Two hundred women with singleton pregnancy at full term undergoing cesarean section with combined spinal-epidural anesthesia were randomly assigned into 2 groups (n=100 in each group). During anesthesia the polyvinyl chloride epidural catheter was used in control group and the wire-reinforced epidural catheter was used in study group.The results showed that the number of patients in whom blood or blood-tinted fluid was withdrawn from epidural catheter was significantly lower in study group than that in control group.The domestic wire-reinforced epidural catheter can reduce the incidence of blood vessel injury induced by insertion of epidural catheter.

This study was aimed to show the extraction research of cpDNA in Gentiana straminea Maxim. and G. crassicaulis Duthie ex Burk., which will increase the knowledge about the chloroplast genome sequence characteris-tics, understand its genetic diversity and improve the efficiency of breeding schemes. G. straminea Maxim. and G. crassicaulis Duthie ex Burk. were taken as study objects. The improved sucrose-gradient centrifugation and purifica-tion methods were used to obtain the cpDNA, measure the concentration, detect the OD value, and amplify the ITS2 sequence to verify the nucleus pollution. The results showed that the high quality and purity cpDNA (0.1 - 0.4 μg/10 g) was demonstrated without other pollution after ITS2 sequence amplification, which met to the subsequent effi-cient sequencing of chloroplast genomes. The purity and mass have an important influence on the accuracy and cred-ibility of the cp genome sequencing. It was concluded that this study improved the sucrose-gradient centrifugation and purification with great effect of the purity and mass of cpDNA, and guaranteed the obtaining of complete cpDNA of Gentiana.

Objective To observe the clinical effect of the club exercise designed ourselves on the prevention of should-hand syndromeafter stroke. Methods 100 stroke patients in early stage, whose motor function of upper limb were lower than Grade Ⅲ evaluated byBrunnstrom assessment and without shoulder pain and swelling of hand, were randomly divided into control group (n=50) and observationgroup (n=50). All of them received routine rehabilitation therapy, and the observation group received club exercise in addition. The incidenceof shoulder pain, the active range of motion of shoulder, the motor function of upper limb and activities of daily living (ADL) of 2groups were evaluated before and 2 courses (60 d) after treatment. Results There was no statistical difference between 2 groups before thetreatment (P>0.05). After 2-course treatment, the incidence of shoulder pain was significantly lower in the observation group than in the controlgroup (P<0.001), the active range of motion of shoulder, motor function of upper limb and ADL were significantly better in the observationgroup than in the control group (P<0.001). Conclusion The club exercise can prevent the pain of shoulder joint, increase the activerange of motion of shoulder joint and improve the motor function of upper limb and ADL in patients after stroke.

Objective: To investigate the community promotion feasibility of superficial needling plus club swing for post-stroke motion impairment of the shoulder joint. Methods:A total of 180 cases (duration <1.5 years) with post-stroke motion impairment of the shoulder joint were recruited from three community health centers in Changning District, 60 from each community. They were randomly allocated into an observation group (n=90) and a control group (n=90). Patients in both groups received standard internal and rehabilitation care. Patients in the observation group received additional superficial needling plus club swing. The visual analogue scale (VAS) was conducted before and 60 d after the treatment to evaluate the severity of shoulder pain. The active movement of the shoulder joint and activities of daily living (ADL) were also observed. Results:There were no between-group statistical differences before the treatment (allP>0.05). After a 60-day treatment, the shoulder pain severity, active range of motion of the shoulder joint and ADL in the observation group were significantly improved than those in the control group (allP<0.01). In addition, no adverse events were reported by participants in the observation group. Conclusion:Superficial needling plus club swing plays a positive role in improving post-stroke motion impairment of the shoulder joint. This safe, reliable and economical therapy has good patient compliance and is suitable for community promotion.

OBJECTIVETo compare the clinical efficacy on upper limb motor impairment in stroke between the interactive dynamic scalp acupuncture therapy and the traditional scalp acupuncture therapy.

METHODSThe randomized controlled trial and MINIMIZE layering randomization software were adopted. Seventy patients of upper limb with III to V grade in Brunnstrom scale after stroke were randomized into an interactive dynamic scalp acupuncture group and a traditional scalp acupuncture group, 35 cases in each one. In the interactive dynamic scalp acupuncture group, the middle 2/5 of Dingnieqianxiexian (anterior oblique line of vertex-temporal), the middle 2/5 of Dingniehouxiexian (posterior oblique line of vertex-temporal) and Dingpangerxian (lateral line 2 of vertex) on the affected side were selected as the stimulation areas. Additionally, the rehabilitation training was applied during scalp acupuncture treatment. In the traditional scalp acupuncture group, the scalp stimulation areas were same as the interactive dynamic scalp acupuncture group. But the rehabilitation training was applied separately. The rehabilitation training was applied in the morning and the scalp acupuncture was done in the afternoon. The results in Fugl-Meyer for the upper limb motor function (U-FMA), the Wolf motor function measure scale (WM- FT) and the modified Barthel index in the two groups were compared between the two groups before treatment and in 1 and 2 months of treatment, respectively.

RESULTSAfter treatment, the U-FMA score, WMFT score and the score of the modified Barthel index were all apparently improved as compared with those before treatment (all P < 0.01). The improvement in the U-FMA score after treatment in the interactive dynamic scalp acupuncture group was better than that in the traditional scalp acupuncture group (P < 0.05). For the patients of IV to V grade in Brunnstrom scale, WMFT score in 2 months of treatment and the score of Barthel index after treatment in the interactive dynamic scalp acupuncture group were improved apparently as compared with those in the traditional scalp acupuncture group (P < 0.05, P < 0.01). But, for the patients of III grade in Brunnstrom scale, WMFT score and the score of Barthel index after treatment in the interactive dynamic scalp acupuncture group were not different significantly as compared with those in the traditional scalp acupuncture group (both P > 0.05).

CONCLUSIONFor the patients of IV to V grade in Brunnstrom scale in stroke, the interactive dynamic scalp acupuncture therapy achieves the superior improvements of the upper limb motor function and the activity of daily life as compared with the traditional scalp acupuncture therapy, and the longer the treatment lasts, the more apparent the improvements are. For the patients of III grade in Brunnstrom scale, the interactive dynamic scalp acupuncture therapy achieves the similar improvement in the upper limb motor impairment as compared with the traditional scalp acupuncture therapy.

Activities of Daily Living ; Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Occupational Therapy ; Scalp ; Stroke ; physiopathology ; therapy ; Stroke Rehabilitation ; Treatment Outcome ; Upper Extremity ; physiopathology

Objective To Btudy effect of standardized acupuncture combined with rehabilitation therapy (function training)on improvement of comprehensive function among patients with stroke in communities,Changning District of Shanghai.Methods One hundred and seventy-six stroke patients were divided into rehabilitation therapy group(88 cases)and control group(88 cages)with block randomization.Patients in rehabilitation therapy group were treated with standardized acupuncture combined with function training in addition to regular medical treatment,and patients in control group regular medical treatment only.All the patients were evaluated with functional comprehensive assessment(FCA)scale by the end of 2-and 5-month of treatment,respectively.Results By the end of 5-month of treatment,scores of FCA in both groups increased significantly (P＜0.01),as compared to those before treatment,more in rehabilitation therapy group than that in control group(P＜0.05).Conclusions Effect of standardized acupuncture combined with rehabilitation therapy Can obviously improve their comprehensive function among stroke patients in communities.

OBJECTIVETo investigate the effects of angiotensin II (Ang II) antagonist telmisartan on retina vessel endothelial cell apoptosis and its impact on the ACE2-Ang-(1-7)-Mas axis in spontaneous hypertensive rats (SHR).

METHODSThirty-six SHR 16 week-old were randomly divided into 3 groups (n = 12 each): SHR, SHRT (telmisartan 10 mg · kg-1 · d-1 by gastric gavage) and SHRTA group (telmisartan 10 mg · kg-1 · d-1 by gastric gavage plus intravenous injection of A-779 0.5 mg · kg-1 · d-1), twelve WKY rats served as normotensive control group. Systolic blood pressure was measured at pre-treatment and 8 weeks later. After 8 weeks, rats were sacrificed, the expression of ACE2 and Mas in retina were analyzed by qRT-PCR, Western blot and Immunohistochemistry, the Ang-(1-7) concentration in serum was measured by ELISA. Specimens were obtained and stained by hematoxylin and eosin, and the morphology of retina vessel was observed. Apoptosis of vessel endothelial cells were determined by using terminal deoxynucleotidyl transferase mediated dUTP nick end labeling method.

RESULTSThe systolic blood pressure of SHR, SHRT and SHRTA groups at baseline were significantly higher than age-matched WKY group (all P < 0.01). Eight weeks later, the systolic blood pressure group was significantly lower in SHRT group than in the SHR group (P < 0.01), this effect was partly reversed in SHRTA group. The retinal ACE2 mRNA and protein expression was significantly lower in SHR group than in WKY and SHRT groups (P < 0.01), which was similar between SHRT group and SHRTA group (P > 0.05). The retinal Mas mRNA and protein expression were significantly lower in SHR group compared to WKY and SHRT groups (all P < 0.01), which was significantly lower in SHRTA group than in the SHRT group (P < 0.05). ELISA results showed that serum Ang-(1-7) protein level was significantly lower in SHR group than in WKY group and SHRT group (both P < 0.05), which was lower in SHRTA group compared to SHRT group. Retinal vessel endothelial cell apoptosis was higher in SHR group than in WKY group, which could be reduced by cotreatment with telmisartan and this beneficial effect could be reversed by A-779.

CONCLUSIONTelmisartan can reduce retinal vessel endothelial cell apoptosis via upregulating the ACE2-Ang-(1-7)-Mas axis.

Angiotensin I ; metabolism ; Angiotensin II ; analogs & derivatives ; Angiotensin II Type 1 Receptor Blockers ; pharmacology ; Animals ; Apoptosis ; drug effects ; Benzimidazoles ; pharmacology ; Benzoates ; pharmacology ; Blood Pressure ; Endothelial Cells ; Peptide Fragments ; metabolism ; Peptidyl-Dipeptidase A ; Rats ; Rats, Inbred SHR ; Rats, Inbred WKY ; Retina ; Systole ; Up-Regulation

Objective:To identify the risk factors for perioperative atelectasis in pediatric patients undergoing day surgery.Methods:The data of pediatric patients (aged 28 days-7 yr) undergoing elective surgery in our hospital from January 2021 to April 2021 were retrospectively collected.The pediatric patients were divided into atelectasis group and non-atelectasis group according to the results of postoperative ultrasound examination of the lung.The basic conditions and perioperative indicators of the children were recorded, and logistic regression analysis was used to identify the independent risk factors.Results:A total of 122 pediatric patients were enrolled, there were 68 pediatric patients in atelectasis group, and the incidence of atelectasis was 55.7%.Compared with non-atelectasis group, significant changes were found in the amount of sufentanil, rate of laryngeal mask insertion, and rate of intraoperative inhalation of high-concentration oxygen in atelectasis group ( P<0.05). After adjusting variables such as age, upper respiratory tract infection, and overweight, intraoperative inhalation of high-concentration oxygen (FiO 2>60%) ( OR=2.863, 95% confidence interval 1.148-7.137, P=0.024) and consumption of sufentanil >0.2 μg/kg ( OR=1.214, 95% confidence interval 1.069-1.379, P=0.003) were independent risk factors for perioperative atelectasis in pediatric patients undergoing day surgery. Conclusion:Inhalation of high-concentration oxygen (FiO 2>60%) and consumption of sufentanil >0.2 μg/kg during operation are independent risk factors for perioperative atelectasis in pediatric patients undergoing day surgery.

Objective:To identify the risk factors for the first weaning failure following mandibular distraction osteogenesis in pediatric patients with Pierre Robin sequence (PRS).Methods:Clinical data of pediatric patients with PRS who underwent mandibular distraction osteogenesis from January 2018 to February 2023 were collected, including sex, age, premature birth, birth weight, surgical weight, cleft palate, syndrome type PRS, laryngeal/tracheobronchial malacia, simple congenital heart disease, complex congenital heart disease, preoperative mechanical ventilation, preoperative pulmonary infection, blood albumin concentration, difficulty in tracheal intubation under a visual laryngoscope, surgical duration, postoperative ventilator-associated pneumonia, duration of mechanical ventilation at first weaning, and traction length at first weaning. Children in whom the first postoperative machine withdrawal failed were included in observation group and matched to control cases(control group) in a 1∶4 ratio. The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify the risk factors for postoperative weaning failure. Results:There were significant differences in birth weight, cleft palate, duration of mechanical ventilation and traction length at first weaning, rate of combined cleft palate, preoperative pulmonary infection rate, rate of preoperative mechanical ventilation, and rate of postoperative ventilator-associated pneumonia between the two groups ( P<0.05). Binary logistic stepwise regression analysis showed that the preoperative mechanical ventilation ( OR=18.154, 95% CI 3.971-82.990, P<0.001) and postoperative ventilator-associated pneumonia ( OR=36.942, 95% CI 1.307-1043.985, P=0.034) were independent risk factors for first weaning failure after mandibular distraction osteogenesis, while birth weight gain ( OR=0.225, 95% CI 0.076-0.668, P=0.007) was a protective factor for first weaning failure ( P<0.05). Conclusions:Preoperative mechanical ventilation and postoperative ventilator-associated pneumonia are independent risk factors and birth weight gain is a protective factor for first weaning failure following mandibular distraction osteogenesis in pediatric patients with PRS.

OBJECTIVETo explore the correlation between 13q33-q34 microdeletion and clinical phenotype.

METHODSRoutine chromosomal banding was performed to analyze the karyotype, while array-based comparative genomic hybridization (aCGH array) and single nucleotide polymorphism array(SNP array) were employed to investigate the genome copy number variations.

RESULTSThe karyotype of patient 1 was 46, XY, 9qh+,13qs. Patient 2 showed 46, XX, der (13). Patient 3 showed 46, XX, r(13) (p11.2q32) [43]/45, XX, 13[4]/46, XX, r(13;13) [2]/47, XX, 2r(13;13) [1]. Patient 4 did not undergo chromosome karyotyping analysis. Array analysis showed that four patients have different microdeletions in 13q33-34 region and had common features of 13q33-q34deletion including intellectual disability, facial dysmorphism, microcephaly, hypotonia, low birth weight and genital abnormality.

CONCLUSIONThe severity of phenotypes showed no correlation with the size of deletion in 13q33-q34. The lower percentage of patients with congenital heart disease suggested a complex pathogenesis of such disease. EFNB2, LIG4 and SOX1 in 13q33-34 region are promising candidates for mental retardation. LIG4 was also a likely candidate for microcephaly.

Child, Preschool ; Chromosome Banding ; methods ; Chromosome Deletion ; Chromosomes, Human, Pair 13 ; genetics ; Female ; Genetic Testing ; methods ; Humans ; Infant ; Intellectual Disability ; genetics ; Male