Objective To investigate effect of different anesthesia on cesarean section perioperative coagula-tion function and D -dimer,to provide a reference for clinical treatment.Methods 120 cases of cesarean section patients were selected,according to the anesthesia they were divided into observation group and control group.Obser-vation group (70 cases) used combined spinal epidural anesthesia,the control group(50 cases) used epidural anes-thesia.The prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fiber clinical indicators fibrinogen (Fbg),DD,analgesia and its complications were compared between the two groups.Results Before surgery,PT,APTT,TT,Fbg had no statistically significant differences between the two groups (P >0.05).6h, 24h after operation, PT,APTT,TT of the observation group were (13.23 ±1.86) s,(31.18 ±5.94) s,(15.52 ± 2.55)s;(12.85 ±1.94)s,(29.74 ±5.52)s,(14.68 ±3.15)s,which were lower than the control group,the differ-ences were statistically significant (t =3.294,4.546,4.143,3.656,3.435,3.115,all P <0.05).6h after operation, Fbg of the observation group was (3.17 ±0.48)g/L,which was lower than the control group,the difference was statis-tically significant (t =3.656,P <0.05);D -D of the observation group before surgery,immediately after surgery,24h after surgery were (0.28 ±0.04)mg/L,0.04mg/L,(0.33 ±0.07)mg/L,(0.33 ±0.07)mg/L,compared with the control group had no statistically significant differences (P >0.05).In the observation group,the incidence rates of pain level 2,3 were 41.43%,30.00%,compared to the control group showed no significant difference (P >0.05). Deep vein thrombosis was not found in the observation group,the control group confirmed one case of femoral vein thrombosis,the incidence of venous thrombosis in the two groups showed no significant difference ( P >0.05). Conclusion Combined spinal epidural anesthesia,epidural anesthesia can both prevent cesarean section patients from perioperative hypercoagulable state,reduce the incidence of thrombotic complications,epidural anesthesia is the preferred method.

Objective To investigate different fentanyl medication methods on propofol intravenous anesthe-sia painless abortion,to provide a reference for clinical treatment.Methods 1 20 patients undergoing painless abor-tion were selected,according to the random number table they were divided into Ciliao point group,subcutaneous group,intravenous injection group,40 cases in each group.Intravenous injection group used intravenous anesthetic propofol,Ciliao point group used Ciliao hole injection anesthesia,subcutaneous group used fentanyl anesthesia subcu-taneous injection.The anesthesia,analgesia and other clinical indicators of complications were compared among the three groups.Results The anesthesia excellent and good rate of Ciliao point group was 97.50%,which was higher than the subcutaneous group,intravenous injection group,the differences were significant(χ2 =4.1 32,3.894,all P <0.05).MAP,HR,SpO2 among three groups showed no statistical differences (P >0.05).Postoperative 4h,8h,VAS scores of Ciliao point group were (2.32 ±0.56)points,(1 .1 3 ±0.23)points,which were lower than those in the subcutaneous group,intravenous injection group,the differences were significant (t =8.656,8.843,6.587,6.335,all P <0.05).The propofol use times,the amount of Ciliao point group were (1 .1 4 ±0.1 4),(1 1 6.37 ±1 4.35)mg respectively,which were less than those in the subcutaneous group,intravenous injection group,the differences were significant (t =6.645,5.587,6.1 32,5.854,all P <0.05).The incidence rate of adverse reaction of Ciliao point group was 2.50%,which of the subcutaneous group was 20.00%,which of the intravenous group was 25.00%,the differences were statistically significant (χ2 =6.596,7.454,all P <0.05).Conclusion Fentanyl uased at Ciliao point can enhance the clinical effect of anesthesia with less postoperative pain and reduce incidence of adverse reac-tions,it is worthy of clinical application.

Objective To investigate clinical manifestation and pathological changes and the expressions of Emerin protein and STA gene of Emery-Dreifuss muscular dystrophy (EDMD).Methods The clinical features and STA gene detection from one patient with EDMD were analyzed retrospectively. Results The onset age of this patient was in early childhood. The four limbs were progressive muscle weakness and muscular atrophy. There were joint contractures and cardiac involvement in the early stage. The serum muscle enzymes increased slightly. The pathological changes in muscles showed that the sizes of muscle fibers were different, the fibers became spherical and some fibers were replaced by fat. Because of normal spinal anterior horn cells and sural nerves, neurogenic muscular atrophy might be ruled out. Emerin protein could not be tested in striated muscle and cardiac muscle. No mutation of STA gene was found in this case. Conclusions Emery-Dreifuss muscular dystrophy is one particular type of muscular dystrophy. It is characterized with joint contractures and cardiac involvement in the early stage. Emerin protein is deficient in EDMD. There is no mutation of STA gene in sporadic EDMD.

Objective To investigate the efficacy and safety of percutaneous microwave ablation in the treatment of hypersplenism.Methods From March 2007 to May 2011,38 patients with hepatitis B virus caused liver cirrhosis and complicated with hypersplenism received percutaneous microwave ablation treatment for several times.Before percutaneous microwave ablation treatment,the volume of spleen was calculated according to 3D computed tomography (CT) scan.Ultrasound,blood routine,urine routine,liver function test,kidney function test,serum amylase and lipase were also tested.For the first time,1/3 volume of spleen was ablated.If no complication were observed in one week after ablation,then another 1/3 volume of spleen was ablated.Blood routine and liver function test were checked on the 1st,3rd and 5th day after microwave ablation.Blood routine,liver function test and ultrasound were examined on 7th and 14th day after microwave ablation.On the 30th day CT examination was conducted.Ultrasound,blood routine,urine routine,liver function test,kidney function test,serum amylase and lipase were detected at one month,three month and every three month after microwave ablation.The follow up duration was over two years.The t-test was performed for clinical data comparison.Results The mean ratio of ablated spleen was (47 ±5)％ (range 41％ to 57％).Preoperative white blood cell count was (2.46±0.78)× 109/L,which gradually increased after operation and peaked on the 3rd day after operation ((5.34 ± 2.10) × 109/L).Then gradually decreased,which was (3.16 ± 1.02) × 109/L at 24 month and the difference was statistically significant compared with that of preoperation (t=-3.349,P＜0.01).Preoperative platelet count was (46.58 ± 17.30) × 109/L,which gradually decreased after operation and was lowest on the 3rd day after operation.Then gradually increased,which peaked at 30 days after operation ((101.79 ± 25.80) × 109/L) and then gradually decreased,which was (61.97 ± 15.09) × 109/L at 24 month and the difference was statistically significant compared with that of preoperation (t＝-4.135,P＜0.01).The inner diameter of portal vein was (14.66±0.88) mm preoperation,which was (13.22±0.64) mm at three month after operation and the difference was statistically significant compared with that of preoperation (t=8.145,P＜0.01).It was (14.64±0.81) mm at six month after operation and the difference was not statistically significant compared with that of preoperation (P＞ 0.05).The major adverse effects were fever,left upper abdominal pain,left shoulder pain,pleural effusion,intraperitoneal hemorrhage and temporary hemoglobinuria which all recovered after symptomatic treatment.No severe complication such as uncontrollable bleeding,splenic abscess,spleen rupture and the surrounding organ injury and treatment related death were observed.Conclusion Percutaneous microwave ablation for several times could safely destroy suitable volume of spleen,increase platelet and white blood cell count,improve portal hypertension and with rare complications,which might be a minimally invasive techniques with clinical application value in the treatment of the hypersplenism.

The aim of this study is to investigate the critical factor affecting the properties of PLGA microspheres fabricated by a solid-in-oil-in-water (S/O/W) emulsion technique with BSA as a model protein. Prior to encapsulation, the BSA microparticles were fabricated by a modified freezing-induced phase separation method. The microparticles were subsequently encapsulated into PLGA microspheres by S/O/W emulsion method, then Motic BA200 biological microscope, confocal laser scanning microscope, scanning electron microscope were used to observe the structure of S/O/W emulsion and PLGA microspheres. The protein content extracted or released from BSA microspheres was measured by Bradford protein assay method. It was found that NaCl added in the outer aqueous phase effectively suppressed material exchange between the inner and outer phase of S/O/W emulsion. Then, the structure and permeability of obtained microspheres were influenced. As a result, with the increase of NaCl concentration in the outer aqueous phase, the encapsulation efficiency of microspheres significantly increased from 60% to more than 85%, the burst release of microspheres reduced from 70% to 20%, and the particle size decreased from 103 microm to 62 microm. Furthermore, the rehydration of encapsulated protein was also retarded and then integrity of BSA was successfully protected during encapsulation process. In vitro release test showed that BSA released from PLGA microspheres in a sustained manner for more than 30 days.

Objective To evaluate the value of left ventricular (LV) torsion for assessing left ventricular function in adult heart transplant patients using two-dimensional speckle tracking imaging.Methods Basal and apical LV short-axis view and apical LV long-axis view of two-demensional images were acquired in 30 heart transplant patients and 17 healthy volunteers. Using two-dimensional strain software,LV basal and apical rotation versus time profiles were obtained at their short-axis level respectively. LV torsion was defined as apical rotation relative to the base, so the LV torsion versus time profiles could be drawn. LV basal rotation,apical rotation,global torsion and their time to peak were respectively measured,and the rate of LV untwisting was calculated. Statistical analysis was used to find the difference between the two groups and to investigate the relationship between LV torsion or the rate of LV untwisting and echocardiographic parameters. Results LV apical rotation and LV global torsion in heart transplant group were significantly lower than those in normal group. LV global torsion inversely correlated with LV end systolic volume,positively with LV ejection fraction. There was no significant difference between the two groups in the rate of LV untwisting. The rate of LV untwisting didn't correlate with echocardiographic parameters. Conclusions LV torsion can be measured exactly by two-dimensional speckle tracking imaging, it can be used to quantify LV global systolic function in heart transplant patients.

[Abatract] In order to improve the result of clinical practice for undergraduate students of clinical medicine, combined with the professional characteristics of hematology and teaching syllabus, Hematology Department in the First Affiliated Hospital of Dalian Medical University developed practi-cal teaching content and tried using a variety of teaching methods and teaching means such as multi-media aided teaching, case teaching and simulation teaching method and so on. Besides, multiple station examination was established; teaching feedback and supervision were strengthened. The prac-tice proved that the reform measures were conducive to the cultivation of medical students' practical skills and clinical thinking, which helped to speed up the transformation from the students to the role of doctors.

Objective To find out the best method for elimination of uranium contamination in rat tissues as low as possible by removal of shrapnel fragments. Methods Experimental rats were divided into six groups: route group, decontamination before surgery group, decontamination in incision group, changing surgical appliances group, removing tissues around group, and comprehensive method group. Uranium concentrations in tissues and fluids in all groups were measured at 7, 14, and 21 d after operation. The efficiency of decontamination by different methods was compared. Results The highest uranium concentration in tissues was found in the route group, but the lowest in the comprehensive method group, and the second lowest in removing tissues around group. Conclusion The comprehensive method is the best one in all of the surgical removal methods. The soft tissues around DU shrapnels should be removed if they are not critical organs.

ObjectiveTo study the effect of consolidated trunk muscle training on balance and motor function in patients with hemiplegia after stroke. Methods96 patients were divided into treatment group (48 cases) and control group (48 cases). All the patients received regularly rehabilitation, and the patients in the treatment group received the control ability training in the trunk muscle in addition. They were assessed with Trunk Control Test (TCT)， Berg Balance Scale (BBS)， Modified Barthel Index (MBI), Functional Ambulation Category (FAC), Fugl-Meyer Assessment (FMA) and walking speed (WS) before and after the treatment. ResultsThe scores of TCT, BBS, FAC, MBI, WS and FMA improved significantly in both groups after treatment (P<0.01)， and improved more in the treatment group than in control group (P<0.05). The scores of TCT correlated with those of BBS, MBI, FAC, FMA, and WS (P<0.05). ConclusionThe consolidated trunk muscle training can obviously improve balance and motor function of stroke patients.

Chuangxinmycin (CM) from Actinoplanes tsinanensis was an antibiotic discovered by Chinese scientists about 40 years ago. It contains a new heterocyclic system of indole fused with dihydrothiopyran, whose biosynthetic mechanism remains unclear. CM is used as an oral medicine in the treatment of bacterial infections in China. The simple structure makes CM as an attractive candidate of structure modification for improvement of antibacterial activity. Recently, we analyzed the secondary metabolites of Actinoplanes tsinanensis CPCC 200056, a CM producing strain, as a natural CM analogue. We discovered the first natural CM analogue 3-demethylchuangxinmycin (DCM) as a new natural product. Compared to CM, DCM exhibited a much weaker activity in the inhibition of the bacterial strains tested. The finding provides valuable information for the structure-activity relationship in the biosynthesis of CM.