OBJECTIVE To investigate the incidence of bacteria colonization on lumbar epidural catheter tips in postoperative analgesia patients. METHODS The catheter tips were cultured in 100 patients with ASA grade Ⅰ-Ⅱ undergoing lower extremity osteoarticular operation.Lumbar epidural catheters were placed in the operating room with aseptic technique.Diluted local anesthetic and fentanyl infusions were used for postoperative analgesia.The epidural catheter was removed with aseptic technique and the tips sent for microbiological culture after 3 days. RESULTS From 100 patients,bacteriological examination revealed bacteria colonization in 9(9.0%),mainly Staphylococcus epidermidis(6;66.7%),followed by Enterococcus(1;11.1%),Gram-negative bacilli(1;11.1%),and yeasts(1;11.1%).No patient developd infectious complications. CONCLUSIONS Our results show that the risk of bacteria colonization associated with lumber postoperative analgesia in three days is low.No patient develops local or central nervous infection.Epidural postoperative analgesia can be routinely used without worry of infection in epidural space.But we recommend prophylactic measures should be applied in the high-risk groups.

Formative evaluation is a medical education evaluation form used to correct its own track in the course of activities so as to get better effect. In the medical education, it can significantly improve the medical students' ability such as active learning ability, relearning ability, ability to master and apply know l edge, ability of scientific thinking and debating, ability of innovation and analysis, ability of association and communication, and so on.

Objective To explore the effect of different doses remifentanil on hyperalgesia and the analgesic effect of gynecological laparoscopic operation.Methods Ninety gynecologic laparoscopic operation patients were divided into A group,B group and C group by random digits table method with 30 cases each.The anesthesia induction in A group and B group was intravenous injection remifentanil 1.5 μ g/kg,propofol 2 mg/kg,cisatracurium 0.2 mg/kg,and in C group was intravenous injection fentanyl 3 μ g/kg,propofol 2 mg/kg,cisatracurium 0.2 mg/kg.The maintenance of anesthesia in A group was infusion of remifentanil 0.3 μ g/ (kg· min),in B group was infusion of remifentanil 0.2 μ g/ (kg· min),and in C group was infusion of fentanyl 2 μ g/kg.The operation time,anesthesia time,time to extubation,intraoperative doses of propofol and remifentanil (A group and B group) were recorded.The visual analogue score (VAS) before operation and 15,30,60,120,240 min after extubation were recorded.The analgesia time,number of analgesia and adverse reaction after extubation were observed.Results There were no statistical differences in operation time and anesthesia time among 3 groups (P ＞ 0.05).The extubation time in A group and B group was significantly shorter than that in C group:(5.9 ± 2.7) and (6.1 ± 2.3) min vs.(9.6 ± 3.3) min,the dose of propofol in A group was significantly lower than that in B group and C group:(461.3 ± 69.7) mg vs.(543.4 ± 101.9) and (552.5 ± 93.8) ng,the dose of remifentanil in A group was significantly higher than that in B group:(1.12 ± 0.33) mg vs.(0.71 ± 0.1 l) mg,there were statistical differences (P＜ 0.05).The VAS 15,30,60,120,240 min after extubation in 3 groups were significantly higher than those before operation,A group:(7.3 ± 1.2),(7.4 ± 1.3),(6.5 ± 0.8),(4.5 ± 0.6),(4.1 ± 0.3) scores vs.(1.2 ± 0.3) scores,B group:(6.4 ± 1.5),(6.6 ± 1.1),(5.3 ± 0.4),(4.6 ± 0.3),(4.0 ± 0.4) scores vs.(1.5 ± 0.4) scores,C group:(3.4 ± 0.5),(4.2 ± 0.8),(4.1 ± 0.6),(3.8 ± 0.7),(3.8 ± 0.6) scores vs.(1.4 ± 0.2) scores,there were statistical differences (P ＜ 0.05).The VAS 15,30,60 min after extubation in A group were significantly higher than those in B group,and the VAS 15,30,60,120 min after extubation in A group and B group were significantly higher than those in C group,there were statistical differences (P ＜ 0.05).There was no statistical difference in VAS 240 min after extubation among 3 groups (P ＞ 0.05).The number of analgesia in A group,B group and C group were 28,29 and 3 cases,and the analgesia time were (16.1 ± 4.6),(17.9 ± 5.8) and (68.5 ± 10.l) min,there were statistical differences (P＜ 0.05),there were no statistical differences between A group and B group (P＞ 0.05),and there were statistical difference between A group,B group and C group (P ＜ 0.05).There was no statistical difference in adverse reaction among 3 groups (P ＞ 0.05),and there was no respiratory depression in 3 groups.Conclusion The degree of hyperalgesia is related to the dose of remifentanil during gynecologic laparoscopic operation.

Objective:To research and compare the therapeutic effect of oxycodone hydrochloride controlled—release tablets and morphine sulfate controlled—release tablets on the visceral cancer pain.Methods:Total of 72 patients with visceral cancer pain were randomly assigned into two groups:OO group was treaded by oxycodone hydrochloride controlled—release tablets,MO Group was given morphine sulfate controlled—release tablets.According to the principle of NCCN(2008),the two groups were titrated by morphine,and then diverted to controlled-release agent.The visual analogue scale(VAS)was kept smaller than 4.The side effects of two groups'and the rescue analgesic doses were recorded after the application of the controlled-release agent for 15 days,and the cost-effectiveness was analysed.Results:The rescue analgesic doses of the OO group were smaller than that of the MO group (P0.05).Conclusion:The two drugs have notable analgesic effect in the visceral cancer pain.Considered gastrointestinal tract side effects and the rescue analgesic dose,Oxycodone hydrochloride controlled—release tablets surpass the Morphine sulfate controlled-release tablets.Oxycodone hydrochloride controlled-release tablets may be a potential regimen for visceral cancer pain.

目的评价Vojta疗法中反射性俯爬配合Bobath法治疗脑瘫患儿爬行的疗效。方法将64例脑瘫患儿随机分为治疗组和对照组。治疗组采用Vojta中的R-K法配合Bobath法治疗;对照组单纯采用Bobath法治疗。结果经过3个月的治疗,治疗组患儿的疗效优于对照组。结论Vojta法中的R-K法配合Bobath法治疗脑瘫患儿爬行有较好的疗效。

Objectives To analyse the etiology and clinical characteristics of syncope in children. Methods The clinical data of 128 children with syncope were retrospectively analyzed. Results According to the definition of syncope and supporting test results, 20 cases of non-syncopal conditions were excluded. In 108 cases of syncope, there were 70 cases (64.81%) of neurally mediated syncope, 8 cases (7.41%) of cardiogenic syncope, and 24 cases (22.22%) of unexplained syncope. Eighty-five cases (78.71%) had incentives before the onsets. Twenty-one cases (19.44%) had the family histories of syncope. One case (0.93%) had the family history of sudden death. The neurally mediated syncope and cardiogenic syncope had the feature of recurrent attacks. The VVS were preceded by limbs weakness, pale complexion, darkness in front of eyes, hearing loss, nausea and chest pain, the POTS by palpitation, chest pain and weakness, the OH by darkness in front of eyes, pale complexion and hearing loss, and the car-diogenic syncope by precordial discomfort, pain and chest pain. Conclusions The VVS is one of the most common cause of syn-cope in children. The onsets of the various types of syncope often have incentives and are preceded by some symptoms. Most of them have the feature of recurrent attacks.

BACKGROUND:Our prior experiments have confirmed that 10 μmol/L oxytocin can induce transformation of bone marrow mesenchymal stem cels into myocardial cels. OBJECTIVE: To investigate the effects of Ginsenoside Rh2 on oxytocin-induced transformation of bone marrow mesenchymal stem cels into myocardial cels. METHODS:Rat bone marrow mesenchymal stem cels were isolated by differential adherence method. These isolated cels were randomly divided into five groups. In the blank control group, cels were routinely cultured. In the oxytocin group, cels were cultured with 10 μmol/L oxytocin for 2 consecutive weeks. In the Ginsenoside Rh2 low-, middle-, and high-dose groups, cels were treated with 0.5, 1, 2 μmol/L Ginsenoside Rh2respectively for 24 hours and then with oxytocin for additional 2 consecutive weeks. RESULTS AND CONCLUSION: Optical microscopy showed that compared to the blank control group, some cels in the oxytocin group exhibited an increased soma and some cels grew in clusters and the cel clusters enlarged with the increase in Ginsenoside Rh2 dose. Immunocytochemical staining and western blot analysis showed that cardiac Troponin T and connexin 43 protein expression in the oxytocin, Ginsenoside Rh2 low-, middle-, and high-dose groups were significantly greater than in the blank control group (P < 0.05), and cardiac Troponin T and connexin 43 protein expression in the Ginsenoside Rh2 groups was increased with the increase in Ginsenoside Rh2 dose and was significantly higher than that in the oxytocin group (P < 0.05). Confocal laser scanning microscopy showed that the relative fluorescence intensity of free calcium in the bone marrow mesenchymal stem cels in the oxytocin group was significantly increased after induction by oxytocin for 2 weeks (P < 0.05), while the relative fluorescence intensity in the Ginsenoside Rh2 groups was significantly higher than that in the Ginsenoside Rh2 groups and was positively correlated with the dose of Ginsenoside Rh2. These findings suggest that Ginsenoside Rh2 can obviously promote oxytocin-induced transformation of bone marrow mesenchymal stem cels into myocardial celsin vitro.

Objective To compare the curative effect and safety of non-X-ray fluoroscopic radiofrequency catheter ablation and conventional X-ray fluoroscopic radiofrequency catheter ablation in treating paroxysmal supraventricular tachycardia by Ensite Velocity three-dimensional electroanatomical mapping system.Methods One hundred cases diagnosed as paroxysmal supraventricular tachycardia in this hospital during 2014-2016 were selected and randomly divided into the control group (conventional X-ray exposure) and the experimental group(non-X-ray exposure by three-dimensional electroanatomical mapping system),50 cases in each group.The operation time,X-ray exposure time,complication rate,immediate and follow-up success rate were compared between two groups.Results There was no statistically significant difference in the operation time between the two groups (P＞0.05),but the X-ray exposure time in the experimental group [(0.46±0.14) min] was significantly lower than that of the control group [(13.87 ±4.03) min] and the complication rate (0 ％) was also significantly lower than that of the control group (8.00％);the immediate success rate (98.00 ％) was significantly was significantly decreased compared with the control group[(0.46± 0.14)min vs.(13.87 ±4.03)min],the complication rate was significantly lower than that in the control group(0 ％ vs.8 ％),the immediate success rate was significantly higher than that in the control group(98.00 ％ vs.84.00 ％),the follow up success rate was also significantly higher than that in the control group (94.00 ％ vs.74.00 ％),the differences were statistically significant (P＜0.05).Conclusion Using Ensite Velocity three-dimensional electroanatomical mapping system to conduct radiofrequency catheter ablation has an ideal clinical effect in the treatment of paroxysmal supraventricular tachycardia,which is safe and reliable.

We report the intrauterine treatment of a case of fetal persistent supraventricular tachycardia complicated by heart failure. The ultrasound findings at 32 +1 weeks of gestation showed fetal tachycardia of 242 beats/min, fetal generalized edema, ascites, and visible pulsation spectrum in the intra-abdominal segment of the umbilical vein. Fetal cardiac arrhythmia persisted after maternal oral digoxin for 46 hours. In view of the continuous deterioration of the fetal condition with the persistent umbilical vein pulsation spectrum and worsening edema, fetal intramuscular injection of cedilanid under ultrasound guidance was performed, resulting in successful cardioversion. The pregnant woman gave birth to a baby girl by cesarean section due to premature rupture of membranes and oligohydramnios at 34 +6 weeks of gestation, with normal functions of heart and other organs. During a follow-up to 8 months, no obvious abnormalities were found.

Objective:To evaluate the relationship between the mechanism of promoting wound healing by modified autologous blood transfusion and metastasis-associated lung adenocarcinoma transcript 1 ( MALAT1) in diabetic mice. Methods:Twenty SPF ICR mice, weighing 21-25 g, in which the diabetic model was successfully established, were divided into 2 groups ( n=10 each) using a random number table method: modified preservation group (group I) and ordinary preservation group (group O). Peripheral venous blood samples were collected and stored in the corresponding preservation solution for 7 days.The platelet aggregation rate, blood glucose, serum glycosylated hemoglobin (GHB) and phosphodiesterase (DPG) concentrations and WBC were measured.Autologous blood was transfused back immediately after the wound model was established.The percentage of wound healing area was calculated at 7, 10 and 14 days after autologous blood transfusion.The expression of hypoxia-inducible factor-1α, vascular endothelial growth factor, matrix metalloproteinase-9, β-actin, type Ⅰ collagen (Col Ⅰ), Col Ⅲ protein and mRNA and MALAT1 was determined by Western blot, immunohistochemistry and quantitative real-time polymerase chain reaction respectively, at 14 days after transfusion. Results:Compared with group O, the blood glucose, serum concentrations of GHB and DPG, and WBC were significantly decreased, platelet aggregation rate was increased, the percentage of wound healing area was increased, the positive staining rate of Col Ⅰ and Col Ⅲ was increased, and the expression of hypoxia-inducible factor-1α, vascular endothelial growth factor, matrix metalloproteinase-9, ColⅠ, Col Ⅲ and β-actin protein and mRNA and MALAT1 was up-regulated in group I ( P<0.05). Conclusion:The mechanism by which modified autologous blood transfusion promotes wound healing may be related to up-regulating MALAT1 expression in diabetic mice.