Objective To explore the feasibility of reducing induction dose of remifentanil,deepening anesthesia and intubation after umbilical removal and its effect on maternal,neonatal and anesthesiologists during cesarean section.Methods Thirty cases of ASA Ⅰ-Ⅱ scheduled for elective cesarean section were divided into three groups according random digits table method with 10 cases each.The induction dose of remifentanil was 1.0,1.5,1.0 μ g/kg in group Ⅰ,group Ⅱ,group Ⅲ.Group Ⅰ and group 11 received routine procedure after induction of anesthesia,intubation,while group Ⅲ received anesthesia umbilical removal.Systolic pressure (SBP),diastolic pressure (DBP) and heart rate (HR) were recorded before induction of anesthesia,skin incision and immediately intubation.And the fetal childbirth time,intubation time and neonatal Apgar score at 1,5,10 min were recorded.Results Three anesthesia procedures could meet the requirements of cesarean section.The SBP,DBP and HR at skin incision in group Ⅰ and group Ⅲ were significantly higher than those at before induction of anesthesia [group Ⅰ:(136.5 ±9.7) mm Hg (1 mm Hg=0.133 kPa) vs.(113.5 ±7.8) mm Hg,(96.5 ±9.1) mm Hg vs.(74.2 ±6.0)mm Hg,(98.5 ± 8.7) times/min vs.(81.2 ± 8.4) times/min; group Ⅲ:(138.1 ± 11.4) mm Hg vs.(118.7 ±9.9) mm Hg,(90.1 ±9.9) mm Hg vs.(77.3 ±7.9) mm Hg,(100.3 ±9.0) times/min vs.(81.7 ±9.2)times/min],there were statistical differences (P ＜ 0.05).The SBP,DBP and HR at immediately intubation in group Ⅲ were significantly lower than those in group Ⅰ andgroup Ⅱ [(97.6±10.1)mmHgvs.(138.9±11.2) and (130.1 ± 4.5) mm Hg,(80.1 ± 5.5) mm Hg vs.(97.7 ± 8.9) and (82.0 ± 8.6) mm Hg,(80.4 ±7.8) times/min vs.(99.3 ± 12.2) and (95.9 ± 9.6) times/min],there were statstical differences (P ＜ 0.05).There was no statistical difference in fetal childbirth time among the 3 groups (P＞ 0.05).The neonatal Apgar score at 1 min in group Ⅱ was significantly lower than that in group Ⅰ and group Ⅲ [(7.4 ± 0.9) scores vs.(8.8 ± 0.6),(8.9 ± 0.6) scores],there was statistical difference (P ＜ 0.05).The intubation time in group Ⅲ was significantly longer than that in group Ⅰ andgroup Ⅱ [(8.5±l.8) min vs.(3.0±0.5),(2.8±0.6)min],there was statistical difference (P＜ 0.05),but the intubation time in group Ⅲ was completed within 10 min.Conclusions Using the protocol of remifentanil 1.0 p g/kg induction,midazolam 2 mg,fentanyl 0.2 mg deepening after the umbilical removal can effectively avoid the effect of remifentanil on neonatal 1 min Apgar score,decrease the intubation stress with no effect on anesthesiologists.This method is simple,method of anesthesia for elective cesarean section.

Objective To explore the effect of compound lidocaine cream and/or psychotherapy in preventing the catheter-related bladder discomfort (CRBD) of male patients with operation under general anesthesia. Methods Eighty male patients undergoing selective upper abdomen operation were selected, and the patients were divided into 4 groups by random digits table method with 20 cases each:control group (C group), compound lidocaine cream group (L group), psychotherapy group (B group) and compound lidocaine cream combined with psychotherapy group (LB group). The incidence of CRBD after extubation, dosage of fentanyl and the number of patients who need flurbiprofen axetil to relief the pain of CRBD were compared among the 4 groups. Results The incidence of no CRBD after operation in LB group was significantly higher than that in C, L and B group: 90%(18/20) vs. 15%(3/20), 60%(12/20) and 50% (10/20), and there were statistical differences (P<0.05). The incidence of mild CRBD in LB group was significantly lower than that in C, L and B group:10%(2/20) vs. 45%(9/20), 35%(7/20) and 40% (8/20), and there were statistical differences (P<0.05). There were no statistical differences in dosage of fentanyl among the 4 groups (P>0.05). The rate of patients who need flurbiprofen axetil to relief the pain of CRBD in C group was significantly higher than that in L, B and LB group: 40%(8/20) vs. 5%(1/20), 10%(2/20) and 0, and there were statistical differences (P<0.05). Conclusions Both the means of compound lidocaine cream and psychotherapy can reduce the incidence of CRBD. However, the method of compound lidocaine cream combined with psychotherapy is able to basically avoid the occurrence of CRBD, and it is worth spreading in clinic.

Objective To compare the influences of general anesthesia and intra spinal anesthesia on circulation, respiration, body temperature and anesthesia-related complications in patients undergoing percutaneous nephrolithotomy (PCNL), and assess the effectiveness and safety of both anesthesia. Methods Forty ASA Ⅰ - Ⅱ patients elective for PCNL surgery were divided into two groups by random digits table with 20 cases each:group Ⅰ (endotracheal general anesthesia) and group Ⅱ (intra spinal anesthesia). The temperature, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) values and postoperative shivering, nausea, vomiting, back discomfort and the incidence of sore throat were observed and recorded. Results The anesthesia was stable, there were no changes in MAP, HR at different time in group Ⅰ . The anesthesia in group Ⅱ was effective, MAP at 15 min after anesthesia,and HR,MAP after lithotomy position and prone position were obviously changed in group Ⅱ compared with those before anesthesia and group Ⅰ (P ＜ 0.05 ). The temperature at 30,60,90, 120 min after anesthesia decreased compared with that before anesthesia in two groups (P ＜ 0.05 ), and the temperature at 30,60 min after anesthesia in group Ⅰ [(35.8 ±0.6), (34.8 ± 0.5)℃] was lower than that in group Ⅱ [(36.2 ± 0.6),(35.6 ± 0.5)℃](P＜ 0.05).During recovery,complications such as shivering, nausea,sore throat, back discomfort occurred to some extent, of which the incidence of shivering was the highest. Conclusion Both of two anesthesia are applicable to PCNL. When intra spinal anesthesia is used,the life indicators of patients need to be observed and general anesthesia is preferable for the obesity,less physical and the old with poorly compensatory function.

Objective To investigate clinical manifestation and pathological changes and the expressions of Emerin protein and STA gene of Emery-Dreifuss muscular dystrophy (EDMD).Methods The clinical features and STA gene detection from one patient with EDMD were analyzed retrospectively. Results The onset age of this patient was in early childhood. The four limbs were progressive muscle weakness and muscular atrophy. There were joint contractures and cardiac involvement in the early stage. The serum muscle enzymes increased slightly. The pathological changes in muscles showed that the sizes of muscle fibers were different, the fibers became spherical and some fibers were replaced by fat. Because of normal spinal anterior horn cells and sural nerves, neurogenic muscular atrophy might be ruled out. Emerin protein could not be tested in striated muscle and cardiac muscle. No mutation of STA gene was found in this case. Conclusions Emery-Dreifuss muscular dystrophy is one particular type of muscular dystrophy. It is characterized with joint contractures and cardiac involvement in the early stage. Emerin protein is deficient in EDMD. There is no mutation of STA gene in sporadic EDMD.

Objective To verify a uncommon neurodegenerative disease accompanying with dementia--frontal lobe dementia, or dementia of frontal lobe type (DFT). Methods A brain sample was obtained from a patient of 46-year-old male with progressive dementia. Conventional neurohistopathological examination and immunostaining for prion protein (PrP) and tau protein were performed, and clinical data were analysed. Results (1) It was shown having progressive neurological and psychical symptoms and a three month illness duration. (2) Atrophy was found in bilateral frontal gray matter in CT scan. Slow waves of high amplitude with long intermission of two second in whole course of electroencephalography examination were seen. (3) Brain weight was 1 050 g. The cerebral cortex was atrophied and restricted to frontal lobes. The temporal lobes were unaffected. (4) A severe loss of nerve cells from second frontal cortical layer with glioses was revealed, but pyramidal cells in this region remained intact. There were no positive findings on staining of Beilschowky and Gallyas methods. (5) No inclusions were seen in remaining nerve cells and gliocyte. (6) Immunohistochemistry revealed no significant changes on PrP and tau protein.Conclusion This is more typical a case of DFT , and now increasingly recognized. It suggests that a dementia of frontal lobe type should be considered when differential diagnosis of neurodegenerative disease with dementia have been made.

Objective To evaluate the teased fibers and the consecutive internodes or segments of the same myeliated nerve fiber. Methods Measurements were performed on 1100 fibers (5522 internodal segment) from 11 control nerves as to detecting the anatomic features and pathologic abnormalities. Results Morphometric study on normal teased fibers revealed three results: (1) There is a certain variation of diameters (Ds) and length (IL) of the internodal segments along a fiber (1.0—2.5 ?m), and as a rule, the longest segment is not the thickest one, and the shortest segment is not the thinnest. Or even, sometimes the thinnest segment is the longest one in all internodal segments. (2) The relationship between IL and Ds is not linear, but shows a parabolic curve; thick segments are relatively shorter than the thinner segment. (3) The IL of segment along 10—20 mm of a fiber may be varied by maximally 50%; on the different IL, there is no casual distribution of internodal segments, but 2—4 (or even 6) segments of about equal length are grouped in a row. Conclusions On the classification of normal teased fibers, myelin of the internode may be ragular, irregular and variable in thickness among internodes.

Objectives To investigate the normal value of myelinated fibre (MF) of healthy human sural nerve. Methods By morphometric analysis on biopsy of 41 normal subjects’sural nerve, the density of MF, and the distribution and proportion of short and long diameters of MF were measured. Results The number of MF for each body had arange from 5 057 to 10 104, and the density of MF showed 5 250～11 413 mm 2. The distribution on diameter size of MF was found double peaked.Conclusions Following the age increase, the density of MF in Chinese people is substantially decreased. As compared with the study of some western countries, the results show that the density value of MF in our study is significant higher than those from the western countrics ( P =0 002 4).

BACKGROUND: Pathological changes of the brain tissue in patients with dementia of frontal type(DFT) are still controversial. This paper brought forward the pathological alterative characteristics of brain tissue in DFT patients through one pathological case study of the brain tissue in one dead dementia patient.OBJECTIVE: To validate one uncommon neurodegenerative disease complicated with dementia, DFT.DESIGN: A case analysis.SETTING: Department of Neurology of the First Hospital of Jilin University METHODS: Brain anatomy, serials of histological staining and immunohistochemical staining for PrP, tau protein, etc. were performed after 3 hours since the death of one patient with progressive dementia.stainingfrontal lobes. EEG displayed a paroxysmal high-amplitude slow wave with and the brain atrophy was limited to frontal lobe and the temporal lobe loss of neurocyte companied with significant gliosis since the second layer; However, the pyramidal cell was relatively healthy. No abnormality was munohistochemical staining had negative reactions.CONCLUSION: This case was typical DFT. This type of dementia should be considered in future analysis of the neurodegenerative disease complicated with dementia.

Objective 　To investigate the neuropathological changes of central nervous system in Guillain-Barré syndrom. Methods　Brain, spinal cord and sciatic nerve were obtained from 22 cases of Guillain-Barré syndrome. Eight cases were examined by general autopsy, 14 cases were examined by limited autopsy. HE, KB, Bielschowsky, Weil and Sudan Ⅲ　staining were carried out, the sections were observed by light microscopy. Results　1.Cerebral superficial veins congested, widening of the cortical sulci, narrowed gyri and mild cerebellar tonsillar hernia were present. 2. Majority of cerbral neurons presented an ischemic changes. Slightly loss of hippocampal pyramidal neurons were found. There was chromatolysis of motor neurons of brain stem. Lymphocytic infiltration around the small vessels occurred in the pons and medullary oblongata in 8 cases. Focal demyelination was noted in pons and frontal white matter in 2 cases. Loss of Purkinje cells and appearance of glial nodules were observed in molecular layer of cerebellum. 3. Swellin, central chromatolysis and eccentric nuclei of anterior horn cells appeared in 16 cases, which were pronounced in cervical and lumbal segment of spinal cord. Vaculated neuroplasma and lymphacytic infiltrition could be seen. 4. Segmental demyelination and lymphocytic infiltration were the main neuropathological changes observed in 20 cases. There were two other cases in which the axon were severely involved, which showed swelling and breakdown of axons and as well as axonal bulbs. Conclusions　1. Lymphocytic infiltration in brain stem and spinal cord were in continuousness of pathological changes of peripheral nerves. 2. Finding of glial nodules suggested that there was possibility of infection of neurotropic virus. 3. Occurence of focal demyelination in cerebrum and brain stem indicated that Guillain-Barré syndrome may have combined involvement of central and peripheral nervous system.

Objective To detect point mutations of the PRNP in 10 sporadic Creutzfeldt-Jakob disease (CJD) patients. Methods Priori protein gene open reading frame was amplified by PCR of genomic DNA extracted from peripheral blood leukocytes. Products were sequenced and digested with restriction endonuc lease Nsp I to check the phenotype at codon 129. Results Two CJD patients were confirmed at autopsy. One full sequencing of the PRNP open reading frame revealed normal, but the other revealed a single novel mutation consisting of a cytosine-to-guanine substitution at nucleotide 729, causing asparagine to replace glutamic acid at codon 211. Among 8 probable CJD patients, 2 full sequencing of the PRNP open reading frame revealed anadenine-to-guanine substitution at nucleotide 751, causing lysine to replace glutamic acid at codon 219. The patients were methionine homozygosity at codon 129. Conclusions The E211D mutation was identified in a confirmed CJD patient. The novel point mutation might be associated with familial CJD. However, E219K identified in 2 possible CJD patients was included in polymorphism of the PRNP as well as M129V. Analysis of PRNP plays an important role for diagnose of familial priori disease.