Objective To investigate the application of anesthesia methods and clinical experience in treatment of severe traumat-ic shock .Methods 48 severe traumatic shock patients were randomly divided into two groups by different anesthesia treatment ,in-cluding delayed resuscitation group (A group) and routine group (B group) ,24 cases in each group .Results Patients completed operation as expected with stable vital signs in the operation .Patients completely awaked and recovered the spontaneous respiration after 3~4 hours .4 cases in group A (16 .6% ) and 12 cases in group B (50% ) were died .The mortality of group A was significant-ly lower than that of group B (P<0 .05) .Conclusion The appropriate anesthetic managements for the severe traumatic shock pa-tients could maintain the function of each organ ,create favorable conditions for operation ,and improve the survival rate of critical patients .

The clinical medical work is accompanied with high risk .The medical treatment risk exists everywhere at anytime, but the graduate students of the Medical colleges lack the understanding of the hygiene laws. Therefore it is necessary for them to accept the education of hygiene law.

Objective To study effect of etoricoxib on IL-1βand TNF-αin patients with gouty arthritis.Methods 86 patients with gouty arthritis from July 2014 to July 2016 in our hospital were selected, all patients were divided into study group and control group according to the treatment method with 43 cases in each group.The patients in the control group were treated with diclofenac sodium, the patients in the study group were treated with etoricoxib.The clinical symptoms, clinical treatment effects, VAS score, serum IL-1β, TNF-αlevels and adverse reactions were observed and compared between the two groups.Results The VAS score, the joint swelling score and the mobility limitation score of the study group were decreased than before treatment and significantly lower than those of the control group, the difference was statistically significant (P<0.05).The effective rate of the study group (95.35%) was significantly higher than that of the control group (79.07%), the difference was statistically significant(P<0.05).The levels of IL-1βand TNF-αin the two groups were significantly lower than before treatment and the levels of IL-1βand TNF-αin the study groups were significantly lower than those in the control group,the difference was statistically significant(P<0.05).The incidence of adverse reactions in the study group was lower than that in the control group, the difference was statistically significant(P<0.05).Conclusion The clinical efficacy of etoricoxib in treating patients with gouty arthritis is significant, which can effectively relieve the clinical symptoms, inhibit the expression of IL-1βand TNF-α, and the adverse reactions less.

Aim Toexplorewhether1-methylhydan-toin(MH)could inhibit the basal secretion of growth hormone (GH ) and suppress the promoting effect of growth hormone-releasing hormone (GHRH ) in rab-bits.Methods Thirty-sixrabbitswererandomlydi-vided into six experimental groups according to the kind of dosing drugs,namely normal saline group(A), MH group (B ),octreotide group (C ),GHRH group (D),GHRH +MH group(E),GHRH +octreotide group(F),with 6 rabbits in each group.Blood was sampled (1. 0 mL each time)from each rabbit before injecting drugs and 5,15,30,45,60 min after drug administration.Clotting spontaneously,rabbits blood samples were centrifugated for 20 minutes at approxi-mately 1000 ×g and the supernatant was collected. Serum GH concentrations were determined by enzyme linked immunosorbent assay kit(ELISA Kit).Mean-while,the behavior of rabbits in each group after injec-tingdrugswascloselyobserved.Results TheGH level of rabbits in group A at each time point had no significant differences(P>0. 05 ).Group B and group C rabbit GH levels were significantly lower than those of group A (P<0. 05 ),while GH levels in group D were obviously higher than those of group A (P <0. 05 ).Compared with group D,rabbit GH levels in group E and group F decreased markedly(P<0. 05 ). No obvious toxic and side effects had been observed within one week after the experimental rabbits were ad-ministered corresponding drugs by intravenous injec-tion.Conclusions 1-methylhydantoincouldinhibit the basal secretion of GH in rabbits.1-methylhydan-toin could suppress the promoting effect of GHRH in rabbits.

Though lack of definite evidences,closed suction drainage after arthroplasty is routinely employed by the majority of orthopaedic surgeons with the aim of preventing the formation of wound haematoma,reducing delayed wound healing and the risk of deep infection.But the optimal time to remove drains is controversial.The usual time to remove drains is 48~72 h after operation when the volume of drains is less than 50ml within 24 h.But some scholars find that the time of draining more than 24 h increases the risk of wound infection.This paper reviews the literature of draining time,and concludes that the optimal time to remove drains is 24 h after the primary arthroplasty.

Aim To investigate the effects of bradykinin preconditioning on the damage produced by focal cerebral ischemia-reperfusion in rats.Methods Rats were scheduled to undergo middle cerebral artery ischemia-reperfusion by intraluminal suture.Prior to ischemia,bradykinin was pumped into the brain via extra carotid artery and control group was given the same amount of normal saline.The infarct volume、brain water content、permeability of blood brain barrier and histological neuronal changes were evaluated after 2 h ischemia and 24 h reperfusion.Results Compared with other groups, bradykinin preconditioning 15min before ischemia reduced infarct volume、brain edema、permeability of blood brain barrier and histological neuronal damage.Conclusion Bradykinin preconditioning may provide protective effects against cerebral ischemic injury.This protection may be due to the protection of cerebral vasculature and the decrease of infarct volume.

BACKGROUND:Gene-modified stem cel s can increase the secretion of peptides and ful-length proteins to protect spinal cord injury and promote recovery of neuronal function, which thus become a research hotspot in recent years. OBJECTIVE:To investigate the effect of nerve growth factor-modified adipose derived stem cel s in repairing spinal cord injury in rats. METHODS:Adipose derived stem cel s were primarily cultured by adherent culture method and cel surface markers were detected by immunofluorescence method, while spinal cord injury models were set by modified Al en method. Nerve growth factor plasmid was transfected into adipose derived stem cel s with Lipofectamine2000 and the expression of nerve growth factor was detected by real-time PCR and western blot. The modified adipose derived stem cel s intervened by nerve growth factor were injected into the injured part of spinal cord injury rat models. Basso-Beattie-Bresnahan score was used to evaluate the repairing effect. Models rats were sacrificed at 3 weeks after cel transplantation. Real-time PCR and western blot were used to testify nerve growth factor expression in the injured spinal segment after cel transplantation. RESULTS AND CONCLUSION:Adipose derived stem cel s were successful y cultured primarily, and positive for CD29 and CD44;the mRNA and protein expression of nerve growth factor was elevated after plasmid transfection. The Basso-Beattie-Bresnahan score was elevated after transplantation of adipose derived stem cel s intervened by nerve growth factor modification compared to control group;and the expression of nerve growth factor in the injured segment of the spinal cord was up-regulated detected by real-time PCR and western blot. These findings indicate that the nerve growth factor-modified adipose derived stem cel s have repairing effects on spinal cord injury in rats.

Objective To investigate effects of two doses of dexmedetomidine (Dex) on the recovery quality from general anesthesia undergoing thyroidectomy.Methods A prospective randomized controlled double-blind trial was conducted in 90 patients admitted to Shengjing Hospital of China Medical University who were scheduled for thyroidectomy.They were randomly divided into three groups:group D0.4 received Dex 0.4 μg/kg intravenously,group D0.8 received Dex 0.8 μg/kg intravenously,and control group with same volume of normal saline.There were 30 patients in each group,and all the patients received the above drug or saline 30 minutes after intubation.The heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded before Dex administration,at the end of surgery,time of eye opening and extubation,and 10 minutes after extubation.Time of eye opening after surgery and time of extubation after eye opening were recorded.End-tidal partial pressure of carbon dioxide (PETCO2) before and after operation as well as restlessness score (RS),Ramsay sedative score,and visual analogue pain scale (VAS) scores at 10 minutes after extubation were recorded.Events during extubation including cough,nausea and vomiting,respiratory depression were also recorded.Results ① Compared with control group,in D0.4 and D0.8 groups incidence of lowering of HR,SBP and DBP was lower at time of eye opening and extubation,and 10 minutes after extubation.Compared with D0.4 group,D0.8 group had lower HR at the time of extubation and 10 minutes after extubation,SBP was lower at the time of eye opening and extubation,and lower DBP at the time of eye opening.② D0.4 and D0.8 groups showed lower RS and VAS scores than those of control group,Ramsay sedative score in groups D0.4 and D0.8 was higher than that in control group (RS:1.40±0.51,1.20±0.42 vs.1.90±0.56; VAS:1.50±0.52,0.80±0.63 vs.2.50 ± 0.52; Ramsay:2.10 ± 0.56,2.40 ± 0.51 vs.1.60 ± 0.51,P＜0.05 or P＜0.01),and VAS score in group D0.8 was lower than that in D0.4 group (P＜0.01).The time of eye opening and extubation were longer in group D0.8 as compared with those in control and D0.4 groups (minutes:12.50 ± 1.08 vs.10.50 ± 1.58,10.40 ± 1.26; 15.00 ± 0.94 vs.13.00 ± 1.63,12.80 ± 1.13,P＜0.05 or P＜0.01),but there was no significant difference between the latter two groups.No significant difference in PETCO2 was found among three groups before and after surgery.③ The incidence rate of cough,nausea and vomiting in control group (16.7％,13.3％) were significantly higher than those in groups D0.4 (3.3％,0) and D0.8 (0,0).There was no respiratory depression in the three groups.Conclusion Adjunctive infusion of Dex 0.4 μg/kg at 30 minutes after anesthesia induction was recommended as it may result in more steady hemodynamics,with shorter recovery time and extubation time after thyroidectomy.

Objective To study the iodine deficiency disorders (IDD) situation in Wenzhou City during 1995-2014.Method According to National IDD Surveillance Project,IDD surveillance had been consecutively carried out during the past 20 years,which consisted of goiter rate in 8-10 years old children,iodized salt and urinary iodine levels.Results The goiter rate of 8-10 years old children was decreased from the highest of 31.09％ (2 190/7 043) in 1995 to the lowest of 2.28％ (77/3 378) in 2014;the highest level of median urinary iodine was 214.78 μg/L,and the lowest level was 74.48 μg/L,and which was increased from 74.48 μg/L in 1995 to 187.00 μg/L in 1996,and then had been maintained at the appropriate level recommended by World Health Organiation (WHO),except that in 1998,2003,2004 and 2006.The qualified rate of iodized salt was increased from 54.95％ (1 471/2 677) in 1996 to 95.52％ (2 548/2 754) in 1999,but decreased to 62.75％ (768/1 224) in 2003,however it was fluctuated from 78.61％ (2 503/3 184) to 92.48％ (2 989/3 232) from 2004 to 2013,and it was 90.43％ in 2014 (2 983/3 300).Conclusions The comprehensive measures for controlling IDD,with universal salt iodization,has been gradually achieved remarkable effect in Wenzhou City,but the non-iodization salt existing in the market is still a problem,and people have misunderstandings about iodization salt.Iodine supplementation had better be conducted according to local conditions and based on scientific policy.

Objective To evaluate how to select operation procedures for different CT manifestation of splenic artery aneurysm ( SAA) with posthepatitic cirrhosis. Methods In 61 cases with SAA,the CT manifestation ( location,number,size,portal vein,varicose vein,proxi-mal splenorenal shunt and spleen changes) of SAA,clinical features of cases,and operation approach were were retrospectively analyzed. Re-sults 4 patients who have the primary tumors located in the distal splenic artery with diameter 1. 0~2. 0 cm,spleen kidney shunt and mega-losplenia were given aortic aneurysm exclusion and branch aneurysms embolism by stages. Amiong the 15 cases of tumors resection,splenecto-my and devascularization,there were 4 cases of the primary tumors located in the middle of splenic artery and 11 cases in the distal splenic artery. There were 15 cases whose diameter of the primary tumor were lager than 2. 0 cm and 13 cases whose diameter of the primary tumor were 1. 0~2. 0 cm. There were 4 cases of cavernous transformation of portal vein,5 cases of splenic and gastric varices,15 cases of esophage-al and gastric varices,4 cases of splenic and gastric venous shunt,15 cases of megalosplenia and 4 cases of splenic infarction. Tumors resec-tion and branch aneurysms embolism by stages were conducted in 7 cases. The primary tumors located in the proximal splenic artery occured in 7cases,and the diameter of the primary tumor were 1. 0~2. 0 cm occured in 7 cases. Esophageal and gastric varices occured in 2 cases and splenomegaly occured in 7 cases. And there were 4 cases whose diameter of the tumor were 1. 0~2. 0 cm were given tumor resection and re-construction of splenic artery and continuity, including 1 case of proximal splenic artery,2 cases of medial splenic artery and 1 case of distal splenic artery. Conclusion Operation procedures were confirmed by CT findings such as location,number,size,portal vein,varicose vein, proximal splenorenal shunt and spleen changes of SAA combined with age,gender,body mass index and history.