OBJECTIVE:To explore the effect of dexmedetomidine with different doses combined with ropivacaine on the bra-chial plexus block. METHODS:Totally 90 patients with upper extremity surgery of brachial plexus block were randomly divided in-to test group,control group 1 and control group 2. Test group was treated with 0.375%ropivacaine 40 ml+dexmedetomidine 100μg, brachial plexus injection;control group 1 was treated with 0.375% ropivacaine 40 ml+dexmedetomidine 50 μg,brachial plexus in-jection;and control group 2 was treated with 0.375% ropivacaine 40 ml,brachial plexus injection. Onset time of sensory and motor nerve block,block duration,postoperative pain time for the first time and pain score,analgesia duration,quality of analgesia and muscle relaxant,before anesthesia induction(T0),plasma cortisol concentrations in nerve block 10 min (T1),the start of surgery (T2)and incidence of adverse reactions were observed. RESULTS:The onset time of sensory and motor nerve block and postopera-tive pain score for the first time in test group werecontrol group 1>control group 2,plasma cortisol concentrations at T1 and T2 were higher than T0,and T2>T1>T0,test group0.05). CONCLUSIONS:Ropivacaine combined with 100 μg dexmedetomidine can effectively im-prove brachial plexus block and shorten the onset time of sensory and motor nerve block,with good safety.

ObjectiveTo study the clinical significance of splenectomy in cirrhotic patients undergoing hepatic resection for PLC.Methods26 PLC patients with portal hypertension and hypersplenism were randomly divided into two groups: incidental splenectomy group ( n =11), and hepatectomy only group ( n =15). Postoperative blood picture and liver function was compared.ResultsThe WBC and PLT count significantly elevated after splenctomy, (8 9?1 6)?10 9 /L, (310?32)?10 9 /L; vs. (3 7?1 4)?10 9 /L and (104?41)?10 9 /L respectively (all P

Objective To study T lymphocyte subsets immunological condition of spleen in primary hepatocellular carcinoma (PHC) with liver cirrhosis. Methods T lymphocyte subsets such as CD4,CD8,CD4/CD8 in peripheral and spleen venous blood in 31 cases of PHC with liver cirrhosis were detected by FCM.and 13 patients with liver cirrhosis were observed as the control group. Results In 6 patients with stage Ⅰ liver cancer, CD8 of peripheral venous blood significantly decreased (P

ObjectiveTo study the changes of immune function after hepatectomy for hepatocellular carcinoma(HCC) in patients with liver cirrhosis.MethodsPatients with liver cirrhosis were used as control group,CD4?CD8?CD4/CD8? and protein expression level of IFN ??IL2?IL10 in peripheral blood from 18 advanced HCC cases with liver cirrhosis before and after heaptectomy were detected by flow cytometry(FCM) and ELISA.Results Postoperative CD4(33?3)%?CD4/CD8(1 1?0 1)?IL2(71?11)?pg/ml?IFN ?(90?15)?pg/ml level elevated compared to that of pre operation 〔CD4(29?4)%?CD4/CD8(0 9?0 3)?IL2(57?15)?pg/ml?IFN ?(78?13)?pg/ml〕(all P

Objective To study the methods and effects of endoscope-assisted partial thyroidectomy through subclavicular approach between the cervical anterior muscles and the sternocleidomastoid muscle.Methods The study included 15 patients with unilateral thyroid benign nodules.A transversal subclavicular incision 2~3 cm in length was made.Endoscope-assisted partial thyroidectomy was performed through the subclavicular approach between the cervical anterior muscles and the sternocleidomastoid muscle.Results The operation was accomplished successfully in all the 15 patients.The operation time was 40~80 min(mean,50 min) and the intraoperative blood loss was 10~50 ml(mean,20 ml).No surgical complications occurred.The patients were discharged from hospital on 3~4 postoperative days.Follow-up observations in the 15 patients for 1~12 months(mean,7 months) revealed no recurrence.Conclusions Endoscope-assisted partial thyroidectomy through subclavicular approach between the cervical anterior muscles and the sternocleidomastoid muscle has the advantages of minimal invasion,little blood loss, low complication rate,quick recovery,and good cosmetic results.

Objective To establish the capability level classification system and capability level staffing standard of ICUs in tertiary hospitals, in an effort to raise the efficiency of nursing resources while ensuring quality of care of patients. Methods Such methods as experts meetings and Delphi Method were called into play to establish the nurses capability level system in ICUs with the convenient sampling method, we made clinical observation and research in 5 ICUs of 3 tertiary hospitals in Shanghai. Results Nurses in ICUs were classified into four levels, so were their responsibilities and job description. This way the system of nursing staff capability levels takes shape, and the staffing standards for nurses in ICUs of tertiary hospitals come into being. Conclusion Such tiered staffing standards in tertiary hospitals enable clinical nursing managers to deploy and efficiently use nursing staff of all levels.

Objective To study the relationship between the low level lead exposure of pregnant woman and the gestational age of fetus. Methods The peripheral blood and the umbilical blood samples were collected from 1 000 healthy puerperants and their newborns. The puerperants were divided into three groups according to the blood lead levels: very low-level group(0.483 ?mol/L). Results The rate of premature labor was 9.40% in the very low-level group, 14.07% in the low-level group and 23.81% in the high-level group respectively. The blood lead level of puerperants had a positive correlation with the umbilical blood lead of newborns. The umbilical blood lead of premature was higher than that of mature. As the blood lead level of the pregnants increased, the gestational age shortened and the probability of low age premature increased. Conclusion As for the toxicity of lead to the fetus, there is no a threshold. Low level lead exposure of the pregnant woman is one of the causes of premature labor.

OBJECTIVE: To analyze the clinical significance of ocular vestibular evoked myogenic potentials (oVEMP) and cervical vestibular evoked myogenic potentials (cVEMP) in primary unilateral benign paroxysmal positional vertigo (BPPV). METHOD: Fifty-two patients with unilateral primary BPPV (BPPV group) and 38 normal subjects (control group) received ocular vestibular evoked myogenic potential (oVEMP) and cervical vestibular evoked myogenic potential (cVEMP) test using tone burst stimuli. The response rate, latency and amplitude were analyzed. RESULT: In BPPV group, the response rate of oVEMP was 46.15% in lesioned side and 48.08% in healthy side, respectively. The response rate of cVEMP was 67.31% in lesioned side and 65.38% in healthy side, respectively. In control group, the response rate on the left ear was 84.21% for oVEMP and 92.11% for cVEMP. On the right ear, was 81.58% for oVEMP and 94.74% for cVEMP in control group, there was no significant difference in cVEMP and oVEMP P1, N1 N1-P1 latency and amplitude between left and right ear. The interaural amplitude ratio and asymmetry of cVEMP and oVEMP was significantly different between BPPV group and control group (P<0.05). CONCLUSION Unilateral primary BPPV with bilateral impaired vestibular otolith pathways function can be objectively evaluated by oVEMP and cVEMP detection. Abnormal oVEMP responses were more frequently detected than cVEMP.
Adult ; Benign Paroxysmal Positional Vertigo ; physiopathology ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Vestibular Evoked Myogenic Potentials ; physiology ; Young Adult

ObjectiveTo compare the efficacy and safety of pregabalin and gabapentin in treatment of patients with diabetic peripheral neuropathic pain.MethodsSixty patients with diabetic peripheral neuropathic pain were allocated into pregabalin group(30 cases ) and gabapentin group (30 cases) for a 4-week period treatment by random digits table method.The efficacy was measured with visual analogue scale (VAS) score,while the side effects were evaluated.ResultsVAS score in both groups was significantly lower at the end of 1st,2nd or 4th week after treatment than that before treatment [pregabalin group:( 4.05 ±0.93),(2.73 ±0.72),(2.06 ±0.58) scores vs.(7.45 ±0.82) scores; gabapentin group:(5A2 ±0.88),(2.93 ± 0.80),(2.19 ± 0.64) scores vs.(7.68 ± 0.84) scores] (P ＜ 0.01 ).VAS score in pregabalin group was lower than that in gabapentin group at the end of 1st week significantly (P＜ 0.01 ).Not only there was no significant difference in VAS score at the end of 2nd or 4th week between two groups,but also in response rates at the end of 4th week (P ＞ 0.05 ).The rate of adverse reaction in pregabalin group was significantly lower than that in gabapentin group [16.67％ (5/30) vs.36.67％( 11/30)] ( P ＜ 0.01 ).ConclusionPregabalin is as effective as gabapentin in treatment of patients with diabetic peripheral neuropathic pain,but it has faster effect and less adverse events than gabapentin.

Objective To explore endoscopic findings and histopathological characteristics of duodenal protuberant lesions in order to improve diagnosis of duodenal protuberant lesions.Methods A total of 869 cases of duodenal protuberant lesions were detected and collected in endoscopy center of Drum Tower Hospital from 2005 to 2010,of which endoscopy findings and pathological characteristics were studied retrospectively.Results Of the 869 case with duodenal protuberance,50 cases were misdiagnosed as real protuberant lesions.Of the 819 real protuberant lesions,781 cases (95.4％)were benign lesions and 38 cases (4.6％) were malignant lesions.Pathological results indicated that most were chronic inflammation benign lesions (338 cases),accounted for 41.3％.Secondary were Brunner gland hyperplasia (155 cases),accounted for 18.9％.Of malignant lesions,most were adenocarcinoma (25 cases,accounting for 3％ ),others were six cases of carcinoid tumor,six cases of malignant lymphoma and one case of embryonal rhabdomyosarcoma.Endoscopic findings of duodenal protuberant lesions were diverse,such as round,hemispheric,finger-like,lobulated,streak and so on.The diameter of duodenal protuberant lesions varied,the largest was 5 centimeter and most were sessile lesions (726 cases,88.6％).Endoscopic ultrasonic findings indicated that internal echo of benign lesions were even and each layer of structure was clear,while malignant lesions presented uneven internal echo,unclear layer structure and adjacent tissue or lymphoma nodes invasion.Conclusions Duodenal protuberant lesions cannot be confirmed by conventional endoscopic findings.Endoscopic ultrasonography may help to improve the diagnosis.Diagnosis should be confirmed by pathology.