Mirror-like tongue is an important predictor of acute heart failure: a cohort study of acute heart failure in Chinese patients.

OBJECTIVE: To reveal that mirror-like tongue, observed via a noninvasive inspection, is a powerful indicator of the severity and prognosis of patients with acute heart failure (AHF). METHODS: This was an observational, prospective study. A total of 408 patients who met the inclusion criteria and were diagnosed with AHF for the first time at Taicang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from August 2019 to January 2021 were selected as the research subjects. According to their tongue fur, the patients were divided into group A (mirror-like tongue group) and group B (non-mirror-like tongue group). The clinical characteristics and incidence of major adverse cardiovascular events (MACEs) within 1 year of follow-up were systematically compared between the two groups. RESULTS: Sixty-five patients were included in group A, and 343 patients were included in group B. There were 32 males and 33 females in group A and 168 males and 175 females in group B. The average age of the overall population was 64 years old, and the average age of group A was significantly higher than that of group B (74 vs 62 years, P < 0.001). Compared with that in group B, the left ventricular ejection fraction (LVEF) in group A was significantly lower (35% vs 42%, P < 0.001), and the log N-terminal pro B-type natriuretic peptide (NT-proBNP) level was significantly higher (4.0 vs 3.4, P < 0.001). The proportion of the combined application of vasoactive drugs in group A was significantly higher than that in group B (64% vs 38%, P < 0.001). Group B had a higher proportion of coronary angiography (29.5% vs 16.9%, P = 0.038). Group A was more inclined to require mechanical ventilation than group B (33.9% vs 22.5%, P = 0.049). The length of hospital stay in group A was significantly longer than that in group B (13.1 vs 7.6, P < 0.001). The incidence of MACEs, such as recurrence of AHF, new myocardial infarction and stroke, in group A within one year was higher than that in group B (P = 0.007, 0.009, < 0.001). The incidence of cumulative MACEs in group A was significantly higher than that in group B [hazard ratio = 2.76, 95% confidence interval (1.73, 4.41), P < 0.001]. Univariate and multivariate Cox regression analyses showed that mirror-like tongue, age, length of stay, LVEF and log NT-proBNP were independent predictors of MACEs in patients with AHF within one year. CONCLUSIONS: Noninvasive tongue inspection technology can be used as a powerful tool for assessing the severity of illness and predicting prognosis in patients with AHF. A mirror-like tongue is an independent risk factor for MACEs in patients with AHF during the first year and has a combination effect with age, length of hospital stay, ejection fraction and NT-proBNP on the occurrence of MACEs.

Effectiveness of Zhuling decoction on diuretic resistance in patients with heart failure: a randomized, controlled trial.

OBJECTIVE: To test the effects of Zhuling decoction on patients with diuretic resistance in heart failure compared with a group of patients undergoing conventional treatment alone. METHODS: This research was a prospective, randomized, controlled study. From July 2018 to August 2020, 96 diuretic resistance patients from the Cardiovascular Research Center of Taicang Hospital affiliated with Nanjing University of Traditional Chinese Medicine (Grade III Hospital of Traditional Chinese Medicine) were enrolled in the study. The subjects were randomly divided into an observation group (48 cases) and a control group (48 cases). Patients in both groups received conventional treatment. In addition, observation group patients received Traditional Chinese Medicine Zhuling decoction. The primary endpoint was the urine output mean difference between Day 1 and Day 7 after treatment. Secondary endpoints were the changes over time in the N-terminal pro-B type natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) functional classification, and Minnesota Living with Heart Failure Questionnaire (MLHFQ). The safety and tolerability of the drug were comprehensively evaluated based on adverse drug reactions, as well as laboratory-assisted tests for liver and kidney function and electrolytes. RESULTS: Significant improvements were demonstrated for urine output in the two groups at Day 7, with a 1325 1045 mL difference in favor of the observation group ( = 0.018). The observation group also had greater improvements in NT-proBNP and NYHA functional classification changes than the control group. At the 30th day of follow-up, a significant reduction in negative findings on the MLHFQ from baseline was observed in both groups, but the observation group demonstrated a significantly greater reduction than the control group ( <0.001). CONCLUSIONS: Zhuling decoction could be used in combination therapy for patients with diuretic resistance in heart failure in addition to standard treatment.

Correlation Between Dose Volume Parameters and Radiation Pneumonitis in Elderly Patients with Esophageal Cancer After Three-dimensional Conformal Radiotherapy / 肿瘤防治研究

Objective To analyze the correlation between ≥grade 2 radiation pneumonitis (RP) and dose volume parameters of elderly patients with esophageal cancer after three-dimensional conformal radiotherapy. Methods We collected the data of 250 elderly patients with esophageal cancer who received three-dimensional conformal radiotherapy from different medical centers. The clinical features of patients were analyzed by Chi-square test while dose volume parameters were analyzed by Logistic univariate and multivariate analyses. ROC curve was used to determine the best cut-off value. Results After three-dimensional conformal radiotherapy, 20% of patients developed ≥grade 2 RP. Univariate analysis showed that bilateral pulmonary V5, V10, V20, V30 and mean lung dose were associated with ≥grade 2 RP but multivariate analysis revealed that only V5 and V20 were independent relevant factors of RP. ROC curve indicated that the best cut-off value was V5 < 52.9% and V20 < 23.2%. Conclusion Bilateral pulmonary V5 and V20 are independently related to ≥grade 2 RP in elderly patients with esophageal cancer after 3-D conformal radiotherapy.

A multi-stage dynamic prevention and control study on hospital workplace violence based on crisis management theory / 中华医院管理杂志

Objective:To construct a multi-stage dynamic prevention and control model, establish a system of intervention points and prevention and control measures for the prevention and control of workplace violence in hospitals, so as to provide guidance for hospitals and medical staffs to effectively prevent and respond to such incidents.Methods:Based on the crisis management theory, a model for the prevention and control of workplace violence in hospitals was constructed, the intervention points and prevention and control measures were screened by the Delphi method.Results:A multi-stage dynamic prevention and control model of workplace violence in hospitals was constructed, and a system of intervention points and prevention and control measures for workplace violence in hospitals were established according to the model. The system was divided into three stages: the pre-event stage contained 10 intervention points and 48 countermeasures, the in-event stage contained 6 intervention points and 17 countermeasures, and the post-event stage contained 3 intervention points and 12 countermeasures.Conclusions:It is an effective way to avoid violence and reduce the damage degree of violent incidents by selecting different countermeasures for different intervention points and carrying out multi-stage dynamic prevention and control of workplace violence in hospitals.

The effect of miRNA-34a antisense oligonucleotide on non-small cell lung cancer cell line HCC827 / 中国医师杂志

Objective To investigate the effect of antisense oligonucleotides of miRNA-34a on non-small cell lung cancer (NSCLC) and its molecular mechanism.Methods The expression of miRNA34a in human non-small cell lung cancer cell line HCC827 and human normal lung cell MRC-5 was detected by real time fluorescence quantitative polymerase chain reaction (qRT-PCR).HCC827 cells were divided into three groups:blank control group,negative control group,anti-sense oligonucleotide group (liposome 2000 transfected anti-sense oligonucleotide miRNA-34a);cell counting kit-8 (CCK-8) method was used to detect cell proliferation,Jimsa staining was used to detect cell cloning ability,Transwell test was used to detect cell migration and invasion ability;RT-PCR and Western blot were used to detect phosphatase and tensin homolog (PTEN),phosphorylation-protein kinase B (p-Akt),phosphatidylinositol-3-kinase (PI3K)mRNA and protein expression.Results The relative expression of miRNA34a in HCC827 cells was significantly higher than that in human normal lung cells (P ＜ 0.01).The relative expression of miRNA34a in antisense oligonucleotide miRNA-34a group was significantly lower than that of negative control group and blank control group (P ＜ 0.05),and there was no significant difference between negative control group and blank control group (P ＞ 0.05).At 48 h,72 h and 96 h,the proliferation level of HCC827 cells in antisense oligonucleotide miRNA-34a group was significantly lower than that in negative control group and blank control group (P ＜ 0.05).The cell cloning rate of antisense oligonucleotide miRNA-34a group was significantly lower than that of negative control group and blank control group (P ＜ 0.01).The number of migration and invasion of HCC827 cells in antisense oligonucleotide RNA-34a group was significantly lower than that in negative control group and blank control group (P ＜0.01).The relative expression of PTEN mRNA and protein in antisense oligonucleotide miRNA-34a group was significantly higher than that in negative control group and blank control group (P ＜ 0.05);the relative expression of p-Akt,PI3K mRNA and protein in antisense oligonucleotide miRNA-34a group were significantly lower than that in negative control group and blank control group (P ＜ 0.05).Conclusions The expression level of miRNA-34a in human nonsmall cell lung cancer cells is significantly higher than that in human normal lung cells.Antisense oligonucleotides of miRNA-34a can inhibit the proliferation,cloning,migration and invasion of human non-small cell lung cancer cells.The mechanism may be related to the negative regulation of PTEN/p-Akt/PI3K signaling pathway.

Thevalueofmodel-basediterativereconstructioninoptimizingthyroidCTimaging / 实用放射学杂志

Objective Toexploretheroleofmodel-basediterativereconstruction (MBIR)algorithminimprovingthequalityof thyroidCTimagesbyreducinghardeningartifactsattheentrancetothethorax.Methods ChestCTscansof20patientswiththyroidnoduleswere retrospectivelyreviewed.AlgorithmsofFBP,ASIR40,MBIRSTNDandMBIRNR40 wereusedtoreconstructatthe0.625mmslicethickness.Region ofinterestwasplacedonthecoronalimageswiththemostobvioushardeningartifacts.ThestandarddeviationsoftheCTvaluesof theleftandrightthyroidarteriesandthesurroundingnormalthyroidtissueweremeasured,furthermore,thevalueofthyroidartifact index(AI)andAI=sqrt(SDa2-SDb2)werecalculated.Tworadiologistsused4-pointmethodtoassessimageartifactssubjectivly.(1 point,severeartifacts,unclearthyroidrimsandnodules,undiagnosed;2points,moderateartifacts,poorlydisplayingthyroid margins andinternaldetails,affectivediagnosis;3points,mildartifacts,showingthyroid marginandinternaldetails,noaffectingthediagnosis;4 points ,no ribbon artifacts ,displaying thyroid edge and internal details very w ell ).ANOVA and paired t-test w ere used to co m pare the CTvaluesofnormalthyroidtissueofleftandrightlobeamongdifferentreconstructedimagesofthyroid.Subjectivescoredifferenceswere testedusingthe W ilcoxon symbolscale.Results ThevalueofCTreductionandAIatFBPandASIR40reconstructionimagesweresignificantly greaterthanthoseatMBIRSTNDandMBIRNR40reconstructionimages. Whiletherewerenodifferenceofleftandrightlobeofthyroid CTreductionand AIvalueatFBPand ASIR40reconstruction imagesnorthoseatMBIRSTNDandMBIRNR40reconstructionimages. SubjectiveevaluationofclavicleartifactswasincreasedatMBIRSTND and MBIRNR40image,andMBIRNR40imagehadoptimalsubjectiveevaluationresults(P<0.05).Conclusion MBIRcansignificantlyreducethe impactoftheclavicularharnesshardeningartifactsandnoiseonthethyroidanditsnodulesduringCTscans,especiallyoptimizingthe low-densitycontrastsettingofMBIRNR40.

Comparison of lung nodule image quality using two adaptive statistical iterative reconstruction algorithms in chest CT:a phantom study / 实用放射学杂志

Objective To compare the values of the lung nodule image quality by using two adaptive statistical iterative reconstruction (ASIR)in a chest phantom CT imaging study.Methods Non-enhanced CT of chest phantom with routine dose was obtained on both GE Discovery CT and Revolution CT.The scan parameters included tube voltage of 120 kVp,a noise index of 14 HU,slice thickness of 5 mm.All scans were reconstructed with FBP and different percentages of (20%－100% ASIR)when using Discovery CT,and different percentages of ASIR-V (20%－100% ASIR-V)when using Revolution CT.The CT attenuation values and SD (the SD represented image noise)of the subcutaneous uniform tissue were measured at the level of thoracic entry,trachea carina and hepatic portal.Based on the standard FBP(FBPs )algorithm,the image noise reduction rate of reconstructed images using different iterative percentage of standard algorithms ASIR and ASIR-V(ASIRs and ASIR-Vs )were compared.The paired t test was used to compare the noise of ASIRs and ASIR-Vs images under the same iterative percentage.The subj ective image quality was independently evaluated by two experienced radiologists,Kappa test was used to evaluate consistency,Wilcoxon test was used to compare subjective scores.Results For all ASIRs and ASIR-Vs images,the objective image noise of subcutaneous uniform tissue decreased along with increasing percentage.Comparison with the average noises of CT image reconstructed with the FBPs algorithm,the image noise reconstructed with ASIRs from 20% to 1 00% were reduced by 1 1.0 6%－48.9 7%,while the image noise reconstructed with ASIR-Vs from 20% to 100% were reduced by 17.06%－79.50%.The image noise of different percentage ASIR-Vs was significantly lower than that of same percentage ASIRs between 40% and 1 00% (P＜0.05 ).In terms of subj ective image evaluation,all ASIR1 and ASIR-V1 reconstructions had good diagnostic acceptability.Two readers scored good or moderate consistency in each iterative reconstruction of each lung nodule.Nodules of smaller size and less dense were more likely to have score differences.The 60%ASIR1 showed significantly superior visibility of lung nodules when compared to other percentages (P＜0.05).60% and 80% ASIR-V1 series showed significantly superior visibility of lung nodules when compared to the 60% ASIR1 and ASIR-V1 of other percentages (P＜0.05).Conclusion In routine dose non-enhanced chest CT, ASIR-V shows greater potential in reducing image noise and improves lung nodule image quality when compared to the same level ASIR algorithm. Combining both the obj ective and subj ective evaluation of images,reconstructed with 60% and 80% ASIR-V in the non-enhanced chest CT image is recommended for the observation and evaluation of pulmonary nodules.

Enhance the affinity of nanobodies to CD47 antigen by fusion expression of COMP48 self-folding peptide / 国际生物医学工程杂志

Objective To modify CD47 nanobody with the self-folding peptide human cartilage oligomeric matrix protein (COMP48) so as to enhance its affinity to CD47 antigen. Methods The fusion sequences of COMP48 and CD47 nanobody (VHHB1) were designed and synthesized, and the recombinant plasmid pET22b-VHHB1-COMP48 was constructed and transformed into E. coli BL21 (DE3) to induce expression of the fusion protein. The binding specificity and affinity of the fusion protein and the antigen CD47 were detected by Western Blot, indirect enzyme-linked immunosorbent assay (ELISA) and non-competitive ELISA. Results The recombinant VHHB1-COMP48 was expressed in BL21(DE3) by inducing with 1 mmol/L IPTG and purified at 90％homogenous in IMAC. Western Blot results showed that the recombinant protein VHHB1-COMP48 specifically binds to antigen CD47 but not to unrelated protein. The indirect ELISA and non-competitive ELISA results showed that the affinity of the conjugated recombinant protein VHHB1-COMP48 was enhanced compared to that of the non-conjugated nanobody, and the difference was statistically significant ( P<0 . 01 ) . Through non-competitive ELISA , the constants of affinity and dissociation constants were 6.97 ×107 L/mol and 1.434 ×10-8 mol/L, respectively. Conclusions The affinity of the nanobody for the antigen can be improved by conjugating a human cartilage matrix protein (COMP48) after the nanobody.

Preparation and identification of the nano antibodies of anti-programmed death receptor-1 / 国际生物医学工程杂志

Objective To prepare camelid-derived nano antibodies with high affinity binding to programmed death receptor-1 (PD-1) antigen,and to provide experimental basis for subsequent functional studies.Methods The PD-1-Fc recombinant protein expressed in eukaryotic expression was used to immunize Xinjiang Bactrian camel 6 times.The peripheral blood was collected and the lymphocytes were isolated.Nested PCR amplification was performed to obtain the genes in variable region of camelid heavy chain antibody (VHH),and to construct a phage display library.The phage display library was screened by solid phase enzyme-linked immunosorbent assay (ELISA).The PD-1 antigen,which was sequentially reduced in mass concentration (5.00、2.50、1.00 μg/ml),was coated in an ELISA plate,and the phage display library was subjected to 3 rounds of affinity selection.Individual clones that bind to PD-1 were further screened by soluble monoclonal ELISA.According to the results of DNA sequencing,three VHH monoclonals with multiple repeats were selected and ligated into pET22b vector,and transformed into E.coli BL21 (DE3) competent cells,and then induced by isopropyl-β3-D-thiogalactoside.The recombinant VHH antibody protein was purified by nickel column affinity chromatography,and its binding activity and affinity to PD-1 antigen were detected by Western Blot and ELISA.Results After immunization of Bactrian camel 6 times with recombinant protein PD-1-Fc,high titer specific antibody was stimulated,and the immune serum titer reached 1∶32 000.A VHH phage display library with a reservoir size of 2.6×108 cfu/ml was constructed from the immunized camel lymphocytes.After 3 rounds of affinity selection,46 VHH monoclonals with absorbance (A600) values above 0.6 were obtained by soluble monoclonal ELISA.Among them,three clones of VHH-B7,VHH-H5 and VHH-H12 had higher repeats,indicating that significant enrichment was obtained.The results of Western Blot and ELISA showed that the purified B7,H5 and H12 nanobodies had good binding activity to PD-1 antigen and had high affinity.Their affinity constants were 1.19×1011 and 1.63×1011,1.59×1011 L/mol,respectively.Conclusion The anti-PD-1 camelid-derived nanobodies were obtained by affinity selection of VHH phage display library,which can bind to the PD-1 antigen with high affinity.This study can provide an experimental basis for subsequent functional studies.

Treatment strategies of complex lesions in patients with acute Stanford type A dissection of important branches involvement / 中华外科杂志

Acute Stanford type A aortic dissection with important branches involved is more complex, could lead to organ malperfusion syndrome even organ failure. The understanding of pathological anatomy, classification, staging, and the pathophysiological change has increasingly mature, but not complete. In addition, the treatment strategy for complex lesions is diversified, some questions may not reach consensus. Fully understanding of the anatomical and pathophysiology is very important for surgeons to choose reasonable treatment strategy. As the rapid development of the basic research, imaging techniques and the concept of surgery procedures, the manage technique of Stanfrod type A dissection and branch vessels at the same time is getting seriously, the related issues also need further discussions.

Analysis of Relationship between Injury and Disease in 17 Cases of Cervical Trauma with Cervical Vertebra Degeneration / 法医学杂志

ObjectiveTo study the characteristics of the relationship between injury and disease in foren-sic identification cases of cervical trauma with cervical vertebra degeneration, and to explore the prob-lems about how to identify the participation rates of injury and disease using the clinical information, forensic examination and imaging examination.MethodsSeventeen forensic identification cases of cervi-cal trauma with cervical vertebra degeneration were collected. The age distributions, injury formations, injury severities and imaging findings of these cases were analyzed and the relationship between injury and disease was evaluated comprehensively.ResultsMiddle-aged and elderly were common in 17 cases and every case was involved with intervertebral disc herniation. The main reasons of injuries were hy-perextension. The degree of injury severity and vertebra degeneration were graded according to the imag-ing findings. The participation rates of injury and disease were also calculated comprehensively.Conclu-sionThe forensic identification cases of cervical trauma with cervical vertebra degeneration should be evaluated with clinical information, forensic examination and imaging finding.

Role of PI3K/Akt signaling pathway and autophagy in reduction of adriamycin-induced myocardial injury by sevoflurane in rats / 中华麻醉学杂志

Objective To evaluate the role of phosphatidylinositol 3-kinase/protein-serine-threonine kinases (PI3K/Akt) signaling pathway and autophagy in reduction of adriamycin-induced myocardial injury by sevoflurane in the rats.Methods Thirty-six healthy male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 6 groups (n =6 each) using a random number table:control group (group C),adriamycin-induced myocardial injury group (group Dox),sevoflurane group (group Sev),LY294002 inhibitor group (group LY),solvent control group (group dimethyl sulfoxide [DMSO]),and 3-MA inhibitor group (group 3-MA).Adriamycin 4 mg/kg was injected intraperitoneally once a week for 3 weeks in all the groups except group C.The rats were mechanically ventilated for 2 h in C and Dox groups.The rats inhaled 2.4％ sevoflurane for 2 h in group Sev.In group LY,0.3 mg/kg LY294002 was injected via the tail vein at 10 min before anesthesia,and the rats inhaled 2.4％ sevoflurane for 2 h.In group DMSO,the equal volume of DMSO was injected,and the rats inhaled 2.4％ sevoflurane for 2 h.After the blood samples were collected from the heart,the rats were sacrificed,and myocardial specimens were obtained for determination of cardiac troponin Ⅰ (cTnI) concentrations in serum (by enzyme-linked immunosorbent assay),expression of total Akt (t-Akt),phosphorylated Akt (p-Akt),mammalian target of rapamycin (mTOR),phosphorylated mTOR (p-mTOR) and autophagy marker microtubule-associated protein light chain 3 Ⅱ (LC3 Ⅱ) (by Western blot),and cell apoptosis (by TUNEL).Apoptosis index (AI) was calculated.Results Compared with group C,the expression of p-Akt and p-mTOR was significantly down-regulated,and the expression of LC3 Ⅱ,AI,and serum cTnI concentration were significantly increased in the other five groups (P＜ 0.05).Compared with group Dox,the expression of p-Akt and p-mTOR was significantly up-regulated,and the expression of LC3 Ⅱ,AI,and serum cTnI concentration were significantly decreased in group Sev (P＜0.05).Compared with group Sev,the expression of p-Akt and p-mTOR was significantly down-regulated,and the expression of LC3 Ⅱ,AI,and serum cTnI concentration were significantly increased in group LY,and the expression of LC3 Ⅱ was significantly down-regulated,and serum cTnI concentrations were significantly decreased in group 3-MA (P＜0.05).Conclusion Sevoflurane can activate PI3K/Akt signaling pathway and inhibit autophagy,thus reducing adriamycin-induced myocardial injury in rats.

Development of evaluation index system of reputation for higher medical institutions based on fac-tor analysis method / 中华医学教育探索杂志

Objective To develop an evaluation index system of reputation for higher medical insti-tutions and to test its reliability and validity. Methods Using literature method and small-group discussion to collect the evaluation indexes, the data was collected by the questionnaire survey and the 1 493 effective questionnaires were collected with effective recovery rates of 61.90%. And the exploratory and confirmatory factor analysis methods were conducted to develop evaluation index system with using the SPSS 17.0 soft-ware for statistics analysis. Results The evaluation index system of reputation for higher medical institutions included six dimensionalities: social responsibility, opinion direction, social image, management quality, emotional attract and environmental facility. The Cronbachs’a coefficients of evaluation index system were greater than 0.7, RMSEA is 0.063<0.08, χ2/df is 3.933<5, therefore, the structural equation model fitting was good and evaluation index system had good validity. Conclusion This article has developed an evalu-ation index system of reputation for higher medical institutions, which has a good reliability and validity. To test the model’s reliability and validity, the suggestion that the future research will be performed between more other medical universities has been given.

Effect of dexmedetomidine combined with seven isoflurane for elderly patients with rectal cancer radical operation on recovery quality / 中国基层医药

Objective To investigate the effects of dexmedetomidine combined with sevoflurane on elderly patients with postoperative recovery quality.Methods Selected 60 cases of abdominal rectal cancer resection for elderly patients,which were ASA I or II,were randomly divided into two groups by a random number table method, while each groupincluded 30 cases:the control group( group N) and the dexmedetomidine group( group D) .Before the induction of anesthesia,group D vein was injected with micro pump ( more than 10 min) of dexmedetomidine 1μg/kg ( which was formulated with physiological saline as 4μg/mL) ,and then was given to maintain the dexmedetomidine 0.5μg/h and N group was injected with micro pump of the same volume of normal saline.The two groups of anesthesia were same,by which the static inhalation of composite general anesthesia.Observation were recorded before induction of anesthesia(T0),given dexmedetomidine(TI),after intubation 1 min(T1),5 min(T2),drawing tube immediately (T3),extubation after 5min(T4),30min(T5)the time of HR,BP,SpO2,BIS;propofol and remifentanil dosage,opera-tive time,operation time,a nesthesia time,recovery time,drawing tube time,extubation after Ramsay Sedation score, pain score,patient satisfaction and adverse reactions were recorded.Results In T3 period,the changes of HR (82 ± 14)times/min,SBP (130 ±8)mmHg,DBP (85 ±13)mmHg in group N were more obvious than (70 ±12)timse/min, SBP (121 ±7)mmHg,DBP (79 ±9)mmHg in group D,the difference between the two groups had statistical signifi-cance(t=6.28,4.63,2.08,all P0.05).In group N,postoper-ative restlessness in 8 cases,nausea and vomiting in 10 cases,chills in 9 cases,which were significantly higher than 2 cases,2 cases,2 cases in group D(χ2 =4.32,6.67,5.45,all P<0.05).At the same time,the satisfaction score of patient in group D (3.0 ±0.3)point,which was significant higher than (2.7 ±0.5)points in group N (t=1.88,P<0.05).Conclusion Dexmedetomidine detomidine composite sevoflurane anesthesia can improve the postoperative re-covery quality of elderly patients with rectal cancer radical surgery.

Dynamic Posturography of Injured Lower Limb in Postural Evoked Response / 法医学杂志

Objective To analyze the balance function of injured lower lim b by dynam ic posturography. Methods Using the dynam ic posturography instrum ent, the postural evoked responses of sixty-two norm al people and two hundred and fifty-eight people with injured lower lim b bones and joints were detected. The test was included sensory organization test(SO T) and adaption test(ADT).The results of two groups were com pared by t test. Results Com pared with the norm al people, the im paired people had significant statistical differences in balance scores of SO T3-SO T6 and proportion score of dynam ic proprioception (P<0.05). There was no obvious decrease in ADT. Conclusion The balance function of injured lower lim b significantly decreases.

Effect of preoperative sleep disturbance on efficacy of postoperative analgesia and comfort in patients undergoing colorectal cancer resection surgery / 中国基层医药

Objective To evaluate the effect of preoperative sleep disturbance on efficacy of postoperative analgesia and comfort in patients undergoing colorectal cancer resection surgery.Methods 60 colorectal cancer patients with elective anesthesia laparoscopic radical resection were selected.According to the presence or absence of preoperative sleep disorders,they were divided into the sleep disorder group (group A) and non-sleep disorders group (group B),30 patients in each group.Two groups of patients used the same method to maintain anesthesia induction.Intraoperative intravenous nicardipine controlled hypotension in parallel to maintain MAP 60-75mmHg,HR 65-95times/min.The patients received PCIA pump at the end of surgery.Postoperative 24h VAS scores were maintained VAS score ≤3 points,when VAS score ＞ 3 points,given the pressing PCA analgesia remedy.The remedy situation within 24 hours after surgery and comfort analgesic score were recorded.Results Compared with group B,postoperative PCIA pressing number of group A significantly increased [A group:(11 ± 5),group B:(6 ± 5),t =2.44,P ＜ 0.05].At the end of surgery,postoperative 2h,4h,8h pain scores of group A were (2.8 ± 0.4),(2.5 ± 0.7),(3.2 ± 0.6),(3.5 ± 0.5),respectively,which were significantly higher than those of group B [(1.8 ± 0.5) points,(1.8 ± 0.4) points,(1.9 ± 0.3) points,(2.9 ± 0.3) points; at the end of surgery t =5.78,postoperative 2h t =4.56,postoperative 4h t =4.17,postoperative 8h t =2.09,all P ＜ 0.05],but postoperative 12h,24h had no significant change in pain scores (P ＞ 0.05).Compared with group B,the comfort scores of A group at the end of surgery,postoperative 2h,4h,8h,12h[group A:(2.8 ±0.3) points,(2.5 ±0.9)points,(2.6 ±0.9) points,(2.5 ±0.5) points,(2.9 ± 0.6) points ; group B:(3.8 ± 0.4) points,(3.3 ± 0.5) points,(3.6 ± 0.8) points,(3.3 ± 0.3) points,(3.3 ± 0.6) points] were significantly lower (at the end of surgery t =9.87 ; postoperative 2h t =4.94 ; postoperative 4h t =6.87 ; postoperative 8h t =7.61 ; postoperative 12h t--2.79,all P ＜ 0.05),after 24h comfort score had no significant change (P ＞ 0.05).Conclusion Preoperative sleep disorders can affect laparoscopic colorectal cancer after radical surgery analgesia and comfort of patients.

Effect of dexmedetomidine and tramadol on perioperative insulin resistance in patients undergoing radical resection of rectal carcinoma / 中国基层医药

Objective To evaluate the effect of dexmedetomidine and tramadol on perioperative insulin resistance in patients undergoing radical resection of rectal carcinoma.Methods Sixty ASA I or II patients undergo-ing radical resection of rectal carcinoma were randomly divided into 3 groups(n =20 each):dexmedetomidine group (group D),tramadol group(group T),control group(group C).Group D was given dexmedetomidine intravenously at 1μg/kg 15min before induction of anesthesia followed by a continuous infusion of 0.5μg·kg -1 ·h -1 until the abdo-men was closed,and group T was given tramadol intravenously at 1.5mg/kg 15min before induction of anesthesia fol-lowed by a continuous infusion of 0.5mg·kg -1 ·h -1 until the abdomen was closed,whereas group C received the same volume of normal saline.Venous blood samples were taken at 30min before anesthesia induction(T1 ),1 h after the beginning of the operation(T2 ),1h after operation(T3 ),24h after operation(T4 )for determination of blood con-centrations of glucose(BG),insulin(INS),interleukin -6 (IL -6),tumor necrosis factor -α(TNF -α).Insulin resistance(HOMA -IR)and insulin sensitivity index(QUICKI)were calculated.The numbers of patients with PONV were studied respectively.Results The serum IL -6,TNF -α,BG,INS concentrations and HOMA -IR were signifi-cantly lower while ISI was significantly higher in both group D[t =7.71,3.37,8.78,8.73,11.45,2.82(T2 ),3.04, 2.95,12.75,10.73,16.09,2.92(T3 ),11.26,2.45,11.40,5.10,14.5,2.51(T4 ),all P <0.05]and group T[t =3.02,2.59,2.93,7.76,6.32,2.03(T2 ),8.78,2.27,4.14,8.83,7.68,2.12(T3 ),6.10,2.05,3.71,2.35,7.12, 2.09(T4 ),all P <0.05]at T2 ,T3 and T4 than those in group C.The serum TNF -αconcentration and HOMA -IR were significantly lower while ISI was significantly higher in group D[t =6.68,4.58,2.05 (T2 ),9.01,6.66,2.23 (T3 ),7.54,5.5,2.02(T4 ),all P <0.05]at T2 ,T3 and T4 than those in group T.The numbers of patients with PONV were significantly higher in group T than those in group D and group C (χ2 =26.13,18.75,all P <0.05 ). Conclusion Both dexmedetomidine and tramadol can attenuate perioperative insulin resistance in patients undergo-ing Radical Resection of Rectal Carcinoma,and the decrease the consentrations of IL -6 and TNF -αmay be involved in the mechanism.The roles of prevention of perioperative insulin resistance in dexmedetomidine group are superior to tramadol group.The incidence of PONV is less in a dexmedetomidine group than that in a tramadol group.

The effect of small doses of dexmedetomidine on postoperative analgesia and comfort after colorectal cancer radical operation in elderly patients / 中国基层医药

Objective To observe the effect of small doses of dexmedetomidine on postoperative analgesia and comfort after colorectal cancer radical operation in elderly patients .Methods 60 cases of elderly patients for elective colorectal cancer resection ,ASAⅠ~Ⅱgrade anesthesia were selected .According to randomly digital table , they were divided into the dexmedetomidine given group ( group D) and control group ( group C),30 cases in each group.The patients of group D was given to 0.5μg/kg dexmedetomidine for induction of anesthesia infusion , 15minutes bolus injection was completed ,intraoperative maintain 0.2μg· kg-1 · h-1 dexmedetomidine fixed to the front end of surgery 10 min.And group C was given to infusion of 0.9%sodium chloride injection in the same capacity . The operation time, amount of fentanyl using , comfort and VAS scores were recorded within 24h, maintain VAS score≤3 points.When VAS score>3 points,the pressing PCA was given ,and the number of times of pressing the PCIA was recorded.The adverse reactions occurred within 24h such as nausea and vomiting were also recorded . Results In the two groups,the results of postoperative analgesia were good ,but the VAS score of group D at each time of PCA point were less than those of group C (tend of surgery =5.99,tafter operation 2h =4.76,tafter operation 4h =4.08,all P<0.01).The Bruggrmann comfort score of group D were greater than those of group C (tend of surgery =9.86,tafter operation 2h =4.91,tafter operation 4h =6.84,all P<0.01).The incidence of adverse reactions of group D was 13.30%,which was less than 26.67%of group C(χ2 =4.32,P<0.05).Conclusion Small doses of dexmedetomidine given to improve the analgesic effect in elderly patients with colorectal cancer cure can improve comfort and reduce the incidence of adverse reactions ,and has a role in reducing postoperative nausea and vomiting .

Research on personnel training mode of health supervision professionals for general education of undergraduates / 中华医学教育探索杂志

To train health supervision talents , one of the scarce talent cultivation plans of National Health and Family Planning Commission, the undergraduate of health supervision was set up by Harbin Medical University and approved by the Ministry of education in 2012. According to the problems of personnel training, the competency model of health supervision was established through empirical research, which covered six aspects and 33 factors, and based on the model, the personnel training model was developed to cultivate the compound health supervision talents to meet the demand of health supervision, and the curriculum system covered medical, law, supervision and management courses. In order to realize the target of talent training, some viable measures were taken such as re-forming the traditional teaching methods, establishing comprehensive teachers, strengthening teacher training, and so on.

Research progress of cervical carcinoma risk factors / 实用肿瘤学杂志

Cervical carcinoma is a serious threat to the health of women around the world ,and its inci-dence ranks at the second position after breast cancer in female reproductive system .In addition to oncogene acti-vation and inactivation of tumor suppressor gene ,endogenous and exogenous factors also affect the development of cervical cancer .