Objective To learn the clinical effect and adverse reaction of hydromorphone for continuous epidural analgesia after cesarean section,and to provide effective anesthesia method for clinical.Methods 116 cases of cesarean section were randomly divided into observation group(65 cases) and control group(51 cases),continuous epidural analgesia was used in the two groups after operation.Among them,hydromorphone + ropivacaine was used for the observation group,morphine + ropivacaine was used for the control group.The analgesic effect and sedation degree of the two groups were evaluated.The adverse drug reactions were observed,and satisfaction of the patients after the operation was investigated.Results 6,9,24 hours after operation,the VAS pain scores of the observation group were lower than those of the control group,the differences were statistically significant(t=3.236,4.970,2.547,all P<0.05).3,6,9,24,48 hours after surgery, the differences of Ramsay sedation score between the two groups were not statistically significant(t=0.717,1.502,0.714,1.051,0.589,all P>0.05).The difference of postoperative first exhaust time between the two groups was not statistically significant(t=0.730,P>0.05).The satisfaction degree of the observation group was significantly higher than that of the control group,the difference was statistically significant(t=2.301,P<0.05).The incidence rate of adverse reactions of the observation group was 7.69%,which of the control group was 11.76%,the difference was not statistically significant(x2=0.552,P>0.05).Conclusion For continuous epidural analgesia after cesarean section,hydromorphone can effectively relieve the pain after operation,the safety of the process is high,and it has good clinical application value.

Ion chromatography(IC)can make up the deficiency of LC or GC for the analysis of ionic drugs because of the unique separation mechanism,so IC is more and more widely applied in the field of drug analysis. In the paper,the application of IC is reviewed in the quality control of chemical drugs.

Objective:To investigate the application value of ultrasound-guided selective pudendal nerve block during vestibular gland resection.Methods:Ninety patients who underwent vestibular gland resection in Lishui Maternal and Child Health Hospital from January 2017 to January 2020 were included in this study. These patients were divided into a control group and an observation group ( n = 45/group) according to the order of admission. Patients in the control group underwent blind nerve block and those in the observation group underwent ultrasound-guided selective pudendal nerve block. Hemodynamics before and after anesthesia, anesthetic effects, pain severity, and the incidence of complications were compared between the control and observation groups. Results:There were no significant differences in hemodynamics and pain severity between the control and observation groups (both P > 0.05). Systolic blood pressure [(124.37 ± 8.12) mmHg], diastolic blood pressure [(91.68 ± 5.44) mmHg] and heart rate [(74.62 ± 3.56) beats/min] were significantly lower than those in the control group [(128.62 ± 9.27) mmHg, (95.24 ± 6.17) mmHg, (76.12 ± 3.32) beats/min, t = 2.248, 2.903, 2.067, all P < 0.05]. In the observation group, pain scores at 2 and 24 hours after surgery were (3.06 ± 0.25) points and (4.21 ± 0.52) points, respectively, which were significantly lower than those in the control group [(3.28 ± 0.24) points and (4.54 ± 0.48) points, t = 2.618, 3.128, both P < 0.05). Anesthetic effect in the observation group was superior to that in the control group, and incidence of complications in the observation group was significantly lower than that in the control group ( χ2 = 12.869, 4.285, 4.864, 3.920, all P < 0.05). Conclusion:Ultrasound-guided selective pudendal nerve block in vestibular gland resection exhibits better anesthetic effect, has no obvious effect on hemodynamics, and has good analgesic effect with low incidence of complications. Therefore, it deserves clinical popularization.

Objective To investigate the effects of valproic acid ( VPA ) on SD rats with experimental autoimmune encephalomyelitis ( EAE) and its possible immunomodulatory mechanism .Meth-ods Fifty female Sprague-Dawley ( SD) rats were randomly divided into five groups by random digit table , including control group (n=10), EAE group(n=10), low dose VPA treated group (100 mg/kg, n=10), median dose VPA treated group (300 mg/kg, n=10) and high dose VPA treated group (600 mg/kg, n=10).The SD rat model of EAE was induced by immunizing with a guinea pigs′spinal cord homogenate (GPSCH).Normal saline and various doses of VPA were given to rats in according groups twice a day from day 0 to day 19 ( close to the peak stage of EAE ) .The severity of EAE was scored according to the signs and symptoms.Pathological changes were observed through Hematoxylin-Eosin staining, and then the degrees of inflammatory infiltration were evaluated .The numbers of activated neuroglia that expressed Iba-1 in cerebral and lumber cords were counted by immunohistochemistry .The expression of IFN-γ, IL-17 and IL-10 in cer-ebral and lumber cords were measured by ELISA .Results Compared with EAE group , rats in the low, me-dian and high dose VPA treated groups had lower incidence of EAE and prolonged latency , but only the me-dian dose treated group showed significant alleviation in clinical symptoms (P<0.05).Both the median and the high dose treated group showed decreased inflammatory cell infiltration in CNS (P<0.05).Immunohisto-chemistry results showed that the numbers of activated microglia were significantly inhibited in rats treated with median and high dose of VPA in comparison with those in EAE group (P<0.05).Results of ELISA demonstrated that the expression of IFN-γand IL-17 in both median and high dose VPA treated groups were significantly decreased compared with those in EAE group (P<0.05), but only the median dose treated group showed a remarkably increased expression of IL-10 (P<0.05).Conclusion VPA, especially medi-um dose of VPA ( 300 mg/kg ) , had neuroprotective effects on rats with EAE .The possible mechanism might be associated with the inhibited activation of microglia and the increased percentage of anti -inflammato-ry cytokines .

OBJECTIVE To study the possibility of air sterilization with solution of camphor leaves. METHODS Every six adjacent sickrooms that had same volume from 9 different clinical sectors were randomly selected for testing.Air of all sickrooms were sterilized by atomizing with solution of camphor leaves that was rough made by boiling and filtering and by direct irradiating with ultraviolet ray respectively.And then screened the sterilization effect of two methods respectively by air culture. RESULTS After sterilization with 100% solution of camphor leaves,all sickrooms were in line with standard of class Ⅲ(500 CFU/m~3),and 70% sickrooms were in line with class Ⅱ(200CFU/m~3).Both atomizing with solution of camphor leaves and direct irradiating with ultraviolet ray showed obvious effect,the result of air culture indicated that CFU of microorganisms were significant differrent between pre-sterilization and post-sterilization in both methods(P0.25). CONCLUSIONS Camphor leaves are very effective for sterilization and deserve to spread.

Xu XP,Xiao N);Department ofGeneral Surgery,Pingxiang People's Hospital,Pingxiang,Jiangxi 337000,China(Rong J) Objective To study the expression of vascular endothelial growth factor(VEGF),S100A4 and survivin in thyroid carcinoma and their clinical significance.Methods The expression of VEGF,S100A4 and survivin in normal thyroid tissues from 28 people and thyroid cancer tissues obtained from 73 patients were detect by immuno-histochemistry method.Results The positive rates of VEGF,S100A4 and survivin in thyroid cancer were 84.93%, 86.30% and 79.45%,which in the normal thyroid tissues were 3.57%,7.14% and 14.29%,respectively.There were significant differences between every two groups,thyroid cancer and the normal thyroid tissues,statistically(χ2 =57.08,55.28,36.26,all P =0.000).VEGF,S100A4 and survivin in the positive expression of capsular infiltration carcinoma group were 97.37%,97.74%,97.74%,which in lymph node metastasis positive group cancer rates were 97.30%,94.60%,97.30% were significantly increased compared with no capsular infiltration group (71.43%, 77.14%,62.86%,respectively)and lymph node metastasis group(72.22%,77.78%,61.11%),the differences were statistically significant(χ2 =8.96,4.37,14.63,9.58,4.77,11.34,all P <0.05);the positive expression rate of three with thyroid cancer histological grade increased.Conclusion VEGF,S100A4 and survivin are closely related to the aggressive and metastatic character of thyroid cancer.A combination of VEGF,S100A4 and survivin may be of grate significance for predicting high aggressive and metastatic character in thyroid carcinoma.

Objective To evaluate the efficacy and safety of intravitreal ranibizumab injection combined with triamcinolone acetonide (TA) for macular edema secondary to type Ⅱ optic disc vasculitis.Methods Totally 19 cases(19 eyes) with macular edema secondary to type Ⅱ optic disc vasculitis from January 2013 to December 2015 were injected ranibizumab intravitreally and triamcinolone acetonide 2 weeks later.The visual acuity,intraocular pressure,ocular fundus,OCT,FFA and related complications were observed during the 6 months follow-up period.If the macuiar edema returns during the follow-up period,the eyes would be given ranibizumab and TA again until the macular edema subsided.Results The visual acuity was 0.16 ± 0.09 and the central retinal thickness was (694.88 ± 79.06) μm before treatment.Compared with pretreatment,the visual acuity of all cases were improved in different degree except for one at 1 month,3 months and 6 months (all P ＜ 0.05).Also central retinal thickness were decreased and macular edema were subsided,there were statistical differences (all P ＜0.05).Compared with results at 1 month,the visual acuity and central retinal thickness was no significant different at 3 months and 6 months (all P ＞ 0.05).The intraocular pressure of all cases were normal throughout the follow-up period but one was increased transitorily in the first day after intravitreal rauibizumab injection.FFA examination at 1 month showed retinal hemorrhage and effusion absorbed obviously,besides,the optic disc and macular fluorescein leakage reduced significantly.The macular edema of 1 eye returned at 3 months and subsided after giving ranibizumab and TA again.The average number of injected eyes was 2.11 times.No complications associated with intravitreal injection and drugs were observed during the follow-up period.Conclusion It is effective and safe that intravitreal ranibizumab junction combined with TA for macular edema secondary to type Ⅱ optic disc vasculitis,which not only shorten the period of treatment but also reduce the times of drug injection,surgical trauma and complications.

Objective: To study convention MRI compared with conventional MRI combined with diffusion-weighted imaging (DWI) in the evaluation of T-staging of gallbladder carcinoma, and to determine the relationship between the apparent diffusion coefficient (ADC) value and histological grading. Methods: Fifty-one patients with gallbladder carcinoma confirmed by surgery and pathology were enrolled into this study. The T-staging was performed according to conventional MRI or with conventional MRI combined with DWI and the results were compared with pathological studies. Results: The ADC value of tumor was measured to determine the correlation with T staging, pTNM staging and pathological tumor differentiation. For conventional MRI, the T-staging rate was 84.3%, which was consistent with the pathological T scoring (Kappa value 0.7580). After DWI, the T staging coincidence rate was 92.2% and the Kappa value was 0.8813. A comparison between conventional MRI versus conventional MRI combined with DWI T-staging compliance rates was performed using the Chi-square test (χ²=1.5111, P>0.05). The ADC values correlated with the T-staging, pTNM staging, and pathological tumor differentiation (r=-0.672, -0.749, 0.707, respectively, all P<0.05). Conclusions Conventional MRI helped in the diagnoses of T-staging in gallbladder cancer. MRI combined with DWI helped to improve the coincidence rate of T-staging. The ADC values correlated with the T-staging, pTNM staging, and pathological tumor differentiation. Conventional MRI combined with DWI better evaluated the T-staging of gallbladder cancer, and could better guide the choice of treatment methods.

Chronic myelogenous leukemia (CML) is a myeloproliferative disease characterized by heterotopic Ph chromosome. Tyrosine kinase inhibitor (TKI) has significantly improved the prognosis of patients with CML. Cytogenetic and molecular monitoring for assessing the therapeutic efficacy of TKI to guide disease management has become an important component of CML therapy. However, the expanded genomic analysis of the disease diagnosis, transformation and drug resistance has not been fully explored in CML research. The paper reviews the frequency and type of gene mutations at initial diagnosis and the time of treatment failure and transformation, and investigates the relationship between genetic mutations and the prognosis of CML patients in the diagnosis and treatment.

With the wide application of tyrosine kinase inhibitor (TKI), to obtain treatment-free remission (TFR) has gradually become the long-term goal for patients with chronic myelogenous leukemia (CML). Self-renewing leukemia stem cells during disease progression are related with the recurrence, and surveillance of residual leukemic cells is hypothesized to be one of the critical factors in successful TFR. On the way to obtain TFR, many breakthroughs have been made in innate and adaptive immunity of CML cells. This paper reviews the immune function of CML patients, the role of the immune markers in maintaining TFR, and the exploration of TKI combined with new immunomodulator therapy to achieve a greater degree of TFR.