Objective To study the relationship between the low level lead exposure of pregnant woman and the gestational age of fetus. Methods The peripheral blood and the umbilical blood samples were collected from 1 000 healthy puerperants and their newborns. The puerperants were divided into three groups according to the blood lead levels: very low-level group(0.483 ?mol/L). Results The rate of premature labor was 9.40% in the very low-level group, 14.07% in the low-level group and 23.81% in the high-level group respectively. The blood lead level of puerperants had a positive correlation with the umbilical blood lead of newborns. The umbilical blood lead of premature was higher than that of mature. As the blood lead level of the pregnants increased, the gestational age shortened and the probability of low age premature increased. Conclusion As for the toxicity of lead to the fetus, there is no a threshold. Low level lead exposure of the pregnant woman is one of the causes of premature labor.

ObjectiveTo study the changes of immune function after hepatectomy for hepatocellular carcinoma(HCC) in patients with liver cirrhosis.MethodsPatients with liver cirrhosis were used as control group,CD4?CD8?CD4/CD8? and protein expression level of IFN ??IL2?IL10 in peripheral blood from 18 advanced HCC cases with liver cirrhosis before and after heaptectomy were detected by flow cytometry(FCM) and ELISA.Results Postoperative CD4(33?3)%?CD4/CD8(1 1?0 1)?IL2(71?11)?pg/ml?IFN ?(90?15)?pg/ml level elevated compared to that of pre operation 〔CD4(29?4)%?CD4/CD8(0 9?0 3)?IL2(57?15)?pg/ml?IFN ?(78?13)?pg/ml〕(all P

ObjectiveTo study the clinical significance of splenectomy in cirrhotic patients undergoing hepatic resection for PLC.Methods26 PLC patients with portal hypertension and hypersplenism were randomly divided into two groups: incidental splenectomy group ( n =11), and hepatectomy only group ( n =15). Postoperative blood picture and liver function was compared.ResultsThe WBC and PLT count significantly elevated after splenctomy, (8 9?1 6)?10 9 /L, (310?32)?10 9 /L; vs. (3 7?1 4)?10 9 /L and (104?41)?10 9 /L respectively (all P

Objective To study T lymphocyte subsets immunological condition of spleen in primary hepatocellular carcinoma (PHC) with liver cirrhosis. Methods T lymphocyte subsets such as CD4,CD8,CD4/CD8 in peripheral and spleen venous blood in 31 cases of PHC with liver cirrhosis were detected by FCM.and 13 patients with liver cirrhosis were observed as the control group. Results In 6 patients with stage Ⅰ liver cancer, CD8 of peripheral venous blood significantly decreased (P

OBJECTIVE:To explore the effect of dexmedetomidine with different doses combined with ropivacaine on the bra-chial plexus block. METHODS:Totally 90 patients with upper extremity surgery of brachial plexus block were randomly divided in-to test group,control group 1 and control group 2. Test group was treated with 0.375%ropivacaine 40 ml+dexmedetomidine 100μg, brachial plexus injection;control group 1 was treated with 0.375% ropivacaine 40 ml+dexmedetomidine 50 μg,brachial plexus in-jection;and control group 2 was treated with 0.375% ropivacaine 40 ml,brachial plexus injection. Onset time of sensory and motor nerve block,block duration,postoperative pain time for the first time and pain score,analgesia duration,quality of analgesia and muscle relaxant,before anesthesia induction(T0),plasma cortisol concentrations in nerve block 10 min (T1),the start of surgery (T2)and incidence of adverse reactions were observed. RESULTS:The onset time of sensory and motor nerve block and postopera-tive pain score for the first time in test group werecontrol group 1>control group 2,plasma cortisol concentrations at T1 and T2 were higher than T0,and T2>T1>T0,test group0.05). CONCLUSIONS:Ropivacaine combined with 100 μg dexmedetomidine can effectively im-prove brachial plexus block and shorten the onset time of sensory and motor nerve block,with good safety.

Objective To study the methods and effects of endoscope-assisted partial thyroidectomy through subclavicular approach between the cervical anterior muscles and the sternocleidomastoid muscle.Methods The study included 15 patients with unilateral thyroid benign nodules.A transversal subclavicular incision 2~3 cm in length was made.Endoscope-assisted partial thyroidectomy was performed through the subclavicular approach between the cervical anterior muscles and the sternocleidomastoid muscle.Results The operation was accomplished successfully in all the 15 patients.The operation time was 40~80 min(mean,50 min) and the intraoperative blood loss was 10~50 ml(mean,20 ml).No surgical complications occurred.The patients were discharged from hospital on 3~4 postoperative days.Follow-up observations in the 15 patients for 1~12 months(mean,7 months) revealed no recurrence.Conclusions Endoscope-assisted partial thyroidectomy through subclavicular approach between the cervical anterior muscles and the sternocleidomastoid muscle has the advantages of minimal invasion,little blood loss, low complication rate,quick recovery,and good cosmetic results.

Objective To establish the capability level classification system and capability level staffing standard of ICUs in tertiary hospitals, in an effort to raise the efficiency of nursing resources while ensuring quality of care of patients. Methods Such methods as experts meetings and Delphi Method were called into play to establish the nurses capability level system in ICUs with the convenient sampling method, we made clinical observation and research in 5 ICUs of 3 tertiary hospitals in Shanghai. Results Nurses in ICUs were classified into four levels, so were their responsibilities and job description. This way the system of nursing staff capability levels takes shape, and the staffing standards for nurses in ICUs of tertiary hospitals come into being. Conclusion Such tiered staffing standards in tertiary hospitals enable clinical nursing managers to deploy and efficiently use nursing staff of all levels.

Objective To explore endoscopic findings and histopathological characteristics of duodenal protuberant lesions in order to improve diagnosis of duodenal protuberant lesions.Methods A total of 869 cases of duodenal protuberant lesions were detected and collected in endoscopy center of Drum Tower Hospital from 2005 to 2010,of which endoscopy findings and pathological characteristics were studied retrospectively.Results Of the 869 case with duodenal protuberance,50 cases were misdiagnosed as real protuberant lesions.Of the 819 real protuberant lesions,781 cases (95.4％)were benign lesions and 38 cases (4.6％) were malignant lesions.Pathological results indicated that most were chronic inflammation benign lesions (338 cases),accounted for 41.3％.Secondary were Brunner gland hyperplasia (155 cases),accounted for 18.9％.Of malignant lesions,most were adenocarcinoma (25 cases,accounting for 3％ ),others were six cases of carcinoid tumor,six cases of malignant lymphoma and one case of embryonal rhabdomyosarcoma.Endoscopic findings of duodenal protuberant lesions were diverse,such as round,hemispheric,finger-like,lobulated,streak and so on.The diameter of duodenal protuberant lesions varied,the largest was 5 centimeter and most were sessile lesions (726 cases,88.6％).Endoscopic ultrasonic findings indicated that internal echo of benign lesions were even and each layer of structure was clear,while malignant lesions presented uneven internal echo,unclear layer structure and adjacent tissue or lymphoma nodes invasion.Conclusions Duodenal protuberant lesions cannot be confirmed by conventional endoscopic findings.Endoscopic ultrasonography may help to improve the diagnosis.Diagnosis should be confirmed by pathology.

Aim To explore the effect of gastrin17 on expression of ?-catenin/Tcf-4 pathway in colonic carcinoma cell line——Colo320WT.Methods Colo-320WT cells were treated with 10-8 mol?L-1 gastrin17 in time-dependent way(0、1、6、12、24、48 h),while treated with 10-6 mol?L-1 L365,260(gastrin17 receptor blocker) for 30 minutes and treated with gastrin17 again for 12 h. The expression levels of ?-catenin in TX-100 solution fraction(cytoplasmic) and TX-100 insolution fraction(cytoskeleton bound) of Colo320WT cells, and the expression levels of ?-catenin/Tcf-4 complex were detected by coimmunoprecipation and Western blot. The expression levels of c-Myc and cyclinD1 were assayed by Western blot.Results Expression levels of ?-catenin in TX-100 solution fraction were decreased apparently, but increased again by L365,260 blocking. Expression levels of ?-catenin in TX-100 insolution fraction were on the contrary. Expression levels of ?-catenin/Tcf-4 complex increased apparently.Expression levels of c-Myc and cyclinD1 in Colo320WT treated by gastrin17 were higher markedly than those of Colo320WT untreated and treated by L365,260.Conclusions Gastrin17 interacted with CCK-2R and effected significantly distribution of ?-catenin in Colo320WT and activated ?-catenin/Tcf-4 pathway which led to c-Myc and cyclinD1 high expression,the way gastrin17 decreased cell-cell cohesion and increased tumor cells invasion and metastasis further.

Objective To investigate the diagnosis and treatment of cervical intraepithelial neoplasia and their clinical effect Methods The cases who were diagnosed as CIN through cytology, colposcopy biopsy and histopathological diagnosis were collected from January 2004 to June 2009 in Songjiang Hospital Affiliated to Shanghai Jiaotong University School. Drug therapy, physical therapy, cervical conization and hysterectomy were performed according to the lesion degree of CIN and patients' willingness. Some cases were further treated with surgery, radiotherapy or chemotherapy according to the pathological findings of the initial excision specimens. With long-term follow-up at 6,24 months after the treatment,we performed a comparative analysis on pathological diagnosis and therapeutic effects. Results Seven hundred and fifty cases of CIN were diagnosed after cervical cancer screening,among which,460 cases of CIN Ⅰ ,180 cases of CINⅢⅡ and 110 cases of CIN Ⅲ. Five hundred and Senventy-eight cases received treatment, among which, 46 cases received drug treatment After 6 months, focus disappeared in 32 cases, sustained in 10 cases, upgraded in 2 cases and canceration occurred in 2 cases. 13 cases received physical therapy,no recurrence occured. Four hundred and thirty-five cases received conization treatment, 34 cases with focus upgraded and 4 case recurred after the operation. 84 cases received hysterectomy, of which, 11 cases focus upgraded after the operation and no recurrence. The cases with focus upgraded or recurred all received additional treatment. The effective rate of physical therapy,conization treatment and hysterectomy on all grades of CIN was more than 98% at 2 years, and 69. 7% of drug treatment. The omission diagnostic rate of colposcopy guided biopsy on invasive carcinoma was 2. 2% , and the residual rate of focus of hysterectomy specimens after conization was 16. 2% . Conclusion Colposcopy including multi-point biopsy has high accuracy and specificity in early diagnosis of CIN . Cervical conization is the main method of the treatment of CIN. Patients with CIN Ⅲ and without desire of fertility should consider the removal of the uterus after cervical conization. Drug conservative therapy of CIN should be chosen carefully.