SUMMARY A patient with previous L3 -4 posterior lumbar interbody fusion,pedicle screws instrumen-tation and L3 -4 decompression,was scheduled for left total hip arthroplasty.Two years ago,due to poor landmarks palpation,the patient experienced a failed lumbar puncture after multiple attempts before her-niorrhaphy.His plain radiography showed bilateral partial laminectomy at L3 -4 level,and between L3 and L4,two posterior pedicle screws connected by metal rods on both sides.This time,we used ultra-sound to locate L4 -5 interlaminar space in paramedian sagittal oblique view and identified the spine midline by transverse interlaminar view before puncture.According to this information,L4 -5 puncture point was verified and the combined spinal-epidural anesthesia was performed in a paramedian approach. After withdrawing clear cerebral spinal fluid,15 mg hyperbaric bupivicaine was injected into intrathecal space.An epidural catheter was then inserted into the epidural space.The sensory block level was fixed at T10 to S within 10 minutes.Intraoperatively,the patient received 10 mL 2% (mass fraction)lido-caine through the epidural catheter in total.The surgery was uneventful.No neurologic complication was observed after the surgery.This case report demonstrates that ultRASound imaging can provide useful in-formation for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine.

[Summary] In recent years , ultrasound guidance has been widely used in local anesthesia , particularly in peripheral nerve blockage .Ultrasound guided neuraxial blockage is also making progress .Previous studies have shown that pre-puncture ultrasound scanning could provide useful information on the correct intervertebral interspace , the midline of the spine , the optimal puncture point , the appropriate angle for needle insertion , and the distance from skin to the spinal canal .In this review, the ultrasonographic techniques and image analysis , as well as its clinical use , including pre-puncture scanning and real-time guidance for spinal and epidural anesthesia , were summarized .

The aim of this study was to explore the myocardial ultrastructure of experimental uremic rats and the effect of myocardiocyte succinate dehydrogenase(SDH) and free cytosolic calcium changes on membrane channel. By making a uremia model in rats, changes of SDH activation was observed by quantitative enzyme cytochemistry methods and membrane calcium channel was checked by laser scanning confocal microscopy. The results showed that with the uremia becoming heavier, myocardiocyte membrane was rolled and broken, myofibrils were swollen and broken. The quantity of mitochondria with SDH products significantly decreased, while activation of cell membrane calcium channel markedly increased and cytosolic calcium piled up. It is suggested that impaired myocardial membrane, decreased contents of mitochondrial function enzyme and cytosolic calcium overload are the pathophisiological basis leading to cardiac dysfunction in uremia.

Objective To know the situation of smoking control in all kinds of restaurants and the attitudes of citizens toward it.Methods Using methods of spot field investigation and questionnaire survey,193 of restaurant staff and 189 customers in 353 restaurants & bars were investigated.Results The average ratio of smoking control of all sorts of restaurants and bars was both about 25%,and in west restaurants,the average ratio of smoking control was 39.2%.Both the customers and the restaurants keepers were consistent on smoking control;the average supporting rate was 72.1%.Conclusion With the opportunity of Beijing 2008 Olympic Games,It is urgent for us to expand propaganda against smoking,and to strengthen non-smoking legislation and make out feasible smoking control measures for this city.

Objective To understand the awareness and attitude about no smoking among citizens in Public Places for Olympic game.Methods 20 spots were selected at random in Qinhuangdao city,and with convenience nonrandom sampling methods,the 30 earlier encountered citizens in every spots were investigated with questionnaire in the morning(6:30-7:30),noon(11:00-12:00) and the afternoon(16:00-17:00) during October 15 to 21,2007.600 pieces of questionnaires were distributed while 528 of them were received.The data were analyzed by Chi Square Test with the software EXCEL.Results The awareness rate of the non-smoking in the Public Places was 93.70% among citizens in core area,87.34% in sub-core area,and 72.93% in the peripheral area(?2=1276.07,P

ObjectiveTo study the methods,techniques,content about standardized induction training of pharmacists.Methods49 pharmacy recruits are accepted standardized 3-month pre-service training.ResultsThe new team of pharmacists enhance their self-confidence,improve skills and can adapt to the hospital environment faster and enter the role of pharmacists.ConclusionThe implementation of standardized training is conductive to increasing the overall quality of pharmacists and practice skills rapidly,in order to meet the clinical role,avoid health risks and ensure drug safety of patients.

Objective To study the values of HMRS and DTI technology for detecting brain damage in heroin-dependent patients.Methods The routine MRI,HMRS and DTI were performed in 7 heroin abuser8 and 8 healthy volunteers without the history of drug abuse.The regions of interest(ROI) were selected in the gray matter and white matter of prefrontal lobe in HMRS exam,and the ratio of NAA/ Cr、Cho/Cr and Cho/NAA were measured respectively.For the DTI,six ROIs were selected,and the values of fractional anisotropy(FA)and ADC were calculated respectively.The independent samples t test was used for the statistics.Results No abnormality was found in the routine MRI.The ratio of NAA/Cr decreased in the prefrontal lobe.the values were 1.40±0.16 in gray matter and 1.72±0.41 in white matter 0f the drug group.1.57±0.09 and 2.08±0.21 in the control group on HMRS examiation.The differenee between the two groups had statistical significance(t=2.183,2.190,P<0.05)On DTI examination,the values of FA decreased in GCC,SCC and AIC,each was 0.70±0.04,0.76±0.41,0.55±0.03 in drug group,and 0.76±0.03,0.82±0.03,0.64±0.03 in controlgroup.The difference betweenthetwo groups had statistical significance(t=3.830,3.713,5.555,P<0.05).The value8 of ADC increased in SCC,PIC and EC in drug group,each Was(8.18±0.48)×10-4,(7.54±0.22)×10-4,(7.72±0.30)× 10-4and(7.50±0.26)×10-4,(7.154-0.20)×10-4,(7.19±0.39)×10-4mm2/s in control group respectively.The difference between tlle two groups had statistical significance(t=3.477,3.507,2.895, P<0.05).Conclusion The early abnormalities of the brain in heroin-induced patients can be found combining HMRS and DRI.

BACKGROUND:Endothelial progenitor cells can be used to repair vascular injuries and predict severity of early vascular injuries. These biological characteristics have been recommended to the research of aneurysm, which provide new ideas for studying the occurrence, expansion and early staging diagnosis of aneurysm.
OBJECTIVE:To elaborate the effects of endothelial progenitor cells on the aneurysm in the clinical trials based on the biological characteristics of endothelial progenitor cells, including proliferation, migration, adherence and senescence.
METHODS:A computer-based search of Wanfang, CNKI, Springer, PubMed, ScienceDirect, and Ovid was performed using the keywords of“endothelial progenitor cells, precursor cell, aneurysm, stem cel”. Irrelevant and repetitive articles were excluded, and the result analysis was conducted.
RESULTS AND CONCLUSION:Aneurysms patients display decreased endothelial progenitor cells in the peripheral circulating blood accompanied by functional impairment. After aneurysm-related treatment, the number of endothelial progenitor cells can increase. Application of endothelial progenitor cells can early predict occurrence, development, and rupture of aneurysms, which is also a therapeutic method to prevent aneurysms. How endothelial progenitor cells are used clinical y to prevent occurrence and development of aneurysms is a serious problem to be solved.

Objective To explore the effects of restraint water-immersion stress (RWIS) on the firing activities of pyramidal neurons in the medial prefrontal cortex (MPFC) of rats.Methods Multi-channel in vivo recording techniques were used to record firing activities of pyramidal neurons before and during 4-h RWIS in rats.Firing rates,inter-spike intervals and burst firing rates were taken as indices to study the influence of RWIS on neuronal firing activities.Results Twenty-five pyramidal neurons of 12 rats were recorded.The opposite patterns of firing activities were observed in two different classes of neurons,type A and type B neurons which account for 72％ and 28％,respectively.In type A neurons,inhibited firing activities were in direct proportion to the stress-exposure.Mean firing rates and mean burst firing rates were significantly reduced to (0.81 ± 0.11) Hz and (1.012 ± 0.50) counts/min after 4h constant RWIS compared with those before RWIS,(3.57 ± 0.63) Hz and (10.29 ± 3.04) counts/min.However,in type B neurons,firing activities were enhanced.After 2h constant RWIS,mean firing rates and mean burst firing rates were increased from (1.77±0.45) Hz and (2.01±0.73) counts/min to (2.67±0.74)Hz and (9.04±2.42) counts/min,respectively.Moreover,the percentage of spikes in bursts was significantly increased and mean inter-spike intervals were remarkably shortened.Interestingly,the effect of RWIS on type B neurons lasted for shorter time compared with its effect on type A neurons.Conclusion RWIS differentially affects the firing activity of pyramidal neuron in the MPFC,i.e.,inhibiting the firing activity of type A neurons,but enhancing the firing activity of type B neurons.

Objective To evaluate the effects of flapless versus flap implant surgery on the tissues surrounding the implants in the esthetic zone.Methods A controlled study was conducted in 20 patients with a single implant in the anterior esthetic zone,as compared with the flapless and traditional flap implant placement.6 and 12 months after the implant ation,the vertical reduction of labial and lingual bone were assessed by cone beam computed tomography (CBCT);6 and 12 months after the crowns restoration,the peri-implant soft tissues were examined by probing depth (PD),modification sulcus bleeding index (mSBI),papillary index (PPI) and evaluated by pink esthetic score (PES) standard.Results The vertical reduction of the flapless labial and lingual bone was lower than that of the flap,in which the change of labial bone was statistical differences at 6 months after implant surgery between groups (P ＜ 0.05).The differences of PES between two groups were not statistically significant,although PES increased over time in both groups,which the flapless group had a significantly change in PES from crown placement to 12 months (P＜0.05).Conclusions A flapless implant surgery in sufficient bone support may provide a better short-term esthetic result,whereas the longterm effects need further studies.