Objective To investigate the clinical application of transcranial magnetic stimulation motor evoked potentials (TMS-MEP) of rectus abdominis in the diagnosis of thoracic spinal cord injury. Methods The innervation of rectus abdominis and dermatomal distribution were studied in 5 adult cadavers. MEP of bilateral rectus abdominis in different segments was measured and recorded in 25 normal subjects for reference and in 23 patients with T4-T12 spinal cord injury. Results The anatomic study showed that rectus abdominis was innervated by 7 pairs of intercostal nerve from T6 to T12, useful to determine the MEP recording points in the body surface. In all normal subjects, T6-T12 MEP of bilateral rectus abdominis were recorded successfully and the referential range of normal MEP was established. The MEP peak latencies of each level were significantly different each with other. Among 23 patients suffering from thoracic spinal cord injury, 12 cases with complete paralysis had no MEP record below the injured level and no neurological recovery during the follow-up; while in 11 cases with incomplete paralysis, abnormal MEP were recorded in all but one with T4 fracture, the MEP of this patient disappeared below T6. The change of MEP of rectus abdominis was consistent with the level of fracture except in 1 case. During follow-up, 9 cases with incomplete paralysis patients showed recovery to different extent. Conclusion According to neuroanatomy, segmental MEP of rectus abdominis can be evoked and recorded in all normal subjects. The MEP peak latencies are significantly different in each level. MEP of rectus abdominis is proved to have the localizing and characteristic diagnostic value in the evaluation of the thoracic spinal cord injury.

OBJECTIVE:To explore the method and approach for traditional Chinese pharmacists to play an active role in case of emergent epidemic situation. METHODS:Taking the opportunity of H1N1 flu treatment,the traditional Chinese pharmacists carried out pharmaceutical services such as drug counseling,establishing medication history for typical cases,offering guidance and advice on medication,retrospectively analyzing prescription and consulting records. RESULTS & CONCLUSION:In the differential treatment,pharmacists of traditional Chinese medicine should take full account of patients' individual differences,actively participate in the design of individualized dose scheme and offer medication guidance so as to enhance patients' medication compliance meanwhile enhancing the status of pharmacists of traditional Chinese medicine.

Objective To study the gender differences in echocardiography in essential hypertensives. Methods Echocardiography measurement was performed in 108 subjects with Grade 1-2 essential hypertension (52 in female patient group, PGf, and 56 in male patient group, PGm). Forty two normotensive subjects (20 in female control group, CGf, and 22 in male control group, CGm) were as controls.Data were obtained by averaging measurements of the traced heart chambers and velocity curves in 5 cardiac cycles. Results Compared with PGm, the following echocardiographic features in PGf were showed:LAID (37.24±5.88 vs 32.14±3.80)mm,P＜0.01] and MVa[(84.18±12.13 vs 81.71±12.30)cm/s, P＜0. 05] were greater; LVMI [ ( 119.26 ± 22.33 vs 128.17 ± 27.00 ) g/m2 , P＜0. 05], EF ( 75.13 % ±6.69% vs 83.00% ±3.68%,P＜0. 01), FS (41.67% ±7.99%0 vs 49.03% ± 7.35%, P＜0.01), MVe[(68. 28±8.66 vs 73. 73±11.46)cm/s, P＜0. 05] and MVe/a(0.83±0. 08 vs 0. 93±0.11, P＜0.01)were lower. The differences between CGf and CGm were not significant. Conclusion There are echocardiographic differences between sexes in hypertensives including cardiac structural and functional changes. Hypertensive woman is more susceptible to both cardiac structure damage and cardiac dysfunction.

Objective To explore the near-term therapeutic effect and long-term result of stereotactie surgery in treatment of moderate hypertensive intraeerebral hemorrhage and discuss related problems of the surgery.Methods 60 cases of moderate hypertensive intracerebral hemorrhage were divided into two groups at random.30 cases treated by stereotactie surgery,the others treated by nonsurgical method, the near-term rebleeding rate, mortality rate and longterm living quality of the two groups were analyzed and compared.Results There were no statistical differences in rebleeding rate and mortality rate between the two groups( all P >0.05 ).The long-term result indicated that there was statistical difference in GOS grades between the two groups( P <0.05).The surgical group had better result than nonsurgical group.Conclusion The patients suffered for moderate hypertensive intracerebral hemorrhage treated by stereotsefic surgery had better long-term therapeutic effect than those treated by nonsurgical method.

Objective To detect the opening of the myocardial mitochondrial permeability transition pores (MPTP) after intrauterine asphyxia in neonatal rats,and to explore the mechanism of the myocardial hypoxic-ischemic and reperfusion injury caused by the opening of MPTP after asphyxia.Methods Cesarean sections were undertaken in female SD rats at the 21st day after pregnancy.The uterine arteries were clamped for 30 minutes followed by releasing for 1 hour and the pups were allocated into the asphyxia group.The uterine arteries were isolated but not clamped and the pups were allocated into the control group.There were 30 neonatal rats in either group and all of them were sacrificed 24 h after birth.Serum cardiac troponin Ⅰ (cTn Ⅰ) levels were detected by enzyme linked immunosorbent assay.The opening degree of MPTP was detected by fluorospectro-photometry.Myocardial ischemic areas were detected by TTC staining.Tissues from the cardiac apex were taken and the pathologic changes of the myocardium were explored by hematoxylin-eosin staining.SPSS for Windows 13.0 was used for statistic analyses.Results In HE staining slices,the myocardial cells in asphyxia group were disarranged and edematous.In control and asphyxia group,the serum cTn Ⅰ levels were (0.08 ±0.04) μg/L and (0.40 ±0.29) μg/L (P ＜0.01),the myocardial ischemic areas were (8.01 ±3.48) ％ and (42.50 ± 15.90)％ (P ＜0.01),and the opening degrees of MPTP were (118.10 ± 19.10) RFU and (79.40 ± 10.57) RFU (P ＜ 0.01) respectively.The serum levels of cTn Ⅰ,the myocardial ischemic areas,and the opening degrees of MPTP were significantly increased in asphyxia group compared with control group.The serum level of cTn Ⅰ was positive correlated with the opening degree of MPTP in either group(r =-0.384,P ＜ 0.01).Conclusion There are myocardial injuries in neonatal rats after asphyxia,which represent as high level of serum cTn Ⅰ,myocardial ischemia and necrosis.Opening of the myocardial MPTP is one of the causes of myocardial injury.

Background and Objective Large randomized controlled trials have demonstrated that percutaneous coronary intervention (PCI) with the routine use ofdrug-eluting stents is safe and effective, however, the patients older than 75 years undergoing PCI are at increased risk for major adverse cardiac events, so that the patients are usually excluded from this trial. The aim of the present study was to assess the early clinical outcome and risk factors in old patients with acute ST elevation myocardial infarction (STEMI) following primary PCI. Methods We analyzed the outcome after stenting in 136 patients older than 60 years in our coronary care unit with acute STEMI, and the patients were further classified in 2 age groups: patients≥75 years and <75 years. Results Though the older group had a higher prevalence of adverse baseline characteristics and lower final TIMI flow than those of the younger, the procedural success had no difference between two groups. The main adverse clinical events (MACE) for the old group was a little higher comparing with the younger in 12-month following up. Conclusions Our study suggest that drug-eluting stent implantation in elderly patients with acute ST elevation myocardial infarction has high initial procedural success rates despite having more severe baseline risk characteristics, and to shorten the time form symptom onset to PC1 and improve final TIMI flow strategy may decrease MACE among old patients following PCI.

Objective To investigate the anesthesia and perioperative blood management of patients with Marfan syndrome (MS) undergoing scoliosis surgery.Methods The clinical data of MS patients underwent scoliosis surgery from January 2013 to December 2015 in Peking Union Medical College Hospital were collected and compared with patients received the same surgery but without MS.Perioperative information and data on anesthesia and blood management were analyzed.Results Compared with control group,MS patients were found with more preoperative comorbidities with statistical significance,including eye disease,echocardiographic abnormalities,and ventilatory defects.MS patients had significantly more blood loss,more intraoperative and postoperative allogeneic and autologous blood transfusion.The operation time,anesthesia time,and length of postoperative hospital stay were all significantly longer in MS patients.Conclusions MS patients are common with multi-system involvement and comorbidities.Considering the high risk of perioperative bleeding,the anesthesia and blood management for MS patients undergoing scoliosis surgery should be with extra caution.Blood management should be applied and appropriate invasive monitoring methods should be considered when necessary.

The data production and management processes were described and the factors influencing the data pro-cessing quality were analyzed with CMCC/CMCI as an example, and measures were put forward for improving the data production and management-the key to database development.

Objective Anti-N-methyl-D-Aspartate (NMDA) receptor encephalitis is a rare disease,recently described as autoimmune disorder of paraneoplastic limbic encephalitis,which is related to the NMDA receptor antibodies and frequently develops in young women with ovarian teratoma.The disease is usually accompanied by symptoms of psychosis and abnormal behaviors,autonomic nervous system dysfunction,central hypoventilation,and hyperthermia.During induction and maintenance of general anesthesia,we should be aware of adverse reactions such as cardiovascular events,hyperthermia and respiratory insufficiency.In order to maintain vital signs stable,pharmacological agents including vasopressors,β-blockers,antihypertensives,and anticholinergics should be prepared before the surgery.Invasive monitoring for blood pressure can be set if necessary.This study described the method for anesthetic management of 3 patients with anti-NMDA receptor encephalitis undergoing resection of ovarian teratoma under general anesthesia.Preoperative treatment included antipsychotic,anti-infective and immune therapy.General anesthesia was induced with propofol,rocuronium,fentanyl and midazolam to facilitate tracheal intubation and was maintained with inhalation of sevoflurane (mixed with oxygen and air) and intermittent iv boluses of fentanyl and rocuronium during the surgery.All the drugs mentioned above had no interaction or had slight indirect action on anti-NMDA receptors to avoid NMDA-related adverse reactions.In conclusion,the adequate preparation for the surgery should be done in this kind of patients,we should avoid using anesthetics having NMDA receptor antagonism (such as ketamine,N2O,methadone,dextromethorphan,phencyclidine) or other anesthetics acting indirectly (such as pentobarbital) on the NMDA receptors during anesthetic management in the patients with anti-NMDA receptor encephalitis.