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Table of Content

    25 January 2021, Volume 42 Issue 1
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    Experimental study on isolation and culture of canine vascular endothelial cells by collagenase digestion scrape and repeat digestion techniques
    LI Gang, XIAO Han, TANG Jun-jian, WANG Feng, YOU Qing-jun
    2021, 42(1):  7-11.  doi:10.3969/j.issn.1007-3205.2021.01.002
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    Objective  To explore a novel culture method of vascular endothelial cells(ECs) in vitro from canine saphenous vein. 
    Methods  Vascular inner membrane was inverted, and both ends of the vein were ligated, followed by digestion with 0.1% collagenase and mechanical scrape. Endothelial cells in canine saphenous vein were obtained by collagenase redigestion, and then cultured with low glucose DMEM medium. Appropriate amount of endothelial cell growth factor was then added for culture. Cells were cultured using 0.25% trypsin and then subcultured. The cultured cell lines were identified by immunofluorescence, immunohistochemistry, light and scanning electron microscopy. 
    Results  The monolayer cells were formed at 14 days after culture in vitro. The ECs arrayed like pitching stone under light microscopy. By transmission electron microscopy, ECs were found spindle shaped and there were many microvilli on the cell surface; Ve-Cadherin in the ECs showed positive reaction by immunofluorescence and immunohistochemistry. Compared with the traditional Veronica Tisato separation method, the cell survival rate using this method was significantly improved ［(75.39±12.61)% vs. (47.28±9.59)%, P＜0.01］. 
    Conclusion  Aplication of collagenase digestion, mechanical scrape and collagenase redigestion can reliably obtain purified ECs of canine saphenous vein, which could be proliferated and successively passaged in vitro.
    Diagnostic value of high-sensitive cardiac troponin T in acute myocardial infarctionin patients with chronic renal failure
    LI Xin-yue, GENG Wei, LIU Su-fen, TIAN Xiang
    2021, 42(1):  12-16.  doi:10.3969/j.issn.1007-3205.2021.01.003
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    Objective  To investigate the diagnostic value of high-sensitive cardiac troponin T(hs-cTnT) in acutemyocardial infarction(AMI)in chronic renal failure(CRF) patients without dialysis. 
    Methods  A total of 52 patients with chronic kidney disease stage 4(CKD stage 4)and without dialysis complicated with AMI(Group A) and 52 patients with CKD stage 4 and without dialysis(Group B) were enrolled in this study. The levels of hs-cTnT in the serum of the two groups at admission were compared, and the optimal diagnostic value for AMI in CKD stage 1 patients without dialysis was discussed. 
    Results  The level of hs-cTnT was significantly higher in group A than in group B(P＜0.05). hs-cTnT was positively correlated with left atrium dimension(LAD),left ventricular end diastolic dimension(LVEDD)and left ventricular end systolic dimension(LVESD)(P＜0.01). In addition, hs-cTnT was negatively correlated with left ventricular ejection fraction(LVEF）and glomerular filtration rate(eGFR). LVEDD,LVEF and eGFR were the independent influencing factors of hs-cTnT level.The sensitivity and specificity of hs-cTnT in the diagnosis of AMI in CRF patients without dialysis was 75.00% and 90.38% respectively, with 72.50 ng/L as the cut-off value. 
    Conclusion  For CRF patients without dialysis, increasing hs-cTnT cut-off value can effectively improve the specificity in AMI diagnosis. 

    Plantar pressure changes and correlating factors in the patients with type 1 diabetes 
    QIU Xuan, MA Chao, TIAN Si-yu, ZHANG Xiao-juan, CAI Si-jia, LIU Kuan-zhi
    2021, 42(1):  17-22.  doi:10.3969/j.issn.1007-3205.2021.01.004
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    Objective  To assess the plantar pressure changes and correlating risk factors in the patients with type 1 diabetes(T1DM). 
    Methods  A total of 40 patients with T1DM were recruited in this study. Plantar pressure was obtained from 10 foot regions at enrollment and two years later. Additionally, some relevant clinical data were recorded. 
    Results  Over the course of 2 years, significant plantar pressure increase in the second and third metatarsal heads was found(P＜0.05). Decrease of impulse under the medial and lateral side of the heel and pressure time integral under the lateral side of the heel were also identified(P＜0.05). The increase of plantar pressure in the second and third metatarsal heads and under the medial and lateral side of the heel was correlated with increased serum total cholesterol(TC)(β=0.336-0.495， P＜0.05). The increase of plantar pressure in the second and third metatarsal heads was correlated with the appearance of calluses during the study period(β=0.259-0.448， P＜0.05). In addition, the increase of plantar pressure in the second metatarsal head was correlated with the change of hemoglobin A1c(β=0.248-0.320， P＜0.05). The increase of maximum pressure in the second metatarsal head was correlated with the change of sensory nerve conduction velocities(SCV) (β=-0.327， P=0.026). 
    Conclusion  With the prolongation of the disease course, the plantar pressure of the second and third metatarsal heads among the patients with T1DM was increased significantly. The increase of plantar pressure was correlated with the changes of serum TC level, hemoglobin A1c, SCV and the appearance of calluses.

    Application of Cox-maze  Ⅲ procedure in patients with atrial fibrillation in valvular heart disease
    LYV Ying, WANG Hui-shan, LI Xiao-bing, YIN Zong-tao, ZHANG Hui-jun, WANG Jun
    2021, 42(1):  23-26.  doi:10.3969/j.issn.1007-3205.2021.01.005
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    Objective  To evaluate the clinical effect of Cox-maze Ⅲprocedure in the treatment of cardiac valvular disease with atrial fibrillation. 
    Methods  The clinical data of 12 patients with cardiac valvular disease complicated with atrial fibrillation undergoing Cox-maze Ⅲ  procedure were retrospectively analyzed. All patients underwent Cox-maze Ⅲprocedure and cardiac valve replacement through median sternal incision under general anesthesia. Cardiac function was observed by echocardiography before and after surgery, and clinical experience was summarized. 
    Results  The whole group successfully completed heart valve surgery and maze surgery, without perioperative death, no third-degree atrioventricular block, coronary artery injury and cerebrovascular accident. The extracorporeal circulation time was 143-201 min, with an average(174.43±15.46) min. Aorta occlusion lasted 81-96 min(88.71±3.54) min on average, and ventilator application lasted 18-47 h. There was no atrial fibrillation heart rate when the surgery was repeated. Postoperative perioperative complications: 1 case of low cardiac output syndrome was improved after treatment of strong cardiac diuretic and improved cardiac function. One case of hypoxemia, after infection control, atomization of sputum drainage, strengthening the recovery after body therapy. During the period of hospitalization, 4 patients were treated with pacemaker pacing, 2 with atrial fibrillation, 1 with atrial rhythm, 1 with electro-cardioversion, the rest were treated with supplementary blood volume and antiarrhythmic drugs, and 11 cases (91.67%) recovered sinus rhythm after discharge. All patients were followed up regularly for 3 months to 2 years after surgery, and their cardiac function was significantly improved. With the extension of time, the left atrial diameter(LAD), left ventricular end diastolic dimension(LVEDD), and left ventricular end-systolic diameter(LVESD) were gradually reduced, left ventricular ejection fraction（LVEF） increased gradually, the difference was statistically significant(P＜0.01). 
    Conclusion  The clinical effect of Cox-maze Ⅲ procedure in the treatment of valvular heart disease combined with atrial fibrillation is positive, accurate grasp of surgical indications and strict grasp of surgical operation technology is conducive to improve the surgical effect.

    Comparison of the efficacy of TVT-E and TVT-O in the treatment of stress urinary incontinence
    KAN Jin-long, QI Jin-chun, LIAN Wen-feng, LU Bao-sai, YIN Yue-wei, XUE Wen-yong
    2021, 42(1):  27-29,53.  doi:10.3969/j.issn.1007-3205.2021.01.006
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    Objective  To compare the clinical efficacy and complications of tension-free trans-obturator vaginal tape exact(TVT-E) and tension-free vaginal tape obturator(TVT-O) for female stress urinary incontinence(SUI). 
    Methods  A retrospective analysis of 159 female SUI patients was performed. They were divided into TVT-E group(n=73) and TVT-O group(n=86) according to different treatment methods.Thesurgical indicators, clinical efficacy and complications were compared in the two groups. 
    Results  The duration of operation was significantly longer in the TVT-E group than in the TVT-O group, and the difference was statistically significant(P＜0.05). There was no statistically significant difference in the amount of intraoperative blood loss, length of hospital stay, and postoperative residual urine volume between the two groups(P＞0.05). No significant difference was found in clinical efficacy and complication rate between the two groups(P＞0.05).  
    Conclusion  The TVT-E group and the TVT-O group had similar surgical effects and complications, but the TVT-E group had a longer duration of operation and a higher risk of bladder perforation, as compared withTVT-O group. Patients who had recurrence after TVT-O can undergo further TVT-E. The TVT-E is simple and effective, and it is worthy of clinical promotion.

    Incidence and risk factors of contralateral hip refracture after hip fracture surgery in the elderly patients
    YANG Zhao-xu, XING Dong, ZHANG Long, ZHENG Shu-hui, LI Wen-yi, ZHU Shi-wen
    2021, 42(1):  30-33.  doi:10.3969/j.issn.1007-3205.2021.01.007
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    Objective  To investigate the incidence and risk factors of contralateral hip refracture after hip fracture surgery in the elderly patients. 
    Methods  Clinial data of 356 patients who underwent surgery retrospectively analyzed. The patients were divided into refracture group(n=32) and non-refracture group(n=324) according to the recurrence of contralateral hip fracture within 1 year after initial hip fracture surgery. The age, body mass index(BMI), regular sun exposure, combined medical diseases, osteoporosis, compliance of anti-osteoporosis drugs after initial hip fracture, frequency of exercise and other variables were recorded and compared between two groups. All variables were entered into a multivariate logistic analysis model to determine the risk factors of contralateral hip refracture. 
    Results  Thirty-two of the 356 hip patients suffered from contralateral hip refracture, with a re-fracture incidence of 9.0%. Multivariate Logistic regression analysis showed that advanced age, serious osteoporosis, lack of regularsunexposure, combined with a variety of medical diseases, poor compliance of anti-osteoporosis drugs after the initial hip fracture, and lack of appropriate exercise were risk factors for contralateral hip refracture after hip fracture surgery in the elderly patients(P＜0.05). 
    Conclusion  The incidence of contralateral hip refracture after initial hip fracture surgery in the elderly was 9.0%. An active management of body weight, regular sun exposure, prevention and treatment of combined medical diseases, regularly intake of anti-osteoporosis drugs, strengthening education, boosting the compliance of anti-osteoporosis, and appropriate exercise can reduce the incidence of hip refracture.

    A comparative study of FHR and PFNA in the treatment of elderly patients with IFF with better ability of daily life before injury
    GAO Shang-ju, LI Wen-yi, ZHANG Long, LI Xu-ming, WEI Jing-chao, CAO Can
    2021, 42(1):  34-37,59.  doi:10.3969/j.issn.1007-3205.2021.01.008
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    Objective  To investigate the effect of artificial head replacement(FHR) and proximal femoral nail anti rotation(PFNA) in the treatment of elderly patients with intertrochanteric fracture(IFF) with good ability of daily living before injury. 
    Methods  A total of 106 elderly patients with better ADL were selected and divided into FHR group(51 cases) and PFNA group(55 cases) according to different treatment methods. The operation time, perioperative blood loss, postoperative ambulation time, hospitalization time, Harris hip score and complications were compared between two groups. 
    Results  The perioperative blood loss of FHR group was higher than that of PFNA group, postoperative ambulation time and hospitalization time were shorter than PFNA group, the difference was statistically significant(P＜0.05). There was no significant difference in operation time between two groups(P＞0.05). 12 months after operation, Harris score of hip joint in two groups was higher than that before operation, and Harris score of hip joint in FHR group was higher than that in PFNA group, the difference was statistically significant(P＜0.05). After 12 months of follow-up, the total incidence of postoperative complications in FHR group was lower than that in PFNA group(P＜0.05). 
    Conclusion  Compared with PFNA, FHR can significantly reduce postoperative bleeding, shorten postoperative ambulation time and hospitalization time, accelerate hip joint function recovery, and have fewer complications.

    Comparison of arthroscopic reconstruction using autologous hamstring tendon in the treatment of fresh and old anterior cruciate ligament rupture
    WANG Qiang, XIE Shui-hua, WANG Xing-yu
    2021, 42(1):  38-41.  doi:10.3969/j.issn.1007-3205.2021.01.009
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    Objective  To explore the optimal timing forarthroscopic reconstruction of anterior cruciate ligament rupture(ACLR). 
    Methods  In this retrospective case-control study,53 patients with ACLR treated by reconstruction using autogenous hamstring tendon were entered into this study. They were divided into fresh group(28 cases that were injured within 10 weeks) and old group(25 cases that were injured for more than 10 weeks) according to the time interval from injury to reconstruction. At the last follow-up after operation, the positive rate of Lachman test and pivot shift test, the International Knee Documentation Committee Knee Uation Form(IKDC)score, Lysholm score and incidence of postoperative secondary complications were compared. 
    Results  There was no significant difference in the positive rate of Lachman test and pivot shift test, Lysholm score and IKDC score between two groups(P＞0.05). The incidence of postoperative complications in the old group was higher than that in the fresh group(P＜0.05). 
    Conclusion  Reconstruction of fresh ACLR has similar clinical effect with reconstruction of old ACLR, but the incidence of complications after reconstruction of fresh ACLR is lower than that of old ACLR.

    Effect of CR prosthesis and PS prosthesis on the outcome of total knee arthroplasty
    LI Ping, CHAI Kai
    2021, 42(1):  42-76.  doi:10.3969/j.issn.1007-3205.2021.01.010
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    Objective  To investigate the effect of posterior cruciate ligament retaining(CR) and posterior cruciate substituting(PS) total knee arthroplasty(TKA). 
    Methods  A total of 80 patients with knee osteoarthritis(KOA) underwent unilateral TKA, including 40 patients with CR-type prosthesis as CR group, and 40 patients with the PS prosthesis as the PS group. The duration of operation, intraoperative blood loss and drainage volume of the two groups were compared. The hospital for special surgery knee score(HSS) and knee joint activity were recorded at 1 and 3 months after operation. Knee activity and visual analog scale(VAS) at 3 and 7 d after operation were recorded; postoperative hemoglobin(HB) decline and postoperative subcutaneous ecchymosis, joint swelling, lower extremity venous thrombosis and other complications were recorded. They were followed up for six months, and the patient satisfaction was assessed using the Western Ontario McMaster university osteoarthritis index(WOMAC). 
    Results  The decrease of HB in the CR group was significantly lower than that in the PS group after operation(P＜0.05). There was no significant difference in the duration of operation, preoperative HB and postoperative drainage between the two groups(P＞0.05). The VAS score of the CR group was lower than that of the PS group(P＜0.05). There was significant difference of VAS score between the two groups and different time points(P＜0.05), and the difference of interaction between groups, time points and time points between groups were not statistically significant(P＞0.05). There was no significant difference in the knee joint activity of the CR group and the PS group before operation, as well as in in HSS scores between two groups(P＞0.05). The knee joint activity in the CR group was less than that in the PS group at 6 months after operation(P＜0.05), and there was no significant difference in the HSS score as compared with the PS group(P＞0.05). The incidence of subcutaneous ecchymosis and joint swelling in the CR group was lower than that in the PS group(P＜0.05). There was no significant difference in the rate of incision healing and the incidence of venous thrombosis in the lower extremity compared with the PS group(P＞0.05). At 6 months after operation, the satisfaction rate of patients in the CR group(87.5%) was higher than that in the PS group(67.5%)(P＜0.05). 
    Conclusion  CR prosthesis can retain the proprioception, reduce the amount of blood loss, pain and postoperative complications. PS prosthesis is more advantageous in improving knee joint mobility. In clinical application, the indications should be strictly controlled, and the level of prosthesis should be selected by the comprehensive skill level of the physician.

    Plasma Visfatin expression in patients with gestational diabetes at different gestational weeks
    HU Li-yan, DU Xiu-ping
    2021, 42(1):  47-53.  doi:10.3969/j.issn.1007-3205.2021.01.011
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    Objective  To detect the changes of plasma Visfatin levels in gestational diabetes mellitus(GDM) patients at different gestational weeks, and to analyze its clinical significance. 
    Methods  The pregnant women systematically examined in our hospital were selected as the research subjects. All pregnant women enrolled underwent oral glucose tolerance test(OGTT) from 24 to 26 weeks of gestation; 40 cases diagnosed with GDM were assigned to GDM group, and 40 cases with normal glucose tolerance(NGT) to NGT group. The plasma Visfatin levels in the two groups were determined by ELISA at 24-26 weeks of gestation, and the GDM group was subdivided into the high Visfatin subgroup(n=20) and low Visfatin subgroup(n=20) according to the median Visfatin. Glycolipid metabolism indexes were detected and Homeostasis model assessment insulin resistance(HOMA-IR) was calculated. The plasma Visfatin was measured at 31-33 weeks and 38-40 weeks of gestation, and the neonatal body mass and body length were recorded to calculate ponderal index. 
    Results  The plasma Visfatin level in high Visfatin subgroup, low Visfatin subgroup of the GDM group and NGT group were increased with the increase of gestational age(P＜0.05). The plasma Visfatin level in high Visfatin subgroup of GDM group was higher than that in the low Visfatin subgroup at 24-26 weeks of gestation, and the level in low Visfatin subgroup was higher than that in the NGT group(P＜0.05). There was no statistically difference of Visfatin level at 31-33 weeks and 38-40 weeks of gestation among high Visfatin subgroup, low Visfatin subgroup and NGT group(P＞0.05). The pregnant fasting glucose, glycosylated hemoglobin, fasting insulin, HOMA-IR as well as triglyceride, total cholesterol, low density lipoprotein cholesterol at 24-26 weeks of gestation in high Visfatin subgroup were higher than that of low Visfatin subgroup, and the above indicators were higher in low Visfatin subgroup than in NGT group(P＜0.05); the plasma high-density lipoprotein cholesterol at 24-26 weeks of gestation was lower in high Visfatin subgroup than in low Visfatin subgroup, and the level was lower in low Visfatin subgroup than in NGT group(P＜0.05). Pearson correlation analysis showed that plasma Visfatin in GDM group was positively correlated with HOMA-IR(r=0.429, P=0.036) at 24-26 weeks of gestation, HOMA-IR(r=0.568, P=0.025) at 31-33 weeks of gestation, and HOMA-IR(r=0.672, P=0.003) at 38-40 weeks of gestation. The neonatal body mass and ponderal index in high Visfatin subgroup of GDM group were higher than that of the low Visfatin subgroup, which were higher in the low Visfatin subgroup than in the NGT group(P＜0.05). 
    Conclusion  The plasma Visfatin is increased with the increase of gestational age. The plasma Visfatin at 24-26 weeks of gestation in patients with GDM is higher than that of NGT pregnant women. Visfatin at 24-26 weeks of gestation is related to the disorder of glucose and lipid metabolism and promotes fetal intrauterine development in patients with GDM.

    The diagnostic and application value of bronchofiberscopy and bronchoalveolar lavage in children with chronic pneumonia
    WU Hui-fang, ZHANG Jing-li, LIU Xiao-juan, LIU Xin-feng, ZHANG Zhong-ping, DUAN Chen-chu
    2021, 42(1):  54-59.  doi:10.3969/j.issn.1007-3205.2021.01.012
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    Objective  To explore the application value of fiberoptic bronchoscopy(BFS) and bronchoalveolar lavage(BAL) in diagnosis and treatment of chronic pneumonia in children. 
    Methods  A total of 136 children with chronic pneumonia were enrolled in this study. Among them, 68 children who received conventional treatment were selected as the control group, and the remaining 68 cases who received combination of conventional treatment and BFS as well as BAL served as the observation group. The results of BFS and pathogen detection in bronchoalveolar lavage fluid were recorded in the observation group. The clinical efficacy, disappearance time of symptoms and signs, arterial blood gas indexes and serum inflammatory factors were compared between the two groups. The possible complications caused by BAL in BFS were monitored. 
    Results  All 68 children in the observation group who received BFS showed different degrees of endobronchial inflammation, including 11 cases of airway dysplasia. The positive rate of bacterial culture in BALF was significantly higher than that in sputum culture(P＜0.05). The total effective rate of the observation group was higher than that of the control group(P＜0.05). The disappearance time of fever, cough, lung moist rales and wheezing sounds in the observation group were significantly shorter than those in the control group(P＜0.05). After treatment, the arterial partial pressure of oxygen(PaO2) and power of hydrogen(pH) in the observation group were significantly higher than those before treatment and in the control group. While the values of arterial partial pressure of carbon dioxide(PaCO2) were significantly lower than those before treatment and the control group(P＜0.05). There was no significant difference in PaO2, PaCO2 and pH in the control group before and after treatment(P＞0.05). After treatment, the serum levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in the two groups were significantly lower than those before treatment, and the levels of IL-6 and TNF-α in the observation group were lower than those in the control group(P＜0.05). In the observation group, there were 4 cases of decrease of percutaneous oxygen saturation and 6 cases of bronchial mucosal hemorrhage during the treatment of BFS with BAL, but all of them were mild and relieved after symptomatic treatment. 
    Conclusion  The application of BFS in BAL treatment of children with chronic pneumonia has high clinical application value in etiological diagnosis, pathogen detection and treatment. In addition, it is well tolerated in children. 

    Correlation analysis of the position of permanent incisor germs after the modified block appliance correcting the deciduous anterior crossbite
    2021, 42(1):  60-65.  doi:10.3969/j.issn.1007-3205.2021.01.013
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    Objective  To study the changes of maxillofacial bone and related factors affecting the position of maxillary permanent incisor germs after treatment with modified block appliance. 
    Methods  A total of 20 patients with deciduous anterior crossbite were selected and the modified block appliance was used to correct deciduous anterior crossbite. The maxillofacial changes before and after treatment were compared, and the influencing factors of changes in permanent incisor germs position after correction were analyzed by correlation analysis. 
    Results  Before and after treatment, there were significant differences in 19 parameters of patients with deciduous anterior crossbite except SNA, SNB, NP-FH, L1-NBMM, MP-SN, FH-MP, facial axis angle, D1i-Y and A-Y(P＜0.05). After treatment, the correlation analysis of occlusal maxillofacial index and permanent tooth germ position index showed that there was a positive correlation between permanent tooth germ position and maxillary position and deciduous tooth position. 
    Conclusion  The modified block appliance is effective in correcting deciduous anterior crossbite. After treatment, the maxillary growth forward and the increase of anterior teeth protrusion are conductive to the change of the position of permanent incisor germs forward and downward, as well as to the establishment of normal overbite relationship in mixed dentition period.
    Application of ropivacaine hydrochloride combined with hydromorphone fine needle spinal anesthesia in cesarean section
    LI Jian-zhong, MA Shi-jun, YI Liang, FENG Li, YANG Ai-jie
    2021, 42(1):  66-70.  doi:10.3969/j.issn.1007-3205.2021.01.014
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    Objective  To explore the value of ropivacaine hydrochloride combined with hydromorphone fine needle spinal anesthesia in cesarean section. 
    Methods  A total of 80 cases of cesarean section women were selected as the research object, and they were divided into observation group and control group by random number method, with 40 cases each. The control group was treated with ropivacaine fine needle spinal anesthesia, and the observation group was combined with oxymorphone fine needle spinal anesthesia on the basis of the control group. The perioperative indicators(operation time, delivery time, anesthesia dose, infusion volume, postpartum hemorrhage volume) and anesthesia effect of the two groups of maternal patients were compare. The visual analogue pain(VAS) score and sedation(Ramsay) score of the two groups at different times were compared. And the difference of pain stress factors［substance P(SP), neuropeptide Y(NPY), nerve growth factor(NGF) and prostaglandin E2(PGE2)］ before and after surgery were compared. And finally the adverse reactions of the two groups were counted. 
    Results  There were no significant differences in the operation time, delivery time, anesthesia dose, infusion volume, and postpartum hemorrhage in the observation group compared with the control group(P＞0.05). The good rate of anesthesia in the observation group was significantly higher than that in the control group, and the difference was statistically significant(P＜0.05). The VAS scores in the two groups were compared after operation, the difference was statistically significant(P＜0.05). The observation group scores were significantly lower than the control group at 12 h and 18 h after operation, the difference was statistical significance(P＜0.05); within two groups of Ramsay score comparisons were significantly higher after surgery, the difference was statistically significant(P＜0.05). There was statistical significance between time points(P＜0.05), but there was no significant difference in interaction between groups and time points(P＞0.05). The postoperative SP, NPY and PGE2 in the observation group were significantly higher than those in the preoperative group and lower than those in the control group. The differences were statistically significant(P＜0.05). Compared with the two groups before and after surgery, the NGF increased significantly with a statistically significant difference(P＜0.05). There was no significant difference between the two groups before and after NGF surgery(P＞0.05). The total incidence of adverse reactions was not statistically significant between two groups(P＞0.05). 
    Conclusion  Ropivacaine hydrochloride combined with hydromorphone fine needle spinal anesthesia can be used in cesarean section to improve the effect of anesthesia, reduce maternal pain and stress reactions without increasing the incidence of adverse reactions.

    Effects of two anesthesia strategies on postoperative analgesia, inflammatory response and vascular endothelial function in patients with lower extremity fracture
    PENG Ming, LIU Rong, XIAO Jin-hui, WU Min
    2021, 42(1):  71-76.  doi:10.3969/j.issn.1007-3205.2021.01.015
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    Objective  To investigate the effects of two anesthesia strategies on postoperative analgesia, inflammatory response and vascular endothelial function in patients with lower extremity fracture. 
    Methods  A total of 86 patients with lower extremity fracture who underwent open internal fixation were selected. According to different anesthesia strategies, they were divided into intravenous general anesthesia group(n=43) and combined spinal epidural anesthesia group(n=43). In general anesthesia group, propofol+sufentanil strategy was used, and 0.75% ropivacaine + sufentanil strategy was used in combined spinal epidural anesthesia group. The anesthetic effects of the two groups were compared. Before anesthesia(T0), immediately after operation(T1), at 6 h after operation(T2), 24 h after operation(T3) and 72 h after operation(T4), changes in pain scores, inflammatory factors and vascular endothelial function factors were compared. 
    Results  The anesthesia effect of the combined anesthesia group(grade Ⅲ: 86.02%) was significantly better than that of the general anesthesia group(grade Ⅲ: 60.47%), and the difference was statistically significant(P＜0.05). At T1-T4, the visual analogy score(VAS) of the two groups showed a progressive decrease whereas vascular endothelial growth factor(VEGF) showed a progressive increase(P＜0.05). However, the VAS of the combined anesthesia group was lower, and VEGF was higher, as compared with those of the general anesthesia group(P＜0.05). The levels of tumor necrosis factor α(TNF-α), interleukin-6(IL-6), hypersensitive C reactive protein(hs CRP), VEGF, compound F,(FC), and angiotensin Ⅱ（AngⅡ）in the two groups were increased from T1 to T3, and began to decrease after reaching the highest level at T2, and decreased at T4, which were lower than those at T0(P＜0.05), while the levels of TNF-α, IL-6, hs-CRP, FC, and AngⅡ in the combined anesthesia group were lower than those in the general anesthesia group at T1-T4(P＜0.05). 
    Conclusion  Both intravenous general anesthesia and combined spinal and epidural anesthesia have good anesthetic effects. However, compared with intravenous general anesthesia, the effect of combined spinal and epidural anesthesia is more significant in improving postoperative analgesia, reducing postoperative inflammatory response and improving vascular endothelial function.

    Comparison of the effect of an equal dose of ropivacaine and levobupivacaine on lumbar plexus block in aged patients undergoing PFNA
    ZHANG Long-sheng, YANG Duo, LI Chun-ran, CHEN Meng, LIN Geng-bin, DUAN Shi-qiang
    2021, 42(1):  77-80,84.  doi:10.3969/j.issn.1007-3205.2021.01.016
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    Objective  To compare the effect of an equal dose of ropivacaine and levobupivacaine on lumbar plexus block in aged patients undergoing PFNA. 
    Methods  A total of 60 patients undergoing elective unilateral PFNA surgery were enrolled. Inclusion criteria were American Society of Anesthesiologists(ASA) medical status of Ⅰ or Ⅱ and age of 65 to 95 years. The patients were divided into group L(n=30) and group B(n=30) by random number table. Both group underwent the lumbar plexus block guided by ultrasound combined with nerve stimulator, and group L and group B were injected with 25 mL of 0.375% ropivacaine and 25 mL of 0.375% levobupivacaine respectively. The onset time of sensory block and motor block, duration of sensory block and motor block, resting VAS values at 6 h, 12 h, 24 h and 48 h after surgery were compared for patients in each group, and analgesia pump use within 48 h after operation and the incidence of adverse reactions were recorded. 
    Results  The duration of sensory block and motor block was significantly shorter in group L than in group B(P＜0.05). The VAS scores of all two groups were increased initially and then decreased, and the increase in group B was significantly less than that in group L. The differences of interaction betweengroups, time points and time points between groups were statistically significant(P＜0.05). The time of first pressing analgesia pump was significantly shorter in group L than in group B(P＜0.05). 
    Conclusion  An equal dose of ropivacaine and levobupivacaine has a good analgesic effect on lumbar plexus block for elderly patients undergoing PFNA, and the block onset time is similar, however, duration of ropivacaine block is shorter than that of levobupivacaine, which is more conducive to the early activities of patientsand faster recovery after surgery, with better safety. Therefore, it is worthy of popularization.

    Effects of two different anesthesia methods on MMSE score, mental disorder and deep vein thrombosis in elderly patients after total knee arthroplasty
    LI Hang, ZHANG Min, LIU Jing
    2021, 42(1):  81-84.  doi:10.3969/j.issn.1007-3205.2021.01.017
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    Objective  To analyze the effect of two different anesthesia methods on deep vein thrombosis(DVT) and mental state in elderly patients undergoing total knee arthroplasty (TKA). 
    Methods  A total of 84 elderly patients with knee osteoarthritis(KOA) who were treated with TKA were divided into two groups: the control group (general anesthesia, n=42) and the observation group(combined spinal and epidural anesthesia, n=42). The levels of nerve growth factor(NGF) and brain derived neurotrophic factor(BDNF) in peripheral blood and the scores of mini-mental state examination(MMSE) were compared before and after operation, and the occurrence of DVT and mental disorder was recorded. 
    Results  The levels of NGF and BDNF in the peripheral blood and the MMSE scores of the two groups were reduced initially and then increased, and both reached the lowest point at 1 h after operation. The differences of interaction between groups, time points, and time points between groups were statistically significant(P＜0.05), The incidence of mental disorder within 3 d after operationand DVT within 7 d after operation was significantly lower in the observation group than in the control group(P＜0.05). 
    Conclusion  Compared with general anesthesia, combined spinal and epidural anesthesia can effectively reduce the incidence of postoperative DVT in elderly patients with KOA treated by TKA, and has a less impact on their mental state.

    DSA manifestation of rabbit liver metastases model of VX2 tumor strain implanted in the spleen
    WU Yong-chao, LI Zhi-gang, LI Jie, ZHAO Yu, LI Shun-zong, WU Zhong-lin
    2021, 42(1):  85-89.  doi:10.3969/j.issn.1007-3205.2021.01.018
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    Objective  To analyze the manifestations of the digital subtraction angiography(DSA) in rabbit liver metastases(LM) model of VX2 tumor strain implanted in the spleen, and to explore whether the model could be an ideal animal model for the treatment of liver metastases by hepatic artery infusion chemotherapy/transcatheter arterial chemoembolization(HAI/TACE). 
    Methods  A total of 40 New Zealand white rabbits were selected to establish the rabbit LM model of VX2 tumor strain implanted in the spleen. The right femoral artery was punctured under direct vision, and the microcatheter was advanced into the hepatic artery. The hepatic artery DSA was performed to observe the blood supply and staining of rabbit LM of the VX2 tumor strain, and then the hepatic artery cone-beam enhanced CT was performed to observe arterial enhancement method of rabbit LM of the VX2 tumor strain, as well as the histological appearance under the HE staining microscope. 
    Results  A total of 37 rabbits LM models of VX2 tumor strain were successfully established, all of which underwent femoral artery puncture and cannulation. Of them, 32 were successful in one puncture and cannulation, and the success rate of puncture was 86.5%(32/37). DSA revealed 57 LMs in rabbit VX2 tumor strain, including 38 with moderate blood supply and 19 with insufficient blood supply. The DSA manifestations included tortuous intrahepatic artery, and the tumor blood supply branch of LM was disordered and irregular. The multiple LM staining could be seen in the middle and late stages of the artery, which had circular shape. The central area staining was lighter than the edge staining, and the parenchymal LM staining was further aggravated, but the staining was less than normal liver parenchyma. Cone-beam enhanced CT of hepatic artery showed multiple LMs of different sizes. The enhancement was characterized by a ring-shaped enhancement around the metastatic tumor and no enhancement in the central area. The DSA stained part of the LM, the location and degree of tumor enhancement of the hepatic artery cone beam CT were consistent with the LM enhancement by the abdominal enhancement CT, which was the peripheral enhancement of LM. This corresponded to the observation of active tumor cells, inflammatory cells and inflammatory cells in the periphery of the tumor under the HE microscope. The DSA center staining of LM was light, and the unenhanced parts of the hepatic artery cone beam CT were consistent with the LM unenhanced performance of the abdominal enhanced CT, which was corresponding to the distribution of basophilic erythrodermic necrosis tumor cell under the HE microscope. 
    Conclusion  The rabbit LM model of VX2 tumor strain implanted in the spleen conforms to the imaging findings of annular enhancement in clinical settings, and DSA revealed medium blood supply or insufficent blood supply. This can provide an ideal animal model for the clinical study of the therapeutic effect of HAI/TACE, which is worthy of popularization and application in basic or clinical experiments. 

    Diagnostic significance of diffusion weighted imaging for cerebral infarction in different periods
    LEI Li-cun, DU Ya-qiang, LIU Zhen-yu, CAI Yun, BAO Li-nan, DU Shao-xu
    2021, 42(1):  90-94.  doi:10.3969/j.issn.1007-3205.2021.01.019
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    Objective  To investigate the characteristics of signal changes of the diffusion weighted imaging(DWI) of magnetic resonance imaging(MRI) for cerebral infarction in different periods. 
    Methods  A total of 130 patients with cerebral infarction confirmed by MRI clinically were collected, and underwent both magnetic resonance plain scan and DWI examination simultaneously. Based on the time interval between onset and magnetic resonance examination, these patients were divided into hyperacute group(＜6 h, n=30), acute group(6-72 h, n=40), subacute group(3-10 d, n=30), chronic group(＞11 d, n=30). Apparent diffusion coefficients(ADC) of infarct foci and contralateral normal tissues were determined, and the characteristics of DWI signal changes in cerebral infarction in different periods were analyzed. 
    Results  DWI of hyperacute lesion showed high signal, and the ADC value of lesion tissue was significantly lower than that of normal tissue, suggesting significant difference(P＜0.05). DWI of acute lesion showed high signal, the ADC value of lesion tissue was lower than that of tnormal tissue, and the difference was statistically significant(P＜0.05). DWI of subacute lesion showed slightly high signal, which was lower than that of acute lesions, and the ADC values of 29 cases of lesions were slightly lower than those of normal tissue, whereas 1 case of lesion was higher than that of normal tissue, with significant difference(P＜0.05). DWI of chronic lesions showed slightly higher signal in 13 patients, and equal or low signal in 17 patients. There was no significant difference between the ADC value of lesion tissue and that of normal tissue(P＞0.05). 
    Conclusion  DWI can make a definite diagnosis of the signal changes of cerebral infarction in hyperacute, acute and subacute phases, with higher sensitivity to hyperacute and acute lesions. The changes of DWI signal and ADC value of cerebral infarction are in line with the characteristic time-evolution law, and DWI combined with conventional MRI can be used to infer the period of cerebral infarction.