Objective To observe the effects of combined penebyclidine hydrochloride-ketamine-propofoi intravenous anesthesia with local anesthesia in transcatheter occlusion of congenital heart diseases (CHD).Methods Eighty-six patients suffered in CHD scheduled for transcatheter Amplatzer occlusio were divided randomly and averagely into two groups with 43 cases each.Group A received combined ketamine--propofol ina'avenous anesthesia with local anesthesia. Group B received combined hydrochloride-ketamine-propofol intavenous anesthesia with local anesthesia.Results The rate of upper airway obstruction of child patient that was caused by increased oral secretion in group B (4.7%) was significantly lower than that in group A(14.0%) (P ＜ 0.05 ).The upper airway obsa-uction was removed by aspirating sputum and oxygen therapy in group A,while removed "by decreasing anesthetic depth in group B.The rate of arrhythmia in operation,the time of operation and wake-up time were not significantly different between two groups [37.2%,(2.65±1.85)h,(45.4±15.2)min in group A,but 34.9%,(2.58±1.74)h,(50.2±17.3)rain in group B (P＞0.05)].Conclusion The combined penehyclidine hydrochloride-ketamine-propofol intravenous anesthesia with local anesthesia is feasible and safe in transcatheter occlusion of congenital heart diseases.

Objective To explore the role of ureteroacopy for acute upper urinary tract obstructive anuria.Methods Clinical data of 37 cases with acute upper urinary tract obstructive anuria were analyzed.Results Among 37 cases,34 cases were successfully performed ureteroseopy or ureteroseopic lithotripsy with double-J sent incubation (successful rate was 91.9%).Renal function were recovery in 32 cases.4 Cases returned to 180μmol/L,1 case need hemodialysis periodically.Conclusion Ureteroscopy could rapidly remove the obstruction and protect renal function in management of acute upper urinary tract obstruction anuria,which was contributed to the diagnosis.It was safe,effective and the preferred method.

BACKGROUND:A large number of clinical trials have found that the number of bone marrow stem cels at the femoral neck and proximal femur in patients with osteonecrosis of the femoral head is significantly reduced, accompanied by decreased activity, which causes a significant decrease in osteogenic capacity that the necrotic bone cannot be effectively repaired after absorption, leading to the colapse of the femoral head. OBJECTIVE:To probe into the early clinical efficacy of autologous peripheral blood mononuclear cel transplantation with porous core decompression for treatment of avascular necrosis of the femoral head. METHODS:Forty-five patients with avascular necrosis of the femoral head (49 hips) were enroled in this study, and underwent autologous peripheral blood mononuclear cel transplantation with porous core decompression. After treatment, pain scores, Harris hip score, scores on the satisfaction of patients were evaluated, as wel as X-ray, CT and MRI examinations. RESULTS AND CONCLUSION:Al the patients received a folow-up visit of 11-14 months, averagely (12.5±0.6) months. During the folow-up, there were no complications and serious adverse reactions. Postoperative pain scores and Harris scores were both improved significantly compared with preoperative ones (P < 0.05). At 12 months after treatment, the excelent satisfaction rate was up to 92%. Patient’s MRI low signal region accounting for a percentage of the volume of the femoral head was decreased from (40.1±7.34)% preoperatively to (20.23±5.4)% at 6 months postoperatively, and there was a significant difference (P < 0.05). These findings indicate that autologous peripheral blood mononuclear cel transplantation with porous core decompression for treatment of avascular necrosis of the femoral head has significantly clinical effects at early stage, which can obviously reduce joint pain, improve and restore hip joint function, and delay progression of disease.

Objective To investigate the clinical feature,pathologic characteristics and prognosis of non-muscle invasive urothelial bladder tumor in young and old patients.Methods From January 2000 to March 2011,the clinicial data of 48 young patients (age ≤ 40 years) with non-muscle invasive urothelial bladder tumor and 50 patients randomly selected with non-muscle invasive urothelial tumor (age ≥ 60 years) were analyzed and compared retrospectively.There were 38 male and 10 female with a median age of 35.4 years (range,18 to 40).There were 34 male and 16 female with a median age of 68.5 years (range,68.5 to 87).All patients had postoperative intravesical instillation for one year.Young patients presented with gross hematuria mostly,which were similmar with old patients.Solitary tumor were 45 cases and 40 cases,and the multiple tumors were 3 cases and 10 cases in the young and old groups,respectively.Of the young group,40 patients were treated by transurethral resection of bladder tumor,and 8 patients by partial cystectomy.Of the old group,35 patients were treated by transurethral resection of bladder tumor,and 15 patients by partial cystectomy.Results According to 2004 WHO classification of papillary urothelial tumor,lower grade tumor were more frequentto occur in young group than in old group.There was significant difference in incidence of PUNLMP between young group and old group (16/48,33.3％ and 8/50,16.0％,P ＜ 0.05).There was significant difference in incidence of high grade bladder cancer between young group and old group (7/48,14.6％ and 17/50,34.0％,P ＜0.05).The incidence of PTa tumor was 70.8％ and 44.0％ in the young and old groups,respectively (P ＜ 0.05).Median follow up was 34 months (range,6 to 132) in young group and 35 months (range,6 to 130) in old group,respectively.Five-year recurrence rate was 36.7％ and 64.3％ respectively (P ＜ 0.05).Conclusions Non-muscle invasive urothelial bladder tumor in young patients had a better prognosis than those in the old group,with lower grade and stage at diagnosisand lower recurrence rate.

Objective To evaluate the performance of ACL TOP coagulation analyzer system in the laboratory of children′s hospital. Methods According to the documents of CLSI, the analytic characteristics including precision, accuracy, linearity, interference and carryover rate were examined; specimens from healthy children were collected and assayed to determine the reference range of Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Thrombin Time (TT), Fibrinogen (FIB) and D-Dimer (D-D) from children on ACL TOP. Results The within-run and between-day coefficient of variability (CV) were within an acceptable range; The accuracy deviation of PT , APTT and FIB were less than 1/2 allowed total errors; The results of determination of FIB linearity test were correlated with the results of calculation: Y = 1.002 1X-0.122, R2 =0.998 2; The extent of influence of low to middle grade of jaundice , fat and hemolysis on each test were all less than 1/2 allowed total error; The carryover rates were lower than 1.81% and within an acceptable range; The reference range of PT, APTT, TT and FIB were PT (9.1-13.1 s), APTT (24.9-42.1 s), TT (12.6-21.1 s), FIB (1.924-4.011 g/L). Conclusion The ACL TOP coagulation analyzer has good repeatability, stability, linearity and capability of anti-interference and anti-carryover.

Objective To investigate the effects of combined epidural block with inhalation - intravenous general anesthesia (GE) on stress response in thepatients for laparoscopic radical colonectomy. Methods Twenty-eight ASA I-II patients scheduled for laparoscopic radical colonectomy were randomly divided into group GE and inhalation-intravenous general anesthesia group(group G) with 14 cases each. In group GE, epidural blocks were operated before induction, MAP,ECG ,HR,SpO2 and PETCO2 were observed and recorded at such point-time: pre-pneumoperitoneum and 1,2,3 h after pneumoperitoneum. Arterial blood-gas analysis ,noradrenaline(NE) and adrenaline(E) were also measured at the same time; Group G was the same as group GE except for no epidural block and extra fentanyl. Results The level of stress response hormones(NE and E) of post- pneumoperitoneum 1,2,3 h were increased VS those of pre-pneumoperitoneum in both groups, and group G was significant (P

Objective To investigate the feasibility, safety and clinical efficacy of staged endo-scopic treatment for refractory ureteral calculus. Methods Eighteen refractory ureteral calculus ea-ses (11 males and 7 females) treated with staged endoscopic treatment were retrospectively analyzed. The mean age of the patients was 32 years (range 2-65 years). Of the 18 cases, 2 had bilateral ure-teral calculi. Of the 20 ureteral calculi, 11 were in the upper, 6 were in the middle and 3 in the lower part of ureter. The mean diameter of the calculi was 0.9 cm (range 0.4-1.6 cm). Staged endoscopic treatment was offered to patients because of failure of ureterscopic lithotripsy or extracoporeal shock-wave lithotrispy caused by uretreal twist or eongential narrow. For all the cases, it was hard to com-pletely clear all the stone load and ureteral stents or percutaneous nephrostomy were performed to drain the kidney in the first session. Then, the calculi were removed by endoscopic manipulations in the second or third session. Results Thirteen patient's calculi were completely cleared in the second sessions 40-50 d after the first operation. The other 5 cases had to accept the third session 50-60 d after the second operations. There was no intra- or post-operative complication in all cases. During the 6 months' follow-up, there was no sign of recurrence. Conclusion Staged endoscopic treatment is a feasible and safe method and has high efficiency in the management of refractory ureteral calculi.

Objective The study of capsaicin (CAP) on the effect and mechanism of indomethacin induced acute gastric mucosal injury in different period.Methods 80 SD rats were randomly divided into 8 groups with 10 rats in each group.The experiment was completed in two phases,and the Ⅰ period was 2 weeks,the Ⅱ period was 4 weeks.The Ⅰ period including group A1 (control group),group B1 (model group),group C1 (CAP group),group D1 (CAP + indomethacin group).The grouping method of the two periods were the same.The rats' gastric mucosa were damaged by indomethacin,and then killed the rats 4 hours later.Last,astric juice was collected to determine the total acidity of gastric acid,counted thegastric mucosal injury index,observed the gastric mucosa pathological injury,detected the expression of TRPV 1、CGRP、MDA、SOD and PGI2.Results The Ⅰ period:the gastric mucosa of group A1 and C1 had no damage.Group D1 compared with group B1,there was no significant difference in gastric mucosa injury (P ＞ 0.05),total acidity decreased significantly (P ＜ 0.05),MDA was no significant difference (P ＞ 0.05),SOD、PGI2 increased significantly (P ＜ 0.05),the expression of TRPV1、CGRP increased significantly (P ＜ 0.05).The Ⅱperiod:the gastric mucosa of group A2 and C2 had no damage.Group D2 compared with group B2,the gastric mucosa injury were significantly reduced (P ＜ 0.05),total acidity decreased significantly (P ＜ 0.05),MDA decreased significantly (P ＜ 0.05),SOD、PGI2 increased significantly (P ＜ 0.05),the expression of TRPV1、CGRP increased significantly (P ＜ 0.05).Conclusion There was no damage to the general morphology and histology of gastricmucosa in rats by intragastric CAP 1 mg/(kg· d) for 2 weeks and 4 weeks.2.It could prevent that indomethacininduced acute gastric mucosal injury in rats by pretreated with CAP 1 mg(kg· d) for 4weeks.

Objective To evaluate the effect of topical anesthesia with compound lidocaine cream coated on the tracheal tube on extubation response in patients undergoing Han-uvulopharyngoplasty (H-UPPP).Methods Eighty-four patients,aged 28-48 yr,weighing 91-108 kg,scheduled for elective H-UPPP,requiring tracheal intubation under general anesthesia,were equally and randomly divided into 2 groups:compound lidocaine cream group (group L) and control group (group C).The compound lidocaine cream 2-3 g were coated on the tracheal tube cuff and exterior before induction of anesthesia in group L,while the paraffin oil was coated in group C.Mean arterial pressure (MAP),HR and pulse oxygen saturation were recorded before induction of anesthesia,at the end of infusion of anesthetics,during extubation and 5 min after extubation (T1-4).Blood samples were taken from the forearm veins on the noninfusion side at T1-4 for detection of plasma adrenergic and norepinephrine concentrations.Cardiovascular events during extubation were recorded.Results Compared with group C,MAP and HR were significantly decreased at T3,4,the incidences of hypotension and tachycardia were decreased,the plasma adrenergic and norepinephrine concentrations were significantly decreased at T2-4 in group L (P ＜ 0.05).Conclusion Topical anesthesia with compound lidocaine cream coated on the tracheal tube can effectively reduce the extubation response in the patients undergoing H-UPPP.

Objective To explore the etiology and the fungi distribution in patients with complex renal calculi,as well as the therapeutic efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL).Methods The mid-stream urine culture was underwent in 891 cases of patients with complex renal calculi.The MPCNL were performed in patients with complex renal calculi combined with fungous infection.Results Of 891 patients with complex renal calculi,3.7%(33/891) patients were presented with fungous infection,including 60.61%(20/33) with Candida albicans and 39.39%(13/33) with Candida glabrata.All the 33 patients had long-term use of broad spectrum antibiotics from 25 to 92 days(averaged 45.8 days).The patients with complex renal calculi combined with fungous infection were treated with MPCNL.The stone-free rate was 87.88%(29/33) and the insignificance stone-residual rate was 12.12%(4/33).Conclusion The patients with complex renal calculi are apt to fungous infection and the abuse of broad spectrum antibiotics should be avoided.The MPCNL is safe and reliable for the treatment of the patients with complex renal calculi combined with fungous infection.