Objective To compare the effects of Dexmedetomidine and Midazolam for sedation in elderly patient with upper cervical spine fracture in awake tracheal intubation.Methods A total of 68 patients with upper cervical spine fracture undergoing awake tracheal intubation who treated in our hospital from Jan.2010 to Jan.2015 were considered as the objects,who was randomly divided into group A and group B.34 cases in group A were treated with Dexmedetomidine for sedation,and the other 34 cases in group B were treated with Midazolam for sedation.The Heart rate (HR),mean arterial pressure (MAP) and BIS value on the before anesthesia (T1),immediately before intubation (T2),immediately after intubation (T3),PaCO2 in before and after intubation,and the adverse reactions were compared between the two groups.Results There was no difference in HR,MAP and BIS at time of T1 between the two groups (P＞0.05).The HR,MAP and BIS were lower in group A than in group B at time of T2 and T3 (P＜0.01).The PaCO2 had no difference between the two groups at before and after intubation (P＞ 0.05).The rate of adverse effects had no difference between the two groups (x2 =1.308,P =0.253).Conclusions Compared with Midazolam,Dexmedetomidine can stable HR,MAP and BIS effectively and has a good safety in the treatment of elderly upper cervical spine fracture in awake tracheal intubation,which is worthy of clinical application.

Objective To explore the related risk factors of type 2 diabetic nephropathy,and to provide theoretical basis to make the strategy of prevention of diabetic nephropathy.Methods By case-control study method,98 patients with type 2 diabetic nephropathy were selected as the observation group.98 diabetes mellitus patients without kidney disease were selected as control group.Single factor analysis and non-conditional logistic regression analysis were conducted in two groups.Results The results of single factor analysis showed that type 2 diabetic nephropathy was closely related to family history of diabetes,course of diabetes,high blood pressure,diabetic retinopathy,BMI,coronary heart disease,HbAlc,FPG,2hPG,CRP (P ＜ 0.05).The results of multiple factors of logistic regression showed that type 2 diabetic nephropathy was closely related to course of diabetes and diabetic retinopathy,CRP,HbA1c,FPG(P ＜0.05).Conclusion Course of diabetes and diabetic retinopathy,CRP,HbA1c,FPG are independent risk factors for type 2 diabetic nephropathy.

Objective To evaluate the diagnostic value of endoscopic miniprobe ultrasonography (MPS) and endoscopic therapies under the guidance of MPS in gastrointestinal submucosal tumors. Methods Patients with submucosal tumors of lower digestive tract were given MPS under colonoscope. Endoscopic therapy or surgery had been taken according to different deriving layers of submucosal tumors. The ultimate diagnosis was confirmed by histology. Results Twenty patients with submucosal tumors were diagnosed with MPS under colonoscope, including 9 patients with stromal tumors, 5 patients with lipoma, 3 patients with car-cinoid, 2 patients with abscess,1 patient with intestines pneumatosis. Four patients with benign stromal tumors derived from muscularis mueosa and 2 patients with carcinoid were resected by endoscopy. Two patients with abscess and 1 patient with intestines pneumatosis were puncture under endoscopy. Three patients with benign stromal tumors from muscularis propria, 2 patients with malignant stromal tumors, 2 patients with lipama and 1 patient with careinoid were resected surgically. 88.24% submucosal tumors diagnosed by MPS were identified by pathology. Three cases were followed-up by endoscopy. Conclusions Different layers of gastrointestinal tract with submucosal tumors can be distinguished clearly by MPS leading to definite diagnosis of submucesal tumors. MPS can play an important role in selecting treatment procedures.

Objective:To research the autoimmune mechanism of prolactin(PRL) in uveitis by observing prolaictin′s effects on peripheral blood mononuclear cells(PBMC) proliferation and activation at different concentration.Methods:1.The serum prolactin levels of uveitis and control were checked by chemical spectrometer. 2.To research the effects of different concentration PRL on uveitis PBMC′s proliferation and activation under the soluble antigen(S-Ag) stimulation. PBMC separated from uveitis and control,were cultured with S-Ag and different concentration PRL,and then were assayed the percentage of CD3~+CD25~+ positive cell through double-stain immunofluorescence flow cytometry after 108 h. After cultured 96 h, ~3H-TdR was mixed and counts per minute were assayed after 12 h.Results:1.There was no significance between the uveitis and control refer to the serum PRL level(t=1.936,P=0.051). 2.When uveitis′ PBMC was positive to S-Ag, there had promote proliferation and activation of PBMC with PRL concentration at 12.5-1 000 ?g/L,with the media concentration at 200 ?g/L,while it became weakened at 1 000 ?g/L(activation t=2.736,P=0.012;proliferation t=2.547,P=0.036).When uveitis′ PBMC was negative to S-Ag,there had no action as before.Conclusion:1.There is no significance between the uveitis and control refer to the serum PRL level. 2.Media concentration PRL(200 ?g/L) and S-Ag have costimulation to promote PBMC proliferation and activation in uveitis,though high concentration PRL loses the function.

Objective:To study if L-arginine cardioplegia can protect myocardium from ischemia/reperfusion injury. Method:Fourteen patients undergoing valve replacement were randomly divided into two groups:control group (crystal cardioplegia,C group),and test group(crystal cardioplegia+L-arginine,E group). Before aortic-clamping and after aortic unclamping,blood samples were taken to measure the concentrations of NO_2~-/NO_3~-, lactic acid (LA), malonylaldehyde (MDA), superoxide dismutase (SOD), xanthine oxidase (XOD). Immediately after aortic clamping and before aortic-unclamping, tissues were taken from the left atrial and examed with electron microscopy. Result: In C group NO_2~-/NO_3~- level decreased at aortic unclamping, 30 minutes later decreased significantly compared with that before aortic-clamping(P

OBJECTIVE To analyze the causes of unqualified medical appliance packs before sterilization and to find countermeasures in order to assure their quality,and to avoid emergence of hospital infection and medical tangles. METHODS Totally 320 packs were checked before sterilization from supply room and clinical departments from Jun 1,2004 to Mar 30,2005. RESULTS The rate of unqualified packs checked before sterilization was 14.12% including 460 medical apparatuses unqualified(21.70%). CONCLUSIONS To avoid the emergence of hospital infection and medical tangles,we should strengthen the work of supply room to realize the centralization of sterilization and supply,and make much of personnel′s professional training,normalize job′s process and quality criterion,and intensify professional and systematizing management of medical appliance purged and packed.

Objective To investigate the effect of ulnar nerve with or without transposition during open reduction and internal fixation of distal humerus fractures.Methods A retrospective case control study was made on 74 cases receiving open reduction and internal fixation of distal humerus fractures between January 2008 and December 2015.There were 28 males and 46 females,with a mean age of 63.2 years (range,32-83 years).AO fracture classification was A2 type in seven cases,A3 type in four,C1 type in 14,C2 type in 28 and C3 type in 21.According to the intraoperative management of the ulnar nerve,the patients were divided into transposition group (n =43) and non-transposition group (n =31).Two groups were compared with respect to operation time,Mayo elbow performance score (MEPS),incidence of ulnar neuritis and postoperative complications.Results Follow-up lasted for 6-24 months (mean,11.7 months).Operation time differed significantly between transposition group [(110.9 ± 20.8) minutes] and non-transposition group [(95.6 ± 18.9) minutes] (P ＜ 0.05).MEPS in transposition group was excellent in 15 cases,good in 20,fair in six and poor in two.MEPS in non-transposition group was excellent in 10 cases,good in 15,fair in five and poor in one,with the same excellence rate of 81％ in comparison with transposition group (P ＞ 0.05).Incidence of ulnar neuritis showed no significant difference between transposition group (9％,4/43) and non-transposition group (7％,2/31) (P ＞0.05).Postoperatively,one case of superficial wound infection and two delayed healing were noted in transposition group;one case of superficial wound infection and one delayed healing were noted in non-transposition group.There was no significant difference in incidence of postoperative complications between groups (P ＞0.05).Conclusions Ulnar nerve with or without transposition can both achieve satisfactory clinical effect during open reduction and internal fixation of distal humerus fractures.But non-transposition group is associated with shorter operation time without increasing the incidence of ulnar neuritis.

Objective To explore the roles of insulin in the early treatment of acute brain injury and its administration methods.Methods 253 patients were randomly divided into the intensive insulin therapy group and the conventional therapy group.Infection rates,the short-term effect (APACHE Ⅱ assessment),and long-term efficacy (GOS prognosis) was compared between two groups.Results The results of the strengthen treatment group in the rate of infection (25.95％ vs 39.34％,x2 =5.17,P ＜0.05),the short-term effect (11.33 ± 7.66 vs 16.49 ± 14.97,u =3.42,P ＜ 0.05) and the long-term efficacy (40.46％,55.73％,3.82％ vs 25.41％,68.85％,5.74％,x2 =7.62,P ＜0.05) were significantly better than the conventional therapy group with the statistically significant differences (P ＜ 0.05).Conclusions The hypoglycemic effect,neuroprotective effect,regulatory role,and nutrition role of insulin occurred in the early treatment of acute brain injury.After acute brain injury,patients with hyperglycemia should be treated early with an enough volume,continuous,and uniform insulin.

Objective To study the regulatory T cells (Treg-cell) frequencies in patients with childhood acute leukemia and evaluate its clinical application value by investigating the relationship between the increasing numbers of Treg cells and minimal residual disease of leukemia (MRD), Methods Foxp3-FITC/CD25-PE/CD4-PerCP/CD3-APC four-color staining flow cytometry was established to identify Treg cells. Treg cells frequencies both in 10 healthy controls and in 33 patients with newly diagnosed childhood acute leukemia ( B-ALL 17 cases, T-ALL 9 cases, AML 7 cases) were detected. The possibility of the accumulation of Treg cells being the prognostic marker for acute leukemia was evaluated by comparing the results of Treg cells frequency with that of MRD. Results The percentage of Treg cells in CD+4 CD+3 T cells was M = 8. 09% in normal bone marrows, which was significantly different from the results in the bone marrows of newly diagnosed childhood acute leukemia ( M = 12.77% , U = 3.41, P < 0.01 ), but it showed no significantly differences among B-ALL, T-ALL and AML groups. No association was observed between the expression of Treg cells and clinical-biologic characteristics studied. In addition, Treg cells frequency in MRD positive group was significantly different from that in MRD continuously negative group ( M = 14. 74% vs M=11.3%, t =252.5,P<0.05). Conclusions Consistent with results from solid tumor, the study identifies a significantly increased numbers of Treg cells in patients with childhood acute leukemia. The situation of accumulation of Treg cells is closely associated with MRD results during chnical remission. High level of Treg cells may cause poor prognosis and increase the possibility of relapse.

Objective To establish the pediatric reference intervals for Troponin Ⅰ and Creatine kinase-MB (CK-MB).Methods Healthy children (223 boys and 162 girls) aged from 7 months to 12 years old were studied.Blood specimens were collected and centrifuged,all serum samples were kept refrigerated below-70 ℃.Troponin Ⅰ and CK-MB were measured on the UniCel DxI 800 immunoassay system (Beckman Coulter) on the same day.Nonparametric statistics was used to estimate the 99th percentile reference intervals.Results The children were divided into three groups (group A 128 cases; group B 128 cases;group C 129 cases) according to age.The upper reference limits for CK-MB were dependent of age,and the group A (7 months-1 years) was shown to be 13.41 μg/L,the group B (2-3 years) was shown to be 9.35 μg/L,the group C (4-12 years) was shown to be 5.48 μg/L.The upper reference limit for Troponin Ⅰ was independent of age or gender and shown to be 0.01 μg/L among 385 children.Conclusions Pediatric reference intervals for Troponin Ⅰ and CK-MB have been defined in healthy children at a relevant age group (7 months-12 years).It is effective for clinical diagnosis and treatment of myocardial damage for children by determining reference intervals for Troponin Ⅰ and CK-MB.