Objective To investigate the application of anesthesia methods and clinical experience in treatment of severe traumat-ic shock .Methods 48 severe traumatic shock patients were randomly divided into two groups by different anesthesia treatment ,in-cluding delayed resuscitation group (A group) and routine group (B group) ,24 cases in each group .Results Patients completed operation as expected with stable vital signs in the operation .Patients completely awaked and recovered the spontaneous respiration after 3~4 hours .4 cases in group A (16 .6% ) and 12 cases in group B (50% ) were died .The mortality of group A was significant-ly lower than that of group B (P<0 .05) .Conclusion The appropriate anesthetic managements for the severe traumatic shock pa-tients could maintain the function of each organ ,create favorable conditions for operation ,and improve the survival rate of critical patients .

The clinical medical work is accompanied with high risk .The medical treatment risk exists everywhere at anytime, but the graduate students of the Medical colleges lack the understanding of the hygiene laws. Therefore it is necessary for them to accept the education of hygiene law.

Though lack of definite evidences,closed suction drainage after arthroplasty is routinely employed by the majority of orthopaedic surgeons with the aim of preventing the formation of wound haematoma,reducing delayed wound healing and the risk of deep infection.But the optimal time to remove drains is controversial.The usual time to remove drains is 48~72 h after operation when the volume of drains is less than 50ml within 24 h.But some scholars find that the time of draining more than 24 h increases the risk of wound infection.This paper reviews the literature of draining time,and concludes that the optimal time to remove drains is 24 h after the primary arthroplasty.

Objective To study effect of etoricoxib on IL-1βand TNF-αin patients with gouty arthritis.Methods 86 patients with gouty arthritis from July 2014 to July 2016 in our hospital were selected, all patients were divided into study group and control group according to the treatment method with 43 cases in each group.The patients in the control group were treated with diclofenac sodium, the patients in the study group were treated with etoricoxib.The clinical symptoms, clinical treatment effects, VAS score, serum IL-1β, TNF-αlevels and adverse reactions were observed and compared between the two groups.Results The VAS score, the joint swelling score and the mobility limitation score of the study group were decreased than before treatment and significantly lower than those of the control group, the difference was statistically significant (P<0.05).The effective rate of the study group (95.35%) was significantly higher than that of the control group (79.07%), the difference was statistically significant(P<0.05).The levels of IL-1βand TNF-αin the two groups were significantly lower than before treatment and the levels of IL-1βand TNF-αin the study groups were significantly lower than those in the control group,the difference was statistically significant(P<0.05).The incidence of adverse reactions in the study group was lower than that in the control group, the difference was statistically significant(P<0.05).Conclusion The clinical efficacy of etoricoxib in treating patients with gouty arthritis is significant, which can effectively relieve the clinical symptoms, inhibit the expression of IL-1βand TNF-α, and the adverse reactions less.

Aim Toexplorewhether1-methylhydan-toin(MH)could inhibit the basal secretion of growth hormone (GH ) and suppress the promoting effect of growth hormone-releasing hormone (GHRH ) in rab-bits.Methods Thirty-sixrabbitswererandomlydi-vided into six experimental groups according to the kind of dosing drugs,namely normal saline group(A), MH group (B ),octreotide group (C ),GHRH group (D),GHRH +MH group(E),GHRH +octreotide group(F),with 6 rabbits in each group.Blood was sampled (1. 0 mL each time)from each rabbit before injecting drugs and 5,15,30,45,60 min after drug administration.Clotting spontaneously,rabbits blood samples were centrifugated for 20 minutes at approxi-mately 1000 ×g and the supernatant was collected. Serum GH concentrations were determined by enzyme linked immunosorbent assay kit(ELISA Kit).Mean-while,the behavior of rabbits in each group after injec-tingdrugswascloselyobserved.Results TheGH level of rabbits in group A at each time point had no significant differences(P>0. 05 ).Group B and group C rabbit GH levels were significantly lower than those of group A (P<0. 05 ),while GH levels in group D were obviously higher than those of group A (P <0. 05 ).Compared with group D,rabbit GH levels in group E and group F decreased markedly(P<0. 05 ). No obvious toxic and side effects had been observed within one week after the experimental rabbits were ad-ministered corresponding drugs by intravenous injec-tion.Conclusions 1-methylhydantoincouldinhibit the basal secretion of GH in rabbits.1-methylhydan-toin could suppress the promoting effect of GHRH in rabbits.

Aim To investigate the effects of bradykinin preconditioning on the damage produced by focal cerebral ischemia-reperfusion in rats.Methods Rats were scheduled to undergo middle cerebral artery ischemia-reperfusion by intraluminal suture.Prior to ischemia,bradykinin was pumped into the brain via extra carotid artery and control group was given the same amount of normal saline.The infarct volume、brain water content、permeability of blood brain barrier and histological neuronal changes were evaluated after 2 h ischemia and 24 h reperfusion.Results Compared with other groups, bradykinin preconditioning 15min before ischemia reduced infarct volume、brain edema、permeability of blood brain barrier and histological neuronal damage.Conclusion Bradykinin preconditioning may provide protective effects against cerebral ischemic injury.This protection may be due to the protection of cerebral vasculature and the decrease of infarct volume.

Objective To evaluate how to select operation procedures for different CT manifestation of splenic artery aneurysm ( SAA) with posthepatitic cirrhosis. Methods In 61 cases with SAA,the CT manifestation ( location,number,size,portal vein,varicose vein,proxi-mal splenorenal shunt and spleen changes) of SAA,clinical features of cases,and operation approach were were retrospectively analyzed. Re-sults 4 patients who have the primary tumors located in the distal splenic artery with diameter 1. 0~2. 0 cm,spleen kidney shunt and mega-losplenia were given aortic aneurysm exclusion and branch aneurysms embolism by stages. Amiong the 15 cases of tumors resection,splenecto-my and devascularization,there were 4 cases of the primary tumors located in the middle of splenic artery and 11 cases in the distal splenic artery. There were 15 cases whose diameter of the primary tumor were lager than 2. 0 cm and 13 cases whose diameter of the primary tumor were 1. 0~2. 0 cm. There were 4 cases of cavernous transformation of portal vein,5 cases of splenic and gastric varices,15 cases of esophage-al and gastric varices,4 cases of splenic and gastric venous shunt,15 cases of megalosplenia and 4 cases of splenic infarction. Tumors resec-tion and branch aneurysms embolism by stages were conducted in 7 cases. The primary tumors located in the proximal splenic artery occured in 7cases,and the diameter of the primary tumor were 1. 0~2. 0 cm occured in 7 cases. Esophageal and gastric varices occured in 2 cases and splenomegaly occured in 7 cases. And there were 4 cases whose diameter of the tumor were 1. 0~2. 0 cm were given tumor resection and re-construction of splenic artery and continuity, including 1 case of proximal splenic artery,2 cases of medial splenic artery and 1 case of distal splenic artery. Conclusion Operation procedures were confirmed by CT findings such as location,number,size,portal vein,varicose vein, proximal splenorenal shunt and spleen changes of SAA combined with age,gender,body mass index and history.

Objective Our previous research demonstrated that trkA and p75 receptors of nerve growth factor(β-NGF) are expressed in human pterygium fibroblasts(HPF), and trkA is expressed only in conjunctiva. The purpose of present study was to investigate the effects of β-NGF on proliferation of HPF and analyse the pathogenesis mechanism of pterygium. Methods The HPF specimen was obtained from Union Hospital of Tongji Medical College, Huazhong University of Science and Technology during the surgery. Explant culture technique was used for the primary culture of HPF tissue. The cells of confluenting 80% were collected and digested using 0. 25% tripsin + 0. 02% EDTA (1:1) and the third to fifth generation of cells were utilized in the experiment. Different concentrations of β-NGF was added in medium. Cultured cells were identified using vimentin, keratin and α-SMA. MTT was used to determine the proliferation of HPF after addition of β-NGF. The expression of trkA and p75 in HPF was detected by immumofluorescence method. Cell proliferation also was semi-quantitatively analyzed by detect of expressions of PCNA protein and mRNA in HPF using Western blot and RT-PCR. Results Cultured HPF cells showed the positive responses for vimentin, α-SMA, trkA and p75 but absent reaction for keratin. MTT revealed that the OD value of HPF cells was gradually enhanced with the increase of β-NGF concentration in 12, 24, 48, 72 and 96 hours after β-NGF action with the maximum stimulation at 48 hours. The expression of PCNA protein and mRNA in HPF was significantly different among various concentrations of β-NGF groups(F_(protein) = 24. 980, P = 0. 000; F_(mRNA) = 64. 490, P = 0. 000) and increased from 5 ng/mL β-NGF group through 50 ng/mL β-NGF group in comparison with 0 and 1 ng/mL β-NGF group (P ＜ 0. 05) . Conclusion The findings demonstrate the potential proliferative effect of β-NGF binding to trkA and p75 on HPF.

Objective To study the Val247Leu and Trp316Ser polymorphisms of β2-glycoprotein Ⅰ(β2GPⅠ) in systemic lupus erythematosus (SLE) patients and their associations with antiphospholipid antibodies and thrombotic complications.Methods We used DNA sequencing to detect the polymorphisms of Val247Leu and Trp316Ser in 378 SLE patients and 240 normal controls.Anti-β2GP Ⅰ antibodies and anticardiolipin (ACA) were tested by enzyme linked immunosorbent assay (ELISA).Lupus-type anticoagulants(LAC) was performed by diluted Russell's Viper Venom Test.Then the patient group was further analyzed according to APLs (Anti-β2GP Ⅰ antibody,LAC and ACA),thrombosis and obstetrical complications using Logistic regression analysis to confirm whether there are associations between β2GPⅠpolymorphism and those factors.Results For Va1247Leu,the predominant genotype was LL in healthy controls which accounted for 57.08％,while it was VL in SLE patients which accounted for 59.5％ (x2=45.01,P=0.000).Frequency of VV genotype was significantly higher in patients with thrombosis,anti-β2GP Ⅰ,ACA and obstetrical complications (OR=6.79,3.75,2.12 and 3.85,respectively;P=0.000,0.001,0.044 and 0.017,respectively).Those patients with VL genotype tended to have positive anti-β2GPI,LAC,ACA,thrombosis and also obstetrical complications (OR=2.95,1.88,2.47,2.97 and 2.74,respectively;P=0.000,0.007,0.000,0.001 and 0.016,respectively) than those negative ones.The predominant genotype of Trp316Ser was TT,then TS.No correlations could be found between Trp316Ser polymorphism and APLs,neither relation to thrombosis complications.Conclusion The polymorphism of Val247Leu is significantly associated with the presence of APLs,thrombosis and obstetrical complications.Both VV and VL genotype are risk factors for the generation of APLs,occurrence of thrombosis and obstetrical complications.The VV genotype is a high risk factor for thrombosis.Trp316Ser polymorphism does not contribute to the APLs production and also have no correlations with thrombotic complication.

Objective To investigate effects of two doses of dexmedetomidine (Dex) on the recovery quality from general anesthesia undergoing thyroidectomy.Methods A prospective randomized controlled double-blind trial was conducted in 90 patients admitted to Shengjing Hospital of China Medical University who were scheduled for thyroidectomy.They were randomly divided into three groups:group D0.4 received Dex 0.4 μg/kg intravenously,group D0.8 received Dex 0.8 μg/kg intravenously,and control group with same volume of normal saline.There were 30 patients in each group,and all the patients received the above drug or saline 30 minutes after intubation.The heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded before Dex administration,at the end of surgery,time of eye opening and extubation,and 10 minutes after extubation.Time of eye opening after surgery and time of extubation after eye opening were recorded.End-tidal partial pressure of carbon dioxide (PETCO2) before and after operation as well as restlessness score (RS),Ramsay sedative score,and visual analogue pain scale (VAS) scores at 10 minutes after extubation were recorded.Events during extubation including cough,nausea and vomiting,respiratory depression were also recorded.Results ① Compared with control group,in D0.4 and D0.8 groups incidence of lowering of HR,SBP and DBP was lower at time of eye opening and extubation,and 10 minutes after extubation.Compared with D0.4 group,D0.8 group had lower HR at the time of extubation and 10 minutes after extubation,SBP was lower at the time of eye opening and extubation,and lower DBP at the time of eye opening.② D0.4 and D0.8 groups showed lower RS and VAS scores than those of control group,Ramsay sedative score in groups D0.4 and D0.8 was higher than that in control group (RS:1.40±0.51,1.20±0.42 vs.1.90±0.56; VAS:1.50±0.52,0.80±0.63 vs.2.50 ± 0.52; Ramsay:2.10 ± 0.56,2.40 ± 0.51 vs.1.60 ± 0.51,P＜0.05 or P＜0.01),and VAS score in group D0.8 was lower than that in D0.4 group (P＜0.01).The time of eye opening and extubation were longer in group D0.8 as compared with those in control and D0.4 groups (minutes:12.50 ± 1.08 vs.10.50 ± 1.58,10.40 ± 1.26; 15.00 ± 0.94 vs.13.00 ± 1.63,12.80 ± 1.13,P＜0.05 or P＜0.01),but there was no significant difference between the latter two groups.No significant difference in PETCO2 was found among three groups before and after surgery.③ The incidence rate of cough,nausea and vomiting in control group (16.7％,13.3％) were significantly higher than those in groups D0.4 (3.3％,0) and D0.8 (0,0).There was no respiratory depression in the three groups.Conclusion Adjunctive infusion of Dex 0.4 μg/kg at 30 minutes after anesthesia induction was recommended as it may result in more steady hemodynamics,with shorter recovery time and extubation time after thyroidectomy.