[Objective]To provide microsurgery anatomical data for the surgical operation in treating of extreme lateral lumbar dsic herniation through the observations of the regional anatomic structure about the post-median approach tolateral vetebral lamina(PMALVL).[Method]Thicknesses of intertransverse ligament,the distribution of anterior branches of lumbar nerve and vessel were measured at the adult cadavas specimens.Retrospectively analyzed with 12 cases of extreme lateral lumbar disc herniation from January 2004 to January 2006,including 7 cases were treated by the lateral approach to the vertebral lamina,5 cases treated by PMALVL.[Result]The thickness of intertransverse lingament is 0.6~1.3 mm.More than 90 percent of anterior branches of lumbar segmental arteries and the accompanying veins from L_3 to S_1 were located ventrally in the superior portion of the intertransverse ligament.A branch from Lumbar artery permanently locates in the hfiddle of post-lateral intertransverse ligament.The angle between the anterior branch of Lumbar nerve root and midline sagittal plane is 18.9?~39.2?.The distance from the root of the tranverse to the anterior branch of lumbar nerve root and from the lateral margin of the pars interarticul aris to the anterior branch of lumbar nerve root(5.6~8.0)mm and(1.7~3.6)mm respectively.The period of follow up in 12 cases was from 3 months to 24 months,with an average of 10 months.The resultwas excellentin 8 cases,good in 3 cases,total fine rate according the classification of Nakal was 91.67%.[Conclusion]Intertransvarse ligament is a reliable landmark for PMALVL and treating extreme lateral lumbar disc herniation through PMALVL may get microtraumatic and excellent effect.

Objective To analyze the β-lactamases-producing Escherichia coli which were isolated from hospital specimens from Jun 2012 to Dec 2014,and provide a more accurate evidence to guide drug-selecting for antibacterial use.Methods An-alyzed 1 587 E.coli from patient sample selected between Jun 2012~Dec 2014 using the microbial analysis system manufac-tured by ZHUHAI DL BIOTECH CO.LTD,A phenotypic test was also conducted to test ESBLs.Results 1 587 stains of E-.coli were isolated,which counted for 23.9% of the specimens;901 stains (56.8%)out of total 1 587 stains appeared to be ESBLs-producing E.coli,and others were non-ESBLs-producing E.coli.The 1 587 Escherichia coli mainly came from De-partment of Urology (408,weight 25.7%),Department of Endocrinology (271,weight 17.1%),Department of Respiration (249,weight 15.7%).Rine specimen contributed 609 stains (47.3%),411 E.coli stains (31.9%)were discovered in spu-tum samples,and 83 stains (6.5%)showed in blood samples.The resistance to imipenem were discovered in the analysis. The rates of resistance to penicillins,cephalosporins were over 90.0%,the rates of resistance to Levofloxacin,ciprofloxacin were above 70.0%,and resistance rates to amoxicillin-clavulanic acid,Ticarcillin-clavulanic acid,piperacillin/tazobactam, amikacin were lower than 7.7%.Conclusion The drug-resistance of the E.coli were increasing over the past three years. There was a significant portion of MDR and PDR present in the trend.Thus,the reinforcement of the drug-resistance survey and testing have a far-reaching meaning to promote rational drug selecting.

Objective To analyze the surgery effect of infant common congenital heart diseases. Methods The clinical data of 1 004 infants with common congenital heart disease were retrospectively analyzed, with male in 508 cases, female in 496 cases, age from 0.7 to 12.0 (7.4 ± 3.6) months, and body weight from 2.4 to 11.5 (6.8 ± 2.2) kg. Among them , there were the ventricular septal defect (VSD) in 680 cases, atrioventricular septal defect (ASD) in 92 cases, patent ductus arteriosus (PDA) in 70 cases, pulmonary valve stenosis (PS) in 12 cases, VSD +ASD in 83 cases, VSD + PDA in 27 cases, VSD+moderate to severe mitral insufficiency (MI) in 12 cases, VSD+ASD+MI in 3 cases, VSD+PS in 5 cases, VSD+ASD+PS in 2 cases, VSD+double chamber right ventricle (DCRV) in 3 cases, and ASD+PS in 7 cases, ASD+PDA in 8 cases. Results The extracorporeal circulation time was 21-72 (40.2 ± 28.6) min, and aortic occlusion time was 4-37 (20.7 ± 15.5) min. The in hospital mortality was 0.8%(8/1 004). Postoperative complications included low cardiac output syndrome in 18 cases, bacterial endocarditis in 2 cases, pneumonia in 27 cases, pulmonary atelectasis in 6 cases, pneumothorax in 2 cases, laryngeal edema in 11 cases, incision fat liquefaction in 12 cases, sternal dehiscence in 3 cases, and third-degree atrioventricular block in 1 case. Eight hundred and forty-five infants (84.2%, 845/1 004) were followed up for 6-12 months.The echocardiogram found 9 cases with residual VSD shunt, 5 cases with mild MI and 1 case with moderate. Conclusions In primary hospital, Seizing the opportunity of surgery, attention on protection of myocardium and other important of organ function during operation, and postoperative intensive care and fine processing can achieve satisfactory clinical results in infant common congenital heart diseases surgery.

OBJECTIVE:To observe the therapeutic efficacy of active immunization combined with dydrogesterone in the treatment of recurrent abortion,and its effects on serum levels of leptin(LP)and adiponectin(ADPN). METHODS:Totally 103 patients with recurrent abortion from department of gyhecology,Jinan Third People's Hospital during Nov. 2015 to Nov. 2016 were selected as trial group,and then divided into trial group one(n＝51)and trial group two(n＝52)according to admission order. Other 100 normal pregnant women were taken as control group. Trial group one was given active immunization combined with dydrogesterone,including that lymphocytes from the patients'spouse were injected subcutaneously into the patient,every half a month,3 times of active immunization as a course of treatment,and was given Dydrogesterone tablet 10 mg after pregnancy,bid, until 3 months after the pregnancy. Trial group two was given Dydrogesterone tablet 10 mg,bid,until 3 months after the pregnancy. The serum levels of β-HCG,LP and ADPN were compared between trial group and control group at admission,the serum levels of β-HCG,LP,ADPN and pregnancy outcome(recurrent abortion,full-term pregnancy and successful delivery rate) was compared between 2 trial groups after treatment. RESULTS:At admission,the serum levels of β-HCG,LP and ADPN in trial group were significantly lower than control group. After treatment,the levels of β-HCG,LP and ADPN,successful delivery rate and full-term pregnancy rate in trial group one were significantly higher than trial group two, recurrent abortion rate was significantly lower than trial group two,with statistical significance(P＜0.05). No adverse reactions were observed in the study. CONCLUSIONS:The use of active immunization combined with dydrogesterone can significantly improve the serum levels of LP and ADPN as well as pregnancy outcome,with good safety.

Deep brain stimulation (DBS) is an effective method to treat motor disorders and a powerful tool to study brain function.With the spread of DBS in clinical practice and the development of electrical stimulation and electrical recording in brain function,it's clear that implanting electrodes at different targets in the brain or allowing different contacts of implanted electrodes reaching multiple target nuclei and functional areas can improve the clinical efficacy of DBS;and more useful information than single neuronal electrophysiological records will also be obtained by the combination of multiple neuronal electrophysiological records.In this paper,the application of multitarget DBS and electrophysiological records is briefly reviewed.

Objective:To evaluate the interaction between remimazolam and propofol for sedation during hysteroscopy.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 20-45 yr, with body mass index of 18-28 kg/m 2, scheduled for elective hysteroscopy, were included. The test was conducted in two steps. Up-and-down sequential allocation was used to determine the median effective dose (ED 50) of remimazolam (group A) and propofol (group B). The ED 50 obtained in A and B groups were then used as the standard to determine the combination regimen in group C (0.25×ED 50 of remimazolam+ 0.75×ED 50 of propofol as the initial dose), in group D (0.5×ED 50 of remimazolam+ 0.5×ED 50 of propofol as the initial dose), and in group E (0.75×ED 50 of remimazolam+ 0.25×ED 50 of propofol as the initial dose). Up-and-down sequential allocation was used to determine the ED 50 of propofol when propofol and remimazolam were combined in C, D and E groups. The interaction between the sedative effects of two drugs was analyzed using the isobolographic analysis method, and the interaction coefficient and synergistic dose ratio of two drugs were calculated. Results:The ED 50 of remimazolam was 0.180 mg/kg in group A, and the ED 50 of propofol was 1.167 mg/kg in group B. The results of isobolographic analysis showed that remimazolam and propofol had a synergistic effect. When remimazolam 0.045, 0.090 and 0.135 mg/kg were combined with propofol 0.546, 0.288 and 0.160 mg/kg, the interaction coefficients were 1.393, 1.339 and 1.127 respectively. The synergistic dosage ratio of remimazolam and propofol was 1.0∶(3.2 to 12.0). Conclusions:Remimazolam and propofol have a synergistic effect on sedation when used for hysteroscopy, and the dose ratio is 1.0∶(3.2-12.0).

Objective:To explore the module of the construction and application of medical first-aid at the door of the space capsule and the air evacuation.Methods:According to the purpose, principle, and method set by the module, it was divided into two sub-modules: medical first-aid at the door of the space capsule and the air evacuation. During the comprehensive first-aid training, independent training and combined training were carried out respectively according to different mission stages of launch and recovery and different recovery terrain. Meanwhile, research was performed to ensure that medical carrying equipment was lightweight, modular, and portable, and the efficiency of modularization construction was tested in the comprehensive training.Results:The module of medical first-aid at the door of the space capsule and the air evacuation obviously shortened the rescuing time during the comprehensive training, the saving effect was remarkable, and the overall saving efficiency was significantly improved.Conclusions:The module of medical first-aid at the door of the space capsule and the air evacuation meet the requirements that the emergency support system of aerospace medicine should function on an immediate basis, ensuring accurate treatment and air evacuation without any delay, so that to achieve the aim of aerospace medicare.

Brain Ischemia ; Cerebral Infarction ; Humans ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial/etiology*

Global Burden of Disease ; Risk Factors ; Quality-Adjusted Life Years

Chuanxiong Rhizoma (CX, the dried rhizome of Ligusticum wallichii Franch.), a well-known traditional Chinese medicine, is clinically used for treating cardiovascular, cerebrovascular and hepatobiliary diseases. Cholestatic liver damage is one of the chronic liver diseases with limited effective therapeutic strategies. Currently, little is known about the mechanism links between CX-induced anti-cholestatic action and intercellular communication between cholangiocytes and hepatic stellate cells (HSCs). The study aimed to evaluate the hepatoprotective activity of different CX extracts including the aqueous, alkaloid, phenolic acid and phthalide extracts of CX (CX_AE, CX_AL, CX_PA and CX_PHL) and investigate the intercellular communication-related mechanisms by which the most effective extracts work on cholestatic liver injury. The active compounds of different CX extracts were identified by UPLC-MS/MS. A cholestatic liver injury mouse model induced by bile duct ligation (BDL), and transforming growth factor-β (TGF-β)-treated human intrahepatic biliary epithelial cholangiocytes (HIBECs) and HSC cell line (LX-2 cells) were used for in vivo and in vitro studies. Histological and other biological techniques were also applied. The results indicated that CX_AE, CX_AL and CX_PHL significantly reduced ductular reaction (DR) and improved liver fibrosis in the BDL mice. Meanwhile, both CX_AE and CX_PHL suppressed DR in injured HIBECs and reduced collagen contraction force and the expression of fibrosis biomarkers in LX-2 cells treated with TGF-β. CX_PHL suppressed the transcription and transfer of plasminogen activator inhibitor-1 (PAI-1) and fibronectin (FN) from the 'DR-like' cholangiocytes to activated HSCs. Mechanistically, the inhibition of PAI-1 and FN by CX_PHL was attributed to the untight combination of the acetyltransferase KAT2A and SMAD3, followdd by the suppression of histone 3 lysine 9 acetylation (H3K9ac)-mediated transcription in cholangiocytes. In conclusion, CX_PHL exerts stronger anti-cholestatic activity in vivo and in vitro than other CX extracts, and its protective effect on the intracellular communication between cholangiocytes and HSCs is achieved by reducing KAT2A/H3K9ac-mediated transcription and release of PAI-1 and FN.