Objective To investigate the clinical effect of dexmedetomidine combined with ropi-vacanie in brachial plexus block (BPB)through modified coracoid approach.Methods Sixty patients scheduled for selective upper extremity surgery were randomly divided into two groups,30 patients in each group.BPB was performed at the point of 2 cm below coracoid directed by nerve stimulator. Ropivacaine (200 mg)was diluted into 40 ml in group R (n=30)and ropivacaine (200 mg)+1 μg/kg dexmedetomidine diluted into 40 ml in group RD (n=30).Motor and sensory block onset times and blockade durations were recorded.HR,SBP,DBP and SpO2 were recorded before drug administration and 1 5,30,60,90 and 120 min after drug administration.Visual Analog Scale (VAS)of normal up-per extremity in group RD was recorded before drug administration and 30 min after drug administra-tion.Side effects were recorded in both groups.Results Sensory and motor block onset time was sig-nificantly longer in group R than those in group RD;Sensory and motor blockade durations in group R was significantly shorter than in those group RD (P <0.01).Compared with group RD,MAP,HR at 30,60,90,120 minutes after drug administration were significantly higher in group R(P <0.05 ). VAS of normal upper extremity in group RD before drug administration and 30 min after drug admin-istration had no statistical significance.7 patients were treated with atropine for bradycardia in group RD.Conclusion Dexmedetomidine combined with ropivacaine for BPB shortens the sensory and motor block onset time and prolongs the duration of sensory and motor blockade.

Objective To investigate the effects of dexmedetomidine plus ropivacanie on lumbar plexus-sciatic nerve blocks and sedation. Methods One hundred and twenty patients( ASA Ⅰ-Ⅲ) scheduled for unilateral arthroscopy of the knee received lumbar plexus-sciatic nerve blocks. The patients were randomly divided into 4 groups(n = 30 in each). In group R,dexmedetomidine was not used for nerve. In group RLD,dexmedetomidine was only used for lumbar-plexus block. In group RSD,dexmedeto-midine was only used for sciatic nerve block. In group RD,dexmedetomidine was used for both lumbar-plexus block and sciatic nerve block. Onset time and maximum time of sensory and motor block,duration of analgesia,Ramsay scores,HR,and the incidence of anesthetic toxicity were recorded at different time points(T0-T4). Results There were no significant differences in the onset time of sensory and motor block among the groups(P > 0. 05). However,there were significant differences in the maximum time of sensory and motor block for the lumbar plexus among the RLD group[(1008. 00 ± 104. 99)min and (800. 00 ± 97. 56)min],RD group[(922. 00 ± 149. 05)min and(732. 00 ± 139. 52)min],RSD group [(768. 00 ± 108. 48)min and(602. 00 ± 84. 09)min],and R group[(742. 00 ± 129. 44)min and (612. 00 ± 109. 62)min]. There were significant differences in the maximum time of sensory and motor block for the sciatic nerve among the RLD group[(1006. 00 ± 117. 58)min and(810. 00 ± 105. 41) min],RD group[(932. 00 ± 144. 18)min and(744. 00 ± 136. 09)min],RSD group[(738. 00 ± 120. 16)min and(582. 00 ± 96. 04)min],and R group[(708. 00 ± 126. 45)min and(548. 00 ± 111. 12)min]. Compare with the R group,the Ramsay scores of at the time point of T1-T4 were higher and the HRs were lower in the RLD group,RSD group and RD group. There were significant differences in the analgesia duration among the RLD group[(1006. 00 ± 117. 58)min],RD group[(918. 00 ± 83. 60)min],RSD group[(898. 00 ± 131. 34)min],and R group[(808. 00 ± 119. 72)min]. No local anesthetic intoxication was noticed. Conclusion Perineural dexmedetomidine plus ropivacaine increase the effects of lumbar plexus-sciatic nerve blocks in a dose-dependent manner. Dexmedetomidine provides a good sedative effect,however,it may lead to bradycardia.

Objective To compare the influence for intravenous dexmedetomidine and midazolam during combined spinal and epidural anesthesia (CSEA) on sedation,respiratory and circulatory.Methods Ninety patients with lower extremity fractures and internal fixation,were divided into dexmedetomidine group,midazolam group and control group by random digits table with 30 cases each.CSEA was performed at L3-4 interspace.After block reached T8 level,dexmedetomidine,midazolam and 0.9％ sodium chloride were given to the three groups.Ramsay score,mean arterial pressure (MAP),heart rate (HR),partial pressure of carbon dioxide in end expiratory gas (PErCO2),respiratory rate (RR) were recorded before anesthesia(T0),after CSEA (T1),and 10,15,30,45,60 min after giving drug (T2-T6),and intraoperative awareness was recorded.Results Ramsay score in dexmedetomidine group and midazolam group at T2-T6 were higher than those in the group T0,T1 and concurrent control group (P ＜ 0.05),MAP were lower than those in the group T0,T1 and concurrent control group (P ＜ 0.05).HR in dexmedetomidine group at T2-T6 were lower than those in concurrent midazolam group and control group (P ＜ 0.05).PETCO2 in midazolam group at T2-T6 were higher than those in concurrent dexmedetomidine group and control group (P ＜ 0.05),RR were lower than those in concurrent dexmedetomidine group and control group (P ＜ 0.05).The rate of intraoperative awareness in dexmedetomidine group and midazolam group was lower than that in control group [16.7％(5/30) and 13.3％(4/30) vs.93.3％(28/30),P＜0.05].Conclusions Dexmedetomidine and midazolam provide good sedation to reduce intraoperative awareness,slight inhibition of blood pressure.Dexmedetomidine can decrease HR,but it does not influence respiratory function.Midazolam restrains respiratory function.

BACKGROUND:Studies have found that both bone marrow mesenchymal stem cels and umbilical cord mesenchymal stem cels have therapeutic effects on liver failure, but little is reported on adipose-derived mesenchymal stem cel transplantation for treatment of liver failure.
OBJECTIVE:To discuss the therapeutic effect of adipose-derived mesenchymal stem cel transplantation on rat liver failure.
METHODS: Forty-five Sprague-Dawley rats were equaly randomized into transplantation, model and control group. Except the control group, animal models of liver failure were made by intraperitoneal injection of D-galactosaminein in the transplantation and model groups. One week after modeling, rats in the transplantation group were given 1 mL of adipose-derived mesenchymal stem celsvia the tail vein.
RESULTS AND CONCLUSION:Adipose-derived mesenchymal stem cell transplantation successfully upregulated alanine aminotransferase and aspartate aminotransferase levels, and moreover, neatly arranged liver cells, reduced inflammatory cells and intact hepatic lobule were shown on B ultrasound after cell transplantation. All these findings indicate that adipose-derived mesenchymal stem cell transplantation has therapeutic effects on rat liver failure by improving rat’s liver function and pathological changes.

Objective To investigate the value of emergency hysterectomy on arresting severe postpartum hemorrhage Methods A retrospective analysis was performed on 10 cases of hysterectomy by reason of postpartum hemorrhage between Jan 1990 and Dec 2000 Results All the patients were severe postpartum hemorrhage that couldn't be controlled by conservative treatment. Among them,there were 5 cases of DIC,2 cases of placental adherence,1 case each of uterine atony,uterine rupture and infection of uterine incision. Blood loss averaged 2 427 ml. All the 10 patients were recovered. Emergency hysterectomy was related to times of gestation and delivery and also to delivery pattern Conclusion Emergency hysterectomy is one of the effective methods on arresting severe postpartum hemorrhage.

Objective To investigate the association between the single nucleotide polymorphisms (SNP)in-308 loci of tumor necrosis factor-α(TNF-α)gene promoter region and chronic hepatitis B (CHB).Methods Genotypes of-308 loci of the TNF-αpromoter were examined by the polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP)in 142 patients with chronic hepatitis B (CHB group)and 150 healthy controls (HC group).The indexes for evalua-ting the curative effect were the ALT,AST,HBeAg,HBV-DNA and the viral load weight,HBV-LP and HBV-PreS1,mean-while,the correlations between related indexes and SNP in TNF-α308 loci were explored as well.Results There was no sta-tistical significance in frequency distribution difference of the genotypes and alleles of-308 loci between CHC and HC groups (P>0.05),the protective factors of TNF-α308 allele A may be not associated with CHB (OR=1.529,OR95%CI:0.872~2.684).There was no association between TNF-αgene promoter-308G/A polymorphism and the positive rates of AST, ALT,HBV-LP and HBV-PreS1 (P>0.05),however,TNF-α-308G/A polymorphism associates with the positive rates of HBeAg and HBV-DNA,and A-allele of 308 loci may increase the risk of HBeAg and HBV-DNA positive expression (HBeAg:OR=3.256,OR95%CI=1.105~9.594;HBV-DNA:OR=2.847,OR95%CI=1.059~7.655).Furthermore,A-allele compared with Gallele,statistically significant differences were observed in the certain HBVDNA viral load range of104~107 copies/ml (P <005).Conclusion TNFαgene promoter308G/A polymorphism would not be associated withCHB,but the TNFα308 gene G mutation of Aallele,which was associated with HBVDNA viral load,may be the susceptible factors of HBV infection.

Objective To evaluate the effect of type Ⅱ odontoid fracture,type Ⅰ Hangman fracture,C2-C3 disc injury on stability of C1-C2 and C2-C3 segments and investigate the clinical significance.Methods Ten fresh-frozen cadaveric cervical specimens (5 men and 5 women; 25-45 years of age,mean 35.7 years) were selected to test the stability of C1-C2 and C2-C3 segments in the settings of intact condition (control group),type Ⅰ Hangman fracture,type Ⅱ odontoid fracture,type Ⅰ Hangman fracture + type Ⅱ odontoid fracture,type Ⅰ Hangman fracture + type Ⅱ odontoid fracture + C2-C3 disc injury.Range of motion (ROM) and neutral zone (NZ) of those segments were measured.Results Compared with the intact condition,type Ⅰ Hangman fracture produced no significant variations in C1-C2 ROM in all loading modes and C2-C3 ROM during left and right lateral bending; type Ⅱ odontoid fracture produced no significant variations in C2-C3 ROM in all loading modes and C1-C2 ROM during left and right rotation; type Ⅰ Hangman fracture + type Ⅱ odontoid fracture revealed no significant variations in C1-C2 ROM during left and right rotation and C2-C3 ROM during extention; type Ⅰ Hangman fracture + type Ⅱ odontoid fracture + C2-C3 disc injury produced no significant variations in C1-C2 ROM during left and right lateral bending and extension-flextion and C2-C3 ROM in all loading modes (P ＜ 0.05).Conclusions Type Ⅰ Hangman fracture can reserve C1-C2 segmental left and right rotation and extension-flextion; type Ⅱ odontoid fracture can reserve C1-C2 segmental left and right lateral bending and extension-flextion; type Ⅰ Hangman fracture + type Ⅱ odontoid fracture + C2-C3 disc injury can reverse atlantoaxial rotationary stability and C1-C3 segmental stability in all directions.This study provides the biomechanical basis for clinical treatments and the related researches of internal fixation.

Objective To investigate the value of echocardiography for assessing the right ventricular function before and af ter treatment in the patients with pulmonary embolism.Methods Ninety-six patients with pulmonary embolism in our hospital from June 2014 to December 2015 were selected as the research subjects and divided into low-risk group,intermediate-risk group and high-risk group according to the disease severity.The echocardiographic examination was performed before and after treatment in all cases.Results The pulmonary artery systolic pressure after treatment in the low-risk group was lower than that before treatment (P＜0.05).The transverse diameter of right ventricle,transverse diameter of right ventricle and pulmonary artery systolic pressure after treatment in the intermediate-risk group and high-risk group were lower than those before treatment (P＜0.05).The Tei index after treatment in the low-risk group,intermediate-risk group and high-risk group was lower than that before treatment (P＜ 0.05).The right ventricle ejection fraction (RVEF),right ventricular end-systolic volume (RVESV) and right ventricular end-dias tolic volume (RVEDV) in the low-risk group had no statistically significant difference between before and after treatment.RVEF after treatment in the intermediate-risk group and high-risk group was higher than that before treatment(P＜0.05),while RVESV and RVEDV after treatment were lower than those before treatment (P＜0.05).Conclusion Echocardiography can objectively re flect the change situation of right heart function before and after treatment in the patients with pulmonary embolism,and can be used as an evaluation method for the effect of pulmonary embolism treatment.

Objective To explore the relationship between infant feeding practices and infants growth,especially the weight gain for length in the first 6 months of life. Methods Two-hundred healthy full-term singlet normal birth weight 5 - 6 months old infants and their main care givers were recruited in Kongjiang community health service center in Shanghai. The questionnaires included infants feeding pattern, feeding environment and care givers feeding behaviors, and were completed on-site by investigators. The birth weight was obtained. The weight and length of infants at 6 months were measured. Results There were 70/200 (35.0%) infants overweight (BMI for age Z score>+1) at 6 months. There were more overweight boys than girls (40.0% vs. 30.9%, x2 = 1.798, P = 0.180). Compared with normal weight infants, the overweight infants had same birth weight (3.30 ± 0.35 kg vs. 3.35 ± 0.32 kg, t =1.010, P = 0.314) and same length at 6 months (67.64 ± 2.10 cm vs. 67.91 ± 1.97 cm, t=- 0.896, P = 0.371). However, the overweight infants gained much more weight for length in the first six months of life. At 6 months, the weight and BMI of overweight infants was significantly higher than that of normal weight infants (9.16 ± 0.67 vs. 7.94 ±0.64, t = 12.324, P < 0.01;19.86 ± 1.24 vs. 17.41 ± 0.80, t = 14.953, P < 0.01). The rates of exclusive breastfeeding for at least four months, continued breastfeeding at six months, complementary food consistency, and complementary feeding frequency, were not significantly differenct between overweight and normal weight infants (x2 =0.723 - 2.701, P > 0.05). The grandparents played an important role in infants feeding in Shanghai. There were 39.0% infants fed only by grandparents, and 23.0% infants fed jointly by grandparents and parents (x2 = 0.175, P > 0.05).The care givers' educational level and knowledge of feeding skill were similar in overweight and normal weight infants (x2 = 0.446, t = 0.949, P > 0.05). However, the overweight infants were fed more quickly than normal weight infants (Z = 2.753, P < 0.01), and there was less language communication between care givers and overweight infants during feeding (Z = 2.932, P < 0.01). In overweight infants, the overfeeding behaviors of care givers were positively correlated with BAZ (r = 0.281, P < 0.05). Conclusions Overweight in early life is associated with some particular infants feeding behaviors of care givers in Shanghai. The long term effect of more rapid weight gain for length in the first 6 months of life on the risk of childhood obesity warranted to be further followed and researched.

Objective To investigate the impact of graft position shift on anterior cruciate ligament reconstruction induced by femoral fixation of interference screw. Methods Nineteen fresh cadaveric knees were used and assigned to three groups. 1) Study of graft position shift: 5 knees were randomly selected, interference screws of 7 mm, 8 mm and 9 mm were used in autologous tendon fixation, then the graft position shift were measured. 2) Study of isometry: 7 knees were randomly divided into the isometric reconstruction group (D group). In the D group, Retrobutton, interference screw and interference screw in location-corrected bone tunnel were used respectively as fixation. The isometry of grafts was evaluated. 3) Study of tibia anterior translation: 7 knees were randomly divided into the anatomic reconstruction group (J group). In the J group,the tibia anterior translation was measured in four different conditions in the same joint: intact knee joint,knee joint without ACL, ACL anatomic reconstruction by interference screw fixation, and ACL anatomic reconstruction by interference screw fixation with corrected bone tunnel location. Results 1) With 7 mm, 8mm and 9 mm interference screw fixation, graft position shift were (2.36±0.11) mm, (2.72±0.06) mm and (3.00±0.06) mm respectively. 2) Graft length change: graft length change in Retrobutton group and corrected bone tunnel group were less than 3 mm, while graft length change in those fixed with interference screw were stretched in more than 3 mm. 3) Study of tibia anterior translation: there was no difference among the intact group, the anatomic group and the corrected group at 0° and 15°. However, the difference was found between the intact group and other groups at 30°、60° and 90° of flexion, as well as between these two reconstructed methods at 20° joint flexion (P＜0.05). Conclusion In both isometric and anatomic ACL reconstruction with interference screw, the graft is pushed tightly toward the femoral tunnel wall, which shifts the graft away from the desired position. In our study we find out that the corrected location of the femoral bone tunnel significantly improves the isometry of ACL reconstruction and anatomic reconstruction.