Objective To explore the high risk factors,clinical prediction and treatment methods of the shoulder dystocia to reduce the incidence of complications in mother and child.Methods The clinical data of 41patients with shoulder dystocia were retrospectively analyzed,and they were divided into the huge baby group and normal weight baby group.The causes,incidence of complications in mother and child and the treatment were ana-lyzed.Results In the 41 cases of shoulder dystocia,the incidence of complications in mother and child in the macro-somia group was higher than the normal weight baby group(the incidence of postpartum hemorrhage,the incidence of neonatal asphyxia in the huge baby group were higher than the normal weight baby group,χ2 =4.439,5.225,all P <0.05;the incidence of gestational diabetes mellitus,III -degree perineal lacerations,new born injury were higher than the normal weight baby,but the difference between the two groups was no significant),the midwife methods was more than normal weight baby group(6 huge baby cases using McRobert method was lower than the 15 normal weight baby cases;12 huge baby cases using McRobert method and press -front shoulder method was higher than the 3 normal weight baby cases,the difference between the two groups was significant,χ2 =10.896,5.036,P <0.05;using 3 and 3 above methods in huge baby group was more than normal weight baby group,but the difference between the two groups was no significant,χ2 =0.139,1.267(likelihood ratio),P >0.05,and the difference between the two groups reach the significant level.Conclusion The shoulder dystocia is a serious maternity emergency,the huge baby is the high factor of the shoulder dystocia,the important treatment to reduce the incidence of complications in mother and child is the correct prevention,prediction,early identification and proper treatment.

Objective To breed and identify steroid receptor coactivator-3 (SRC-3) knock-out mice. Methods Heterozygote mice were bred and reproduced. Wild genotype, heterozygote genotype, and homozygote genotype would appear in offsprings of parents. Genome DNA extracted from the murine tails was subjected to PCR for genotype identification. Male homozygote mice were selected to mate with the female heterozygote mice for acquiring homozygote baby mice according to Mendel law. Results Breeding and reproducing were successful and more heterozygote genotype mice were reproduced. Conclusion Appropriate methods for breeding, reproducing, and identifying are the effective way for acquiring SRC-3 knock-out mice from heterozygote mice.

OBJECTIVE: To investigate the effects of Baobaole oral liquid on neuronal excitability in lateral hypothalamic area (LHA) and ventromedial hypothalamic nuclear (VMN) in anorectic rats. METHODS: The anorectic rat model was established by feeding with special prepared forage for a week, and then Baobaole oral liquid, a liquid extract of a compound traditional Chinese medicine for activating spleen, was administered once a day for 3 weeks. Finally, extracellular recording from LHA and VMN neurons in rats were made in order to characterize their responses to gastric vagal nerve stimulation and intravenous injection of glucose in the normal, untreated, and Baobaole-treated groups. RESULTS: There was no statistical difference in response characteristics of LHA neurons to gastric vagal stimulation among 3 groups. The duration of VMN neuron excitation response to gastric vagal nerve stimulation in the untreated group was significantly longer than that of the normal control group (P<0.01), while the required stimulation intensity was significantly decreased (P<0.01). Moreover, among the neurons responding to the gastric vagal stimulation in the untreated group, the number of glycemia-sensitive neurons decreased in LHA and increased in VMN (P<0.01). The gastric vagal stimulation induced neuron responses in LHA and VMN of the Baobaole-treated group were not significantly changed as compared with the normal control group (P<0.01), and neither were the intravenous injection of glucose induced responses. CONCLUSION: Baobaole oral liquid can modulate the sensitivity of LHA and VMN neurons to the peripheral signal and make the coordination between LHA and VMN neurons in order to improve the appetite of anorectic rats.

BACKGROUND: Cervical sympathetic ganglia block accelerates the re covery of the homeostasis of organic nervous-endocrine-immune system, butit is still unclear whether it can suppress the imbalance of homeostasis in duced by post-traumatic stress disorder. OBJECTIVE: To observe the effect of cervical sympathetic ganglia blockon the mortality of mice with combined radiation and burn injury, andwhether it can become an easy and effective method to treat secondarydamage after serious trauma. DESIGN: A randomized grouping design, an animal controlled experiment. SETTING: Department of Anesthesiology, Guangzhou General Hospital, Guangzhou Military Area Command of Chinese PLA.MATERIALS: The experiments were carried out in the Institute of Combined Injury, the Third Military Medical University of Chinese PLA between February 2004 and July 2005. Totally 160 Kunming mice were randomly divided into control group (n=50) and cervical sympathetic ganglia block group (n=50). In the control group, the mice were only induced to models of combined radiation and bum injury, and treated with injection of 0.3 mL saline at cervical part. In the cervical sympathetic ganglia block group, the mice were induced to models of combined radiation and burn injury, and then treated with cervical sympathetic ganglia block, once a day for 14 days continuously.METHODS: Methods to induce injury in the animals: ① Radiation injury: The mice were given even radiation of 60Coγ ray (5 Gy) at a distance of 1.5 m to the whole body, the rate of absorptive dosage was (5.17-5.33) mGy/s. ② Burn injury: After the radiation injury, coagulated gasoline was smeared on the back and burnt for 8 s to induce degree Ⅲ burn injury of 15% of the total body surface, which was proved by the pathological section. Methods of cervical sympathetic ganglia block: Cervical sympathetic ganglia block was given bilaterally, and then the mice were injected with 0.2 mL lidocaine (5 g/L), and it was observed whether the symptoms similar to Horner syndrome (hyperemia of conjunctiva, drooping eyelid,blushing, smaller eyeslit) occurred or not at 5 minutes after injection.MAIN OUTCOME MEASURES: The mortality at 2, 5, 7, 10, 20 and30 days after injury and the changes of the numbers of red blood cells,white blood cells and blood platelet in peripheral blood at 7, 14 and 21 days after injury were observed in both groups. The effects of cervical sympathetic ganglia block on the levels of tumor necrosis factor-alpha (TNF-α),interleukin-1β (IL-1β) and interleukin-6 (IL-6) in serum at 3, 6 and 14days after combined radiation and burn injury were also observed.RESULTS: All the 160 mice were involved in the analysis of results without deletion. ① Compared with the control group, the mortalities at 5,7, 10, 15, 20 and 30 days in the cervical sympathetic ganglia block group were significantly decreased [control group: 8%, 22%, 32%, 54%, 74%,82%, 90%; cervical sympathetic ganglia block group: 8%, 14%, 16%, 22%,28%, 34%, 56%]. ② Compared with the control group, the numbers of red blood cells, white blood cells and blood platelets in peripheral blood at 7,14 and 21 days after injury in the cervical sympathetic ganglia block group were significantly increased [at 21 days: red blood cells: 23.21×1012 L-1, 14.58×1012 L-1; blood platelet: 16.87×1011 L-1, 12.57×1011 L-1; white blood cells: 20.65×109 L-1, 14.58×109 L-1]. ③ The levels of TNF-α, IL-1β andIL-6 in serum at 3, 6 and 14 days after injury in the cervical sympathetic ganglia block group were significantly decreased as compared with those in the control group [at 14 days: TNF-α: 189, 365 ng/L; IL-1β: 14, 23 ng/L;IL-6: 70, 132 ng/L].CONCLUSION: Cervical sympathetic ganglia block can significantly decrease the mortality of animals with combined radiation and burn injury,and it is an easy and effective method to treat serious trauma, and the mechanism may be realized through accelerating the recovery of hematopoietic function and suppressing the excessive inflammatory reaction.

Objective To explore the epidemiology, clinical and pathological characteristics,treatment and prognosis of Richter's syndrome (RS). Methods The clinical and laboratory feature,treatment, prognosis of two cases were reported, and the related literature was reviewed. Results The major symptom of two cases suffered with enlarged lymph nodes, and pathological examination indicated a diffuse large B cell lymphoma. A large number of mature small lymphocytes were found in peripheral blood and bone marrow, and the immune phenotype was consistent with chronic lymphocytic leukemia. CHOP regiment was used on two cases. One obtained complete remission, and the other cases partial remission. Conclusion RS may occur at early stage after CLL diagnosis. In some cases, the diagnosis of RS and CLL are concomitant.Prognosis of some patients of RS is unfavourable. It was important to take biopsy at early stage.

10.3969/j.issn.2095-4344.2013.23.013

Objective To analyze the adult hemophagocytic syndrome' s pathogeny,clinical features,prognostic factors and therapeutic options.Methods 18 cases of adult hemophagocytic syndrome were analyzed,the Kaplan-Meier analysis was used to investigate the total survival rate,and 17 clinical pathological factors and clinical treatment methods which may influence survival were analyzed by Log-rank test in the univariate analysis.Results In this group of patients,EBV infection and malignant lymphoma were the most common initiating diseases.The most common clinical features were peripheral cytopenia in two or three lineages (100 ％),fever (83 ％),splenomegaly (78 ％),swollen lymph nodes (56 ％).The mortality rates as high as 66.7 ％.The median survival time was 7.4 weeks.One-way ANOVA results showed that the initial symptoms as fever (P =0.039),age ＞ 30 years old (P =0.031),enlargement of the liver (P =0.041),Hb ＜ 100 g/L and Ph ＜ 50 g/L (P =0.039) were relevant prognostic factors.Conclusion Adult hemophagocytic syndrome patients with fever as the initial symptoms,age ＞ 30 years old,liver enlargement,Hb ＜ 100 g/L,Plt ＜ 50 g/L indicates poor prognosis,thus these patients having HPS risk factors should be given active chemotherapy and supportive therapy.

Objective This study was to compare surgical safety and oncologic adequacy of laparoscopy-assisted gastrectomy (LAG) versus open gastrectomy (OG) for advanced gastric cancer.Methods 120 consecutive AGC patients undergoing LAG with D2 lymph node dissection between September 2005 to December 2009 were compared with 120 AGC patients undergoing OG during the same period.In each group,50 underwent distal gastrectomy,70 for total gastrectomy.Results There was no conversion to open surgery in LAG.The operative time was significantly longer in LAG than OG [(307 ± 84) min vs.(203 ± 52) min,t'=11.556,P ＜ 0.01].The estimated blood loss was significantly less in LAG group than OG group [(258 ± 78) ml vs.(318 ± 89) ml,t =5.550,P ＜ 0.01].The number of lymph nodes retrieved was(17 ±11) in LAG,(16 ±10)in OG (t =0.723,P＞0.05).All margins were tumor free in both groups.9 patients had the postoperative complication in LAG,8 patients in OG (P ＞ 0.05).Length of postoperative stay was significantly shorter in LAG than OG [(10.6 + 4.7) vs.(14.3 ± 2.9) days,t' =7.339,P ＜0.01].There was no mortality in both groups.The 5-year recurrence-free survival rate were comparable (47.6％ in LAG vs.42.8％ in OG,x2 =0.577,P ＞ 0.05) between the two groups.Conclusions This study suggested that laparoscopy-assisted gastrectomy is safe and feasible in terms of surgical outcome and oncologic adequacy for advanced gastric cancer.

Objective To investigate the efficacy and adverse events of BACOD regimen for relapsed and refractory non-Hodgkin lymphoma (NHL). Methods Sixty patients with relapsed and refractory NHL received chemotherapy of BACOD regimen: bleomycin 10 mg/m2, intravenous drip on the 2nd and 9th day;cyclophosphamide 750 mg/m2, intravenous drip on 1st day; vindesine 3 mg/m2, intravenous drip on 1st and 8th day; cytarabine 150 mg/m2, intravenous drip on 2nd-5th days; dexamethasone 10 mg/m2, intravenous drip on 2nd-5th days; every 3 weeks was one cycle. Results Eighteen cases (27.7 %) received the complete remission (CR), 30 the partial remission (PR), 13 stable disease (SD) and 4 progressive disease (PD). The overall response (CR+PR) rate was 70.8 %. The median remission time of patients with response was 11 months(2-38 months). The 1-year survival rate was 32.3 % and the 2-year survival rate was 24.6 %. The main adverse events were myelosuppression. Conclusion BACOD regimen can be used as the relief regimen of relapsed and refractory NHL.

Objective To investigate the epidemiology of patients in malignant hematologic neoplasms with fungemia and provide evidence for clinical therapy. Methods 23 cases of patients of malignant hematologic neoplasms with fungemia concurrent clinical material, the dangerous factor, the fungus colony classification as well as the treatment and the prognosis were carried on the review analysis. Results Each patient with fungemia was seriously ill with two or more predisposing factors;Candida ablicans accounted for 47%;the rate of candida parapsilosi, candida tropicalis were 17%, 12%. In the 23 cases of patients,13 cases of patients cure (56.5%), 8 cases of patients died (34.7%);2 cases of patients give up (8.6%). Conclusion Fungemia in the patients of malignant hematologic neoplasms usually occurred with predisposing factors. Important measures to reduce mortality include curing the underlying diseases, emphasis on mornitoring fungal pathogen and susceptibility tests, early diagnosis and compliance medication principles.