Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Palpation ; Tonsillar Neoplasms ; diagnosis ; secondary

Objective To study the effect of mesylate ropivacaine programmed intermittent epidural injection for labor analgesia. Method 100 cases of ASA I or II single cephalic term primiparae , randomly divided into epidural rules intermittent administration group (Group A) and continuous epidural infusion group (Group B), 50 cases of each group. Two groups were treated with 0.12%mesylate ropivacaine and 2 μg/mL fentanyl. The two groups were observed in different stage of labor , uterine contraction analgesic effect , mode of delivery , fetal distress and neonatal asphyxia. Result Compared with Group B, the VAS scores of women in Group A were decreased significantly and the difference was statistically significant (P < 0.05) after they had the labor analgesia 60min later, the mouth of the uterus opened to 5-6cm and all. There is no statistical significance in the mode of delivery and Apgar score. Conclusion Ropicacaine mesilate epidural programmed intermittent bolus are safe and effective for labor analgesia. Compared with continuous epidural infusion analgesia in labor , maternal satisfaction is higher and there is no significant adverse effects on mother and infant.

Objective Onto investigate the significance of the pleth variability index (PVI) in predicting hypotension after epidural anesthesia for cesarean delivery. Methods Sixity seven pregnant women, with ASAⅠ~Ⅱ, aged 19 ~ 34 years, were enrolled for elective cesarean delivery. SBP, BDP, MAP, HR, PI and PVI were measured at 5 min after the parturients arrived in the operation room. SBP, BDP, MAP and HR were measured every 3 min after epidural anesthesia. According to the change rate of SDP or MAP was higher than 30% or not, the parturients were divided into two groups (the hypotension group and the non-hypotension group). Results No significant differences were found in parturients'age, body height, weight, BMI, gestational weeks, SDP, DBP, MAP and HR before anesthesia between two groups. The PVI in the hypotension group was significantly higher than that in the non-hypotension group (P<0.05). A receiver operator characteristic curve analysis showed the area under curve was 0.888 when PVI was used for boundary value. When PVI over 17.35 was used as the occurrence of hypotension, the sensitivity of PVI was 0.727, and specificity was 0.895. Conclusion PVI can be used to predict the occurrence of hypotension after epidural anesthesia for cesarean delivery.

Objective To explore the clinical application value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in diagnosis and treatment of symptomatic patent ductus arteriosus (sPDA) in preterm infants. Methods A total of 107 preterm infants with gestational age of 28-32 weeks and birth weight less than 1500 g who were admitted to the neonatal intensive care unit from October 2013 to September 2014 were recruited. Plasma NT-proBNP were on 4th and 7th day after birth. The echocardiography examination was performed within 30 minutes after the blood was drawn. According to the echocardiography examination on 4th day after birth, the infants were divided into the patent ductus arteriosus (PDA) group (n?=?39) and the control group (n?=?68). According to whether there were signiifcant hemodynamics changes of ultrasonography and clinical symptoms, the PDA group were classiifed into the sPDA group (n?=?20) and the asymptomatic PDA group (asPDA, n?=?19). Then according to whether ibuprofen was taken, the sPDA group was further divided into treatment group (n?=?13) and non-treatment group (n?=?7). Results On the 4th day after birth, the level of plasma NT-proBNP in the sPDA group was signiifcantly higher than that in asPDA group, and the level of plasma NT-proBNP in asPDA group was signiifcantly higher than that in the control group (P??0.05). In the treatment group, the level of plasma NT-proBNP on the 7th day after birth was signiifcantly lower than that on the 4th day after birth (P??0.05). In PDA group, the level of plasma NT-proBNP on the 4th day after birth was positively correlated with ductus arteriosus (DA) diameter, ratio of the left atrium to aortic root diameter (LA/AO ratio) and transductal diameter-to-left pulmonary artery ratio (TDD/LPA) (r?=?0.498-0.670, respectively). The area under receiver operator characteristic (ROC) curve for prediction of sPDA by the plasma NT proBNP on the 4th day after birth was 0.969 (95%CI:0.938-1.000). When the NT-proBNP was 13964 pg/ml on the 4th day after birth, the sensitivity for diagnosis sPDA was 95%, the speciifcity was 95.4%. Conclusions The level of plasma NT-proBNP is signiifcantly higher in preterm infants with sPDA and is decreased after treatment. Plasma NT-proBNP on the 4th day after birth is a sensitive marker for predicting sPDA. Dynamic monitoring of plasma NT-proBNP has important clinical value in selection of the treatment strategy in preterm infants with PDA.

Objective To investigate the antenatal influencing factors associated with birth weight of twins and the risk factors for the occurrence of discordant twins. Methods Totally, 834 twins delivered at the Third Affiliated Hospital from January 2000 to December 2009 and the First Affiliated Hospital of SUN Yat-sen University, from January 2000 to June 2009, were recruited in the study. The diagnosis criteria of discordant twins was intrapair birth weight difference more than 25 %.Antenatal factors on birth weight were retrospectively investigated among twins and discordant twins respectively with Logistic analysis. Results (1) There were several factors associated with birth weight of twins, including maternal age, conceptive style, chorionicity, gestational diabetes mellitus and placental cord insertion ( P = 0. 021, 0. 000, 0. 000, 0. 012 and 0. 017, respectively). While hypertensive disorder in pregnancy, parity and fetal gender differences were not associated with the birth weight of twins (P＞0.05). Hypertensive disorder in pregnancy (OR=2. 600, 95% CI:1. 566-4. 316) and monochorionicity (OR= 1. 833, 95% CI: 1.010-3. 582) were risk factors of discordant twins. All 834 twin pregnancies were divided into 4 groups according to materal age, ＜25 yrs (n=69), 25-30 yrs (n=312), 30-35 yrs (n=325) and ≥35 yrs (n=128). The average birth weight of twins were (2205±483) g, (2347±406) g, (2381±439) g and (2352±455) g. Significant difference was found bewteen every two groups (P＜0. 05) except that between the 30-35 yrs and ≥35 yrs group (P＞0.05). Among twins of different gender (n=270), the average birth weight of boys and girls were (2416±-514) g and (2322±488) g, and that of female twins (n=272) and male twins (n=292) were (2301±418) g and (2381±428) g. Significant difference was shown between every two groups (P＜0.05) except that between the male twins and male fetus of twins of different gender (P＞0.05).Conclusions The fetal birth weight of twins decreases remarkably when maternal age ＜25, or monochorionicity twins, or complicated with marginal or velamentous placental cord insertion or female pairs.However, birth weight of twins would increase if the pregnancy conceived by assisted reproductive technology or complicated with gestational diabetes mellitus. Twin pregnancy complicated with hypertensive disorder in pregnancy or monochorionicity should alert the clinicians of discordance twins.

Objective To discuss the safety and clinical effect of fine needle single-step centesis in percutaneous endoscopic nephrolithotomy for renal staghorn calculi. Methods Percutaneous endoscopic nephrolithotomy with fine needle single-step centesis was employed in 75 patients (single-step group) with renal staghorn calculi, and percutaneous endoscopic nephrolithotomy with two-step centesis was adopted in other 75 patients with renal staghorn calculi (two-step group). The clinical effect and the incidence of complications were compared between the two groups. Results The placement of drainage catheter was successfully accomplished in all 150 patients. In single-step group the operation time was 18-45 minutes with a mean of 36 minutes; the mean blood loss during the procedure was about 5 ml. After the treatment, massive bleeding occurred in 3 cases that needed blood transfusion, and residual stone was observed in 6 cases. In two-step group the operation time was 16-42 minutes with a mean of 34 minutes; the mean blood loss during the procedure was about 7 ml. After the treatment, massive bleeding occurred in 7 cases that needed blood transfusion; one of them had renal pseudoaneurysm and the bleeding was stopped after renal artery embolization treatment; and residual stone was observed in 7 cases. No procedure-related perirenal organ injury was seen in single-step group, while in two-step group pneumothorax (n=1) and injury of splenic flexure of colon (n=1)were found. Conclusion In performing percutaneous endoscopic nephrolithotomy, fine needle single-step centesis is more safe and effective than conventional two-step centesis.

Objective To investigate the relationship between serum uric acid ( SUA) concentration and urinary albumin excretion rate ( UAER) and carotid intima-media thickness (CIMT) in patients with type 2 diabetes mellitua (T2DM). Methods The clinical data of 372 patients with T2DM. including 184 males and 188 females, were collected. The correlations between SUA and the other clinical indexes were analysed by Pearson method, and multiple regression analysis was employed to examine the effects of various factors on UAER and CIMT. Results SUA concentration was higher in males than in females with T2DM (P <0. 01). and was positively correlated with UAER both in males and females with T2DM, even after adjustment for the creatinine clearance (r = 0.24, P < 0.01 for males; r = 0. 29, P < 0.01 for females). Positive correlation was found between SUA concentration and CIMT in females (r =0. 29, P < 0. 01). Multiple regression analysis demonstrated that SUA concentration was an independent determinant of UAER for males as well as females (β=0.16, P<0.05 for males; β=0. 20, P < 0. 05 for females), and was also an independent determinant of CIMT for females (β =0.16, P <0.05). Conclusion SUA plays an important role in the progression of diabetic nephropathy and cardiovascular diseases in patients with T2DM. SUA control may provide a novel approach for the treatment of diabetic nephropathy and vascular complications.

Objective To investigate the influential factors for refracture of the adjacent vertebral body following percutaneous vertebroplasty (PVP) treatment of patients with osteoporotic vertebral compression fractures (OVCFs).Methods A retrospective analysis was conducted on OVCFs patients undergone mono-segmental PVP from July 2007 to March 2010.Patients' age,gender,bone density,bone cement infusion dosage,bone cement leakage and pre-and post-operative fracture reduction were documented.Kaplan-Meier remaining rate curve was used to predict the trend of time to refracture.The related factors for adjacent vertebral body refracture following PVP were analyzed.Results In all,216 patients (98 males and 118 females; age range of 55-76 years,average 65.4 years) were enrolled in this study.Follow-up lasted for 12-18 months.Ninety-two patients sustained refracture including 68 patients with refracture of the adjacent vertebral body.Refracture of the adjacent vertebral body presented time-concentrated tendency and 66％ (45/68) occurred within 100 days followed by a notably lower incidence.Whereas the time to refracture of the non-adjacent vertebral body was not obviously centralized.Bone cement infusion dosage and vertebral body reset condition were strongly associated with the refracture incidence of the adjacent vertebral body,while opposite results were observed in regard of age,gender,bone density and bone cement leakage (or not).Conclusion PVP predisposes OVCFs patients to refracture of the adjacent vertebral body and its influential factors may be associated with bone cement infusion dosage and vertebral body reduction condition.

ObjectiveTo explore the clinical characteristics and the relationship between rational therapy and prognosis in primary central nervous system lymphoma (PCNSL).MethodsClinical data of 23 patients pathologically confirmed as PCNSL and treated in our hospital from January 2005 to December 2007 were collected and analyzed retrospectively.SPSS 13.0 statistical analysis software was used to analyze the correlation between therapy,clinical characteristics and prognosis.Among the 23 patient,10 were male and 13 were female,with a median age of 50 (2-75) years old.Eighteen patients were undertaken lumbar puncture,and tumor cells in cerebral spinal fluid (CSF) was found in 4 patients.Tumorectomy was performed in 8 patient,while 15 patients biopsy.Among them,4 accepted whole brain irradiation,6 accepted associated chemotherapy based on a high-dose of methotrexate (MTX)and 13 accepted radiotherapy combined with chemotherapy.Results Kaplan-Meier analysis showed that in this serial patients,the median survival time was 45.0 months and the 3-year survival rate was 56.5％.Log-Rank test revealed that the whole survival time and the non-progression survival time of radiotherapy combined with chemotherapy (43.8 and 30.0 months,respectively) and high-dose MTX chemotherapy ( 39.7 and 29.7 months,respectively )were much longer than those of radiotherapy alone (25.7 and 19.8 months,respectively,all P ＜ 0.05 ).Log-Rank test showed no significant difference between high-dose MTX chemotherapy alone and radiotherapy combined with chemotherapy (P ＞0.05 ),but the whole survival time was much shorter in high-dose MTX chemotherapy ( P ＜ 0.05 ).ConclusionsThe detection of tumor cells in CSF can confirm the diagnosis,but pathological biopsy is the gold standard.The efficacy of associated chemotherapy based on a high-dose of MTX combined with radiotherapy is much better than radiotherapy or chemotherapy alone.

Objective To prepare the single chain antibody against N protein of SARS-CoV. Methods With N protein of SARS-CoV expressed in E.coli as antigen, we obtained the single chain antibody against N protein by screening the phage display library of human single chain antibodies. Results The anti-N protein antibody didn’t cross-interacte with BSA and the short peptide containing 6 histidines. The specific interaction between the antibody and N protein was inhibited by the anti-N protein monoclone antibody from immunized mice. ConclusionThe single chain antibody we got is specific to N protein of SARS-CoV,it can be a candidate antibody for fast detection of N protein of SARS-CoV and SARS virus particles in clinical trial study of SARS pathogenesis.