Objective To analyze the anesthetic effect of Compound Articaine on Children's dental pulp without pain, and provide reference for clinical treatment.Methods124 patients with children with dental pulp disease in hospital from February 2015 to May 2016 were selected, patients were randomly divided into observation group and control group, every group with 62 cases.Control group patients were given Lidocaine anesthesia, observation group patients were taken trentment of compound articaine anesthesia, anesthetic effect of patients were compared.Changes in heart rate, blood pressure, adverse effects, and patient pain were recorded before and after anesthesia.ResultsThe total effective rate (96.8%) in the observation group was significantly higher than that in the control group (80.9%) (P<0.05).Observation group (79%) was significantly higher than the control group (1.6%,P<0.05), the observation group of severe pain rate (58.1%) was significantly lower than the control group (11.3%) (P<0.05),The heart rate and blood pressure in the observation group were no significant change, In the control group, the diastolic blood pressure (71.7±10.8) mmHg was significantly lower in the observation group (74.5±12.8) mmHg and the heart rate (80.2±8.8)/min was significantly higher than that in the observation group (76.2±8.3).Two groups of patients in the treatment of adverse reactions, including tachycardia, dizziness, headache, observation group of adverse reaction rate and the control group was not significantly different.ConclusionCompound articaine anesthesia was the implementation of children's dental painless treatment, can reduce the pain of patients, maintain the blood pressure and heart rate stable, has the use value.

Objective To investigate the safety and feasibility of Minocycline Hydrochloride Ointment and metronidazole membrane in the treatment of periodontal abscess.Methods80 cases of patients with periodontal abscess in our hospital from May 2014 to May 2016 were selected, these patients were randomly divided into Minocycline Hydrochloride Ointment group (n=40) and metronidazole membrane group (n=40) two groups, the periodontal probing depth, gingival bleeding index, plaque index, attachment loss, clinical efficacy, the incidences of adverse reactions and recurrence of the two groups were statistically analyzed.ResultsThe periodontal probing depth, gingival bleeding index, plaque index, attachment loss of the Minocycline Hydrochloride Ointment group were significantly lower (P<0.05), the total treatment efficiency 95% (38/40) was significantly higher than the metronidazole membrane group 77.5% (31/40) (P<0.05), the recurrence rate 2.5% (1/40) was significantly lower than the metronidazole membrane group 15% (6/40) (P<0.05), but the difference of the incidences of adverse reactions 10% (4/40), 7.5% (3/40) between the two groups was not significant.ConclusionMinocycline Hydrochloride Ointment metronidazole membrane in the treatment of periodontal abscess has higher safety and feasibility than metronidazole membrane, so is worthy of promotion in the clinical.

Objective To analyze the clinical manifestations,diagnosis,treatment and prognosis of patients with splenic abscess.Method The clinical data,including baseline clinical data,clinical features,past history,pathogen culture result,treatment and the prognosis were retrospectively analyzed in the patients with the discharge diagnosis splenic abscess from January 1991 to March 2012 in Peking Union Medical College Hospital.Results The media time from onset to Peking Union Medical College Hospital of the 19 patients were 29 days.Among them,9 patients were cured,8 were improved and 2 died.Risk factors,such as tumor burden,diabetes,and using immunosuppressive agents etc,can be found in most patients with splenic abscess.All the 19 patients had splenic image changes and non-specific clinical features.The most common three clinical symptoms were fever(18 cases),chills (12 cases) and shivering (11 cases).The most common three signs were abdominal tenderness (9 cases),left upper quadrant sensitive to percussion (7 cases) and splenomegaly (4 cases).The most common etiological culture results were gram negative bacilli (9 cases),gram positive coccus (8 cases),and fungi (4 cases).Conclusions Clinical features are non-specific in splenic abscess patients.Related exam such as ultrasound should be performed on patients with splenic abscess risk factors to avoid misdiagnosis.Empiric antibiotic administration should begin right after the diagnosis based on the image.Pathogen culture should be timely conducted after pus collection.Individual therapeutical protocol should be chosen according to patient's condition.

10.3969/j.issn.2095-4344.2013.26.006

Objective To evaluate role of intracoronary electrocardiogram (IcECG) in examining early myocardial damage during elective percutaneous coronary intervention (PCI). Methods Eighty-six patients of coronary heart disease with normal serum levels of creatine kinase-myoglobin (CK-MB) and cardiac troponin T (cTnT) before the procedure and undergone elective PCI were enrolled in the study.Their IcECG were recorded by a intracoronary guidewire and serum levels of CK-MB and cTnT were measured at baseline and eight and 24 hours after the procedure, respectively. The patients were divided into two group, abnormal and control, according to whether they had significant shift at ST-segment in IcECG.Cardiac events after intervention in the patients were followed-up and recorded. Myocardial damage was defined as serum level of cTnT increased to above the upper normal value after intervention. Results Significant shift at ST-segment in IcECG during PCI in 30 (35%, abnormal group) and no shift in other 56patients (65%, control group) of 86 patients with normal serum levels of cardiac markers before the procedure was observed, and all the procedure were successful Serum levels of cTuT and CK-MB significantly increased after intervention in 30 patients of abnormal group than those in control one ( P <0. 01 ). Sensitivity of intracoronary ST-segment shift was 77 percent for predicting myocardial damage, and specificity was 94 percent, with positive and negative predictive values of 90 percent and 86 percent,respectively. More cardiac events were observed at 4-week follow-up after intervention in abnormal group than those in control one (P<0. 05) and major coronary event-free survival was significantly lower in those with post-procedural ST-segment elevation in IeECG (P < 0. 05). Conclusions ST-segment shift in IcECG may be helpful for predicting myocardial damage during PCI procedure on time.

Objective To evaluate the validity and reliability of multi-slice spiral CT (MSCT) in preoperative TNM staging judgment of rectal carcinoma. Methods Three hundred and one patients with rectal carcinoma were diagnosed and treated consecutively in Colorectal and Anal Surgery Department of Shanxi Province Tumor Hospital from January 2009 to December 2009. The clinical data of these patients were analyzed retrospectively. The diagnosis results were compared between the preoperative MSCT staging and the postoperative pathological staging,the ROC curve and the diagnostic concordance test were analyzed by software Medcalc 11.2. Results The sensitivity, specificity, Kappa value, area under the curve of TNM staging were 64.7% ,96. 8% ,0. 667,0. 808 for T2 staging tumors; 93.8% ,75.0% ,0.709,0.844 for T3 staging tumors;87. 8% ,98. 1% ,0. 859,0. 929 for T4 staging tumors; 72. 0% ,91.2% ,0. 619,0. 816 for N staging tumors;92. 7%, 99. 7%, 0. 925,0. 963 for M staging tumors respectively. Conclusion The diagnostic value of independent use of MSCT in estimating the infiltration degree and lymph node metastasis of rectal cancer is very poor and cannot be used in preoperative staging judgment.

ObjectiveTo evaluate the efficacy of hypertonic saline (HS) treatment in cardiopulmonary resuscitation (CPR) in animal models of cardiac arrest (CA).Methods PubMed and EMBASE data were retrieved from January 1st, 1966 to September 30th, 2014, and Wanfang data and CNKI were searched from January 1st, 1990 to September 30th, 2014 for randomized controlled trials (RCTs) regarding CPR intervention of CA animal models with HS. HS was intravenously infused at the initiation of CPR in HS group, without limiting its dosage or concentration. The same volume of normal saline (NS) was given in NS group. Meta-analysis concerning the rate of restoration of spontaneous circulation (ROSC), the serum sodium concentration before CA and during CPR, and related hemodynamic parameters, including mean arterial pressure (MAP) and coronary perfusion pressure (CPP) at the immediate beginning of CPR and 90 minutes after ROSC was conducted by RevMan 5.3 software.Results A total of 8 RCTs were included. Meta-analysis showed that compared with NS group, the rate of ROSC [relative risk (RR) = 1.23, 95% confidence interval (95%CI) = 1.05-1.43,P = 0.010], serum sodium concentration during CPR [weight mean difference (WMD) =17.44, 95%CI = 12.57-22.31,P< 0.01], and the level of MAP at 90 minutes after ROSC (WMD = 4.81, 95%CI =1.58-8.03,P = 0.003) were significantly improved in HS group. There was no significant statistic difference in other hemodynamic parameters, including serum sodium concentration before CA (WMD = 0.78, 95%CI = -0.26-1.82,P =0.14), MAP (WMD = 5.43, 95%CI = -0.74-11.59,P = 0.08) and CPP at the immediate beginning of CPR (WMD =6.82, 95%CI = -5.54-19.19,P = 0.28), and CPP at 90 minutes after ROSC (WMD = -0.77, 95%CI = -10.33-8.80, P = 0.88) between two groups. It was showed by funnel chart that bias was not significant in the published articles. Conclusion This systematic review indicates that HS infusion is followed by an improved ROSC rate, serum sodium concentration during CPR, and MAP at 90 minutes after ROSC in animal models of CA.

Objective To explore the protective effect and mechanism of gardenoside on the damage of dopaminergic neurons induced by lipopolysaccharide (LPS). Methods Both neuron-enriched cultures and neuron-astrocyte cultures were pretreated with vehicle or gardenesides ( 10, 20 and 40 mg/L) for 30 min at 37℃. The culture media were subsequently renewed in order to remove gardenesides. LPS was then added into all culture media at a final concentration of 10 mg/L Twenty-four hours later, the culture media was collected to measure TNF-α, NO, IL-6, GDNF and MMP-9; the cells were collected to count the number of cells labeled with an antibody against tyrosine hydroxylase (TH) and to assess the expression of TH mRNA using reverse transcription-polymerase chain reaction. Results Gardeneside didn't promote the survival of dopaminergic neurons in neuron-enriched culture, but significantly increased the survival of dopaminergic neurons in neuron-astrocyte culture, compared with the vehicle group, the survival of dopaminergic neurons increased from 203.0%±17.4% to 256.7%±15.2% ( F = 17.22, P = 0.001 ) in 40 mg/L gardenaside group. The amount of TNF-α, NO and GDNF released from the neuron-astrocyte cultures after 24 h of addition of LPS was not changed significantly, while the expression of IL-6 and MMP-9 was increased significantly. In this study, the gardenoside concentration-dependently attenuated the LPSinduced increase of the expression of IL-6 and MMP-9, compared with the vehicle group, the expression of IL-6 and MMP-9 decreased to 67.2%±6.4% (F= 12.89,P =0.001 ), 77.3%±9.8% (F =8.27,P = 0.001 ) respectively in 40 mg/L gardenoside group. Conclusions Astrocytes play a neuroprotective role on dopaminergic neurons, which is decreased by LPS via inducing the secretion of pro-inflammatory factors. Gardeneside may protect dopaminergic neurons from LPS-induced injury in an astrocyte-dependent manner and it inhibits the production of proinflammatory factors instead of promoting the secretion of GDNF. From the point of view that a very low toxicity of gardenesides has been well documented, this report may reveal a new way of developing therapeutic interventions for inflammation-related diseases such as Parkinson's disease.

Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy.Methods According to whether the patients accepted the invasive rescue therapy or not,2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR).There were 2 147 cases in group R and 526 case in group DNR.The rescue consent form or do not rescue consent form was required to sign by patient self,patient' s family member or relatives.The patient' s basic information,underlying disease,payment of medical expenses,personnel who signed the consent form,treatment and prognosis in both groups were investigated.Results There was no significant gender deference in both groups (x2 =1.86,P =0.173).The mean age of patients in group DNR was much higher than that in group R (69.5 ±-12.5 vs.58.6 ± 19.2 years,F =28.92,P =0.000).The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90％ vs.44.01％,x2 =10.59,P =0.001).The ratios of chronic heart failure,chronic respiratory failure,chronic hepatic encephalopathy,chronic renal failure,malignant tumor in group DNR were significantly higher than that of group R (8.17％ vs.3.03％,8.17％ vs.2.61％,3.80％ vs.1.16％,5.32％ vs.1.44％,11.98％ vs.2.28％,all P=0.000).The proportion of patients without insurance in group DNR was higher than that of group R (52.09％ vs.41.08％,x2 =20.87,P =0.000).Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04％ vs.0.42％,x2 =64.40,P =0.000),there were no significant deference in other people who signed the consent form such as patient's offspring,spouse,parents,siblings and others.Univariate and multivariate logistic regression analyses showed older age,non Beijing patients,chronic underlying diseases,without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy.The mortality rate of group DNR was much higher than that of group R (19.39％ vs.7.68％,x2=64.40,P=0.000).Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease.The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain.

Objective_To investigate the effect of estrogen(E2) on different age rat groups of Parkinson’s disease (PD) models induced by Rotenone and its mechanism.Methods_24-month-old SD rats(high age group)and 12-week-age SD rats( low age group ) were divided into control group ( saline ) , Rotenone treatment group ( Rotenone 2 mg/kg), Estrogen treatment group(Rotenone 2 mg/kg and E2 1 mg/kg)and Tamoxifen treatment group(Rote-none 2 mg/kg, E2 1 mg/kg and Tamoxifen 1 mg/kg).Behavior tests were carried out to observe the change of movement function, Immunohistochemistry and Western blot were used to assess the changes of TH and LC-3. HPLC-ECD was used to detect possible changes of monoamine neurotransmitters in striatum.Results_1) Rotenone reduced significantly old age rat’s rotarod latencies and prolonged the climbing pole time(P<0.05).E2 ameliorated this effect, Tamoxifen reduced the effect of E2.2) Rotenone significantly reduced the number of TH positive cells in
high age rats(P<0.05), E2 partly restored TH positive cell loss, Tamoxifen reduced this effect of E2, so did the ex-pression of TH protein.3)Rotenone increased the expression of LC-3(P<0.05), E2 did not affect the expression of LC-3, so did Tamoxifen.4)Rotenone significantly decreased the level of DA and its metabolite DOPAC(P<0.05), elevated the level of 5-HT especially in old rats(P<0.05).E2 downregulated the influence, and Tamoxifen reduced the effect of E2.5)Rotenone increased the number of autophagosomes, but E2 increased the proportion of autolyso-somes/autophagosomes.Conclusions_Old age rat PD model was more reliable.Estrogen promoted autophagy ma-ture, and had obvious therapeutic effect on rat PD model induced by rotenone.