Objective To analyze the serum level of 25-hydroxy vitamin D [25-(OH) D] in pregnant women in Nanjing and its relationship with age,gestational week,pre-pregnancy body mass index (BMI) and season,so as to provide some guidance on clinical application of vitamin D measurement and supplementation.Methods 880 pregnant women (in 21-36 gestational weeks) regularly visiting antenatal clinic in Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University were selected from January to December 2015.Their serum 25-(OH)D concentrations were measured by enzyme-linked immunosorbent assay (ELISA).Results The mean serum 25-(OH) D concentration in these pregnant women was (42.03 ± 19.22) nmol/L and sufficient in only 42 (4.77％).Vitamin D levels showed seasonal variation (P =0.0164),with the levels in summer [(44.61 ±23.57) nmol/L] and autumn [(43.43 ± 19.31) nmol/L] being higher than spring [(39.68 ± 16.91) nmol/L] and winter [(39.65 ± 13.36) nmol/L].There was no statistically significant difference in serum vitamin D level among different gestational weeks (P =0.929 4).There was statistically significant difference in serum vitamin D level among different age groups (P =0.038 3).Vitamin D level was not associated with pre-pregnancy BMI.Conclusions Vitamin D deficiency is highly prevalent among pregnant women in Nanjing.We suggest vitamin D testing be carried out more actively.

Objective To probe the validity and security of cervical dorsal rand nerve block in posterior approach of cervical vertebra surgery.Methods Eighty-six adults ASA class I-II patients undergohag posterior approach of cervical spine operation randomized equally to cervical dorsal rami nerve block group (group I )and partial infiltration anesthesia group (group II ).In group I ,according to regional anatomy characteristic of the nerve and by means of preopomtively measuring the cervical vertebra X -ray,the body surface projection of articular process joint waist of cervical vertebra were calibrated.Away 3 cm from latter median line,percutaneous puncture via 45° angle relative into sagittal plane ,adopting long 8 cm 7# needle and anesthetic to block ~e surgical incision corresponding bilateral dorsal rami nerves.In group II,using traditional local infiltration anesthesia.The effect and response time of anesthesia,influence on breathing and hemodynamics or pulse oxygen saturation,visual analogue score( VAS ) and calmed grade postoperatively and adverse reaction were observed and recorded.Results The anesthesia excellent rate (74%) in group I was obviously higher than that(42%) in group II (P ＜ 0.05 ).The surgeries average time in group I was less than that in group II,but no statistical significance (P＞ 0.05).The average dose of anesthetic in group I was obviously lower than that in group II (P ＜ 0.01 ).The mean arterial pressure elevated after anesthesia in both groups,and in group I was significantly lower than that in group lI (P ＜ 0.05 ).The SpO2 of both ＞ 95%.Calmed grade and VAS at 24 and 48 h postoperatively were significantly lower in group I than that in group II (P＜ 0.05).There was no adverse reactions.Conclusions Compared to other anesthesia methods in posterior approach of cervical vertebra surgery,the method of cervical dorsal rami nerve block has so undermentioned dominances: simple,less anesthetic,exact effect of anesthesia,light influence on breathing and hemeodynamies and lower injury of spinal cord or spinal nerve root that the method is safe and feasible.

The analgesic, sedative and convulsive effects of procaine were determined by animal experiments. The analgesic ED50 of procain were 21.7mg/kg or 52.8ug/ each (iv or icv, hot plate) and 29.2mg/kg or 52.2ug/ each (iv or icv,electral stimulation) in mice.Procaine In subthreshold dose had additive hypnotic effect of phenobarbital in mice and rabbits, but could not de crease spontaneous activity in mice.The convulsive ED50 of procaine were 13.5mg/kg (iv) or 2.4mg/each (icv) in rabbits.There was no influence on the righting reflex in all the experiment animals when iv or icv procaine was given alone.These results suggest that the analgesic and sedative effects of procaine are weak, but may be potentiated when administered concomitantly With other potent drugs.

The interaction between sodium oxybate and ketamine were studied in conscious animals. Sodium oxybate increased the LD_(50) of ketamine, increased the incidence of sleep caused by ke tamine and prolonged the sleep duration and potentiated analgesic action of ketamine. Sodium Oxybate didn't effect the respiratory and circulatory function in rabbits. The results showed sodium oxybate po tentiated the anesthetic action of ketamine and reduced the side effect of ketamine. So It is suggested that sodium oxybate has the anesthetic synergism with ketamine in animals.

Objective To analyze the clinical presentations and radiological characteristics of acute exacerbation of idiopathic pulmonary fibrosis (IPF).Methods Clinical and radiological data of 2 patients with acute exacerbation of IPF from April 2006 to July 2008 were retrospectively analyzed and literatures were reviewed.Results Both patients were senior male patients over 60 years old.Dyspnea, cough and inspiratory crackles were the major symptoms and signs.Two patients were experiencing an exacerbation of dyspnea for one week and half of month,respectively.PaO2/FiO2 of both patients was less than 225 mm Hg.In both patients, high-resolution computed tomography (HRCT) scans at the exacerbation showed typical signs of IPF including peripheral predominant, basal predominant reticular abnormality, with honeycombing and traction bronchiectasis and bronchiolectasis,and newly developing alveolar opacity.HRCT scan showed peripheral area of ground-glass attenuation adjacent to subpleural honeycombing in one patient,and diffusely distributed ground-glass opacity in another patient.Two patients had received cortieosteroid treatment.For one patient, the symptoms improved, and ground-glass attenuation adjacent to subpleural honeycombing had almostly resolved.The other patient died of respiratory failure.Conclusions Some acute exacerbation in idiopatic pulmonary fibrosis can be idiopathic.The chnical presentations mainly include the worsening of dyspnea within short time.HRCT generally demonstrates new bilateral ground-glass abnormality with or without areas of consolidation, superimposed on typical changes of IPF.

Objective To observe the effects of Shenfu injection on intestinal mucosal barrier of rats with hepatic ischemia-reperfusion.Method Ninety SD male rats and weight from 230 to 270g were randomly divided into three groups( 30 rats in each),and 30 rats in each group divided again into 6h and 12h group( 15 rats in each):(1)SO group received sham operation(SO);(2) IR + NS group received so and 0.9 normal saline intravenously imediately before the ischemia reperfusion injury;(3) IR + SF group received Shenfu injection intravenously imediately before the ischemia reperfusion injury,IR + NS group and IR + SF group occlusion of the hepatoduodenal ligament,and endotoxin,ALT and MDA were detected.Results The levels of ALT,MDA in IR + NS group were higher than those in IR + SF group,and the rate of bacterial translocation( BT)group.

Objective To investigate the value of magnetic resonance (MR) diffusion weighted imaging(DWI) in the diagnosis of prostate cancer(PCa). Methods Fifty-seven patients with suspected prostate cancer underwent DWI and T_2-weighted imaging (T_2W). These images and apparent diffusion coefficient (ADC) maps results were compared with histopathologic findings. Receiver operating characteristic(ROC) analysis was used to compare the cancer detection performance of them. The results were rated on a scale of scores Ⅰ (benign) to Ⅴ (malignant) on the basis of ADC maps. Abnormal voxels were overlaid on the corresponding transverse TRUS images and used to perform voxel-guided biopsy. Results DWI had a sensitivity of 85%, specificity of 82%, positive predictive value of 80%, negative predictive value of 86% , and accuracy of 83%. T2WI had a sensitivity of 77%, specificity of 71%, positive predictive value of 69%, negative predictive value of 79%, and accuracy of 74%. The areas under the ROC curves for DWI and T_2WI were 0. 830 and 0. 742, respectively. The performance of DWI in PCa detection was significantly better than of T_2WI (P<0. 05). 6 of 30 patients with negative DWI results also had negative biopsy findings. PCa was detected in 17(85%) of 24 men findings with voxel score Ⅳ , with a sensitivity of 100%, specificity of 46%, positive predictive value of 71 %, negative predictive value of 100% , and accuracy of 77%. Conclusions The performance of DWI in PCa detection was better than of T_2 WI. ADC maps can be transferred to TRUS images and used to sample regions of cancer in men with rising PSA levels and negative findings at prior biopsy with good accuracy. DWI appears to be a robust and reliable method to examine the whole prostate within an acceptable scan time in clinical settings.

Objective To discuss the effect of two different warming methods on the circulation of free flaps during operation and seek for an optimal warming method which is benificial for the circulation of free flaps, and thus provide clinical evidences for intraoperative care. Methods A total of 96 patients undergoing free flap transplantation were divided into routine warming group and diversification warming group randomly (n=48 each). In routine warming group, temperature in the operating room was set at routine temperature and flaps were douched by routine heated saline. In diversification warming group, the temperature in the operation room, fluids used for washing wounds and flaps were warmed, fluids for intravenous application were pre-warmed by a fluid warmer, in addition, the operation table where patients were lying on was covered with warmer blanket. The influence of two different warming methods on the circulation of free flaps was observed. Results The scores of flap elasticity and capillary refill time in routine warming group were 2.02 ± 0.79 and 2.04 ± 0.81, respectively, vs. 2.50 ± 0.61 and 2.48 ± 0.6 in diversification warming group, showing diversification warming group was statistically better than routine warming group (Z=1.949, 3.872, P<0.05). In addition, the flap survival rate in routine warming group was 81.2%(39/48) vs. 95.8%(46/48) in diversification warming group, showing significantly better results in diversification warming group (χ2=4.02, P < 0.05). Conclusions The diversification warm keeping method can effectively promote the circulation and survival of flaps, improve clinical prognosis, accelerate postoperative rehabilitation, therefore is worthy of being recommanded its clinical application.

BACKGROUND:Although the mechanism why neuronal cels wil die after transient cerebral ischemia has not been completely elucidated, many researches nowadays have investigated the pathological mechanism in the level of celular organs, such as mitochondria.
OBJECTIVE:To summarize and discuss the functions of neuronal mitochondria and apoptosis signaling pathways in transient cerebral ischemia.
METHODS: A computer-based online retrieval was performed to search papers in CNKI and PubMed databases using the key words of “cerebral ischemia, mitochondrion, apoptosis, reactive oxygen species, reperfusion, superoxide dismutase, nitric oxide synthase, Bcl-2 protein family, review” in Chinese and English, respectively. Papers published recently or in the prestigious journals were selected in the same field. After excluding objective-independent papers and repeated studies, 50 papers were included for further analysis.
RESULTS AND CONCLUSION:Recently mitochondria are found to play an important role after transient cerebral ischemia by producing a lot of reactive oxygen species to activate many kinds of signaling pathways and regulate mitochondria-mediated apoptosis. Reactive oxygen cannot only induce biomacromolecule injury but also induce apoptosis signal transduction. Deeply investigation is needed on the pathological mechanism after transient cerebral ischemia.

Objective: To observe the clinical efficacy of acupuncture treatment for migraine. Methods: Forty cases were randomly allocated to a treatment group and a control group, 20 cases in each group. Cases in the treatment group were treated with acupuncture, while cases in the control group were treated with oral Sibelium. After that, the changes of cerebral blood flow were observed before and after treatment. Results: There was significant difference in clinical efficacies between two groups (P<0.05). There were also significant differences in arterial blood flow velocities of before and after treatment. Acupuncture can produce substantial differences (P<0.05) in blood flow velocities of vertebral artery (VA), middle cerebral artery (MCA) and anterior cerebral artery (ACA) during an increased flow rate. It can also produce statistical differences in blood flow velocities of VA during a decreased flow rate (P<0.05). Conclusion: Acupuncture can effectively alleviate the pain of migraine sufferers and exert a two-way regulation on the cerebral blood flow.