Objective To investigate the effects of 3 different delivery methods on maternal and fetal complications during labor and determine better mode of delivery. Methods Sixty pregnant women with ASA class Ⅰ or Ⅱ were randomly divided into three groups with 20 cases each: the cesarean section group (group Ⅰ), the pain relief group (group Ⅱ) and normal delivery group (group Ⅲ). In group Ⅰ and Ⅱ, an epidural catheter was placed through L_(2-3) interval. 0.5% ropivacaine was injected via the epidural catheter for continuous epidural anesthesia in group Ⅰ. After a loading dose of 8-10 mL 0.125% ropivacaine+2 μg/mL fentany, the patient-controlled epidural analgesia (PCEA) during labor was started with bolus 5 mL, lockout interval 20 min and back ground infusion rate 6-8 mL/h in group Ⅱ. The level of block was controlled below T_(10). BP, HR and RR were continuously monitored during labor. Blood samples were taken from umbilical vein at delivery for blood gas analysis and determination of lactate concentration. Neonates were assessed by Apgar score and neurological and adaptive capacity score (NACS). Maternal postoperative complications were recorded. Results There was no statistical differences in plasma pH, PCO_2, PO_2, SO_2, Apgar score and NACS among 3 groups. The umbilical vein blood lactate concentration was significantly increased in group Ⅱ and Ⅲ compared to the group Ⅰ, while blood lactate concentration in group Ⅱ was lower than that in the group Ⅲ (P<0.05). Base excess (BE) was significantly higher in group Ⅲ than in group Ⅰ. Compared with group Ⅱ and Ⅲ, maternal postoperative complications such as urinary retention, postpartum hemorrhage and so on were increased significantly in group Ⅰ (P<0.05). PCEA provided satisfactory effect in group Ⅱ. Conclusions Epidural labor analgesia with 0.125% ropivacaine+2 μg/mL fentany can provide comparative and effective analgesia for pain relief during labor without adverse effects on the mothers and fetuses and may reduce the postoperative complications. It is a safer and more effective technique in pain relief during labor.

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with hydroxyethyl starch (HES) 130/0.4 on intestinal mucosal barrier in a rat model of sepsis.Methods Thirty healthy New Zealand rabbits of both sexes weighing 2.0-3.0 kg were randomly divided into 3 groups (n=10 each):group I sham operation; group II sepsis and group III AHH+sepsis.Sepsis was produced by modified colon ascendens stent peritonitis(CASP).At 4 h after CASP group III meceived HES 130/0.4 20 ml/kg iv at a rate of 20 ml/min.The MAP and HR were monitored and recorded at 4 h (before AHH) and 5,6,7,8 h after CASP.Blood samples were taken from carotid artery and superior mesenterie vein (SMV) at 4 h and 8 h after CASP for blood gas analysis and determination of plasma D-lactate concentration and intestinal oxygen extraction ratio.The rabbits were sacrificed at 8 h after CASP and a segment of ileum of 3 cm in length,5 cm from ileocecal valve,was removed for determination of wet/dry ileum weight ratio and microscopic examination.The degree of damage to intestinal mucous membrane was scored according to Chiu score (0=normal,5=severe damage).Results Sepsis-induced hypotension and metabolic acidosis,increased plasma D-lactate concentration,decreased intestinal oxygen extraction ratio,increased wet/dry ileum weight ratio and Chiu score in group II as compared with group I.AHH with HES 130/0.4 20 ml/kg significantly attenuated the scpsis-induced changes in group III.Conclusion AHH with HES 130/0.4 can attenuate damage to intestinal mucosal barrier produced by sepsis.

Objective To compare the effects of different modes of delivery on arterial oxygen saturation in the fetus.Methods One hundred and twenty ASA Ⅰ or Ⅱ parturients aged 22-32 yr with a single fetus at full term lying in normal headdown position were divided into 3 groups according to the modes of delivery (n =40 each):group cesarean section (group CS) ; group labor analgesia (group LA) and group spontaneous labor (group SL).In group CS cesarean section was performed under epidural anesthesia with 0.5％ ropivacaine.Epidural catheter was placed at L2,3 interspace in groups CS and LA.In group LA labor analgesia was started from the first stage and maintained until complete cervical dilatation.The patients received epidural PCA (PCEA) with O.125 ％ropivacaine plus fentanyl 2 μg/ml.PCEA setting was as follows:a loading dose of 8-10 ml; demand bolus 5 ml;20 min lockout; background infusion 6-10 ml/h.Blood samples were taken from umbilical artery at delivery for blood gas analysis and determination of serum concentrations of lactate,β-endorphin (β-EP) and neuropeptide Y (NP-Y).Apgar score and neurological and adaptive capacity score (NACS) were recorded.Results There was no significant difference in Apgar score,NACS and NP-Y and β-EP concentrations in umbilical arterial blood among the 3 groups.The lactate concentration and the absolute value of BE were significantly higher while pH was lower in group SL than in groups CS and LA.PO2 was significantly higher while PCO2 was lower in group LA than in groups SL and CS,and the lactate concentration and absolute value of BE were significantly lower while pH was higher in group LA than in group SL.Conclusion The 3 modes of delivery have significant effects on arterial oxygenation in fetus but have no clinical significance.

Objective To compare the time-course of relaxant effect of rocuronium between patients with ocular and generalized myasthenia gravis (MG).Methods Twenty-seven ASA physical status I or Ⅱ patients with MG of both sexes,aged 12-64 yr,with body mass index of 17-26 kg/m2,scheduled for elective extended thymectomy,were divided into 2 groups according to Osserman stage:ocular group (group O,n =10) and generalized group (group G,n =17).Anesthesia was induced with iv injection of fentanyl 2 μg/kg,midazolam 0.05 mg/kg,and propofol 1.5 mg/kg.All patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol 4-8 mg· kg-1 · h-1 and remifentanil 0.2 μg· kg-1 · min-1.Twitch tension was monitored in the adductor pollicis muscle by train-of-four stimulation of the ulnar nerve (intensity 60 mA,interval 12 s,frequency 2 Hz,wave length 0.2 ms).Rocuronium 0.6 mg/kg was injected intravenously after calibration.Mean arterial pressure (MAP),HR,heart rate variability (HRV) and low frequency and high frequency (LF/HF) ratio was recorded.The onset time of muscle relaxation,time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were recorded.Results Compared with the baseline value,there were no significant changes in MAP,HR,HRV,LF/HF ratio at all time points in the two groups (P ＞ 0.05).Compared with group O,there was no significant change in the onset time of muscle relaxation,and the time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were significantly prolonged in group G (P ＜ 0.05).Conclusion The duration of rocuronium-induced neuromuscular block is significantly longer in patients with generalized MG than those with ocular MG,while the onset time is comparable between the two groups.

Objective To observe the effects of berberine on neuralogical function,serum oxidized low density lipoprotein(ox-LDL),and matrix metalloproteinases-9(MMP-9) in patients with acute cerebral infarction.Methods Ninety-two patients with acute cerebral infarction were randomly divided into treatment group and control group (n=46).Control group received routine treatment,while treatment group was given 0.3 g of berberine three times a day besides routine treatment for 14 days.In both groups,decubitus venous blood was harvested before,7 and 14 days after treatment.Serum ox-LDL and MMP-9 were determined with enzyme-linked immunosorbent assay (ELISA).Before and 7 and 14 days after treatment,the neural function defect was graded by the US National Institutes of health stroke scale (NIHSS) and the modified Rankin scale (mRS).Results The neurological function was improved significantly in 7 and 14 days after the treatment for both two groups according to NIHSS and mRS,and the difference between treatment group and control group was statistically significant (P<0.05).After treatment,ox-LDL and MMP-9 declined significantly in both groups,and were lower in treatment group than in control group (all P<0.05).Conclusion Berberine significantly reduces ox-LDL and MMP-9 levels in patients with acute cerebral infarction and improves the degree of neurological function deficit.

ObjectiveTo assess the current situation of postgraduates knowledge about medical research design and optimize the curriculum setting of research design.MethodsAn investigation was carried out in the postgraduates of 2011 using questionnaires in a medical university..The questionnaire ineluded basic information of participants and cognition of basic methods of research design.ResultsA total of 473 postgraduates participated in the investigation.Among them,311 systematically learned medical statistics before enrollment,and 275 ( 58.14％ ) once participated in scientific researches.Most of them ( ＞80％ ) knew about the 10 basic methods of research design listed in the questionnaire,but only a few of them were familiar with them,and some even didn't know about the methods.ConclusionWe should pay attention to the culture of scientific research thought in statistical design,strengthen the practice of research design teaching,and the curriculum of research design should be led into undergraduate course.

Objective To evaluate the application value of situational simulation method based on SimMan 3G in anesthesiology teaching. Methods 5-years anesthesiology under-graduates of 2012 grade and 2013 grade in Wannan Medical Colloge anticipating in clinical practice of anesthesia were selected as observation group. All students were divided into two groups: control group (teachers demonstrated cases, 2012 grade, n=35) and observation group (students role-played simulation cases, 2013 grade, n=36). In control group, teachers firstly applied a multimedia courseware, and then demonstrated the cases to adopt the SimMan 3G simulated system. In observation group, SimMan 3G situational simulation method was used to teach the course , and then the students played roles and videotaped the whole course in the simulated operating room. After training, the students discussed their performance in the simulated training (by the playback of the simulated video), and the teachers commented and summarized the case. The effect of teaching was evaluated by questionnaire and examination. The date were analyzed through Chi-square and t-test test. Results There was no significant difference in essential characteristics, including age, gender, the scores of specialized theory at routine examination between two groups (P>0.05). Statistical difference was found in the theoretical assessment between observation group and control group [(79.44±5.41) vs. (73.46± 4.62), P=0.001]. Meanwhile, questionnaire survey of teaching effect showed that in observation group 31 students (86.1％) were satisfied with the teaching contents, 33 students (91.7％) had consolidated clinical thinking, and 34 students (94.4％) believed it improved their teamwork and communication ability (P=0.031, P=0.018, P=0.013). Conclusion Using SimMan3G for role-playing situational simulation teaching can significantly improve student's comprehensive theoretical scores, facilitate the exercise of clinical thinking, and improve their teamwork and communication skills.

OBJECTIVETo analyze the correlation between mitral regurgitation grading and left ventricular ejection fraction in elderly patients (>60 years of age) in a 2-year follow-up.

METHODSA total of 455 patients with the diagnosis of at least mild mitral regurgitation by echocardiography were divided into ischemic mitral regurgitation (IMR) group and non-ischemic regurgitation (NIMR) group. The patients were followed up with echocardiography every 6 months and the data were analyzed at the end of 24 months.

RESULTSMitral regurgitation grade was inversely correlated with left ventricular ejection fraction (LVEF). Patients with moderate and severe IMR had a lower LVEF than those with NIMR (P<0.05). After adjustment for age, sex, body mass index, high blood pressure, diabetes, atrial fibrillation and cardiomyopathy, the mean LVEF at 2 years was lowered by 2.7% (1.4%-4.1%), 2.7% (1.3%-4.0%), and 5.2% (3.5%-6.9%) in mild, moderate and severe IMR patients, respectively (P<0.04), and by 3.2% (1.6%-4.8%), and 3.0% (1.4%-4.5%), and 1.7%(-0.5%-3.9%) in mild, moderate and severe NIMR patients (P=0.30).

CONCLUSIONThe mean LVEF in IMR patients is significantly lowered compared to that in NIMR patients. The grade of mitral regurgitation is inversely correlated with the regurgitation area in IMR patients. Stratified management might help improve LVEF in severe IMR patients.

Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Male ; Mitral Valve Insufficiency ; Stroke Volume ; Ventricular Dysfunction, Left ; physiopathology

Objective:To explore the technical points and efficacy of gradual traction-unlocking closed reduction technique (GT-UCRT) for Tile C old pelvic fractures.Methods:From August 2012 to June 2021, 6 patients with Tile C old pelvic fracture were treated and followed up at Department of Orthopedics, The Fourth Medical Center, General Hospital of Chinese PLA. They were 4 males and 2 females with an age of (35.8±10.5) years. By Tile classification: 4 cases of type C1.2, 1 case of type C1.3, and 1 case of type C2; time from injury to surgery: 153.8 (64.3, 204.8) days. The 6 patients were treated with GT-UCRT. The time for gradual traction reduction, operation time, hospital stay, intraoperative blood loss and complications were recorded. The modified Matta score was used to evaluate the reduction quality of pelvic fractures, and the Majeed score was used to evaluate the pelvic function at the last follow-up.Results:The 6 patients were followed up for (40.3±22.9) months (from 12 to 72 months) after surgery. The time for gradual traction reduction was (26.7±4.6) days, operation time (119.2±4.6) minutes, hospital stay (11.5±2.9) days, and intraoperative blood loss (533.3±189.6) mL. By the modified Matta score, the pelvic reduction after surgery was rated as satisfactory in 5 cases and as unsatisfactory in 1 case. The length disparity between both lower limbs in the 6 patients was (6.9±1.6) cm before surgery and (1.0±0.4) cm immediately after surgery, showing a statistically significant difference ( t=11.135, P<0.001). One fracture healed 3 months after surgery and 5 fractures 6 months after surgery. The Majeed pelvic score at the last follow-up was (80.8±9.0) points for the 6 patients, yielding 2 excellent cases, 3 good cases and 1 fair case. Delayed wound healing was reported in 1 patient, calf intermuscular venous thrombosis in 2 cases, and emotional anxiety and sleep disorder in 1 patient. No new lumbosacral plexus injury was found in any patient. Conclusions:In the treatment of Tile C old pelvic fractures, since our self-designed GT-UCRT combines the advantages of Ilizarov technique and unlocking closed reduction technique, it can not only protect the lumbosacral plexus but also obtain satisfactory reduction of the fracture.