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.

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Objective To evaluate the efficiency of combined screening for chromosomal abnormalities in the first trimester and the ultrasound characteristics of these fetuses.Methods Retrospective study for 5000 singleton pregnancies by combined screening of trisomies 21,18,13 and Turner syndrome.Risk algorithms were developed for calculation of patient-specific risks for each of the three trisomies based on maternal age,fetal nuchal translucency,free β human chorionic gonadotropin and serum pregnancy associated plasma protein A at 11 to 13 +6 weeks of pregnant.The value of nuchal translucency (NT) and β-hCG and pregnancy-associated plasma protein A (PAPP-A) level were inputted computer,and calculate the risk value (≥ 1 ∶ 270) by automatic analysis software.Two hundred and four cases with high risk were performed transabdominal chorionic villus biopsy to detect the fetal chromosomal karyotypes.Meanwhile,other ultrasonic characteristics of fetal were elevated.Results (1) Five thousand cases of pregnant women were detected,including 4983 normal cases,62 cases were induced labor for a variety of reasons in the second trimester,including 40 cases with normal karyotype but with congenital heart disease,17 cases of chromosome abnormalities (9 cases trisomy 21,2 cases trisomy 18,1 cases trisomy 13,4 cases 45X),2 cases spina bifida,2 cases digestive tract obstruction,1 cases giant bladder.One case with low risk of fetal chromosomal abnormalities in combined screening,but high risk of age (maternal age were over 40 years old),it was 21 trisomy syndrome after the prenatal diagnosis.(2) Five cases of nasal bone loss in 9 cases of trisomy 21 (5/9),5 cases with three tricuspid regurgitation (5/9),4 cases of venous ductus a wave flow reverse (4/9),3 cases of fetal nasal bone loss accompanied by tricuspid regurgitation and venous ductus a wave flow reverse (3/9).One case of nasal bone loss in 2 cases of trisomy 18,2 cases were tricuspid regurgitation and venous ductus a wave flow reverse.Two cases in 4 cases of 45X had venous ductus a wave flow reverse.There were 8 cases (0.16％) nasal bone absence in 4983 cases of normal karyotype fetus,48 cases (0.96％) of tricuspid regurgitation and 44 cases (0.88％) of venous ductus a wave flow reverse.Thirty-two cases in 40 cases (80％) of fetal congenital heart disease were tricuspid regurgitation,30 cases of venous ductus a wave flow reverse (75％).Eight cases of nasal bone absence normal karyotype fetus were found the nasal bone at 20 weeks gestation.Conclusion Combination screening of nuchal translucency with serum markers in the first trimester were high detection rate and low false positive rate; a wave reversion and fetal nasal bone absence accompanied by tricuspid regurgitation can improve the detection rate of abnormal karyotype; abnormalities ultrasound marker may be associated with fetal congenital heart disease at 11-13 +6 weeks of pregnancy.

Objective To assess the clinical value of fetal chromosomal aneuploidy diagnosed by free fetal DNA in maternal plasma in 11-13+6 gestational weeks.Methods A total of 2 650 pregnant women who had prenatal care in Tianjin Center Hospital of Obstetrics and Gynecology from January 1,2010 to December 31,2010 were included.Each of them had an ultrasound scan to measure fetal nuchal translucency thickness.Maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein A test was performed as part of screening for chromosomal abnormalities.Results of ultrasound and maternal plasma biochemical analysis were entered into the database,and converted into multiple of median (MoM) by factors such as maternal age,weight,ethnicity,smoking history and mode of conception.The cutoff value was 1 ∶ 270.Meanwhile,20 cases had cell free fetal DNA (cffDNA) test and the ratio of the single nucleotide polymorphism on two alleles of plancenta-specific 4 (PLAC4) were measured in 16 cases.T-test,rank sum test,MannWhitney U test and Chi-square test were used as statistical methods.Results (1) A total of 74 cases were judged as high-risk,among which 35 cases underwent transabdominal chorionic villus sampling (18 cases had cffDNA test),37 cases underwent amniocentesis at the week of 20,and two cases of Rh negative did not receive the invasive examination.Totally 20 cases,including two Rh negative cases,had the cell-free fetal DNA test.(2) By cffDNA test of maternal plasma,two cases of 21 trisomy,one case of 18 trisomy,two cases of 45,XO and one case of balanced translocation were diagnosed.(3) In the two cases of 21 trisomy,maternal plasma G/A ratio ofPL4C4 RNA-single nucleotide polymorphism alleles was 1.00 (0.98,1.02) ; in 14 pregnancies with normal chromosome,the ratio was 1.055 (1.02,1.13,Z=3.5).There was no significant difference (P=0.066).Conclusion Diagnosing of fetal chromosomal aneuploidy by cffDNA in maternal plasma is feasible and noninvasive with high negative predictive value,and can be used in Rh-negative pregnant women for prenatal screening and diagnosis.

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.

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.

The protective effect of selenium ( Se ) on cobalt cardiomyopathy was investigated in rats given cobalt chloride ( 5 mg/kg?d-1?7 i.p.). Pretreatment of Se (50 ?g/kg?d-1 ?14 i.p.) could protect the myocardium injured by Co as demonstrated by the decrease in plasma CPK and GOT activities and absence of histopathologic abnormalities. Se contents in hearts and the cardiac glutathione peroxidase activity were increased, but the level of lipid peroxide in the heart was unaltered after i.p. Se. As compared with the Co group rats, SDH reaction was increased in intensity, lipid staining and free fatty acid contents in myocardium of the Se + Co group were decreased to the normal extent, indicating that the protective effect of Se appeared to be related to the prevention of the cobalt-induced inhibition of SDH and disturbance of lipid metabolism in the heart.