Objective To investigate the effect of the general anesthesia combined with peridural anesthesia on hirschsprung's radical operation through children abdominoscope. Methods 40 children patients with hirschsperung were elective eradicative operated by using endotrachal intubation complex vein general anesthesia combined with continuons peridural anesthesia.ECG,HR,MAP,SPO 2,P ET CO 2 were monitored, and blood gas were recorded and analyzed before pneumoperitoneum,15 minutes and 40 minutes after pneumoperitoneum,1 minute after deflation,before decannulation at the operation termination.Results Compared with before pneumoperitoneum date,HR inereased obviously 40 minutes after pneumoperitoneum,and before decannulation at the operation termination,peak pressure in airway increased obviously after pneumoperitoneum,the difference was notable,SPO 2 decreased after pneumoperitoneum,the difference was also significant.pH decreased gradually with the time prolongation,there was obviously difference.The trend of P ET CO 2 and PaCO 2 changes were analogous,P ET CO 2 had much notable difference after pneumoperitoneum,PaCO 2 had notable difference at the operation termination,and before decannulation,it was decreased to the basic value.Conlusions Hirschsprung's Disease eradical operation using general anesthesia combined with peridural anesthesia under abdominoscope guide,can immobilize ill children completely,relieve pain perfectly,muscular relaxation satisfactory,the physical interference to body is little and less complication.

OBJECTIVE:To prepare jumazhitong film and establish its quality control method.METHODS:The jumazhitong film former was made with PVOH-124 as the base,the content of the principal agent-dyclonine hydrochloride was determined by HPLC.RESULTS:Good linear relation was achieved when the detection concentration range of dyclonine hydrochloride was 40.8～408?g/ml(r=0.9 998),the average recovery was 101.3%(RSD=1.3%,n=6).CONCLUSION:The preparing technique of jumazhitong film former is simple,its quality is stable and the control method is feasible.

Objective To evaluate the value of acoustic radiation force impulse imaging (ARFI) technique in differential diagnosis of renal tumors.Methods Totally 86 patients with 86 renal tumors underwent conventional ultrasound and ultrasound with ARFI technique.The shear wave velocity (SWV),virtual touch tissue imaging (VTI) score between tumors and the surrounding renal parenchyma,benign and malignant tumors were compared.Results In 86 patients with renal tumors,32 cases were renal benign tumors and all them were angiomyolipomas (AML),54 cases were renal malignant tumors,inculding 26 cases of renal clear cell carcinoma (ccRCC),8 cases of renal color cell carcinoma (cRCC),5 cases of renal papillary carcinoma (pRCC),15 cases of invasive urothelial carcinoma (IUC).The difference of SWV and VTI scores between lesions and the surrounding renal parenchyma were statistically significant (both P＜0.05).The SWV and VTI score renal benign tumors were lower than those of malignant tumors (both P＜0.05).The area under the ROC curve with SWV＞1.37 m/s or VTI score＞3.83 to distinguish benign and malignant renal tumors were 0.898,0.847,sensitivity were 88.9％,83.3％,specificity were 84.4％,78.1％,respectively (P＜0.05).Among renal malignant tumors,SWV and VTI score of ccRCC significantly higher than those of other malignant tumors,and the area under the ROC curve with SWV＞2.06 m/s or VTI score＞4.31 to distinguish ccRCC and other renal malignant renal tumors were 0.766,0.729,sensitivity were 65.4％,57.7％,specificity was 82.1％,78.6％,respectively (P＜0.05).Conclusion ARFI has important value in differential diagnosis of renal tumors,and can help to distinguish ccRCC with other renal malignant tumors.

Objective To investigate the incidence and risk factors for surgical site infection (SSI)in clean wound orthopedics surgery.Methods SSI among patients receiving clean wound orthopedic surgery from April 1 to Sep-tember 30 in 2014 were monitored,risk factors for SSI were analyzed.Results A total of 665 patients were moni-tored,14 cases(2.11 %)of SSI occurred.Univariate analysis showed that types of skin,skin preparation modes, and ASA score were risk factors for SSI in clean wound orthopedic surgery (all P <0.05 ).Multivariate logistic analysis revealed that conventional skin preparation,ASA score ≥ grade Ⅱ,and duration of operation ≥90 minutes were independent risk factors for SSI in patients receiving clean wound orthopedic surgery (OR [95%CI ],3.96 [1 .07-14.70],6.45[1 .97-21 .11],and 4.08[1 .35 -12.30]respectively).Conclusion The improved method of skin preparation,grade I ASA score,and shortening duration of operation can reduce the incidence of SSI in clean wound orthopedic surgery,on the basis of improving the autoimmunization of patients,strengthening prevention and control of healthcare-associated infection can reduce the incidence of SSI in clean wound orthopedic surgery.

Objective To discuss how to reduce the incidence of postoperative infection and am-putation of patients after earthquake.Methods The wound infection and corresponding therapeutic outcome were analyzed in 592 patients in front line hospitals and station hospitals.Results The inci-dence of infection was 30. 7% in patients treated in front hospital within 8 hours post-trauma but 79. 9% after 8 hours post-trauma. There included 1 patient(0. 2%) with amputation due to clostridial myonecro-sis and 5(1. 2%)with amputation due to serious infection. Incidelice of postoperative wound infection was 7. 1% after selective operation for close injury. The incidence of infection in patients in station hospi-tals was 50. 8%, with no amputation, because they received debridement and antibiotics in site or front line hospitals. No postoperative infection was found in patients with close injury treated with selective op-eration in station hospitals. The major bacteria of wound infection in either front line hospitals or station hospitals were enterococcus faecalis and Eschrichia Coli. Incidence of combined infection was higher than that of single infection. And Gram-Negative bacillus infection exceeded Gram-Positive bacillus infection. The major wound infection obrained effective control through treatment with sensitive antibiotics.Con-clusions After earthqiale, the incidence of infection in patients with open injury is high, with high am-putation rate due to serious infection. Therefore, we propose performing as soon as possible debridement and external fixation with antibiotic treatment but reducing internal fixation. The postoperative infection late of patients with close injury in front line hospitals is much higher than that in station hospitals;their-fore, patients with stable vital signs should be transported to station hospitals as early as possible in order to reduce incidenee of infection.

Objective To evaluate the bone healing effect of vascularized tissue-engineered bone induced by endothelial progenitor cells(EPCs)in repair of large segmental radius defects in rabbits.Methods A total of 68 healthy New Zealand white rabbits were enrolled in the study and randomized into three groups,ie,experimental group(EPCs group):EPCs plus bone marrow mesenchymal stem cells (BMSCs)plus decalcified bone matrix(DBM);control group:BMSCs plus DBM;sham control group:pure DBM.Materials mentioned above were implanted into middle radius defects for 15 mm.At 12 and 16 weeks post-operatively,X-ray test,bone mineral density test,histological light microscopic test,osteocalcin immunohistochemical staining test and biomechanical test were carried out.Results Growth and plasticity of callus,speed of medullary cavity recanalization,bone healing speed and biomechanical intensity in the experimental group were all significantly better than those of control group.Conclusions Vascularized tissue-engineered bone induced by EPCs has strong osteegenic ability,can accelerate bone healing and hence is an effective method for repair of large segmental bone defects.

Objective To evaluate satisfaction and complications of deep inferior epigastric perforator (DIEP) flaps breast reconstruction afer mastectomy in breast cancer patients.Methods The 26 consecutive breast cancer patients who underwent DIEP flap breast reconstruction were collected.General patient satisfaction and esthetic satisfaction with DIEP flap breast reconstruction were accessed using a study-specific questionnaire modified from the Michigan Breast Reconstruction Outcome Study.Results Flap success rate was 100％.The general satisfaction of DIEP breast reconstruction was 61.9％ (13/21),and the esthetic satisfaction was 66.7％ (14/21).Age (≤40 years old was 81.8％ [9/11],＞40 years old was 40.0％ [4/10],P=0.049) and previous abdominal wall surgery (no previous abdominal wall surgery was 75.0％ [12/16] and previous abdominal wall surgery was 20.0％ [1/5],P=0.027) were significant negative factors affecting general satisfaction;Body mass index (BMI ＜25 kg/m2 was 76.5％ [11/17],BMI 25-30 kg/m2 was 50.0％ [2/4],P=0.049) was a statistically significant factor associated with esthetic satisfaction.Four flaps presented venous congestion.One patient had fat necrosis and one had flap infection of the reconstructed breast.One patient had a decrease in abdominal rotational strength.Conclusions DIEP flap breast reconstruction will offer distinct advantages to patients,in terms of decreased donor-site morbidity and shorter recovery periods.

Objective To observe the clinical efficacy of metronidazole tablets combined with sophora gel in treatment of bacterial vaginitis ( BV) . Methods Eighty-seven cases of BV patients were randomly divided into the study group(45cases) and the control group(42cases).The control group was given metronidazole tablets (400 mg, two times a day), oral for seven days, while the study group was given sophora gel (vaginal implantation) on the basis of control group.Seven days as a course of treatment.Pared the leukocyte esterase test positive rate in vaginal fluid and the recurrence rate within a year of the two groups before and after treatment.ResuIts After 7 days’treatment, the positive rate of leukocyte esterase (LE) in two groups were all significantly declined, which was more significant in the study group (P<0.05);the total effective rate of the study group was 95.6%, which was significantly higher than that of the control group 78.6%(P<0.05).The recurrence rate within a year of the study group was 6.7%, which was significantly lower than that of the control group 26.2%( P<0.05 ) .ConcIusion The therapy of metronidazole tablets combined with sophora gel in treating BV can significantly decline the LE positive rate and recurrence rate, and improve the clinical curative efficacy as well.

Objective To analyze the effect on clinical outcome of sepsis patients treated by early positive and standardized treatment in primary hospitals. Methods The clinical data of sepsis patients admitted to intensive care unit (ICU) of Dushanzi People's Hospital from January 1, 2015 to December 31, 2018 were retrospectively analyzed. The sepsis patients were further divided into a control group (from January to December, 2015) who received non-standardized treatment of sepsis, only according to doctors' experience, using routine antibiotics, fluid resuscitation, detection of lactic acid, etc. and a study group; from 2016, the patients with sepsis (the study group) received standardized diagnosis and treatment according to the Guidelines of Sepsis 3.0 and the actual conditions of our hospitals, and they were further subdivided into three periods: 2016 (from January to December, 2016), 2017 (from January to December, 2017), and 2018 (from January to December, 2018) periods. The main clinical outcome indicator of these patients in 4 time periods, 28-day mortality, the secondary clinical outcome indicators such as the length of stay in ICU and medical expenses in ICU were observed. Results Sixty-six patients with sepsis were finally enrolled, including 17 cases in 2015, 18 cases in 2016, 17 cases in 2017 and 14 cases in 2018. Compared with 2015, the length of ICU stay in 2016, 2017 and 2018 were significantly shorter (days: 17.45±9.09, 12.95±5.93, 12.14±4.92 vs. 20.85±13.45, all P <0.05), and the medical cost of ICU stay were significantly lower (ten thousand yuan: 9.93±5.35, 7.22±3.86, 5.15±2.88 vs. 13.37±14.14, all P < 0.05); the 28-day mortality was significantly decreased [16.67% (3/18), 11.76% (2/17), and 14.29% (2/14) vs. 35.3% (6/17), all P < 0.05]. Conclusion Early standardized treatment for patients with sepsis can significantly reduce the length of stay in ICU and medical expenses in ICU.

This study was performed to evaluate the role and mechanism of Ephedra aqueous extract in alleviating lung injury of rats with Streptococcus pneumoniae pneumonia via regulating reactive oxygen species(ROS)/NOD-like receptor protein 3(NLRP3)/caspase-1 pathway.Male SD rats were randomly divided into control group,model group,Ephedra aqueous extract(100 mg/kg,200 mg/kg,400 mg/kg)groups,solvent control group(110 ml/kg DMSO),model+solvent group,high-dose Ephedra aqueous extract+solvent group,and high-dose Ephedra aqueous extract+trimethylamine N-oxide(TMAO,110 mg/kg)group.Pneumonia model was established by instilling Streptococcus pneumoniae solution into the trachea.After 24 hours of modeling,each group was given medication by gavage for 10 consecutive days.24 hours after the last gastric lavage,pathological changes in lung tissue and the contents of interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α)in serum and bronchoalveolar lavage fluid(BALF)were detected;and the contents of malondialdehyde(MDA),superoxide dismutase(SOD),the activity of ROS and the expression levels of NLRP3,Caspase-1,GSDMD-N in lung tissue were detected.The model group rats demonstrated pathological changes in lung injury including thickening of alveolar septa and infiltration of inflammatory cells,as well as the contents of IL-1β,IL-6,TNF-α in BALF and serum,the content of MDA,the activity of ROS,the expression levels of NLRP3,Caspase-1 and GSDMD-N in lung tissue were higher than those of the control group,while the SOD content in lung tissue was lower than that of the control group(P<0.05).The lung injury of the low,medium,and high dose Ephedra aqueous extract groups were reduced,and the contents of IL-1β,IL-6,TNF-α in BALF and serum,the content of MDA,the activity of ROS,the expression levels of NLRP3,Caspase-1 and GSDMD-N in lung tissue were lower than that of the model group,while the SOD content in lung tissue was higher than that of the model group(P<0.05).The lung injury of rats in the high-dose ephedra aqueous extract+TMAO group worsened,the contents of IL-1β,IL-6,TNF-α in BALF and serum,the content of MDA,the activity of ROS,the expression levels of NLRP3,Caspase-1 and GSDMD-N in lung tissue were higher than those of the high-dose Ephedra aqueous extract+solvent group,while the SOD content in lung tissue was lower than that of the high-dose Ephedra aqueous extract+solvent group(P<0.05).In conclusion,Ephedra aqueous extract alleviates the lung injury of rats with Streptococcus pneumoniae pneumonia via inhibiting the inflammatory response,oxidative stress and pyroptosis mediated by ROS/NLRP3/Caspase-1 pathway.