Objective To investigate the effect of ropiyacaine combined with intra-spinal epidural anesthesia by using the same volume but different injection speed on anaesthetic level.Methods 80 cases of patients of ASA～Ⅱdegree suitable to use intra-spinal epidural combined anesthesia for gynecologic operation were selected and ran- domly divided into three groups,0.75 % ropivacaine 2mg(15mg)administered,group A the speed of injection was 10 seconds,group B injection speed was 20 seconds,group C injection speed was 30 seconds,the anaesthetic level reached T_(10).The time of highest level in spinal anesthesia,30 minutes after spinal anesthesia MAP,and number of cases need to add epidural drug were all recorded.Results The best effect of anesthesia was found in group B,the block level of anesthesia was satisfactory,blood dynamic was stable,and there was no need to add epidural drug.Conclusion The speed of 0.75 % ropivacaine 2ml spinal epidural combined with anesthesia was suitable at the speed of 20 seconds.

Objective: To explore the effects of Vitamin K2 (VK2) on theaortic artery calciifcation and oxidative stress injury in experimental rats.
Methods: A total of 24 rats were divided into 4 groups:①Control group,②6-week calciifcation group,③12-week calciifcation group and④6-week calciifcation + 6-week VK2 group;n=6 in each group. The arterial calciifcation was induced by warfarin (WFN) treatment. The calcium nodule and deposition in rat’s theaortic artery were detected by Alizarin red staining and o-cresolphthalein complexone method, the reactive oxygen species (ROS) were measured by DHE probe staining and the morphological changes of mitochondria in smooth muscle cells were detected by transmission electron microscopy.
Results: Calciifcation nodule formed in both 6-week and 12-week calciifcation groups, the calciifcation deposition and ROS were higher than Control group,P<0.01. Compared with both calcification groups, the above indexes were decreased in 6-week calciifcation + 6-week VK2 group,P<0.01. Both calciifcation groups showed mitochondria swelling with unclear structure and cytoplasm vacuoles degeneration in vascular smooth muscle cells. The vascular smooth muscle cell volumes were similar between Control group and 6-week calcification + 6-week VK2 group, and no cytoplasm vacuoles degeneration was observed.
Conclusion: Warfarin induced aortic calciifcation is related to oxidative stress injury which may cause the ultra-micro structural damage in smooth muscle cells; VK2 may reduce the oxidative stress injury and improve the condition of vessel calciifcation in experimental rats.

Objective: To explore the effect of oxidative stress injury on the mechanism of vascular smooth muscle cell (VSMC) calciifcation induced by calcium and phosphorus in experimental rats.
Methods: The VSMC calcification was induced by incubating the cells with calcium chloride (CaCl2) andβ-sodium glycerophosphate (β-GP) for 8 days, and the cells were divided into 4 groups: ① Control group, ② Calcification group,③ Calciifcation+H2O2 group, ④ Calciifcation+catalase group. The calcium nodule formation and calcium deposition in VSMC were detected by Alizarin red staining and o-cresolphthalein complexone method, the reactive oxygen species (ROS) was detected by DCFH-DA probe staining and the protein expression of Runx2 was examined by Western blot analysis.
Results: Compared with Control group, Calciifcation group showed the higher ROS production, more calcium nodule and calcium deposition, higher Runx2 protein expression;while compared with Calciifcation group, the above indexes were even higher in Calciifcation+H2O2 group, P<0.05. The ROS production, calcium nodule, calcium deposition and Runx2 protein expression were lower in Calciifcation+catalase group than those in Calciifcation group and Calciifcation+H2O2 group, but still higher than that in Control group. The protein expression of Runx2 was similar between Calciifcation+catalase group and Control group, P>0.05.
Conclusion: CaCl2 andβ-GP treatment may induce VSMC calciifcation via activating ROS-Runx2 signal pathway in experimental rats.

OBJECTIVETo evaluate the safety and reliability of percutaneous internal fixation for pelvic ring injuries with cannulated screws.

METHODSForty-eight patients (21 male and 27 female, aged from 17 to 61 years with an average age of 38 years) with unstable pelvic ring injuries were treated with closed reduction and percutaneous cannulated screws fixation under C-arm fluoroscopic guidance. According to Tile's classification, the patients were classified into type B1 in 4 cases, B2.1 in 8, B2.2 in 10, B3 in 4, C1 in 11, C2 in 7 and C3 in 4. Among them, 39 patients were treated with anterior and posterior fixation, 4 were treated with anterior fixation, and 5 were treated with posterior fixation alone. Anteroposterior, inlet and outlet X-ray radiographs and CT scans of the pelvis were taken preoperatively to evaluate the stability and deformities, and after surgery the plain radiographs and CT scans were taken to evaluate the reduction and the location of screws.

RESULTSThe average operative time was 55 minutes (range, 15 to 95 minutes), and the average intraoperative blood loss was 60 ml (range, 15 to 150 ml), no patient accepted blood transfusion during or after operation. All 48 patients were inserted 157 cannulated screws (mean 3.3, range 2 to 8 per patient). Forty-two patients (135 screws) underwent postoperative pelvic CT scan and 91.11% (123 screws) of them was considered in optimal location; 7 screws penetrated the wall of pelvis and acetabulam because of overlength (<0.5 cm) or deviation, 5 screws interfered with the sacral canal or foramen. Fortunately, these 12 screws did not cause any symptom to the patients. The average follow-up period was 13 months (range 8 to 49 months), the displacement of injured pelvis was satisfactorily corrected in 45 patients (93.75%) and the fractures were healed at one stage. Among all patients, 40 cases (83.33%) had returned to their original works, 4 were still in the process of recovery at the last follow-up and the other 4 were unemployed as sciatic nerve injury or amputation. According to Lindahl improved standard of functional assessment of pelvic injury, the result was excellent in 35 cases, good 10 and fair 3, the average score was 78.7.

CONCLUSIONWith better understanding of the pelvic anatomy, and under C-arm fluoroscopic guidance, treatment of closed reduction and percutaneous cannulated screw internal fixation for unstable pelvic ring injuries is a safe, reliable and feasible method. The clinical outcome is satisfactory.

Adolescent ; Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Pelvic Bones ; injuries

This study was aimed to explore the clinical features and prognosis outcome of childhood T-cell acute lymphoblastic leukemia (T-ALL). The clinical data of 38 cases of newly diagnosed T-ALL from Jan 2005 to Aug 2010 were analyzed retrospectively, and 78 cases of B-ALL with intermediate and high risk were collected as control group, then the sensitive rate of patients to prednisone pretreatment, complete remission (CR) rate at day 33 after induction chemotherapy, relapse rate and 3-year event-free survival (EFS) were compared between T-ALL and B-ALL children. The results showed that no significant statistic difference were found in distribution of age, infiltration of liver, spleen and lymph nodes as well as central nervous system disease, chromosome abnormality, expression level of fusion gene and so on between T-ALL and B-ALL groups (p > 0.05), but there were significant differences in sex and number of cases with WBC count ≥ 50 × 10(9)/L between them (p < 0.05). The sensitive rate of T-ALL and B-ALL patients to prednisone pretreatment was 51.9% and 89.3% respectively (p < 0.05). The ratio failed to achieve CR at day 33 after induction chemotherapy was 15.4% and 8.1% in the two groups (p > 0.05). The relapse rate of T-ALL and B-ALL cases was 30.8% (8/26) and 14.9% (11/74) respectively (p > 0.05). The time from CR to relapse was (9.78 ± 3.48) month and (21.28 ± 14.32) month (p < 0.05). The 3 year EFS of T-ALL cases with intermediate and high risk was (37.5 ± 17.1)% and (22.2 ± 9.8)%, while 3 year EFS of B-ALL cases was (66.7 ± 7)% and (51.7 ± 9.3)% respectively (p < 0.05) according to Kaplan-Meier survival curve. It is concluded that as compared with B-ALL cases, the male ratio and initial WBC count are higher, moreover the early response to prednisone pretreatment and 3 year EFS are poor in T-ALL cases, the prognosis outcome is poor also.
Adolescent ; Child ; Child, Preschool ; Disease-Free Survival ; Female ; Humans ; Immunophenotyping ; Infant ; Male ; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma ; diagnosis ; immunology ; mortality ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; diagnosis ; immunology ; mortality ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma ; diagnosis ; immunology ; mortality ; Prognosis ; Retrospective Studies ; Survival Rate

Objective To investigate the prevalence of adolescent scoliosis in Guangzhou for development of effective prevention and treatment program to the disease. Methods From November2007 to July 2009, 30 142 students between 7 to 20 years old in primary and junior middle schools received physical check-up for detection of scoliosis through physical and radiographic examination.Results 211 cases were diagnosed as scoliosis (Cobb angle≥10°) , with the prevalence rate as 0.70%. 192 patients with idiopathic scoliosis (IS) were detected, accounting for 91.00%. There were 19 cases of congenital scoliosis, accounting for 9.00%. Sex ratio of scoliosis was 180/31. The prevalence of scoliosis was significantly lower in boys than that in girls (x2= 112.332, P＜0.001 ).Conclusion The crude prevalence of adolescent scoliosis was 0.70% in Guangzhou with majority of idiopathic scoliosis. Investigation on scoliosis among school-age population seemed to be important for the purposes of early diagnosis, selection of effective prevention and treatment.

Objective To explore the effects of diagnostic delay on early disease course of Crohn's disease (CD ), and to analyze the risk factors related with the progress of early disease course. Methods From December 2014 to July 2017,a total of 56 patients in Renmin Hospital of Wuhan University initially diagnosed as CD were selected.The clinical manifestation,previous history,imaging examination, endoscopic examination and pathological results of the patients were collected after initial diagnosis of CD. CD-related surgery,CD-related rehospitalization and use of immunomodulators were followed.According to time interval between initial symptom onset and initial diagnosis,the patients were divided into diagnostic delay group (diagnostic delay time＞two years,14 cases)and non-diagnostic delay group (diagnostic delay time≤two years,42 cases).The clinical characteristics at initial diagnosis and early prognosis were compared between the two groups.The risk factors affecting early prognosis of CD patients were analyzed. Kaplan-Meier was used for prognosis analysis.Log-rank test and Cox proportional hazards model were performed to analyze factors affecting early prognosis.Results The results of imaging examination indicated that the proportion of intestinal injury of diagnostic delay group was significantly higher than that of non- diagnostic delay group (χ2＝ 4.49,P ＝ 0.03 ).During follow-up,the proportion of CD-related rehospitalization of diagnostic delay group was higher than that of non-diagnostic delay group,and the difference was statistically significant (χ2＝7.34,P＝0.01).During follow-up,the nine patients received surgery.The one-year and three-year cumulative incidence of surgery was 10.7% and 22.7%,respectively;one-year cumulative incidence of surgery in diagnostic delay group and non-diagnostic delay group was 38 .6%and 9 .6%,respectively.The results of Cox univariable and multivariable analyses both indicated that intestinal injury in imaging examination at diagnosis was the risk factor of surgery (both hazard ratio (HR)＝2.313,both P＜0.01).A total of 21 patients had CD-related rehospitalization during follow-up.And one-year and 31-month cumulative incidence of hospitalization was 27 .8% and 5 6 .3%,respectively;one-year cumulative incidence of CD-related rehospitalization in diagnostic delay group and non-diagnostic delay group was 43 .7% and 2 1 .6%,respectively;and the difference was statistically significant (χ2＝5 .88 ,P＝0.02).The results of Cox univariable analysis indicated that having systematic manifestation,intestinal inj ury in imaging examination and diagnostic delay were the risk factors of CD-related rehospitalization (HR＝2.972,2.313 and 1.403,all P＜0.05).The results of multivariable analysis indicated that having systematic manifestation and intestinal injury in imaging examination were independent risk factors of CD-related rehospitalization (HR＝3.891 and 2.541, P ＜ 0.01,respectively).Conclusions The proportion of intestinal injury of patients with diagnostic delay is high and the early prognosis is poor. Intestinal injury in imaging examination at initial diagnosis is independently risk factor of CD-related surgery and rehospitalization during follow-up.

Objective To predict monthly incidents of extended spectrum β-Lactamases (ESBLs)-producing Escherichia coli in Zhejiang Hospital by establishing multiple seasonal autoregressive integrated moving average (ARIMA) model, so as to provide scientific evidence for reducing the incidents of nosocomial infection of ESBLs producing Escherichia coli. Methods Multiple seasonal ARIMA model was established by monthly records of ESBLs producing Escherichia coli from 2010 to 2016 in Zhejiang hospital. Monthly incidents of ESBLs producing Escherichia coli from 2017 to February 2018 were used to verify the predicted result. The predictions were evaluated by models of mean absolute percent error (MAPE) and bayesian information criterion (BIC) . Results The optional model for the monthly incidence from 2010 to 2016 was ARIMA (0, 1, 1) (0, 1, 1)12. The MAPE was 14.76, BIC was 2.01, and the Ljung-Box statistics value Q was 16.79 (P=0.40) . These parameters suggested a good model fitting. The average relative error between the predictive value and the actual value of the monthly incidents ESBLs producing Escherichia coli from 2017 to February 2018 was 14.08%.The actual values were within the 95% confidence interval. Conclusion The multiple seasonal ARIMA model of ARIMA (0, 1, 1) (0, 1, 1 )12 fits and can be used for short-term prediction and dynamic analysis of the incidents of ESBLs producing Escherichia coli in Zhejiang Hospital.

Objective To study the effect of improved gastric lavage with intermittent pumping liquid at stomarch regions.Methods 110 cases poisoned by intoxication orally were randomly divided into two groups in equal number,that is to say,with an experimental group of 55 cases and a control group of 55 cases.The experimental group was treated with the improved gastric lavage with electrostomach irrigator,and the control group with traditional method.The quality of the stomach lavnging between the two groups were compared.Results In comparison of the two groups,the following differences were significant,that is,in time of lavaging and the vohmn of gastric lavage,smooth aspiration of washing-out liquid,mistakes of absorbing washing-out liquid,vomitus 1 h after lavnge,injury of gastric mucosa (for each of all,P < 0.05).Conclusions The improved gastric lavage with intermittent pumping liquid is more effective in reducing liquid,shortening lavage time,reduing gastric injury of mucous membrane,preventing mis-aspiration and avoiding the vomiting after gastric lavnge operation.

Adult ; Antibodies, Viral ; blood ; China ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; SARS Virus ; immunology ; isolation & purification ; Severe Acute Respiratory Syndrome ; blood ; diagnosis ; virology ; Time Factors