Objective To investigate the diagnostic method,microsurgical operation time and effect of brain arteriovenous mal-formation(AVM)rupture hemorrhage in childhood.Methods 72 children (≤16 years old)of AVM hemorrhage from 2003 to 2013 were retrospectively analyzed.Results The CT diagnosis rate was 48.6%(35/72),the MRI diagnosis rate was 78.3%(47/60),56 cases were performed the early whole brain DSA under the condition permitting,its diagnosis rate was 98.2%(55/56).All the cases were performed the hematoma clearance plus the pertinent lesion resection.70 cases were re-examined by DSA/CTA/MRA during postoperative perioperation period.The lesion resection rate was 91.5%,the partial resection rate was 8.6%.60 cases(85.7%) were successfully followed up for 6 months to 6 years and assessed by the Glasgow outcome scale,5 points in 5 5 cases,4 points in 2 cases,3 points in 2 cases and 2 points in 1 cases.Conclusion DSA is the main detection measure for early diagnosing AVM hem-orrhage and the microsurgical operation in the acute stage can reduce the fatality and improve the prognosis.

BACKGROUND:Currently the ultrasound-guided continuous femoral nerve block has been widely used as a postoperative analgesia method after knee replacement surgery, but there are stil some technical and practical details issues to be studied. OBJECTIVE:To evaluate the effect of ultrasound-guided imaging and safety evaluation of different puncture techniques and needle choice in the ultrasound-guided continuous femoral nerve block after total knee arthroplasty.METHODS:One hundred and sixty patients undergoing total knee arthroplasty were randomly divided into four groups, with 40 cases in each group. Continuous femoral nerve block was done after general anesthesia induction. Patients in each group were respectively punctured using 20 G needle (diameter 1.1 mm) out-of-plane approach, 20 G needle (diameter 1.1 mm) in-plane approach, 18 G needle (diameter 1.3 mm) out-of-plane approach, and 18 G needle (diameter 1.3 mm) in-plane approach. Patient-control ed analgesia pump was used 30 minutes before the end of surgery. The operating time of continuous femoral nerve block was recorded. The visual analogue scale scores at rest, active functional exercise and continuous passive movement state on 6, 24, 48, 72 hours after total knee arthroplasty were estimated. The presses of the pump, time of first walk, daily walk times and complication of continuous femoral nerve block were observed. RESULTS AND CONCLUSION:The operating time of continuous femoral nerve block in group D was shorter than that in other groups (P<0.05). There was no difference of visual analogue scale scores, the presses of the pump, time of first walk, and daily walk times among each group. The incidence of puncture site pain in group C was higher than that in other groups (P<0.05). The best ultrasound imaging was obtained by using 18 G needle in-plane approach for ultrasound-guided continuous femoral nerve block after total knee arthroplasty, and the complication incidence was not increased.

Heart rate variability (HRV) is an important point to judge a person's state in modern medicine. This paper is aimed to research a person's fatigue level connected with vagal nerve based on the HRV using the improved Welch method. The process of this method is that it firstly uses a time window function on the signal to be processed, then sets the length of time according to the requirement, and finally makes frequency domain analysis. Compared with classical periodogram method, the variance and consistency of the present method have been improved. We can set time span freely using this method (at present, the time of international standard to measure HRV is 5 minutes). This paper analyses the HRV's characteristics of fatigue crowd based on the database provided by Physio-Net. We therefore draw the conclusion that the accuracy of Welch analyzing HRV combining with appropriate window function has been improved enormously, and when the person changes to fatigue, the vagal activity is diminished and sympathetic activity is raised.
Fatigue ; diagnosis ; Heart Rate ; Humans ; Regression Analysis

Objective To evaluate the clinical effect of different temperature of fluids and blood infusion on postoperative recovery quality in elderly patients undergoing total knee arthroplasty (TKA).Methods One hundred and fifty-six cases of elderly patients (male 42,female 1 14,aged 65-85 years,ASA Ⅰ or Ⅱ)scheduled for selective single TKA were recruited and divided into three groups randomly(n =52 each),normal temperature group (group NT),constant temperature group (group CT)and warming temperature group (group WT).Patients of group NT were infused with blood or fluids of room temperature (22-24 ℃)and surgical area were flushed with fluid of room tem-perature too.Patients of group CT were infused with blood or fluids of 37 ℃ by heating apparatus and temperature of fluids used to flushing was 37 ℃ too.Otherwise,in group WT,the tempreture of blood and fluids for infusion were kept at 37 ℃ and the surgical area were flushed with fluid of 39 ℃. The nasopharyngeal temperature were recorded on time points of before anesthesia (T0 ),30 min (T1 )and 1 h (T2 )after surgery beginning,30 min (T3 )and 1 h (T4 )after surgery.Time of sponta-neous breathing,time of eye opening on call,time of fully conscious,extubation time and Steward scores of patients were recorded too.And the cognitive function were evaluated by Postoperative Quality Recovery Scale (PQRS)on time points of 1 5 min and 40 min after extubation and the 1,3, 30 d after surgery.Results Compared with T0 ,the nasopharyngeal temperature of three groups were significantly decreased at T1-T4 (P <0.05 or P < 0.01 ).The nasopharyngeal temperature of group CT and group WT were significantly higher than in group NT at T1-T4 (P <0.01).And the nasopha-ryngeal temperature of group WT was significantly higher than in group CT at T4 (P <0.05).Com-pared with group NT,time of eye opening on call and spontaneous breathing in groups CT and WT were significantly shorter (P < 0.01 ).Time of fully conscious in group WT was obviously shorter than in group NT (P <0.01),and the Steward score in group WT was significantly higher than in group NT (P <0.05).Compared with before extubation,the cognitive function scores in all patients at 1 5,40 min after extubation and 1,3,30 d after surgery were increased significantly (P <0.01).The cognitive function scores in group CT and group WT at all time points were significantly higher than that in group NT (P <0.05).And the cognitive function scores in group WT was significantly higher than that in group CT at 30 d after surgery (P <0.05).Conclusion The elderly patients undergoing TKA receiving blood transfusion and infusion at 37 ℃ and flushing the area with fluid at 39 ℃ can prevent the occurrence of hypothermia and improve the postoperative recovery quality and cognitive function recovery.

Objective To explore the role of ? chemotactic factor- MCP-1 in the pathogenesis of congestive heart failure by detecting its expression changes.Methods PBMCs were collected from 25 patients with congestive heart failure and 10 healthy controls. RT-PCR was used to detect the mRNA expression of MCP-1 in PBMCs. Correlation of the clinical indexes of heart failure patients with to their MCP-1 mRNA expression levels were analysed.Results The expression level of MCP-1 in the heart failure patients was higher significantly than that of controls (P

Objective To evaluate intra- and interatrial asynchrony and its determinants in aged patients with paroxysmal atrial fibrillation (PAF) by using tissue Doppler imaging. Methods Ninty-one patients without PAF (control group, including 40 elder patients and 51 non-elder patients) and 52 aged patients with PAF were included. As to assessment of intra- and interatrial synchronicity, the atrioventricular plane were selected on the right atrial (RA) free wall, interatrial septum (IAS), and left atrial (LA) free wall. The time differences from the onset of the P wave to the onset of the A wave at the left atrium (P-LA), the IAS (P-IAS), and the right atrium (P-RA) were measured. Intra-atrial asynchrony was defined as the differences between P-IAS and P-RA (RA asynchrony) and between P-LA and P-IAS (LA asynchrony). Interatrial asynchrony was defined as the difference between P-LA and P-RA. Stepwise regression was made to determine the influencing factors for atrial asynchrony in aged patients with PAF. Results Compared with the control group, aged patients with PAF had significant LA and interatrial asynchrony (P＜0.01). Multivariate stepwise regression demonstrated that systolic blood pressure (x2), age (x1) and left ventricular mass index (LVMI x5) entered the regression equation in aged patients with PAF (Y=-57.241+0.481 x1+0.223 x2+0.294 x5). Conclusions Aged patients with PAF have LA and interatrial asynchrony. LVH, aged and SBP are important factors leading to these asynchronies in the aged patients with PAF.

Objective:To evaluate the preventive effect of Danshen Shuizi Capsule on vascular restenosis after stent implantation.Methods:48 patients with endovascular stent implantation were randomly assigned to control group(n=25) (treated with western medicines)and treatment group(n=23)(treated with Danshen Shuizi Capsule)after endovascular stenting implantation.The intraluminal diameter of stenting segment was measured by QCA at 6 months after stent implantation.Results: The diameter of reference vessel in two groups was not significantly different.The intraluminal diameter of stent segment in the treatment group was not larger than that in the control group(2.22?0.21)mm vs(2.18?0.25)mm.The index number of vessel diameter reduction in treatment group was not less than that in the control group(0.50?0.16)mm vs(0.51?0.11)mm.The rate of restenosis(18.4%)and reintervention(13.1%)in treatment group were not lower than those in the control(20%,12%).However,the complication in treatment group was significantly lower than that in control group.Conclusion:These findings indicated that endovascular was useful for the prevention of endovascular restenosis after stent implantation with fewer complications

OBJECTIVE:To establish the quality standards for Shenshuaikang granule. METHODS:TLC was used for the quali-tative identification of Astragali Radix and Rhei Radix et Rhizoma in the preparation. HPLC was used for the contents determina-tion of emodin and chrysophanol ,the column was Agilent HC-C18 with mobile phase of methanol-0.1% phosphoric acid (85:15 , V/V)at a flow rate of 1.0 ml/min,the detection wavelength was 254 nm,the column temperature was 30 ℃ and the injection vol-ume was 10 μl. RESULTS:TLC showed clear spots and good separation. The linear range was 1.9-60.8 μg/ml for emodin(r=0.999 9, n=6) and 1.6-51.2 μg/ml for chrysophanol (r=0.999 9),RSDs of precision,stability and reproducibility tests were lower than 3%,recoveries were 95.76%-103.66%(RSD=2.83%,n=9)and 97.24%-104.34%(RSD=2.65%,n=9),respectively. CONCLU-SIONS:The standard can be used for the quality control of Shenshuaikang granule.

Objective To evaluate the effect of dorsal dual-plate fixation for unstable distal radius fractures.Methods Twenty-two cases of unstable distal radius fractures undergone dorsal fixation with a 2.4 mm plate from June 2010 to June 2012 were enrolled.There were 16 males and 6 females with mean age of 54.5 years (range,22-75 years).According to the AO fracture classification,there were 12 cases of type B2,6 type C1 and 4 type C2.Five cases had autologous or allogeneic bone grafting.Results Mean period of follow-up was 14 months (range,5-30 months).According to Gartland-Werley score,the result was excellent in 13 cases,good in 5 cases and fair in 4 cases,with the excellent and good rate of 82％.Volar inclination [(11.07 ± 1.77) °],ulnar declination [(22.30 ± 3.13) °],and radial height [(11.40 ±1.51) °] showed statistical differences from that [(-1.50 ± 7.59) °,(11.90 ± 3.87) °,and (5.20 ±1.55) ° respectively] before operation (P ＜ 0.05).Conclusions Dorsal dual-plate fixation can be a reliable and effective technique for AO-B2 shear fractures with intact volar-cortex and dorsal criticallycomminuted fractures of the distal radius.Active bone grafting should be performed for bone defection to promote bone healing.

Objective To investigate the inhibitory effect of bone marrow mesenchymal stem cells ( BMMSC) on the inflammatory response of microglial cells .Methods The samples were divided into four groups .Group I:microglial (BV-2) cells were cultured in DMEM (high glucose).Group II: BV-2 cells were cultured in DMEM containing lipopo-lysaccharide (LPS).Group III:BV-2cells and BMMSCs were co-cultured in DMEM.Group IV: BMMSCs were cultured in DMEM containing LPS .The growth state and ultrastructure of BV-2 cells were observed and the changes of TNF-αex-pression were detected .Results Different cell densities of BV-2 cells were observed under the optical microscope in an or-der from high level to low level:group I >group III >group II.The expressions of TNF-αwere:group Ⅱ >groupⅢ>group Ⅰ.Ultrastructural observation of BV-2 cells showed that there were a large number of swollen mitochondria and endoplasmic reticulum , some of them showed vacuolization .No BV-2 cells with multiple hucleoli were found in the group II indicating the absence of active cell growth .At the same time, cytolysis was observed only in the group II .The growth of BV-2 cells in the group III was better than that in the group II .Conclusions BMMSCs can inhibit inflammatory response of microglial cells, therefore, play a neuroprotective role.