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.

BACKGROUND: Polyvinyl alcohol (PVA) displays limitation to cell adsorbability. Can collagen improve the adsorbability of PVA to cells?OBJECTIVE: To develop a novel type composite of PVA and collagen, and explore the feasibility to serve as soft tissue substitute.DESIGN: Single sample observation.SETTING: Guangzhou Red Cross Hospital, Jinan University Medical College, Guangzhou Institute of Traumatic Surgery.MATERIALS: Fifteen New Zealand rabbits of 2.0-3.0 kg, either male or female, were provided by Medical Experimental Animal Center of Guangdong Province. The experiment was carried out in the Laboratory of Guangzhou Institute of Traumatic Surgery, and the experimental procedure was accorded with the animal ethical standards. Bovine typeI collagen was purchased from Guangzhou Trauer Biotechnology Co., Ltd. and PVA-124 from Guangzhou Chemical Reagent and Instrumentation Co., Ltd.METHODS: The experiment was performed in Guangzhou Red Cross Hospital, Jinan University Medical College between July 2003 and December 2006. ①Preparation of PVA-collagen material: 5 g/L bovine type I collagen was mixed with 5% PVA-124 at a ratio of 1 : 1. The mixture was freeze-dried at vacuum until becoming gelatinous. The internal structure was observed under the use of scanning electron microscope. ②Cytotoxicity test: PVA-collagen composite was cut into pieces of 10 mm×5 mm× 1 mm, put into 48-well culture plate after sterilized by Y ray, cultured with 1×104 3T3 cells in each well. Cell growth was observed under scanning electron microscope and laser scanning confocal microscope. ③Embedding test in vivo: Two longitudinal incisions were cut at the two sides of spine. The subcutaneous tissue was separated bluntly to form subcutaneous lacuna. Four pieces of PVA-collagen material were implanted in the lacuna and fixed. Nine specimens and the surrounding tissues were harvested from three rabbits each at one, four, eight and sixteen weeks postoperatively for pathological observation.MAIN OUTCOME MEASURES: The internal structure of gel film under scanning electron microscope, cytotoxicity test and embedding test in vivo results.RESULTS: ①Internal structure of PVA-collagen material:PVA-collagen material showed white gel shape after freeze-drying at vacuum. Penetrating three-dimensional pores were observed in the surface and inner section under scanning electron microscope. ②Cytotoxicity test results showed that 3T3 cells grew normally on the PVA-collagen material. ? Embedding test in vivo results suggested that one week after PVA-collagen implantation, foreign body reaction occurred, and the interface between material and tissue was clear. Four weeks later, only rare lymphocyte infiltration was observed, and a great amount of fibroblast hyperplasia formed collagen fibrils and false simple cuboidal epithelium coating material. In 8 weeks, no lymphocyte infiltration, neutrophilic granulocyte infiltration or foreign body giant cell were found; dense capsule wall and capsule coating material generated from a great amount of fibroblasts were observed. In 16 weeks, extending collagen fibrils were found arranged regularly with shrank nucleus, showing long ovoid or long fusiform in shape; no new formation small vessels, lymphocyte, neutrophilic granulocyte infiltration or foreign body giant cell infiltration were observed. The capsule wall was stable and thinned. CONCLUSION: PVA-collagen composite has good cell compatibility and tissue compatibility but no toxic or adverse effect. It can serve as in vivo implant.

Objective To study the effects of electroacupuncture (EA) on the elderly's postoperation cognitive dysfunction (POCD) after general anesthesia.Methods Patients who need to have surgical operation done for lumbar spinal stenosis were randomly divided into an observation group (electroacupuncture and routine intravenous anesthesia) and a control group (only routine intravenous anesthesia),and EA was administered to those in the electroacupuncture group for 30 minutes at an interval of 10 minutes,beginning at 30 minutes prior to routine intravenous anesthesia and lasted till the end of the surgery.The differences regarding intraoperative propofol and remifentanil dosage,cognitive function,the levels of serum interleukin-6(IL-6),interleukin-10 (IL-10) and S100-β were compared.Results The intraoperative propofol and remifentanil dosages in observation group were (6.54 ± 3.27) μg/(kg· h) and (3.67 ± 2.53) mg/(kg· h),respectively,while those in control group were (9.70 ± 4.82) μg/kg and (5.62 ± 1.73) mg/kg.The intraoperative propofol and remifentanil dosages in observation group were significantly lower than those in control group (P ＜ 0.05).At 72 hours post-operation the incidence of POCD in observation group was significantly lower than that in control group (1 case,2.5％ versus 8 cases,20％),while the MMSE score was higher in observation group than that in control group (25.7 ± 1.9 versus 23.2 ± 2.1).The post-operation level of serum IL-6,IL-10 and S100-β in observation group were significantly lower than that in control group (P ＜ 0.05).Conclusion Electroacupuncture could significantly improve the elderly's postoperation cognitive dysfunction after general anesthesia.It could inhibit the excessive expressions of IL-6,IL-10 and S100-β,alleviate the brain damage and reduce the incidence of POCD.

Objective To summarize the safety and efficacy of Sunitinib in the treatment of metastatic renal clear cell carcinoma. Methods Fifteen patients with clear cell metastatic RCC were treated with Sunitinib,with 11 males and 4 females,aged from 26 to 74 years with median age of 55 years.Thirteen cases of 15 were T3 to T4 stage,and 8 cases underwent radical nephrectomy,while 5 other cases underwent renal biopsy with the pathological diagnosis of renal cancer.The other two cases (one man and one woman)with the solitary kidney renal cell carcinoma ( stage T1a) and renal insufficiency,were diagnosed as metastatic renal cell carcinoma by biopsy.Sunitinib monotherapy was administered by the regimen of 6 weeks per cycle with daily oral Sunitinib 4 weeks,followed by 2 weeks off ( from 1 - 10 cycles).Response was evaluated by RECIST.Renal tumor was 9.52 ± 3.3 cm in diameter at baseline,and the assessment of metastases included retroperitoneal lymph nodes (6 cases),mediastinal lymph nodes (3 cases),brain (2 cases),lung (6 cases),bone (2 cases) and liver (2 cases).Karnofsky score,tumor changes,adverse events and the survival of each patient was assessed and recorded. Results The follow-up duration was from 1.5 - 15months,with median follow-up of 6 months,and tumor response was evaluated by RECIST.Seven of 15 patients (46.7％) treated with Sunitinib achieved partial responses (PR),7 patients (46.7％) demonstrated stable disease (SD),and 1 patient (6.7％) developed progressive disease (PD) during the follow-up.Objective Response Rate (ORR) was 46.7％,PR + SD was 93.3％,6 months PFS was 93.3％,and median PFS was 12 months,respectively.Renal tumor was 8.7 ± 4.0 cm in diameter after therapy.Two PR patients with the obvious effectiveness had experienced progressed hypertension,and one cases with hypertension that could be controlled below 140/90 mm Hg ( 1 mm Hg =0.133 kPa) by a single drug before treatment,showed increased blood pressure ( ＞ 160/105 mm Hg) following the second cycles treatment,who were administered increased dosage and combination therapy.The other case without history of hypertension,showed high blood pressure ( ＞ 150/100 mm Hg) in the third cycle,and could be controlled well by antihypertensive drugs.Fortunately,the tumor of these two cases reduced obviously by more than 50％. 1/2 adverse reactions of 12 cases:yellowing of the skin and yellow sweat ( 12 cases,80％ ),fatigue ( 12 cases,80％ ),4 cases of hypothyroidism (26.7％),bilirubin and triglyceride levels elevated in 7case (46.7％); Four cases showed 3/4 degree adverse events with the emergence of gastrointestinal bleeding in one case secondary to platelets reduction (6.7％).Three cases (20％) showed serious fatigue,nausea,vomiting and severe hand-foot skin reaction. Conclusions Sunitinib is recommended for the treatment of metastatic renal clear cell carcinoma with good efficacy and safety.

The aim of the study was to investigate the population ecology of medical shellfish and the infection of An-giostrongylus cantonensis in Longhai ,Fujian Province ,China .Aquatic and terrestrial shellfish were collected in survey points according to different types of breeding grounds .Then ,lung-microscopy method was involved in the detection of the lung tis-sue in Ampullaria gigas .Other shellfishes were mashed to detect the third-stage larvae of Angiostrongylus cantonensis .Hom-ogenization and lung microscopy were compared in the detection of the larvae of A .cantonensis in Achatina snails .Factors re-lated to the environment and influence of shellfish hosts were also included .Results showed that 8 species of molluscans were found ,including Pila gigas ,Bellamya aeruginosa ,Bellamya lithophaga ,Melanoides tuberculata ,Achatina fulica ,Vag-inulus alte ,Philomycus bilineatus ,and Bradybaenasimilaris with 1 673 specimens in 27 survey points from 9 townships .The infectionratewas19.78% inaverage.TheinfectionrateinV.altewas56.63% (47/83);theinfectionratesforA.fulicaand P .gigas were 39 .32% (92/234) and 27 .14% (130/234) ,respectively .The infection rate of each survey point was closely re-lated to the distances from the residents living area .Morever ,A .cantonensis larvae were detected in M .tuberculata .Lung mi-croscopy and homogenization method detection rate was 87 .1%and 100 .0% ,respectively .The difference was statistically sig-nificant .In conclusion ,V .alte ,A . fulica and P .gigas were A . cantonensist infection dominant population . The infection rate was closely related to micro-ecological environment for all kinds of shellfish .M .tuberculata was the new host of A .can-tonensis .Lung microscopy method should not be used in the qualitative screening detection of A . f ulica infected with A .can-tonensist .

OBJECTIVETo compare the surgical effect of three-dimensional (3D) versus 2D laparoscopic surgery in ureter lithotomy.

METHODSFrom January 2014 to 2015 May, 45 patients with ureteral calculi were randomly allocated into 2 groups to undergo ureter lithotomy under 3D laparoscopy (25 cases) and 2D laparoscopy (20 cases). The time used for each surgical process (including the exposure, D-J tube discharge, suture and other surgical procedures) was recorded and compared between the two groups.

RESULTSThe operation was completed smoothly in all the 45 patients. In this cohort, the wound drainage tube was removed in a mean of 3.0mnplus;0.8 days after the operation, the catheter was removed after a week, and the double J tube was removed at 1 month. Follow-up intravenous pyelography at 3 months after the operation reveal ureteral stricture in none of the cases. Comparison of the surgical data showed that the time used in each surgical process was significantly shorter in the 3D group than in the 2D group (P<0.05). 3D laparoscopic surgery allowed more precise operation by providing a good sense of depth as in an open surgery to reduce the operation time.

CONCLUSIONSAs a minimally invasive surgical technique, 3D laparoscopic surgery facilitates more precise and easier operation compared with 2D laparoscopy in ureter lithotomy.

Humans ; Imaging, Three-Dimensional ; Kidney Pelvis ; Laparoscopy ; methods ; Operative Time ; Retroperitoneal Space ; Ureter ; Ureteral Calculi ; surgery

OBJECTIVE:To observe clinical efficacy and safety of Kangfuxin liquid in the treatment of radioactive dermatitis of nasopharyngeal carcinoma patients. METHODS:A total of 73 nasopharyngeal carcinoma patients with radioactive dermatitis in the Third Affiliated Hospital of Kunming Medical University during Feb. 2016 to Feb. 2017 were divided into control group (36 cases) and observation group (37 cases) according to random number table. Both groups received routine treatment as Methylrosanilinium chloride solution,Compound cod liver oil and zinc oxide ointment for external use. Observation group was additionally given gauze soaked with Kangfuxin liquid on affected area,3 times a day on the basis of routine treatment. Both groups were treated for 4 weeks. Clinical efficacies of 2 groups were compared,and RTOG classification and dermatitis area were compared before and after treatment. The occurrence of ADR was recorded. RESULTS:There was statistical significance in the total response rate between observation group (94.6％) and control group (97.2％)(P<0.05). Before and after treatment,there were no RTOG Ⅳ patients in 2 groups. Before treatment,there was no statistical significance in the proportion of RTOG 0-Ⅲpatients or dermatitis area between 2 groups (P>0.05). After treatment,RTOG classification of observation group was improved significantly, the proportion of grade 0 patients was significantly higher than control group, that of gradeⅠpatients was significantly lower than control group,with statistical significance(P<0.05). There was no statistical significance in the proportion of RTOG 0-Ⅲpatients of control group before and after treatment(P>0.05). Two,four weeks after treatment,dermatitis areas of 2 groups were decreased significantly;dermatitis area 4 weeks after treatment was significantly smaller than 2 weeks after treatment;observation group was significantly smaller than control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:Additional use of Kangfuxin liquid in the treatment of radioactive dermatitis of nasopharyngeal carcinoma patients can effectively relieve symptoms and reduce dermatitis area with good safety.