Objective To explore the effect of Ulinastatin on proinflammatory cytokines of patients undergoing operation of intracranial aneurysm embolization. Methods 40 patients undergoing operation of intracranial aneurysm embolization were randomly divided into 2 groups (n = 20): ulinastatin group (Group U), normal saline group (Group C). In group U, 6 000 IU/kg Ulinastatin was infused via vein before anesthesia induction, the group C received the injection of isovolume normal saline. Exsanguinated arterial blood at T1, T2, T3, T4 and T5 five time points were taken to measure TNF-α and IL-6 in serum. Results The contents of TNF-α and IL-6 in serum both increased at T3, T4 and T5 compared to that at T1 in both groups; both TNF-α and IL-6 significantly decreased in Group U compared to that in Group C at the same time point. Conclusion Ulinastatin may inhibit the release of inflammatory mediators and lighten cerebral ischemia-reperfusion injury in patients undergoing operation of intracranial aneurysm embolization.

[Summary] Thyroid nodules are the most common endocrine and metabolic diseases,and most of them are accidental nodules.How to distinguish the state between benign and malignant thyroid nodules is the clinical core problems in diagnosis and treatment.In addition to detailed history collecting and physical examination,highresolution ultrasound,serum thyrotrophin levels,and fine needle aspiration biopsy (FNAB) form the basis for the diagnosis of thyroid nodules.Endocrinologists should grasp the indications of FNAB.When the pathological finding is unable to distinguish between benign and malignant nodules,molecular or genetic diagnosis should be adopted for further diagnosis.Appropriate treatment is selected according to the definitive results.In this article,we share the whole process that one case with thyroid nodule was diagnosed as papillary thyroid carcinoma and eventually treated with surgery,so as to make clinicians pay more attention to thyroid nodules with standardized clinical diagnosis and treatment.

Objective To compare the efficacy of ultrasound-guided continuous fascia iliac compartment block (cFICB) and neurostimulator-guided continuous femoral nerve block (cFNB) for postoperative analgesia in patients undergoing total knee arthroplasty.Methods Sixty-six ASA Ⅰ or Ⅱ patients,aged 46-78 yr,weighing 45-88 kg,scheduled for unilateral total knee arthroplasty,were randomly divided into 2 groups (n =33 each):cFNB group (group Ⅰ) and cFICB group (group Ⅱ).At 30 min before surgery,the patients received FNB guided by neurostimulator in group Ⅰ and FICB guided by ultrasound in group Ⅱ.A bolus of 0.5％ ropivacaine 20 ml was injected and a catheter for continuous nerve block was inserted in both groups.At 0.5 h after surgery,the catheter was connected to a patient-controlled analgesia (PCA) pump.PCA with 0.2％ ropivaeaine was used for postoperative analgesia (48 h).The PCA pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤ 3.The distribution of sensory block was assessed at 10 min after the first administration,and at 0.5,4 and 24 h after surgery.The effective rate of sensory block was calculated.When VAS score ＞ 4,tramadol 50 mg was given intravenously or orally every 12 h as a rescue analgesic.When VAS score ＞ 5,pethidine 50 mg was injected intramuscularly as a rescue analgesic.The number of attempts was recorded during 0-4 h,4-12 h and 12-24 h after surgery.The consumption of tramadol and pethidine was also recorded during 0-24 h and 24-48 h after surgery.The sleep quality score during the nighttime was also recorded during 0-24 h and 24-48 h after surgery.Vascular puncture and parasthesia during nerve block were recorded.The toxic reaction,severe nausea and vomiting (lasting for more than 1 day) and nerve damage were recorded after surgery.Results Compared with group Ⅰ,the effective rate of sensory block in the medial aspect of the thigh was significantly decreased at 10 min after the first administration,and the effective rate of sensory block in the lateral aspect of the thigh was significantly increased at 0.5 h after surgery in group Ⅱ (P ＜0.05).There was no significant difference in the number of attempts,consumption of tramadol and pethidine,and sleep quality score during the nighttime during different time periods between the two groups (P ＞ 0.05).No vascular puncture or parasthesia was found during nerve block in the two groups.No toxic reaction,severe nausea and vomiting or nerve damage was found after surge,y in the two groups.Conclusion Ultrasound-guided cFICB has the similar analgesic efficacy with neurostimulator-guided cFNB after operation,but it can provide a wider distribution of sensory blockade in patients undergoing total knee arthroplasty.

Objective To investigate the effect of rocuronium of on the function of acetylcholine receptor (AchR)/channel in cone neurons of hippocampal cortex in rats.Methods SD rats of both sexes (2-5 days old) were killed by decapitation. Brain was immediately removed and hippocampal cortex was cut into slices which were incubated in decalcified and magnesium-free artificial cerebro-spinal fluid (CSF) and mechanically dissociated and then digested in artificial CFS containing 2.5% trypsin. Cell suspension was prepared. The AchR/channel function was studied in the absence and presence of various concentrations of rocuronium (0, 0.05, 0.1, 0.2, 0.4mmol? L-1) and/or atropine 0.1 mmol ?L-1 using patch clamp technique.Results (1) The conductance, open probability (P0) and short term open constant (?01) were significantly higher in R-0.05 group than those in the control group (R-0) , but there was no significant difference in long term open constant (?02) , short term close constant( (?c1) and long term close constant(?c2) between the two groups. The conductance, P0 ,?01 ,?02 , ?c1, and ?c2 were significantly longer or higher in R-0.0, 0.2 and 0.4 groups than those in control group. (2) There was no significant difference in the conductance, P0 , ?01 , ?02 , ?c1 , and ?c2, between R-0.5 and control group but those in R-0.0, 0.2 and 0.4 groups were significantly higher or longer than control group, when rocuronium was used with atropine. Conclusions AchR/channel ( muscarinic and nicotinic ) in cone neuron of hippocampal cortex were excited by different concentrations of rocuronium. The results suggest that adverse effect may be induced on CNS by rocuronium in case it permeates the injured blood-brain barrier.

OBJECTIVETo investigate the reconstruction of thumb II-III degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint.

METHODSBetween May 2004 to July 2012, 25 cases with thumbs II-III degree defects were treated. The ipsilateral big toe wrap-around flap combined with second toe proximal interphalangeal joint was designed to reconstruct the thumb defects based on the thumb size on the healthy side. The distal end of hallux was covered by flap at tibial side. The wound at the fibula side was covered by skin graft and flap. The bone defect at the second toe was filled with remnant hallux or iliac bone.

RESULTSAll the 25 reconstructed thumbs survived completely. The patients were followed up for 6-26 months without any joint degeneration. According to the finger reconstruction functional criterion publicized by China Medical Association, the finger function was assessed as excellent in 10 case, good in 11 cases, poor in 4 cases. Joint necrosis happened in 2 cases and bone malunion in 2 cases. The 4 cases received dead bone debridement and iliac bone graft. No malfunction occurred in the donor site.

CONCLUSIONSOur surgical method is a currently effective way to reconstruct II-III degree thumb defects. Satisfactory functional and cosmetic results can be achieved both in donor site and recipient site.

Aged ; Bone Transplantation ; methods ; China ; Hallux ; Humans ; Ilium ; transplantation ; Necrosis ; etiology ; Postoperative Complications ; pathology ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Thumb ; surgery ; Toes

Heat shock protein 70 (HSP70) family is one ofthe most conserved proteinin evolutionand plays critical,role in proteostasis.HSP70 is becoming an interesting target for multiple diseases such as cancer and Alzheimer's disease.There are many drugs targeted to HSP70 in preclinical study.In this review,the classification,the structure,the function of HSP70,and the drugs of the HSP70 family are reviewed.

Local anesthetics have neurotoxicity, which can lead to temporary or permanent sensory and motor dysfunction.And regional anesthesia is commonly used in diabetics undergoing limbs or lower abdominal surgery, so that local anesthetics were widely used in them.However local anesthetics sensitivity in patients with diabetics is not yet clear.In this paper, we will discuss the problem and make a summary.

Objective To evaluate the clinical application of fat granule auto-graft in facial soft tissue depression reconstruction.Methods Autologous subcutaneous fat granules were obtained by syringe aspiration from donating site.then washed with normal saline.Small amounts of fat granules were injected into the facial sites with soft tissue depression by means of multiple passes immediately.Results We performed such fat iniection in a total of 18 cases,all of the procedures were safe and successful.In most cases,single injection were enough,only one underwent two sessions of fat iniection.All members were followed-up for 1.5 months to 24months,the average were 14 months.All facial tissue depression were reconstructed for difierent degrees.The rate of fullness and symmetry.fullness and pretty symmetry and fullness with little asymmetry were 77.8%,16.7%and 5.5%.respectively.No infection,fat necrosis or liquefaction occured.Conclusion Being satisfled in correction of deformity of facial depression.the implantation of autologous fat globules iS safe and effective with less side-effects.

Objective To observe the short term effects of Rho-kinase inhibitor and Qiliqiangxin capsule on serum tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)levels in patients with chronic heart failure,and explore the mechanism.Methods 120 chronic heart failure patients received conventional treatment for 4 weeks were divided into blank control group(Group A,n=30),Rho-kinase inhibitor treated group(Group B,n=30), Qiliqiangxin capsules-treated group (Group C,n =30 ),and the other 30 cases were treated with Rho-kinase inhibitor combined with Qiliqiangxin capsules(GroupD,n=30).TNF-α,IL-6 and BNP were measured and cardiac function was evaluated before and after treatment.The difference between 4 groups was analyzed. Results After treatment,the levels of TNF-α,IL-6,BNP in the observation group were lower than that in the control group.The difference was statistically significant(P<0.05 ).The levels of TNF-α,IL-6,BNP in the D group were lower than that in the B and C group.The difference was statistically significant(P<0.05 ).Conclusion Rho-kinase inhibitor combined with Qiliqiangxin capsule can improve cardiac function and reduce levels of serum cytokines associated with chronic heart failure,which is conducive to the treatment of chronic heart failure.

As a normative technical term, “nine needles” appears repeatedly inThe Internal Canon of Medicine, in which Miraculous Pivot set theNine Needles and Twelve Source Acupoints as the first passage. Therefore, the significance of “nine needles” is evident. This article expounded “nine needles” from the following six aspects:the origin, the name, the types, the functions, the use and the application, with a purpose to standardize the contents of “nine needles”, and analyse the connotation.