Objective To observe the clinical feasibility and effects of regional nerve blockade in patients with heart failure.Methods The study enrolled a total of 10 patients,age range from 55 to 75 years old(average 64?11 years old).The subject includes 8 males and 2 females,among which 6 cases were ischemic cardiomyopathy and 4 cases were dilated cardiomyopathy.All the patients met the criteria of NYHA class Ⅲ-Ⅳ heart function with heavy fluid load unresponsive to optimal medical therapy.Patients with diabetes and renal failure were ruled out from the study.After application of local anesthesia,15 mL of 0.25% Naropin was injected inside Gerota's fascia to achieve regional nerve blockade under CT guidance.Serum and urine electrolytes,neurohormones,renal clearance of sodium and 24-hour urine volume were recorded 24 h before and after the operation.Variartions in heart rate,blood pressure and symptons of dyspnea and edema were also under monitor.Results After nerve blockade,the 24-hour urine volume and renal sodium clearance increased obviously while the level of neurohormones decreased compared with that before operation.No obvious changes in heart rate and blood pressure were recorded and the symptons of heart failure were improved in the patients after operation. No complication was recorded in the study. Conclusion Regional nerve blockade may be a feasible,safe and effective treatment for congestive heart failure patients who do not respond well to the existing optimal medical therapy.

Objective To investigate the incidence of fetal malnutrition( FM), its affected factors and their relationship with small - for gestational - age (SGA) fetus. Methods The intrauterinal growth of fetus was evaluated by the body weight of neonates and FM was detected by clinical assessment of nutritional status ( CANS ). Results ①33 out of 204 cases were found to be FM (16% ). FM in SGA group was significantly higher than that in AGA group ( 5.9% ) (x2 = 69.9, P ＜ 0. 01 ).② When ot = 0. 05, the body weight and head circumference of neonates, the education level of mothers were included into logistic regression model, and their regression coefficient were negative. Conclusion SGA was supposed to be two of the risk factors in developing FM. Fetus with low body weight, small head circumference and not - so - well educated mother were prone to suffer from FM.

OBJECTIVE:To study the association between the reticulated platelets(RP) percentage and aspirin resistance(AR) with the percentage of reticulated platelets in whole blood representing the platelets turnover rate to illuminate the influence of platelets turnover rate on AR.METHODS:The RP percentage and arachidonic acid(AA) and adenosine diphosphate(ADP)-induced platelet aggregation in 80 patients after receiving aspirin(100 mg?day) for no less than 7 days were determined.The patients were divided into AR group,aspirin semi-resistance(ASR) group,and aspirin sensitive(AS) group,and the RP percentage in the three groups were compared.RESULTS:RP percentages in AR,ASR,and AS groups were(4.11?2.62)%,(2.23?1.79)%,and(2.18?1.24)%,respectively,showing signficant differneces between AR group and AS group(P0.05).CONCLUSION:Increased platelets turnover may induce AR,therefore,the patients with coronary artery disease should receive aspirn for multiple daily(antiplatelet therapy) or to take controlled release or sustained release aspirin.The safety and efficacy of these therapies should be confirmed in clinical trials.

Objective Investigate the postmortem stability of the six immunohistochemical markers of fibronectin(Fn),fibrinogen(Fg),C5 complement(C5), myoglobin(Mb), actin(HHF35)and desmin(Dm)for the postmortem diagnosis of myocardial infarction.Method The areas of depletion ofMb、HHF35 and Dm,and the positive reaction areas of Fn、Fg and C5 in the ischemic myocardium were studied with immunohistochemistry,image analysis technique and statistical system.The postmortem stability of the six immunohistochemical markers was compared.Results The specimens of normal myocardium kept at 4℃ for 1 to 2 days showed homogenous brown reactions for Dm, HHF35 and Mb; depletion of Dm, HHF35 and Mb became evident when these specimens were kept at 4℃ for 3 days postmortem, and the depletion area increased with the lapse of postmortem interval; the depletion area of Dm, HHF35 and Mb in ischemic myocardial tissues also increased with the lapse of postmortem interval;the positive reaction areas of Fg, C5 and Fn in ischemic myocardial tissues decreased with the lapse of postmortem interval.Fg became negative when the ischemic myocardium were kept at 4℃ for 2 weeks postmortem,C5 became negative when kept at 4℃ for 3 weeks postmortem,but Fn remained positive when kept at 4℃ for 4 weeks postmortem.No positive reactions for Fg,C5 and Fn could be found in normal myocardium when kept at 4℃ for different time intervals. The image analysis result showed that the positive reaction areas decreased with the lapse of postmortem interval. Conclusion The Dm and HHF35, Mb showed least postmortem stability, easily influenced by autolysis, only suitable for detection in fresh corpses(1to 2dayspostmortem) ;Fgislittlebitbetter,suitableforcorpsesat4℃ 1weekpostmortem ;C5isbet ter,suitableforcorpsesat 4℃ 2weekspostmortem ;Fnisthebestmarker ,suitableforcorpsesat 4℃ 4 weekspostmortem .

Objective To understand the development situation of the purified protein derivative of tuberculin (PPD) test ,the prevalence of tuberculosis(TB) among the school students in Guangxi and the related influence factors of strong positive result in order to provide the basis for establishing the physical examination system of student TB in Guangxi .Methods The PPD test was conducted in the students participating in the survey firstly ,then the students with strong positive PPD test results and the TB sus-picious symptoms and the suspected TB cases were performed chest X-ray and sputum smear examination .The related factors in the students with strong positive PPD test results and non-strong positive PPD test results were comparatively analyzed .Results To-tally ,53 217 students received the PPD test with the positive rate of 5 .74% (3 055 cases) and the strong positive rate of 1 .46%(775 cases) .The detection rate of active TB was 0 .03% (15 cases) .The χ2 test and the Logistic regression analysis showed that the age group and the regional distribution were the influence factors of strong positive PPD test result (P<0 .05) .Conclusion The preliminary screening by the PPD test and then conducting chest X-ray and sputum smear examination are the effective method for find TB in school and the TB clinic .At the same time the TB screening should be strengthened in the schools in high epidemic areas of TB ,especially the college students .

Objective To investigate the relationships between serum osteocalcin levels of fasting plasma glucose(FPG),fasting serum insulin(FINS),insulin resistance,β-cell function as well as lipid metabolism in male traumatic patients.Methods A prospective cohort study was carried out in the Emergency Room of Shanghai Sixth People's Hospital from April to October of 2015.The male adult traumatic patients without traumatic brain injury,shock and the medical history such as the fractures,diabetes were enrolled as trauma group,and then patients' age,body mass index(BMI),injury severity score(ISS), admission time after trauma and fluid resuscitation volume before testing(FRVT) were recorded.A total of 80 heathly male adult subjects were enrolled from the physical examination center as control group with matched age and BMI.Comparison of biochemical characteristics were carried out between two groups, and relationships between serum osteocalcin levels and glycolipid metabolism in trauma group were analyzed.Insulin resistance and β-cell function were calculated by Homeostasis model assessment-insulin resistance(HOMA-IR)and Homeostasis model assessment of β-cell function(HOMA-β).Results A total of 102 male adult traumatic patients mostly subjected to traffic accident (56.9%) with FRVT (208.78±98.68)mL and ISS(9.30±3.67)were enrolled in trauma group.Serum OC levels,HOMA-β,total cholesterol(TC),high density lipoprotein(HDL-c)and low density lipoprotein(LDL-c) were lower,but FPG,FINS,C-peptide(C-P),HOMA-IR were higher compared with control group(P<0.05).Serum OC levels wer were negatively correlated with FPG and TC(P<0.05),and positively correlated with FINS,HOMA-IR,and HOMA-β(P<0.05),but there were no correlation of OC with FRVT and ISS.By multiple linear regression analysis after adjusting for age,BMI,FRVT and ISS,serum osteocalcin levels were significantly related to TC in traumatic patients (β=-0.812,P=0.024).Conclusion The glycolipid metabolism may be impacted by the serum level of osteocalcin after trauma.

Objective:To investigate the efficacy of the combined application of fluconazole and sodium bicarbonate in treatment of oral fungal infections among elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:A total of 360 elderly patients with AECOPD treated in the Emergency Ward of our hospital during July 1, 2018 and December 31, 2019, were included for observation. After admission, the oral mucosal lesions were observed every day, and fungal smear and fungal culture were performed immediately once signs of fungal infection appeared. Meanwhile, fluconazole was given with 300 mg. oral. qd., followed by 150 mg. oral. qd., and 2.5% sodium bicarbonate was given three times a day as gargle.Results:The prevalence of oral fungal infection was 8.3% among which candida infection accounted for 83.2%. The mean treatment time was 5.0 ± 0.3 days. Daily observation of the oral cavity, early detection and application of fluconazole combined with sodium bicarbonate had significantly clinical effect in elderly AECOPD patients with oral fungal infection, with an effective rate of 16.7%, and a cure rate of 83.3%. No toxic side effects on liver and kidney function were found during the treatment. Obvious efficacy was found in relieving clinical symptoms, and there was no increase in hospitalization costs and time.Conclusion:Early combination of fluconazole and sodium bicarbonate has a significant clinical effect on control of oral fungal infection in elderly patients with AECOPD.

ObjectiveTo test the the association between PRODH gene variant rs385440 and the susceptibility to schizophrenia and the severity of schizophrenia in Guangxi Zhuang and Han population,further exploring the genetic mechanisms of schizophrenia in Guangxi Zhuang and Han population.MethodsThe schizophrenia patients were diagnosed according to ICD-10 criteria in this study.The subjects in the association analysis were 282 unrelated schizophrenia patients(94 Zhuang and 188 Han) and 282 healthy controls (94 Zhuang and 188 Han).A quantitative real-time PCR TaqMan MGB experimental method was carried out to analysis rs385440.The clinical psychotic symptoms of 246 schizophrenia patients (83 Zhuang and 163 Han) were assessed by PANSS.Statistical analyses were carried out with SPSS13.0 for windows.ResultsThere was no statistically significant difference in different allele and genotype frequencies of rs385440 between schizophrenia cases and controls in Zhuang samples,Han samples and combined samples respectively (P＞ 0.05 ).In Zhuang schizophrenia patients the score of N4 (passive/apathetic social withdrawal) item in A allele carriers (3.28 ± 1.34) was higher than that of G allele carriers ( 2.40 ± 1.36 ) significantly (P ＜ 0.05 ),and the score of G12 ( lack of judgment and insight) item in A allele carriers(4.92 ± 1.55 ) was higher than that of G allele carriers ( 4.12 ± 1.85 ) significantly (P ＜ 0.05 ).Conclusion There is no association between PRODH gene variant rs385440 and the susceptibility to schizophrenia in Guangxi Zhuang and Han population.Rs385440 associated the severity of passive/apathetic social withdrawal symptom and poor attention symptom of schizophrenia in Zhuang.

Objective To investigate the incidence of aspirin resistance (AR) in patients with Type Ⅱ Diabetes mellitus (DM) and the correlation between AR and advanced glycosylation end products (AGEs) as well as the homeostasis model assessment for insulin resistance index (HOMA-IR). Methods A total of 69 patients with Type Ⅱ DM and another 23 patients without DM as control group were enrolled between October 2009 and July 2010. Blood lipid, blood routine, fasting blood glucose, Glycated hemoglobin (GHb/Hb A1c) ,fasting insulin were determined at first. After aspirin treatment for at least 7 days, platelet aggregation stimulated by arachidonic acid(AA) and adenosine diphosphate (ADP) were measured. In addition, the level of serum AGEs was measured by using ELISA assay. The degree of insulin resistance was obtained by using HOMA-IR. Results The incidence of AR in patients with Type Ⅱ DM was higher than that in the controls(30.4% vs. 8.7%, P = 0.037 ); the levels of serum AGEs and HOMA-IR in patients with Type Ⅱ DM were higher than those in the controls [ (359.56 ± 120. 14) pg/mL vs. (275.45 ± 118.06)pg/mL, P=0. 004; (4.42 ±4.78) vs. ( 1.5 ±0.78), P＜0.01, respectively]; platelet aggregation stimulated by AA in the diabetic group was correlated with serum AGEs and HOMA-IR( R =0.463, P ＜0.01; R=0.290, P =0.016, respectively); and platelet aggregation stimulated by ADP was only positively correlated with HOMA-IR(R =0.242, P = 0.045). Conclusions The incidence of AR in patients with Type Ⅱ Diabetes mellitus is higher than that in the controls, and diabetics with higher serum AGEs and HOMA-IR are more likely to develop aspirin resistant.

Objective To describe the association between age and the sex-based outcome difference and analyze the potential mechanism responsible for sex-based outcome difference in severe trauma patients.Methods A retrospective analysis derived from the Emergency Intensive Care Unit of the acute trauma center of the Shanghai Municipal Sixth People's Hospital during the 2010-2013 period was performed to identify sex-based outcome differences after severe blunt trauma.The study cohort of patients was then stratified by age:(1) 18 years ≤ age ＜45 years,(2) 45 years ≤ age ≤ 55 years,and (3) age ＞55 years.Crude and adjusted odds ratios (ORs) were calculated to evaluate the association between gender and the hospitalized mortality,both overall and subgroups according to age categories.Results A total of 987 severe trauma patients met our inclusion criteria were enrolled in this study.Crude mortality was higher in male severe trauma patients (male 9.1％ vs.female 5.0％,P ＜ 0.05).Multiple logistic regression revealed that females had a 79％ decrease in hospitalized mortality compared with males (OR =0.21,95％ CI:0.07-0.64,P =0.006).This difference was most distinct in patients with age ＜ 45 years,(OR =0.15,95％ CI:0.04-0.67,P =0.012).There is no significant difference between genders in mortality of trauma patients with 45 years ≤ age ≤ 55 years and age ＞ 55 years.Conclusions The present study revealed a statistical significant association between gender and mortality among severe blunt trauma patients,particularly in patients with age ＜ 45 years.These results may highlight the importance of sex hormones in outcomes of severe trauma.