Objective To investigate the efficacy of ultrasound ablation combined with autologous transplantation of bone marrow mononuclear cells in treatment of arteriosclerosis obliterans.Methods Clinical data of 39 patients with arteriosclerosis obliterans treated with ultrasound ablation and autologous transplantation of bone marrow mononuclear cells were analyzed.There were 21 male and 18 female patients,With average age of 63 years.At operation,260 mL of autologous bone marrow was withdrawn,mononuclear cells were separated,and 40 mL supension fluid of stem cells was prepared.Through percutaneous approach or surgical approach the ultrasound ablation catheter was inserted into occluded arterial segments.After ablation was performed,autologous bone marrow mononuclear cells were directly injected into the skeletal muscles of the ischemic leg.Results No complications were found in this group.Postoperatively,rest pain of all the patients was significiently improved and distance of claudication increased.The skin became warm in all legs.Conclusions Ultrasound ablation and autologous transplantation of bone marrow mononuclear cells is a simple,safe and effective method for treating patients with arteriosclerosis obliterans.

Leptomeningeal metastasis (LM),with a high omission rate in diagnosis in approximately 5 ％～8 ％ of all patients, is increasingly recognized as a lethality complication. The diagnosis of LM remains challenges,but commonly can be established by CSF cytology or by definitive neuroimaging. Although a combination of focal radiotherapy,intrathecal chemotherapy,and systemic chemotherapy may be necessary to achieve optimal treatment of patients, but prognosis is unacceptable and therapy remains palliative in most patients.

0.05). The incidence of emergency cesarean section in borderline oligohydramnios group was significantly higher than that of the control group. Conclusions Patients with borderline oligohydramnios may have a trial of labor under intensive monitor.

Objective To investigate the method of screening metra scar flaw of late trimester of pregnancy with B ultrasound and predict the risk of scar uterine rupture. Methods The depth and scar of lower uterine segment were observed continuously by B ultrasound between 33～41 weeks of gravida having the history of cesarean section. Results Lower uterine segment has all been formed after 33 weeks of 396 gravida. Lower uterine segment flaw was found in 69 cases by B ultrasound, nine cases were diagnosed to be aura uterine rupture which were confirmed in operation. Conclusion With B ultrasound we can observe the development of lower uterine segment during pregnancy so as to predict aura uterine rupture.

Objective To investigate the relationship between the single nucleotide polymorphisms (SNP) of rs1008438 in HSP70 promoter and the susceptibility of high altitude pulmonary edema (HAPE) .Methods The PCR‐DNA sequencing method was used to analyze gene distribution of rs1008438 in 100 HAPE patients and 200 healthy people ,and the relationship between dif‐ferent genotypes and HAPE was evaluated .Meanwhile ,HSP70 protein in cytoplasm and nuclei of white blood cells were detected by ELISA in patientgroup and healthy group .TNF‐α,IL‐1β and IL‐6 levels were analyzed by protein chip technology and EVI‐DENCE180 automatic chip reader .Results The TT ,GT ,and GG genetype frequencies of rs1008438 in HAPE patients and healthy controls were 76 .0% ,20 .0% ,4 .0% ,and 93 .0% ,6 .5% ,0 .5% ,respectively .The TT genetype frequency in HAPE patients was significantly lower than that in healthy control(P<0 .05) .The HAPE incidence rate in GT/GG genetype was 4 .195 times higher than that in TT genetype ,and the allele G can also significantly increase the prevalence of HAPE compared to T allele (OR=4 .178) .ELISA showed that HSP70 were higher in HAPE group of all genotypes than those in healthy control of the same geno‐type .And the nuclei/cytoplasm ratio of HSP70 in TT genotype was higher than that in GT/GG genotype .Protein chip showed that the levels of TNF α,IL‐1β,and IL‐6 in HAPE group were significantly higher than those in healthy control .Conclusion The poly‐morphism of rs1008438 is related to susceptibility of HAPE .Mutate genetype may change the promoter activity and increase the ex‐pression of HSP70 ,which induced HAPE .

OBJECTIVE:To evaluate the feasibility of using CYP2C19 gene to guide the use of antiplatelet agents in acute cor-onary syndrome(ACS)patients undergoing interventional operation in China from the viewpoint of pharmacoeconomics. METH-ODS:Based on global PLATO trial data,the patients were divided into 3 groups according to treatment strategies(clopidogrel group,ticagrelor group,genetic test group). By applying Treeage Pro 2011 software,short-term decision tree model and long-term Markov model were established,and related data were imported to evaluate cost-effectiveness of different treatment strategies. RE-SULTS&CONCLUSIONS:For ACS patients,according to the level of GDP in China,conventional use of ticagrelor is of pharma-coeconomic advantage for in Shanghai and uninsured patients insured patients;the use of antiplatelet agents guided by CYP2C19 gene test is of pharmacoeconomic advantage among nationwide insured patients.

BACKGROUND: It is demonstrated that ropivacaine has less toxicity than bupivacaine, but bupivacaine has higher liposolubility and efficacy, so a less dose of bupivacaine is needed in clinical comparing with ropivacaine. Serious convulsion is usually followed by cardiotoxicity induced by local anesthetics. The ratio of medial lethal dose (CD50) and median convulsant doses (LD50) is usually used to assess the comparative safety of local anesthetics.OBJECTIVE: To establish CD50 and LD50 of 2% lidocaine, 0.75% bupivacaine and 0.75% ropivacaine for Kunming mice and select proper indicator for neurotoxicity, then to compare neurotoxicity of the three local anesthetics on central nervous system.DESIGN: Randomized and controlled study.SETTING: Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: This study was carried out from July to December in 2002 in the Laboratory of Anesthesiology, Tongji Hospital, Tonji Medical College, Huazhong University of Science and Technology. Totally 310Kunming mice aged of 1-month with clean grade were enrolled in this study.METHODS: ① To determine the relation of dose of local anesthetics with conclusion rate and death rate in mice. Todetermine the dose-effect relationship for ropivacaine, 50 mice were selected and divided into 5 groups with 10rates in each group who received dose of 76.80, 68.69, 61.44,49.15, 31.46 mg/kg respectively. For bupivacaine, 90 mice were divided into 9 groups, with 10 rates in each group who received intraperitoneal dose of 50.00, 47.29, 44.72, 42.29, 40.00, 35.78, 32.00, 28.62, 25.60 mg/kg respectively. For lidocaine, 100 mice were divided into 10 groups,with10rates in each group who received dose of 183.11, 163.77, 146.48,131.02, 117.19, 93.75, 75.00, 60.00, 48.00, 38.40 mg/kg respectively. For each local anes thetic, the rates of convulsion or death were tried to distribute on both sides of 50% symmetrically. On the dose-response curve, 4or 5 well-spaced points were obtained for probit analysis to determine CD50 and LD50 of each agent. ② The effect of different dose of lidocaine on conclusion duration and c-fos expression in brain with different doses.Forty mice were divided into 4 groups with 10 rates in each group who received 0, 30%, 60% and 90% convulsant doses of lidocaine intraperitoneally. The duration of convulsion were recorded carefully for the convulsant mice that should be marked correctly for next procedure. Two hours later, the convulsant mice were anesthetized deeply and fixed by transcardiac perfusion for Immunohistochemistry to detect c-Fos expression. ③ Comparison of neurotoxicity induced by CD50 of three agents.Thirty mice were randomly divided into 3 groups with 10 rates in each group who received intraperitoneally CD50 of lidocaine, bupivacaine and ropivacaine respectively. The duration of convulsion and the number of neurons expressed with c-Fos in mice brain were compared among these three groups.MAIN OUTCOME MEASURES: The response of mice to intraperitoneal local anesthestics, duration of convusion and c-Fos expression using immunohistochemistry methods.RESULTS: Date of totally 310 mice was entered into final results analysis. ① The relation of dose of local anesthetics and conclusion rate or death rate in mice. The therapeutic index (LD50/CD50) of 2% lidocaine,0.75% bupivacaine and 0.75% ropivacaine were 2.89, 1.48 and 1.34, respectively. ② c-Fos expression induced by lidocaine in mice brain: The cFos expression in mice brain was mainly distributed in three zones-thalamencephal, hypothalamus, amydyla and pyriform cortex. ③ Compare of the duration of convulsion and number of neurons with c-Fos expression induced by different dose oflidocaine. Compared with control group, the duration of convulsion and number of neurons with c-Fos expression in amydyla and pyriform cortex all increased significantly in CD30, CD60and CD90 group (P ＜ 0.05). ④ Neurotoxicity induced by CD50 of lidoacaine, bupivacaine and ropivacasine The duration of convulsion and expression of c-fos in amydyla and pyriform cortex were significantly increased in ropivacaine group compared to bupivacaine or lidocaine group intraperitoneally (P ＜ 0.05). There were no significant differences in the duration of convulsion and expression of c-Fos between lidocaine and bupivacaine group (P ＞ 0.05).CONCLUSION: Compared with bupivacaine, ropivacaine produced less toxicity when identical dose was used in clinic. It is indicated that if an accidental convulsion induced by ropivacaine, it may be more severe than that induced by correspondent either lidocaine or bupivacaine. It may be the reason that ropivacaine have less lipid solubility, absorbed easily from this tissue compartment, and to get a high concentration in blood.