Objective To evaluate the efficacy of ultrasound-guided combined C5 and superficial cervical plexus block in patients undergoing clavicle surgery.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,scheduled for elective clavicle surgery,were randomly divided into 2 groups (n =30 each) using a random number table:injection with 10 ml local anesthetic guided by ultrasound group (group U),and injection with 10 ml local anesthetic guided by anatomical landmark group (group A).A mixture of 0.375 ％ levobupivacaine and 1.0％ lidocaine was used.The time spent performing the block onset time of analgesia,onset time of analgesia in the medial border,midpoint and lateral border of the clavicle and duration of analgesia were measured.The effectiveness of block (excellent,good,failure) was assessed.The complications were observed.Results Compared with group A,the time spent performing the block was significantly prolonged,the onset time of analgesia in the lateral border and midpoint of the clavicle was shortened,the rate of excellent anesthesia was increased,and the duration of analgesia was prolonged in group U (P ＜ 0.05).No complications occurred in group U,while vascular puncture occurred in 3 cases,and one patient developed mild toxic reaction in group A.Conclusion Ultrasound-guided combined C5 and superficial cervical plexus block provides better block,with faster onset time of analgesia in the lateral border and midpoint of the clavicle,longer duration of analgesia and fewer complications as compared with that guided by anatomical landmarks in patients undergoing clavicle surgery.

Objective To investigate the effect of gabapentin on the activation of glial cells in the spinal cord after chronic constrictive injury (CCI) to sciatic nerve in rats.Methods Twenty-four male SD rats weighing 180-220 g were randomly divided into 3 groups (n = 8 each): group Ⅰ sham operation (group S), group Ⅱ CCI and group Ⅲ gabapentin + CCI. Right sciatic nerve was exposed and 4 loose ligatures were placed with 6-0chromic catgut. Seven days after operation gabapentin 50 mg/kg in 5 ml was given by intragastric gavage twice a day for 5 days in group Ⅲ. Paw withdrawal threshold to mechanical stimulation with von Frey filaments was measured one day before (baseline) and at 7, 15 d after operation. The animals were killed at 15 d after operation. The lumbar segment L4-5 of the spinal cord was removed. Immunohistochemical double mark technique was used to detect the activation of astrocytes and microglias in the spinal cord. Results Paw withdrawal threshold to mechanical stimulation was significantly decreased on the 7th and 15th day after CCI operation in group CCI as compared with group S. After 5 day treatment with gabapentin, the withdrawal threshold to von Frey hair stimulation was significantly higher in group Ⅲ than in group Ⅱ . The activation of astrocytes and microglias in the spinal cord was significantly enhanced in group CCI as compared with group S. Treatment with gabapentin significantly inhibited CCI-induced activation of astrocytes and microglias in the spinal cord. ConclusionGabapentin reduces neuropathic pain by inhibiting activation of glial cells in the spinal cord.

BACKGROUND:Some scholars suggest that the nerve root palsy after cervical spinal stenosis treated with
decompression and implant internal fixation is related with the cervical stability and cervical lordosis, but there is controversial.
OBJECTIVE:To explore the C 5 nerve root palsy and stability after cervical spinal stenosis treated with posterior laminectomy lateral mass fixation and single-door decompression laminoplasty.
METHODS:Twenty-nine cervical spinal stenosis patients were selected and treated with posterior
decompression and implant internal fixation. Posterior laminectomy lateral mass fixation for the treatment of
cervical spinal stenosis:C3-6 lateral mass and C7 pedicel screw internal fixation was performed and caused rough surface on the facet joint;the unstable segment was confirmed according to the preoperative anteraposterior
plain film and dynamic radiographs combined with MRI and CT images, and then the corresponding segments were treated with lateral mass internal fixation, single-door decompression laminoplasty and laminoplasty.
RESULTS AND CONCLUSION:Al the 29 cervical spinal stenosis patients were fol owed-up for 8 months to 2.3 years. Among them, 14 cases were treated with posterior laminectomy lateral mass fixation, two cases had nerve root palsy in the early stage after implantation, three cases had incomplete paralysis after long-term symptom recurrence and treated with second surgery of scar remove and decompression;15 cases were treated with single-door decompression
laminoplasty, and one case had C 5 never root palsy and shoulder abduction dysfunctionafter treatment, no preoperative symptom recurrence. The nerve root palsy wil restored in 6 weeks for shortest and 9 months for longest. As the limitation of the case number, it is not clear whether there were significant differences in the correlation between C 5 nerve root
palsy and segmental stability, cervical lordosis, spinal decompression degree and the range for spinal cord shift, as wel as the nerve root palsy degree and the cervical spinal stenosis recurrence caused by forward scar between two
treatment methods, so accumulation observation of the cases and clinical experience are needed.

Objective To evaluate the efficacy of parecoxib sodium for preemptive analgesia.Methods PubMed,EMBASE,Cochrane Library,and CNKI database were searched for randomized placebo-controlled trials involving the efficacy of parecoxib sodium for preemptive analgesia.The modified Jadad scale was used for quality assessment.Evaluation indexes included VAS scores at 1,6,12 and 24 h after operation,consumption of morphine within 24 h after operation,and incidences of nausea and vomiting after operation.Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0.2 software.Results Fourteen randomized placebo-controlled trials involving 1086 patients were included in our meta-analysis.The modified Jadad scale scores for the 14 studies were ≥ 4.The patients were divided into 2 groups:placebo group and parecoxib sodium 40 mg injected before operation group.The results of meta-analysis showed that VAS scores at 1,6,12 and 24 h after operation were significantly decreased,the consumption of morphine within 24 h after operation was reduced,and the incidences of nausea and vomiting after operation were decreased in parecoxib sodium 40 mg injected before operation group as compared with placebo group (P ＜ 0.05).Conclusion Intravenous injection of parecoxib sodium 40 mg before operation can produce significant preemptive analgesic efficacy and is helpful in decreasing the adverse effect of postoperative analgesia.

This paper introduced the background, contents, methods and main results, as well as its strategic goals for the next decade and strategic development planning for the next five years. The authors believed that inherent logic, supports from the governments and other authorities as well as the executive power of the hospital in question were the basic factors for the success of its strategic planning and implementation. The authors also held that a package of actions would be conducive to correctly positioning tertiary hospitals and that medical services pricing ought to be rational for the costs, technology and policy guidelines of medical care.

LA G1 was identified as a gene that is differentially expressed during the yeast replicative life span and was shown to play a role in determining yeast longevity. The cDNA of rat LASS1, the mammalian homolog of yeast LA G1, was cloned from rat cerebral cortex and sequenced, which is different to the predicted sequence in the GenBank. Sequence analysis revealed that this cDNA clone contains an open reading frame of 1 053 bp. The deduced amino acid sequence has 350 residues and shares a predicted Laglp motif and a TLC domain conserved in Lag1 proteins. Total RNAs were isolated from rat cerebral cortices at varying ages: newborn, one month, six months, twelve months, and twenty-four months. Semi-quantitative RT-PCR and Northern blot analysis were performed to analyze the LASS1 expression level in rat cerebral cortex tissues at varying ages. Senescence-associated β-galactosidase (SA-β-gal) activity was firstly used as a biomarker for assessing senescence in rat neurons. The results showed that LASS1 expression was upregulated from newborn to adult rats (1～6 month) and declined in aged cortex. SA-β-gal staining positive neurons significantly increased in the aged cerebral cortex. The age-related expression alternation of LASS1 in rat cerebral cortex provides an important clue in exploring the role of LASS1 in mammalian neuron aging.

Objective To evaluate the cause and the treatment of the vagus nerve reflex in patients with hemoptysis during bron-chial artery embolization (BAE).Methods 1 12 patients with much hemoptysis were enrolled,9 of whom represented vagus nerve reflex in the process of interventional embolization.Results In 9 patients with mixed vagal reflex,5 occurred in the process of bron-chial artery embolization,1 in removing of sheath,1 in hemostasis by compression and 2 in returning to the ward.The intraoperative vagus reflex during BAE was related to over tension and unnormolized operation,and it improved by block of vagus nerve,raising blood pressure and fluid expansion without serious complications.Conclusion Vagus nerve reflex during BAE should be noticed, and early detection and timely intervention may improve its prognosis.

Objective To discuss the value of combining superselective mesenteric angiography (SSMA)with methylene blue in-jection for localization of the Obscure Gastrointestinal Bleeding (OGIB).Methods 12 patients presenting with OGIB had preopera-tive localization of the bleeding site by SSMA.The microcatheter was remained inside the bleeding artery branch after angiography. Then the methylene blue was injected via the microcatheter for localization during exploratory laparotomy and the dyed intestine was then removed.Results The detected rate of bleeding sites by using preoperative SSMA was 100%.The lesions in total 12 patients were found quickly during the exploratory laparotomy.The length of the removed intestine was 9 -12 cm (median,10 cm).After followed up for 10-24 months (median,18 months),all patients with OGIB had no recurrence.Conclusion The method of SSMA combined with the use of methylene blue injection is a safe and effective procedure for the localization of OGIB and could be beneficial for increasing the surgical success rate of hemostasis.

Objective To investigate the clinical application of chemokine receptor 4 (CXCR4)-targeted PET/CT imaging in breast cancer using 68Ga-1,4,7-triazacyclononane-1,4,7-triacetic acid-TN14003 (NOTA-NFB) and the correlation between 68Ga-NOTA-NFB uptake and pathology.Methods From June 2014 to December 2014,11 female patients (age range:38-68 years) with non-specific invasive breast cancer were recruited in this study.All patients underwent neoadjuvant chemotherapy before surgery.68GaNOTA-NFB and 18F-fluorodeoxyglucose (FDG) PET/CT imaging were performed before the chemotherapy.Three patients also underwent 68Ga-NOTA-NFB PET/CT imaging after the fourth cycle of chemotherapy.The region of interest (ROI) method was used to measure the maximum standardized value (SUVmax) and tumor/non-tumor (T/NT) ratio was calculated.Paired t test and Spearman correlation analysis were used for statistical analysis.Results The SUVmax values of primary lesions were 3.78±2.03 and 8.11±5.14 (t=-3.01,P＜0.05) respectively in 68Ga-NOTA-NFB imaging and 18F-FDG imaging.The T/NT ratios for primary lesions were not significantly different between the two imaging methods (9.36±7.81 vs 15.62±14.51;t=-1.63,P＞0.05).In the metastatic lymph nodes,SUVmax values were not significantly different between 68Ga-NOTA-NFB imaging and 18F-FDG imaging (t=-2.02,P＞0.05),but T/NT ratios were significantly different (t=-2.43,P＜0.05).After neoadjuvant chemotherapy,T/NT ratios were decreased in the 3 patients.Correlation was not found between T/NT in 68Ga-NOTA-NFB imaging and Ki-67,but the P value was close to 0.05 (rs =0.600,P=0.051).Conclusion 68Ga-NOTA-NFB PET/CT can be used as a new CXCR4-targered imaging in diagnosis of breast cancer,and it may be beneficial to evaluate the effect of neoadjuvant chemotherapy.

Objective To analyze kinematic characteristics of children with spastic cerebral palsy during walking based on the method of gait analysis. Methods The gait of 14 children with spastic cerebral palsy and 16 healthy children, who were required to walk back and forth on level ground at normal speed, was tested using portable gait analyzer. The gait differences between diseased side and healthy side of lower limbs for children with spastic cerebral palsy, as well as the gait differences between children with spastic cerebral palsy children and healthy children were compared. Results For children with spastic cerebral palsy, single step time, swing time and toe-off time of diseased side were significantly longer than those of healthy side (P＜0.05), while step frequency, velocity and terminal stance were significantly shorter than those of healthy side (P＜0.05). Compared with healthy children, gait cycle time, single step time, stance time, swing time, percentage of stance phase, mid stance phase, pre-swing stage and toe-off time for diseased side of children with spastic cerebral palsy were significantly longer (P＜0.05). Stride, velocity, step frequency and terminal stance of the children with spastic cerebral palsy were significantly lower than those of healthy children (P＜0.05). Pulling acceleration for children with spastic cerebral palsy also decreased compared with healthy children (P=0.05). Conclusions The stability of children with spastic cerebral palsy decreased during walking, and their single step time, swing time, toe-off time and pulling acceleration might be considered as the sensitive indicators.