Objective To observe the effects of combined spinal-epidural anesthesia (CSEA) with small dose of ropivacaine on the circulatory and respiratory function in aged patients undergoing hip arthroplasty surgery.Methods Forty ASA Ⅱ or Ⅲ patients were randomly divided into two groups,20 cases in each group.In group A,0.25％ ropivacaine 5-7mg was given for spinal block and 0.25％ ropivacaine for epidural block.Patients in group B were given 0.5 ％ bupivacaine 8-10mg and 0.375％ bupivacaine,respectively.The anesthetic efficacy,BP,HR,SpO2,Bromage score were recorded.Results The analgesic plane was T8-T10 in group A,and that was T6-T8 in group B.The changes of BP,HR,SpO2 in group A were less than those in group B.Bromage scores of group A were 1-2 for nonoperative extremity and 0-1 for the operative extremity,which were 3-4 for two extremities in group B.Conclusion The CSEA with 0.25％ ropivacaine 5-7mg for spinal block and 0.25％ ropivacaine for epidual block is suitable for patients undergoing hip arthroplasty surgery.

Objective To study the diagnosis and treatment of acute testicular torsion. Methods 17 cases of testicular torsion treated from January 1995 to December 2000 were reviewed.The diagnosis and treatment were analysed. Results The diagnosis of testicular torsion in all the 17 cases was assessed on color Doppler ultrasonics.1 case was cured by manual detorsion,2 by surgical detorsion and orchidopexy,14 by orchiectomy and contralateral orchidopexy.The fertile ability of 4 cases over 18 years old was observed,3 being normal and 1 slightly below normal. Conclusions Color Doppler ultrasonics examination can serve as a chief adjuvant diagnostic method.All cases with a torsion more than 360? and longer than 24 h will have the ipsilateral testicular loss,whereas in case the torsion is less than 360? and less than 24 h have a chance to preserve the testis by surgical detorsion and orchidopexy.

Objective To evaluate the diagnostic value of MR urography(MRU) in the diagnosis of renal tuberculosis. Methods MRU features of 18 cases of renal tuberculosis,nonvisualized or poorly visualized in IVU,were analyzed and compared with pathologic findings. Results MRU provided high-resolution images of the kidneys and upper urinary tract in all patients.MRU features of renal tuberculosis and corresponding pathologic changes were summarized. Conclusions MRU has a great value in diagnosing renal tuberculosis when the kidneys are nonvisualized or poorly visualized in IVU.It can provide diagnostic evidence and is helpful with choice of the therapeutic strategy.

Objective To clarify the mechanism of lipoprotein (a) ［Lp (a)］ metabolic disorder in patients receiving maintenance hemodialysis (MHD), and to offer theoretical basis for seeking for modus operandi of disorder control.Methods The apolipoprotein (a)［apo(a)］ isoforms were identified by high-resolution SDS-agarose gel electrophoretic method followed by immunobloting in 61 patients receiving maintenance hemodialysis (MHD group), 51 patients with end-stage renal disease (ESRD group) and 62 healthy controls (healthy control group). The influential factors for elevated serum level of lipoprotein (a) in MHD group were analyzed by applying statistical method.Results No statistical difference of Lp (a) median level was found between MHD group and ESRD group in LWM isoforms, but their level was significantly higher than that of healthy control group. In MHD group, the concentrations of serum creatine(Crea),cystatin C(CysC) and C-reactive protein(CRP) were significantly higher (P<0.05), while the concentrations of albumin(Alb) and Hb were lower than those of healthy control group (P<0.05). The concentration of LDL-C had no significant difference between MHD group and healthy control group. Compared with those of ESRD group, the levels of Crea, CRP and CysC were not significantly increased (P<0.05) in MHD group. There was no difference in the level of Lp (a) between the MHD and the ESRD patients with LMW-apo (a) isoforms (P>0.05), but compared with healthy control group, the serum levels of Lp (a) in the two groups were remarkably increased (P<0.05). The level of Lp (a) with LMW-apo (a) were significantly correlated with Alb and CysC respectively (P<0.05). The level of Lp (a) with HMW-apo (a) of MHD patients were higher than that of ESRD patients (P<0.05). The patients in the two groups had higher levels of Lp (a) as compared with those of healthy control group. The positive correlation of Lp (a) level with CRP and CysC was observed in patients with HMW-apo (a) (P<0.01). As MHD group as concerned, Lp (a) level was associated with Alb and CysC (P<0.01); regression analysis showed that apo (a) isoforms, Alb and CysC were listed in the regression equation, and the determinate coefficient (r2) was 0.348, in which the respective r2 of apo (a) isoforms, Alb and CysC was 0.121, 0.178 and 0.049.Conclusion Multiple factors may contribute to the high level of Lp (a) in MHD patients. Moreover, Lp (a) with different isoforms of apo (a) had different influencing factors. The corresponding therapeutic measure should be taken according to apo (a) isoforms in order to acquire better therapeutic efficacy for MHD patients.

Objective To study the clinical and pathological features, diagnosis and treatment of malig-nant mesothelioma of the tunica vaginalis testis. Methods One case of malignant mesothelioma of the tuni-ca vaginalis testis was reported. The patient was a 73 years old man, presented with a history of aggravated hydrocele for 1 year. B-ultrasound showed 7.5 cm×4.1 cm liquid anechoic area around the testis. The Pubmed and CBM databases were searched for related articles, and the clinical data were reviewed. Results An operation was performed to incise the tunica vaginalis. The pathology showed fecal caneeration in the tunica vaginalis testis and the immunohistology showed CK5/6, Calretinin and E-cadlberin positive. Right or-chiectomy was performed after three weeks. Local tumor recurrence and inguinal lymph nodes metastasis were found 11 months after operation, and local tumor and lymph nodes were resected. The tumor was diagnosed as malignant mesothelioma of the tunica vaginalis testis and CK5/6 and Calretinin fecal positive. Conclu-sions Malignant mesothelioma of the tunica vaginalis is a rare disease of the testis with potentially aggres-sive behavior. Due to the lack of tumor markers and characteristic symptoms, correct preoperative diagnosis is extremely difficult. Radical surgical treatment is of major importance to the survival of the patients. Life-long follow-up should be offered to patients with malignant mesothelioma of the tunica vaginalis.

Objective To investigate the effect of metronidazole powder on the prevention of alveolalgia after extraction of mandibular impacted teeth. Methods two groups of mandibular teeth underwent surgical removal treatment, study group for teeth after Metronidazole Tablets will grind it into powder and dexamethasone sodium phosphate filling extraction wound and sutured; the control group were only given mandibular teeth tight control suture. Two groups of patients with postoperative mandibular impacted teeth were treated with oral amoxicillin for 1 weeks and effective follow-up, record the occurrence of dry socket, the data input SPSS software to give the corresponding analysis and conclusions. Results The incidence of dry socket after tooth extraction was 3.45％ in the study group and 20.69％ in the control group. The difference between the 2 groups was statistically significant(P<0.05). Conclusion Application of metronidazole powder of mandibular impacted tooth extraction, can significantly reduce the incidence of alveolalgia, it is worthy of clinical application.

Objective To investigate the efficacy and safety of Solifenacin for the treatment of overactive bladder in children. Methods A retrospective analysis was done in a children admitted to our hospital in January 2010,with lower urinary tract obstruction lead to overactive bladder.The boy was 4 years old,suffering from difficult urinating,urinary frequent,urgency and incontinence for 4 years.Imaging studies (B ultrasound,intravenous urography,CT,bladder voiding urethrography) found bilateral hydronephrosis and kidney collecting system separation with left 3.3 cm and right 2.3 cm in diameter; ureteral dilation with left 1.3 cm,right 1.6 cm in diameter.A transverse septum crossing the urethra at a right angle distal to the verumontanum was detected.According to history,physical examination and imaging examination,a diagnosis for posterior urethral valves was established.Under general anesthesia,urethroscopy found that the valve was attached below urethra wall,divided into two forks towards urethral lateral wall.The valve was excised.Three months later,although good voiding,the hydronephrosis and hydroureter still did not improve.After cystostomy and 6 months follow-up,hydronephrosis and hydroureter still not improved. B ultrasound showed the renal pelvis dilation with left 3.2 cm,right 2.0 cm in diameter,and bilateral ureteral dilation with left 1.3 cm,right 1.4 cm in diameter.Solifenacin (5 mg/tablet),1/3 tablet,about 1.7 mg per day was added. Results After oral Solifenacin one month,hydronephrosis and hydroureter began to improve.After 3 months,hydroureter disappeared; hydronephrosis improved significantly.. B-ultrasound showed the renal collecting system mild dilation with left 1.1 cm,right 1.0 cm in diameter.After 13 months follow-up,no side effects was detected. Conclusions Combined with the surgical treatment,Solifenacin can alleviate hydronephrosis secondary to OAB,and can also protect the renal function.

The paper reported an investigation of the pharmacokinetics of SN-38 (7-ethyl-10-hydroxy-camptothecin) in rats and the tissue distribution in mice after injection of irinotecan hydrochloride nanoparticles (CPT-11) via tail veins. An LC-MS/MS method was established to determine the concentrations of SN-38 in whole blood of rats and in different tissues of mice. The pharmacokinetics and tissue distribution of SN-38 were compared after the intravenous injection of CPT-11 NPs and CPT-11 solution. Compared with irinotecan solution, the elimination half-life of SN-38 was prolonged from 2.17 h to 2.67 h after the intravenous injection of CPT-11 NPs, but its AUC had little change. After the injection of CPT-11 NPs in mice, over time, the concentrations of CPT-11-metabolized SN-38 in CPT-11 NPs were significantly higher in the whole blood, colon and lungs than those in CPT-11 solution, followed by in the spleen and liver, but those in the heart and brain had no change. However, the amount of SN-38 in the kidneys was reduced with time. CPT-11 NPs could prolong SN-38's (one of its metabolites) blood circulation time in rats and significantly increased the concentration of CPT-11-metabolized SN-38 in the whole blood, colon and lungs of mice. CPT-11 NPs made SN-38 efficiently target-bind to the colon and lungs of mice.

Objective To investigate the clinical efficacy of allogeneic cross-linked dermal dressing (ACLD) for the treatment of enteroatmospheric fistula (EAF) in patients with open abdomen (OA).Methods The clinical data of 44 patients with experienced trauma who received OA at Nanjing General Hospital of Nanjing Military Command from January 2011 to January 2014 were retrospectively analyzed.All patients received temporary abdominal closure (TAC) by modified sandwich-vacuum package (MSVP).From January 2011 to December 2012,33 patients with OA received vaseline gauze as abdominal cover layer (VG group),and from January 2013 to January 2014,11 patients with OA received allogeneic cross-linked dermal dressing as abdominal cover layer (ACLD group).Patients were followed up via outpatient examination or telephone interview till October 2014.The incidence of EAF,time for skin-grafting,hematologic indexes in 2 weeks after surgery (white blood cell counts,percentage of neutrophil,the mean value of procalcitonin and C reactive protein),the duration of postoperative hospital stay,hospital expenses and survival rates in the 2 groups were analyzed using t-test,repeated measures analysis of variance and Fisher's exact test.Results The incidence of EAF in the VG group and ACLD group was 42.4％ (14/33) and 0,respectively,with a significant difference between the 2 groups (P ＜ 0.05).The duration of skin-grafting was (15 ±6) days in the VG group and (11 ±3)days in the ACLD group,with a significant difference between the 2 groups (t =2.10,P ＜ 0.05).The mean values of preoperative procalcitonin and postoperative procalcitonin at day 1,3,7,14 in the VG group were (1.20 ± 0.60)pg,/L and (2.50-± 0.90)pg,/L,(1.70 ± 0.30) pg/L,(1.90 ± 0.40) μg/L and (2.70 ± 0.60) μg/L,which were significantly higher than that of (0.90 ± 0.30) μg/L and (1.80 ± 0.60) μg/L,(1.30 ± 0.50) μg/L,(0.60 ± 0.20) μg/L and (0.30 ± 0.07) μg/L in the ACLD group (F =8.50,P ＜ 0.05).The white blood cell counts and percentage of neutrophil and the percentage of C reactive protein between the 2 groups were changed from (13.8 ±2.4) × 109/L,(12.9 ± 2.1) × 109/L,0.90±0.09,0.88 ±0.06,(81 ± 19)mg/L,(136 ±28)mg/L to (16.2 ±3.3) × 109/L,(7.9 ± 3.0) x 109/L,0.85 ±0.12,0.79 ±0.09,(131 ±30)mg/L,(59 ±22)mg/L at postoperative day 14,showing no significant difference between the 2 groups (F =3.10,0.50,1.20,P ＞ 0.05).Duration of hospital stay and hospital expenses in the VG group and ACLD group were (137 ±32)days,(638 831 ± 113 670) yuan and (82 ± 44)days,(474 839 ± 78 543)yuan,respectively,with a significant difference between the 2 groups (t =3.60,4.43,P ＜ 0.05).The time of follow-up and overall survival rate in the VG group and ACLD group were 29 to 38 months and 81.8％ (27/33),and 10 to 20 months and 90.9％ (10/11),respectively,with no significant difference (P ＞ 0.05).Conclusion Allogeneic cross-linked dermal dressing as abdominal cover layer can effectively decrease EAF in patients with open abdomen.

ObjectiveTo evaluate the clinical efficacy of acupuncture at Waiguan (TE5) and Zhigou (TE6) in treating post-stroke hand spasm.MethodSixty patients with post-stroke hand spasm graded≥Ⅰand≤Ⅲby the Modified Ashworth Scale (MAS) were randomized into a treatment group (30 cases) and a control group (30 cases). The treatment group was intervened by acupuncture at Waiguan and Zhigou plus rehabilitation training, while the control group was by dry rehabilitation training alone. The acupuncture and rehabilitation were performed once a day, 5 sessions a week, totally for 3 months. The change of hand spasm degree was observed by using MAS; the Fugl-Meyer Assessment (FMA) was adopted to observe the change of hand function; the Modified Barthel Index (MBI) was used to observe the change of the activities of daily living (ADL).ResultAfter treatment, there was a significant difference in comparing the MAS score between the two groups (P<0.05); there was a significant difference in comparing the FMA score between the two groups after treatment (P<0.05); after intervention, there was a significant difference in comparing the MBI score between the two groups (P<0.05).ConclusionAcupuncture at Waiguan and Zhigou can significantly improve the hand spasm sate after stroke; acupuncture plus rehabilitation can substantially improve the hand function and ADL of the patients, and can produce a more significant efficacy compared to dry rehabilitation training.