0.05).There were no serious side reactions such as total spinal anesthesia and local anesthetic intoxication.Conclusion:Combined basal anesthesia and perpendicular sticking caudal anesthesia is a feasible method for congenital clubfoot surgery in infants.It has the advantages of simplicity,time saving,safety,less injuries,etc and is worth applying clinically.

Objective:To probe the anesthesia methods and management of respiration in the operation on congenital esophageal atresia accompanying tracheo-esophageal fistula.Methods:Retrospective analysis was used to study anesthesia process during operation of 9 cases.Results:Vital signs of 7 cases during operation were stable.No increased airway resistance or bronchospasm was observed.Seven patients who received endotracheal intubation and controlled respiration after slow induction developed no significant atelectasis or more severe pneumonia on post -operation X-ray.Stomach gassiness happened in two patients who received fast induction.Gradually increased airway resistance was observed and more severe pneumonia accompanying atelectasis happened in the two patients.No hypothermia happened among these 9 patients owning to right keeping warm.Seven patients were discharged in good health.The families of two patients gave up treatment.Conclusion:Pulmonary complication can be reduced effectively and the same stable anesthesia can be obtained by combining the existing autonomous breath after slow induction with controlled breath after blocking up fistula cannula.The effective aspiration,keeping warm, intensive transfusion and consummate analgesia during and after the operation are very important to guarantee the security for patients.

Objective To investigate the role of interleukin-18 (IL-18 )and interleukin-33 (IL-33 )in the pathogenesis of bronchial asthma.Methods 40 cases with acute attack of bronchial asthma admitted in Wuhan Third Hospital from March 2011 to January 2012 were chosen as the hormone group,and 30 cases healthy people in the same period who underwent routine physical exa mination were chosen as control group.The serum levels of IL-18 and IL-33,the rate of forced expiratory volume in one second(FEV1 )and forced vitalcapacity(FVC,FEV1%),the number of eosinophil cells(EOS)and immunoglobulin E(IgE)were detected in control group and hormone group before and after treatment.Compare the serum levels of IL-18 and IL-33 in hormone group before and after treatment,and the relevance between IL-18,IL-33 and IgE,EOS and FEV1%. Results Compared with control group,the serum levels of IL-18 and IL-33 in hormone group pre-treatment were significantly increased(P<0.05),FEV1%,EOS and IgE had significant difference(P<0.05).Compared with hormone group pre-treatment the serum levels of IL-18 and IL-33 in hormone group post-treatment were significantly decreased(P<0.05),FEV1%,EOS and IgE improved significantly (P<0.05).Compared with control group,the serum levels of IL-18, IL-33,FEV1% and IgE in hormone group post-treatment had no significant difference.The pearson correlative analysis showed that there were positive correlations between the levels of IL-18,IL-33,IgE and EOS,respectively(P<0.05),and there were negative correlations between IL-18,IL-33 levels and FEV1%,respectively(P<0.05).Conclusion IL-18 and IL-33 participate in the acute asthma,and may play stimulation role in the inflammatory process of asthma.

Nursing experiences on 4 children with organic acidemia were summarized. The nursing care focused on correct collection of samples for early diagnosis,prompt opening of an effective intravenous route to manage water,electrolyte,acid-base and metabolic imbalances,special medication nursing,strict diet control to prevent relapse,health education to keep normal growth and development. Three children were followed up for 1 month,7 months and 1 year respectively with disease controlled and a child was withdrawn treatment from.

BACKGROUND:Recent studies indicate that osteolysis surrounding prosthesis is the main reason causing artificial joint loosening.The reason and development process of osteolysis surrounding prosthesis are not fully understood.OBJECTIVE:To observe the pathological changes of limiting membrane surrounding sterile loosened prosthesis of artificial hip ioint and compare that with cicatricial tissue surrounding internal fixation.DESIGN,TIME AND SETTING:Histological observation was done at The Second Hospital of Soochow University between September 2000 and December 2005.PARTICIPANTS:Limiting membrane surrounding prosthesis of eight artificial hip joints overhauled for loosening were removed during operation for pathological examination.METHODS:Specimens were fixed with 10%formaldehyde solution and embedded with paraffin,and were cut into sections,the sections were stained by hematoxylin-eosin(HE)staining and immunohistochemistry staining.The specimens were done bacterial culture.MAIN OUTCOME MEASURES:Histopathological changes.RESULTS:Wear particles,cellular proliferation and osteolytic factors were found in the limiting membrane surrounding loosening prosthesis.The bacterial culture results of the specimens were negative.CONCLUSION:Wear particles generated in the using process of prosthesis can activate osteolytic factors produced by inflammatory cells and is an important reason leading to sterile loosening of prosthesis.

Objective To investigate the effect of different doses of dexmedetomidine(Dex)on sevoflurane consumption in patients undergoing laparoscopic oophorocystectomy.Methods Eighty ASA Ⅰ or Ⅱ patients aged 25-50 yr with body mass index 18-25 kg/m2 undergoing laparoscopic oophorocystectomy were randomly divided into 4 groups (n =20): control group (group C),low dose Dex group(group DL),medium dose Dex group(group DM) and high dose Dex group(group DH).Normal saline 20 ml and Dex 0.3,0.6,0.9μg/kg was infused iv over 10 min at 10 min before skin incision in groups C,DL,DM and DH,respectively.End-tidal sevoflurane concentration (ETsev) was recorded before Dex administration(T1 ),skin incision(T2 ),immediately after pneumoperitoneum (T3 ),10 min of pneumoperitoneum(T4 ) and the end of surgery (T5 ).Duration of anesthesia,consumption of sevoflurane,emergence time,extubation time were recorded and restlessness at 10 min after extubation was also recorded.The concentrations of blood glucose and corticosteroid were measured by quickly by glucose analyzer and radio-immunity gefore anethesia induction (T0) and at T3,T4,T5 respectively.Results The consumption of sevoflurane per hour,ETsev at T2-5,concentrations of blood glucose and corticosteroid at T3-5 were decreased gradually in groups C,DL,DM and DH ( P ＜ 0.05).The emergence time and extubation time were shorter and the incidence of restlessness was lower in groups DL,DM and DH than in group C ( P ＜ 0.05 ).Conclusion Dexmedetomidine can reduce the consumption of sevoflurane in a dose-dependent manner in patients undergoing laparoscopic oophorocystectomy.

Objective To explore the influence of treatment duration on the prognosis of Cryptococcus neoformans meningitis (CNM). Methods The clinical data of 30 patients with CNM were retrospectively analyzed. The time of Cryptococcus neoformans culture in cerebrospinal fluid turned to be negative were compared between patients with and without amphotericin B (AmB)endoneurilemma injection to determine whether endoneurilemma injection would make any difference on prognosis of CNM. Statistic analysis was performed by t test. Results The time of Cryptococcus neoformans culture in cerebrospinal fluid turned to be negative was (22. 73 ± 10. 00) days in 11patients with AmB endoneurilemma injection compared to (18. 92±7. 26) days in 13 patients without endoneurilemma injection. The difference was not statistically significant (t = 0. 172,P>0. 05). The effective rate was 45. 8% after 2-week anti Cryptococcus neoformans treatment, which increased to 100.0% after 6-week treatment. However, the curative rate at week 6 of treatment was 0. All ten patients who finished the treatment (three to four months' treatment) were acquired effective.Conclusion Treatment with standard dosage and adequate duration is crucial in improving the prognosis of Cryptococcus neoformans meningitis.

Objective To compare the clinical effect for treatment of scapula neck or body fractures by straight incision approach and the Judet approach.Methods From July 2001 to July 2011,32 patients with scapula neck or body fractures were treated using the two different approaches:(1) the straight incision approach in 15 patients including 11 males and 4 females,the average age of 38.10 years,fractures classified by Ada-Miller including 4 ⅡA,6 ⅡB and 5 Ⅳ; (2) the Judet approach in 17 patients including 12 males and 5 females,the average age of 39.47 years,fractures classified by Ada-Miller including 5 ⅡA,4 ⅡB and 8 Ⅳ.All patients were followed up.Intraoperative data and postoperative pain of two groups were compared by visual analogue score (VAS),the efficacy were evaluated by Rowe-Zarins scores and the patient's postoperative shoulder function were assessed by Constant-Murley functional score.Results All fractures were preliminary healed after 8 weeks of surgery,there was no wound infection,no internal fixation loosening,no shoulder deformity and other complication.Length of incision,operative time and blood loss of straight incision approach was 6.73±0.96 cm,58.67±4.39 min,94.25±6.14 ml and length of incision,operative time and blood loss of Judet approach was 18.88±1.41 cm,82.24±4.49 min,227.77±23.08 ml.VAS of straight incision approach and Judet approach were 2.60±1.55 and 4.65±1.93,mild and moderate postoperative pain evaluated by VAS were significant differences between two groups.The excellent rate by Rowe-Zarins scores of straight incision approach and Judet approach were 93.3％(14/15) and 88.2％(15/17),they were no significant differences.There was no significant differences in the shoulder joint mobility and muscle strength of Constant-Murley functional score between two groups.However,pain and daily life of Constant-Murley functional score were significant differences between two groups and Constant-Murley functional score of straight incision approach and Judet approach were 85.60±3.31 and 80.65±3.44.Conclusion Compared with Judet approach,straight in cision approach has many advantages,such as a short time of surgery,minor injury,light postoperative pain,good postoperative functional recovery.It is the better surgical approach for the treatment of scapular fractures.

Objective To conduct the diagnostic treatment in the children under 5 years old with suspected asthmatic disease and to evaluate its safety .Methods The children outpatients with suspected asthmatic diseas were selected and divided into the experi‐mental group and the control group according to odd days and even days .The conventiona therapy of anti‐infection ,relieving cough , reducing sputum and supporting treatment were administered in both groups .The experimental group was added tulobuterol tape . The cough relieve on daytime and nighttime ,initial effective time ,cough disappearance time and occurrence rate of adverse events at 24 ,72 h and on 5 d after treatment were compared between the two groups .Results The total effective rate of cough sysmptom re‐lief in the experimental group at 3 time points and nighttime was higher than that in the control group with statistical difference be‐tween the two groups(P < 0 .05) .The initial effective time had no statistically significant difference in daytime between the two groups(P> 0 .05) ,but which in daytime showed the statistically significant difference (P < 0 .05) ,especially the cough disappear‐ance time at nighttime in the experimental group was significantly shortened than that in the control group( P < 0 .05) .The oc‐curence rate of adverse events had no statistical difference between the two groups(P > 0 .05) .Conclusion Tulobuterol tape by transdermal delivery as one of diagnostic treatment measures for children under 5 years old with suspected asthmatic disease is defi‐nitely effective ,safe and convenient in application with the high compliance for children patients and acceptability by the family members ,obviously shortens the course of treatment ,which is worthy of being promoted .

Objective To evaluate the differences of the thinnest-point corneal thickness (TCT) decrease after three different corneal crosslinking (CXL) protocols for progressive keratoconus.Methyds Retrospective clinical case study.From August 2010 to November 2015,consecutive 85 patients (110 eyes) with progressive keratoconus were enrolled and treated with CXL in Department of Opthalmology,Navy General Hospital.21 patients of 25 eyes underwent standard epithelium-off corneal crosslinking (S-CXL),14 patients of 22 eyes underwent 1 g · L-1 riboflavin-sodium lactate Ringer's solution iontophoresis-assisted CXL (I-CXLa),and 50 patients of 63 eyes underwent 0.1％ riboflavin-distilled water solution I-CXLb.Preoperative and postoperative TCT were measured by ALLEGRO oculyzer.The differences of TCT decrease after treatment were compared among the three CXL protocols.Results The differences of TCT from baseline after 3 months,6 months and 12 months in the S-CXL group were (-14.93 ±27.16) μm,(-31.94 ±22.89) μm,(-27.71 ±26.01) μm,respectively,the I-CXLa group were (-20.14 ± 19.09) μm,(-10.10 ± 24.28) μm,(-7.11 ± 22.26)μm,respectively,the I-CXLb group were (-28.08 ± 26.14) μm,(-21.08 ± 25.62) μm,(-15.91 ± 19.19)μm,respectively.Three months after treatment,the differences of TCT decrease in the three groups was not statistically significant (P =0.188);Six and 12 months after treatment,the differences between S-CXL and I-CXLa were statistically significant (all P ＜0.05),but the differences between S-CXL and I-CXLb,between I-CXLb and I-CXLa showed no significant difference (all P ＞ 0.05).Conclusion Six and 12 months after treatment,TCT decrease is related to the CXL protocol.TCT decrease degree may reflect the intensity of crossinking.TCT decrease in I-CXLb is smaller than that in S-CXL,but there is no statistical difference.