An allergic reaction was occurred in a 17-years old girl who was undergoing local anesthesia before tonsillectomy. Ptosis was observed in right side of patient shortly after injection of lidocaine to right palate. Then the patient feel grasp and cough, accompanied by nausea and vomiting. The patient was placed in supine position. Dexamethasone and epinephrine was administrated intramuscularly, symptoms were relieved 10 minutes later.
Adolescent ; Anesthesia, Local ; adverse effects ; Eyelids ; drug effects ; Female ; Humans ; Lidocaine ; adverse effects ; Muscle Weakness ; chemically induced

Objective: To investigate the clinical therapy for Gustilo type Ⅲ B、ⅢC open fractures with skin and soft tissue defects on the upper extremities. Methods: From July 2014 to July 2016, 19 patients with Gustilo type Ⅲ open fractures (type ⅢB 12 cases , type ⅢC 7 cases) and soft-tissue defects in upper extremity were admitted, including 14 males and 5 females , aged 22 to 59 years (average 42 ). All the cases were treated by staged treatment. In the first stage, early debridement, nerves, vessels and tendons repairment, fixation of the fractures, VSD for the wound were performed. One patient underwent amputation 5 days after first operation. All the other 18 patients received flap transplantion, including 10 anterolateral thigh perforator flaps, 3 latissimus dorsal muscular flaps and 5 free lateral arm flaps. Results: 8 patients were followed up for an average duration of 14.5 months(ranged from 7 to 23 months). Partial necrosis happened at the distal end of one anterolateral thigh perforator flap and healed with skin-grafting.1 flap encountered vascular complication which survived with 5cm-in-width skin necrosis at the distal end of the flap after successful surgical exploration. 1 case had superficial infection at wound. The wounds at donor sites were primarily healed except for 1 case with skin graft necrosis and superficial infection. All the other flaps survived completely. The patients received 2-6 operations each. The average hospital stay was 34 days (12-71 days). All Skin flap texture was soft and had varying degrees of pigmentation. The flap sensory recovery was S2 in 4 cases, S3 in 9 cases, S4 in 5 cases. 1 case had obvious scar hyperplasia. Conclusions Staged surgical treatment in Gustilo type Ⅲ open fractures with soft-tissue defects in upper extremity provide a high survival rate of flaps and satisfactory results. The treatment is well tolerate by patients.

Objective To investigate the predictive value of white blood cell-to-hematocrit ratio(WBCHR)for in-hospital major adverse cardiovascular events(MACE)after reperfusion therapy in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A case-control study was conducted to retrospectively select 319 patients with first-time diagnosis of STEMI who un-derwent percutaneous coronary intervention(PCI).Patients were divided into MACE group(69 ca-ses)and non-MACE group(250 cases)based on the occurrence of MACE during hospitalization.Clinical data,including general information,laboratory test indicators,echocardiography,and coro-nary angiography results,were compared between the two groups.Univariate and multivariate Logistic regression analyses were performed to explore the risk factors for in-hospital MACE after reperfusion therapy in STEMI patients.Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the predictive value of WBCHR for in-hospital MACE after reperfusion therapy in STEMI patients.Results The levels of fasting blood glucose,uric acid,creatinine,white blood cell count,neutrophil count,high-sensitivity C-reactive protein(hs-CRP),D-dimer,and WBCHR were significantly higher in the MACE group than in the non-MACE group,while red blood cell count,hemoglobin,hematocrit,and left ventricular ejection fraction were lower(P＜0.05).No significant differences were observed in age,gender,smoking history,hypertension history,diabetes history,door-to-wire(D2W)time,total cholesterol,triglycerides,and the number of diseased vessels be-tween the two groups(P＞0.05).Multivariate Logistic regression analysis revealed that elevated u-ric acid levels(OR=1.005;95％CI,1.002 to 1.009;P=0.004),decreased hemoglobin concen-tration(OR=0.964;95％CI,0.941 to 0.988;P=0.003),increased hs-CRP levels(OR=1.032;95％CI,1.009 to 1.056;P=0.007),and increased WBCHR(OR=1.455;95％CI,1.295 to 1.635;P＜0.001)were independent risk factors for in-hospital MACE after reperfusion therapy in STEMI patients.ROC curve analysis showed that the area under the curve of WBCHR for predicting in-hospital MACE after reperfusion therapy in STEMI patients was 0.855(95％CI,0.796 to 0.914,P＜0.001),with a sensitivity of 63.8％and a specificity of 99.6％.Conclusion WBCHR is an independent influencing factors of in-hospital MACE after reperfusion therapy in STEMI patients and has a high predictive value for in-hospital MACE in these patients.

Objective To investigate the predictive value of white blood cell-to-hematocrit ratio(WBCHR)for in-hospital major adverse cardiovascular events(MACE)after reperfusion therapy in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A case-control study was conducted to retrospectively select 319 patients with first-time diagnosis of STEMI who un-derwent percutaneous coronary intervention(PCI).Patients were divided into MACE group(69 ca-ses)and non-MACE group(250 cases)based on the occurrence of MACE during hospitalization.Clinical data,including general information,laboratory test indicators,echocardiography,and coro-nary angiography results,were compared between the two groups.Univariate and multivariate Logistic regression analyses were performed to explore the risk factors for in-hospital MACE after reperfusion therapy in STEMI patients.Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the predictive value of WBCHR for in-hospital MACE after reperfusion therapy in STEMI patients.Results The levels of fasting blood glucose,uric acid,creatinine,white blood cell count,neutrophil count,high-sensitivity C-reactive protein(hs-CRP),D-dimer,and WBCHR were significantly higher in the MACE group than in the non-MACE group,while red blood cell count,hemoglobin,hematocrit,and left ventricular ejection fraction were lower(P＜0.05).No significant differences were observed in age,gender,smoking history,hypertension history,diabetes history,door-to-wire(D2W)time,total cholesterol,triglycerides,and the number of diseased vessels be-tween the two groups(P＞0.05).Multivariate Logistic regression analysis revealed that elevated u-ric acid levels(OR=1.005;95％CI,1.002 to 1.009;P=0.004),decreased hemoglobin concen-tration(OR=0.964;95％CI,0.941 to 0.988;P=0.003),increased hs-CRP levels(OR=1.032;95％CI,1.009 to 1.056;P=0.007),and increased WBCHR(OR=1.455;95％CI,1.295 to 1.635;P＜0.001)were independent risk factors for in-hospital MACE after reperfusion therapy in STEMI patients.ROC curve analysis showed that the area under the curve of WBCHR for predicting in-hospital MACE after reperfusion therapy in STEMI patients was 0.855(95％CI,0.796 to 0.914,P＜0.001),with a sensitivity of 63.8％and a specificity of 99.6％.Conclusion WBCHR is an independent influencing factors of in-hospital MACE after reperfusion therapy in STEMI patients and has a high predictive value for in-hospital MACE in these patients.

OBJECTIVETo investigate spontaneous metastasis, micrometastasis and genetic stability in human breast carcinoma xenografts in nude mice.

METHODSIntact tissue from surgical specimens from breast carcinoma patients was xenografted into nude mice and transplanted from generation to generation. Cells from the xenografts were cultured in vitro and retransplanted into nude mice. Microsatellite DNA in the genome of human breast carcinomas, xenotransplanted tumors and metastases in nude mice were analyzed at three microsatellite loci.

RESULTSThe tumorigenicity of orthotopic xenotransplantation was 88.6% (31/35), with a metastatic rate of 41.9% (13/31). Cells from xenotransplants were successfully cultured in vitro. The taking rate of retransplantation into nude mice and the spontaneous lung metastasis rate were both 100% (10/10). Microsatellite DNA sequences in the genome of xenotransplanted tumors and metastases in nude mice were identical with that of the original human breast carcinoma at three microsatellite loci.

CONCLUSIONSTumorigenicity and metastatic potential can be improved in human breast carcinoma xenografts using intact fresh tumor tissue and orthotopic grafts. Xenotransplanted tumors and tumors after serial passage maintained the genetic stability. The detection of microsatellite DNA may identify micrometastases in a nude mouse model.

Aneuploidy ; Animals ; Breast Neoplasms ; genetics ; pathology ; Cell Division ; Female ; Humans ; Mammary Neoplasms, Experimental ; genetics ; pathology ; Mice ; Mice, Nude ; Microsatellite Repeats ; Neoplasm Metastasis ; Neoplasm Transplantation ; Time Factors ; Transplantation, Heterologous ; Tumor Cells, Cultured

Objective To evaluate the effect and mechanism of tribulus terrestris in kidney calcium oxalate stone in rats.Methods Sisty healthy male Wistar rats were divided into control group,model group,low-dose prevention group,high-dose prevention group,low-dose treatment group,high-dose treatment group by random number table method,each group of 10 rats.The control group was had free access to water,the model group was given 1％ ethylene glycol had free access to water,and the low-dose prevention group was given 1％ ethylene glycol had free access to water while was added in Tribulus terrestris extract 250 mg/(kg · d) treated by gavage,the high-dose prevention group was given 1％ ethylene glycol had free access to water while was added in Tribulus terrestris extract 500 mg/(kg · d) treated by gavage.The low-dose treatment group received 1％ ethylene glycol had free access to water while was added in tribulus terrestris extract 250 mg/(kg · d) treated by gavage on the 15th day.The high-dose treatment group received 1％ ethylene glycol had free access to water while was added in tribulus terrestris extract 500 mg/(kg · d) treated by gavage on the 15th day.At the end of the experiment on the 28th day,the body weight,blood urea nitrogen,creatinine,P,Ca2+,Mg2+ content,24 h urine volume,24 h urine Ca2+,Mg2 +,P,oxalic acid secretion,renal tissue homogenate detection of superoxide dismutase (SOD),glutathione peroxidase (GPX),malondialdehyde content of each group were detected.The crystal deposition and pathological changes of calcium oxalate were observed under the microscope.Measurement data were expressed as mean ± standard deviation (Mean ± SD),multiple comparisons between groups were performed using LSD-t test,and comparison between groups was performed by one-way anova analysis of variance.Results Compared with the control group,the rats in the model group had blood urea nitrogen (28.93 ±3.37) mmol/L,creatinine (162.31 ± 34.08) μmol/L,24 h uric acid (132.67 ± 27.96) μmol,Ca2+ (18.24 ± 1.94) μmol/24 h,the content of malondialdehyde (191.04 ± 20.56) nmol/mgprot in kidney homogenate was significantly increased,blood Ca2+ (2.01 ±0.28) mmol/L,renal GPX (479.82 ± 136.97) μmol/gprot,SOD(1.54 ±0.21) U/mgprot decreased significantly,these differences were statistically significant (P ＜ 0.05).Renal histopathology showed low-dose and high-dose prevention and treatment groups kidney calcium oxalate crystals and kidney damage were less than the model group.Conclusion The extract of Tribulus terrestris has a beneficial effect against calcium oxalate urinary stone formation induced by ethylene glycol.

Objective:To investigate the relationship between the E2 and E4 alleles of apolipoprotein E (apoE) gene and myocardial infarction (MI) in type 2 diabetes Mellitus (T2DM) patients, and to explore the relationship between apoE polymorphism and blood lipid metabolism.Methods:This case control study was conducted from August 2016 to March 2020 in China-Japan Friendship Hospital, 3 459 inpatients with T2DM were included including 3 044 patients without MI (T2DM group) and 415 patients with MI (T2DM+MI group). Real time fluorescent quantitative PCR was used to detect apoE polymorphism. Automatic biochemical analyzer was used to detect lipid levels. Logistic regression analyses were performed to determine the association of apoE with risk of MI in patients with T2DM.Results:(1) The frequency of E4 allele in T2DM+MI group (12.29%, 102/830) was significantly higher than in T2DM group (9.13%,556/6 088), while the frequency of E2 allele in T2DM+MI group (7.35%,61/830) was significantly lower than that in T2DM group (8.21%,500/6 088), P=0.012. Logistic regression analyses showed that E4 allele carrier (E3/E4+E4/E4) faced a higher risk for MI in T2DM patients ( OR=1.48, 95% CI 1.14-1.92, P=0.003), while E2 allele carrier(E2/E3+E2/E2)did not face a higher risk of MI in T2DM patients ( OR=0.88, P=0.642). (2) The levels of apoE polymorphism and blood lipid: The levels of TC, LDL-C and apoB increased in the order of E4 allele, wild type and E2 allele ( P<0.05). The levels of HDL-C, apoA1 and apoE decreased in the order of E4 allele, Wild type and E2 allele ( P<0.05). Conclusion:The E4 allele is a risk factor for MI in T2DM patients, and apoE polymorphism can affect blood lipid level in this patent cohort.

Objectives: To evaluate the tumor-infiltrating PD-1 positive lymphocytes and regulatory T cells (Treg) as prognosis predic-tors of metastatic renal cell carcinoma (mRCC), and investigate the expression of PD-1 and Treg cells in mRCC and elucidate their corre-lation with clinicopathological parameters and prognosis. Methods: A total of 269 mRCC patients from June 2007 to June 2017 in Zhongshan Hospital, Fudan University, were included in the study. The expression of PD-1 and Tregs in mRCC samples were detected by immunohistochemistry. The relationship between the expression of PD-1 and Tregs was analyzed. Results: PD-1 positive expression in mRCC was 31.60% (85/269) and it was positively correlated with the tumor Fuhrman grade and negatively correlated with progno-sis. Tumor infiltration of Tregs in mRCC was 36.80% (99/269), and it was also positively correlated with the tumor Fuhrman grade and negatively correlated with prognosis. Univariate analysis showed that PD-1 positive lymphocytes and high Treg infiltration numbers were negatively correlated with overall survival (OS) and progression free survival (PFS) rates. Thus, PD-1 positive lymphocytes and high Treg infiltration numbers are independent prognostic indicators of OS and PFS and when combined, they can render a better pre-diction for prognosis. Conclusions: Intra-tumoral infiltration of PD-1 positive lymphocytes and Tregs can be used as significant prognos-tic indicators of mRCC, and the combined predictive effect is better than the individual predictive effect. Therefore, evaluating the number of PD-1 positive lymphocytes or infiltrating Tregs in mRCC is helpful in clinically estimating mRCC prognosis in patients.

Objective To investigate the clinical therapy of early internal fixation combined with perforator flap for forearm open fractures of Gustilo types Ⅲ B & Ⅲ C.Methods A retrospective study was conducted of the 45 patients with forearm open fracture of Gustilo type ⅢB or Ⅲ C who had been treated from July 2012 to October 2016 at Department of Traumatic Orthopaedics,The Ninth People's Hospital of Wuxi.They were 26 men and 19 women,aged from 20 to 61 years (average,41 years).Twenty cases were Gustilo type ⅢB and 25 Gustilo type ⅢC.By AO classification,8 cases were type A,21 ones type B,and 16 ones type C.The wound size ranged from 4 cm × 3 cm to 36 cm × 8 cm.Thirty-three patients were treated by primary internal fixation plus secondary transfer with a perforator flap,12 ones by secondary internal fixation plus transfer with a perforator flap.The period from injury to secondary flap transfer ranged from 5 to 20 days (average,12 days).In this series,36 anterolateral thigh perforator flaps,5 latissimus dorsal muscular flaps and 4 lateral arm flaps were transferred.Results All the 45 free flaps survived with no deep infection or osteomyelitis.Partial necrosis happened at the distal ends of 2 latissimus dorsal muscular flaps which were cured by skin graft.Postoperative circulatory crisis happened after transfer of an anterolateral thigh perforator flap which survived with 5 cm skin necrosis at the distal end after successful surgical exploration.Superficial wound infection happened in 12 patients with no deep or bone infection.All the patients were followed up for 12 to 36 months (average,18.5 months).All the flaps were soft in texture,with varying degrees of pigmentation.The sensory recovery was S2 in 8 flaps,S3 in 29 flaps,and S4 in 8 flaps.Obvious scar hyperplasis was observed at the donor site in 5 cases while no obvious scar hyperplasis was observed in the other 40 ones.All the fractures got united after 4 to 14 months (average,8.6 months).Nonunion happened in 2 patients who were treated with autologous iliac graft 8 months after operation.By Anderson criteria,the curative efficacy was assessed as excellent in 15 cases,as good in 21,as fair in 7 and as poor in 2,yielding an excellent to good rate of 80.0％.Conclusion Early internal fixation combined with perforator flap transfe is an effective strategy for treatment of forearm open fractures with soft tissue defects of Gustilo types Ⅲ B &Ⅲ C,due to its advantages of shortened treatment period,possibility for early rehabilitation,decreased complications and satisfactory functional recovery.

Objective: To assess psychological acceptance and occupational stress of medical staff, analyze the relationship among personality, psychological acceptance and occupational stress and discuss the direct or indirect effects of personality to occupational stress. Methods: Eysenck Personality Questionnaire (EPQ-RSC) , Acceptance and Action Questionnaire-II (AAQ-Ⅱ) and Revised Occupational Stress Inventory (OSI-R) were administered to 749 medical staff. Results: The level of occupational stress of medical staff was high, the score of PSY was 26.8±7.13 and the score of PHS was 24.3±6.50. Personality and psychological acceptance can predict occupational stress. Psychological acceptance was a protective factor of occupational stress. Medical staff with personality of introversion, neuroticism and psychoticism suffered higher occupational stress. Personality have both direct and indirect effects on occupational stress. Neuroticism have the strongest effect on occupational stress with effect size of 0.496 (psychological stress) and 0.431 (physical strain) . Conclusion Medical staff have heavier occupational stress. There is a significant correlation between personality and occupational stress. Measures depending on personality should be taken to deal with this situation.