Objective To observe the efficacy of enalapril folic acid in the treatment of H type hypertension. Methods 196 H type hypertension patients with carotid atherosclerosis were randomly divided into the enalapril folic acid tablets group(leaf group 99 cases)and the control group(enalapril group 97 cases),respectively,enalapril folic acid tablets and enalapril,once a day.Continuous administration of 10 months,before and after treatment,the blood pressure control level,plasma homocysteine levels and carotid intima media thickness were compared between the two groups.Results ,Before and after treatment,the systolic blood pressure in the leaf group were (159.51 ±8.55)mmHg, (138.68 ±7.82)mmHg,and the diastolic blood pressure were (98.11 ±7.44)mmHg,(82.98 ±5.22)mmHg.In the enalapril group,before and after treatment,the systolic blood pressure were (160.10 ±9.12)mmHg,(139.47 ± 7.99)mmHg,and the diastolic blood pressure were (97.88 ±7.62)mmHg,(83.12 ±5.57)mmHg.Blood pressure before and after treatment in the two groups were significantly different(all P <0.05),there were no significant differ-ence between the two groups(all P >0.05).In the leaf group,before and after treatment,the plasma homocysteine concentrations were (16.89 ±5.62)μmol/L,(10.37 ±3.06)μmol/L,there was significant difference(P <0.05), and in the enalapril group before and after treatment,the plasma homocysteine concentrations were (17.11 ± 6.33)μmol/L,(16.88 ±6.48)μmol/L,there was no significant difference(P >0.05).In the leaf group,before and after treatment the carotid artery intima media thickness were (1.28 ±0.33)mm,(1.08 ±0.36)mm,there was sig-nificant difference(P <0.05),and in the enalapril group before and after treatment the carotid artery intima media thickness were (1.29 ±0.38)mm,(1.31 ±0.43)mm,there was no significant difference(P >0.05).Conclusion Enalapril folic acid tablets in treatment of H type hypertension has significant efficacy,it can reduce blood pressure and plasma homocysteine levels and delay the progression of atherosclerosis.

Objective To summarize cardiopulmonary bypass management in open heart surgery of children with congenital heart disease. Methods The clinical data of 80 children with age less than 4 years old underwent open heart surgery under cardiopulmonary bypass from January,2005 to January,2009 were retrospectively analyzed. Results The operations of all 80 cases were basically smoothly and no severe complications associated with extracorporeal circulation occurred. After cross-clamping releasing,automatically re-beating occurred in 75 cases,and 5 re-beat after electric shock. There was no postoperative death. Conclusions Open heart surgery under cardiopulmonary bypass is safe and efficacy in children with congenital heart disease.

Objective To determine the effective volume of 1.5％ lidocaine for obturator nerve block (ONB) in 50％ of patients (EV50) undergoing transurethral resection of bladder tumor (TURBT).Methods Thirty-six ASA physical status Ⅰ or Ⅱ patients with bladder tumor,aged 18-64 yr,with body mass index of 19-30 kg/m2,scheduled for elective TURBT and required ONB before TURBT,were enrolled in the study.ONB was performed with 1.5 ％ lidocaine using the pubic approach under the guidance of a nerve stimulator.The volume of 1.5％ lidocaine was determined by up-and-down sequential trial.The initial volume of hdocaine was 10 ml and the ratio between the two successive volumes was 1.1.Successful ONB was considered to be positive response.The EV50 and 95 ％ confidence interval (CI) of 1.5 ％ lidocaine for ONB were calculated.Results The EV50 of 1.5 ％ lidocaine for ONB was 5.53 rnl and the 95 ％ CI was 5.10-6.00 ml.Conclusion The EV50 of 1.5 ％ lidocaine is 5.53 ml when used for ONB in patients undergoing TURBT.

Objective To compare the efficacy of suprainguinal approach and pubic tubercle approach to obturator nerve block (ONB) in patients undergoing transurethral resection of bladder tumor.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 41-80 yr,with body mass index of 17.5-31.0 kg/m2,scheduled for elective transurethral resection of bladder tumor,were randomly divided into 2 groups (n =30 each) using a random number table:pubic tubercle approach group (group P) and suprainguinal approach group (group S).Nerve blocks were performed using a 100-mm insulated needle for ONB (21-gauge) under the guidance of a nerve stimulator.In group P,the insertion point of the needle was 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle.In S group,the insertion point of the needle was at the midpoint of the line drawn in the inguinal crease between the femoral artery and the inner border of the adductor longus tendon and the needle was advanced 3 cm cephalad in the major axis of thigh.The number of puncture eliciting contraction of adductor muscle,time taken to elicit contraction of adductor muscle starting from onset of puncture,depth of puncture,and highest visual analog scale (VAS) pain scores during application of the block were recorded.The myodynamia of adductor muscle was evaluated.The development of complications was also recorded.Results Compared with group P,the number of puncture,highest VAS scores,and myodynamia of adductor muscle at 4 and 6 min of blockade were significantly decreased,the time taken to elicit contraction of adductor muscle was shortened,and the success rate of puncture at first attempt was increased in group S (P ＜ 0.05 or 0.01).There was no significant difference in the incidence of puncture point bleedings between the two groups (P ＞ 0.05).Conclusion The suprainguinal approach for ONB offers more accurate location,faster onset,lighter degree of noxious stimulation and better safety than the pubic tubercle approach in patients undergoing transurethral resection of bladder tumor.

Objective Comparing the effects of ultrasound with nerve stimulation guided obtu-rator nerve block(ONB)with simple nerve stimulation guided ONB for transurethral resection of blad-der tumor(TURBT),so as to realize the validity and advantages of ultrasound with nerve stimulation guided ONB.Methods Sixty ASA Ⅰ or Ⅱ,male or female,age 39-77 years old,BMI 1 9-30 kg/m2 patients undergoing elective TURBT were randomly divided into two groups,nerve stimulation group (group S)and ultrasound and nerve stimulation group (group US).Success rate of the first puncture, visual analog scale (VAS)pain score,insertion-adductor contraction interval (ICI),puncture times corresponding to ICI,adductor strength,incidence of complications and validity were observed during and after ONB.Results There was no significant difference of the general validity,adductor strength and complication incidence between the two groups.The success rate of the first puncture was signifi-cantly higher in group US than that in group S (P < 0.01).VAS pain score,ICI and puncture times were significantly lower in group US than those in group S (P < 0.05).Conclusion Compared with simple nerve stimulation guided ONB,ultrasound with nerve stimulation guidance showed less punc-ture time,more accurate positioning and more comfort.

Objective To compare the therapeutic effects of transureteroscope holmium laser lithotripsy ( URL) and retroperitoneal laparoscopic ureterolithotomy ( RLU) for unilateral upper ureteral calculi and evaluate the selection of indications and clinical value of URL and RLU .Methods 37 patients were enrolled into the study . 14 patients received URL ,23 patients received RUL .Double-J stent was routinely indwelled in both groups .The oper-ation time,hospitalization time,clearance rate of the stone and incidence of postoperative complications .Results The stone clearance rate after postoperation of RLU group was 100%, which was significantly higher than that of URL group 64.4%(χ2 =4.15,P<0.05).The mean operation time in RLU group was(132.0 ±7.8)min,which was sig-nificantly longer than URL group(46.5 ±7.2)min(t=6.23,P<0.05).The mean intraoperative blood loss of RLU group was(38.0 ±4.6)mL,which was significantly higher than URL group (10.0 ±3.2)mL(t=5.20,P<0.05). The postoperative complication rate of RLU group was 8.7%,which was significantly lower than URL group 21.5%(χ2 =4.06,P<0.05).There was no significant difference in hospitalization time and stone clearance rate between the two groups(P>0.05).Two cases converted to operation in URL group ,while only 1 case converted to operation in RLU group.Conclusion Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy .Laparoscopic ureterolithotomy is a safe and effective therapeutic method for unilateral upper ureteral stones .

Objective To investigate the role of spinal glucocorticoid receptors (GR) in phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) signal pathway in rats with morphine tolerance.Methods Forty healthy male SD rats aged 8-10 weeks weighing 300-350 g in which intrathecal (IT) catheters were successfully implanted without complication were randomly divided into 4 groups (n =10 each):control group(group C) received IT injection of normal saline 10 μl twice a day for 7 consecutive days; morphine tolerance group(group M) received IT injection of morphine 10 μg twice a day for 7 consecutive days; dexamethasone (a GR agonist) group( group DEX)received IT injection of dexamethasone 4 μg 30 min before IT injection of morphine,twice a day for 7 consecutive days;RU38486(a GR blocker)group (group R) received IT injection of RU38486 2 μg 30 min before IT injection of morphine,twice a day for 7 consecutive days.Tail-flick test was measured once a day after first IT administration and 1 d after the end of IT administration,and the percentage of maximum possible antinociceptive effect (MPAE)was caculated.After the last measurem of tail-flick test,the spinal dorsal horns were removed for determination of PI3K,Caspase-3 expression and Akt activity.Results Morphine tolerance developed in groups M,DEX and R,but did not develop in group C.Compared with group C,Akt activity was decreased,PI3K expression was downregulated and Caspase-3 expression was up-regulated in group M (P ＜ 0.05).Compared with group M,MPAE and Akt activity were decreased,PI3K expression was down-regulated and Caspase-3 expression was up-regulated in group DEX,and MPAE and Akt activity were inecreased,PI3K expression was up-regulated and Caspase-3 expression was down-regulated in group R (P ＜ 0.05).Conclusion Spinal cord GR is involved in morphine tolerance by inhibiting PI3K/Akt signal pathway.

Objective To investigate the metabolism change of intestinal flora due to chronic hypoxia in infants. Methods Ten infants with tetralogy of fallot were considered as the chronic hypoxia group,10 healthy infants were regarded as the control group. The urine concen-tration of hippurate in the morning with fasting was detected by 1 H nuclear magnetic resonance. Results The concentration of hippurate was decreased in hypoxia group compared with the control group,(47. 15 ± 32. 88) mg/L vs (346. 698 ± 13. 555) mg/L,with significant differ-ence,P=0. 002. Conclusion Chronic hypoxia alters metabolism of intestinal flora in infants.

Objective To determine the median effective concentration (EC50) of lidocaine for obturator nerve block (ONB) guided by a nerve stimulator in patients undergoing transurethral resection of bladder tumor (TURBT).Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients with bladder tumor,scheduled for elective TURBT,required ONB according to the results of cystoscopy or CT examination performed before operation,with body mass index of 19-30 kg/m2,aged 18-64 yr,were enrolled in the study.ONB was performed with lidocaine using the suprainguinal approach under the guidance of a nerve stimulator.The concentration of lidocaine was determined by up-and-down sequential trial.The initial concentration of lidocaine was 1.5％,and the ratio between the two successive concentrations was 1.2.Successful ONB was considered to be positive response.The EC50 and 95％ confidence interval of lidocaine for ONB guided by a nerve stimulator was calculated.Results The EC50 of lidocaine was 0.57％,and the 95％ confidence interval was 0.55％-0.59％ when used for ONB guided by a nerve stimulator.Conclusion The EC50 of lidocaine is 0.57％ when used for ONB guided by a nerve stimulator in the patients undergoing TURBT.

BACKGROUND:The structure of tissue engineering carrier affects the bio-action of cells greatly.OBJECTIVE: To investigate the biological characteristics of bone marrow stem cells (MSCs) in different concentrations of alginate combined with de-antigen bone xenograft (DBX).DESIGN: Observational trial.SETTING: PLA Institute of Trauma and Orthopedics, the Fourth Military Medical University of Chinese PLA.MATERIALS: Alginate, calcium chloride, MSCs, bone xenograft.METHODS: Bovine cancellous bone was out into cubes, which were degreased, deproteinized and then lyophilized.Cubes in pore size within 300-500 μm were selected for use after ethylene oxide sterilization. The purified sodium alginate was dissolved in DMEM cell culture medium of concentrations as different as 0.5%, 2%, 8% and 16%; 1×1012 L-1 induced MSCs were blended with isopyknic alginate-DMEM and compounded with DBX at a status of 0.5 Mpa negative pressure for 5 minutes in order to make a cell suspension fully fill into the pores of the cancellous bone. Then alginate was crosslinked with 50 g/L calcium gluconic acid for 30 seconds. The complex was put into a CO2 incubator and cultured for 4 days. The gel compound and cell growth in the pores of the complex were grossly observed with an inverted microscope. Status of cell growth in the complex with different concentrations of alginate was observed with scanning electron microscopeMAIN OUTCOME MEASURES: Compound status of alginate and bone xenograft, cell growth status and matrix secretion in compound carries.RESULTS: When the concentration of alginate was 0.25% or 1%, alginate was equally combined in DBX, while that of 4% and 8% only combined on the surface of cancellous bone. After in vitro cultured for 4 days, alginate of 0.25% were broken off from DBX surface. But alginate of 1% was equally combined with DBX pores with cells secreting well in alginate. Development of cells in alginate of 4% was restricted and no cells were seen in alginate of 8%.CONCLUSION: Alginate of 1% is suitable for constructing the carrier of bone tissue engineering with bone xenograft.