Objective To observe the influence of combined spinal and epidural anesthesia( CSEA) of different po-sitions on the anesthesia effect, anesthesia operation and hemodynamic index during cesarean section of obese par-turients. Methods Eighty obese parturients[BMI≥30] undergoing cesarean section were randomly divided into two groups, that was group A and B, with 40 cases each. In group A, the parturients were required to undergo lat-eral decubitus position with 0.5% ropivacaine hydrochloride of 2. 4 ml. In group B, the parturients were required to undergo sitting position with the same ropivacaine hydrochloride as group A. The following data was recorded, which were the percentage of one-attempt's successful epidural needle placement, the anesthesia level,the anesthe-sia effect and the hemodynamic change. All the complications were also observed,such as the supine hypotension syndrome during operation,headache after spinal anesthesia and postoperative spinal nerve stimulation. ResultsThe difference of anesthetic effect between the two groups was insignificant in statistics while group B's rate of one-attempt successful puncture was higher than gruop A ( P <0.05 ) . The difference of hemodynamic index between them was significant in statistics ( P<0.05 ) with group B's rate of supine hypotension syndrome lower than group A. Conclusion Both body positions have the same anesthtic effect for obese parturients during cesarean section while the puncture operation of sitting positon is easier than lateral decubitus position and the hemodynamic change is also more stable.

[Objective]To discuss the surgical technique and clinical effects of open reduction and internal fixation with T style plate in the treatment of Die-punch fracture of distal radius.[Method]From August 2003 to October 2007,twenty-nine patients diagnosed as Die-punch fracture according to X-ray and computerized tomography were treated with open reduction through volar approach and internal fixation with T style plate and bone-grafts to support the articular surface of impacted fractures.There were 20 males and 9 females,with an average of 40.5 years(range 19-62 years).The fractures were caused by falling(n=23),traffic(n=4) and by athletics(n=2).There were 6 cases of open fracture.Eighteen cases were in the right wrist,and 11 in the left wrist.The displacement of articulatzons was from 1.5 to 3.5 mm.[Result]Twenty-six patients were followedup for 9 to 45 months,with an average of 28 months.Posteroanterior and lateral radiographs were taken periodically and fracture healing occurred all within 12 weeks.According to ADL standard and radiographs,21 cases were excellent(ADL scores:38-40),3 cases were good(scores:35-37).The excellent to good rate was 92.3%.No infection occurred.[Conclusion]Open reduction and internal fixation can help restore the smoothness of the articular surface and reduce the incidence of traumatic osteoarthritis.It is effective against the Die-punch fractures of distal radius.

BACKGROUND: The inheritance tendency and immunity imbalance of atherosclerotic brain infarction (ABI) have attracted the attention of many scholars at home and abroad, which suggests that immune mechanism plays a key role in ABI development. It has been found that ABI is related to polymorphism of human immune inheritance gene (HLA), particularly HLA-DR gene.OBJECTIVE: To investigate the correlation between HLA and ABI immune heredity.DESIGN: Single sample and single factor analysis.SETTING: Sino-Japanese Friendship Hospital of Jilin University; Neurological Department of the First Hospital of Harbin City.PARTICIPANTS: Totally 31 patients in experimental group and 30 healthy people in control group, whose three generations were of the Han Nationality in north China and who had no blood relation, were selected from Department of Neurology in First Hospital of Harbin between January 1998 and December 2000.METHODS: The experiment was conducted in the Blood Research Center of Department of Neurology in First Hospital of Harbin between June and December 2003.5 mL peripheral blood in both groups was taken to extract genome DNA with the previous method. Human HLA gene map had been described at gene bank in the Internet, in which mono-nucleic acid obtained from HLA of the sixth chromosome were retrieved. Each DR and DQ allele, sense primer and antisense primer were composed selectively. Amplification of DNA fragment was checked respectively and specifically. The primer was provided by Shanghai Gene Research Institute. PCR instrument (4 800) and its related reagents produced by PE Company (the US) were used. Fourfold table exact probability method was used to calculate the relative risk (RR) and P value.which was obviously higher than that of other sites (P ＜ 0.05). However,associated with the ABI susceptible gene of the Han Nationality in north China.

BACKGROUND: Existing research shows that in situ regeneration of skin deep within the second degree bum wound and donor site wound healed without physical scarring, can promote three-degree burn wounds liquefied necrotic tissue removement, the growth of transplanted skin, reduce scar; scar-shift using the in situ regeneration is expected to reach significantly reduce scar symptoms, and to reduce the effect of scar, which have not be reported.OBJECTIVE: To observe effects of skin regeneration in situ method to remove scar in the treatment of hypertrophic scar. METHODS: A total of 32 patients with many hyperplastic scars, including 25 males and 7 females, aged 16-52 years, disease course of 1-11 years. Two similar scar regions were selected from each patient for self control. In the experimental group, scar removal, scar skin replantation after the application of in situ regeneration of the skin treatment using burn cream coated yarn. In the control group, scar removal, scar skin replantation after the application of traditional Vaseline covered by treatment. Curative effects were observed and compared. Scar hyperplasia was assessed using Vancouver Scar Assessment Scale assessment. RESULTS AND CONCLUSION: Replanted scar skin explants were survived in both groups. In the experimental group, healing speed and quality of wound surface were better than the control group (P< 0.05). After 6 months, the Vancouver Scar Assessment Scale assessment in the experimental group was better than control group (P < 0.05, P < 0.01). Scar caused by pain, itching and other symptoms disappeared, skin formation and color back to pre-implantation were significantly improved compared with the surrounding skin almost. Results indicated that with regarding to the lack of autologous skin source, large area of scar in patients with hypertrophic scars or unwilling to add a new donor site wounds in patients, in situ replantation method is an ideal approach.

ObjectiveTo observe the effect of Qishen Tongluo Zengzhi decoction on cognitive impairment in patients with acute phase of ischemic stroke.Methods A prospective randomized controlled trial was conducted, and 130 patients with acute phase of ischemic stroke and cognitive impairment accompanied by Qi deficiency and blood stasis and stagnationof phlegm-dampness syndrome admitted into the Neurology and Rehabilitation Departments of Rizhao Hospital of Traditional Chinese Medicine(TCM) Affiliated to Shandong University of TCM were randomly divided into treatment group and control group, 65 cases in each group. In the two groups, conventional internal treatment was given to all patients, and in the treatment group, additionally the Qishen Tongluo Zengzhi decoction was administered orally(composition: astragalus membranaceus 30 g, radix pseudostellariae 30 g, notoginseng 10 g,spatholobus stem 25 g, hirudo 3 g, pberetima 10 g, radix paeoniae rubra 12 g, Chinese angelica 12 g, peach kernel 10 g, carthamus tinctorious 10 g, achyranthes 12 g, radix rhapontici 10 g, rhizoma alismatis 6 g, Acorus gramineus Soland 9 g, polygala root 9 g, rhizoma cyperi 10 g, herba siegesbeckiae 15 g),one dose a day. While in the control group, oxiracetam 4.0 g intravenous drip was given, once a day. The whole course was 21 days in both groups. Before and after treatment, the cognitive function of all the patients in two groups was assessed by Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA) scores, and incubation period and amplitude of P300 wave were recorded.Results Finally 62 cases were in treatment group and 63 cases in control group. Before treatment, the comparisons of the MMSE score, MoCA score and P300 latent period and amplitude between the two groups had no statistically significant differences(allP>0.05). After treatment in the two groups, the MMSE score, MoCA score and P300 wave amplitude were elevated, P300 latency period was shortened compared with those before treatment, and the changes were more prominent in treatment group〔score of MMSE: 25.33±2.32 vs. 21.68±2.29, score of MoCA(score): 26.61±3.06 vs. 22.40±2.93, P300 wave incubation period(ms): 349.62±20.01 vs. 371.87±19.63, P300 wave amplitude(μV): 8.70±2.92 vs. 5.72±2.33,allP<0.01〕.ConclusionQishen Tongluo Zengzhi decoctioncan effectively intervene cognitive impairment in patients with acute phase of ischemic stroke, and improve their cognitive function.

Objective: To observe the efficacy of skin regenerative medical technique in treating proliferative scars. Method: Select 32 patients (age16-52) with proliferative scars after burns or wound for 1-11 years,which include 25(male) and 7(female). 2 scar similar spots are chosen in each patient for self-comparison.After the experimental group uses the scar detachment, scar Pi Huizhi applies the beautiful valuable moist burn medicinal plaster gauze cover the cooperation of Chinese and Western medicine home position skin regenerative method treatment; After the control group uses the scar detachment, scar Pi Huizhi applies the petroleum jelly cover the traditional method treatment.The observation comparison curative effect, applies the Vancouver scar appraisal meter appraisal scar proliferation situation. Results: Two groups return to the scar skin which plants to survive.The experimental group regenerates the skin to be good, the cicatrization speed and the quality surpass the control group (P

Objective To study the effects ofautologous bone marrow mononuclear cells (BMMCs)transplantation during coronary artery bypass gafting (CABG) on myocardial infarct size. Methods Forty myocardial infarction patients diagnosed by coronary angiography (CAG) and SPECT and confirmed at surgery were enrolled and randomly assigned CABG alone (group Ⅰ) or CABG with intramyocardial or intracoronary injection of autologous BMMCs (group Ⅱ), 20 cases in each group. Baseline and followed up evaluations included SPECT and NYHA-FC before and after 6 months operation, recorded the major adverse cardiac events (MACE) at the same time. The number of autologous BMMCs injected was (6.84 ± 2.88) ×107 in group Ⅱ. Results There was no procedure-related complication during 6 months followed up in all patients. After 6 months operation,left ventricular ejection fraction in group Ⅱ was significantly higher than that in group Ⅰ [(57.40 ±5.21)% vs. (50.75 ±5.88)%,t =3.79,P＜0.05],NYHA-FC in group Ⅱ was significantly improved than that in group Ⅰ [(1.30 ± 0.47) grades vs. (1.85 ± 0.59) grades, t = 3.27, P ＜0.05],SPECT showed myocardial infarct size in group Ⅱ was significantly lower than that in group Ⅰ[(14.57 ±5.20)% vs. (20.45 ±5.18)% ,P ＜0.05]. Conclusion Autologous BMMCs transplantation during CABG is safe and feasible, which can reduce the myocardial infarct size in patients with myocardial infarction.

Objective:To study the predictive value of red cell distribution width (RDW)on poor myocardial perfu- sion in patients with acute myocardial infarction(AMI)treated by percutaneous coronary intervention (PCI).Meth-ods:From August 2013 to August 2015,a total of 212 ACS patients undergoing PCI in our hospital were selected. According to RDW of blood analyzer,patients were divided into RDW<13.0% group (n=115)and RDW≥13.0%group (n=97).According to ST segment regression rate (STR)on single lead of ECG 1~2h after PCI,patients with STR≤50% were enrolled as poor myocardial perfusion group (n=78)and those with STR>50% were regar- ded as good myocardial perfusion group (n=134).Clinical data were compared between two groups,and single fac- tor and multi-factor analysis were used to analyze influencing factors for myocardial perfusion.Results:Compared with RDW<13.0% group,there were significant rise in age [(62.85±5.23)years vs.(67.33±6.17)years],and significant reductions in left ventricular ejection fraction [LVEF,(52.37±6.14)% vs.(50.55±5.53)%]and STR [(0.73±0.26)vs.(0.57±0.39)]in RDW≥13.0% group,P<0.05 or <0.01. Compared with good myocardial perfusion group,there were significant reductions in percentage of RDW<13% (59.70% vs.44.87%)and LVEF [(52.25±3.81)% vs.(50.29 ± 4.08)%],and significant rise in age [(63.29 ± 1.93)years vs.(66.42 ± 2.15) years]in poor myocardial perfusion group,P<0.05 all.Multi-factor Logistic regression analysis indicated that age, LVEF and RDW were independent predictors for poor myocardial perfusion (r=3.826~6.525,P<0.01 all).Con-clusion:Red cell distribution width possesses good predictive value for poor myocardial perfusion in patients with a- cute myocardial infarction undergoing percutaneous coronary intervention,which is worth extending in clinic.