Objective To compare the effect of different puncture positions in the combined spinal epidural anesthesia (CSEA)in cesarean section.Methods Ninety uterogestation women under-going elective Caesarean section were randomly divided into two groups,45 in each group.L3-4 inter-vertebral space was selected as puncture point.Group R kept right lateral position for two minutes af-ter puncture and turned 30°left tilt supine position until ready for surgery.Group L was turned to su-pine position after left lateral punctured and then turned to 30 left tilt supine position until ready for surgery.1% ropivacaine 1.5 ml+ 10% glucose 0.5 ml was used for spinal anesthesia.The sensory block level and adverse reaction within 1 5 min after the spinal anesthesia were observed,and the neo-natal Apgar score and the pH value of umbilical artery blood were recorded.Results The final block level of the group R was significantly lower than group L,and the time achieving final block height was significantly shorter than that in group L(P <0.05 ).The ephedrine dosage of group R 0 (0-6) mg was significantly lower than that of group L6 (0-12)mg (P <0.05).The PH value of umbilical artery blood in group R was significantly higher than that in group L (P <0.05).There was no sig-nificant difference in neonatal Apgar score.Conclusion In Cesarean section,keeping right lateral puncture position for two minutes after infusion and then turning 30° left tilt supine position can a-chieve better effects than 30°left tilt supine position immediately after puncturing.

Objective:To observe clinical therapeutic effect of Bushen Tiaochong Decotion on anovulatory dysfunctional uterine bleeding. Methods:One hundred and twenty-eight out-patients were randomly divided into two groups.The treatment group(n=78)was treated by oral administration of Bushen Tiaochong Decoction and the control group(n=50)by oral administration of Provera. Results:The cured rate and the total effective rate were 67.9% and 94.8% in the treatment group and 50.0% and 88.0% in the control group,respectively,with significant difference between the two groups(both P

OBJECTIVE To investigate the characters of urinary noscomial infection in intensive care unit(ICU)of our hospital in order to reduce its incidence. METHODS The 661 patients in ICU of our hospital from Jan 2005 to Jun 2006 were analyzed,and in which 63 nosocomial urinary infection patients(9.53%) were found.We analyzed the 63 patients retrospectively. RESULTS Nosocomial urinary infection occurred in 9.53% patients admitted to the ICU.Nosocomial urinary infection in ICU was correlated with ages,using of antibiotics and hormones,duration of catheterization and APACHEⅡ score,but not with gender.The most prevalent pathogens of nosocomial urinary infection in ICU were fungi(40.66%),gram-negative bacteria(31.87%) and Gram-positive bacteria(27.46%).The clinical manifestation of nosocomial urinary infection in ICU was atypical. CONCLUSIONS Nosocomial urinary infection in ICU has its own characters which clinicians should pay more attention to.To reduce its incidence,we should avoid abusing of antibiotics and hormones,and make the duration of catheterization as short as possible.

Ninety elderly patients with coronary heart disease were randomly divided into 2 groups:in study group (n = 45) the cognitive-behavioral intervention as well as conventional medical treatment were performed and in control group ( n = 45 ) only conventional treatment was given. Short Form-36 ( SF-36),symptom checklist 90(SCL-90), Hamilton anxiety scale( HAMA), Hamilton depression scale( HAMD)were evaluated before and after intervention, the serum total cholesterol (TC), triglyceride (TG)and body mass index (BMI)were measured, the smoking and drinking behaviors were recorded. After 6-month of intervention the smoking [(0. 6 ± 0. 2)cigarettes/d] and drinking [(10. 1 ± 2. 3)g/d] behaviors, the scores of SF-36 (85 ± 16), SCL-90 (104 ±4), HAMA (10 ±4) and HAMD (12 ±3), the systolic blood pressure [( 123 ± 11 ) mm Hg ( 1 mm Hg = 0. 133 kPa)], diastolic blood pressure [(77 ± 5 ) mm Hg], the fasting blood glucose [(4. 2 ± 2. 6 ) mmol/L] and BMI ( 22.5 ± 0. 5 ) in study group were significantly improved compared to control group ( P ＜ 0. 01 ). The results indicate that cognitive-behavioral intervention can improve the mental state and quality of life in elderly patients with coronary heart disease.

Objective:To explore the effect of instant blood glucose monitoring system (FGM) in perioperative blood glucose management in patients with hip fracture complicated with diabetes mellitus, and to provide guidance for perioperative blood glucose management.Methods:A total of 100 patients with hip fracture complicated with diabetes mellitus treated in the Department of Orthopaedics, Gongli Hospital, Pudong New Area, Shanghai from July 2018 to July 2020 were selected as subjects.The patients were divided into experimental group and control group by random digits table method with 50 cases in each group. The patients in both groups adopted the mode of multidisciplinary cooperation.The experimental group was used to monitor blood glucose based on FGM, and traditional blood glucose monitoring was used in the control group. The waiting time before operation, the pain caused by blood glucose acupuncture, the satisfaction of patients and medical staff, the blood glucose level at different time points and the incidence of adverse reactions were compared between the two groups.Results:The waiting time before operation, the proportion of patients with moderate and severe pain after acupuncture and the incidence of hyperglycemia in the experimental group were (2.58 ± 1.30) d, 2% (1/50) and 30% (15/50), respectively, the control group were (3.67 ± 1.59) d, 22% (11/50) and 50% (25/50), respectively. The differences were statistically significant( t value was -2.087, χ2 values were 9.470, 4.170, P<0.05). The satisfaction of patients and medical staff in the experimental group were (46.43 ± 1.87), (46.58 ± 2.10) points, respectively, the control group were (40.67 ± 3.24), (43.84 ± 2.92) points, respectively.The differences were statistically significant( t values were 8.441, 8.087, P<0.05). There was no significant difference in fasting blood glucose, 2-hour postprandial blood glucose and pre-bedtime blood glucose between the two groups( P>0.05). Conclusions:The application of FGM can realize the continuous blood glucose monitoring and management of patients,making the blood glucose reach the standard more quickly and smoothly, meanwhile it may effectively shorten the waiting time before operation and reduce the acupuncture pain of blood glucose monitoring and recognize patients with concealed abnormal blood glucose. The application can improve the satisfaction of patients and medical staff, and promote the rapid recovery of patients as well.

AIM: To observe the changes of adengl cyclase(AC) and phosphodiesterase(PDE) activities of at different time point in hypothalamus of rats with fever and hypothermia. METHODS: Radioisotope method was used to measure the activity of AC and PDE. RESULTS:The fresh yeast caused rats fever after subcutaneous injection 4h( P

Objective To investigate the clinical and pathological characteristics of nephrogenic adenoma. Methods Eleven patients were diagnosed as nephrogenic adenoma including 5 men and 6 women, aged 37-78 years (56 on average). The pathological findings in all cases of nephrogenic adenoma were presented with a review of the literature. Results Eleven cases of nephrogenic adenomas were evaluated, 2 cases were in ureter and 9 cases were in the bladder. Eight of the 9 bladder cases underwent TUR-BT surgery in continuous epidural anesthesia, 1 case underwent partial cystectomy with general anesthesia. A right ureteroscopy and left ureterolithotomy were performed respectively in continuous epidural anesthesia for the 2 cases in ureter. The final diagnosis was based on histopathological findings. For all of cases, 8 cases were diagnosed as nephrogenic adenomas, 2 cases as atypical nephrogenic adenoma and 1 case as nephrogenic adenoma with malignant transformation. The microscopic appearance of nephrogenic adenoma demonstrated that morphology closely resembled aberrant tubules of the kidney. In addition, atypical nephrogenic adenomas appeared as the presence of cytologic atypia, including nuclear enlargement, nuclear hyperchromasia and prominent nucleoli. The morphologic changes of nephrogenic adenomas with malignant transformation were that tumor cells retained the basic structural characteristics of typical nephrogenic adenomas, and the similar morphological cells lost adhesion ability among cells and presented diffuse solid growth in the surrounding area.Intravesical perfusion was further performed for treating the patients with atypical nephrogenic adenomas or nephrogenic adenomas with malignant transformation. The mean patient follow up was 46 months (range, 24- 104 months), and there was only 1 case of recurrence. Conclusions Nephrogenic adenoma is an uncommon benign lesion of the urinary tract. The symptoms and cystoscopic manifestations are not unique. We reported one patient of nephrogenic adenomas with malignant transformation and provided some evidence for malignant alteration in morphology and invasive behavior. All patients underwent local excision of the lesions. Intravesical perfusion was further performed for treating the patients of atypical nephrogenic adenomas or nephrogenic adenomas with malignant transformation. Whether it is nephrogenic adenoma or atypical nephrogenic adenoma, long-term follow-up after treatment is necessary.

Objective To discuss the clinical and pathological features of urachal carcinoma.Methods The clinical and pathological data of 7 patients diagnosed as urachal carcinoma were retrospectively analyzed,and the cIinicopathologic features,diagnosis and treatment,surgical characteristics and surgical outcomes were reviewed.There were 6 males and 1 female.Patient's age ranged from 26-75 years,with average of 52 years.Examinations before surgery included ultrasound,cystoscopy,urine cytology,CT and IVU.Six patients underwent extensive partial cystectomy and 1 patient underwent conventional partial cystectomy. Results Pathological diagnosis were 5 cases of mucinous adenocarcinoma,1 case of not classified adenocarcinoma,1 case of small cell neuroendocrine carcinoma.Clinical stages according to Sheldon staging system were 6 cases of stage ⅢA and 1 case of ⅢC.One patient died of bone metastasis 3 months after operation,1 patient experienced recurrence in bladder neck and urethra in 15 months and 24 months after operation and received TUR-Bt,the other 5 patients were alive without recurrence and metastasis with follow-up of 2-30 months. Conclusion Urachal carcinoma is a rare malignancy,and patients with this disease haye a poor prognosis.

Objective To study the clinical significance of the change of plasma BNP levels in patients with grades sepsis and its correlation with the left ventricular ejection fraction.Methods One hundred patients of sepsis who were admitted in intensive care unit of Taizhou hospital were selected.It was divided into four groups:30 patients with septic shock,40 patients with severe sepsis,30 patients with sepsis and 20 persons without disease as control group.The concentration of plasma BNP was determined using sandwich immunoflurescence,and ultrasonic cardiogram was used to evaluate heart function and clinical features in all groups.To compare with the differences of the concentration of plasma BNP and the correlation between the concentration of Plasma BNP and LVEF in all groups,the data of clinical features,28-day mortality,prognostic values of BNP and the length of stay (ROG) in ICU were collected and compared.Result Plasma BNP levels in patients with septic shock[ (976.3 ± 160.7) pg/ml] were obvious higher than severe sepsis[ (648.4 ± 267.3) pg/ml ],sepsis [ (217.2 ± 89.7) pg/ml ] and control group [ (50.3 ± 25.4)pg/ml] (P ＜0.01).LVEF in patients with septic shock [ (48.2 ±9.6)% ] was obvious lower than severe sepsis[ (52.8 ±9.4)% ],sepsis[ (61.3 ± 8.9)% ] and control group[ (66.4 ±9.3)% ] (P ＜0.05 or P ＜0.01).It appeared to be inverse relationship between LVEF and the plasma BNP levels (r =-0.876,-0.724,P ＜0.01).BNP levels were significantly higher in non-survivors compared with survivors[ (1367.6±506.4)pg/ml vs (420.3 ±82.6)pg/ml,P ＜0.01 ].The receiver operating characteristic (ROG) curves indicated that values of areas under the curve of plasma BNP levels for 28-days mortality were 0.918(P ＜0.01).Conclusion The concentration of plasma BNP in patients was different in different grades of sepsis.It appeared to be negative correlation between the concentration of plasma BNP and LVEF.Plasma BNP levels had predictive value to the patients with sepsis.

Objective To evaluate the efficacy of bronchial blocker outside the endotracheal tube for one-lung ventilation (OLV) in pediatric patients. Methods Thirty-eight American Society of Anesthe-siologists physical status ⅠorⅡ patients of both sexes, aged 4-8 yr, weighing 14. 0-28. 6 kg, scheduled for elective thoracic surgery under general anesthesia, were enrolled in this study. The size of tracheal tube was selected according to the endotracheal diameter at the level of clavicle and sternum on chest X-ray. Af-ter anesthesia induction, the distal end of the bronchial blocker was bent toward the target bronchus with a videolaryngoscope and then inserted until resistance was felt, and the preselected tracheal tube was inserted with a videolaryngoscope at a depth of (age∕2+12) cm. The position of the bronchial blocker was adjusted using a bronchofiberscope so that the upper edge of the blue cuff was 0. 5-1. 0 cm below the carina. The heart rate, mean arterial pressure, SpO2and airway pressure were recorded, arterial blood gas analysis was performed, and PaCO2and PaO2were recorded immediately before OLV (T1), at 30 min after OLV (T2) and at the end of OLV (T3). The intubation time, success rate of intubation at first attempt, displacement of bronchial blocker and occurrence of postoperative laryngeal pain and hoarseness were recorded. The pul-monary collapse was evaluated according to the standard described by Campos.Results Compared with the baseline at T1, PaO2was significantly decreased and airway pressure was increased at T2,3(P＜0. 05), and no significant change was found in heart rate, mean arterial pressure, PaCO2or SpO2at T2,3( P＞0. 05). The average intubation time was (185±38) s. The success rate of intubation at first attempt, rate of bronchial blocker displacement, excellent and good rates of pulmonary collapse and incidence of laryngeal pain and hoarseness were 95%, 16%, 100% and 11%, respectively. Conclusion Bronchial blocker outside the endotracheal tube can be effectively used for OLV in pediatric patients.