Objective To investigate the value of myocardial enzymes and cerebrospinal fluid examination in diagnosis of hand , foot and mouth disease(HFMD) complicated with systemic inflammatory response syndrome (SIRS) and multi-organ dysfunction syndrome(MODS) .Methods During April 2010 to January 2013 ,204 cases were retrospectively analyzed and checked myocardial enzymes and cerebrospinal fluid examination of the children to analyze the correlation between inspection results and incidence of SIRS and MODS .Results The incidence of SIRS and MODS and mortality rate of severe and critical group was significantly higher than ordinary group(P<0 .05) .CSF protein ,CK-MB ,LDH and cTnT content of SIRS group were significantly higher than non-SIRS group(P<0 .05) .CSF protein ,CK-MB ,LDH and cTnT content of MODS group were significantly higher than non-MODS group(P<0 .05) .Spearman rank correlation analysis showed that CSF protein ,CK-MB and cTnT was positively correlated to inci-dence of SIRS and MODS(P<0 .05 ,P<0 .05) .Conclusion Myocardial enzymes and cerebrospinal fluid examination have a higher value in diagnosis of HFMD complicated with SIRS and MODS .

Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty.

Objective To compare the influence of general anesthesia and spinal anesthesia on the mortality in rats with fat embolism.Methods Three hundred and seventy five rats were randomly assigned to receive general anesthesia （group GF,n=125）,spinal anesthesia （group SF,n=125）,or no anesthesia （group F,n=125）.Rats were injected with a half lethal dose of fat from caudal vein 20 min after anesthesia induction. The mortality was recorded at 2,8,12,and 24 h after fat injection,respectively.Results The mortality was lower in group GF than those in groups SF and F （P0.05）,while there was no statistical difference between group SF and group F.Conclusion The mortality in rats with fat embolism under general anesthesia was lower than that under spinal anesthesia.

Rheumatoid arthritis(RA) and systemic lupus erythematosus(SLE) are autoimmune disorders.The incidence and morbidity of coronary artery disease are much higher in patients with RA and SLE than in the general population.Traditional cardiovascular risk factors do not fully explain the excessive cardiovascular events.Some new factors,such as high cysteine,insulin resistance,metabolic syndrome and inflammation,may play an important role in the development of atherosclerosis.Inflammatory response,endothelial damage and autoantibodies may be associated with the pathogenic mechanism.This review provides an overview of atherosclerosis in RA and SLE.

Objective To study the transfer of ropivacaine across the single cotyledon of the term human placenta and the effects of maternal hypoproteinemia and fetal acidemia on the transfer. Methods Eighteen placentas were obtained from healthy full term parturients within 5 min after vaginal or cesarean section delivery. The dual perfused human placental model was made. The placentas were randomly divided into three groups of 6 placentas : (A) control group in which 100% fresh frozen plasma was used in both maternal and fetal circulation with pH maintained at 7.4 on both sides; (B) fetal academia group in which 100% fresh frozen plasma was used in both circulations but fetal pH was reduced to 7.0; (C) maternal hypoproteinemia group in which 50% fresh frozen plasma used in maternal circulation and 100% fresh frozen plasma in fetal circulation, pH was maintained at 7.4 on both sides. Samples were taken from the perfusate in the reservoir at 15, 30, 60, 90, 120 min after ropivacaine (2?g?ml-1) and antipyrine (10 ?g?ml-1 ) were added in maternal circulation for determination of concentrations of ropivacaine, antipyrine, glucose and lactate. Glucose consumption rate, lactate generation rate and relative and absolute transfer ratio of ropivacaine were calculated. Results Absolute transfer ratio of ropivacaine was gradually increasing with perfusion time, reaching 8.7?1.0% (A) , 10.5 ?1.6% (B) and 11.8?1.1% respectively at 120 min. Relative transfer ratio of ropivacaine was relatively constant during 120 min perfusion and was significantly higher at each time point in group B and C than in group A ( P

Objective To investigate the change in expressions of lipoxin A4 (LXA4) and lipoxin A4 receptor (ALX) in rats with fat embolism syndrome(FES).Metbods Sixty healthy male SD rats were assigned to control group and FES group which was subgrouped at l,6,12 and 24 h according to the random number table,with 12 rats each.Allogeneic perinephric fat (0.706 ml/kg) was injected to rat caudal veins in FES group.Instead isotonic saline in an equal volume was given to rats in control group.Lung samples were harvested from each group to detect pathological morphology,concentration of total protein and LXA4 in bronchoalveolar lavage fluid (BALF),lung weight to dry ratio (W/D),and activity of myeloperoxidase (MPO) and ALX mRNA.Additional 40 SD rats were divided into control group,FES 24-hour group,BML-1 11 + FES 24-hour group,and Boc-2 + FES 24-hour group according to the random number table,with 10 rats each.Pathology of lung tissue was observed using microscopy and expression of lung MPO mRNA was detected.Results Lung tissues in FES group were seriously injured compared with control group.Total protein concentration in BALF was (71.12 ± 11.05) μg/ml in FES 12-hour group,significantly increased compared to (29.82 ± 0.64) μg/ml in control group (P ＜ 0.05).LXA4 concentration in BALF was (2.72 ± 0.24) ng/ml in FES 24-hour group,significantly higher than (0.69 ±0.05)ng/ml in control group (P ＜ 0.05).Lung W/D value was 9.13 ±0.83 and 9.60 ±0.86 respectively in FES 6-hour and 12-hour groups,higher than 3.09 ±0.10 in control group (P ＜0.05).Activity of MPO in lung tissue was (0.74± 0.07)U/g and (0.53 ±0.08)U/g respectively in FES 6-hour and 12-hour groups,significantly higher than (0.19 ± 0.03) U/g in control group (P ＜ 0.05).Expression of ALX mRNA was 3.99 ± 1.09 in FES 24-hour group,significantly higher than 1.00 ±0.21 in control group (P ＜0.05).Expression of MPO mRNA was lower in BML-111 + FES 24-hour group (0.69-0.08) and was higher in Boc-2 + FES 24-hour group (2.05-0.14),when compared to 1.52 ±-0.07 in FES 24-hour group (P＜0.05).Conclusion LXA4 mainly involves in the resolution of inflammation in FES rats,which may be achieved at least in part by binding to ALX.

Objective To determine the median effective concentration (EC50) of ropivacaine for ultrasound-guided brachial plexus block.Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 19-72 yr, weighing 45-83 kg, scheduled for upper extremity surgery under brachial plexus block guided by ultrasound, were enrolled in this study. Brachial plexus block was performed under the guidance of ultrasound. After successful location, ropivacaine 30 ml was injected. EC50 of ropivacaine was determined by up-and-down sequential method. The initial concentration was 0.50% . Each time the concentration increased/decreased by 0.05% . EC50 of ropivacaine required for ultrasound-guided brachial plexus block and 95% confidence interval were calculated using Probit analysis.Results The EC50 of ropivacaine resulting in complete block of the brachial plexus nerve was 0.436%(95% confidence interval 0.393%-0.477% ). Conclusion The EC50 of ropivacaine is 0.436% for ultrasoundguided brachial plexus block.

Objective To investigate possible changes of lipoprotein(a) [Lp(a)] and oxidized Lp (a) [ox-Lp(a) ] levels after PCI and it mechanisms. Methods Bloods were selected from 75 patients with ACS undergoing PCI, and at 24 hours, 2 and 3 days, and 6 months pre-and post-PCI treatment, and from 29 control patients pre-and post-coronary angiography without undergoing PCI. The levels of Lp(a) , ox-Lp(a) , Lp(a) immune complexes (IC) and its autoantibody were determined by ELISA. The extents of CAD were determined by coronary angiography. The differences of variants pre-and post-operations were analyzed by paired samples t test. The differences of levels of Lp(a) and ox-Lp(a) among time points after PCI were analyzed by ANOVA. Correlations between Lp(a) and ox-Lp(a) , and between angiographic variables and Lp(a), ox-Lp(a) levels were calculated. Results Compared to pre-PCI, Lp(a) [233.10 (152.86-328.79) mg/L vs 202.05 (106.15-271.42) mg/L, t=6. 81, P<0.01], ox-Lp(a) [19.05 (10.98-31.80) mg/L vs 10. 51 (4.98-17.97) μg/ml, t = 13. 22,P <0. 01] and Lp(a)-IC [2.72 (1.604.91) AU vs 2. 11 (1.04-3. 97) AU, t = 3. 34, P < 0. 01 ] levels significantly increased immediately in post-PCI, while its antoantibody levels significantly decreased (A = 0. 81 ± 0. 33 vs A = 0. 72 ± 0. 28, t = 5.58, P < 0. 01). Strong correlations were noted between levels of ox-Lp( a) and Lp( a) both in pre-PCI (r =0. 66, P <0.01) and post-PCI (r = 0. 62, P <0. 01). PCI resulted in rapidrise of Lp(a) and ox-Lp(a) levels and then decreased quickly in 24 hours, returned to baseline in 2-3 days. The changes of Lp(a) and ox-Lp(a) levels in pre-and post-PCI were positively related with severity of ACS. In contrast, in the angiography-only control group, no significant changes were noted in Lp(a) , ox-Lp(a) , Lp(a)-IC and Lp(a) autoantibodies levels between the pre-and post-angiography samples. Conclusion PCI results in acute plasma acute increases of levels of Lp(a) and ox-Lp(a) ,and the changes are related with lesion severity of the coronary artery.

Objective To observe the characterization of fat emboli in cardiac chamber in pig model and the patients undergoing total hip arthroplasty(THA) by transesophageal echocardiography(TEE). Methods Different dose of fatty liquid was injected slowly via the internal jugular vein. The changes of the image were observed by continuous TEE. The lethal dose of fat embolism was recorded. Twenty-two patients underwent TEE during THA. Gray scale and echo intensity of fat embolism in right atrium were studied quantitatively in varied periods of the operation. Results With the increase of fat liquid injected in pig model, the strong- echo particles in right atrium and ventricle became more and more, the imaging of the particles was from “moving star”, “shower-like” to “snow fluffy”, at last paradoxical fat embolism occurred when the dose of fat liquid was over 4 ml. The accumulated lethal dose of fat embolism was 15.8 ～ 27.8 ml.②Fat emboli appeared as strong- echo particles in right atrium were found in different period of THA. Average gray scale and echo intensity of emboli in right atrium were significantly higher in period B than in other periods during THA. Conclusions Fat emboli in cardiac chamber can be found sensitively by TEE. Intra-operative monitoring and quantitative analysis is helpful to identifying fat embolism syndrome.Paradoxical embolism is a reliable evidence of fat embolism syndrome.

Objective To investigate the role of aquaporin 4 (AQP4) in partial pathologic process of lung injury in rat models of fat embolism syndrome (FES).Methods A total of 120 healthy male C57BL/6J mice were assigned to control group and FES group which was subgrouped at 4,6,12,24,and 48 hours with 20 mice per group,according to the random number table.Allogeneic perinephric fat was injected to rat caudal veins in FES groups.Lung samples were harvested from each group to examine pathological morphology and lung weight to dry ratio (W/D) to verify the FES models and observe the pathologic process.Expression of AQP4 was detected by western blot and immunohistochemistry.Additional 36 C57BL/6J mice were divided into control group,DMSO group,FES 12-hour group,and AQP4 inhibitor group according to the random number table,with 9 mice per group.Pathologic process of FES-induced lung injury was detected after the inhibition of AQP4.Results Damage to lung tissues was notable in FES group compared with control group.Lung W/D value was 5.06 ± 1.23,5.22 ± 1.58,6.18 ± 1.65,and 5.07 ± 0.31 at 6,12,24,and 48 hours respectively,which was higher than 3.16 ± 1.58 in control group (F =3.62,P ＜ 0.05).Expression of AQP4 was 1.71 ± 1.05 at 12 hours and 1.28 ± 0.68 at 24 hours in FES group,which showed significantly increase when compared with 0.65 ±0.08 in control group (F =4.12,P ＜0.01),whereas at 4 hours (0.76 ± 0.36),6 hours (1.17 ± 0.60),and 48 hours (0.85 ±0.45) in FES group,no statistical difference was observed when compared to control group.W/D value in FES 12-hour group (5.22 ± 1.17),DMSO group (4.96 ±1.66),and AQP4 inhibitor group (3.25 ± 1.19) was higher than 3.03 ± 1.68 in control group (F =3.69,P ＜ 0.05).Meanwhile,there was no statistical difference between DMSO and FES 12-hour groups,but significantly lowered W/D value was observed in AQP4 inhibitor group than in FES 12-hour group.Conclusion AQP4 may be implicated in mitigating lung injury induced by FES.