Objective To observe the postoperative analgesic effects of ultrasound-guided transversus abdominis plane block after cesarean section. Methods Forty patients having underwent cesarean section under intraspinal anesthesia were selected, and they were divided into experiment group and control group by random digits table method with 20 cases each. All the patients were given ultrasound-guided transversus abdominis plane blocks when surgery finished. The patients in experiment group were injected 0.25%ropivacaine 20 ml, and the patients in control group were injected 0.9% sodium chloride 20 ml. All the patients received patient controlled intravenous analgesia (PCIA) pump after surgery. The movement and resting visual analog score (VAS), incision VAS at 4, 8, 12 and 24 h after surgery, and the compression time of analgesis pump were compared between 2 groups. The correlated adverse reaction of transversus abdominis plane block were recorded. Results The movement VAS at 4 and 8 h after surgery in experiment group were (4.1±1.7) and (5.3±1.8)scores, and in control group were (6.3±2.0) and (7.0±1.2) scores, and there were statistical differences (P<0.05). The incision VAS at 4 and 8 h after surgery in experiment group were (0.9±0.4) and (1.2±0.8) scores, and in control group were (3.6±2.1) and (6.8±2.4) scores, and there were statistical differences (P<0.05). The compression time of analgesis pump in experiment group was significantly lower than that in control group: (2.8± 1.4) times vs. (4.0±1.9) times, and there was statistical difference (P<0.05). The using dose of tramadol in experiment group was significantly lower than that in control group:(214±12) mg vs. (224±15) mg, and there was statistical difference (P<0.05). All the patients did not appear the correlated adverse reaction of transversus abdominis plane block. Conclusions Ultrasound-guided transversus abdominis plane block is accurate and easy. It provides effectual post-cesarean section analgesia with lower adverse reaction, which is a better choice of multimodal analgesia for cesarean section.

Objective To investigate the safety and efficiency of radiofrequency ablation (RFA) in the treatment of complicated multifetal gestations.Methods There were 6 multifetal pregnant women (gestational age ranged from 14+6 to 27 +2 weeks) diagnosed in the Department of Obstetrics,Provincial Hospital Affiliated to Shandong University:two with twin-twin transfusion syndrome (TTTS) stage Ⅳ,one with reversed arterial perfusion sequence,one with dichorionic triamniotic triplets,one with absence of a lower limb,one with severe intrauterine growth restriction.All of them accepted ultrasound-guided selective fetocide by RFA.Results (1) Blood flow of three reduced fetuses stopped completely after one RFA circulation,whereas the other three stopped after two circulations.One reduced fetus stopped heartbeating in 10 minutes after RFA; three reduced fetuses' heartbeats slowed down and stopped completely in 35 minutes after RFA ; and the heartbeats of the other two cases stopped completely within 3 to 7 minutes after RFA.The heartbeats of the reserved fetuses were normal.All of the operations succeeded.(2) The reserved fetuses received a series of ultrasound examinations after the operations.In Case 1,the ascites of the reserved fetus,which was 4.0 cm× 2.3 cm before RFA,disappeared two weeks later; and the umbilical artery systolic/diastolic (S/D) ratio,which was 3.35 before the operation,decreased to 2.70 six weeks later.Amniotic fluid depth decreased from 44.6 cm to normal two weeks after RFA.The reserved fetus received brain MRI three weeks after RFA and no abnormality was detected.In Case 2,the increased heart size (cardiothoracic ratio ＞ 0.35) of the reserved fetus recovered to normal size ten days after the operation ; and the umbilical artery S/D decreased from 4.69 to 3.39 seven days after the operation.Reserved fetuses of the other three cases were normal on ultrasound and MRI after the operations.In Case 6,the ascites of the reserved fetus,which was 2.3 cm × 1.5 cm before RFA,disappeared sixteen days after the operation.The brain MRI suggested normal three weeks after the procedure.Amniotic fluid depth reduced from 11.0 cm to normal two weeks after the operation.(3) Three women delivered normal premature babies,and the other three got healthy mature infants.At present,all children are still in follow-up,and their physical examinations suggest normal.Conclusions RFA is a safe,efficient,minimal invasive treatment,which provides a new choice for fetocide,especially for complicated monochorionic multifetal gestations.Fetocide by RFA can effectively improve the life quality of the reserved fetuses.

OBJECTIVETo explore the effects of acupuncture with different filiform needles on structure of fascial connective tissues, cellular activity, arrangement and content of collagen fibers in acupoint area of rats.

METHODSA total of 32 SD rats were randomly divided into a blank group, a thin needle group, a medium needle group and a thick needle group, 8 rats in each one. Except for the blank group, rats in the remaining groups were treated with horizontal acupuncture at "Zhongwan" (CV 12) towards Conception Vessel with different filiform needles, and twirling mild reinforcing-reducing method was applied, once a day. Rats in the blank group were treated with identical anesthesia, grasping and fixation. After 3-day intervention, the fascial connective tissue of acupoint area was collected. HE staining, immumohistochemical staining of proliferating cell nuclear antigen (PCNA) and MASSON staining were adopted to observe the morphology of fascial connective tissues, expression of PCNA in cells and arrangement and expression of collagenous fiber.

RESULTSAfter acupuncture in each group, the consistency of morphology of fascial connective tissues and arrangement of collagenous fiber were changed; the expression of PCNA protein in the fascial connective tissue in each group was significantly increased (P<0. 01, P<0. 05). The area distribution of collagenous fiber were changed, and that in the thin needle group was insignificantly increased compared with that in the blank group (P>0. 05), and that in the medium needle group and thick needle group were reduced compared with that in the blank group (both P<0. 05).

CONCLUSIONSAcupuncture with different filiform needles can change the local tissue morphology of acupoints, strengthen cell activity and adjust the exyression of collagenous fiber protein, which may be one of the cellular biomechanics principles of the acupuncture therapy's "regulating meridians" effects. However, the stimulation is produced by different fifiform needles, and the complex relationships exist between cells and collagen fibers.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; methods ; Animals ; Cell Proliferation ; Collagen ; genetics ; metabolism ; Connective Tissue ; anatomy & histology ; metabolism ; Fascia ; anatomy & histology ; cytology ; metabolism ; Male ; Meridians ; Needles ; Proliferating Cell Nuclear Antigen ; metabolism ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo compare clinical efficacy of anatomic locking plate and Gamma nail in treating unstable femoral intertrochanteric fractures with external wall fractures.

METHODSFrom June 2010 to June 2014,clinical data of 44 patients with intertroehanteric fractures associated with lateral wall fractures (type 31A2.2-3.3) followed more than 12 months,which treated with Gamma nail or anatomic locking plate,were retrospective analyzed. Sixteen patients were treated with anatomic locking plate, including 6 males and 10 females aged from 32 to 83 years old with an average of 56.5 years old. Twenty-eight patients were treated with Gamma nail including 17 males and 11 females aged from 26 to 87 years old with an average of 60.4 years old. Operative time, intraoperative fluoroscopy times, blood loss (intraoperative and hidden blood loss), hospital stays were observed and compared. PPMS and HHS scoring were used to evaluate postoperative clinical effect.

RESULTSAll patients were followed up from 12 to 24 months with an average of 16.2 months. Operative time in Gamma nail was shorter than anatomic locking plate; while blood loss( intraoperative and hidden blood loss) and intraoperative fluoroscopy times in anatomic locking plate were less than that of in Gamma nail. There was no significant meaning in hospital stays between two groups. Postoperative full weight-bearing time in anatomic locking plate was prolonged than Gamma nail. At the final following-up, PPMS in Gamma nail was 7.50 ± 1.78 and 6.82 ± 1.38 in anatomic locking plate, and there was no obvious meaning between two groups (t = 2.341, P = 0.132); there was no significant differences in HHS score between Gamma nail (83.25 ± 11.18) and anatomic locking plate (86.14 ± 12.36) (t = 1.923, P = 0.243). The incidence of complications in Gamma nail was less than anatomic lock-ing plate (P = 0.005).

CONCLUSIONAnatomic locking plate for intertrochanteric fractures with external wall fractures could avoid re-injury of external wall, especially for severe comminuted fractures, difficult for intramedullary nailing, and there was no significant meaning in hip joint function compared with Gamma nail, while postoperative incidence of complications was higher than Gamma nail, so early weight-bearing was not stress.

Adult ; Aged ; Bone Nails ; Bone Plates ; Female ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Hip Fractures ; surgery ; Hip Joint ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Objective To describe the clinical features of convulsive status epileptieus (CSE) in our hospital and to provide a basis for future CSE prevention and treatment. Methods Patients with CSE hospitalized from January 1996 to October 2007 were prospectively observed. Logistic regression was used to identify predictors of prognosis. Results All 220 eases of CSE were prospeetively analyzed, a hundred and two patients(46.4%) originated from rural areas. The primary cause of CSE was central nervous system(CNS)infectian (72cases, 32.7%), followed by discontinuation or reduction of antiepileptie drugs (AEDs, 35 cases,15.5%). The median duration of CSE was 5 hours and median duration of seizures before treatment was 2 hours; both were longer in rural patients (7.0 and3.5 hours respectively) than in urban patients (3.0 and 2.0 hours, Z=-3.433,-1.558,both P<0.05). The fatality rate by the time of discharge was 15.9%. Logistic regression analysis showed that the duration of CSE (χ2=20.941), a history of epilepsy (χ2=4.910), and respiratory depression (χ2=16.086) were independent predictors of CSE prognosis (allP<0.05) . Comparisons between these data of USA and Europe were made. Conclusions CSE occurs mostly in rural population and epilepsy patients. CNS infection and withdrawal or reduction of AEDs in patients with epilepsy were important triggers of CSE. Antiepileptic therapy for status epilepticus in China falls behind that in the European countries.

Objective To assess the effects of dynamic monitoring of plasma Pro-B-type Natriuretic Peptide(Pro-BNP) in the evaluation of prognostic value and myocardial dysfunction in patients with septic shock.Methods The levels of plasma Pro-BNP were tested in 102 patients with septic shock on the 1,3,and 5 days.Data on ICU mortality and 28-day mortality were collected.The patients were divided into non-dysfunction group (CI＜3.0) and cardiac dysfunction group (CI≥3.0) according to levels of hemodynamic variables ( CI level).The prognostic value of plasma Pro-BNP was analyzed.Results Plasma Pro-BNP levels on the 1,3 and 5 days in 28-day survivors have a significant declining trend [( 1649.0 ± 257.5 ) ng/L,( 1867.6 ± 291.7 ) ng/L vs.(1229.9 ± 194.5) ng/L),while plasma Pro-BNP levels in non-survivors have an increasing trend [(4128.8 ± 1051.1),( 5315.9 ± 925.4 ) vs.( 6899.9 ± 1327.9 ) ng/L].There is statistical significance of plasma Pro-BNP levels at day 1,3 and 5 for the two groups ( t=3.057,5.083,and 6.290 respectively,P＜0.01 ).The 28-day mortality and Plasma Pro-BNP levels in cardiac dysfunction group were higher than of non-dysfunction group ( 28-day mortality:62.1％ vs.20.0％;Pro-BNP1:( 1592.8 ± 362.2 )ng/L vs.( 4556.6 ±732.7 ) ng/L;Pro-BNP3:( 2933.6 ± 421.7 ) vs.( 5768.5 ± 793.7 ) ng/L,Pro-BNP5:( 3014.5 ± 587.5 ) ng/L vs.(8873.9 ± 1670.1) ng/L ( x2=20.635,P=0.000,t=3.626,3.154,3.310,P＜0.01].Pro-BNP level greater than 3053 ng/L on the 5-day was an independent prognostic indicator of 28-day mortality ( sensitivity:88.4％;specificity:91.5 ％ ).Pro-BNP level greater than 2378 ng/L on the 5-day was an independent prognostic indicator of hospital mortality ( sensitivity:84.9％;specificity:91.8％ ).In multivariate logistic regression analyses,Pro-BNP level and APACHE score were independent predictors of 28-day mortality and hospital mortality.Conclusion Plasma Pro-BNP level shows obvious significance in evaluation of sepsis-induced myocardial depression severity in patients with septic shock.Pro-BNP level in ICU at day 5 after inclusion is an independent prognostic marker of mortality in septic shock.

Objective To explore the respective advantages of different direction Hegu needlings by using them to treat the pain stage of scapulohumeral periarthritis (periarthritis of shoulder) and investigating their clinical therapeutic effects. Method A randomized controlled trial was carried out. Sixty patients with scapulohumeral periarthritis in the pain stage were allocated into group Ⅰ (30 cases) and group Ⅱ (30 cases). Group Ⅰ received acupuncture at points Jianyu(LI15), Jianliao(TE14) and Jianzhen(SI9) in the direction parallel to the meridian course and group Ⅱ , in the direction perpendicular to the meridian course. Treatment was given 30 min once for a total of 12 times. The simplified Mcgill Pain Questionnaire score and the Japanese Orthopaedic Association (JOA) score were recorded before and after treatment. Result There were no statistically significant differences in the pain, joint activity and joint function between the two groups before, during and after treatment. Conclusion Two different direction Hegu needlings both have a marked therapeutic effect on the pain stage of scapulohumeral periarthritis. The two have no significant difference.

Objective:To study the reversal effect of tamoxifen(TAM)on the expression of mdr1 in human pancreatic cancer cell lines.Methods:The inhibtion effect of TAM on pancreatic cancer cell line SW1999、Capan-Ⅱ and mammary cancer cell line T47D were studied;The influence of TAM on mdr1 protein/mRNA expression in SW1999、Capan-Ⅱ and T47D were studied using the method of flow cytometer and RT-PCR.Results:The high dose TAM could inhibit Capan-Ⅱ cell line.TAM could reverse the expression of mdr1 protein and mRNA in Capan-Ⅱ cell line and T47D cell line. Conclusion:The high dose TAM could inhibit Capan-Ⅱ cell line,maybe related with reduction of the expression of mdr1 protein and mRNA.

Academic Inspection is not only an important part of clinical teaching,but also a vital tache of improvement for medical treatment quality.Unlike internal medicine and surgery,acdemic inspection of ICU has its own characteristics.PBL teaching method on acdemic inspection of attending doctor in ICU is explored in this article.

Objective To investigate influence of preservation of remnant ligament on vascularization of grafts in anterior cruciate ligament (ACL) reconstruction.Methods Seventy-eight New Zealand rabbits were involved and both knees of the rabbits received one-stage ACL reconstruction simultaneously.One knee was reconstructed with preservation of residual fibers (remnant preservation group),and the contralateral one was treated with conventional debridement of residual fibers (remnant removal group).Blood flow of grafts was evaluated in vivo by laser doppler flow meter,expression of CD34 in vessels of grafts was measured by immunofluorescence method,growth of vessels surrounding grafts was observed with ink perfusion under stereomicroscope at 6,12,18,and 24 weeks after reconstruction.Results Laser doppler flow meter showed blood flow of grafts was significantly larger in remnant preservation group than in remnant removal group (P ＜ 0.01).Immunofluorescence testing revealed positive expression of CD34 of grafts was notably higher in remnant preservation group than in remnant removal group (P ＜ 0.05).Ink perfusion showed that the number of vessels surrounding grafts was much more in remnant preservation group than that in remnant removal group (P ＜ 0.05).Conclusion Remnant preservation benefits the vascularization of grafts in early stage after ACL reconstruction.