Objective:To evaluate the safety and effectiveness of pecto-intercostal fascial plane (PIFP) block and erector spinae plane (ESP) block for postoperative analgesia in median open heart surgery.Methods:A total of 158 patients who underwent elective midline open heart surgery at the Nanjing First Hospital, Nanjing Medical University from October 2022 to October 2023 were randomly divided into a PIFP block group (P group) and ESP block group (E group) using a random number table method, with 79 patients in each group. Before anesthesia surgery, the group P underwent ultrasound-guided bilateral PIFP block, while the group E underwent ultrasound-guided bilateral ESP block. Both groups received sufentanil intravenous patient-controlled analgesia after surgery. The resting and activity Visual Analog Scale (VAS) scores of two groups of patients at 6, 12, 18, and 24 hours after surgery were recorded; The first press time of the patient′s postoperative patient-controlled analgesia pump, the cumulative dose of sufentanil within 24 hours, the number of effective presses, and the rate of salvage analgesia were recorded; and extubation time, intensive care unit (ICU) stay, and adverse reactions; the time of nerve block operation, clarity score of puncture needle imaging under ultrasound, and patient satisfaction with nerve block were also recorded.Results:There was no statistically significant difference in resting VAS scores and activity VAS scores between the two groups at 6, 12, 18, and 24 hours after surgery (all P>0.05). The activity VAS scores of the group P were lower than those of the group E at 6 and 12 hours after surgery (all P<0.05); Compared with the group E, patients in the group P had significantly longer first press time of postoperative analgesia pump (all P<0.05), lower salvage analgesia rate, cumulative dose of sufentanil 24 hours after surgery, and fewer effective presses of analgesia pump (all P<0.05); There was no statistically significant difference in extubation time, ICU stay, and incidence rate of nausea between the two groups of patients (all P>0.05); Compared with the group E, the group P had shorter nerve block operation time, higher clarity score of puncture needle imaging under ultrasound, and higher patient satisfaction (all P<0.05). Conclusions:Compared with ESP block, PIFP block can provide better perioperative analgesia for cardiac surgery patients, reduce the use of opioid drugs, and the operation of PIFP block is simpler, with good safety and effectiveness.

Objective:To compare the efficacy of pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve (LFCN) block versus fascia iliaca compartment block (FICB) in elderly patients undergoing total hip arthroplasty under general anesthesia.Methods:Fifty-eight patients of both sexes, aged 65-85 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective direct anterior approach to total hip arthroplasty, were divided into 2 groups ( n=29 each) using a random number table method: PENG block plus LFCN block group (PL group) and FICB group (F group). In group PL, the mixture (20 ml) of 0.375% ropivacaine hydrochloride and dexamethasone 3.3 mg was injected around the nerve innervating the hip joint capsule under ultrasound guidance.In group F, the mixture (30 ml) of 0.375% ropivacaine hydrochloride and dexamethasone 5 mg was injected around the nerve innervating the fascia iliaca compartment under ultrasound guidance.All the patients received patient-controlled intravenous analgesia with oxycodone after surgery.When visual analogue scale scores≥4 points, oxycodone 1 mg was intravenously injected as rescue analgesic.The intraoperative consumption of remifentanil was recorded.First time to ambulation, discharge destination, length of hospital stay, and effective pressing times of analgesic pump, requirement for rescue analgesia and the incidence of quadriceps weakness, nausea and vomiting and nerve block related complications within 48 h after surgery were recorded. Results:Compared with F group, intraoperative consumption of remifentanil was significantly decreased, effective pressing times of analgesic pump and incidence of quadriceps weakness were decreased, first time to ambulation and length of hospital stay were shortened, and first discharge destination was prolonged ( P<0.05), and no significant change was found in the requirement for rescue analgesia and the incidence of nausea ( P>0.05) in group PL. Conclusion:PENG block combined with LFCN block can reduce intraoperative consumption of opioids, be helpful for inhibiting postoperative pain sensitivity, and improve early recovery than FICB when used for total hip arthroplasty under general anesthesia.

AIDS as a mainly sexually transmitted disease , in its prevention and control , detection , and diagno-sis and treatment process , is bound to generate a lot of conflicts of interest due to the rights and obligations of both doctors and patients .It includes the enforcement and autonomy in testing , informed and privacy protection , public interests and personal interests and other conflicts .Without harming the community and others ' interests , we should fully respect the autonomy and privacy protection of AIDS patients , and create a tolerant social moral environment .

Objective To explore the diagnostic value of MR susceptibility weighted imaging (SWI) in the cerebral micro-bleedings(CMBs). Methods Conventional MR sequences including TSE , FLAIR and SWI sequences were per-formed in 50 patients as well as SWI sequence.The numbers of CMB and sensitivity of positive rare on SWI and conventional sequences were compared and statistically analyzed. Results SWI sequences clearly exhibited dot,stripe,round or ring-shaped low signal shadows. With diameter from 0.4 to 6.5 mm. Cerebral microbleeds mainly located in cortex, subcortex and basal ganglia in 50 patients. Compared to 23 cases with spin echo TSE, and 20 cases with FLAIR. Conclusion SWI has predomin flilt advantage over conventional MRI sequences in detecting CMBs. SWI provides an important reference for the treatment and evaluating prognosis of cerebral infarction.

Objective To analyze the characteristics of gastric stromal tumors(GST)under endoseopic ultrasonography(EUS)according to its aggressive risks.Methods The clinical data of 36 patients with GST,who underwent surgery from July 1997 to July 2007,were analyzed retrospectively.All the patients underwent EUS before operation and were classified according to Fleether's 4-tier system to predict the aggressiveness of the tumors.The features of the tumor under EUS including its size,ulceration,border,echo charateristies and growth pattern were recorded and the difference between each tumor group were analyzed by ANOVO and rank sam test.Results The mean maximal diameter of GST Was 7.3 cm(range 1.0-20.0 cm),and the size of tumors with hiisher aggressiveness risk Was significantly larger than that with lower risk(P＜0.01).The mucosal ulceration,obscure border,irregular shape and echo heterogeneity were more commonly seen in the groups with higher risk(P＜0.05).There Was no difference in the internal echo and growth pattern of GST between different groups.Conclusion EUS features are useful in differentiation of the aggressiveness risk of the GST.and guide the management of the tumors.

BACKGROUND: It is difficult to cover aneurysm-like ventricular septal defect (VSD) of large inlet and multiple outlets completely with symmetrical type occluders or eccentric type occluders. OBJECTIVE: To investigate the feasibility of A4B2 occluder devices for covering aneurysm-like VSD, and to observe the effects of proper occhiders selected according to pseudoaneurysm size on coveting aneurysm-like VSD. DESIGN: Case analysis.SETTING: the First Hospital of Hebei Medical University. PARTICIPANTS: From August 2004 to May 2006, 226 patients with the pseudoaneurysm of petimembranous VSD, who underwent interventional therapy in the First Hospital of Hehei Medical University, were recruited in the study. According to the results of the left ventricular angiography, 36 patients of pseudoaneurysm of petimembranous VSD with large inlet and multiple outlets were closured with A4B2 occluder devices. According to the results of the left ventricular angiography, the mean diameter of the left inlet of VSD was (10.6+8.7) mm (ranged from 8 to 21 mm), the mean diameter of the right outlet of VSD was (3.1 ± 2.9) mm (ranged from 2 to 8 ram). Main materials: Occluder device and delivery mechanism were offered by Shanghai Shape Memory Alloy Materials Company and Beijing Starway Medical Technology Inc. They were processed into double disks using nickel-titanium shape memory alloy wires by a special technology to close VSD by a transcatheter approach. The size of the occluder was denoted with the diameter of the waist, and the Size ranged from 4 to 16 mm in the present study. METHODS: All the occluders were transferred by a 7-10 F transferring sheath from right heart system, and the mean diameter of the occluders was (6.364-2.48) nun (ranged from 4 to 16 ram). Fifteen minutes after the procedure, left ventricular angiography and transthoracic echocardiography (TIE) were performed again to evaluate the efficacy. After the procedure, electrocardiogram (ECG) monitoring lasted for 5 successive days in all patients, and ECG and TIE were performed 1, 3, 6 and 12 months later. MAIN OUTCOME MEASURES: Residual shunt, arrhythmia and valve function as well as blood compatibility. RESULTS: Sixteen cases were closured by placing the occhiders into left inlet of VSD, 16 cases were closured by placing the occluders into the pseudoaneurysm completely, and 4 cases were closured at the outlet of the defects. The results of the left ventricular angiography and TTE that performed fifteen minutes after the procedure demonstrated that 32 cases were completely closured and slightly residual shunts (< 3 mm) was found in other 4 patients. And confirmed by TIE, the residual shunts completely disappeared in 2 of the 3 patients 24 hours later while in the other one in 1 month after the procedure. Temporary left bundle branch block was found in 3 cases while temporary right bundle branch block was found in 2 cases, and all of them recovered within one week. Without severe complications, all of the 36 patients were treated successfully with A4B2 (thin waist shape) occluder devices made in China. Critical appraisal in blood compatibility of the implantation materials used in this research had been performed. The hemolysis ratio was less than 5%, the platelet adhesion was less, and the blood coagulation function ,the immune system response( immunoglobulin and complement)and the re-endothelialization of material surface were all normal. CONCLUSION: Transcatheter interventional therapy with domestic A4B2 occluder devices for VSD with pseudoaneurysm is safe, effective, promising, and has fewer complications. The key to the procedure is to select suitable occluders and suitable positions where to plant them according to the size, morphologic characteristics, position, and maturity of the pseudoaneurysm.

With the development of the medical imaging and computer aided technology,the trend of the medical imag es visualization from2D to3D is focused.This paper introduces the methods and ke y technology of3D medical images visualization,and discusses its applications to medical diagnoses and clinic therapy.There is a promising direction in the fiel ds of virtual endoscope,computer assisted operation and long-distance operation.

Objective To study on the effectiveness of endoscopic ultrasonography (EUS) in diagnosing common bile duct (CBD) stones. Methods Accuracies for the diagnosis of choledocholithiasis by abdominal ultrasonography ( B-US) and computed tomography (CT) are compared with those by EUS in 45 patients. Final diagnosis is determined by endoscopic retrograde cholangiography ( ERC) with or without sphincterotomy ( EST) or operative exploration. Results Forty-three out of 45 patients with choledtx-holithia sis were diagnosed by EUS, of them 2 patients with slight dilation of common bile duct in which stones were confirmed in the proximal part of common bile duct by EST. In 2 out of 43 patients EST and operation diagnosed cholecystolithiasis instead of choledocholilhiasis. The sensitivity and the positive predictive value are both 95%. With 41 patients choledocholithiasis were confirmed by EUS, the sizes of stone were diameter ≥ 10mm in 5 patients, 6-9 mm in 10 patients and ≤5mm in 26 patients. Four out of 45 patients were suspected to have CBD stones and 2 patients had tumor in periampullar area by B-US. Three patients were diagnosed to have CBD stone and 1 patient was suspected to have tumor in peri-ampullar area by CT. Conclusions EUS appears to be the best diagnostic tool for the diagnosis of choledocholithiasis compared with other noninvasive procedures such as B-US and CT. EUS is at least as sensitive as ERC especially in diagnosis of small CBD stones.

Objective To determine the function and clinical significance of OMOM capsule endos-copy. Methods To review the history and outcomes of 65 patients underwent capsule endoscopy from Oct. to Dec. 2004. Results OMOM capsule endoscopy failed to pass the pylorus within the effective working time in one case. The significant pathological findings were revealed in 47 patients among 64 patients (73. 4% ). Inflammatory small bowel diseases in 21 patients including Crohn's disease in 3 patients, small intestinal pol-yps in 8 patients including one Peutz-Jeghers syndrome, angiodysplasia in 9, diverticula in 3, hookworm in 3, submucosal tumor in 3 including one myosarcoma finally diagnosed by operation. OMOM capsule endosco-pies have working time 473 min (360-630) averagely. The duration from oral to anus was 1723 min (690-2370 min) averagely. Conclusion The capsule endoscopy is a highly useful technique in detecting small in-testinal diseases. It can be recommended as part of the routine work-up in patients with obscure bleeding.

Purpose:To investigate the changes in plasmaendothelin-1(ET-1) level in gastric carcinoma patients before and after chemotherapy and its significance.Methods:Radioimmunoassay was used to detect the level of plasma ET-1 in 25 cases of normal controls and 52 cases of patients with gastric carcinoma before and after chemotherapy. Results:levels of plasma ET-1 were elevated in all subgroups of patients with gastric cancer compared to thecontrols (P