Objective To compare effects of both ends of the injection cesarean section anesthesia differ-ences.Methods ASAⅠ-Ⅱgrade cesarean section 226 cases were selected and randomly divided into the observa-tion group and control group on the basis of number characterization.Observation group:After the success of epidural puncture needle oblique injection of 1.7% for the end of lidocaine carbonate 5mL,then needle bevel steering head end 3-5min without observing all spinal abnormalities such as re-injection of 5mL of 1.7% lidocaine carbonate,fol-lowed by epidural catheter inserted,modified supine position to continue after injection of 1.7% lidocaine carbonate 5mL;Control group:after the success of epidural catheter tip administered by traditional teaching methods.Two groups of maternal range block plane , intraoperative pain intensity and time of delivery of the fetus were recorded .intraoperative changes in vital signs and Apgar score after the fetus were observed.Results The block wide range for anesthesia of the observation group[(14.43 ±1.21)points]were significantly higher than that of the control group,and intraopera-tive pain was (1.61 ±0.92)points,fetal childbirth lengthwas (1.8 ±0.6)minutes,which were better than those in the control group(t=12.76,13.07,12.86,all P<0.05);The MAP,HR,R,SpO2 between the two groups showed no significant differences(F=4.32,2.73,3.54,3.06,all P<0.05);Intraoperative vital signs and Apgar score was con-firmed no difference between the two groups(all P>0.05).Conclusion Both ends of the epidural injection for ce-sarean section is better than the traditional mode of administration of anesthesia.

Background Triamcinolone acetonide (TA) is often used in the treatment of uveitis and fundus disease,but whether it has toxic effect to normal tissue around eyes is unclear.Objective The aim of this study was to explore the adverse and toxic effects of TA on the periorbitally normal tissue following the periocular injection.Methods Twenty-seven New Zealand albino rabbits were randomly divided into experimental group,normal saline solution group and blank control group.TA was periocularly injected twice (20 mg for each) at 1-month interval in the rabbits of the experimental group,and 0.5 ml normal saline solution was used in the same way in the rabbits of the normal saline solution group.Not any drug was used in the blank group.The rabbits were sacrificed 1 month and 2 months,3 months after the secondary injection.For the preparation of the specimens of extraocular muscles,peribulbus adipose tissue,lacrimal gland and optic nerve.Hematoxylin and eosin staining of the specimens was performed to examine the the pathological change under the optical microscope,and the ultrastructural of peribulbus tissues was observed under the transmission electron microscope.Results No statistically significant change was found in IOP among various time points and groups (Fgroup =0.952,P =0.881 ; Ftime =7.297,P =0.411).The hyphological structures and ultrastructure of extraocular muscles,peribulbus adipose tissue,lacrimal gland and optic nerve were normal in the rabbits of the normal saline solution group and the blank control group.However,the optical microscopy showed varying degrees of atrophy or dissolving in the extraocular muscle fibers,the increase of glandular epithelial cells and enlargement of nuclei in the lacrimal gland as well as visible disorder arrangement of nerve fibers,vacuoles degeneration and the decrease of glial cells in optial nerve tissue in the rabbits of the experimental group from 1 month though 3 months after the secondary injection.Under the transmission electron microscope,the muscle stripes,bright band and dark band were incompletely disappeared,and expansionary sarcoplasmic reticulum and oval nucleus at the inferior to sarolemma were seen in the extraocular muscles.In addition,swelling lacrimal gland epithelial cells,thickening nuclear membrane and more organelles were exhibited in the lacrimal gland.In the optic never tissue,uneven myelin,space between axons and myelin,lamellar separation and degeneration also were revealed in the rabbits of the experimental group after injection of TA.Peribulbus adipose tissue was near normal both by optical microscope and transmission electron microscope in the experimental group.Conclusions The periocular injection of TA dose not elevated the IOP.However,it will result in the histogical and ultrastructural damages of extraocular muscles,lacrimal gland and optic nerve.

Objective To introduce a procedure, proximally based conjoined t en don transfer, which is to be used for coracoclavicular ligment reconstruction in the treatment of acromioclavicular separation. Methods From 2001 to 2003, 26 pa tients with acromioclavicular dislocation of Rockwood Grades Ⅲ-Ⅴwere treated with transfer of the lateral half of the conjoined tendon to the distal clavicle in a proximally based fashion with additional coracoclavicular fixation. Radiol ogy was used to evaluate the acromioclavicular correspondence. ASES (American Sh oulder &Elbow Surgeon) score, SST (Simple Shoulder Test) form and Constant-Mur ley score were adopted to evaluate the shoulder functions. Results Follow-ups o f 22.6 months on average revealed that the height of distal clavicle reached ana tomic reduction in all the cases during operation. At the latest follow-up, the mean ASES score was 94.2, the mean VAS(Visual Analog Scale) score for pain was 1.2,the mean forward flexion was 150?,and the mean external rotation was 35? . The mean Constant-Murley score was 92.8. The number of positive answers to th e SST was 11. The overall satisfaction rate was 88.5%(23/26) and all patients r eplied with “Yes”when questioned with “Do you want to accept the same operati on if the same condition happens to your contralateral shoulder?”Conclusions Th is surgical procedure proves reliable without sacrificing the coracoacromial lig ament during coracoclavicular reconstruction. When the patients are complicated with fresh or old rotator cuff injury, or the coracoclavicular ligament is thin, or long ligament is needed in the reconstruction, the proximally based conjoine d tendon can be served as a good source of autograft ligament.

PurposeTo explore the relationship between expression of apoptosis-modulating proteins and chemotherapeutic efficacy in acute leukemia. MethodsImmunocytochemical method was used to detect the expression of Bcl-2、Bcl-XL、Bax and Bak in 36 cases of acute leukemia including previously untreated/ drug-sensitive group and refractory/relapse group. ResultsThe average positive cell rates of Bcl-2 and Bcl-XL in refractory/relapse group were (41.68 ± 14.39) % and (35.96 ± 9.95 ) %, while the rates in previously untreated/drug-sensitive group were (15.64 ± 8.51 )% and (12.91 ± 8.63 )%. Statistical analysis showed the average positive cell rates of Bcl-2 and Bcl-XL in refractory/relapse group were higher than those in previously untreated/drug-sensitive group (P ＜ 0.01 ). There was no significant difference in average positive cell rates of Bax and Bak between refractory/relapse group (25.28 ± 15.49) %, (15.53 ± 10.64) % and previously untreated/drug-sensitive group (21.55 ± 12.58)%, (13.23 ± 8.36)%. The Logistic regression of expression of Bd-2 、Bcl-XL、Bax and Bak to complete remission rate (CR) of 36 cases of acute leukemia showed that Bcl-XL was the most risk factor in reducing the CR.ConclusionsBcl-2 and Bcl-XL might play important roles in multi-drug resistance of acute leukemia and Bcl-XL was more important than Bcl-2.

To explore the mechanism of the absorption enhancement of Angelica dahurica extract (Ade), the absorption mechanism of baicalin in the Scutcllaria water extraction as well as the effect of Angelica dahurica extract on absorption of baicalin were investigated. In order to determine the main absorption site, everted intestinal sac model was used to study the effect of Angelica dahurica extract on the absorption of baicalin at duodenum, jejunum, ileum and colon. In situ single pass intestinal perfusion model was performed to study the absorption of various concentrations of baicalin and the effect of Angelica dahurica extract on the absorption of baicalin at the main absorption site. To authenticate the consequence of perfusion by getting the blood from the hepatic portal vein and determine the concentration of the baicalin in the blood. The result showed that baicalin could be absorbed at all of the four intestinal segments with increasing absorption amount per unit as follows: ileum > colon > jejunum > duodenum. The absorption ofbaicalin in the duodenum significantly increased with Angelica dahurica extract, thus, duodenum was chosen to be the studying site. Apparent permeability values (Papp) and absorption rate constant (Ka) of baicalin in the duodenum increased gradually with higher concentrations. When the concentration of baicalin rises to a certain degree, the absorption increase had a saturable process, the absorption of baicalin may be an active transportation. Baicalin may be not a substrate of P-gp as verapamil which had not significantly affected the Papp and Ka of baicalin. The absorption of baicalin in the duodenum significantly increased (P < 0.01) in the two models with Angelica dahurica extract and the concentration of baicalin in the blood from the hepatic portal vein showed that the Angelica dahurica extract can increase the absorption of baicalin.

Objective To observe the influence of dexamethasone on the gene expression profiling of PBMCs from patients with internal heat due to Yin deficiency-type SLE. Methods The PBMCs from 3 patients with internal heat due to Yin deficiency-type SLE were incubated with dexamethasone of 10-6 g/L for 48 hours followed by the detection of gene expression profiling of PBMCs by a GeneChip. Results The incubation with dexamethasone upregulated the expressions of 85 genes and downregulated those of 126 genes in PBMCs from the SLE patients. Conclusions Dexamethasone can regulate the expressions of numerous clusters of genes in PBMCs from patients with internal heat due to Yin deficiency-type SLE, and functional proteins encoded by these genes are located at various organelles and regions of cells. Not all the results of gene regulation by dexamethasone favor the relief of SLE. To study the regulation of genes may be beneficial to the elucidation of mechanisms underlying the therapeutic effect of dexamethasone on SLE.

Objective To evaluate the narrow-band imaging (NBI) in differential diagnosis of colo-rectal proliferative lesions. Methods Suspected lesions in colon were examined with white light and NBI colonoscopy, respectively. The ensitivity and specificity in diagnosing colorectal inflammatory hyperplasia, adenoma, early cancer and advanced cancer were compared between NBI and conventional colonoscopy with reference to pathology as gold standard. The pit patterns and the surface microvessels of the lesions were also determined and scored with NBI combined with magnifying endoscopy, and were compared with pathological diagnosis. Results (1) A total of 368 lesions were detected in 280 patients with conventional colonoscopy and NBI. The sensitivity and specificity of NBI in differential diagnosis of colorectal lesions were superior to those of conventional colonoscopy. (2) The pit patterns of colorectal inflammatory hyperplasia were mainly type Ⅰ and Ⅱ , while in adenomas were mainly type Ⅱ and Ⅲ (94. 2%). The pit patterns of early cancer were type Ⅲ (18. 8%), Ⅳ (56. 3%) and Ⅴ (25.0%), and those of advanced cancer were mainly type Ⅴ (94. 0%). (3) The average scores of surface microvesseis of colorectal inflammatory hyperplasia, ade-noma, early cancer and advanced cancer were 1.35 ± 0. 72, 3. 86 ±1.07, 6. 52±2. 59 and 11.42 ± 3.59, respectively. Scores over 6. 5 was a strong indicator of malignant lesions. Conclusion NBI is superior to conventional eolonoscopy in differential diagnosis of colorectal lesions. Observing pit patterns and microves-sels of the lesion with combination of NBI and magnifying endoscopy is helpful in diagnosis.

Objective To analyze the relationship between visceral obesity and hyperuricemia (HUA), and to provide the basis for the further study of obesity and HUA. Methods A total of 1 824 participants came from Tianjin Heping District Health Education Guidance Center in 2014 were selected in this study. The investigation was performed with physical examination and laboratory test for all subjects. Body fat analyzer was used to measure the visceral fat area (VFA). The Logistic regression analysis was used to evaluate the relationship between visceral obesity and HUA. Results The prevalence of HUA in men and women increased gradually with VFA increasing (P<0.05). There was a positive correlation between VFA, waist circumference (WC), waist-to-hip ratio (WHR) and serum uric acid (SUA) level (P<0.05). According to the results of Logistic regression analysis, VFA (OR=1.805,95%CI=1.166-2.794) and WHR (OR=2.108,95%CI=1.061-4.189) were the risk factors of HUA in men. And in women, VFA (OR=1.775,95%CI=1.154-2.732), WC (OR=2.015, 95%CI=1.137- 3.570) and WHR (OR=2.489, 95% CI=1.400- 4.426) were the risk factors of HUA. Conclusion The accumulation of visceral fat will increase the risk of HUA. So it is necessary to strengthen the detection of visceral obesity to prevent the development of HUA.

Objective To screen the glycoproteins as biomarkers for intracranial aneurysm (ⅠA) in cerebrospinal fluid (CSF) and evaluate the specificity and sensitivity of the biomarker candidates.Methods A complementary proteomic approach integrated with multidimensional chromatography was employed to simultaneously measure relative changes in the gylcoproteins of cerebrospinal fluid (CSF) obtained from patients with ruptured ⅠA (RIA) and unruptured ⅠA (UIA) compared to the healthy controls (HC) and disease controls (DC).One protein-receptor tyrosine kinase Axl with a unique change in RIA was validated in CSF and plasma.The sensitivity at 95％ specificity of Axl in CSF and plasma was evaluated with receiver operating characteristic curve (ROC curve).Results Firstly,a total of 294 glycoproteins were identified in human CSF with believable evidence.Secondly,the proteomic findings showed the quantitative changes in RIA and UIA as compared to HC and DC.Of 294 identified CSF proteins,59,24 and 33 proteins displayed quantitative changes unique to RIA,UIA or IA,respectively.At last,one of these unique proteins-receptor tyrosine kinase Axl with unique increase in RIA was confirmed both in CSF and plasma.ROC curve analysis showed that the sensitivity at 95％ specificity of Axl in CSF to differentiate RIA from UIA was 60％.When compared to CSF,the sensitivity at above setting in plasma to differentiate RIA from HC was 40％ and to differentiate RIA from UIA was 25％.Conclusions A glycoprotein biomarker Axl might be used as a promising biomarker to predict the rupture of ⅠA.The further investigation of the relations between Axl and IA formation as well as rupture might help to elucidate the underlying pathogenesis and find new therapeutic targets.

BACKGROUND: Artificial humeral head replacement is an effective method for the treatment of complex proximal humeral fractures, which has received good results in relieving pain. However, the final functional recovery is unpredictable. OBJECTIVE: To compare biomeshanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement models.METHODS: Eight pairs of fresh-frozen shoulder cadavers (16 shoulder joints) were match-paired into two groups. Standardized humeral head replacement procedure was performed in all specimens, and anatomical and overlapping reconstruction of thegreater tuberosity was adopted in each group respectively. For overlapping group, the greater tuberosity was reattached to the proximal humeral shaft in an overlapping style, which was achieved by an additional 5 mm bone osteotomized from the medial cortex of the humeral diaphysis. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion.RESULTS AND CONCLUSION: When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in the anatomical reconstruction group was smaller than that of the overlapping reconstruction group (P < 0.05). When the gleno-humeral joint was elevated to 30～ and 60～ forward flexion (accounting for 45° and 90° shoulder forward flexion), there was no significant difference of greater tuberosity displacement between the anatomical group and overlapping group. The findings demonstrated that, although overlapping reconstruction can increase the bone healing area between the greater tuberosity and the humeral diaphysis, there may be some loss in mechanical stability as the trade-off. Even though we strictly follow the standardized postoperative rehabilitation protocol after humeral head replacement, prominent displacement between the greater tuberosity relative to the humeral diaphysis was detected. Accordingly, postponing of the postoperative rehabilitation program after humeral head replacement for a decent period may improve tuberosity healing.