Objective To study the application of remifentanil combined with brachial plexus block using in the operation of children with upper limb.Methods A total of 40 children,aged 4～10 years,undergoing arm-fracture operation,breathing oxygen with opening veil,were randomly divided into two groups.The children were administered basal anesthesia before brachial plexus block.During the operation,the study group(n=20)was infused remifentanil，the initial rate was 0.05μg·kg-1·min-1，and the control group was infused ketamine to reinforce the analgesia.Results All patients finished the surgery safely.In study group,children recovery time[(14.0±4.8)min]Was more quickly than that of control group[(30.4±10.3)min](t=6.5 88,P＜0.01).Conclusion Remifentanil could efficiently assistant brachial plexus block in the operation of children with upper limb.

Objective To investigate the effect of the psychological behavior intervention on the mental status and clinical symptom of patients with functional constipation. Methods All of 78 patients with functional constipation diagnosed by Rome m diagnostic code were randomly divided into study group (n =40) and control group (n = 38). The psychological behavior intervention was used in the study group, the caccagogue and symptomatic treatment was used in the control group. The self-rating anxiety scale(SAS),self-rating depressive scale (SDS) was analyzed and the improving of clinical symptom, adverse effect was compared before and after 4 weeks of treatment respectively. Results The scores of SAS and SDS in the study group significantly decreased after treatment [ (36.25±8.61 )scores vs (42.97±9.25 )scores, P<0.01 ;(38.81±6.53)scores vs (43.36±7.18 )scores ,P < 0.01].There was significant difference between the two groups after treatment (P <0.05).The effective rate of study group was higher than that of control group .(97.50% vs 84.21%,P <0.05). The rate of celiodynia, diarrhea and the recrudescence after the course of treatment in control group was 23.68%, 15.79% and 89.47% respectively, while this numerus in study group was 5.00%,2.50% and 5.00%. Conclusions Psychological behavior intervention plays an important role in the treatment of functional constipation. It can improve the mental status, clinical symptom, and decrease the adverse effect.

Objective To investigate the role of osteopontin (OPN) in the pathogenesis ot cholesterol gallstone formation in bile.Methods The nucleation time of OPN in model bile and human gallbladder bile was studied by the nucleation time assay,the effect of OPN on cholesterol crystal growth in model bile was examined by the cholesterol crystal growth assay.The effect of OPN on vesicle was detected by the transmission electron microscopy in model bile and gallbladder bile; then the content of OPN and calcium were detected via the commercial kits in human bile.Results Osteopontin prolonged nucleation time in a dose dependent manner in model bile and human bile,and this effect was correlated with calcium.Compared with control group,the nucleation times were prolonged by 1.50and 1.93 times in lithogenic bile at the concentration of osteopontin 50 μg/ml and 100 μg/ml (P＜0.01),respectively. Nucleation time were prolonged by 1.17 and 1.33 times in normal bile (P＜0.01) and by 1.29 and 1.48 times in model bile (P＜0.01),respectively.The rate of cholesterol crystals growth was not influenced by calcium ions,but inhibited by osteopontin in a dose dependent manner in the model bile.Furthermore,the formation,aggregation and fusion of vesicles were delayed by osteopontin in bile samples as indicated by the transmission electron microscopy.The concentration of osteopontin [(0.53± 0.08) mg/ml vs. (0.65 ± 0.14) mg/ml,P＜0.05] and the calcium ions [ (0.71 ± 0.17) mmol/L vs. ( 0.84 ± 0.08 ) mmol/L,P ＜ 0.05 ] were lower in lithogenic bile than in control.Conclusions Osteopontin can inhibit the cholesterol gallstone formation in model and human gallbladder bile as the anti nucleating factor.

Objective To investigate the role of osteopontin (OPN) in cholesterol gallstone formation.MethodsGallbladder bile was obtained from patients with cholelithiasis (n=36,the experimental group) and from donors of liver transplantation (n=19,the control group).OPN,calcium ion and lipid were analysed quantitively.The nucleating role of OPN in bile was evaluated using nucleating time (NT) approach.ResultsOPN inhibited cholesterol nucleation in a dose dependent manner.OPN (50 μg/ml and 100 μg/ml) prolonged NT by 48.90％ (91.51％) and 17.07％ (32.93％) in lithogenic and control bile,respectively.OPN (100 μg/ml) also inhibited the nucleating effect induced by calcium ion.Furthermore,a combination of OPN (50 μg/ml) and calcium prolonged NT by 75.78％ and 33.96％ in lithogenic and control bile,respectively.A combination of OPN (100 μg/ml) and calcium prolonged NT by 125.9％ and 62.26％ in the 2 groups.The contents of osteopontin and calcium were significantly lower in lithogenic bile than control bile (P＜0.05).On the other hand,the cholesterol saturation index and the contents of cholesterol,phospholipid and bile acid were significantly higher (P＜0.05).ConclusionsOPN inhibited cholesterol gallstone formation.It may be involved in the pathogenesis of cholelithiasis.

BACKGROUND:Tissue-engineered transplantation technique has become an ideal therapeutic regimen for degenerative disc diseases through reconstituting the biological functions of the degenerated intervertebral discs.
OBJECTIVE:To construct a novel tissue-engineered annular fibrosus scaffold.
METHODS:Konjac glucomannan, nano-hydroxyapatite and colagen were used to fabricate a new tissue-engineered annular fibrosus scaffold by wet spinning, chemical crosslinking, and freeze drying methods. Afterwards, X-ray diffraction and Fourier transform infrared spectrometer were used to analyze the scaffold qualitative components, physico-chemical property, biomechanical performance and cytocompatibility.
RESULTS AND CONCLUSION:The bionic scaffold had a three-dimensional porous structure, with the average pore size of (425.8±47.3) μm, the average porosity of (73.4±5.6)%, and the water absorption of (718.6±24.3)%. In addition, the compressive strength of the scaffold was similar with that of the natural annular fibrosus. More importantly, the scaffold had good biocompatibility without cytotoxicity. These results show that the tissue-engineered annular fibrosus scaffold constructed by konjac glucomannan, nano-hydroxyapatite and colagen has proper three-dimensional porous structure, biocompatibility, porosity, water absorption and biomechanical strength.

The establishment of a scientific salary system is a key measure to improve the incentive and re-straint mechanisms, adjust and optimize the relations of the production, release the reform “bonus”, and is also an important health care reform today. In order to establish a scientific salary system of medical personnel adapting to the health industry characteristics, the paper makes an investigation on the salary level in the years of 2010—2012 in Shanghai, and analyzes the main problems of the present performance pay policy. On this basis, starting from the point of the health industry characteristics, the paper builds the salary system of medical personnel containing the comprehensive budget management, theoretical workload for approval, authorized personnel, performance appraisal and distribution, structural proportion within the industry, fund distribution management through the establishment of the salary level’s average wage and social linkage mechanism, and builds a theoretical framework on salary system of medical personnel in Shanghai.

AIM: To observe effect of Diyu Shengbai Tablet on preventive treatment for interferon-induced leu-kopenia. METHODS: One hundred and twelve patients with chronic hepatitis B treated by IFN were randomly as-signed into two groups, and they were respectively treated with Diyu Shengbai Tablet and Leucogen for 7 days before treatment by IFN. The leukocyte count of each group was done in 3 days,7 days, 10 days, 14 days,28 days after treatment by IFN. Comparison was made on the value of leukocytes between two preventive treatment groups. RE-SULTS: In the third day after treatment by IFN the value of ANC were(1.91±0.56)×10~9/L, (1.48±0.55)× 10~9/L respectively. The value of leukocytes were (3.91±0.33)×10~9/L, (3.16±0.49)×10~9/L respectively. They had the statistical difference (P<0.05). CONCLUSION: Diyu Shengbai Tablet has an effect on preventing lekopenia induced by IFN, and it is a safe, cheap and convenient drug to treat leucopenia by IFN.

Objective To investigate the effect of different duration skeletal muscle denervation on acetylcholine receptor activity in rats.Methods Fourteen Balb/c mice weighing 18-22 g were used in this study.The denervation model was established by excising sciatic nerve.Two rats were chosen before(T0 ) and at days 1,4,7,14,21 and 28 after excising sciatic nerve (T1～6),and flexor digitorum brevis of the hindfoot was acutely isolated Skeletal muscle cells were isolated ( five cells in each rat),the acetylcholine currents were recorded using whole-cell patch-clamo technique.Extracellular fluid containing 30 μmol/L acetylcholine was first applied to skeletal muscle cells for 10 s,acetylcholine currents (11)were recorded,then the ceils were washed out using extracellularfluid.Skeletal muscle cells were balanced using extracellular fluid containing 0,0.1,1,10,30,100,1000,3000,or 10 000 nmol/L atracurium for 3 min respectively,then perfused using extracellular fluid containing 30 μmol/L acetylcholine and differents concentrations of atracurium mentioned above for 10 s respectively,and acetylcholine currents were recorded,then the cells were washed out,and 30 μmol/L acetylcholine was perfused again and currents(I2 ) were recorded.The mean value of I1 and I2 was taken as control current,and inhibitory percentage of control current was calculated,and the inhibition concentrations for the half-maximal response (IC50) of atracurium were determined by nonlinear regression analysis.Results Compared with T0,IC50 significantly increased at T1～6 ( P ＜ 0.05).IC50 was increased gradually at T1～3 ( P ＜ 0.05).Compared with T3,IC50 was decreased at T4～6 ( P ＜ 0.05).IC50 was decreased gradually at T4～6 ( P ＜ 0.05 ).Conclusion Skeletal muscle denervation can inhibite acetylcholine receptor activity,which is relate to the denervation time.

Objective:To investigate the biomechanical characteristics and clinical outcomes of arthroscopic superior capsular reconstruction for massive irreparable rotator cuff tears (MIRCT) using the long head of biceps tendon (LHBT) with tenotomizing its distally or not (the "Chinese way" ).Methods:Eight fresh-frozen cadaveric shoulders were used to create a MIRCT model by detaching the footprints of the supraspinatus and infraspinatus tendons on the greater tuberosity. LHBT autograft was transferred and securely fixed onto the footprint of supraspinatus tendon for superior capsular reconstruction. Further, all cadaveric specimens were assigned to the tenotomy group or reservation group (4 cadaveric specimens in each group) according to whether the distal part of LHBT was tentomized or not. Biomechanical tests were conducted to observe the stiffness, ultimate load of fixed LHBT and to measure the length between LHBT tear site and its insertion on the superior labrum. A total of 41 patients with MIRCT who underwent arthroscopic superior capsular reconstruction using LHBT autograft between July 2016 and December 2018 were enrolled in the study. There were 17 males and 24 females, aged from 46 to 76 years (62.6±7.3 years). All patients were assigned to the tenotomy group (23 cases) or reservation group (18 cases) according to whether the distal part of LHBT was tentomized or not. The visual analogue scale (VAS), University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score and Fudan University Shoulder Score (FUSS) were used to evaluate the clinical outcomes. The range of motion (ROM) of shoulder was recorded before and after operation. Magnetic resonance imaging was used to assess the structural integrity of reconstructed tissue at 12 months after operation (refers to the failure of the transposed LHBT, which may be accompanied by a retear of partial repaired supraspinatus tendon).Results:Biomechanical research showed that the stiffness, ultimate load of fixed LHBT and the length between LHBT tear site and its insertion on the superior labrum in the reservation group (54.0±6.6 N/mm, 141.8±15.9 N, 93.3±12.4 mm, respectively) were significantly higher than those in the tenotomy group (25.7±4.2 N/mm, 80.8±8.0 N, 47.4±2.0 mm, respectively) ( P<0.05). All patients were followed up for 12-18 months (14.5±1.8 months) without significant complications and adverse reactions. No matter the distal part of LHBT was tentomized or not, the ROM and clinical scores (VAS score, UCLA score, Constant-Murley score, ASES score and FUSS) of patients improved significantly at 1 year follow-up than that before operation ( P<0.05). However, there were no significant differences between the reservation group and tenotomy group in terms of postoperative ROM [flexion, abduction, external rotation at side, internal rotation (vertebral level) were 144.3°±15.5° vs. 148.0°±10.3°, 145.1°±14.1° vs. 142.3°±11.2°, 67.3°±14.4° vs. 62.7°±11.7°, 8.3±2.1 vs. 7.8±2.5, respectively], VAS scores (2.3±1.6 vs.1.5±1.2), functional scores (Constant-Murley score, UCLA score, ASES score and FUSS were 88.2±11.4 vs. 85.6±9.6, 29.3±2.8 vs. 31.4±3.5, 86.8±11.8 vs. 82.6±9.2, 92.1±10.1 vs. 88.3±8.2, respectively) and structural failures (35.2% vs. 30.0%, P>0.05). Conclusion:Arthroscopic superior capsular reconstruction using LHBT with reserving its distal part could achieve higher mechanics strength. However, the short-term follow-up showed that tenotomizing the distal part of LHBT exerted no obvious influence on postoperative function and structural integrity.

Objective To investigate the effect of arthroscopy-assisted latissimus dorsi transfer (LDT) on posterosuperior massive rotator cuff tear (psMRCT) and analyze factors related to the outcome.Methods A retrospective case cohort study was conducted to analyze 31 patients with psMRCT admitted from January 2013 to December 2015.There were 13 males and 18 females,aged 52-67 years [(58.4 ± 4.5) years].The mean duration of symptoms was (1.9 ± 0.9) years.All patients received arthroscopy assisted LDT combined with rotator cuff repair.Postoperative rehabilitation training was carried out according to the standard procedures.Before operation and at the last follow-up,X-ray films were taken to measure the acromiohumeral talus,and magnetic resonance imaging was obtained to check the integrity of repaired tissue.Visual analog scale (VAS),active range of motions,Constant-Murley score and Fudan University Shoulder Score (FUSS) were measured to assess the shoulder joint function,and complications were documented.Furthermore,subgroup analysis was made according to "concomitant subscapularis tendon tear or not","concomitant pseudoparalysis or not","Goutallier Ⅲ/Ⅳ level fatty infiltration","complete or partial rotator cuff repair",and " Hamada Ⅰ/Ⅱ level acromiohumeral distance".Pearson correlation analysis was performed to detect the relationship of subgroup factors with postoperative Constant-Murley score and FUSS score.Results All patients were followed up for (38.8 ± 13.0) months.No complications including fever,infection,adhesion or neural malfunction were reported.Mean acromiohumeral distance increased from preoperative (5.4 ± 0.9) mm to (7.0 ± 1.0) mm at the last follow-up (P ＜ 0.05).MRI image showed intact fixation of rotator cuff and transferred latissimus dorsi tendon.At the last follow-up,VAS score decreased from preoperative (4.8 ± 1.4)points to (0.6 ± 0.7)points;the active range of motions was restored significantly;the Constant-Murley score improved from (32.9 ± 9.5) points to (67.4 t 6.7) points;the FUSS score increased from (53.3 ± 9.1) points to (85.1 ± 4.8) points (all P ＜ 0.01).Pearson Correlation analysis indicated that,among subgroup factors,only partial rotator cuff repair was significantly inversely associated with ConstantMurley score (P ＜ 0.05) and FUSS score (P ＜0.01),and the Constant-Murley score and FUSS score of patients with complete repair were significantly higher than those of patients with partial repair (P ＜ 0.05 and P ＜ 0.01,respectively).Conclusions For psMRCT,the effect of arthroscopy-assisted LDT is confirmed,which can relieve pain,restore range of motion and improve shoulder function.Preoperative pseudoparalysis,subacapularis tendon tear,Goutallier Ⅳ level fatty infiltration and Hmada Ⅱ level acromiohumeral distance do not significantly influence postoperative outcome.The torn rotator cuff tear should be repaired as possible.