were observed in 95.8% of patients in the intralesional and 60% of the patients in the tumor resection and reconstruction groups. Conclusions: Regular follow-up is essential for the early diagnosis of RABC. The re-recurrence rate following intralesional re-curettage was within an acceptable range, and postoperative limb function was satisfactory; therefore, intralesional re-curettage is the treatment of choice for RABC in-volving the extremities. Tumor resection can be performed in patients with severe articular surface destruction and repeated recur-rence, although long-term complications may occur.
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Multiple sclerosis ( MS) is an autoimmune disease of the central nervous system ( CNS) characterized by demyelination and inflammation lesions.MS predominantly affects young adults with a high incidence of disability. However, the exact pathogenesis of MS is still not clear.Studies found that microglia polarization tending to pro-inflammatory M1-like state during the onset of MS, causing the M1/M2 ratio imbalance, forming pro-inflammatory microenvironment state, and which further leading to nervous tissue damage ultimately.Microglia polarization may be considered as the initiator of pathologic alterations by releasing pro-inflammatory cytokines and secondarily trigger the initial microglia response.Given the pivotal role of imbalanced microglia polarization in MS initiation, a critical review of microglia polarization is presented here, in order to elucidate the pathogenesis of MS and highlight the noteworthy candidate therapeutic targets for clinic treatment.
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MicroRNAs (miRNAs) are critical for both development and function of the central nervous system. Significant evidence suggests that abnormal expression of miRNAs is associated with neurodevelopmental disorders. MeCP2 protein is an epigenetic regulator repressing or activating gene transcription by binding to methylated DNA. Both loss-of-function and gain-of-function mutations in the MECP2 gene lead to neurodevelopmental disorders such as Rett syndrome, autism and MECP2 duplication syndrome. In this study, we demonstrate that miR-130a inhibits neurite outgrowth and reduces dendritic spine density as well as dendritic complexity. Bioinformatics analyses, cell cultures and biochemical experiments indicate that miR-130a targets MECP2 and down-regulates MeCP2 protein expression. Furthermore, expression of the wild-type MeCP2, but not a loss-of-function mutant, rescues the miR-130a-induced phenotype. Our study uncovers the MECP2 gene as a previous unknown target for miR-130a, supporting that miR-130a may play a role in neurodevelopment by regulating MeCP2. Together with data from other groups, our work suggests that a feedback regulatory mechanism involving both miR-130a and MeCP2 may serve to ensure their appropriate expression and function in neural development.
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Animals , Rats , Dendrites , Genetics , Metabolism , Dendritic Spines , Genetics , Metabolism , Down-Regulation , Physiology , Methyl-CpG-Binding Protein 2 , Genetics , MicroRNAs , Genetics , MetabolismABSTRACT
Axonal transport of mitochondria is critical for neuronal survival and function. Automatically quantifying and analyzing mitochondrial movement in a large quantity remain challenging. Here, we report an efficient method for imaging and quantifying axonal mitochondrial transport using microfluidic-chamber-cultured neurons together with a newly developed analysis package named "MitoQuant". This tool-kit consists of an automated program for tracking mitochondrial movement inside live neuronal axons and a transient-velocity analysis program for analyzing dynamic movement patterns of mitochondria. Using this method, we examined axonal mitochondrial movement both in cultured mammalian neurons and in motor neuron axons of Drosophila in vivo. In 3 different paradigms (temperature changes, drug treatment and genetic manipulation) that affect mitochondria, we have shown that this new method is highly efficient and sensitive for detecting changes in mitochondrial movement. The method significantly enhanced our ability to quantitatively analyze axonal mitochondrial movement and allowed us to detect dynamic changes in axonal mitochondrial transport that were not detected by traditional kymographic analyses.
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Animals , Rats , Axonal Transport , Physiology , Cerebral Cortex , Cell Biology , Metabolism , Drosophila melanogaster , Cell Biology , Metabolism , Embryo, Mammalian , Gene Expression , Lab-On-A-Chip Devices , Microscopy, Confocal , Mitochondria , Metabolism , Motor Neurons , Metabolism , Movement , Mutation , Primary Cell Culture , RNA-Binding Protein FUS , Genetics , Metabolism , Rats, Sprague-Dawley , SoftwareABSTRACT
Ubiquitin specific protease 33 (USP33) is a multifunctional protein regulating diverse cellular processes. The expression and role of USP33 in lung cancer remain unexplored. In this study, we show that USP33 is down-regulated in multiple cohorts of lung cancer patients and that low expression of USP33 is associated with poor prognosis. USP33 mediates Slit-Robo signaling in lung cancer cell migration. Downregulation of USP33 reduces the protein stability of Robo1 in lung cancer cells, providing a previously unknown mechanism for USP33 function in mediating Slit activity in lung cancer cells. Taken together, USP33 is a new player in lung cancer that regulates Slit-Robo signaling. Our data suggest that USP33 may be a candidate tumor suppressor for lung cancer with potential as a prognostic marker.
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Female , Humans , Male , Middle Aged , Blotting, Western , Cell Line, Tumor , Cell Movement , Genetics , Physiology , Cohort Studies , Down-Regulation , Gene Expression Regulation, Neoplastic , HEK293 Cells , Immunohistochemistry , Intercellular Signaling Peptides and Proteins , Metabolism , Kaplan-Meier Estimate , Lung Neoplasms , Genetics , Metabolism , Pathology , Nerve Tissue Proteins , Metabolism , Prognosis , RNA Interference , Receptors, Immunologic , Metabolism , Reverse Transcriptase Polymerase Chain Reaction , Signal Transduction , Genetics , Physiology , Ubiquitin Thiolesterase , Genetics , MetabolismABSTRACT
Down syndrome cell adhesion molecule (DSCAM) acts as a netrin-1 receptor and mediates attractive response of axons to netrin-1 in neural development. However, the signaling mechanisms of netrin-DSCAM remain unclear. Here we report that AMP-activated protein kinase (AMPK) interacts with DSCAM through its γ subunit, but does not interact with DCC (deleted in colorectal cancer), another major receptor for netrin-1. Netrin-treatment of cultured cortical neurons leads to increased phosphorylation of AMPK. Both AMPK mutant with dominant-negative effect and AMPK inhibitor can significantly suppress netrin-1 induced neurite outgrowth. Together, these findings demonstrate that AMPK interacts with DSCAM and plays an important role in netrin-1 induced neurite outgrowth. Our study uncovers a previously unknown component, AMPK, in netrin-DSCAM signaling pathway.
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Animals , Humans , Mice , AMP-Activated Protein Kinases , Genetics , Metabolism , Cell Adhesion Molecules , Genetics , Metabolism , Cells, Cultured , HEK293 Cells , Nerve Growth Factors , Pharmacology , Netrin-1 , Neurites , Physiology , Neurons , Cell Biology , Metabolism , Phosphorylation , Protein Binding , Protein Kinase Inhibitors , Pharmacology , RNA Interference , RNA, Small Interfering , Recombinant Fusion Proteins , Genetics , Signal Transduction , Transfection , Tumor Suppressor Proteins , PharmacologyABSTRACT
Mutations in the Fused in sarcoma/Translated in liposarcoma gene (FUS/TLS, FUS) have been identified among patients with amyotrophic lateral sclerosis (ALS). FUS protein aggregation is a major pathological hallmark of FUS proteinopathy, a group of neurodegenerative diseases characterized by FUS-immunoreactive inclusion bodies. We prepared transgenic Drosophila expressing either the wild type (Wt) or ALS-mutant human FUS protein (hFUS) using the UAS-Gal4 system. When expressing Wt, R524S or P525L mutant FUS in photoreceptors, mushroom bodies (MBs) or motor neurons (MNs), transgenic flies show age-dependent progressive neural damages, including axonal loss in MB neurons, morphological changes and functional impairment in MNs. The transgenic flies expressing the hFUS gene recapitulate key features of FUS proteinopathy, representing the first stable animal model for this group of devastating diseases.
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Aged , Animals , Humans , Aging , Genetics , Metabolism , Pathology , Amyotrophic Lateral Sclerosis , Genetics , Metabolism , Pathology , Animals, Genetically Modified , Disease Models, Animal , Drosophila melanogaster , Genetics , Metabolism , Gene Expression , Microscopy, Electron, Scanning , Motor Neurons , Metabolism , Pathology , Mushroom Bodies , Metabolism , Pathology , Mutant Proteins , Genetics , Metabolism , Mutation , Photoreceptor Cells, Invertebrate , Metabolism , Pathology , Plasmids , RNA-Binding Protein FUS , Genetics , Metabolism , Recombinant Fusion Proteins , Genetics , Metabolism , Retinal Degeneration , Pathology , TransfectionABSTRACT
The nervous system is one of the most complicated organ systems in invertebrates and vertebrates. Down syndrome cell adhesion molecule (DSCAM) of the immunoglobulin (Ig) superfamily is expressed widely in the nervous system during embryonic development. Previous studies in Drosophila suggest that Dscam plays important roles in neural development including axon branching, dendritic tiling and cell spacing. However, the function of the mammalian DSCAM gene in the formation of the nervous system remains unclear. Here, we show that Dscam ( del17 ) mutant mice exhibit severe hydrocephalus, decreased motor function and impaired motor learning ability. Our data indicate that the mammalian DSCAM gene is critical for the formation of the central nervous system.
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Animals , Mice , Cell Adhesion Molecules , Genetics , Metabolism , Corpus Callosum , Metabolism , Pathology , Genotype , Hydrocephalus , Genetics , Metabolism , Pathology , Mice, Knockout , Motor Activity , Genetics , Physiology , MutationABSTRACT
ObjectiveTo evaluate the effects of parecoxib on efficacy of patient-controlled epidural analgesia(PCEA) with different doses of morphine after cesarean section.MethodsThree hundred ASA Ⅰ or Ⅱ parturients at full term aged 20-40 yr weighing 54-89 kg undergoing elective cesarean section were randomly divided into 3 morphine groups-regular,median and small dose (groups Ⅰ,Ⅱ[ and Ⅲ) ( n ＝ 100 each).Each group was further divided into 2 subgroups ( n ＝ 50 each):parecoxib group (groups P1.2.3 ) and control group (groups C1,2.3 ).In groups P1.2.3 psrecoxib 40 mg was administered iv at the end of operation while in groups C1.2.3 normal saline (NS) was administered instead of parecoxib.Groups Ⅰ,Ⅱ and Ⅱ received a loading dose of morphine 2.0/1.5/1.0 mg+ 0.15％ ropivacaine 8 ml respectively.The PCEA solution contained morphine 3.0/2.0/1.5mg+ ropivacaine 150 mg + granisetron 3 mg+ dexamethasone 5 mg in 100 ml of NS in groups Ⅰ,Ⅱ,and Ⅲ respectively.PCEA pump was set up with a background infusion of 2 ml/h,and a bolus dose of 0.5 ml with a lockout-interval of 15 min.VAS was used to assess intensity of pain (0 ＝ no pain,10 ＝ worst pain).VAS score ≤4 was considered as effective analgesia.Adverse effects including nausea and vomiting and pruritus were recorded.ResultsThere was no significant difference in the rate of effective analgesia between groups P1,P2 and C1,C2 The rate of effective analgesia during movement was significant higher in group P3 than in group C3.The incidence of nausea and vomiting and pruritis were significantly lower in group P3 than in groups P1 and P2.Conclusion Parecoxib can enhance the efficacy of PCEA with small dose of morphine.
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Objective To investigate the clinical characteristics of methylmalonic academia in adolescence cases. Methods 4 cases were diagnosed methylmalonic academia by gas chromatography- masss pectrogram whose clinical, manifestations and treatment process were analyzed. Results The main clinical manifestations in 4 cases with methylmalonic academia were intellect impairment,epilepsy, pyramid signs; 2 of them suffered with hypopsia and optic atrophy, one of them suffered with papilledema. Symptoms were improved after treated with cobamamide and L-carnitine in all the 4 cases 1 months later. Conclusions The main clinical characteristics of methylmalonic academia in adolescence were intellect impairment, epilepsy and pyramid signs. The symptoms could be improved after treatment.
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Objective To explore the reliability of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)to evaluate the severity of the neurologic diseases and its accuracy to predict the outcome of patients with these diseases.Metllods Four hundred and four consecutive patients with severe neurologic diseases between 2005 and 2006 were enrolled to obtain the APACHE Ⅱ scores at 0.24,48,72 h after admission to neurointensive care unit.Results The APACHE Ⅱ scores were positively associated with the outcome of the patients with severe neurologic diseases.The higher score corresponded with the higher mortality rate.The areas under the receiver operating characteristic curves of APACHE Ⅱ to predict the outcome was 0.866(95% CI 0.824 to 0.907.P=0.000).The optimal cutoff of APACHE Ⅱ scores to predict the outcome was 17 scores with the sensitivity of 76.7%and the specificity of 78.7%.The predictive chance that was mostly associated with the outcome was 72 h after admission in logistic regression model (x2=137.345,P=0.000,correct class%=85%).The factors that were the most statistically associated with the outcome in the 14 parameters of APACHE Ⅱ were GCS score,heart rate,serum creatinine,body temperature and WBC count.Conelusion APACHE Ⅱ favorably reflects the severity of the neurologic diseases and reliably and accurately predicts the prognosis of the patients.
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Objective To study the effect of preemptive analgesina of morphine injected to subarachnoid space on postoperative epidural analgesia with morphine. Methods Sixty ASA Ⅰ-Ⅱ patients were randomly divided into two groups. All patinents received combination spinal-epidural anesthesia(CSEA). In experimenta group (n=30), 0 5% bupivacaine 2ml and morphine 0 5mg were injected into the subarachnoid space of the patients for CSEA, and morphine 2 8mg was used for postoperative epidural analgesia. In control group (n=30),0 5% bupivacaine 2ml was injected into the subarachnoid space of the patients for CSEA, and morphine 3 3mg was used for postoperative epidural analgesia. The numerical rating score (NRS) and Ramsay sedation scores were performed after operation. The postoperative analgesic duration and frequency of side effect were recorded. Rusult NRS was significantly less and postoperative analgesic duration was obviously longer in experimental group compared with control group. Ramsay sedation scores and the frequency of side effect significantly increased in the experimental group compared with the control group. But the shaking frequency in experimental group was significantly less than that in the control group. Conclusions Preemtive analgesia of morphine injected to subarachnoid space could improve postoperative epidural analgesia with morphine and increase analgesia time. But it had more side effects.