Peripheral nerve block technique is one of the basic skills necessary to residents and it is also one of the difficult points in the resident standardized training in the department of anesthesiology. In order to maximize the learning effect of the anesthesia professional residents in the case of limited number of cases, we need to constantly enrich the teaching technologies and teaching methods. Human 3D anatomy is used for theory teaching to maintain comprehension of nerve anatomy; Ultrasound-guided nerve block technique and ultrasound simulation training are used for nerve block practice to improve nerve block skills;Problem-based learning teaching method is introduced in nerve block cases to increase the residents' ability of clinical cases management.

Objective To analyze the diagnostic process of a rare case of acute myeloid leukemia with minimal differentiation undergoing a lineage switch to mixed phenotype acute leukemia, NOS-rare types,and to investigate its difference from other acute myeloid leukemia and mixed phenotype acute leukemia. Methods Following tests were performed on the patient with switched mixed phenotype acute leukemia and three control leukemia patients ( including two acute myeloid leukemia with minimal differentiation and one mixed phenotype acute leukemia ). Cell morphology was analyzed by bone marrow smear and related cell chemical staining. Immunophenotyping of bone marrow was performed by flow cytometry ( FCM ). G-banding technique was used for karyotype analysis and RT-PCR was used for fusion gene detection. All the laboratory data of the switched patient were compared to that of three control patients in order to reveal the characteristics of such a rare phenotype switch in acute leukemia. Results Before switching, the morphology of acute myeloid leukemia with minimal differentiation demonstrated 0.82 blasts occurring in bone marrow, distinct nucleoli and absence of Auer rods. Blast cells expressed hematopoieticassociated antigens ( CD38, HLA-DR ), myeloid antigens ( CD13, CD56, CD11b ) and CD7. And these blasts were negative for MPO, CD33, CD15, CD79, CD19, CD22, cytoplasmic CD3, CD4 and CD8. After switching, 0. 42 blasts were found in bone marrow, showed eosinophilia and presence of basophile. Blast cells expressed hematopoietic-associated antigens ( CD38, HLA-DR ), myeloid antigens ( MPO, CD13 ),lymphoid antigens ( CD19, CD79a ,cytoplasmic CD3, and CD7 ). The control group showed typical morphology and immunophenotyping. No abnormal karyotype and fusion gene were detected. Conclusions It is a rare and complicated case that acute myeloid leukemia with minimal differentiation switched to mixed phenotype acute leukemia, NOS-rare types. The laboratory features, especially the change of immunophenotyping play an important role in the diagnosis.

Objective To introduce the nursing care of severe asthma patients treated by sedatives and muscle relaxants combined with mechanical ventilation. Methods Nurses with more than 3 years of working experiences in respiratory intensive care unit participated in the nursing care,such as ventilation monitoring,sedative effect assessment and artificial airway management. Results All the 18 patients were treated successfully,and the duration of mechanical ventilation ranged from 6 to 192 hours. The indicators of circulation and arterial gas after weaning were improved significantly (P<0.01). Conclusion Proper nursing care and correct sedative effect assessment is an important point to ensure treatment efficacy and reduce complications for severe asthma patients treated by sedatives and muscle relaxants combined with mechanical ventilation.

Objective The indication of hysterectomy in obstetrics emergency was studied in order to defend and decrease the incidence of hysterectomy.Method 27 cases with hysterectomy in obstetric emergency were retrospectively analyzed.Results The all indication of 27 cases of hysterectomy was endometrorrhagia in obstetric emergency.The first cause of endometrorrhagia was placental complication,the second cause was puerperal disseminated intravascular coagulation,the third cause was puerperal uterine anonym.Conclusion In order to decrease the incidence of hysterectomy in obstetric emergency,the family planning and health work of perinatal period should be done goodly,the antenatal examination should be strengthened and disseminated intravascular coagulation should be made a diagnosis and treatment timely.

Objective Knowledge about the infiltration of macrophages in diabetic wounds can help to figure out the pathogene -sis of poor healing of diabetic wounds .The aim of this study was to observe the macrophage infiltration and the expression of relative in-flammatory factors during the wound healing of diabetic rats and explore the relationship between macrophages and diabetic wound heal -ing. Methods Male Sprague Dawley rats were randomly divided into STZ induced diabetic group and normal control group .Each group had 15 rats.A 1 cm2 full-thickness skin defect was created on the rat dorsum .Wound samples and was excised .On post injury day (PID) 3, 7, and 14, rats of each group were sacrificed after wound samples and tissues around the wound edge were obtained .The differences of the wound closure rate , macrophage infiltration and the relative mRNA expression of the inflammatory factors from macro-phages were observed . Results The wound closure rate was lower in diabetic group on PID 3, 7, and 14 ([29.5 ±5.4]%vs [45.9 ± 12.8]%, [71.6 ±3.1]%vs [80.1 ±6.9]%, [93.9 ±2.8]%vs [99.4 ±1.4]%, P<0.05).HE staining showed inflammatory cells infil-diabetic wound tissue on PID 3 (P<0.05) and a higher expression on PID 14 (P<0.05).The CCR7 fluorescence staining showed more positive staining cells stayed in diabetic wound on PID 14. Conclusion Macrophage infiltration decreases in the early phase of diabetic wound healing and sustains in wound tissue in advanced stage accompanied by the expression change of related inflammatory factors, which could contribute to the difficult wound healing of diabetic rats .

Objective To explore the targeted nursing care for patients with severe traumatic brain injury complicated with intracranial infection. Methods 35 patients of severe traumatic brain injury complicated with intracranial infection from January, 2009 to December, 2011 were reviewed. Results There were 10 cases cured, 12 cases improved very well, 4 cases improved, 5 cases invalid and 4 cases died. The total effective rate was 62.86%and the fatality rate was 11.43%. Conclusion Intracranial infection can be controlled effectively by the venous and intrathecal injection of antibiotics and targeted care in the patients with severe traumatic brain injury.

Objective To observe the change of brain iron content in deep gray nucleus using susceptibility weighted imaging (SWI) in patients with Parkinson's diseases (PD). Methods The SWI examination was performed in 40 PD patients (10 patients with Hoehn-Yahr stage Ⅰ , 9 patients with Hoehn-Yahr stage Ⅱ , 9 patients with Hoehn Yahr stage Ⅲ , 6 patients with Hoehn-Yahr stage Ⅳ, 6 ptients with Hoehn Yahr stage Ⅴ ) and 33 gender- and age- matched controls, after conventional brain magnetic resonance imaging examination on a 3.0T magnetic resonance imaging.The signal values of substantia nigra zona compacta (SNc), substantia nigra zona reticulate (SNr),red nucleus (RN), putamen (Pu), globus pallidus (GP) and caudate nucleus (CN) were assessed.Results Compared with the controls, the PD patients had statistically significance of signal value differences of SNc (P=0.002), SNr (P=0.043). RN (P= 0.003), Pu (P=0.023). GP (P=0.001) andCN (P=0.033). The more significant differences of SNc(P=0.001), SNr (P=0.010),RN (P＜0. 001 ), Pu (P=0. 008), GP (P＜0. 001) and CN (P=0. 011) were observed between more severe PD lesion and control. The signal values of SNc and GP showed obviously negative correlations with Hoehn-Yahr grading (SNcr=-0.943. P＜0.001; GPr=-0.923, P＜0.001). But there was weakly correlation of the signal values of SNr, RN, Pu, CN with Hoehn Yahr grading (SNr r=0. 496. P=0.001; RN r=-0. 480. P=0.002; Pu r=-0. 494, P=0.001; CN r=-0.471, P=0.002) Conclusions Measurement of the brain iron content of SNc and GP using SWI on MRI is a reliable means of diagnosing PD, and it has significant correlation with Hoehn-Yahr grading, It could evaluate the severity of PD.

Objective To explore the effect of antinuclear antibody ( ANA+dsDNA),extractable nuclear antigen (ENA) and antineutrophil cytoplasmic antibody (ANCA) on the clinical manifestation and cerebrospinal fluid characteristics of neuromyelitis optica (NMO).Methods All 41 patients with NMO in PUMC hospital from 1985 to 2009 were retrospectively reviewed.All patients underwent examination of serum ANA+dsDNA,ENA and ANCA.Fourteen positive-autoantibody patients were compared with 27negative-autoantibody patients in gender,onset age,duration,relapse ratio,first demyelination event,the extent of optic neuritis and myelitis,EDSS,CSF protein,WBC,Oligoclonal band, 24 hours IgG index and myelin basic protein.Results The 14 NMO patients (34.1%) had positive non-organ-specific antibodies.NMO patients who had negative autoantibodies were compared with NMO patients with positive autoantibodies with significantly higher EDSS (the EDSS score were 4.5 and 2.5 respectively,U=92.5,P=0.008),more complete damage of spinal cord (3/14 vs 0/27, x2=6.736, P=0.0095) and tended to have higher visual Function Scale in remitting phase.There was no significant difference on the gender,onset age,duration,relapse ratio,first demyelination event.The positive-autoantibody patients had higher CSF WBC (2.0 vs 0,U=68.0,P=0.007) and tended to have lower 24 hours IgG index (-8.663 vs 0.163,U=30.0,P=0.053).There was no significant difference in CSF protein,MBP and OB.Conclusion NMO patients with positive autoantibodies have more severe intrathecal autoimmune inflammatory and disability,so they might need more intensive treatment.

Aim To investigate the effects of retinoic acid (RA) on induction osteroporosis model rats andpreventive effects of Danshengubao.Methods 4-month-old female Sprague-Dawley rats were given RA at 70 mg·kg~(-1)·d~(-1) and were given Danshengubao at different doses at the same time.All rats were treated by oral gavaged for 28 days.The static and dynamic parameters in cancellous bone of the fifth lumbar vertebrae (LV5) were examined and the dynamic changes of the tibial shaft (Tx) were observed with histomorphometrical analyses; the forth lumbar vertebrae (LV4) was used to perform the compression test.Results Compared with control group, biomechanical properties of LV4, the static parameters ( total tissue area, trabecular area, trabecular perimeter) and the dynamic parameters of LV5 were significantly decreased in RA group.Compared with control group, bone formation of Tx was decreased in periosteal surfaces but enhanced in endocortical surfaces in RA group.Compared with RA group, the biomechanical properties of LV4 were increased significantly in low and medium dose of Danshengubao groups.Conclusion sRA can decrease the size and the biomechanical properties of LV, but it can not change the percentage trabecular area. The mechanism may be related to the act that RA can inhibit cancellous bone formation, decrease the modeling of cortical bone in periosteal surfaces and enhance the remolding of cortical bone in endocortical surfaces. Danshengubao can improve biomechanics of LV induced by RA in rats.

Objective To evaluate the value of multislice spiral CTA in diagnosis of intracranial aneurysm.Methods CTA data in 32 patients with intracranial aneurysms proved by operation and DSA were retrospectively analysed in comparison with the results of DSA.Results 38 aneurysms in 32 patients were detected by DSA and operation.Six cases of 32 had two aneurysms.36 and 34 aneurysms were detected by DSA and CTA respectively.4 aneurysms located at anterior communicating artery,7 at middle cerebral artery,9 at posterior communicating artery,14 at internal carotid artery and 4 at basilar artery.Conclusion MSCTA can be used as the method in screening intracranial aneurysms for surgery and interventional therapy.