Objective To investigate the effects of muscle relaxants on motor evoked potentials (MEPs) monitoring during intracranial surgery. Methods 62 patients with neurological tumor were divided into 2 groups: muscle relaxant group (n=21) and non-muscle relaxant group (n=41). The incidence of successful MEPs monitoring was investigated. Results The incidence of successful MEPs monitoring was 76.2% in the muscle relaxant group and 41.5% in the non-muscle relaxant group (P<0.05). Conclusion Muscle relaxants can affect the MEP monitoring, which would not be administered as possible during anesthesia for intracranial surgery in functional area.

Objective: To evaluate the value of MELD-Na scoring system, MELD scoring system and Child-Pugh scoring system for liver failure with artificial liver support. Methods: The values of MELD-Na scoring system, MELD scoring system and Child-Pngh scoring system were evaluated using receiver operating characteristic (ROC) curves. Results: The area under curve (AUC) values generated by the ROC curves for Child-Pugh score were higher (AUC=0.794) than those of ME LD-Na score (AUC=0.724) and MELD score (AUC=0.664) respectively. The eutoff scores of three systems were 10.5, 24.8, 26.4 respectively, which could discriminate higher and lower mortality accurately. There were no significant statistic differences in predictive values of three systems for different liver failure(sub-acute liver failure and chronic-on-acute liver failure). But the Child-Pugh scoring system was the best for prediction of the chronic liver failure. Conclusion: MELD-Na scoring system,Child-Pugh scoring system and MELD scoring system can predict the prognosis of liver failure, in which the Child-Pugh scoring system was the best.

Objective To study the effects of HBeAg in new born infants on the response to anti-hepatitis B immunoglobulin combined with hepatitis B vaccination.Methods Two hundred and eight infants who were born during January 2008 to January 2011 in the Department of Obstetrics in Second Affiliated Hospital of Southeast University,including 120 serum HBeAg positive infants without intrauterine infection,and 88 HBeAg negative infants as control group were recruited in the study.Infants in both groups were vaccinated with genetically engineered hepatitis B vaccine (CHO cell) 20 μg according to a standard vaccination regimen (i.e.0,1,6) and 200 IU doses of hepatitis B immunoglobulin immediately after birth and at day 15 respectively.Hepatitis B virus (HBV) serological markers and HBV DNA were measured at birth prior to immunization.HBsAg,HBeAgand hepatitis B surface antibody (anti-HBs) were detected at 1,7,and 12 months after birth to evaluate the effects of immune response.The date were analyzed by the chi-square test and groups were analyzed by t test.Results No statistical significances of anti-HBs were observed between the serum HBeAg positive group and the serum HBeAg negative group at the 1st,7th and the 12th month of birth (t=1.285,0.563 and-0.971,respectively; all P＞0.05).The anti-HBs titers in both groups at 1 month were higher than at birth (P＜0.05).At 7 months after birth,the anti-HBs titers in both groups were even higher than those at 1 month.At 12 months after birth,the anti-HBs titers in both groups were lower than those at 7 months,but still higher than those at 1 month(F=34.3959 and 64.908,respectively; both P＜0.01).Infants who were born with positive serum HBeAg were further divided into two subgroups according to the HBeAg titers,using the median HBeAg titer (47.495 S/CO) as the cut off point.Between the two subgroups,there were also no significant differences of anti-HBs at 1 month,7 months and 12 months (all P＞0.05).The HBeAg titers in HBeAg positive infants decreased gradually after birth.At 7 months,only 3 infants remained HBeAg positive.At 12 months,HBeAg turned negative in all of the 120 infants who were previously HBeAg positive,and no anti-HBe positivity were detected.Conclusion The production of anti-HBs after combined immunization with anti-hepatitis B immunoglobulin and hepatitis B vaccine in infants is independent of HBeAg serology at birth.

Objective To explore the feasibility and safety of dexmedetomidine sedation in interventional neuroradiology operations.Methods Eighty-five cases ASA grade Ⅱ-Ⅲ grade patients undergoing cerebral angiography according to age divided into two groups:old group(more than 60 years old,35 cases) and young group (18-59 years old,50 cases).The loading dose of dexmedetomidine were dexmedetomidine 0.5 μ g/kg in old group and 1.0 μ g/kg in young group,respectively.The loading dose was administered for 10 min followed by continuous infusion dexmedetomidine 0.5 μ g/ (kg· h).Blood pressure,heart rate (HR),peripheral oxygen saturation (SpO2) and respiratory rate (RR),Ramsay score and bispectral index(BIS) were monitored and recorded during the study.Results The BIS,Ramsay score after administration 10,15,30,45 min in two groups was significantly longer than that before administration [old group:84 ±22,83 ±22,85 ± 15,75 ±23 vs.94 ±5; (2.0 ±0.4),(2.3 ±0.6),(2.8 ±0.7),(3.0 ±0.7)scores vs.(1.7 ± 0.5) scores; young group:91 ± 8,89 ± 11,86 ± 12,81 ± 13 vs.96 ± 2; (1.9 ± 0.6),(2.3 ±0.7),(2.7 ± 0.9),(3.0 ± 0.9) scores vs.(1.6 ± 0.5) scores,P ＜ 0.05].The systolic blood pressure,diastolic blood pressure,mean arterial pressure (MAP) after administration 10,15,30,45 min in two groups was significantly longer than that before administration [old group:(152 ± 23),(144 ± 23),(140 ± 21),(135 ±21) mm Hg(1 mm Hg =0.133 kPa) vs.(165 ± 25) mm Hg; (87 ± 11),(83 ± 11),(78 ± 8),(75 ± 8) mm Hg vs.(89± 13)mm Hg;(106±14),(100±13),(99±12),(95±12)mm Hg vs.(113±16)mm Hg;young group:(131 ± 24),(127 ± 23),(124 ± 25),(124 ± 26) mm Hg vs.(142 ± 23) mm Hg; (81 ± 13),(79±13),(77±13),(76±13)mmHgvs.(86± 14) mmHg;(97±16),(94±16),(91±19),(92±20) mm Hg vs.(104 ± 19) mm Hg,P ＜0.05],but the decreases in blood pressure were ＜20％ from baseline.The HR,RR and SpO2 was no significant difference (P ＞ 0.05).Conclusions Continuous infusion of dexmedetomidine sedation during cerebral angiography has little effect on hemodynamics,no significant respiratory depression,is safe and effective.

Objective To explore the survival rate and early-term effects of sensory reconstruction of the modified first dorsal metacarpal artery (FDMCA) flap in treatment of thumb distal soft tissue defect.Methods From March 2004 to October 2007, 65 patients with soft tissue defects of the thumb underwent the FDMCA flap in our department. Forty-nine cases with complete data were included in the study. There were 37 males and 12 females, with an average age of 32 years (ranged, 18-65 years). The conventional surgical methods were used in 18 cases while the improved surgical methods were in 31 cases. The distal necrosis, the vascular crisis rate and the sensory recovery were recorded. Results The mean follow-up period was 2 years (ranged, 20 months to 3 years). Forty-six flaps survived completely. Vascular crisis occurred in five cases harvested by the conventional methods. Eventually, three of them had a partial distal necrosis.Improved FDMCA flap survived well in all 31 patients. Flaps in these patients with nerve anastomosis restored satisfied sense and all sense were located in the thumb. Eighteen cases of nerve transfer group had different levels of mixed feelings (33%) or ectopic sensory (62%). Sense was located in the thumb completely in 1 case. Conclusion The modified FDMCA flap significantly increased the survival rate. Neurorrhaphy could make the sense of the flap locate in the thumb; however it had not been proved that its impact on the recovery of two-point discrimination and stereognosis.

Objective To explore the capability of diffusion weighed imaging (DWI) in differentiating malignant cervical lymph nodes from benign ones in nasopharyngeal carcinoma (NPC) patients, and to assess the appropriate b value in 3.0T MR DWI. Methods Conventional MR and DWI scan were performed in 50 patients with histopathologically proven NPC and 20 healthy volunteers with GE 3.0T MR scanner, and neurovascular array 8 channels head and neck unite coil. DWI was performed with single shot spin-echo echo-planar imaging (SE-EPI) sequence at 4 different b values (600, 800, 1000,1200 s/mm~2). The apparent diffusion coefficient (ADC) values between metastatic lymph nodes of NPC patients and benign nodes of volunteers were compared. Results The mean ADC value (×10~(-3) mm~2/s) of metastatic cervical lymph nodes of NPC at different b value (600, 800, 1000, 1200 s/mm~2) was 0.808±0.112, 0.769±0.098, 0.732±0.095 and 0.696±0.083, respectively; the mean ADC value (×10~(-3) mm~2/s) of lymph nodes of volunteers was 0.993±0.172, 0.967±0.165, 0.903±0.157 and 0.855±0.122, respectively (P<0.05). When b value was 800 s/mm~2, and ROC cut-off point was 0.873×10~(-3) mm~2/s, the diagnostic sensitivity, specificity and accuracy was 88.41%, 69.43%, and 75.22%, respectively. Both the satisfying images and the accurate measurement were acquired. Conclusion As a rapid and sensitive new MR technique, DWI can offer help in discriminating benign and malignant cervical lymph nodes in NPC patients.

Upper gastrointestinal haemorrhage (UGIH) in severe dengue represents a clinical dilemma in term of management. The recommended treatment in dengue with UGIH involves blood product transfusion support and proton pump inhibitor (PPI) infusion. Despite being the mainstay of treatment in non-dengue UGIH, the role of endoscopic haemostatic intervention in severe dengue remains controversial. In the present report, we present a case of severe dengue complicated with upper gastrointestinal haemorrhage successfully underwent early therapeutic endoscopic intervention in a district hospital.
Dengue

Background The development of retinopathy of prematurity(ROP) is associated with many regulatory cytokines related to neovascularization;however,the retinal expression and regulated mechanism of stromal cell-derived factor-1 (SDF-1) in mouse model of oxygen-induced retinopathy (OIR) remain uncertain.Objective This study was to investigate the expression of SDF-1 in retina of mouse model of OIR.Methods Forty 7-day-old C57BL/6J mice were divided into OIR group and control group.In OIR group,20 mice were exposed to 75% oxygen for 5 days and then to room air for 5 days.In control group,20 mice were raised in room air.The expression of SDF-1 in retina of mice was studied by immunochemistry and quantified by real time reverse transcriptase polymerase chain reaction (RT-PCR).Results The positive immunohistochemical staining for SDF-1 was found mainly locating at the ganglion cell layer in 12-day-old mice of OIR group;the stronger positive immunohistochemical staining for SDF-1 was noted mainly locating at the ganglion cell layer,vascular endothelial cells of inner retina,neovascular endothelial cells in 17-day-old mice of OIR group;the delicate positive immunohistochemical staining for SDF-1 was both found mainly locating at the inner retina and being around the retinal vascular in 12-day-old mice of control group and 17-day-old mice of control group.The expression of SDF-1 mRNA in 17-day-old mice of OIR group was higher than that of 12-day-old mice of OIR group (t=8.072,P＜0.05)and 17-day-old mice of control group(t=10.026,P＜0.05),respectively.The expression of SDF-1 mRNA in 12-day-old mice of OIR group was lower than that of 12-day-old mice of control group (t=4.336,P＜0.05).Conclusion SDF-1 might improve the onset of retinal neovascularization of OIR.

Objective:To construct an adenovirus vector harboring human basic fibroblast growth factor (bFGF) cDNA and investigate the expression of bFGF in human umbilical vein endothelial cells (HUVEC) in vitro. Methods: The adenovirus expression vector Ad5-bFGF was constructed by homologous recombination technique. The best value of MOI was tested by transfecting human umbilical vein endothelial cells (HUVEC) with Ad5-GFP. Ad5-bFGF was used to transfect HUVEC at the obtained value of MOI and the expression of bFGF protein was detected by immunocytochemistry method and Western blotting. Results: The best value of MOI for adenovirus 5 to transfect HUVEC was 200 and the transfection rate was 90%. Immunocytochemistry method and Western blotting showed that bFGF was expressed in HUVEC after transfection with Ad5-bFGF and the expression was significantly higher than that in untransfected HUVEC (P

Objective To investigate the applications of antibacterial agents to outpatients in primary hos -pitals in Hefei City of Anhui Province,and to provide reference for rational use of antibacterial agents.Methods In 2011, fourty-five primary hospitals in Hefei City were selected randomly ,including urban community health service centers (Group A) and township hospitals(Group B),and thirty or fourty outpatient prescriptions were analyzed monthly . Results In Group A, the percentage and intensity of antimicrobial usage , the proportion of the combination and injectable formulation were ( 45.36 ±20.02 )%, ( 89.73 ±25.50 ) DDDs · ( 100 cases ) -1 · d-1 , 13.34%, 23.16%,respectively,and the data in Group B were (61.36 ±17.18)%,(108.46 ±32.27)DDDs· (100 cases) -1 · d-1,29.13%,46.39%,respectively,which the former were significantly lower than the latter.Conclusion In primary hospitals,the applications of antibacterial agents to outpatiants are not rataional ,including high percentages of usage and unreasonable selection of species ,and more supervision and training need to be given to the medical staff , especially in township hospitals .