Objective To compare the influences of combined spinal-epidural anesthesia(CSEA)and general anesthesia(GA)on patients who underwent laparoscopic gynecological operation.Methods A total of 60 patients of ASA Ⅰ～Ⅱ,were divided into two groups:the CSEA group and the general anesthesia group.Each group consisted of 30 patients.Glucose and cortisol levels were determined before anesthesia,10 minutes after anesthesia,10 minutes after pneumoperironeum and 10 minutes after abdominal deflation.Results No significant differences existed between the two groups on age,weight,operation time,pneumoperitoneum time,time to regain consciousness after operation,HR,SpO2,ECG and MABP(P＞0.05)No significant difference was found in cortisol level between two groups at various time points(P＞0.05).In the general anesthesia group,glucose level at 10 minutes after pneumoperitoneum was significantly lower than that before anesthesia(P＜0.05),but no significant difference was found in glucose level between the two groups at other time points(P＞0 05).At the same time,significant difference was found in postoperative complication rate between two groups(P＜0.01).Conclusion Both CSEA and general anesthesia can effectively inhibit the patients'stress response in laparoscopic gynecological operation.

OBJECTIVETo explore therapeutic effects of reconstructing coracoclavicular ligament for the treatment of Rockwood-III Acromioclavicular dislocation by palmaris longus muscle with polyester suture.

METHODSFrom August 2011 to November 2013,37 cases with Rockwood-III acromioclavicular dislocation were treated with reconstructing coracoclavicular ligament by palmaris longus muscle with polyester suture. Among patients, 24 were males and 13 were females, ranging the age from 19 to 46 years old, with an average of 32 years old. There were 11 cases on the left side and 26 cases on the right side. Twenty-nine cases were fresh dislocation and 8 cases were old dislocation. Blood loss, operative time were observed, and Karlsson evaltae standard were applied for assessing postoperative recovery of shoulder joint function.

RESULTSAll patients were followed up from 2.5 to 5 months with an average of 3.5 months. Operative time ranged from 52 to 98 (meaned 72) min, blood loss ranged from 50 to 180 (meaned 75) ml. All operative incision were healed at the satge I . According to Karlsson standard, 32 cases obtained excellent results and 5 cases were moderate.

CONCLUSIONFor Rockwood-III acromioclavicular dislocation,reconstructing coracoclavicular ligament by palmaris longus muscle with polyester suture has advantages of simple operation, and rapid recovery of shoulder joint function.

Acromioclavicular Joint ; injuries ; surgery ; Adolescent ; Adult ; Female ; Humans ; Ligaments, Articular ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; instrumentation ; Shoulder Dislocation ; surgery ; Sutures ; Young Adult

Objective To reveal the research focus of schistosomiasis in China through analyzing highly cited schistosomiasis related papers in journals from 2005 to 2012,so as to provide the information for formulating the plan of selecting topics of the edi-tors. Methods The published articles related to schistosomiasis in CNKI from 2005 to 2012 were collected,the citation frequen-cy of the papers was calculated according to formula,and the highly cited papers were selected according to the citation frequency. Then the information of highly cited papers including the published time,type,author and author affiliation,citation frequency, journal,grant and research item,research status and development tendency were analyzed. Results A total of 3 639 published papers related to schistosomiasis were searched and 343 papers(the citation frequency≥8)were selected as highly cited papers, and Chinese Journal of Schistosomiasis Control shared 45.19%of them. Among these papers,original articles,reviews and special reports occupied 44.90%,12.54%and 6.12%,respectively. The first authors of these papers were mainly from centers for disease control and prevention(CDCs)(17.33%),research institutions(22.67%)and colleges/universities(36.00%). Totally 50.44%of the articles received financial supports from research funds/foundations,and most of them were national or provincial funds. The research hotspots focused on epidemiology and prevention,epidemic situation analysis,vaccine,immunologic diagnosis,pharma-ceutical research,immunity and infection. Conclusions The highly cited papers related to schistosomiasis are mainly from CDCs,institutions and colleges/universities. The research hotspots mainly focus on epidemiology and prevention,vaccine,immu-nology and pharmaceutical study. The related journals can use this information to chose topic and solicit contributions to improve their influence.

Dead-in-bed syndrome (DBS) is a rare but devastating sudden death condition that mainly affects young patients with type 1 diabetes.Its mechanism is quite complicated and may involve multiple factors.Acute onset of recurrent and severe nocturnal hypoglycemia,abnormal cardiac repolarization,genetic factors,and obstructive sleep apnea may all contribute to ventricular arrhythmias and even sudden death.The future research plans include elucidating and understanding the underlying mechanisms and triggers for DBS,developing a risk stratification system,using real-time continuous glucose monitoring system to detect severe nocturnal hypoglycemia,and initiating appropriate therapeutic interventions to uhimately prevent the tragedy.

Objective To analyze the highly cited malaria papers published in Chinese journals from 2006 to 2013,so as to provide the evidence for formulating the plan of selecting topics to the journal editors. Methods The published articles related to malaria included in CNKI and Wanfang medical network from 2006 to 2013 were collected,and the highly cited papers were selected according to the citation frequency calculated by Price’s formula. Then the characteristics of the highly cited papers were analyzed. Result From 2006 to 2013,a total of 1 976 published papers related to malaria were searched in Chinese jour?nals and 98 papers of them were selected as highly cited papers. In the highly cited papers,18 papers were published in China Tropical Medicine,and 16 and 15 papers were published in Chinese Journal of Parasitology and Parasitic Diseases and Chi?nese Journal of Schistosomiasis Control,respectively;and original articles accounted for 42.86%;the first authors of these pa?pers were from 44 institutions,and 40.91%of them were from centers for disease control and prevention(CDCs);a percentage of 22.45%of the highly cited papers received fund programs,and most of them were national or provincial funds. The research hotspots were focused on the epidemiology and control,and epidemic situation of malaria. Conclusion The highly cited papers related to malaria are mainly from CDCs and research institutions,and the related journals could use this information to chose topics and solicit contributions to improve their influence.

Based on hematological laboratory case study,we discussed the importance of cultivation of stuedents’medical communication competence in the process of laboratory medicine teaching and put forward several suggestions for the cultivation of the students’medical communication competence.

Objective To investigate the pathogenistic, clinical and pathologic characteristics and treatment in elder patients with thyroid carcinoma(TC). Methods The clinical and pathologic manifestation, the treatment and prognosis of forty elder patients with thyroid carcinoma were analysed. Results The incidence of TC in elder patients was 14.2% in all of the thyroid carcinomas in the same period. The clinical course was longer and the neoplasm was bigger. A majority of the pathology was follicular adenocarcinoma(35%), followed by adenocarcinoma, undifferentiated carcinoma and pipallary adenocarcinoma. Surgerical management was the primary therapy. 17 cases underwent redical thyroidectomy with neck dissection, 13 total thyroidectomy or subtotal thyroidectomy, 4 palliative resection. Isotopic or radiotherapy as an adjuvant therapy was done if necessary. Five year survival rat was 52.0%, mortality was 45.0% in follow up period. Conclusions The main causes of the poorer prognosis of elder patients with thyroid carcinoma are follows: ① the malignant degree of the tumor is higher; ② the reaction for the tumor in elder patients is duller. So it is important to pay attention to elder patients with thyroid nodule, and an operation should be done as quick as possible.

OBJECTIVE:To explore security of interstitial chemotherapy by implanting 5-fluorouracil sustained-release reagent into interstitial tissues of oesophageal tumor tissue and tumor peripheral tissue under orthoptic endoscope. METHODS:Relative articles were retrieved from Pubmed database from January 1988 to December 2008 and CNKI database from January 2000 to December 2008. Inclusion criteria:articles which were related to 5-fluorouracil sustained-release reagent for the treatment of esophageal carcinoma were included;Exclusion criteria:Duplicated articles were excluded. A total of 29 patients with grade Ⅲ-Ⅳ esophageal carcinoma who received implantation of 5-fluorouracil sustained-release reagent under orthoptic endoscope were collected from Department of Oncology,Shenyang Red Cross Hospital from March 2001 to December 2007. There were 22 males and 7 females,aging 51-82 years and mean age of 60.2 years. 5-fluorouracil sustained-release particles were implanted into tumor interstitial tissue under orthoptic endoscope. 800 mg 5-fluorouracil sustained-release particles were gradually implanted for 3-5 particles each time. RESULTS:Implantation of 5-fluorouracil sustained-release reagent has been reported to safely and effectively treat esophageal carcinoma. Clinical results indicated complete remission(n=3) ,partial remission(n=16) ,stable pathogenetic condition(n=6) ,and no remission(n=4) . Body mass increased in 21 patients(72.4%) ,and average effectiveness level was 70.9%. Symptoms including hemorrhage,light descent of leukocyte,light malignancy,diarrhea but excluding functional disorder of liver and kidney were found. Easement of pain in 22 patients was 75.8%,and discontinuing analgesics accounted for 50%(P

Currently,tracheal stents used in clinic include silicone,dynamic and metal types.The metal stents contain Ni-Ti memory alloy,stainless steel,and coating stents,which are cylinder and network structured.These stents are more expensive than silicone stents.The internal stents,mainly metal stents,have been used recently in clinic to treat tracheal stenosis.Tracheal stenting methods are divided into bronchofibroscope and hard lens implantation.Both tracheal and esophageal stent implantations are invasive treatment.However,tracheal stent implantation is different from esophageal stent implantation.As patients with airway obstruction are always complicated by dyspnea and hypoxemia,even respiratory failure,which increases risk and difficulty of stent implantation.During tracheal stent implantation,the bronchofibroscope or stent entering the stenosis site may lead to complete tracheal obstruction-induced asphyxia.Corrosion of metal wire of stent to airway mucosa and vessels may result in hemorrhea,leading to postoperative hemoptysis.Stent dislocation is mainly caused by inappropriate selection of stent,inappropriate implantation position or severe cough.Carcinoma tissue growing along stent lumens can induce re-obstruction in stent,resulting in atelectasis relapse.Although there are many unsolved problems and the incidence of complication is 10%-20%,tracheal stent is still a safe,effective and simple therapy for tracheal stenosis.Prevention and treatment of tracheal stenosis following stent implantation and development of novel stents with better effect and fewer side effects is future study focus.

Objective Myocardial infarction and subsequent heart failure remain the most dominant health challenges worldwide.Therapeutic angiogenesis has emerged as a potential novel treatment for severe ischemic heart disease and there is increasing evidence that cell transplantation may improve the perfusion and contractility of myocardium in animal models.This study was designed to examine the endothelial growth potential and whether transplantation of human umbilical cord derived mesenchymal stem cells can improve local blood flow in a mouse ischemic hindlimb model.Methods The mesenchymal stem cells derived from human umbilical cord of passage 5 were differentiated in an endothelial differentiation medium containing vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in vitro.Samples were observed for 2 weeks.The human umbilical cord derived mesenchymal stem cells were transplanted into a hindlimb ischemia mouse model in vivo.Four weeks later,immunofluence was used to identify the migration and differentiation of the transplanted cells towards endothelial linage.Laser Doppler perfusion image was used to evaluate the local blood flow of the hindlimb.Results Results After incubation with VEGF and bFGF,the human umbilical cord derived mesenchymal stem cells started to form interconnected clusters and a network was formed.Four weeks after transplantation,the transplanted cells were sprouting f0rom the local injection and differentiated into endothelial cells,contributed to the recovery of local blood flow obviously as compared with control group.Conclusion Human umbilical cord derived mesenchymal stem cells have the ability to differentiate into endothelial cells,contribute to the local angiogenesis in a hindlimb ischemia mouse model and represent a new source for therapeutic angiogenesis for clinical applications.