[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.

Objective To investigate the changes of venous cord blood nitric oxide(NO) and endotnelin-1(ET-1) levels and to find out its relationship with umbilical arteries blood flow velocities in the pregnant women with diabetes mellitus.Methods 66 cases of the pregnant women with diabetes mellitus(DM) were selected at random,including 30 diabetes mellitus complicated with pregnancies(DMP) and 36 gestational diabetes mellitus(GDM).36 cases of the normal pregnant(NP) women were selected as the control group.Venous cord blood samples were collected from all the subjects after delivery.Cord blood NO and ET-1 levels were detected by Griess assay and radioimmuno-assay respectively,and umbilical arteries blood flow velocities(S/D) were measured just before delivery.Results Compared with the control group,cord blood NO levels decreased and ET-1 levels increased and S/D increased in the DMP group significantly(P0.05).Conclusion Umbilical blood NO and ET-1 levels are abnormal in DMP,which induces the high resistance of fetal-placental circulation,and finally might cause adverse pregnancy outcomes.

Objective:To optimize the ethanol extraction process of Rhizoma Corydalis and Salvia miltiorrhiza, and study the effect of comminution degree of the medicinal materials on the effective constituent. Methods:Using the alcohol concentration, alcohol vol-ume, extraction time and extraction times as the impacting factors,the content of tetrahydropalmatine and salvianolic acid as the indi-ces, the extraction process was optimized by orthogonal test of L9(34). Results:The best extraction conditions were as follows:Rhizo-ma Corydalis was crushed into coarse powder, the material / liquid ratio was 1∶6 with 75% ethanol as the extraction solvent,extracting twice with 1. 5h each. Conclusion:The extraction method is appropriate and simple,and can be used in the industrial production.

Objective To investigate the residual functions in the hepatic lobe with deprivation of bile duct by observation of histomorphological and functional changes in the hepatic cells in a rat model. Methods The right hepatic bile ducts of rats were obstructed with cyanoacrylate and then ligated two weeks after the left and caudate lobes were removed. The lobus quadratus hepatis served as self-control with or without portal vein ligation. The venous blood from individualized liver lobe was examined and histological observation was done to examine the histomorphological and functional changes in the hepatic cells. Results Compared to the controls of both sham operation and untreated lobe, the hepatic lobe with bile ducts deprived did not undergo atrophy significantly with few ultrastructural changes. The hepatocytes of the hepatic lobe with bile duct deprived contained plenty of mitochondria, ribosomes and rough endoplasmic reticulum when observed under transmission electron microscope (TEM). The results of periodic acid-Schiff staining revealed normal glycogen metabolism in the hepatic cells. No significant decrease was detected in the serum albumin and fibrinogen concentrations by examination of blood collected from vein of this liver lobe with deprivation of bile ducts. Conclusions The liver lobes with bile ducts deprived retain most of the liver functions such as protein synthesis and nutrition metabolism, and show no atrophy during the observation period. It is suggested that the hepatic lobes with bile duct deprived still possess the value of preservation. The present study has founded a theoretic basis for remaining the remaining liver lobes with bile duct deprived or ligated in some emergency and specific clinical situations.

Objective To investigate the possible risk factors for lead poisoning in order to prevent the lead poisoning in children.Methods One thousand and fifty-five children aged 5 months to 16 years who were outpatients in Beijing children′s hospital were chosen. Blood lead was analyzed by 3010-B lead analyzer for each child.Also the risk factors were recorded by using a standardized questionnaire.Results The mean level of blood lead was(110.1?41.9) ?g/L with the occurrence of lead poisoning (blood lead ≥100 ?g/L) at 43.51%.No difference were found in blood lead level among different age groups.Several environmental and social factors were found to be related to lead poisoning in children,such as non-balanced diet,rarely hand washing,frequent eating crisp foods,not frequency of calcium and zinc supplementation and frequency of room decoration.Conclusion Unhealthy dietary and life styles contribute to lead poisoning in children.

Objective To study the T cells lineage polymorphism of TCR BV CDR3 in the peripheral blood of ankylosing spondylitis (AS) patients,in order to provide experimental basis for the immunological patho-genesis study of AS.Methods Twenty-six subfamilies of CDR3 T cells of TCR BV in the PBMC of AS patients were amplified by RT-PCR method,then TCR BV CDR3 lineages polymorphism were analyzed by immunization scanning spectrum.Results TCR BV CDR3 scanning spectrum of 20 active AS patients showed abnormal distribution peak,including monoclonal,oligoclonal/oligoclonal trend,skewing peak and irregular abnormal peak.Among them,some subfamilies of 18 patients showed oligoclonal/oligoclonal trend expansion,BV16 and BV18 two subfamilies of one case showed monoclonal expansion.Most spectral type of PBMC TCR BV CDR3 in five normal controls showed Gauss distribution.Conclusion TCR BV CDR3 lineage have significant characteristic polymorphism and spectrum drift characteristics in the peripheral blood of AS patients,which further indicate that T cells has plaied an important role in the immunological pathogenesis of AS.Monoclonal/oligoclonal expansion of T cells may be autoreactive T cells in nature and they may be involved in the pathogenesis of AS.

Administration, Intranasal ; Humans ; Mucociliary Clearance ; drug effects ; Nasal Mucosa ; drug effects

The paper is to systematically evaluate the efficacy and safety of Deng Zhan Xi Xin injection ( DZXXI) as an adjuvant treatment for patients with angina pectoris. The Cochrane Library, Medline, EMbase, CBM, CNKI, VIP, and Wan fang Data base were searched. Randomized controlled trials (RCTs) of DZXXI combined with western medicine routine treatment versus western medicine routine treatment alone for angina pectoris patients were all included. All trials were assessed according to the Cochrane Reviewer' s Handbook 5.1 for Systematic Reviews of Intervention and Meta analyses were performed by RevMan 5. 2 Software. A total of 30RCTs (3 086 patients including 1 572 patients of treatment group and 1 514 patients of control group) were included. Meta-analysis of treatment group compared with control group showed superior effect over reducing cardiovascular events ( OR = 0.33; 95% CI: [0.16, 0.67], P = 0.002, improving effective rate of DZXXI as adjuvant treatment for angina pectoris patients (OR = 3.97; 95% CI: [3.15, 5.02]; P < 0.000 010 and electrocardiogram curative effect (OR = 2.21; 95% CI; [1.83, 2.68]; P < 0.000 010. Funnel figure seemed that there was publication bias. The current limited evidence showed that when compared with the control group, treatment group was superior in improving patients with angina pectoris. But based on the limitations of the study, rigorous design with long follow up clinical trials are necessary for further evidence.
Adjuvants, Pharmaceutic ; Adult ; Aged ; Angina Pectoris ; drug therapy ; physiopathology ; Drugs, Chinese Herbal ; administration & dosage ; Electrocardiography ; Female ; Heart ; physiopathology ; Humans ; Injections ; Male ; Middle Aged ; Randomized Controlled Trials as Topic

Objective: To study influence of glycosylated hemoglobin A1c (HbA1c) on major adverse cardiovascular events (MACE) in patients with diabetes mellitus (DM) complicated coronary heart disease (CHD) after percutaneous coronary intervention (PCI).Methods: A total of 100 DM+CHD patients after PCI were selected from our hospital.According to HbA1c level, they were divided into HbA1c<6.5% group (n=48) and HbA1c≥6.5% group (n=52).Levels of C reactive protein (CRP), tumor necrosis factor α (TNF-α), erythrocyte sedimentation rate (ESR) and interleukin (IL)-6 before PCI, incidence rate of MACE on six and 24 months after PCI were compared between two groups.Results: Compared with HbA1c<6.5% group before PCI, there were significant rise in serum levels of CRP[(18.5±6.2) mg/L vs.(25.8±4.2) mg/L]and TNF-α[(32.4±12.3) ng/L vs.(48.3±11.8) ng/L]in HbA1c≥6.5% group, P<0.01 both.On six months after PCI, incidence rate of myocardial infarction in HbA1c≥6.5% group was significantly higher than that of HbA1c<6.5% group (9.62% vs.0, P=0.028);24 months after PCI, compared with HbA1c<6.5% group, there were significant rise in incidence rates of myocardial infarction (2.08% vs.15.38%) and diseased vessel restenosis (12.50% vs.32.69%) in HbA1c≥6.5% group (P<0.05 all).Conclusion: In DM+CHD patients after PCI, those with lower HbA1c level possess better prognosis.