Objective To observe the application effects of postoperative analgesia of ultrasound guided transverses abdominis plane (TAP) block in patients undergoing hysterectomy.Methods 50 patients with hysterectomy under general anesthesia were selected,and they were randomly divided into two groups according to the digital table,25 cases in each group.The patients of group A were injected with 0.45% ropivacaine mesylate 20mL in ultrasound guided bilateral TAP after the end of surgery before extubation,the patients of group B were injected with the same amount of normal saline in ultrasound guided bilateral TAP block.Postoperative patient-controlled intravenous analgesia with sufentanil was provided to all patients.The VAS score of the two groups after operation,the postoperative dosage of sufentanil in 24h and pressing times of analgesia pump,and the satisfaction of patients with postoperative analgesia,and adverse reactions were observed.Results The VAS scores of 2h of group A (0.96±0.74)points vs.group B (1.88±0.73)points (t=4.45);The VAS scores of 4h of group A (1.52±0.65)points vs.group B (2.24±0.72)points (t=3.69);The VAS scores of 8h of group A (1.88±0.44)points vs.group B (2.68±0.56)points (t=5.64);The VAS scores of 12h of group A (2.24±0.52)points vs.group B (2.96±0.54)points (t=4.80);The VAS scores of 24h of group A (2.44±0.51)points vs.group B (3.24±0.44)points (t=5.99);there were statistically significant differences(all P=0.00).The postoperative dosage of sufentanil in 24h[group A (51.60±1.02)μg vs.group B (55.46±1.37)μg,t=11.30,P=0.00],the pressing times of analgesia pump[group A (7.20±2.04)times vs.group B (14.92±2.74)times,t=11.30,P=0.00],the satisfaction of patients with postoperative analgesia[group A (9.20±0.71)points vs.group B (7.52±0.77)points],t=8.03,P=0.00].There were 2 cases of postoperative nausea and vomiting in group B,and 8 cases in group A,the difference was statistically significant(x2=4.50,P=0.03).Conclusion The application of postoperative analgesia of ultrasound guided TAP block in patients undergoing hysterectomy can reduce postoperative intravenous analgesic drug usage,reduce the incidence of adverse reactions induced by drugs,improve patients' comfort and satisfaction,it is suitable for clinical application.

Objective To investigate the relation between different glucose metabolism status and the IL‐6 and IL‐18 levels . Methods The pre‐diabetes group ,type 2 diabetes mellitus(T2DM) group and healthy control group(NC) were selected with 30 ca‐ses in each group .Fasting venous blood was collected for detecting fasting plasma glucose (FPG) ,triglyceride(TG) ,total cholester‐ol (TC) ,low‐density lipoprotein‐cholesterol (LDL‐C) and high‐density lipoprotein‐cholesterol (HDL‐C) levels .Serum IL‐6 and IL‐18 levels were measured by adopting the enzyme‐linked immunosorbent assay(ELISA) .Results The IL‐6 and IL‐18 levels in pre‐diabetes and T2DM groups were significant increased compared with those in the NC group ,the difference was statistically signifi‐cant (P<0 .01) .The IL‐6 level was positively correlated with FPG ,TG and IL‐18(P<0 .05) ,the IL‐18 level was positively correla‐ted with FPG ,TG and IL‐6(P<0 .05) .But IL‐6 and IL‐18 were negatively correlated with HDL‐C(P<0 .05) ,however ,had no cor‐relation with TC and LDL‐C (P>0 .05) .Conclusion IL‐6 and IL‐8 participated in the pathogenesis of T2DM ,their serum concen‐trations can be used as the evaluation indexes of pre‐diabetes screening and reverse intervention effect .

Objective To observe the effects of adiponectin on mRNA and protein expressions of connective tissue growth factor (CTGF) in hepatic stellate cells (HSCs) and the levels of procollagen type Ⅲ (PC Ⅲ) and hyaluronic acid (HA).Methods Cultured rat HSCs were treated with different concentrations of adiponectin.CTGF mRNA and protein expressions were analyzed by reverse transcription polymerase chain reaction (RT-PCR) and Western Blot.The levels of PCⅢ and HA were detected by enzymelinked immunosorbent assay (ELISA).Results Compared with the control group,the result of RT-PCR showed that the four groups had different degrees of inhibitory effect,of which group D exhibited the strongest inhibitory effect.The absorbance ratio was 1.54 ±0.18,1.21 ±0.14,0.96 ±0.10,and 0.79 ± 0.08,respectively (t =2.42,P ＜0.05;t =2.73,P ＜0.05;t =3.28,P ＜0.01;t =4.67,P ＜0.01).Western Blot also indicated that four groups had different degrees of inhibitory effect,of which D group exhibited the strongest inhibitory effect.The ratio of integral absorption was 1.54 ± 0.18,1.21 ±0.14,0.96±0.10,and 0.79 ±0.08,respectively (t =2.84,P ＜0.01;t =4.05,P ＜0.01;t =6.25,P ＜0.01;t =9.72,P ＜0.01).The levels of PCⅢ and HA secreted in culture media were also decreased.It was significantly decreased with the concentration of adiponectin increased.Conclusion Adiponectin can inhibit the levels of PC Ⅲ and HA,which may be achieved through reducing CTGF mRNA and protein expressions.

A series of novel 4-substituted-3-nitrobenzamide derivatives were designed and synthesized. The structures of the target compounds were confirmed with 1H NMR, 13C NMR, MS and element analysis. Anti-tumor activities against HCT-116, MDA-MB435 and HL-60 cell lines in vitro were evaluated by SRB assay. The results indicated most of the target compounds exhibited potent anti-tumor activity. Compound 4a showed the most potent inhibitory activities against three cancer cell lines with the GI50 values of 1.904-2.111 micromol x L(-1). Compounds 4g, 41-4n exhibited more potent inhibitory activities against MDA-MB435 and HL-60 cell lines with the GI50 values of 1.008-3.586 micromol x L(-1) and 1.993-3.778 micromol x L(-1), respectively. The structure-activity relationship of these compounds is discussed preliminarily.

A series of [1,3]dioxolo[4,5-f]isoindolone derivatives were designed, synthesized and evaluated as inhibitors of acetylcholinesterases (AChE). Furthermore, their effects on memory impairment of mice induced by scopolamine were investigated with step-through test. The results suggested that most of the target compounds exhibited potential inhibition on AChE with IC50 values at micromolar range. Compounds I1 (IC50 value of 0.086 μmol · L(-1)) and I2 (IC50 value of 0.080 μmol · L(-1)) showed the strongest AChE inhibitory activity, which are equipotent to donepezil (IC50 value of 0.094 μmol · L(-1)). Moreover, compounds I1-I4 could improve the memory impairment induced by scopolamine in mice.

Objective To summarize the etiology and surgical treatment of obstructive infantile cholestasis.Methods Clinical data of 108 cases of obstructive infantile cholestasis was studied retrospectively from April 2009 to April 2014.Results Correct diagnosis was established in all 108 patients by laparoscopic biliary tract exploration and cholangiography.Among those,there were noncorrectable biliary atresia in 81 cases (75.0％),correctable biliary atresia in 5 cases (4.6％),inspissated bile syndrome in 8 cases (7.4％),infantile hepatitis syndrome in 6 cases (5.6％),choledochal cyst in 4 cases (3.7％),biliary hypoplasia in 2 cases (1.9％),1 case (0.9％) suffered from spontaneous bile duct perforation,1 case (0.9％) suffered from oppression of lymph nodes in hepatic portal.Patients of nocorrectable biliary atresia were treated with open Kasai portoenterostomy or laparoscopic Kasai portoenterostomy,correctable biliary atresia and choledochal cyst underwent laparoscopic cyst excision and Roux-Y hepaticojejunostomy,inspissated bile syndrome,infantile hepatitis syndrome and biliary hypoplasia were treated by laparoscopic cholecystostomy and biliary tract irrigation.The patient of spontaneous bile duct perforation was treated with laparoscopic common bile duct exploration and T-tube drainage,the lymph node was excised in patient with oppression of lymph nodes in hepatic portal.All infants were followed-up for 3 months to 48 months,the clearance of jaundice rate varied in patients with Kasai portoenterostomy,patients with non-Kasai portoenterostomy were all in good condition and there were no symptom recurrence.Conclusion Biliary atresia,inspissated bile syndrome,infantile hepatitis syndrome,choledochal cyst and biliary hypoplasia are the most common cause of surgery-related infantile cholestasis.Kasai portoenterostomy,hepaticojejunostomy and cholecystostomy and biliary tract irrigation are the main surgical method for surgery-related infantile cholestasis.

OBJECTIVETo evaluate the usage of Mayo staging system in Chinese patients with primary light chain (LC) amyloidosis.

METHODClinical data, treatment and outcome of 162 primary LC amyloidosis patients with Mayo Clinic staging in Peking Union Medical College Hospital from January 2009 to June 2015 were retrospectively analyzed.

RESULTSThe median age of 162 patients with Mayo Clinic 2004 stage was 57 (20-81) y, of them 62.3% were male. The number of patients with stage I to III were 44 (27.2%), 69 (42.6%), and 49 (30.2%), respectively. The median overall survival was not reached, 23 months and 12 months in patients with Mayo Clinic 2004 stage I, II, and III, respectively (P<0.001). Among 128 patients with Mayo Clinic 2012 stage, 48 patients (37.5%), 32 patients (25.0%), 32 patients (25.0%) and 16 patients (12.5%) were staged as Mayo Clinic 2012 stage 1 to 4, and the median OS was not reached, not reached, 13 months and 3 months, respectively (P<0.001).

CONCLUSIONMayo Clinic staging systems had important prognostic value in patients with primary LC amyloidosis.

Adult ; Aged ; Aged, 80 and over ; Amyloidosis ; diagnosis ; Female ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Young Adult

Objective: To evaluate the clinical characteristics and outcomes of very high risk patients with primary immunoglobulin light-chain amyloidosis (pAL) at a single center in China. Method: Clinical data, treatment and outcome of 205 pAL patients in Peking Union Medical College Hospital from January 2009 to February 2016 were retrospectively analyzed. A 'very high risk’ group includes patients with Mayo 2004 stage Ⅲb and Mayo 2012 stage 4. Results: Of 205 patients, 34 (16.6%) were defined as very high risk pAL patients. The median age at diagnosis was 57 (20-84) years, and 22 patients (64.7%) were male. All 34 patients were diagnosed with cardiac involvement, multi-organ involvement was observed in 15 patients (44.1%) , and 27 (81.8%) had New York Heart Association Class Ⅲ or Ⅳ. Median values of serum cTnI, NT-proBNP, and free light chains difference were 0.25 μg/L, 11 733 ng/L, and 403 mg/L, respectively. Eight (24.2%) had more than 10% plasma cell on the bone marrow aspirate. Sixteen (47.1%) patients received bortezomib based chemotherapy and overall hematologic response rate was 58.3%. Median overall survival (OS) was 4 months. The estimated OS at 3, 6, 12, and 24 months was 51.3%, 44.0%, 35.2%, and 29.6%, respectively. Fourteen (41.2%) patients died within 3 months after the diagnosis. The estimated 1-year survival rate for the patients who got hematologic response, without hematologic response, and palliative treatment was 90.9%, 11.1%, and 0, respectively (P<0.001) . Conclusion Patients with very high risk pAL had very poor prognosis and the early death rate remained high. Those patients who obtained hematologic remission would have significantly better outcomes.

Objective To explore the occurrence of fetal chromosomal abnormalities among pregnant women with an adverse reproductive history using traditional karyotyping and single nucleotide polymorphism microarray(SNP-array)technology.Methods Totally 94 in 2 163(4.35%)cases of singleton pregnant women with an adverse reproductive history were performed amniocentesis in Jinhua Maternal and Child Health Care Hospital from June 2015 to June 2017. Traditional karyotyping and SNP-array were employed simultaneously for prenatal diagnosis,and the detection rates of the two methods were compared. Results All of the 94 specimens were successfully analyzed, 11 cases were found with chromosomal anomaly, the overall detection rate was 11.7%(11/94). Seven (7.4%,7/94) abnormalities cases were detected by karyotyping,and 7(7.4%)by SNP-array.The karyotyping results of trisomy 21,and 45,X and the deletion of chromosome 13 were consistent with SNP-array.Only 3(3.2%,3/94)microdeletion/duplications (the sizes of duplications and deletions were between 422.4-1 708.4 kb)and 1(1/4)loss of heterozygosity were detected by SNP-array,but were missed by karyotyping.Furthermore, 2 cases′copy number variation were found pathogenic gene related, while the other 2 were considered benign or variant of uncertain significance. Four cases(4/7)of abnormalities were detected by karyotyping, while confirmed balanced translocation and inversion by SNP-array.All patients were informed and chosen to continue the pregnancy.Conclusions The rate of abnormal fetal chromosomes in pregnant women with an adverse reproductive history is still high.SNP-array is a new molecular genetic technique,and combined with use of traditional karyotyping,it could improve the detection rate of fetal chromosomal abnormalities and reduce abortion rate, thus providing a basis for genetic counseling and prenatal diagnosis.

Objective To systematically evaluate and analyze the evidence level of randomized controlled trials (RCT) of preoperative skin preparation for emergency percutaneous coronary intervention (PCI), and to understand the current research status and evidence level of preoperative skin preparation randomized controlled trials for emergency PCI, and provide reference for skin preparation for emergency PCI. Methods PubMed, EMbase, The Cochrane Library, CINAHL, JBI, CBM, CNKI, Wanfang DATA were searched by computer from inception to March, 2018 for emergency PCI preoperative skin preparation randomized controlled trials. Two evidence panel members searched and selected articles independently and the quality was assessed in accordance with Cochrane Manual. The articles were analyzed with Review Manager 5.3, and the evidence quality was assessed with GRADE profiler 3.6.1 software. Results A total of 5 RCTs were included, of which the number of RCTs with grade A quality was 1 and the number of RCTs with grade B was 4. The results of the Meta analysis showed that there was no significant difference in the incidence of skin infections at the postoperative puncture site by conventional methods for routine removal of surgical wild hair and no removal of hair prior to emergency PCI (P＜0.05). In addition, regular removal of hair before surgery may result in prolonged preoperative preparation and may cause psychological discomfort to the patient. After the GRADE system rating, the quality of the evidence body was of a lower level. Conclusions It is more beneficial to shorten the treatment time without routine removal of all the hair at the puncture site and the surrounding patients. The evidence included is not yet certain whether the incomplete removal of hair can reduce the infection rate. In the future, more large-scale, multi-center, high-quality research should be carried out to provide more credible evidence for this study.