Objective To investigate the postoperative complications of pregnant women with two cesarean section.Methods Clinical data of 543 cases of pregnant women with two cesarean section (group A) were retrospective analyzed,and at the same period two spontaneous vaginal delivery in 963 cases(group B),225 cases of pregnant women with the first cesarean delivery add second vaginal delivery(group C) were analyed in contrast.The postoperative close,long-term complications of three different delivery way were censused.Results (1) Postoperative complications:141 cases(26％) in group A,29 cases(3％) ingroup B,27 cases (12％)in group C,and three complications occurrence rate had significant difference (x2 =182.711,29.712,43.040,all P ＜ 0.05).(2) The complications of postpartum bleeding,pelvic adhesions in group A were significantly higher than those of C group(all P ＜0.05) ;And the close complications of postpartum hemorrhage,infection of incision,postpartum fever and the long-term complications of chronic pelvic inflammation,pelvic adhesion in group A,C were significantly higher than those in group B (all P ＜ 0.05).Conclusion The cesarean section is traumatic,which can significantly increase maternal intraoperative,postoperative complications.Clinicians should avoid no indications of cesarean section,reduce the cesarean section rate;For secondary pregnancy after cesarean section,vaginal delivery can be given under the strict observation.

Accreditation of professional titles is a work with which all professionals are prevailingly concerned. In review of the accreditation work since the professional title reform, it has been thought that the Central Professional Title Reform Offices regulations on service seniority and the widely used accreditation methods at present have some drawbacks. Further reform of professional title accreditation is imperative.

Separating the appraisement and engagement of professional titles,an important task in the reform of the personnel system,renders the appraisement of professional titles more objective and fair,thus avoiding the influence of man-made factors in the appraisement of professional titles within an institution.However,there have appeared such problems as high passing rates and great pressure with regard to engagement.Thus the appraisement of professional titles is in need of reform.

ObjectiveTo investigate the effects of intravenous fentanyl combined with scalp nerve block with ropivacaine on the hemodynamic response to skin incision during craniotomy.Methods43 ASA Ⅰ～Ⅱ patients scheduled for selective frontotemporal craniotomy were randomly assigned into 3 groups: the isoflurane group(group I,n=14), the fentanyl group (group F, n=15) and the fentanyl-ropivacaine group (group B, n=14 ).Anesthetic induction was performed with IV remifentanil 2 μg/kg, propofol 2 mg/kg, and vecuronium 0.1mg/kg. Group F received fentanyl 3 μg/kg 5 min before skin incision .Group B received the same doses of fentanyl prior to skin incision as well as scalp nerve block with 1% ropivacaine before induction. Anesthesia was maintained with isoflurane. The "up and down" method was used to determine MAC-BAR in each group.ResultsThe end-tidal isoflurane concentration blocking sympathetic response to incision in group I, F and B were 2.0%,1.8%,1.0% respectively.The MAC-BAR of group I, F and B were 1.7 MAC,1.55 MAC,0.8 MAC respectively. The end-tidal isoflurane concentration blocking sympathetic response to incision and MAC-BAR of group B decreased obviously compared with that of group I and F(P<0.05).ConclusionIntravenous fentanyl combined with scalp nerve block with ropivacaine can successfully reduce the hemodynamic response to skin incision.

ObjectiveTo determine the effectiveness of scalp nerve block for attenuating intraoperative hemodynamic stress, decreasing anesthetics and postoperative pain in neurosurgical patients.Methods60 adult patients undergoing frontotemporal craniotomies were randomly divided into three groups to receive scalp nerve block with normal saline as control in group A, 0.8% lidocaine combined with 0.13 % menthol in group B, and 1% ropivacaine in group C after intubation. Anesthesia was maintained with isoflurane. Mean arterial pressure (MAP) was controlled within-20%～+10% of the baseline with isoflurane (maximum limitation of isoflurane was 2 times of minimal alveolar air concentration) and intravenous nicardipine (0.5 mg bolus iv). Heart rate was controlled below 100 bpm with esmolol (50 mg bolus iv). Patient controlled analgesia (PCA) with tramadol was used for the postoperative analgesia. MAP, heart rate (HR) and end tidal isoflurane concentration were monitored during craniotomy. Visual analogous score (VAS) was observed after craniotomy.ResultsThe concentrations of end-tidal isoflurane in group A were significantly higher than that in group B and group C. MAP and HR in group A increased significantly than baseline values during operation, especially in skin incision, opening bone,while MAP and HR in group C did not increased significantly than baseline. VAS within 2 h postoperative in group B was significantly lower than that in group A (P<0.05).ConclusionThe scalp nerve block can effectively decrease intraoperative isoflurane concentration, attenuate hemodynamic responses and reduce postoperative pain.

This study demonstrated with the immunocytochemical ABC method that thedistribution pattern of TH,5-TH,SP,L-ENK and OXY immunoreactive fiberswere alike in the intermediate zone of the thoracic and upper lumbar spinal cord.These fibers located in the lateral funiculus,lateral horn,intermediate gray and thearea surrounding the central canal,forming a transversal fiber band with most ofthe fibers in the lateral horn.In the lateral horn,TH,5-HT,SP and L-ENKimmunoreactive fibers and terminals aggregated in fiber clusters and numerous fib-ers made up a longitudinal bundle running through the fiber clusters.These immuno-reative fibers and terminals surrounding the central canal and distributed mainly dorsalto it.TH and 5-HT fibers accumulated in midplane where some fibers ran in alongitudinal fiber bundle and bilateral fibers and terminals distributed sparsely.SP and L-ENK fibers and terminals were relatively less in the midplane whiledense laterally.All kinds of the immunoreactive fibers were found close to theependyma.Two small 5-HT fiber bundles ran parallel and lateral to the centralcanal and a small SP fiber bundle ventral to it.Moderate immunoreactive fiberswere found periodically in the intermediate gray and formed distinct bands to linkfiber clusters in the lateral horn and fibers dorsal to the central canal.The imm- unoreactive fibers in lateral funiculus accumulated near the lateral horn and mostdensely in upper thoracic cord.OXY-containing fibers were much less than theothers,thus obvious fiber clusters,longitudinal bundle or transversal bands had notbeen found.In general,the distribution pattern of some monoaminergic and pepti-dergic fibers in the intermediate zone was provided with a laddershaped configura-tion.The two longitudinal immunoreactive fiber bundles——dorsal to the centralcanal and within the lateral horn,located medial and lateral in the spinal grayrespectively,and the transversal bands appeared periodically in the intermediate graybridging between the two longitudinal bundles.This configuration of immunorea-ctive fibers coincided with nuclear regions which contained preganglionic sympatheticneurons as well as their dendrites.

Ectopic human chorionic gonadotrophin (hCG) is an autocrine hormone expressed by most malignant tumor cells. Increasing data recently showed that the expression pattern and biological properties of ectopic hCG was significantly different from that of the normal hCG secreted by trophoblastic cells. Evidence from different research groups strongly indicated that there was a direct relationship between the expression of ectopic hCG and the development of malignant tumor. Ectopic hCG may play a key role in regulation of tumor growth,metastasis and immune tolerance versus malignant tumor. The advances in the research of the molecular biologic characteristics and functions of ectopic hCG are reviewed and evaluated. [

Objective:To explore changes of oxidized loW density lipoprotein (ox-LDL)and tumor necrosis factor (TNF)-αcontent in patients With different degrees coronary heart disease (CHD)and their correlation.Methods:A total of 100 CHD patients diagnosed by coronary angiography (CAG)Were selected and divided into stable angina pectoris (SAP)group (n=23),unstable angina pectoris (UAP)group (n=48)and acute myocardial infarction (AMI)group (n=29);single vessel group (n=31),double vessel group (n=33)and multi-vessel disease group (n=36);mild stenosis group (n=27), moderate stenosis group (n=31)and severe stenosis group (n=42).A total of 30 middle-aged and aged people Without CHD and severe organic diseases,Were enrolled as healthy control group.Content of total cholesterol (TC),triglyceride(TG),high density lipoprotein cholesterol (HDL-C),loW density lipoprotein cholesterol (LDL-C),ox-LDL and TNF-α Were measured among above groups.Results:Compared With healthy control group,there Were significant increase in blood lipid levels (except HDL-C),TNF-αlevel,and significant decrease in HDL-C level in CHD group,P <0.05 all; compared With SAP group,thereWere significant increase in levels of ox-LDL and TNF-αin UAP group and AMI group (P <0.05 all),and those of AMI groupWere significantly higher than those of UAP group (P <0.05 both);comparedWith single vessel disease group,there Were significant increase in levels of ox-LDL [(432.19±80.75)μg/L vs.(560.47± 84.21)μg/L,(619.31±88.49)μg/L]and TNF-α[(9.01±2.75)ng/L vs.(10.06±2.78)ng/L,(11.14±2.74)ng/L] in double-vessel and multi-vessel disease group (P <0.05 all),and those of multi-vessel disease group Were significantly higher than those of double-vessel disease group (P <0.05 both);comparedWith mild stenosis group,thereWere significant increase in levels of ox-LDL [(459.43±53.36)μg/L vs.(531.33±68.12)μg/L,(610.62±93.43)μg/L]and TNF-α[(8.98±2.66)ng/L vs.(9.94±2.87)ng/L,(11.12±3.21)ng/L]in moderate stenosis group and severe stenosis group (P <0.05 all),and those of severe stenosis groupWere significantly higher than those of moderate stenosis group (P <0.05 both);Spearman correlation analysis indicated that ox-LDL levelWas positively correlatedWith TNF-αlevel (r =0.83,P <0.01).Conclusion:Levels of ox-LDL and TNF-αare closely correlatedWith lesion severity in CHD patients.

To explore the establishment of an asthmatic model with airway remodeling in rats by observing the morphological changes of the airway in different stages.

OBJECTIVE: To explore the mechanism of the bronchial asthma and to study the treating effects of Zhichuan Capsule on the airway remodeling of asthmatic model rats. METHODS: The rat model was established by being sensitized and activated with different density of ovalbumin through prolonged and repeated exposure for 8 weeks. The rats were randomly divided into model group, Zhichuan Capsule treated group, dexameson treated group, and Zhichuan Capsule and dexameson treated group. Another group of normal rats were taken as control. General histological changes were observed by hematoxylin and eosin stained sections. Being standardized by internal perimeter (Pi), the wall thickness (d), internal area (Ai), outer area (Ao) and wall area (WA) of the airway were quantified by computer-assisted image analysis system. The express of MMP-9, TIMP-1, Col I, Col III and ColV in the airway were examined by immunocytochemical methods. During the course of airway remodeling, the dynamic changes of model rats were observed at different time points (2, 4, 6 and 8 weeks after the activating). Statistical comparison was performed by ANOVA followed by Fisher LSD test. RESULTS: (1) Histologic examination showed eosinophil infiltration within the airway walls, epithelial damage, excessive mucus in the lumen and edema in the submucosa of the airways in model rats, and that the collagen deposition increased accompanied by increasing of TIMP-1. In the model rats, MMP-9 increased at the time point of 2 weeks, but it decreased in the late stage (8 weeks after activating) of airway remodeling. And the level of TIMP-1 was far higher than MMP-9 at the time point of 8 weeks. (2) Zhichuan Capsule could down-regulate the level of TIMP-1 in the airway wall, as well as the thickness of airway wall and the collagen deposition. And there were progressing effects when it was used together with dexameson. CONCLUSION: (1) The early increase of MMP-9 is a key point to start remodeling; and the increase of TIMP-1 in the late stage, which inhibits collagenase activity, may play an important role in developing airway fibrosis. Imbalance between MMP-9 and TIMP-1 is a marker of airway remodeling. (2) Zhichuan Capsule can decrease the deposition of collagen and suppress the airway remodeling by inhibiting the TIMP-1 expression.