Objective To observe safety and effectiveness of Dezocine in postoperative analgesia of pediatric tonsillectomy and adenoidectomy by the continuous intravenous infusion of different doses,and to explore appropriate dosage of Dezocine for pediatric postoperative analgesia.Methods Elective tonsillectomy and adenoidectomy require-ments of postoperative analgesia in children 120 cases,they were randomly divided into A,B,C,D groups of 30 cases by using number table.After surgery patient -controlled intravenous analgesia(PCIA)two days,A,B,C groups were given Dezocine 0.2,0.3,0.4mg·kg -1 ·d -1 continuous intravenous infusion,D group received Sufentanil 1μg· kg -1 ·d -1 continuous intravenous infusion.Observed and recorded pain scores and sedation scores for postoperative 6h,12h,24h and 48h;recorded adverse reactions,pressing the number and effective pressing times of children within 48h after surgery.;recorded overall evaluation of postoperative analgesia of children and parents.Results A group at each time point pain score was significantly higher than B,C,D three groups,the difference was statistically significant (tAB =12.003,PAB =0.049;tAC =7.542,PAC =0.036;tAD =40.990,PAD =0.009);A,B,C three groups at each time point sedation score was significantly lower than D,the difference was statistically significant(tDA =3.894,PDA =0.030;tDB =5.020,PDB =0.039;tDC =36.103,PDC =0.016);D group of adverse reactions were significantly higher than A,B,C three groups,the difference was statistically significant(χ2DA =20.738,PDA =0.000,χ2DB =4.35,PDB =0.029,χ2DC =5.98,PDC =0.025);A group within 48h postoperative analgesia press times and the number of valid pressing were significantly higher than B,C,D three groups,the difference was statistically significant(tAB =3.003, PAB =0.036;tAC =5.720,PAC =0.031;tAD =37.157,PAD =0.015);B,C two groups of children and parents to evaluate postoperative analgesia overall satisfaction rates were 90.0%,93.3%,significantly higher than A 63.3%,D 60.0%,and the difference statistically significant (χ2AB =5.310,PAB =0.031;χ2DC =19.640,PDC =0.000). Conclusion Dezocine 0.3mg·kg -1 ·d -1 continuous intravenous infusion for pediatric tonsillectomy and adenoid-ectomy is safe and effective in postoperative analgesia and fewer adverse reactions,and should be promoted.

Objective To study the variation of serum Hcy and UA of Parkinson's disease.Methods 46 pa-tients with Parkinson's disease in our hospital from April 2015 to March 2016 were selected as observation group,and 57 patients with other disease at the same time were selected as control group.The contents of serum Hcy and UA of the two groups were analyzed and compared.Results The contents of serum Hcy and UA of the observation group were (17.82 ±3.12)μmol/L,(321.42 ±79.42)μmol/L.Those of the control group were (10.12 ±3.05)μmol/L, (420.15 ±70.18)μmol/L.The content of serum Hcy of observation group was higher than the control group,the con-tent of serum UA of the observation group was lower than the control group(t =12.608,P <0.01).Hcy content of middle and late patients[(18.86 ±3.12)μmol/L]was higher than early patients[(16.16 ±3.04)μmol/L](t =2.378,P <0.05),serum Hcy level was positively correlated with UPDRS(r =0.462,P =0.037),the differences were significant.Conclusion Changes of serum Hcy and UA levels were related to the occurrence of Parkinson's disease.

OBJECTIVE: To improve the accuracy of diagnosis and treatment efficacy of hemangiopericytoma in nasal cavity and paranasal sinuses. METHOD: The clinical and pathological data of 5 cases with hemangiopericytoma in nasal cavity and paranasal sinuses verified by pathology were analyzed retrospectively. RESULT: Computed tomography scan revealed vascular in 5 cases. On CT scan, hemangiopericytoma generally appeared to be a uniform high density mass with obvious enhancement upon injection of contrast material. In pathological examination, there were plentiful capillaries which were like tree branch. The normal endocytes were in the inner wall of the vessel. The round, oval and spear-like pericytes scattered around the vessel. The split phase of the nucleus could be found in the tumor cell. All cases underwent surgical resection and were proved by pathological examination. The clinical data showed that the prognosis of sinonasal hemangiopericytoma was closely related to its histological grade. The recur rate in highly malignant hemangiopericytoma was obviously higher than that in middle and low malignant tumor. The rate of misdiagnosis was 80%. CONCLUSION Hemangiopericytoma is a potentially malignant tumor. Medical imaging can help to demonstrate the site, configuration, and characteristics of the tumors and contribute to the treatment. But there are not characteristic medical features. The final diagnosis must depend on the closely related to its pathological grade. The doctor should pay attention to the description of histological pathology. All the patients must be followed up carefully.
Adult ; Aged ; Female ; Follow-Up Studies ; Hemangiopericytoma ; diagnosis ; pathology ; Humans ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Paranasal Sinus Neoplasms ; diagnosis ; pathology ; Retrospective Studies ; Young Adult

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 evaluate the applied value of multislice CT (MSCT) in the selection of living donor kidneys and excision methods.Methods Ninety living renal donors underwent MSCT assessment.The nonenhanced,arterial,venous and excretory phase examinations were performed.Using maximum intensity projection and volume rendering techniques for vascular imaging,two blinded radiologists independently analyzed and evaluated all MSCT images.According to the CT reconstructive images,radiologists and physicians selected the left renal or the right renal donors,and chose laparoscopic or open live donor nephrectomy.Results On the 90 cases of donors,78 donors underwent nephrectomy in the left kidney.Seventy-one left kidney donors having no significant variation received the routine laparoscopic live donor nephrectomy.Seven left kidney donors on both sides had relatively obvious anatomical variations such as accessory renal artery,multi-branch renal vein and renal vein in the back of the abdominal aorta,and they were subjected to the left kidney open donor nephre.ctomy.Other 12 donors having significant variation in the left kidney were given nephrectomy in the right kidney,and all of them received hand-assisted laparoscopic live donor nephrectomy.All intraoperative records of urine collection system and renal vascular anatomy were consistent with the preoperative evaluation of MSCT,and the accuracy was 100 ％.Two imaging experts in the evaluation of renal artery,renal vein and urine collection system showed good consistency.Nephrectomy was successfully performed on 90 cases of donors,and.postoperative recipients had no renal vein thrombosis and other vascular complications.Conclusion MSCT can provide accurate and valuable information for the selection of living donor kidneys and excision methods as a “one-stop” technique for the preoperative evaluation of living renal donors.

Objective To explore the clinical features of type 2 diabetic patients with hypertension , and to analyze the influencing factors of glycemic control. Methods Using stratified cluster random sampling method, 5 communities were selected from urban areas of Huai'an in 2014. Type 2 diabetic patients managed by the communities were surveyed with questionnaire, physical and biochemical examinations. The related information and clinical features were compared between diabetic patients with and without hypertension. Logistic regression analysis was used to analyze the influencing factors of glycemic control. Results The number of well-controlled diabetic patients (HbA1c<7.0%) with and without hypertension (HbA1c<7.0%) were 419 (39.3%) and 480 (52.1%), respectively. Mean values of body mass index (BMI), diabetic duration and serum creatinine in diabetic patients with hypertension were significantly higher than those in diabetic patients without hypertension (P<0.05). The proportions of macrovascular complications and dyslipidemia in diabetic patients with hypertension were significantly higher than diabetic patients without hypertension (P<0.05). Multiple logistic regression analysis showed that high degree of education, high annual family income and high frequency of glucose monitoring were beneficial factors for glycemic control in diabetic patients with hypertension. Older age, hypertension, higher waist to hip ratio (WHR), the elevated triglyceride and serum creatinine were harmful factors for glycemic control. Conclusions The situation of glycemic control in diabetic patients with hypertension in urban areas of Huai'an is not optimistic. Therefore, community managements of risk factors such as central obesity and increased triglyceride in elder diabetic patients should be strengthened.

A total of 9 806 type 2 diabetics managed by the communities were selected by the stratified cluster random sampling.The characteristics, behavior and life style, history of diseases and treatments, and familial history were collected by a standard questionnaire.Their heights and weights were measured.Furthermore, their HbA1C was tested.Logistic regression was used to analyze the association between familial history of diabetes and glycemic control.The results showed that among the diabetics, patients with familial history accounted for 18.99%, and glycemic control rate was 42.72%.Compared with the diabetics without familial history, glycemic control rate in patients with parental history of diabetes and with many relatives decreased by 0.27 fold (OR=1.27, 95%CI 1.01-1.59) and 1.01 fold (OR=2.01, 95%CI 1.25-3.23), suggesting that family history of diabetes could reduce the glycemic control rate.

Objective To investigate a more pedect method for a nice outward appearance of a reconstructed thumb.Methods A free one-stage plasty second toe transfer for thumb reconstruction by interchanging the whole skin-nail flap from the great toe with another one from the second toe.Results There were 12 cases in this group,following-up 6-9 months in 8 cases,7 cases was excellent and 1 cases was good.The reconstructed thumb got a nice looking and more normal function while no blight to the great toe occurred.Conclusion It is an effective new procedure in ameliorating outward appearance of the reconstructed thumb by transferring the free moulded second toe.

OBJECTIVETo investigate the efficacy of catheter aspiration or combined with thrombolysis in the treatment of superior mesenteric artery embolism(SMAE).

METHODSClinical and imaging data of 25 SMAE patients who underwent catheter aspiration or combined with urokinase thrombolysis in the First People's Hospital and the Second People's Hospital of Changzhou from January 2005 to July 2013 were retrospectively analyzed.

RESULTSTwenty patients were confirmed as SMA trunk embolism and 5 as SMA branch artery embolism. The embolic SMA trunks were completely recannulated by catheter aspiration in the above 20 cases, but small emboli embolized distal branch artery in 6 cases. These 6 patients plus above 5 patients with branch artery embolism received catheter aspiration combined with thrombolytic therapy. Among these 11 patients, complete open, partial open and non-open of branch arteries were found in 5, 3, 3 cases respectively, while collateral circulation increased significantly in non-open patients. During the follow-up period of (4.1±2.2) months, clinical symptom relief and digestive function recovery were observed in 24 cases. Only one case underwent bowel resection because of intestinal necrosis 24 hours after treatment and developed short bowel syndrome.

CONCLUSIONCatheter aspiration or combined with thrombolysis is a safe and effective method in treating SMAE.

Objective:To explore a clinical discipline-oriented teaching model for laboratory diagnostics and evaluate its effect in medical education.Methods:changed the arrangement of traditional teaching content, re-edited the content of the teaching materials under the guidance of clinical subjects, compiled innovative textbooks and introduced new teaching methods such as CBL and PBL. The procedure could be briefly described below. 78 students from two natural classes in batch 2015 were selected as the observation group, and 77 students from other two natural classes were selected as the control group. The new teaching model and traditional teaching model were applied respectively in the students to compare the teaching effect in the way of formative evaluation.Results:The total score of theoretical exams in the observation group was significantly higher than that of control group ( P<0.01). It was found that the scores of the observation group were significantly higher than of the control group in terms of practical techniques, clinical application type and the selection and evaluation of test items ( P<0.01). However, there was no significant difference in terms of the scores of basic knowledge and theory between the observation group and the control group ( P=0.470). Conclusion:The clinical discipline-oriented teaching method of laboratory diagnostics can promote the students in the assessment of applied and improved knowledge as well as the selection and evaluation of clinical disease examination items, which is helpful to cultivate students' clinical thinking ability, and the ability to reasonably select the test items and analyze the test results scientifically.