Objective To compare two methods of patient controlled epidural analgesia (PCEA) with 0 2% ropivacaine plus fentanyl 2?g?ml -1 with or without background infusion for labor Methods Ninety ASA Ⅰ Ⅱ full term primigravidae in active labor who had a single fetus with vertex presentation and were expected to have vaginal delivery were randomly divided into three groups of 30 each: group A received PCEA without background infusion; group B received PCEA with background infusion and group C received no analgesia of any kind and served as control PCEA included a bolus of 4 ml with a 15 minute lock out When the primigravida was in first stage of labor, an intravenous line was established and 5% glucose normal saline 500 1000 ml was being infused When the external cervical os was dilated to 3 cm, epidural catheter was placed at L 2 3 and a test dose of 4 ml was given 5 min later when no signs of subarachnoid injection was evident, block height was tested by pinprick and another 6 ml was given 30 min later in group B background infusion of 0 2% ropivacaine + fentanyl 2?g?ml -1 was started at a rate of 4 ml?h -1 until the second stage of labor began Maternal vital signs (BP, ECG, SpO 2, P ET CO 2), VAS scores, degree of motor block, drug consumption, side effects of PCEA, gas analysis of umbilical venous blood, progress of labor, and Apgar scores were noted Venous blood samples were taken before PCEA and at the end of first stage of labor for determination of serum epinephrine and norepinephrine levels Results There were no significant differences in Apgar scores, blood gas of umbilical venous blood and the durations of first and second stage of labor among the three groups There were no differences in VAS scores, degree of sensory and motor block, serum concentrations of epinephrine and norepinephrine and percentage of cesarean section between group A and B The percentage of cesarean section was significantly higher in control group than that in group A and B Plasma NE and E concentrations at the end of the first stage of labor were significantly higher in control group than those in group A and B The ropivacaine and fentanyl consumption was less and the incidence of itching and percentage of instrumental delivery were lower in group A than those in group B Conclusions PCEA with 0 2% ropivacaine and fentanyl 2?g?ml -1 was safe and effective It reduces the percentage of cesarean section PCEA without background infusion provides the same level of analgesia as PCEA with background infusion with less drugs and side effects

Objective To explore the immunosuppression effects,outcomes and clinical significance of mesenchymal stem cells (MSCs) transplantation in burn treatment by comparing the levels of WBC,C-reaction protein (CRP),interferon-γ(IFN-γ),interferon-o (TNF-α),interleukin-6 (IL-6),interleukin-10 (IL-10) between control burn models and models conducting MSCs transplantation.Methods After stripping Wharton's Jelly from the neonatal umbilical cord,MSCs was cultured and expanded.Burn models were constructed in male SD rats weighted at (200± 5) g,and randomly grouped for control and MSCs transplantation.The rats in transplantation group were injected subcutaneously with hUCMSCs (1.5× 106) at 24 h after burning.The content of WBC,CRP,IFN-γ,TNF-α,IL-6,IL-10 in blood samples at 0,1,2,3,5 and 7 d after burning were detected by enzyme-linked immunosorbent assay (ELISA).The ELISA results,the wound healing rate at 7,14,21 and 28 d,as well as wound healing time were compared and analyzed statistically by ANOVA between the two groups.Results WBC in control group increased significantly at 1 and 2 d,and CRP in control group increased substantially at 2 and 3 d.IFN-% IL-6 and IL-10 levels in serum showed increase on 5 d,and TNF-α arrived at its peak value at 7 d.By contrast,WBC,CRP,TNF-α,IL-6 and IL-10 of the MSCs transplantation group showed slightly increase after burning and the differences were convinced by statistical analysis,while IFN-γ showed little difference among the two groups.The MSCs transplantation group also showed significantly higher wound healing rate at 14,21,28 d and shorter wound healing time than that of the control.Conclusions MSCs transplantation can suppress the over-inflammatory response by significantly mediating the inflammatory cytokines as WBC,CRP,TNF-α,IL-6,IL-10 in burn.IFN-γseems not affected by MSCs transplantation.MSCs would be suitable to promote wound healing and repair in burn,which is achieved not only by differentiation and paracrine,but also by subtle immunoregulation.

Objective To investigate the precision, trueness, and accuracy of self-developed detection system in clinical chemistry.Methods This was a methodological evaluation.Take serum creatine kinase( CK) for instance, 6 serum sampleswith different leves ( on the upper or lower limit of the reference range or close to the medicine decide levels ( MDLs) , were collected for within-run precision( repeatability) and within-laboratory precision ( intermediate precision ) experiments.5 proficiency testing ( PT ) samples, 5 samples assigned value by reference method, and 40 fresh-frozen serums were measured and compared with reference method for trueness verification.Drawing method evaluation decision chart, calculating total errors and sigma level evaluation experiment based on the CV, bias, and allowed total errors(TEa)were used to evaluate the accuracy performance.The precision, trueness, and accuracy were compared with the quality indicators.Results The within-run precision and within-laboratory precision were less than the highest requirement of Chinese industrial standard.The mean bias was -8.96%, didn′t reachthe required standard (5.5%).After taking corrective actions, all samples but one ( -5.8%) met the required standard. Compared with the reference method, the mean bias on the MDLs was less than TEa.The performance points of the method evaluation decision chart indicated excellence performance.The total errors on MDLs were 14.2%, 10.4% and 7.6%, less than 15%.The sigma levels on MDLs were 5.9, 7.5 and 15, also achieved excellent level. Conclusions The precision, trueness, and accuracy performance of CK measured by self-developed detection system achieved excellent level of the Chinese industry standard, and the same results were found from different evaluation methods.

Objective To investigate the association between gene polymorphism of cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) and Graves ophthalmopathy (GO) in Qinghai Han population.Methods Ninety cases of Graves disease were selected from June 2011 to February 2014 in The People's Hospital of Qinghai Province,and the 90 patients were divided into two subgroups according to GO (49 cases) and GD without GO(41 cases).Then the genotype and allele of CTLA-4 exon 1 (+ 49A/G) were detected in surum by the method of polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP).Results The distribution of CTLA-4 exon 1 (+ 49 A/G) genotype frequencies (AA,AG,GG) was not different between GO and GD without GO subgroups [4.1％ (2/49) to 7.3％ (3/41),44.9％ (22/49) to 61.0％ (25/41),51.0％ (25/49) to 31.7％ (13/41),Fisher exact probability,P =0.180 ＞ 0.05]; the distribution of CTLA-4 exon 1 (+ 49A/G) allele frequencies (A,G) was not different between GO and GD without GO subgroups [26.5％ (26/98) to 37.8％ (31/82),73.5％ (72/98) to 62.2％ (51/ 82),x2 =2.622,P＞ 0.05].Conclusion CTLA-4 gene exon 1 (+ 49A/G) may not be a candidate susceptibility gene for Qinghai Han GO.

Objective To investigate the mutation of type Ⅱ human hair basic keratin (hHb) gene in a family with monilethrix.Methods Scanning electron microscopy was used to observe the structure of hair shafts.With informed consent,blood samples were drawn from affected and unaffected membets in this family,as well as from 50 healthy controls.Genomic DNA was isolated from these samples.The exon 1 and exon 7 of hHb1,hHb3 and hHb6 were amplified by polymerase chain reaction (PCR).All the PCR products were sequenced directly using ABI3730 automated sequencer.DNA sequence alignment was carried out with BLAST software.Results A typical beaded appearance was observed in affected hairs by using scanning electron microscopy.There were obvious longitudinal ridges and sulcuses in hair node.and hair cuticles were irregularly shaped.Most cortex and medullary substance were absent in affected hairs of a patient.After sequence alignment,a G1289A point mutation in exon 7 of hHb6 gene,which led to a substitution of arginine for glutamide at codon 430,was detected in affected members of this family,but not in unaffected family members or 50 unrelated human controls.No mutation was observed in exon 1 or exon 7 of hHb1 and hHb3 gene or exon 1 of hHb6 gene.Conclusion The missense mutation of R430Q is a novel mutation.which may be associated with the pathogenesis of monilethrix in this pedigree.

Objective To estimate the methodology for evaluating the analytical measurement range ( AMR) and the clinically reportable range ( CRR) in lab-developed system in clinical chemistry .Methods Method evaluation .Take serum CK for instance , a series of samples were prepared from both a specimen with a high concentration of the analyte of interest and a specimen with a low concentration for the following assays.Average slope method , linear dilution recovery method and the method recommended by Clinical and Laboratory Standards Institute ( CLSI ) EP6-A were used to established AMR in the lab-developed clinical chemistry system.Based on the maximum valid dilution of the specimen and the results of AMR , CRR were determined.One-half of the total error allowance ( TEa) of Chinese health standard was set up as allowance error (7.5%).Results X-Y scatter plot was made by assigning sample numbers to the horizontal axis and actual measured values to the vertical axis , which determined the upper limit of AMR was approximate 1 651 U/L.The results analyzed by average slope method indicated that the linear correlation between expected values and actual measured values was determined , the correlation (r), the intercept (a) and the slope (b) met the linear standard, and AMR was 5-1 699 U/L.The results analyzed by EP6-A indicated that the best fitting curve was obtained by using cubic polynomial method , and the linearity deviation of the minimum concentration was -77.1%, which exceeded one-half of TEa.Followed by the deletion of the maximum concentration , the resumed experiment was done .The results showed that the nonlinear coefficient c of quadratic polynomial and the nonlinear coefficient c and d of cubic polynomial have no significant difference to 0, and AMR was 7.5-1 458.0 U/L.By linear dilution recovery method , the linear correlation between expected values and actual measured values was determined , the correlation ( r) , the intercept ( a) and the slope ( b) met the linear standard , the recovery rates was between 100.0%and 104.8%, and AMR is 5 -1 699 U/L.The CRR was determined to be 5 -33 880 U/L, which met the standard of TEa . Conclusions Average slope method, linear dilution recovery method and EP 6-A method were all used to established AMR in lab-developed clinical chemistry system .Without complicated statistical analysis , linear dilution recovery method was suitable for clinical use .The linearity deviation of the minimum concentration analyzed by EP6-A did not meet the standard of the quality objective system , suggesting defects in the statistical analysis of the results .CRR was feasibly determined by using linear dilution recovery method align with AMR.

BACKGROUND:Recent studies have found that bone marrow mesenchymal stem cels that culturedin vitro for a long time can naturaly differentiate into neural stem cels, which then differentiate into neurons and glial cels, thereby providing a new therapeutic thinking for Parkinson’s disease, sequela of cerebral infarction, cerebelar atrophy and brain dysplasia.
OBJECTIVE:To discuss the influence of neural stem cel transplantation on neurologic function of rats with cerebral hemorrhage at recovery stage and the relevant mechanism of action.
METHODS: Sixty male Sprague-Dawley rats were randomly divided into normal group (n=18), cerebral hemorrhage group (n=21) and transplantation group (n=21). Cerebral hemorrhage models were established in the latter two groups using VII type colagen enzyme induction method. At 21 days of modeling, rats in the transplantation group were injected neural stem cels via the tail vein, and those in the other two groups received the same volume of normal saline. At 7, 14, 21 days after cel transplantation, modified adhesive removal test (MST) was employed to evaluate the neurologic function of rats, and then the rats were kiled. RT-PCR was used to detect angiopoietin-1 mRNA expression in the bleeding tissues, and western blot assay was employed to measure tyrosine kinase receptor-2 protein expression.
RESULTS AND CONCLUSION:Compared with the normal group, the MST scores in the cerebral hemorrhage group and transplantation group were significantly decreased (P< 0.05). From the 7th day after transplantation, MST scores in the transplantation group were significantly higher than those in the cerebral hemorrhage group (P < 0.05). At 7, 14, 21 days after transplantation, expressions of angiopoietin-1 mRNA and tyrosine kinase receptor-2 protein were ranked as folows: transplantation group > cerebral hemorrhage group > normal group, and there was a significant difference among the three groups (P< 0.05). These findings indicate that neural stem cel transplantation can effectively promote the neurologic recovery of rats with cerebral hemorrhage at recovery stage, and the concrete mechanism may be related to the increase of angiopoietin-1 mRNA and tyrosine kinase receptor-2 protein in the bleeding tissues.

Objective To analyze the causes of hypoglycemia coma in emergency diabetes patients and its corresponding nursing strategies.Methods The reasons of hypoglycemia coma was retrospectively analyzed in our hospital and the risk factors of hypoglycemic coma were analyzed by multivariate logistic regression,and the corresponding nursing strategies were summarized.Results Of the 767 critically ill patients,100 (13.04％) had hypoglycemia,among whom 27 patients (3.52％) had severe hypoglycemia.Multivariate logistic regression analysis showed that patients with type 2 diabetes history,hypoglycemic drugs therapy,hypoproteinemia,renal insufficiency,hemodialysis,malnutrition were risk factors for hypoglycemic coma.While normal hemoglobin was a protective factor for hypoglycemic coma.Conclusion Hypoglycemia is the result of multiple factors in emergency patients.Reasonable nursing measures can effectively prevent the occurrence of hypoglycemic coma in emergency patients.

Objective To analyze the causes of hypoglycemia coma in emergency diabetes patients and its corresponding nursing strategies.Methods The reasons of hypoglycemia coma was retrospectively analyzed in our hospital and the risk factors of hypoglycemic coma were analyzed by multivariate logistic regression,and the corresponding nursing strategies were summarized.Results Of the 767 critically ill patients,100 (13.04％) had hypoglycemia,among whom 27 patients (3.52％) had severe hypoglycemia.Multivariate logistic regression analysis showed that patients with type 2 diabetes history,hypoglycemic drugs therapy,hypoproteinemia,renal insufficiency,hemodialysis,malnutrition were risk factors for hypoglycemic coma.While normal hemoglobin was a protective factor for hypoglycemic coma.Conclusion Hypoglycemia is the result of multiple factors in emergency patients.Reasonable nursing measures can effectively prevent the occurrence of hypoglycemic coma in emergency patients.

Objective To investigate the relationship between polymorphism of resistin(RETN)gene and metabolic associated fatty liver disease(MAFLD)in type 2 diabetes mellitus(T2DM)patients in middle and high altitude areas.Methods A total of 400 patients with T2DM in Qinghai area were recruited and divided into simple T2DM group(T2DM,n=200)and T2DM combined with MAFLD group(T2DM+ MAFLD,n=200)according to liver ultrasonography.Healthy individuals confirmed by physical examination were selected as the normal control group(NC,n=180).Plasma resistin levels were measured by ELISA.The polymorphism of RETN-420C/G and +299G/A genes were detected by PCR sequencing.Results By comparing the polymorphism of RETN-420C/G gene in each group,it was found that the frequencies of G/G genotype and G allele frequency in T2DM+MAFLD group were higher than those in NC group and T2DM group(P<0.05),while the frequencies of C/C genotype and C allele frequency were lower than those in NC group and T2DM group(P<0.05).The risk of MAFLD increased by 1.571,2.126 and 1.537 times respectively in T2DM patients with C/G,G/G genotype and G allele.Logistic regression analysis showed that G/G genotype was a risk factor for MAFLD in T2DM patients.By comparing the polymorphism of RETN+299G/A gene in each group,it was found that A allele frequency in T2DM+MAFLD group was higher than that in NC group and T2DM group,while G allele frequency was lower than that in NC group and T2DM group(P<0.05).The allele A increased the risk of MAFLD in T2DM patients by 1.432 times compared to allele G.Conclusion RETN gene-420C/G locus G/G genotype increases the risk of T2DM combined with MAFLD in middle and high altitudeareas.