Objective To explore clinical effect of sufentanil combined with ropivacaine in interscalene brachial plexus block by ultrasound-mediated.Methods 66 patients received the treatment of interscalene brachial plexus block were divided into group A,B and C randomly.Group A received traditional blind puncture interscalene brachial plexus block with ropivacaine;Group B received interscalene brachial plexus block with ropivacaine by ultrasound-mediated;Group C received interscalene brachial plexus block with combination of sufentanil and ropivacaine by ultrasound-mediated.The operation time,VAS score,pain and movement block onset time,anesthesia fine ratio and incidence of complications were observed and compared.Results The operation times of group B and C were significantly shortened compared with group A(all P ＜0.05) ;The pain and movement block onset time was shortened significantly in group B (all P ＜ 0.05),and more significantly in group C than those in group A (all P ＜ 0.05) ;The VAS score at 30min,60min and 120min after operation of brachial plexus block were significantly decreased in group C than those in group A and B (all P ＜ 0.05) ; Anesthesia fine ratio in group B and C significantly improved than that in group A (all P ＜ 0.05) ; Incidence of complications of group B and C was significantly lower than that in group A after operation of brachial plexus block (all P ＜ 0.05).Conclusion Sufentanil combined with ropivacaine in interscalene brachial plexus block by ultrasound-mediated has good effect and safety,and it can improve the onset time and effect of pain and movement block.

Objective To study the initial experience and outcomes of laparoscopic enucleation with preoperative selective arterial embolization ( PSAE) for the treatment of renal angiomyolipomas. Methods A total of 43 patients with sporadic renal angiomyolipomas from July 2013 to November 2014 underwent laparoscopic nephron-sparing surgery ( NSS) .The patients were divided into either PSAE group ( n =19 ) or non-PSAE group ( n =24 ) .The data of patient demographics, success rate of surgery, perioperative complications rate, operating time ( OT ) , warm ischemia time ( WIT ) , estimated blood loss ( EBL ) , length of hospitalization, kidney estimated glomerular filtration rate (eGFR) and serum creatinine (Scr) level over 3 months, and ipsilateral recurrence were collected and compared between the two groups. Results Enucleation was successful in 100%patients (19/19) of the PSAE group and in 62.5%patients (15/24) of the non-PSAE group,with no significant difference ( Fisher' s test, P=0.105) The EBL was (46.4 ±20.6) ml in the PSAE group, which was significantly less than the non-PSAE group [(89.5 ±30.4) ml, t=-5.287, P=0.000].The OT and WIT were significantly shorter in the PSAE group than those in the non-PSAE group [(90.3 ± 21.1) min vs.(131.7 ±18.6) min, t=-6.831,P=0.000;(9.5 ±5.7) min vs.(24.2 ±4.8) min, t=-9.181, P=0.000]. The length of hospitalization was significantly longer in the PSAE group than that in the non-PSAE group [(7.7 ±1.1) d vs.(6.3 ± 1.3) d, t=3.748, P=0.000].No severe complications occurred in the PSAE group, whereas the non-PSAE group had 1 case of urinary leakage and 1 case of hematoma.The Scr level over 3 months after surgery was more ideal in the PSAE group [(70.1 ±13.7)μmol/L vs.(84.2 ±9.1) μmol/L, t=-4.045, P=0.000].No statistically significant difference was found in the eGFR between the PSAE group and the non-PSAE group [(72.6 ±12.8) ml· min-1· 1.73 m-2 vs.(68.0 ±10.7) ml· min-1· 1.73 m-2, t=1.284, P=0.206].No evidence of recurrence was found during follow-up period in both groups. Conclusions Laparoscopic enucleation with PSAE is a safe and effective minimally invasive procedure for the treatment of renal angiomyolipomas.As compared to traditional laparoscopic partial nephrectomy, it has advantages of less WIT, less EBL, and better protection of renal functions.It can be recommended in well-selected patients.

Adolescent ; Child ; Child, Preschool ; Chronic Disease ; Cough ; etiology ; Female ; Humans ; Male ; Rhinitis ; complications ; diagnosis ; drug therapy ; Sinusitis ; complications ; diagnosis ; drug therapy

Objective To investigate the effect of conductive education applied in water exercise on cerebral palsy. Methods 58 children with cerebral palsy who could accept conductive education were divided into observation group (n=29) and control group (n=29) randomly. All the children accepted routine rehabilitation, and the observation group accepted water exercise in the model of conductive education. They were assessed with muscular strength, muscular tension (modified Ashworth Scale) and the Gross Motor Function Measure (GMFM) before and after training. Results The score of GMFM improved more in the observation group than in the control group (P<0.05), as well as the incidence of improvement of muscle tension (released 1 grade or more, 75.9% vs. 44.8%, P<0.05) and muscle strength (increased 1 grade or more, 82.8% vs. 58.6%, P<0.05). Conclusion Water exercise with the conductive education model can improve the gross motor function and muscle strength, release the spasticity in children with cerebral palsy.

Objective To observe the effects of Atorvastatin on matrix matalloproteiases-2 (MMP-2) level in patients with stable an ginapectoris(SAP) and acute coronary syndrome(ACS).Methods Sixty SAP and sixty ACS patients were randomly divided into either the Atorvastatin group or the control group.The levels of MMP-2 before and after treatment were detected.Results After treatment with Atorvastatin,the levels of MMP-2 in both two groups significantly de- creased(P

Objective To explore the clinical and pathological characters of Xp1 1.2 translocation renal cell carcinoma.Method We screened patients of renal cell carcinoma of PUMCH between Jan.2011 and Dec.2015,6 patients with Xp11.2 translocation renal cell carcinoma were found.There were 2 males and 4 females,with average age of 39 (ranging from 16 to 73 years old).Diameter of tumor ranged from 1.9cm to 19.0cm,and 9.6cra in average.Among which,3 cases were detected by routine physical examination,1 by severe anemia (Hb 66g/L),1 by gross hematuria,and 1 by flank discomfort.Before treatment,2 cases had local metastasis (local lymph node,renal pelvis invasion),1 had distant metastasis (pulmonary metastasis).CT examination showed that the tumors had soft tissue density / low density,with significant enhancment or uneven enhancement in enhanced scanning,and were all considered malignancy.6 patients were all treated with surgeries,of which 5 patients received radical nephrectomy,1 patient received nephron sparing surgery.Result Pathologically,most clear cells arranged in a papillary,nest like structure,with psaamoma bodies in them.Immunohistochemical examination showed that all patients were positive for TFE3.AE1/AE3,RCC,Vimentin,CD10,EMA,P504 were positive in different degree.According to pathological result,all 6 patients were proved to be Xp1 1.2 translocation renal cell carcinoma.After surgery,2 patients received immunotherapy,2 received targeted drug therapy,and 1 received local radiotherapy.The follow-up duration ranged from 9 to 56 months (average 37 months).Among which,1 patient died from tumor recurrence and multiple metastasis 22 months after surgery,1 had pulmonary metastasis 12 months after surgery,and the tumor had no significant progress after receiving targeted drug therapy.All the other patients survive without tumor recurrence.Conclusions Xp1 1.2 translocation renal cell carcinoma predominantly occurs in children and adults younger than 40 years.Arterial phase enhancement is slightly lower for Xp1 1.2 translocation renal cell carcinoma in CT scan than that of renal clear cell carcinoma.Histological features and immunohistochemical staining of TFE3 positive expression are important means of diagnosis of this disease.If necessary,gene detection could be done to make better diagnose.Surgery is preferred treatment option.Metastatic leads to poor prognosis,and need to be supplemented by targeted drug therapy.

10.3969/j.issn.2095-4344.2013.26.005

Objective To evaluate CT and MRI features of brain lesions in CO poisoning and to compare the ability of detecting rate of lesions by CT and MRI.Methods CT and MRI appearances in 52 cases with CO poisoning were analysed and compared.Results Necroses and degenerations of globus pallidus in 9 cases,cerebral white matter demyelination in 3 cases and brain atrophy in 3 cases were showed by CT.The detecting rate was 28.8% by CT while,necroses and degeneration of glodus pallidus were observed in 24 cases and white matter change in 7 cases were observed by MRI,the detecting rate was 59.6% which was higher than that of CT (?

Forty-two patients with type 2 diabetes mellitus (DM) were refered to 3 groups:type 2 DM without diabetic nephropathy (DN),type 2 DM with DN in the initial stage and type 2 DM with DN in the clinical stage.Ten healthy subjects were served as control group.Plasma adrenomedullin (ADM),urinary?_1- microglobulin (MG) and?_2-MG were detected.The results showed that the level of plasma ADM rose gradually with the development of DN and was positively correlated with markers of tubulointerstiial injury such as urinary?_1- MG and?_2-MG (both P

Objective To explore the cause and the interventional treatment of restenosis after percutaneous transhepatic biliary stent.Methods 20 patients with biliary restenosis after percutaneous transhepatic biliary stent placement were collected.According to drainage volume from biliary tract and degree of amelioration of jaundice,post-operation hepatic function,blood,urine and stool routines,ultrasound,CT scan and cholangiography were performed to determine the nature and location of biliary restenosis,and then all cases underwent recanalization with intervention method by the exteriorized drainage tube approach.The China-made nickel-titanium alloy stents with diameter of 10 mm and length ranged from 40 mm to 80 mm were used.Results The biliary restenosis occurred in mid-inferior segment of common bile duct in 9 patients, common hepatic duct in 7 patients and hepatic porta in 4 patients. As regarding the causes of restenosis included tumor compression in 9 cases, angulation in upper segment of stent in 3 cases, obstruction in stent by bile, food or clot in 4 cases, cholangitic stenosis in 2 cases and granulation proliferation in 2 cases.The obstruction in all cases was relived by extraction through drainage tube, drug irrigation,dredging by wire, balloon dialtion or stent replacement, so that the total survival rate was beyond 6 months.Conclusion After percutaneous transhepatic biliary stent placement in treating the malignant biliary obstruction,the rate of biliary restenosis is still high,which should be attached importance to.