OBJECTIVE:To investigate the effects of small dose of bupivacaine lumbar-epidural block on related indexes inwomen underwent cesarean section. METHODS:124 singleton term primipara underwent elective cesarean section were randomly divided into observation group(62 cases)and control group(62 cases). Observation group received 0.5% bupivacaine 7.5 mg lum-bar anesthesia+1.6% lidocaine epidural block. Control group received 0.5% bupivacaine 10 mg lumbar anesthesia+1.6% lidocaine epidural block. HR,SBP,DBP,onset time of sensory block,fixation time of block level,operation start time,the occurrence of traction reaction and supine hypotensive syndrome,the application of ephedrine,Apgar score the occurrence of ADR were ob-served in 2 groups before anesthesia(T0),1(T1),3(T2),5 min(T3)after anesthesia,at skin incision(T4),after fetal disengage-ment(T5). RESULTS:There was no statistical significance in HR,SBP and DBP between 2 groups at T0(P>0.05). There was no statistical significance in HR,SBP and DBP of observation group at different time points(P>0.05). At T1-3,SBP and DBP of con-trol group were significantly lower than at T0 and observation group;HR was significantly higher than at T0 and observation group, with statistical significance(P<0.05);there was no statistical significance in HR,SBP and DBP of control group,compared to at T1-3(P>0.05);there was no statistical significance in above 3 indexes of control group at T4-5,compared to at To and observation group(P>0.05). The onset time of sensory block,fixation time of block level and operation start time in observation group were all longer than control group;the incidence of supine hypotensive syndrome,the number of ephedrine cases,the amount of ephed-rine,the incidence of nausea and vomiting,the incidence of postoperative urinary retention were significantly lower than control group;the incidence of traction reaction was significantly higher than control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of respiratory depression,Apgar score,overall incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:The small dose of bupivacaine lumbar-epidural block for women underwent cesarean section keep he-modynamics stable and reduce the incidence of supine hypotensive syndrome without increasing the incidence of ADR.

Objective To study the expression of plasma oxidized low-density lipoprotein (oxLDL) in children with acute phase Kawasaki disease (KD), and investigate its value for early prediction of coronary artery lesions in KD. Methods Totally 80 children with KD were collected. Children were divided into four groups by the results of echocardiogram of coronary artery in different periods: CAL1 group (children with coronary artery lesions (CAL+) both in acute and sub-acute phase, 8 cases), CAL2 group (children with CAL+in acute phase but recovery normal (CAL-) in sub-acute phase, 10 cases), NCAL1 group (children with CAL-in acute phase but occur CAL+ in sub-acute phase, 10 cases) and NCAL2 group (children with CAL- both in acute and sub-acute phase, 52 cases). The serum samples (before the use of intravenous immunoglobulin) were collected in acute phase. Twenty healthy controls and twenty fever controls were enrolled into the study, and their serum samples were collected. OxLDL was measured by enzyme linked immunosorbent assay (ELISA). They were compared using ANOVA, pairwise comparison LSD-t test. And ROC curve analysis was used to determine the threshold. Results Compared with the control groups,plasma oxLDL levels were higher in children with KD, both CA+and CAL-[(15.0±3.3) mU/L, (12.3±3.5) mU/L vs (9.2±2.2) mU/L, (8.0±2.3) mU/L, F=20.435, P<0.05]. Plasma oxLDL levels were increased more significantly in children with CAL+ than children with CAL- in KD [(15.0 ±3.3) mU/L vs (12.3 ±3.5) mU/L, t=2.28, P=0.002]. There was significant difference in the concentration of oxLDL between the groups of Kawasaki disease (F=5.068, P=0.003). Plasma oxLDL levels were significantly higher in the NCAL1 group than those in the NCAL2 group [(14.5 ±3.8) mU/L vs (11.9±3.3) mU/L, t=2.29, P=0.02], but there were no statistically significant difference between the NCAL1 group and CAL1 or CAL2 group [(14.5±3.8) mU/L vs (15.9±3.9) mU/L, (14.5±3.8) mU/L vs (14.2±2.7) mU/L, t=0.73, 0.20;P=0.41, 0.84]. ROCs analysis indicated that oxLDL≥13.83 mU/L, could be the threshold for the prediction of coronary artery lesions with the sensitivity of 0.607 and a specificity of 0.75. Conclusion OxLDL plays an important role in coronary artery lesions in KD. The coronary endothelial dysfunction is earlier than coronary dilatation, and oxLDL is expected to become a reliable early predictor of coronary artery lesions in KD.

Objective:To investigate the risk factors for delirium after intertrochanteric fracture surgery in the elderly.Methods:The data of 423 elderly patients with femoral intertrochanteric fracture were retrospectively analyzed who had been treated by closed reduction and internal fixation with proximal femoral nail antirotation (PFNA) at Department of Orthopedics, The Second Central Hospital of Baoding from December 2010 to April 2018. They were 205 males and 218 females, aged from 70 to 98 years (mean, 78.6 years). By AO classification, 239 fractures were type 31-A1, 141 ones type 31-A2, and 43 ones type 31-A3. Of them, 362 were complicated with disease of internal medicine. The interval from injury to surgery ranged from 4 to 72 hours with an average of 46.6 hours. The incidence of postoperative delirium was recorded. The risk factors were screened by univariate analysis from the hidden blood loss, gender, age, body mass index, complications, anesthesia method, preoperative preparation time and electrolyte disturbance; multivariate logistic regression analysis was used to determine the independent risk factors from the factors with P< 0.05. Results:Post-operative delirium occurred in 49 of the 423 patients (11.58%) (29 cases on the first postoperative day and 20 ones on the second postoperative day). It was not observed in the other 374 (88.42%) patients. Univariate analysis showed significant differences in the interval from injury to surgery, hidden blood loss and electrolyte disturbance between the patients with and without postoperative delirium ( P<0.05). Multivariate logistic regression analysis showed that the interval from injury to surgery >48 hours ( OR=3.386, 95% CI: 1.362 to 6.638), hidden blood loss>600 mL ( OR=10.292, 95% CI: 1.244 to 35.091) and electrolyte disturbance ( OR=4.157, 95% CI: 1.595 to 7.626) were the independent risk factors for postoperative delirium in elderly patients with intertrochanteric fracture. Conclusion:Long preoperative preparation, a large amount of hidden blood loss and postoperative electrolyte disturbance may be the risk factors for post-operative delirium in elderly patients with intertrochanteric fracture afterinternal fixation.

Objective: To explore the mediation mechanism of coronary artery lesion among both male and female Kawasaki disease (KD) children. Methods: Children with KD that hospitalized in the Wenzhou Medical University affiliated Yuying Children’s Hospital from January 2009 to December 2014, were included in this study. Differences on demographical characteristics, clinical manifestations, laboratory indicators, regimen and time of treatment, results from pre/post echocardiography and treatment between male and female patients, were compared. The independent effect of gender on the risk of coronary artery lesions (CAL) was evaluated, and the mediating effect of BMI, visiting time and KD type on the association between gender and CAL were also studied. Results: The average BMI level of male patients was higher than that of female patients. The difference was statistically significant (P<0.001). The prevalence of overweight among male patients (20.9%) was higher than female (14.1%). The difference was statistically significant (P=0.011). Data from the multivariate logistic regression analysis confirmed that the incidence of CAL in male patients was higher than that in female patients (aOR=1.50, 95%CI: 1.06-2.12) but the CAL was mainly different before on the immunoglobulin therapy. Results from the mediation analysis showed that BMI was an important mediator in the association between gender and CAL, with the indirect effect as 1.05 (95%CI: 1.01- 1.10) and the proportion mediated as 13.0%. Conclusions Male patients presented higher incidence of CAL but was mainly reflected in the difference of CAL before the treatment. BMI was probably an important mediator related to the association between gender and CAL.