ObjectiveTo observe the effcacy of isoflurane supplemented with ropivacaine for sacral block in indirect inguinal hernia.Methods120 cases of children who were going to be operated in inguinal hernia repairs were randomly divided into isoflurane group( A),ropivacaine group( B ),and isoflurane supplemented with ropivacaine group(C).Sacral block was performed after induction with different anesthetics.Haemodynamics( MAP、HR 、SpO2 ) in three groups were compared,and anesthesia effect,waking time,drug dosage and adverse reactions were analyzed.ResultsHaemodynamics in isoflurane supplemented with ropivacaine group were more stable than the other two groups,and anesthesia effect was better than isoflurane group and ropivacaine group( all P ＜0.05).Moreover,waking time,drug dosage and adverse reactions in group C were statistical differently conpared with controls( all P ＜ 0.05 ).ConclusionIsoflurane supplemented with ropivacaine for sacral block was helpful for respiration and circulation management applied in indirect inguinal hernia and could be a perfect anesthetic methods.

Objective To investigate the causes of failure of manually rotating fetal head technology and its delivery outcomes.Methods One hundred and Ninety-eight cases with persistent occipito transverse position or persistent occipitoposterior position admitted to our hospital form January 2008 to December 2010 were enrolled as our subjects.According to the result of manually rotating fetal head technology,these patients were divided into the success group (126 cases) and the failure group (72 cases).The information related to delivery was recorded.Results The proportion of fetal weight ≥ 3500 g in the failure group was 76.4％ (55/72),higher than that of the success group(31.7％ (40/126)),and there has statistic significant difference (x2 =30.177,P =0.001).The proportion of uterine inertia in the failure group(58.3％ (42/72)) was higher than that of the success group(38.1％ (48/126)),and there has statistic significant difference (x2 =7.569,P =0.006).The proportion of critical or low-grade narrow birth canal in the failure group(38.9％ (28/72)) was significantly higher than that of the success group (23.8％ (30/126)),and there has statistic significant difference (x2 =5.030,P =0.002).The proportion of the improper time for manually rotating fetal head (opening of cervix was less than 6 cm,and fetal head was above ischial spine and opening of cervix was 8-10 cm,fetal head reach to more than 2 cm lower of ischial spine) in the failure group was 61.1％ (44/72),which was significantly higher than that of the success group (38.9 ％ (49/126)),and there has statistic significant difference (x2 =9.084,P =0.003).The proportion of maternal and neonatal complications (postpartum hemorrhage,puerperal morbidity,fetal distress,neonatal asphyxia) in the failure group were significantly higher than those of the success group (x2 =9.586,P =0.002 ; x2 =9.334,P =0.002 ; x2 =5.910,P =0.015 ; x2 =5.240,P =0.022).The proportion of cesarean section in the failure group(72.2％ (52/72)) was significantly higher than that of the success group(34.1％ (43/126)),and there has statistic significant difference(x2 =26.641,P =0.001).Conclusion The manually rotating fetal head technology can transform from dystocia to normal delivery and decrease the rate of cesarean section.It is necessary to prevent and deal with the failure causes of manually rotating fetal head technology.And it must be cautious to perform the follow-up correction and trial production after the failure of previous correction.

Objective To study the clinical application of 3-dimensional arterial spin labeling technology (3D-ASL) in brain tumors.Methods Twenty patients with the pathological diagnosis of brain tumors were selected in this study,with low grade glioma in 4 cases,the high grade glioma in 2 cases,lymphoma in 1 case,metastatic tumor in 7 cases,meningioma in 6 cases.All patients were appLIed preoperative 3D-ASL and dynamic contrast-enhanced perfusion magnetic sensitive (DSC) MR imaging line two methods,to analyze the value of 3D-ASL in brain tumors.Results 3D-ASL examination lesions in patients with brain tumors might be displayed in high or low perfusion; 3D-ASL and DSC were obtained from tumor tissue blood supply,the local relative cerebral blood flow (rCBF),there was no significant difference (P ＞ 0.05).The high grade glioma in 3D-ASL image showed a high perfusion,rCBF was 3.0 ± 1.3; Low grade gliomas showed low perfusion,rCBF was 0.6 ± 0.2,the rCBF between the high-and low-grade gliomas was significantly different (P ＜ 0.01).Metastatic tumor 3D-ASL showed ring high perfusion,central necrosis and edema area of low perfusion.Lymphoma 3D-ASL showed slightly higher perfusion.Meningioma showed high perfusion,and highest rCBF,3.5 ± 1.9.Conclusions 3D-ASL in the diagnosis of brain tumors,has high repeatability,non-invasive,without contrast agent.3D-ASL can be further developed into the brain blood flow dynamics of conventional evaluation methods,and can be used for brain tumors level assessment,has broad application prospects.

Type 2 Diabetes is the consequence of the disturbances of both α- and β-cell secretions.Glucagon-like peptide-1 ( GLP-1 ),which regulates the function of alpha and beta cells,has led to the emergence of a new class of oral anti-diabetic drugs.DPP-4 inhibitors,which increase the concentration of GLP-1 and consequently improve HbAlC,have become a choice for patients in different stages of diabetes.

The adenosine triphosphate-binding cassette subfamily member 4 (ABCB4) gene encodes multidrug resistance rotein 3 (MDR3),which is expressed on the cannalicular membranes of hepatocytes and translocates major phospholipids from the inner to the outer leaflet.Phospholipids are the major carrier and solvent of cholesterol,and in combination with bile salts form mixed micelles.Defects in ABCB4 function cause a low phospholipid content in bile,resulting in cholesterol supersaturation and crystal formation.Low phospholipid-associated cholelithiasis (LPAC) is characterized by the association of ABCB4 mutations and a low biliary phospholipid concentration,resulting in symptomatic gallstones starting before age 40 years,a high serum gamma glutamyl transferase (γ-GT) activity,intrahepatic microlithiasis,and recurrent biliary symptoms despite cholecystectomy.LPAC is an autosomal recessive condition caused by a rare single-gene mutation,commonly occurring in ABCB4,and can include homozygous and heterozygous point mutations in introns,coding exons,and 5 UTR regions.

Objective To discuss the influence of clean-up frequency of the operative cavity on the curative effect after endoscopic sinus surgery.Methods 368 patients with sinusitis or nasal polyps were randomly divided into observation group and control group,184 patients in each group.Control group was treated with operative cavity cleaning in moderate frequency,while observation group in intensive frequency.Results The obvious effective rate of observation group was 80.98％,which was significantly higher than that of control group(69.02％) (x2 =12.468,P ＜0.05).The ineffective rate of observation group was 2.17％,which was significantly lower than that of control group (9.78％) (x2 =15.717,P ＜ 0.05).The recurrence rate of observation group was 11.96％,which was significantly lower than that of control group (26.09％) (x2 =9.361,P ＜ 0.05).Conclusion The clean-up frequency of the operative cavity after endoscopic sinus surgery can influence curative effect,moderate clean-up frequency can significantly improve the treatment effects and deserved promotion.

With Chira's proposal of building an innovative country and implementing national intellectual property strategy,the rapid development of intellectual property,reward system of science and technology had a profound effect.This article made preliminary discussion from the level of scientific and technological achievements,the evaluation system and the types of science and technology rewards.

Objective To investigate the influence of spleen aminopeptidase lyophilized powder on serum levels of transforming growth factor -β1 (TGF -β1),monocyte chemoattractant protein -1 (MCP -1),stromal cell derived factor 1 (SDF -1 )in pediatric asthma.Methods 128 patients with asthma were randomly divided into observation group(64 cases)and control group (64 cases).Two groups of children were given symptomatic treat-ment.The control group was orally administered montelukast,the observation group was treated with montelukast and splenic ammonia lyophilized powder for 3 months.The levels of TGF -β1,MCP -1,SDF -1 of the two groups were compared before and after treatment.Results After treatment,the asthma control test table (ACT)score,expiratoryvolume in one second (FEV1 )and peak expiratory flow rate (PEF)in the observation group were (24.25 ± 3.98)points (80.25 ±4.25)%,(7.25 ±0.69)L/min,which were significantly higher than those in the control group [(20.12 ±4.02)points,(75.02 ±3.96)%,(5.82 ±0.70)L/min,t =7.203,6.757,14.459,26.677,P <0.01].After treatment,the serum levels of TGF -β1,MCP -1,SDF -1 of the observation group were (42.23 ± 6.02)ng/mL,(48.56 ±3.96)pg/mL,(252.36 ±32.22)ng/L,which were significantly lower than those in the con-trol group [(42.23 ±6.02)ng/mL,(59.02 ±4.22)pg/mL,(425.25 ±40.62)ng/L,t =6.757,14.459,26.677,all P <0.01].Conclusion Montelukast combined with splenic aminopeptidase lyophilized powder for asthma can effec-tively reduce serum TGF -β1,MCP -1,SDF -1 levels and improve clinical symptoms and lung function,improve the treatment of children.

Objective To explore the value of ultrasound on the early bone erosion of finger joint in patients with rheumatoid arthritis (RA).Methods Sixty-three cases of RA patients (patients group) with 486 finger joints was examined by high-frequency ultrasound,X-ray films and MRI,and compared with 20 controls (control group).Results The ultrasound results were significant difference between two groups (P＜0.01).The positive rate was 84.2％(409/486) in high-frequency ultrasound,and 56.2％(273/486) in X-ray films,there was significant difference between the two (P ＜ 0.05 ).The positive rate by high-frequency ultrasound was 63.8％ (136/213) in X-ray check-negative patients,and 68.1％ (145/213) by MRI.The results of the MRI contrast sensitivity of 97.6％,specificity of 75％,accuracy of 96.5％ by high-frequency ultrasound.Conclusion The high-frequency ultrasound on the X-ray check-negative patients with rheumatoid hand early joint bone erosion have some diagnostic value.

Recently,alveolar recruitment maneuver is one of effective management of mechanically ventilated patients with acute respiratory distress syndrome.Recruitment maneuvers are widely used in clinical practice to open the lung and prevent lung injury by derecruitment,improving the compliance,increasing PaO2,increasing the PaO2/FiO2 ratio,and reducing the pulmonary shunt fraction,although the evidence is still discussed.This review discussed recruitment maneuvers in pediatric patients with acute respiratory distress syndrome.