Objective To investigate the risks and anesthetic management of scar uterus undergoing cesarean section.MethodsOne hundred pregnant women(aged 24-43 years old)with scar uterus underwent cesarean section.Epidural anesthesia was used in 90 cases(group A)and general anesthesia in 10 cases(group B).The monitorings included ECG,BP,HR and SpO_2.CVP was measured in the high risk cases.The time from skin incision tO neonatal delivery(I-D).the time from uterine incision to delivery(U-D),and Apgar scores of neonates were recorded.Results Incomplete blockade was seen in 20 cases(22％).The I-D time was shorter in group B than that in group A[(7.5±2.0)min vs.(12.3±2.6)min](P<0.01).Intraoperative hypotension occurred in 32 cases (32％).Neonatal asphyxia happened in 21 cases(21%).Apgar scores of 11 neonatals werc less than 3,of whom 5 neonates died.Apgar scores were 4 to 7 in 10 cases,8 to 10 in 79 cases.Subtotal uterectomy was performed in 2 cases.Repair of injuried bladder had to be done in one case.Intraoperative huge bleeding took place in 15 cases.Conclusion The scar uterus undergoing cesarean section has a high risk for mothers and neonates.The incidence of incomplete epidural blockade is higher.Effectively preventing and managing the risk factors are the keys for reducing maternal and neonatal complications and mortality.

The new round of medical and health system reform proposed the need to explore effective ways to gradually reform the mechanism of “using medicine costs to supply medical care”, through the implementation of “medical separation”, solve patients’ problem of “difficult and expensive”. While implementing the mode of the “medical separation”, according to exploring and practicing the actual situation of the region, it describes on the main mode of “medical separation”, analyzes the advantages and disadvantages, and proposes policy recommendations of “medical separeation” according to analysis of different modes.

AIM: To study the effectiveness of urapidil and nitroglycerine on controlling the cardiovascular responses to tracheal intubation/extubation in patients with essential hypertension. METHODS: 45 patients with essential hypertension undergoing general anesthesia were divided randomly into control (C, without depressor, n=15), urapidil (U, 0.5 mg?kg -1 , n=15), and nitroglycerine (N, 1 ?g?kg -1 , n=15) groups. The SBP, DBP, MAP, HR and RPP were measured during intubation and extubation and at the induction of anesthesia and the end of operation respectively. RESULTS: The SBP, DBP, MAP, HR and RPP increased markedly (P

Objective:To explore the changes of serum cholinesterase(ChE)and its clinical significance in patients with sepsis.Methods:Serum cholinesterase concentration,acute physiology and chronic health evaluation(APACHE)Ⅱ scores were estimated in patients.The patients in this study were divided into the sepsis group and the non-sepsis group.The patients with sepsis were further divided into the death group and the survival group.The influence of altered serum ChE levels on prognosis was compared between the groups.Results:(1)Serum ChE was significantly lower in patients of sepsis group than that of control group(P ＜ 0.01).(2)In patients with sepsis,the serum ChE level was significantly lower in the death group compared with that of survival group(P ＜ 0.05).(3)In patients with sepsis the serum ChE levels were significantly negatively correlated with APACHE Ⅱ scores(r=-0.280,P ＜ 0.05),positively correlated with serum albumin and body mass index(r=0.458 and 0.287,P ＜ 0.05).Conclusion:Serum ChE levels can be used to determine the prognosis and severity of illness in patients with sepsis.

Objective To investigate the changes in severe burn patients with acute renal failure by using continuous blood purification(CBP). Methods Twelve severe bum patients underwent early CBP were included in this study. The levels of creatinine、blood urea nitrogen and interleukin-6(IL-6) in plasma were determined. The termperature and heart were also observed. Results After the treatment of CBP,the clinical symptoms were improved obviously ( P ＜ 0. 05 ). The levels of creatinine[( 376. 2 ± 24. 5 ) μ mol/L vs ( 145.2 ± 57. 1 ) μmol/L] 、sodium concentration [( 5.3 ± 1.6 ) mmol/L vs ( 4. 0 ± 0. 7 ) mmol/L] and potassium concentration [( 153. 4 ± 13.0 ) mmol/L vs( 140. 1 ±8.6)mmol/L]in plasma were all decreased evidently after the treatment of CBP. There were significant differences ( t = 2. 79,3.06,3. 01, P ＜ 0. 05 ). The levels of IL-6 and APACHE Ⅱ score were ( 264. 31 ± 122.42 ) ng/Land( 15.2 ±5.8) scores before treatment. While after treatment,their levels were(94. 18 ±63. 82) ng/L and(5.4 ±3. 6) scores. The difference was also significant ( t = 4. 17,3. 67, P ＜ 0. 05 ). In this study, 8 patients cured and 4 patients died. Conclusion CBP could eliminate inflammation factors effectively in severe burn patients with acute renal failure. It could afford a useful assist treatment to these patients.

BACKGROUND:Forceful fixation and enough blood supply in fracture site are the fundament for treating bone nonunion. OBJECTIVE:To investigate the outcome of autologous lilac bone-grafting and plate fixation in treatment of the ununited distal ulnar fracture with osseous defects. DESIGN,TIME AND SETTING:The own control study was performed at the Department of Orthopaedics,Sixth People's Hospital,Shanghai Jiao Tong University from August 2002 to May 2006. PARTICIPANTS:Of 21 cases of the ununited distal ulnar fracture with osseous defects,13 cases were induced by ulnar and radial fracture,and 8 cases were induced by ulnar fracture. There were 15 cases of open fracture and 6 cases of closed fracture of first onset. Bone defects were 1.5 cm-5.0 cm,averagely 3.1 cm. METHODS:Bone defects were filled with intercalary lilac grafts. Length and axial ray of ulna were controlled. Ulna was fixed utilizing 5-8 wells 1/3 tubular plate,reconstruction plate or locking compression plate. At least two screws were used at the distal end,and 3 or 4 screws were fixed in the proximal end,FoUow-up was conducted once per month to observe clinical appearances and radiograph in each patient. MAIN OUTCOME MEASURES:Fracture nonunion,dorsal extension and palmer flexion of wrist joint,pronation and supination of the forearm were measured. RESULTS:All 21 cases were followed up for a mean time of 14.7 months. All the patients obtained bony union,and a mean time of 4.6 months (ranged 3 to 7 months). The distal ulnar healed with < 10° of angular deformity in a coronal plane in one patient and with 15° of angulation in a sagittal plane in another one,while others (19 patients) obtained satisfactory alignment. The excellent and good rate was 90.5％. CONCLUSION:Intercalary bone-grafting with autologous lilac and secure fixation for treating the ununited distal ulnar fracture with osseous defects can reconstruct ulnar length,correct deformities,and obtain good bone healing and functional recovery.

Aqueous extract of Dracocephalum tanguticum Maxim. (DtM ),when given ig or ip to experimental hypoxia mice,markedly increased their tolerance to normobaric and hypobaric hypoxia. Erythrocyte superoxide dismutasc (SOD ) activity of mice or rats determined at high altitude (animaquing mountain 4700 m above sea level ) showed an elevated dismutation activity of peroxide anions. At an experimentally simulatcd altitude of 6000 m above sea level,determunation of MDA, Hb and Hct showed an obvious reduction of all the abnormally elevated criteria. It is suggested that the antihypoxia activity of DTM may be partly due to its free radical scavenging activity

BACKGROUND: Forceful fixation and enough blood supply in fracture site are the fundament for treating bone nonunion. OBJECTIVE: To investigate the outcome of autologous iliac bone-grafting and plate fixation in treatment of the ununited distal ulnar fracture with osseous defects. DESIGN, TIME AND SETTING: The own control study was performed at the Department of Orthopaedics, Sixth People’s Hospital, Shanghai Jiao Tong University from August 2002 to May 2006. PARTICIPANTS: Of 21 cases of the ununited distal ulnar fracture with osseous defects, 13 cases were induced by ulnar and radial fracture, and 8 cases were induced by ulnar fracture. There were 15 cases of open fracture and 6 cases of closed fractureof first onset. Bone defects were 1.5 cm-5.0 cm, averagely 3.1 cm. METHODS: Bone defects were filled with intercalary iliac grafts. Length and axial ray of ulna were controlled. Ulna was fixed utilizing 5-8 wells 1/3 tubular plate, reconstruction plate or locking compression plate. At least two screws were used at the distaend, and 3 or 4 screws were fixed in the proximal end. Follow-up was conducted once per month to observe clinical appearanceand radiograph in each patient. MAIN OUTCOME MEASURES: Fracture nonunion, dorsal extension and palmer flexion of wrist joint, pronation and supination othe forearm were measured. RESULTS: All 21 cases were followed up for a mean time of 14.7 months. All the patients obtained bony union, and a mean timof 4.6 months (ranged 3 to 7 months). The distal ulnar healed with

The process of protein synthesis is terminated by one of the three stop codons which are recognized by classⅠ polypeptide release factors.Subsequently, it could promote the hydrolysis of the ester bond of peptidy-tRNA, resulting in release of the nascent polypeptide.Recent results from cryoelectron microscopy, crystallography, NMR, molecular dynamic and biochemical experiments have shed considerable light on the function and structure of the classⅠ release factors.The progress in these aspects were summarized.

Objective:To report the results of neurocutaneous axial island flaps in the forearm in clinical application.Methods:12 patients with soft tissue defects around the elbow and the wrist were treated with proximally or distally based island flaps based on the lateral and medial forearm cutaneous nerves.The flaps measured 9cm?8cm to 4cm?3cm.Results:The flaps totally survived in 11 pa- tients,the other was patially survived.The color and texture of the flaps were good.Their appearance and function were satisfactory after 12～18 months follow—up.Conclusions:On the basis of the vascu- larization of the lateral and medial cutaneous nerves of the forearm,some reliable island flaps were raised successfully.These flaps are easy to dissection and have a large arc of rotaion.They were satisfac- tory in repairing the soft tissue defects around the elbow,the distalone of third of the forearm and the wrist.