[Summary] In recent years , ultrasound guidance has been widely used in local anesthesia , particularly in peripheral nerve blockage .Ultrasound guided neuraxial blockage is also making progress .Previous studies have shown that pre-puncture ultrasound scanning could provide useful information on the correct intervertebral interspace , the midline of the spine , the optimal puncture point , the appropriate angle for needle insertion , and the distance from skin to the spinal canal .In this review, the ultrasonographic techniques and image analysis , as well as its clinical use , including pre-puncture scanning and real-time guidance for spinal and epidural anesthesia , were summarized .

SUMMARY A patient with previous L3 -4 posterior lumbar interbody fusion,pedicle screws instrumen-tation and L3 -4 decompression,was scheduled for left total hip arthroplasty.Two years ago,due to poor landmarks palpation,the patient experienced a failed lumbar puncture after multiple attempts before her-niorrhaphy.His plain radiography showed bilateral partial laminectomy at L3 -4 level,and between L3 and L4,two posterior pedicle screws connected by metal rods on both sides.This time,we used ultra-sound to locate L4 -5 interlaminar space in paramedian sagittal oblique view and identified the spine midline by transverse interlaminar view before puncture.According to this information,L4 -5 puncture point was verified and the combined spinal-epidural anesthesia was performed in a paramedian approach. After withdrawing clear cerebral spinal fluid,15 mg hyperbaric bupivicaine was injected into intrathecal space.An epidural catheter was then inserted into the epidural space.The sensory block level was fixed at T10 to S within 10 minutes.Intraoperatively,the patient received 10 mL 2% (mass fraction)lido-caine through the epidural catheter in total.The surgery was uneventful.No neurologic complication was observed after the surgery.This case report demonstrates that ultRASound imaging can provide useful in-formation for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Cyclin D1 ; metabolism ; Female ; Humans ; Immunohistochemistry ; Lymphatic Metastasis ; Male ; Middle Aged ; Mitogen-Activated Protein Kinase 1 ; metabolism ; Mitogen-Activated Protein Kinase 3 ; metabolism ; Mouth Mucosa ; chemistry ; metabolism ; pathology ; Mouth Neoplasms ; metabolism ; pathology ; Prognosis

BACKGROUND: Pharmacological researches demonstrate that Chinese crude drugs of invigorating the kidney contain flavonoids such as prepared rhizome of rehmannia and kudzuvine root, they possess phytoestrogenic effect, among them, isoflavone acts as a regulator of estrogen receptor.OBJECTIVE: To approach the effects of self-planned Bushen Huoxue Fang (BSHXF) on the serum estradiol and estrogen receptor α mRNA expression in pituitary gland in rats with collagen-induced arthritis. DESIGN, TIME AND SETTING: Randomized grouping controlled animal experiment was performed in the central laboratory of Bethune Intemational Peace Hospital of Chinese PLA between May 2006 and May 2008. MATERIALS: Sixty female and healthy Wistar rats were randomly divided into sham operated group (n=10) and operation group (n=50). Operation group was reproduced collagen-induced arthritis model at 2 weeks following ovariectomy. The rats of arthritic index ≥ 5 were assigned into model group, BSHXF group, methotrexate (MTX) group, and MTX + BSHXF group, each group included 10 rats. The Chinese crude drugs were bought from LERENTANG drugstore in Shijiazhuang, including rhizoma drynariae, safflower, prepared rhizome of rehmannia, Herba Epimedii, danshen root, kudzuvine root and so on. After routine decoction, centrifugalization, rogue and condensing 1.3 kg/L decoction, the solution was sealed up, divided pack and reserved at 4℃.METHODS: Sham operated group and model group were intragastrically administered with normal saline 2 mL per day; BSHXF group with BSHXF decoction 2 mL per day; MTX group with MTX 2.6 mg/kg (2 mL) once a week, and normal saline 2 mL per day at other time points; MTX + BSHXF group with MTX 2.6 mg/kg (2 mL) once a week and BSHXF juice 2 mL per day. Each group was given 6 weeks.MAIN OUTCOME MEASURES: After blooding by abdominalis aorta, magnetic-split enzyme linked immunosorbent assay was applied to detect the level of serum estradiol. Reverse transcription-polymerase chain reaction detected the expression of estrogen receptor a mRNA in rat pituitary gland.RESULTS: Compared with model group, the expression of estrogen receptor a mRNA in pituitary gland increased in the MTX group, but there was not statistically significant. BSHXF + MTX group showed a significantly increased expression (P < 0.01). The expression of estrogen receptor α mRNA in BSHXF group was higher than MTX group, but lower than BSHXF + MTX group (P < 0.05). No significant difference existed between BSHXF group, BSHXF + MTX group and sham operation group. Compared with sham operation group, there were statistically significant decrease of estradiol in the model group. Compared with model group, the estradiol levels were shown to increase in three treatment groups. Among them, MTX group had slightly slower level with no significant difference (P > 0.05), while BSHXF + MTX group had the most obvious increase, which was close to normal level (P < 0.01). There was a significantly positive correlation between estradiol and the expression of estrogen receptor o mRNA (r=0.483, P < 0.05).CONCLUSION: Serf-planned BSHXF possessing oestrogenic hormonelike role can elevate the level of serum estradiol and upregulate the expression of estrogen receptor a mRNA in pituitary gland.

Objective To summarize clinical diagnosis and microsurgical treatment method of cerebellopontine angle epidermoid cyst presenting with trigeminal neuralgia.Methods Thirty-seven cases of cerebellopontine angle epidermoid cyst presenting with trigeminal neuralgia treated by microneurosurgery procedure were analyzed retrospectively.Results Complete resection was achieved in 31 cases,and subtotal was achieved in 6 cases,with no operative mortality.Postoperatively,the symptom of trigeminal neuralgia disappeared in 28 cases,was eased obviously in 6 cases,and was eased in 3 cases.The symptom of dizziness in all 6 cases vanished,and hearing in 3 cases was improved.Three cases appeared cerebrospinal fluid leakage,and 4 cases appeared oral herpes.Symptom in 1 case aggravated after 6 months,and oral medicine was ineffective.The pain symptom disappeared after reoperation.Conclusions The suboccipital retrosigmoid approach microneurosurgery is the principal treatment method for cerebellopontine angle epidermoid cyst presenting with trigeminal neuralgia.Microsurgical technique combined with surgical skill is the guarantee for increasing total removal rate of tumors and decreasing complications.

Objective To study the Mediating effect of insecurity between childhood abuse and emotional distress of medical students,and to provide basis to intervene their mental disorder.Methods Through stratified sampling,262 medical students in Jiangsu were investigated by the Personal Report of Childhood Abuse( PRCA),Self-Rating Feeling of Insecurity Scale( SRFIS),Beck Depression Inventory( BDI ),Self-rating Anxiety Scale(SAS)and Suicide Ideation Scale(SIS).A path analysis was applied by Analysis of Moment Structures(AMOS) version 7.0.Results The path analysis showed that childhood abuse was directly related to insecurity of medical students ( β =0.538,P ＜0.01 ),and was directly related to emotional distress ( β =0.435,P ＜ 0.01 ).Insecurity were directly related to emotional distress of medical students ( β =0.342,P ＜ 0.05 ).Insecurity mediated partly the relationship between childhood abuse and emotional distress of medical students.The model fit indexes were X2/df =1.365 ＜ 3.000,P =O.082 ＞ 0.05,RMSEA =0.037 ＜ 0.050,GFI =0.971,AGFI =0.940,NFI =0.943,RFI =0.902,IFI =0.984,TLI =0.972,CFI =0.984.Conclusion Insecurity as mediated variable mediates the relationship between childhood abuse and emotional distress of medical students.

0.05).But GR number[sites/cell]and the expression of GR mRNA in PBMCs from PM/DM was significantly lower than those in healthy controls(P

Objective:To explore the application effect of medical science competition in nursing interns whocontribute to "healthy China" , and to improve their health education awareness, ability, method and self-confidence.Methods:A total of 205 nursing interns who worked in Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from 2019 to 2020 were selected as the research objects. They were divided into the control group (105 cases) and the experimental group (100 cases) according to whether they participated in the medical science competition. The control group learned the form and method of health education in clinical rotation according to the traditional practice teaching plan. The experimental group volunteered to participate in the medical science competition, which required the dissemination of health knowledge through various forms. Before and after the competition, the health education ability assessment scale was used for comparison.Results:Before the medical science competition, there was no significant difference in the total score of assessment, planning, implementation, evaluation and health education between the control group and the experimental group ( t values were 0.765 - 1.749, all P>0.05). After the medical science competition, the total scores of assessment, planning, implementation, evaluation and health education ability of nursing interns in the experimental group were (24.38 ± 4.72), (17.98 ± 3.98), (25.16 ± 5.36), (12.57 ± 2.96) and (80.09 ± 15.65) respectively, while those in the control group were (22.45 ± 6.29), (16.61 ± 4.77), (23.04 ± 6.55), (11.31 ± 3.46) and (73.41 ± 19.69).The differences between the two groups were statistically significant ( t values were 2.226 - 2.795, all P<0.05). Conclusions:The medical science competition can improve the health education ability of assessment, planning, implementation, evaluation of nursing interns and contribute to "healthy China" .

Salmonella enterica serovar Choleraesuis strain C500 is a live attenuated vaccine that has been widely used in Chi‐na for over 50 years to prevent piglet paratyphoid .However ,as C500 is obtained by chemical methods ,the genetic background of this strain remained unclear .In this study ,we compared the genomic differences between the virulent reference strain C 78‐2 and C500 by suppression subtractive hybridization combined with the mirror orientation selection method (MOS‐SSH ) .Six genes (asr ,ydgF ,ydgD ,ydgE ,rpoS ,and ptsG) were lost in C500 strain .Using real‐time PCR analysis ,we demonstrated that the genes regulated by rpoS ,a vital transcriptional regulator playing an important role in Salmonella infection ,were downregulated in C500 .Additionally ,the virulence of the rpoS mutant strain C78‐2ΔrpoS was 100 000 times lower than the parental strain in BALB/c mice .So loss of rpoS gene is the major factor leading to the attenuation of C500 strain .

Objective To analyze the causes and manifestations of non-pulmonary embolism induced perfusion defects (PDs) on dual-energy perfusion imaging (DEPI) using dual source CT.Methods Consecutive 208 patients without pulmonary embolism who underwent DEPI were reviewed retrospectively.The causes of PDs were analyzed by two radiologists, the pulmonary segment numbers, the proportion and the perfusion patterns of each case were recorded and analyzed respectively.Results 1 118 of 3 716 pulmonary segments showed the PDs.Among them, 752(67.26%), 36(3.22%), 308(27.55%) and 22(1.97%) pulmonary segments had PDs due to intra-pulmonary lesions, vascular diseases, artifacts and unidentifiable causes, respectively.In PDs resulted from intra-pulmonary lesions, vascular diseases and unidentifiable causes, three patterns (wedge-shaped, heterogeneous and regionally homogeneous) were identified,and most of those PDs were heterogeneous and regionally homogeneous, which were largely in accordance with the lesions showed on non-contrast enhanced scans.Artifacts included the beam hardening artifacts and artifacts caused by heart beat or diaphragmatic movement.The PDs caused by artifacts usually had particular locations and shapes.Conclusion Understanding of the manifestations and causes of PDs in patients without pulmonary embolism can improve the diagnosis accuracy of pulmonary embolism on DEPI.