Objective To investigate the feasibility and superiority of combined spinal epidural anesthesia incesarean section.Methods 100 lying-in women who experienced cesarean section were collected and divided into combined spinal epidural anesthesia group(CSEA,n=50)and continuous epidural anesthesia group(CEA,n=50).The change of heart rate(HR),blood pressure(BP)and saturation of peripheral oxygen(SpO2),HR and BP of lyingin womeu in pre-anesthesia,5min,15min post-anesthesia and the time of taking effect,time between beginning of anesthesia and laboar of newborn were observed.The side effects of surgical anesthesia and Apgar score of newborn were compared between the two groups.Results There were no difference in clinical data,change of HR,BP and spO2 between two groups.The anaesthetic time of taking effect and the time between beginning of anesthesia and labour of newborn in group CSEA were shorter than in group CEA(all P＜0.05).Conclusion The combined CSEA and CEA was safe and efficient in cesarean section,and CSEA had greater efficacy than CEA in cesarean section.

Objective To acknowledge the value of interventional therapy in gastrointestinal massive bleeding after abdominal surgery. Methods Retrospectively analyzed 11 patients with acute gastrointestinal bleeding after abdominal surgery, failure to conservative treatment and then undergone emergency angiography or interventional therapy. The correlative evaluation of DSA and interventional therapy was summarized. Results All together 11 case of abdominal postoperative massive gastrointestinal bleeding were undertaken DSA, revealing the bleeding sites as follows: the left gastric artery in 1 case, the gastroduodenal artery pseudoaneurysm in 4, hepatic artery pseudoaneurysm in 2, splenic artery pseudoaneurysm in 1, infected pseudoaneruysm of the branches of the inferior mesenteric artery in 1 and small branches of the superior mesenteric artery in 2 cases. Conclusion Interventional therapy in the treatment of gastrointestinal massive hemorrhage after abdominal surgery is effective.

BACKGROUND: The meniscus has limited ability in repairing itself after being injured. However, tissue engineering provides a new way to meniscus repair after injury. Bone marrow mesenchymal stem cells (BMSCs), which possess the potential of multi-directional differentiations, can be ideal seed cells in meniscus tissue engineering. OBJECTIVE: To investigate the feasibility of differentiation of in vitro cultured porcine BMSCs into fibrochondrocyte phenotypes in inductive medium. METHODS: BMSCs were isolated with whole bone marrow culture method. Then, BMSCs of the third passage were digested and incubated in a medium containing transforming growth factor-β1, insulin-like growth factor-Ⅰ, dexamethasone and ascorbic acid in a 24-well plate at a density of 2.0×10~4/cm~2 in the experimental group. While in the control group, the DMEM-LG complete culture medium containing no inductive factor were used instead. At day 7, 14 and 21 after induction respectively, Toluidine blue staining and immunocytochemical staining were performed to detect differentiation. MAIN OUTCOME MEASURES: ①Population double time (PDT) of BMSCs; ②Morphological changes of BMSCs under light microscope;③Proteoglycan expression;④Collagen type Ⅰ and type Ⅱ expression. RESULTS AND CONCLUSION: ① The PDT of the second passage BMSCs was 2 days, which was the shortest. The PDT prolonged relatively after the fourth passage, which were 5 to 9 days. ② The BMSCs changed from a spindle-like appearance into a polygonal shape after induction. ③ In the experimental group, toluidine blue staining resulted in hyacinthine-stained cytoplasm and the blue was even deeper in the area where cells were dense; The degree of staining increased with the increasing induction time. While in the control group, only nucleus of BMSCs were stained blue. ④ Collagen type Ⅰ immunocytochemical staining was positive in both the experimental and the control group and there was no difference of significance between various induction time. No collagen type Ⅱwas seen expressed in the control group, while in the experimental group it was seen to be expressed steadily after 14 days of induction. It is indicated tlat BMSCs can be induced to synthesize fibrochondrocyte-characterized extracellular matrixes in vitro, which suggests that BMSCs are available as seed cells in meniscus tissue engineering.

Objective To investigate the characteristics and mechanism of W-shaped orthotopic ileal neobladder. Methods A total of 20 patients with W-shaped orthotopic ileal neobladder after total cystectomy were evaluated by urodynamic examinations (questionnaire of urination,uroflowmetry,post-voiding(PVR) residual urine volume measurement,enterocystometry and resting urethral pressure profilometry);meanwhile cystourethrography,B-ultrasound,renal function test and IVU were performed. Results Of the 20 cases,2 suffered from daytime incontinence and 6,nocturnal incontinence.The maximum capacity of neobladder was (492.9?177.8)ml,and maximum pressure within the reservoir was (32.1?8.6 )cm H 2O (1 cm H 2O=0.098 kPa).The urine flow curve showed continual type in 12 cases and intermittent type in 8,with maximum uroflow rates of (14.9?2.5 )ml/s,(7.7?2.8)ml/s;capacity of neobladders of (409.0?96.1)ml,(622.1?197.7)ml;PVR of (9.2?11.8)ml,(69.0?38.4)ml,respectively,in the 2 type groups.These values were significantly different between the 2 groups (P

[Objective]To explore the short-term outcome and surgical technique of minimally invasive unicondylar knee arthroplasty(MIS-UKA) for medial compartmental osteoarthritis of the knee. [Methods]Forty-five patients(48 knees) with medial compartmental osteoarthritis of knee treated by MIS-UKA from May 2005 to December 2008 were reviewed and analyzed.The pain and range of motion(ROM) of the knees were evaluated by HSS score system before and after MIS-UKA.Pre-and postoperative alignment of the lower limbs was measured and compared.Surgery indications and surgical technique of MIS-UKA were also summarized.[Results]Forty-three knees in 40 patients were followed up for a mean time of 24 months(12-40 months).The pain over medial compartment of the knees was subsided or relieved in all cases.The post-operative ROM of the knees was 0?~135?(mean 120?),and alignment was 2? varus on the average(0?~6? varus).HSS score increased from 70(60~82) to 90(75~95).The good-to-excellent rate was 92%.[Conclusion]MIS-UKA is an effective method for medial compartmental osteoarthritis of the knee.Surgery indications and surgical technique are the key factors for the final results.

Objective To summarize the experience in prevention and management of delayed-diagnosed injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 5 patients with injury in chole-docho-pancreatico-duodenal junction who had received surgery from 2000 to 2007 in Peking Union Hospital was summarized and analyzed retrospectively. All the 5 patients were diagnosed 24 hours after the injury. The injury was caused after endoscopic retrograde cholangiopancreatography (or endoscopic sphincterotomy) +endovascular stent placement in 4 patients and by vehicle accident in 1 patient. Results All the patients were treated conserva-tively for 24-72 hours, and peritonitis was not alleviated, and were subsequently transferred to surgery. Three patients received gastrostomy +choledochostomy +jejunostomy. The abdominal pain was alleviated in 1 patient, and 2 died of multiple organ dysfunction syndrome 5-6 weeks later. Two patients received duodenal diverticulariza-tion + gastrostomy + jejunostomy + Roux-en-Y choledachojejunostomy + Roux-en-Y gastrojejunostomy, and had good prognosis. Conclusion Duodenal diverticularization is a proper choice for patients with perforation combined with severe intraabdominal infection.

Objective To reseach the time point of the highest percentage of neural precursor cells derived from adipose stromal cells (ADSCs) in vitro, and to observe the ultrastructure features of neural precursor cells. Methods Used the β-mercaptoethanol to induce ADSCs to differentiate into neural precursor cells and neuron-like cells. The morphology of the uninductedcells and inducted cells were observed with inverted phase contrast microscope. The expression of nestin which was the marker of neural precursor cell in each group was detected using immunofluorescence staining method. The ultrastructural feature of cells which was induced for 3 hours were observed. Results The highest ratio of positive expression of nestin was 3 hours following induction,with the ratio ( 86.25 ± 4.82) %. There were many protuberance on the cell membrane under transmission electron microscopy.There were plenty of organelles in the neural precursor cells. The neural precursor cells had a large size nucleus,large nucleoplasmic index, much extended chromatin,and less condensed chromatin. The nucleus had double-layer nuclear envelope, more nuclear pore on the nuclear envelope. Conclusion The time point of the highest percentage of neural precursor cells derived from ADSCs is 3 hours,and the ultrastructral feature of induced neural precursor cells confirm that cells at this time point are in a state of split active period.

Objective To induce adult adult adipose-derived stem cells(ADSCs) in vitro to differentiate into neuronal-like cells,and to analyze the features of their cell morphology and ultrastructure. Methods Adipose stromal cells were obtained and amplified in vitro. Then make use of chemical induction to induce them. Observed ADSC and differentiation of cells in morphology and ultrastructure under inverted microscope and transmission electron microscopy. Immunocytochemistry to detection of Nestin, Neuron Specific Endolase( NSE) ,and glial fibrillary acidic protein(GFAP) expression in cells. Used Real-time PCR to detection of Nestin,GFAP gene mRNA expression before and after induction in ADSC. To observe the morphology and ultrastructure of the cells prior to and after induction under microscope and electron microscope. Results The morphology of ADSC was similar to fibroblasts ,and could be amplified stability within 10 passages in vitro. Some of the cells induced display a typical astrocyte-like cells in ultrastructure. Followed neuronal induction,astrocyte-like cells began to stain brightly for CFAP, Nestin. GFAP stained in both the cytoplasm and nuclei of astrocyte-like cells, but Nestin only stained in the cytoplasm. The peak positive expression rate within 14d following neuronal induction. The rate of positive expression cells was( 14.4 ± 3. 6) % for Nestin, (87. 3 ± 5. 3 ) % for GFAP. Then two kinds of protein expression remained the similar rate. The average relative concentration of GFAP and Nestin gene mRNA have significant statistical difference between ADSC and differented cells analyzed by Real-time PCR (P<0.05).The peak concentration of GFAP was within 20 d after induction,and GFAP was within 14 d after induction. Conclusion In the cytoplasm of adult adipose-derived cells possess Nestin genetic material,which is the marker of neural stem cell. The differential astrocyte-like cells have the typical morphology, ultrastructure and GFAP phenotype of mature astrocytes.

Objective To investigate the diagnosis and treatment strategy of primary sclerosing cholangitis (PSC). Methods From January 1991 to August 2009, 31 patients with PSC were treated at the Peking Union Medical College Hospital. A retrospective study was performed based on the clinical data of these patients to evaluate the methods of diagnosis, curative treatment and prognosis. Results Obstructive jaundice, fever and abdominal pain were the main symptoms of PSC, which accounted for 90% (28/31) , 65% (20/31) and 52% (16/31) , respectively. Thirty patients presented with an elevation of alkaline phosphatase. The positive rate of autoantibody was 45% (14/31). The positive expression of serum tumor markers of 15 patients was elevated, and 13 of the 15 patients had an elevated expression of CA19-9 (84-5000 U/mL). The diagnostic accuracies of B-mode ultrasound, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography (ERCP) were 3/28, 2/24, 2/18, 18/25, respectively. Nineteen patients received drug therapy and only one patient had no obvious discomfort after the treatment. Twelve patients received surgical treat-ment and the prognosis of two patients who underwent liver transplantation was good. Eleven patients received endoscopic treatment, only one patient had no obvious discomfort and the condition of the remaining 10 patients was alleviated after treatment. Conclusions PSC is usually characterized by an elevated expression of CA19-9. ERCP has a high diagnostic accuracy. Conventional treatments can only relieve the symptoms, whereas liver transplantation has a favorable long-term efficacy.

Objective To recommend the safety guidelines for workplace violence on health care sector according to the incidents of violence status on medical workplace.Methods A pilot study was conducted using a two-round Delphi method to study out the safety guidelines for hospital violence.Results In two subsequent rounds,the group discussed and screened out 50 entries from 51 items in the six modules as safety guidelines for hospital violence.Conclusions Establishment of safety guidelines for hospital violence on health care sector using Delphi method requires further clinical validation.