OBJECTIVE:To observe the effect of ondansetron on the anesthesia of cesarean section surgery with spinal-epidur-al anesthesia. METHODS:A total of 60 singletons full-term pregnancy were randomly divided into test group and control group. Test group was given 6% Hetastarch(130/0.4)electrolyte injection 500 ml by intravenous infusion 30 min before anesthesia,and Ondansetreon hydrochloric acid injection 4 ml by intravenous infusion 5 min before anesthesia;control group was given 6% Hetas-tarch(130/0.4)electrolyte injection 500 ml by intravenous infusion 30 min before anesthesia,and 0.9% Sodium chloride injection 4 ml by intravenous infusion 5 min before anesthesia. The clinic data was recorded,including the mean arterial pressure (MAP) and heart rate(HR)before anesthesia puncture(T1),after anesthesia maternal left side(T2),after fetal childbirth(T3)and at the end of surgery(T4),Apgar score and incidence of adverse reactions. RESULTS:MAP in control group at T2,T3 was obviously low-er than T1 and test group,HR was obviously higher than T1 and test group,the difference was statistically significant(P<0.05);there were no significant differences in the MAP and HR in test group at each time point(P>0.05). Apgar score of newborn after 1 min birth in test group was significantly higher than control group,the difference was statistically significant (P<0.05),and there was no significant difference in the Apgar score of newborn after 5 min birth between 2 groups(P>0.05). The ADR incidence in test group was significantly lower than control group(P<0.05). CONCLUSIONS:Ondansetron can effectively reduce the inci-dences of vomit vomitting and hypotension in on the cesarean section surgery with spinal-epidural anesthesia,with good safety.

Objective To evaluate the management strategy for gallbladder carcinoma found during the procedure of intended laparoscopic cholecystectomy (LC) Methods Twenty one cases of primary gallbladder carcinoma were incidently found during a period of 1996-2003, among them 17 cases of Nevin stage Ⅱ、Ⅲ and Ⅳ were divided into group A (6 cases) converted to open radical resection, and group B (11 cases) treated by LC ? 2 test and Kaplan Meier analysis were used to analyze postoperative survival rates Results (1) Two Nevin stage Ⅰ cases are still alive for 6 and 47 months at a follow up after LC; (2) For stage Ⅱ、 Ⅲ and Ⅳ patients, open surgery resulted a much longer survival ( ? 2=4 55, P =0 0328) Conclusion (1) For Nevin stage Ⅰ patients, simple LC is enough; (2) Patients of Nevin stage Ⅱ、 Ⅲ and Ⅳ should be coverted to open radical resection

Objective To determine the effect of moderate hypothermia on coagulation in patients with severe traumatic brain injury (sTBI) and investigate the clinical significance of thrombelastogram (TEG) monitoring.Methods Seventy-five patients with sTBI were randomly assigned to hypothermia group (conventional treatment + moderate hypothermia within 24 hours posttrauma,n =38) and control group (conventional treatment alone,n =38).TEG aided in monitoring coagulation function by measuring clot reaction time (R),clot formation time (K),clotting rate (α),maximal amplitude (MA),and percent fibrinolysis at 30 minutes after MA (LY30).Meantime,the intracranial pressure,vital signs,blood gas values,and blood electrolytes were also measured.Outcome was evaluated by using Glasgow outcome scale (GOS).Results The two groups were similar on admission with respect to R,K,α,MA,and LY30 (P ＞ 0.05),but the coagulation index in hypothermia group was significantly different from that in control group at days 1,2,3 and 7 posttreatment (P ＜ 0.05).Moreover,moderate hypothermia therapy demonstrated decrease of intraeranial pressure (P ＜ 0.01),with no severe complications,low mortality and improved outcome in comparison with control group.Conclusion Moderate hypothermia improves the hypercoagulability in patients with sTBI without increasing the risk of hyperfibrinolysis and protects brain tissue by decreasing intracranial pressure.

Objective To investigate the effect of astilbin on expressions of perforin and granzyme B in activated T cells of mouse heart transplantation model with acute rejection.Methods Cardiomyocytes of BALB/C mouse and spleen cells of C57BL/6 mouse were harvested and made into single cell suspensions.The cardiomyocytes(2?10~5 ml~(-1))as stimulators and spleen cells(1?10~6 ml~(-1)) as responsers were mixed and cultured.The model of mouse heart transplantation with acute rejection in vitro was therefore established.There were two groups in the experiment.Control group is the mixed culture of the cardiomyocytes and spleen cells;Astilbin group is the mixed culture of the cardiomyocytes and spleen cells with astilbin(15?g/ml).Apoptosis of T cells were analyzed by TUNEL assay.The expressions of perforin and granzyme B were measured by RT-PCR.Results Apoptosis of activated T cells in Astilbin group was significantly increased than that of the control group(P

Objective To study the clinical experience and determine the optimal timing for periop-erative internal aortic balloon pumb (IABP) support in high-risk patients who had coronary artery bypass grafting (CABG) had been demonstrated. Methods Fifteen cases of emergency CABG with IABP were performed from September 2003 to April 2008. Eight cases were supported by IABP before operation,1 case was supported after succeeding in cardiopulmonary resuscitation,2 cases were supported by IABP for acute myocardial infarction,5 cases were supported by IABP for acute coronary syndrome. Seven cases were supported by IABP in the time of intra-or postoperation,2 cases were supported by IABP in order to help re-moving cardiopulmonary bypass in the operation. Result Three cases supported by IABP in the time of in-tra-or postoperation were dead, the other 12 cases were healed. Conclusions IABP can improve the heart function effectively and therefore can increased the success rate of operation.The beneficial effect of preoperative IABP in high-risk patients who have CABG is confirmed.

Acute kidney injury (AKI) is a clinical syndrome characterized by a rapid decline of renal function in a short period of time. In recent years, the incidence of AKI has been increasing gradually. Once the AKI occurs in a patient whose mortality in hospital may be increased significantly, the length of stay in hospital will be prolonged and the hospitalization costs increased in a short term, the long-term consequences include AKI recurrence, development into chronic kidney disease (CKD) or end-stage kidney disease (ESRD), cardiovascular events and death, etc. Ischemia/reperfusion (I/R) injury and contrast agents are common causes of AKI. The nephropathy induced by I/R and contrast agent is associated with intracellular calcium overload caused by Na+-Ca2+ exchanger (NCX). In this article, a systematic review of the relationship between NCX and AKI was conducted, aiming to provide a reference for further recognizing the prevention, treatment and prognosis of AKI.

Objective To discuss the function of pelvic lymphadenectomy in radical cystectomy. Methods Ninety-five patients with bladder cancer (76 males and 19 females) underwent radical cys-tectomy. Clinical data were reviewed. Median age was 62 years old (25-78). Among all patients, 49 were newly diagnosed and 46 had recurrent disease. Of 95 patients, 87 were urothelial cell carcinoma, 5 were adenocarcinoma, and 3 were squamous cell carcinoma. Of 87 urothelial cell carcinoma cases, 17 were grade 1, 39 were grade 2, and 31 were grade 3. Of 95 patients, 10 were Ta-T1,54 were T2 ,26 were T3 ,and 5 were T4 according to AJCC classification. All cases accepted bilateral pelvic lymphade-nectomy according to standard protocol. Results Bilateral lymphadenectomy was taken an average time about 20 min. No important vessels and nerves injury occurred and average bleeding volume was 25 ml during procedure. A median of 10 lymph nodes were removed (range, 1-20). The nodal posi-tive rate was 17.9% (17/95) with 58.8% (10/17) bilateral lymph nodes positive. Short-term opera-tion-related complication rate was 12.6% (12/95). No operation-related death happened. Median fol-low up time was 34 months (3 to 64 months). Sixteen cases died during followup and the 3-year over-all survival rate was 84.5%. Conclusions Bilateral pelvic lymphadenectomy should be routinely per-formed during radical cystectomy. Standard lymphadenectomy could document accurately the staging and improve the overall survival in radical cystectomy without severe complications.

Objective To investigate the short- to medium-term therapeutic effects of a new internal fixation device,intraosseous internal fixation(IO-FIX),in the foot-ankle arthrodesis.Methods From August 2016 to December 2018,32 patients(40 feet) underwent foot-ankle arthrodesis with IO-FIX at Department of Orthopaedic Surgery,The Ninth Peopled Hospital of Shanghai.They were 6 males and 26 females,aged from 23 to 83 years(61.7±15.1 years).There were 28 cases(36 feet) of hallux valgus,2 cases(2 feet) of ankle arthritis,one case(1 foot) of ankle rheumatoid arthritis and one case(1 foot) of naviculocuneiform arthrosis.The therapeutic effects were assessed in terms of imaging evaluation,American Orthopaedic Foot and Ankle Society(AOFAS) score,fusion rate and full weight-bearing time.Results The follow-up ranged from 3.0 to 31.3 months(mean,12.6 months).The total fusion rate was 95.0%(38/40);the total AOFAS score increased significantly from preoperative 41.9±9.5 to postoperative 86.9±4.7(P<0.05).The 28 patients(36 feet) with hallux valgus achieved a successful fusion rate of 97.2%(35/36) and full weight-bearing at 8 weeks after operation.Their fusion time ranged from 45 to 64 days(57.1 days).Their metatarsophalangeal angle was decreased significantly from 52.10±13.50 preoperatively to 13.40±4.90 postoperatively and their 1-2 intermetatarsal angle significantly from 14.5°±2.4°to 8.90±2.4°(P<0.05).Their AOFAS ankle-hindfoot score was improved significantly from 41.8±9.9 to 87.0±4.8(P<0.05).All the 3 cases of ankle arthrodesis achieved good bone union and full weight-bearing within 12 weeks and their AOFAS ankle-hindfoot score was improved significantly from preoperative 43.4±3.5 to 86.3±3.5 at the final follow-up.Conclusion In foot-ankle joint arthrodesis,due to advantages of stable fixation,zero profile,limited soft tissue irritation,reinforced bone bridge and easy reproducibility,10-FIX can lead to satisfactory short- to mid-term therapeutic effects.

OBJECTIVETo report two myelodysplatic syndromes (MDS) patients with t(3; 5) (q25; q34).

METHODSChromosome specimens were prepared by short-term culture of bone marrow cells. Karyotype analysis was performed by R banding technique, chromosome painting (fluorescence in situ hybridization, FISH) by using whole chromosome 3 and 5 probes in case 1.

RESULTSThe clinical and hematological findings were compatible with diagnosis of MDS. Karyotype analysis showed that both patients had identical t(3; 5) (q25; q34) translocation. A reciprocal translocation between chromosomes 3q and 5q was proved by FISH in one patient.

CONCLUSIONSt(3; 5) translocation is a rare chromosome abnormality specifically associated with MDS and frequently displays trilineage dysplasia. Chromosome painting technique is a reliable tool for detecting this translocation.

Adolescent ; Adult ; Antigens, CD ; analysis ; Chromosomes, Human, Pair 3 ; Chromosomes, Human, Pair 5 ; Humans ; In Situ Hybridization, Fluorescence ; methods ; Leukocytes, Mononuclear ; classification ; immunology ; Male ; Myelodysplastic Syndromes ; genetics ; physiopathology ; Translocation, Genetic

Objective To verify the efficacy and safety of intravesical instillation of Cystistat in reducing complications caused by intravesical chemotherapy after TUR-BT in non-muscle invasive bladder cancer patients. Methods One hundred and twenty patients who met the inclusion/exclusion criteria were enrolled into this multi-centered, randomized and blank controlled clinical study. Selected patients were randomized into the observation group and control group. TUR-BT was carried out in both groups followed by pirarubicin (THP) and Cystistat intravesical instillation in the observation group, and THP intravesical instillation alone in control group. Visual analog scale (VAS) was used as the primary efficacy variable. The secondary efficacy variables were assessments of hematuria and bladder irritation symptoms. Adverse events, laboratory tests and changes of vital signs before and after treatment were strictly observed during observation to evaluate the efficacy and safety of Cystistat.Results Demographics and baseline characteristics were comparable in both groups. The differences and the improvement rate of VAS score in the 2 groups were significant, both P＜0.01. The changes of VAS score and the improvement rate before and after treatment were (2. 24±1.70) and (92. 92±14.76) % in observation group and (0. 70±1.82) and (20. 59±87.34)% in control group respectively. According to the covariance analysis, there were significant differences in changes of VAS score between the observation group and the control group. Also, the improvement rate of VAS score was significant from visit 2. The urine frequency decreased from 9.06±4.09 to 6. 69±2.89 in observation group and increased from 8. 85±3. 32 to 10. 15±4.40 in control group, P＜0.01. There were also significant differences in changes of nocturia before and after treatment between these two groups (P＜0.01), the nocturia decreased from 2. 88±1.74 to 1. 47±1.62 in observation group and 3. 22±2.30 to 2.91±1.73 in control group, respectively. The changes of WHO assessment for hematuria,urgency and dysuria were not significantly different between the 2 groups. No Cystistat related adverse event was observed. Conclusions Cystistat combined instillation can significantly improve the VAS score of patients with chemotherapeutic agent instillation. Relief of bladder pain, frequency and nocturia are more rapidly and more durable in Cystistat combined instillation group. The improvement is more effective in patients with a high VAS score. Cystistat instillation with chemotherapeutics agents is both well tolerated and safe.