Objecttve To investigate the effects of snfentanil and ropivacaine used in labor combined spinalepidural analgesia(CSEA)and its influence on labor course and infants and its side effects.Methods 160 primiparas who chose deliver analgesia were randomly divided into two groups:group A intrathecal 5μg sufentanil plus saline up to 2.5ml,extradural 0.2μg/ml sufentanll plus 0.1% ropivacaine and saline up to 100 ml;group B extradural ropivacaine 1.5mg plus glucose 100g/L up to 2ml;group C have no analgesia.Then to investigate the effects of analgesia VAS scores,labor course duration,caesarean section rate,flooding volume,neonatal Apgar scores and its side effects.Results Compared with group C,the analgesia effects of group A and B were definitely(P＜0.05,P＜0.01);visual analogue score(VAS)at 5min,10min and 30min in group A were(3.4±1.2),(1.6 ±0.7)and(0.7 ±0.5)respectively,while in group B were(5.3±1.5),(4.3±1.8)and(3.1±1.7),which had significant difference in two groups(all P＜0.01);they all could reduce the first labor course duration,caesarean section rate,and there were no difference with group C(P＞0.05);and the flooding volume and neonatal Apgar scores had no differences(P＞0.05).Conclusion Sufentanil and ropivacaine combined used in CSEA has stronger effect and longer duration without prolonged labor coulee and poor side effects,which would be a more perfect analgesia worth clinical application in obstetrics.

BACKGROUND: Frenulum of prepuce of penis contained many nerve terminals is an extremely sensitive region. If the frenulum is injured in circumcision or other operations, the complication, such as postoperative spontaneous pain of penis, sexual disturbance and so on, will occur. But there still is no define explanation for this up to now.OBJECTIVE: To observe the distribution of immunoreactive nerve terminal of calcitonin gene-related peptide (CGRP) in prepuce of penis and frenulum of prepuce of adult SD rats, and look for the source of CGRP immunoreactive nerve terminal in frenulum of prepuce.DESIGN: A single sample trial.SETTING:Department of Anatomy, School of Medicine, Zhejiang University.MATERIALS: The experiment was performed at Department of Anatomy,School of Medicine. Zhejiang University from September 2004 to May 2005. A total of 20 adult male SD rats were selected, and were raised in warm, quiet, photophygous environment for 1 week before the trial so as to make the rats fit for the environment and maintain their basal state.METHODS: The rats were assigned randomly into 2 groups. Ten rats in the first group were treated with the immunohistochemical method to observe the distribution of CGRP immunoreactive nerve terminal in prepuce of penis and frenulum of prepuce of adult rats. Ten rats in the second group were treated with fluorogold (FG) retrograde labeled combined with CGRP immunofluorescence labeled method to look for the source of CGRP immunoreactive nerve terminal in frenulum of prepuce of penis. MAIN OUTCOME MEASURES: ①The morphology and distribution of CGRP immunoreactive nerve terminal in prepuee of penis and frenulum of prepuce of adult SD rats were observed under light microscope. ②The distributive density and difference of CGRP immunoreactive nerve terminal in prepuce of penis and frenulum of prepuce were detected and compared (represented by A). ③Morphology and distribution of FG retrograde labeled -positive, CGRP single-labeled positive and FG/CGRP double-labeled positive neurons in dorsal root ganglion were observe under fluorescence microscope. ④Mean quantity of FG retrograde labeled positive, CGRP single abeled positive and FG/CGRP double-labeled positive neurons in dorsal root ganglion was counted.RESULTS: Totally 20 rats were involved in the analysis of results. ① Amber-coloured CGRP immunoreactive nerve terminal appeared in prepuce of penis and frenulum of prepuce of adult rats. These nerve terminal mainly occurred in basal layer of epidermis and papillary layer of dermis, distributed as twig shape or intestiniform; mostly of them were bundled, different in length, and some of them showed enlarged nodosity. ②The distributive density of CGRP immunoreactive nerve terminal in frenulum of prepuce of penis was significantly larger than that in prepuce of penis (2.15±0.32, 1.02±0.22,t =-2.03,P＜0.01). ③Combined with the FG retrograde labeled method it was found that these nerve terminal was derived from neurons of dorsal root ganglion opposed to the sixth lumbar spinal cord and the neurons of dorsal root ganglion opposed to the first acral spinal cord. FG retrograde labeled positive neurons differed in length. The cell body showed round or orbicular-ovate, without obvious prominence. Bright inaurate fine particle appeared in cytoplasm, no label in nucleus. Most cells arranged in line along nerve tract or diffusedly distributed. Most CGRP single-labeled positive neurons were middle or small cells found by CGRP immunofluorescence labeling. Dyeing was too dark.Reaction product distributed evenly in cytoplasm, which showed bright dark green (FITC labeled color). The same positive section was observed comparatively under different excitation light. It was found that FG/CGRP double-labeled positive cells were middle or small, and its amount accounted for a half of the total number of FG retrograde positive cells.CONCLUSION: CGRP may participate the transmission of sensory information in prepuce of penis and frenulum of prepuce of rats. The CGRP immunoreactive nerve terminal in frenulum of prepuce of penis of rats is sourced from neurons of dorsal root ganglion opposed to the sixth lumbar spinal cord and the neurons of dorsal root ganglion opposed to the first sacral spinal cord.

Esophageal cancer is a unique malignant disease in China. A fundamental difference exists between the Chinese population and the western population on esophageal cancer in terms of epidemiology, histogenesis, and carcinogenic risk factors. Therefore, ap-plying the western academic achievements to Chinese is difficult. Thus, Chinese scientists have the responsibility to conquer esopha-geal cancer in China. This article reviews the progress of esophageal cancer focused on the molecular mechanism for interactions of ge-netic and environmental risk factors and human esophageal multistage carcinogenesis.

Objective To evaluate the efficacy and adverse effects of thalidomide plus melphalan and VAD regimen in the treatment of multiple myeloma(MM). Methods 24 patients in the treatment group were treated with thalidomide plus melphalan and VAD regimen. Two continuous treatment were considered valuable. Observational content included results of serum myeloma protein; liver and renal function; protein-uria of 24-hours; bone marrow and peripheral blood and soon. The side reactions were recorded. The clinical efficacy evaluation was divided into complete response(CR), partial respouse(PR), none response(NR). Results 13 cases in the treatment group achieved CR, 6 cases achieved PR, 5 cases no change, 19 cases achieved overall response. Conclusion The prominent clinical efficacy was achieved with thalidomide plus melphalan and VAD regimen in multiple myeloma. The clinical manifestation was improved significantly.

Objective To explore the diagnostic value of dual syringe and dual-channel direct multi-slice computed tomography venography(MSCTV) for lower extremity deep venous obstructive disease.Methods 100 patients highly suspected deep vein thrombosis by clinic wereunderwent dual syringe and dual-channel direct MSCTV.The original data processed with technology of subtraction,and put into workstation and reconstructed with maximum intensity projection(MIP),multiplanar reformation(MPR) and volume rendering (VR).Images of deep venous obstructive lesions were analysed and graded.All patients were underwent DSA in one week.Results Direct MSCTV showed that the reconstructed images and the vascular contrast were very clear.In the evaluation of deep venous,excellent proportion was 95 ％ for the inferior vena cava,94 ％ for the common iliac vein,95 ％ for the external iliac vein,95.5 ％ for the femoral vein,96.5％ for the popliteal vein and 92 ％ for the low leg vein.Direct MSCTV displayed complete and regular vein in 8 normal patients,92 cases displayed different parts and different degrees of thrombosis.On original axial images,eccentric filling defect of vascular were showed (there were 64 multiple vein occlusion cases and 28 solitary obstruction cases).The occlusion locations in deep venous were as following:3 in the inferior vena cava,67 in the common iliac vein,28 in the external iliac vein,50 in the femoral vein,26 in the popliteal vein,89 in the anterior tibial vein,35 in the posterior tibial vein and 5 in the peroneal vein.There were 7 normal patients and 93 patients with different parts and different degrees of thrombosis.Conclusion Direct MSCTV can accurately show deep vein thrombosis,which image is clear and reliable for displaying the scope and extent of lesions of the vascular and whether the collateral circulation established.Direct MSCTV has a significant clinical value in diagnosing the thrombotic disease of deep vein obstructive lesions.

Objective To compare the reliability of modificatory method and traditional method in preparing ischemic stroke rat model in rehabilitation period.Methods 173 female SD rats were divided into traditional method group(n=63),modificatory method group(n=109) and control group(n=37).In the traditional method group,the thread embolus was inserted through the left external carotid artery(ECA),and then left ECA and pterygopalatine artery(PPA) were ligated.In the modificatory method group,the thread embolus was inserted through the left internal carotid artery(ICA) and only left common carotid artery(CCA) was ligated.In the control group,the thread embolus was not inserted,only CCA was ligated.Results There was no significant difference in neurofunction score between the modificatory method group and the traditional method group(P>0.05).The operating time was significantly shortened(P<0.01) and the survival time was significantly prolonged in the modificatory method group compared with that of the traditional method group(P<0.01).The two-month survival rate was 54.13% in the modificatory method group and 31.75% in the traditional method group receptively,the former was significantly longer than the latter(P<0.01).Conclusion The ischemic stroke model established by modificatory methods is not only precisely and reliable but also save operating time and improve survival rate of the animals compared with the traditional method.The main death causes of animals are large-area cerebral edema and electrolyte imbalance after operation.

Objective To study the effects of constraint-induced movement train (CIMT) on the neurological medullary sheath in the rats after middle cerebral artery occlusion (MCAO). Methods 55 SD rats were randomly divided into CIMT group and nature recovery (NR) group after MCAO. The CIMT group were trained with balance beam and rolling cage everyday, with restrictting the movement of the intact upper limbs. The NR group lived in the same condition. The rats in CIMT group were assessed with ethology 5 d, 10 d, 15 d, 30 d and 60 d after operation respectively. At last, 5 rats of each group were checked with MRI, then they were immolated for myelin staining. Results The balance and muscle strength of CIMT group improved better compared with the NR ones (P<0.05), as well as the diameter and the demyelination of neurofibril in the infarcted area. Conclusion CIMT can collect more functional neurofibra and decrease myelinolysis.

Objective Analysis of the expression of CD38,CD133 antigen and their clinical significance in myelodysplastic syndrome (MDS).Methods CD38 and CD133 antigen were analyzed by flow cytometry in 31 cases of MDS patients.Results CD38 was expressed in 18 cases (58.1% ),among them,12 cases were found to be myelodysplastic syndrome refractoryanermia ( MDS-RA ),accounting for 57.1%,6 cases were found to be MDS-RAEB,accounting for 66.7%.CD133 was expressed in 20 cases(64.5% ) ,among them,11 cases were found to be MDS-RA ( 52.4% ),1 case MDS-RAS,and 8 cases of MDS-RAEB,accounting for 88.9% .CD38 expressed significantly higher in MDS than anemia and relatively normal group ( P ＜ 0.05 ).CD133 expression in anemia groups was different from MDS-RA without statistical significance ( P ＞ 0.05 ),but was significantly different from relatively normal group (P ＜0.05).CD133 expression was significantly higher in these with MDS-RAEB than those in anemia and normal group ( P ＜ 0.05 ).Conclusions Combining with conventional antibodies,flow cytometry used in detection of CD38 ,CD133 ,could improve the diagnostic rate of MDS.