Objective To study the clinical application of midazolam combined with remifentanil in spinal anesthesia.Methods80 cases of vertebral fractures in Jiaxing hospital, Zhejiang armed police corps from February 2014 to December 2016 were selected as the research object in this study.They were randomly divided into two groups: control group and experimental group, each group had a total of 40 cases.Patients in the control group were treated with midazolam anesthesia, the experimental group was treated with midazolam combined with remifentanil anesthesia.Comparative analysis of the experimental group and control group of patients with vital signs and anesthesia recovery time and anesthetic effect indicators.ResultsAfter the corresponding anesthesia, the respiratory frequency and heart rate of the experimental group were significantly higher than those of the control group, with statistical difference (P<0.05).There was no significant difference between the control group and the experimental group, no statistical significance.The recovery time, the time of open eyes and extubation time of the experimental group were significantly lower than those of the control group (P<0.05).The excellent rate of anesthesia in the experimental group was 95.0%, and the excellent rate of anesthesia in the control group was 75.0%.As a result, the excellent rate of anesthesia in the control group was significantly lower than that in the experimental group, the OAAS score of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05).ConclusionThe application of midazolam combined with remifentanil in anesthesia of spinal fracture surgery, anesthesia effect is good, the patient's recovery time is faster, with the clinical significance of further promotion and application.

OBJECTIVE:To guarantee that the medical institutions to purchase qualified drugs from legal suppliers of drug.METHODS:The qualification documents of the pharmaceutical manufacturers and management enterprises were collected,examined and verified,numbered and filed.RESULTS & CONCLUSIONS:Strict examination of the qualification documents of the drug suppliers contributed to scientific and normalized management of drug purchase of medical institutions so as to guarantee the drug quality.

Objective To study the effect of Exendin-4 on oxidative stress and neural apoptosis following spinal cord injury (SCI). Methods Adult male SD rats, with weight between 200-250 g, were randomly divided into three groups (12 in each group):Sham group, SCI group and Exendin-4 group (Ex-4 group). Rats in Sham group achieved spinal cord exposure. SCI group and Ex-4 group were induced according to Allen′s test (using a weight-drop device). Rats in Ex-4 group were ad?ministrated with Exendin-4 (10 μg/rat) through intraperitoneal injection immediately after establishment of SCI models. Rats in Sham group and SCI group were given the same volume of normal saline solution instead. Level of malondialdehyde (MDA) and the activity of catalase (CAT) were assessed in spinal cord tissues 24 hour after drug administrations. Neural apoptosis was detected by TUNEL staining and the expression levels of caspase-9 and AIF were determined using Western blot. Results Compared with Sham group, the levels of MDA, caspase-9 and AIF as well as neuronal apoptosis rate in?creased obviously, while activity of CAT decreased markedly in SCI group(P<0.01). Compared with SCI group, the levels of MDA, caspase-9 and AIF as well as the neuronal apoptosis rate decreased obviously, while activity of CAT increased re?markably in Exendin-4 group(P < 0.01). Conclusion Exendin-4 restrain neural apoptosis following spinal cord injury through relieving oxidative damage.

Objective To investigate the effects of hydrogen sulfide on autophagy and the apoptosis after acute spinal cord injury in rats. Methods Thirty-six adult male SD rats (250-300 g) were randomly divided into three groups (n=12 for each group):sham operation group (Sham group), spinal cord injury group (Model group) and hydrogen sulfide pre-treatment group (H2S group). Allen’s method was used to establish the rat model of spinal cord injury. Rats of sham operation group re?ceived only laminectomy. Rats of H2S group received sodium hydrosulphide injection intraperitoneally (50μmol/kg) 1h after spinal cord injury, and Model group was given the same amount of saline solution. Rats in the three groups were sacrificed 24 h after spinal cord injury, then the spinal cord was removed. The expressions of LC3, p70S6K and Cleaved caspase-3 were detected by Western blot assay. The expression of LC3 was also detected by immunofluorescence. The cell apoptosis was as?sessed by TUNEL stain. Results Compared with Sham group, the expression levels of LC3Ⅱ/LC3Ⅰand Cleaved caspase-3 were increased in Model group, but the expression of p70S6K decreased and cell apoptosis increased in Model group (P<0.01). Compared with Model group, the expression levels of LC3Ⅱ/LC3Ⅰand Cleaved caspase-3 were decreased significant?ly, while the expression of p70S6K increased and cell apoptosis decreased significantly in H2S group (P < 0.01). Conclu?sion Hydrogen sulfide can inhibit autophagy and reduce cell apoptosis after acute spinal cord injury in rats.

OBJECTIVE:To establish a method for the determination of related substances in Lovastatin tablet. METHODS:HPLC was performed on the column of Waters XTerra? MS C18 with mobile phase A of 0.01%Phosphoric acid solution and B of acetonitrile(gradient elution)at a flow rate 1.0 ml/min,column temperature was 40 ℃,the detection wavelength was 238 nm,and the injection volume was 10 μl. RESULTS:The impurity components were well separated in principal components;the linear range of lovastatin was 17.5-700 μg/ml(r=0.9999);RSDs of precision,stability and reproducibility tests were lower than 1%;recov-ery was 99.30%-100.67%(RSD=0.4%,n=9). CONCLUSIONS:The method is reproducible with good durability and high preci-sion,and can be used for the quality control of Lovastatin tablet.

Objective To investigate the effects of edaravone (EDA) on cell apoptosis induced by endoplasmic reticu?lum stress (ESR) after spinal cord injury (SCI) in rats. Methods Thirty-six healthy adult SD rats were randomly divided in?to three groups (12 rats for each group):Sham group, SCI group and EDA group. The rat model of SCI was made by Allen’s method and the sham group was only received laminectomy and kept the spinal cord intact. Rats in sham group and SCI group accepted the same volume and frequency of saline injection as EDA group. The EDA group was given 10 mg/kg EDA once every 12 h intraperitoneally. Three days after injuring, the spinal cords were harvested, and the protein levels of C/EBP homologous protein (CHOP), Cleaved caspase-12 and Cleaved caspase-3 were detected by Western blot assay. Immunofluo?rescence staining was used to analyze the positive ratio of caspase-12 and CHOP in spinal cord of three groups. Meanwhile, TUNEL staining was used to identify cell apoptosis of spinal cord. Results Compared with sham group, the protein levels of CHOP, Cleaved caspase-12 and Cleaved caspase-3 were obviously higher in SCI group (P<0.01);the proportion of Cas?pase-12 and CHOP positive cells was significantly increased (P<0.01), and the apoptotic rates were also significantly in?creased in spinal cord (P<0.01). However, compared with SCI group, the protein levels of CHOP , Cleaved caspase-12 and Cleaved caspase-3 were significantly decreased in EDA group (P<0.01);the proportion of Caspase-12 and CHOP positive cells was significantly reduced (P<0.01), and the apoptotic rates were also significantly decreased in spinal cord (P<0.01). Conclusion EDA has neuroprotective potential to spinal cord injury. The mechanism of its neuroprotective effect may asso?ciate with its inhibitory effect to the cell apoptosis induced by endoplasmic reticulum stress after SCI.

Objective To investigate and analyze the clinical effect of laryngeal mask airway inhalation anesthe-sia with sevoflurane on pediatric colic surgery.Methods From July 2014 to November 2016,92 cases with pediatric hernia in Jiaxing Hospital of Zhejiang Corps of Armed Police Force were randomly divided into study group and control group according to the digital table ,with 46 patients in each group.All patients were selected according to the specific circumstances given hernia surgery ,sevoflurane inhalation anesthesia with laryngeal mask airway in the study group in the operation,the control group was given tracheal intubation anesthesia.The changes of vital signs ,the anesthesia effect and treatment satisfaction etc.were observed and analyzed.Results All the patients were treated by surgery , the heart rate (HR) and mean arterial pressure(MAP) changes in the study group were significantly better than those in the control group(all P＜0.05).The eye opening time and awake time in the study group were (7.28 ±1.07)min, (12.96 ±1.38 ) min, respectively, which were significantly better than those in the control group [ ( 13.02 ± 1.75)min,(21.13 ±2.82)min] (t＝18.979,P＝0.001;t＝17.649,P＝0.001).The total satisfaction rate of the study group was 97.83%,which was significantly higher than 82.61%of the control group (χ2＝13.126＝0.002). Conclusion The application of laryngeal surgery in children with hernia in mask ventilation of sevoflurane anesthe -sia,has good anesthetic effect ,it has less influence on hemodynamics in children ,and rapid postoperative recovery.

Objective To investigate the indication of approach,type of fixation and the clinical outcome of minimally invasive internal fixation for treatment of pelvic anterior ring injury.Methods From January 2012 to August 2016,data of 32 patients with 44 pelvic anterior ring injuries who had been treated with minimally invasive internal fixation were retrospectively analyzed.There were 22 males and 10 females with an average age of 38.2 years old (range,20-65 years).14 patients were injured by traffic accident,12 patients by falling and 6 patients by crush injury.There were 4 cases of pubic symphysis diastasis,27 fractures of anterior ring which included 12 billatral fractures and 1 combined vertical displacement of pubic symphysis associated with pubic fracture.According to AO classification,there were 3 cases in A2.3,3 cases in B1.2,4 cases in B2.2,4 cases in B2.3,2cases in C1.1,1 case in C1.2,5 cases in C1.3,4 cases in C2,6 cases in C3.There were 25 patients associated with other injuries,including brain injury in 2,thoracic injury in 17,abdominal injury in 8,urogenital system injury in 5,lumbosacral nerve plexus injury in 4 and the extremity or lumbar fracture in 19.The average period from injury to operation was 9.2 d (range,5-32 d).4 patients who had the pubic symphysis diastasis,3 had pelvic anterior ring fracture medial obturator foramen and 1 combined vertical displacement of pubic symphysis associated with pubic fracture were reduced by modified Pfannenstiel incision and fixed with cannulated screws,while 36 patients with fractures of lateral obturator foramen were reduced by modified Pfannenstiel incision associated with small ilial crest incision and fixed with locking reconstruction plates,and 25 patients received the fixation of pelvic posterior ring injury simultaneously.Results The average time of operation was 44.5 min (range,30-65 min),and the average amount of blood loss intraoperative was 56.2 ml (range,20-150 ml).All patients were followed up successfully,with an average time of 28.2 months (range,16-42 months).All the fractures were healed with an average time of 4.5 months (range,3-9 months).According to Matta standard of reduction assessment,30 fractures' reduction were excellent,12 were good and 2 were fair,which the rate of satisfaction was 95.5％ (42/44).Neither reduction loss or fixation failure nor infection occurred,and the occurrence rate of complication was 9.1％ (4/44),including one patient with fatal liquefaction and was cured 3 weeks after wound dressing,one patient with lateral femoral cutaneous nerve injury who was cured within 3 months by oral drug and 2 patients who complained discomfort of inguinal area because of the fixation prominence and were lessened by physical therapy.Conclusion Minimally invasive internal fixation can be recommended for treatment of pelvic anterior ring injury because of the advantages of less damage,safer manipulation,less complications and good prognosis.

Objective:To evaluate the clinical outcomes of traumatic spinopelvic dissociation treated with robot-assisted bilateral triangular fixation.Methods:From March 2016 to March 2020, 30 patients with traumatic spinopelvic dissociation were retrospectively analyzed. According to operation and fixation methods, the patients were divided into robot-assisted minimally invasive bilateral triangular fixation group (Robot triangular group) and traditional open reduction lumbopelvic fixation group (Lumbopelvic group). There were 16 patients in the Robot triangular group, 4 males and 12 females, average age 35.7±13.3 years (range, 16-58 years). There were 10 cases of U-shaped, 4 cases of H-shaped, 2 cases of Y-shaped sacral fractures according to shape classification of sacral fractures. According to ROY-Camille classification, there were 4 cases of type I, 9 cases of type II, 3 cases of type III. There were 13 cases with sacral nerve injuries, including 10 cases of Gibbons grade II, 3 cases of grade III. There were 14 patients in the Lumbopelvic group, 4 males and 10 females, average age 37.4±15.1 years (range, 18-66 years), there were 10 cases of U-shaped, 3 cases of H-shaped, 1 case of Y-shaped sacral fractures according to shape classification of sacral fractures. According to ROY-Camille classification, there were 1 case of type I, 10 cases of type II, 3 cases of type III. There were 10 cases with sacral nerve injuries, 7 cases of Gibbons grade II, 3 cases of grade III. The patients' age, operation time, intraoperative blood loss, and Majeed score of the two groups were compared by independent sample t-test; gender, sacral fracture classification, ROY-Camille classification, fracture reduction quality, postoperative wound infection, and sacral nerve recovery were compared by Chi-square test. Results:All patients were followed up for 23.6 months (range, 12-54 months). In the Robot triangular group, the operation time was 95.3±27.5 min (range, 70-180 min), and intraoperative blood loss was 98.7±47.5 ml (range, 50-250 ml). According to Mears and Velyvis imaging evaluation criteria, anatomical reduction was achieved in 6 cases, satisfactory reduction was achieved in 9 cases and unsatisfactory reduction in 1 case. The Majeed score was 85.5±7.7 points. 8 cases of Gibbons grade II sacral nerve injury were recovered to grade I after surgery, 1 case of grade III recovered to grade I, and 1 case recovered to grade II. In the Iliolumbar fixation group, the operation time was 148.6±59.1 min (range, 90-240 min), and intraoperative blood loss was 582.1±244.6 ml (range, 300-1 200 ml). According to Mears and Velyvis imaging evaluation criteria, anatomical reduction was achieved in 7 cases, satisfactory reduction was achieved in 6 case and unsatisfactory in 1 case. The Majeed score was 77.6±7.7 points. 5 of 7 cases of Gibbons grade II sacral nerve injury were recovered to grade I after surgery, and 2 of 3 cases of grade III recovered to grade I. Compared with the Iliolumbar fixation group, the Robot triangular group has shorter operation time ( t=3.23, P<0.05), less bleeding ( t=7.76, P<0.05), and higher postoperative Majeed score ( t=2.83, P<0.05). There are statistical differences in the above indicators significance. Conclusion:For traumatic spinopelvic dissociation, especially fractures involving the lumbosacral junction, those who do not require sacral nerve decompression, Robot-assisted bilateral triangular fixation shows satisfactory clinical outcomes, which is minimally invasive, with fewer postoperative complications.

Objective:To investigate the clinical efficacy of MIPO combined with non-contact bridging periprosthesis fracture plate (NCB.PP) in the treatment of re-fracture around the nail after intramedullary fixation of intertrochanteric fracture.Methods:From October 2015 to January 2020, 12 patients with re-fracture around the nail after intramedullary fixation of intertrochanteric fracture were treated in our hospital. There were 7 males and 5 females with an average age of 74.88±12.1 years (range, 65-83 years old); 8 patients on the left side and 4 patients on the right side received short nail of proximal femoral nail (PFN), 6-36 months after operation, they fell down and caused closed fracture around the nail body. According to Vancouver classification system, all the patients were Vancouver type B; preoperative bone mineral density examination showed that 1 case had normal bone mass, 10 cases had osteoporosis, and 1 case had low bone mass. All patients were treated with minimally invasive plate osteosynthesis (MIPO) technique for reduction and fixation, and fixed with proximal femur NCB.PP. The visual analogue scale (VAS) and Harris hip score at 1 day, 3 months and the last follow-up were compared.Results:The average operation time was 68.7±4.33 min (range, 65-75 min); the average intraoperative blood loss was 291.67±114.48 ml (range, 150-400 ml); the average postoperative drainage volume was 79.17±17.17 ml (range, 50-100 ml). After fracture reduction, all patients were able to obtain 2-5 bicortical screws fixation, with an average of 3.25±0.96. Among them, 3 cases were fixed with additional binding straps; 3 cases underwent autologous iliac bone grafting during the operation. All cases were followed up for 9-60 months, with an average of 16 months. At the last follow-up, 10 patients had fracture healing, the healing time was 7.75±2.83 months (range, 4-13 months), and the fracture healing rate was 83.3% (10/12). Among the other two patients, one was an 83 years old patient with severe osteoporosis, who was bedridden after operation and remained unhealed after 12 months of follow-up; a 68 years old patient had bone restoration at the broken end of the fracture 6 months after operation. The second operation was performed. Iliac combined with allogeneic bone graft was taken from the broken end. At the end of 13 months after operation, the fracture was partially healed. The VAS at one week, three months and the last follow-up were 8.00 (8.00, 9.00), 2.50 (2.00, 3.00) and 0.00 (0.00, 0.75), respectively. There were significant differences in VAS scores between 1 week after operation and 3 months after operation, 1 week after operation and the last follow-up, and 3 months after operation and the last follow-up ( Z=-3.129, -3.097, -3.134, all P < 0.05). The Harris scores at 3 months after operation and at the last follow-up were 72.50±2.91 and 86.67±5.30 respectively. After statistical analysis, the difference was statistically significant ( t=8.857, P< 0.001). At the last follow-up, except for 1 case of fracture nonunion and 1 case of reoperation, the Harris score of hip joint of the other 10 patients was excellent in 6 cases and good in 4 cases, and the excellent and good rate was 83.3% (10/12). One case of superficial wound infection was healed by intravenous drip of sensitive antibiotics. One patient had incision fat liquefaction and was given local dressing change to heal the incision. Conclusion:MIPO combined proximal femoral NCB.PP in the treatment of re-fracture around the nail after intramedullary fixation of intertrochanteric fracture has the advantage of less surgical damage, less blood loss, higher healing rate, and it can obtain satisfactory short and medium-term clinical efficacy.