Objective To investigate the changes and the significances of pregnant women with hypothyroidism companied with gestational diabetes mellitus.Methods 76 cases of hypothyroidism and subclinical hypothyroidism companied with gestational diabetes mellitus pregnant women admitted to our department from Sept 2014 to Mar 2016 were selected as the observation group.According to the levels of FT3,FT4 and TSH,the observation group were divided into two group(A group and B group).Cobas e601 was used to examine TSH and PT,APTT,TT,FIB and ATⅢ were determined with ACL-TOP.PLT,MPV and PDW were determined by Sysmex2000i.Results FIB (3.98±1.74 g/L),MPV (10.18±1.53 fl)and PDW (15.03％±1.54％)in A group were significant higher than those in B group (3.91±1.62 g/L,9.37±1.48 fl,14.41％± 1.35％％) and the control group (3.47±1.43 g/L,8.96±1.42 fl,13.67％±1.26％).FIB,MPV and PDW in B group was higher than those in the control group.PT (12.26±1.41 s,12.21±1.39 s) and APTT (31.80±8.72 s,30.43±8.54 s) in A group and Bgroup were higher than those in the control group (12.13 ± 1.32 s,29.24± 8.37 s).Otherwise,AT Ⅲ (78.47％± 10.36％,79.58％ ± 10.22％) in A group and B group was significant lower than that in the control group (86.56％±8.86％).There were distinct difference (t=3.072～6.153,P＜0.05).Conclusion The disorder of blood coagulation existed in pregnant women with hypothyroidism companied with gestational diabetes mellitus.Early diagnosis and intervention can reduce the occurrence of thrombotic disease and cardiovascular disease.

OBJECTIVE:To compare the effects of morphine and nalbuphine on related indexes of maternal after cesarean sec-tion. METHODS:A total of 120 maternal underwent cesarean section were randomly divided into observation group(60 cases)and control group (60 cases). After surgery,observation group was given Nalbuphine hydrochloride injection 20 mg+0.75% Ropiva-caine hydrochloride injection 20 mL for patient-controlled epidural analgesia. Control group was given Morphine hydrochloride injec-tion 8 mg+0.75% Ropivacaine hydrochloride injection 20 mL for patient-controlled epidural analgesia. VAS score,systolic pres-sure,diastolic pressure,respiration rate(RR),SpO2 at the onset of analgesia(T0),6 h(T1),12 h(T2),24 h(T3)and 48 h(T4) after analgesia as well as the levels of IL-6,IL-8,CRP and PRL at T0,T3,T4 were observed in 2 groups. The satisfaction rate of analgesia and the occurrence of ADR were also observed. RESULTS:There was no statistical significance in satisfaction rate of an-algesia between 2 groups(96.67% vs. 98.33%,P>0.05). At T0,T1,T4,there was no statistical significance in VAS score between 2 groups(P>0.05). VAS scores of 2 groups at T2-3 were significantly higher than at T0,T1,T4,with statistical significance(P<0.05);but there was no statistical significance between 2 groups(P>0.05). There was no statistical significance in diastolic pres-sure,RR and SpO2 between 2 groups at T0-2(P>0.05). The systolic pressure of 2 groups at T3-4 were significantly higher than at T0, with statistical significance(P<0.05);but there was no statistical significance between 2 groups(P>0.05). There was no statisti-cal significance in the levels of IL-6,IL-8,CRP or PRL between 2 groups at T0(P>0.05). The levels of IL-6,IL-8 and CRP in 2 groups at T3 were significantly higher than at T0,but the observation group was significantly lower than the control group;at T4,the levels of IL-6,IL-8 and CRP in control group were significantly higher than at T0,with statistical significance(P<0.05),but there was no statistical significance in observation group,compared to at T0(P>0.05). The levels of PRL in 2 groups at T3-4 were significantly higher than at T0,and increased gradually as time;the observation group and significantly higher than the control group,with statistical significance (P<0.05). The incidence of ADR in observation group was significantly lower than control group,with statistical significance(P<0.05). CONCLUSIONS:For maternal after cesarean section,nalbuphine is similar to mor-phine in analgesic effect and cardiovascular effect,but it is better than morphine in reducing inflammatory level,promoting lacta-tion and safety.

Objective To investigate the effect of ulinastin on the gastro-intestinal circulation and systemic inflammatory response during open heart surgery with cardiopulmonary bypass( CPB) .Methods Thirty adult patients undergoing valve replacement with mild hypothermic CPB were randomly divided into two groups: ulinastin group (U ,n = 15) and control group (C , n = 15). In ulinastin group patients received ulinastin 6000 IU?kg-1iv after induction of anesthesia and another 6000 IU?kg-1 was added into the priming solution. In control group patients received equal volume of normal saline, instead of ulinastin. The patients were premedicated with morphine 0.2 mg?kg-1 and scopolamine 0.06 mg?kg-1 .Ranitidine 1 mg?kg-1 was given iv before induction of anesthesia. Anesthesia was induced with midazolam 0.1 mg?kg-1 , fentanyl 10?g?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with fentanyl 50-60?g?kg-1, midazolam, isoflurane and vecuroinum. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 35-45 mm Hg during operation. Gastric intramucosal PCO2 (PiCO2 ) was measured (pHi was calculated) and blood concentrations of TNF-?and IL-6 were determined before CPB (T0), 30 min after aorta was cross-clamped (T1), 60 min after termination of CPB(T2 ) and 6 h after operation (T3 ) .Results The two groups were comparable with regard to age, sex, body weight, ejection fraction, duration of CPB and cross-clamping time. (1) pHi decreased significantly at T1-2 as compared with the baseline value at T0 (P

ObjectiveTo investigate the role and mechanism of cervical sympathetic ganglia block in alleviation of cerebrovascular spasm (CVS) of rabbits after subarachnoid hemorrhage ( SAH ).Methods A total of 18 healthy male white rabbits whose cervical sympathetic ganglia were successfully blocked were randomly divided into three groups:sham operation group (Group A),SAH group (Group B) and SAH with cervical sympathetic ganglia block group (Group C).Venous blood (2 ml) and cerebrospinal fluid (2 ml) were obtained before the first blood injection ( T1 ),at 30 minutes after injection ( T2 ) and at day 7 after injection ( T3 ),respectively,and conserved in a low temperature refrigerator for spare use.Basilar artery value at T1,T2 and T3 was measured via cerebral angiography.The degree of damage to nervous system at T3 was recorded.ResultsThere was no significant difference in diameter of basilar artery at T1 among three groups.At T2 and T3,the diameters of basilar artery of Groups B and C were shorter than that of Group A,with Group B shorter than Group C,with statistical differences ( P ＜0.01 ).There were no significant differences in NO and NOS in plasma and cerebrospinal fluid at T1 among three groups (P＞0.05).NO and NOS contents at T2 and T3 were lower than those at T1,with Group A lower than Groups B and C,with statistical differences (P＜0.01 ).At T3,the nerve function of Groups B and C were better than that of Group A,with Group C better than Group B ( P ＜0.01 ).Conclusion Cervical sympathetic ganglia block relieves CVS,increases NO content and NOS activity in plasma and cerebrospinal fluid and promotes neural functional recovery after SAH.

Objective To investigate the effects of stellate ganglion block (SGB) on erythrocyte immunity in patients with acute cerebral infarction.Methods Twenty-four patients (13 male, 11 female) who developed acute cerebral infarction for less than 3 days were randomly divided into 2 groups (n=12each): Group A receiving traditional treatment and Group B receiving traditional treatment + SGB.The patients ranged in age from 51 to 64 yr and weighed 52-71 kg. All patients received intravenous 5% glucose 25 ml plus citicoline sodium 1.0 g and sodium ozagrel injectio 250 ml daily for 10 days in addition to dehydration and effective control of complications and intracranial pressure. Group B received SGB on one side alternatively with 1% licocaine 10 mi once a day for 10 days. Fasting venous blood samples were taken in the early mornings of the day before treatment (baseline, T1 ) and the 1st, 5th and 10th day of treatment (T2-4) for determination of the plasma MDA concentration and SOD activity, erythrocyte C3b receptor rosette rate (RBC-C3bRR) and RBC immune complex rosette rate (RBC-ICR) and Ne+-K+-ATPase activity in erythrocyte membrane.Results The plasma MDA concentration and RBC-ICR were significantly decreased during treatment es compared with the baselines at T1 in both groups (P＜0.05 or 0.01), but were significantly lower in Group B than in Group A (P＜0.05 or 0.01 ).The activities of plasma SOD and Na+ -K+ -ATPase in erythrocyte membrane and RBC-C3bRR were significantly increased during treatment as compared with the baselines at T1 and were significantly higher in Group B than in Group A.Conclusion SGB combined with traditional treatment can increase the activities of plasma SOD and Na+ -K+ -ATPase in erythrocyte membrane, inhibit production of oxygen free radicals and enhance RBC immune function in patients with acute cerebral infarction.

Objective To investigate the effects of stellate ganglion block (SGB) on brain injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB). Methods Forty ASA Ⅱ or Ⅲ patients of both sexes aged 22-50 yr weighing 40-64 kg undergoing elective cardiac valve replacement were randomly divided into 2 groups (n = 20 each): control group (group C) and SGB group. Radial artery and right internal jugular vein were cannulated for BP and CVP monitoring. A catheter was inserted into left internal jugular vein under local anesthesia and advanced cephalad until resistance was met for blood sampling. Right SGB was performed with 0.25% ropivacaine 10 ml. Successful block was confirmed by ipsilateral Homer's syndrome.ECG, BP, CVP and SpO2 were monitored. Anesthesia was induced with midazolam 0.2 mg/kg, fentanyl 5-8 μg/kg and vecuronium 0.12 mg/kg and maintained with fentanyl infusion at 8-10 μg· kg- 1· h- 1 and intermittent iv boluses of midazolam and vecuronium. Blood samples were collected for determination of plasma NO, ET-1, S100β protein and NSE concentrations and NOS activity immediately after left internal jugular vein was retrogradely catheterized (T0 ), at 30 min of CPB (T1), 10 min after release of aortic cross clamp (T2 ), 6 and 24 h after operation (T3 ,T4 ). The patients' cognitive function was assessed by using mini-mental state examination (MMSE) the day before operation and on 1st and 7th day after operation. Results The plasma ET-1, S100β protein and NSE concentrations were significantly increased during and after operation at T1-3 as compared with baseline values at T0 in both groups and were significantly lower in group SGB than in group C. Plasma NO concentration was significantly increased during CPB at T1 as compared with the baseline at T0 in both groups but was significant higher after CPB at T2 but lower after operation at T3,4 in gToup SGB than in group C. The NOS activity was significantly higher during operation at T1,2 in group SGB than in group C. The cognitive function was significantly better at 1st postoperative day in group SGB than in group C. Compared with the baseline value,NO/ET-1 ratio was significantly decreased during and after operation in group C,but no significant change in NO/ET-1 ratio was found in group SGB. Conclusion SGB can attenuate brain injury induced by CPB by improving cerebral perfusion through maintenance of relative balance of NO/ET-1.

AIM:To observe the expression of Toll like receptor 4 (TLR4) in the left ventricle of Goldblatt rats and to explore the role and mechanism of TLR4 in left ventricular remodeling of hypertension.METHODS:Goldblatt model of Two-kidney,one-clip (2K1 C) renovascular hypertension was induced in twenty-five rats(H group),and twenty rats served the sham-operated group(sham group).The tail cuff blood pressure was detected every week and echocardiogram was observed every other week.After eight weeks of operation,the rats were killed and the samples of the left ventricle were collected.The concentration of Ang Ⅱ in left ventricle was assessed by tadioimmunoassay.Western blotting and RT-PCR were used to exam the mRNA and protein expression of TLR4 in the left ventricle.Immunohistochemistry was adopted to exam the location of TLR4 in the myocardium.RESULTS:TLR4 mRNA and protein expression were consistently upregulated in the left ventricle of H group compared with sham group.In H group, predominantly sarcolemmal staining was observed,especially focal areas of intense TLR4 staining were found in juxtaposed regions of two or more adjacent myocytes;However,in sham group,TLR4 expression was diffuse and presumably cytoplasmic.Considerable correlation was found between blood pressure,MESS,LVMI,RWT,the concentration of Ang Ⅱ in left ventricle and the protein expression of TLR4 in myoeytes.CONCLUSION:During the development of left ventricular remodeling of Goldblatt rats,expression of TLR4 increases significantly.Enhanced expression of TLR4 locates in the sarcolemma,especially in juxtaposed regions of two or more adjacent myocytes.These indicate that TLR4 transmembrane receptor which is closely relative with inflammation and immunity probably contributes to the development of ventricular remodeling.[KEY WORDS]Hypertension;Ventricular remodeling;Receptors,Toll-like;Goldblatt rats

Objective To investigate the clinical effect and survival quality of raltitrexed and radiotherapy in treatment of esophagus cancer. Methods 100 cases with esophagus cancer were selected. There were 50 cases using raltitrexed combined with concurrent radiotherapy as observation group. Others were treated with 5-Fu combined with concurrent radiotherapy as control group. The clinical therapeutic effect and survival situation of two groups were evaluated. Results After treatment, the total response rate of observation group (86.0%) was higher than control group (58.0%), the differences between the two groups was statistical difference(P<0.05).The one- and two-year survival rates in observation group were higher than control group (χ2 = 4.32, 7.954, P=0.038, 0.005<0.05).There was no significant difference between the two groups in incidence rate of acute esophagitis, acute bone marrow suppression and acute skin reaction. Conclusion The clinical therapy of raltitrexed plus radiotherapy in treatment of esophagus cancer is distinct, and improve the survival time and the quality of life of patients.

The electrocatalytic oxidation of dopamine (DA) was studied by electrochemical approaches at a carbon ionic liquid electrode (CILE) modified with the composite film of nafion and L-aspartic acid (NL-CILE). The CILE was fabricated by replacing non-conductive organic binders with a room-temperature hydrophobic ionic liquid, 1-butyl-3-methyl-imidazolium hexafluorophosphate. The composite film of NL was used as matrix to adsorb DA and catalyze the oxidation of DA in phosphate buffer solution (PBS). The electrochemical response of DA was investigated at the NL-CILE, the traditional carbon paste electrode (TCPE), CILE and the nafion modified CILE (N-CILE) in 0.1M PBS (pH 7.4), respectively. The results showed the superiority of NL-CILE to N-CILE, CILE and TCPE in terms of provision of higher sensitivity, faster electron transfer and better reversibility. Under optimum condition, the oxidation peak current was rectilinear with DA concentration range from 0.1μM to 0.1mM, with a detection limit of 0.03μM (S/N=3) by differential pulse voltammetry. The proposed method was applied to determine DA in samples successfully.

ObjectiveTo study the effect of exercise on expression of p38 after cerebral infarction in rats.MethodsThe right middle cerebral artery was occluded(MCAO) with electric coagulation in Wistar rats,and then were divided into three groups at random 48 hours later: training group which were given wheel-running exercise everyday(n=20);control group(n=20) and sham group(n=10).The expression of p38 in cortex of the three groups were detected on 7th,14th,21th and 28th day after the MCAO.ResultsIn the cortex around the infarcted focus,the expressions of p38 elevated much significantly after cerebral infarction(P<0.05).The expression of p38 in training group were higher than those in control group(P<0.05) on the 21th and 28th day.ConclusionThe cerebral infarction could induce the expression of p38.The exercise could enhance its expression.