Objective To study the effects of acute hypervolemi c hemodilution (AHH) on the coagulation and cardiac function in elderly surgical p atients. Method Sixty surgical patients, aged 60 to70, ASA Ⅰ~ Ⅱ, were randomly divided into three groups (n=20 for each group). 6% HES 50 0~1000ml was infused in a rate of 20ml/min during vasodilation with isoflurane i nhalation (group 1), nitroglycerin (group 2), or nicardipine (group3) with the a id of an intravenous injection pump. The blood coagulation and cardiac functions were observed during hemodilution. Results No significant diff erence was found among the three groups on cardiac function and coagulation func tion during 500ml 6% HES infusion. When the volume of infusion was over 1000ml, the parameters of cardiac function increased and those of coagulation decrease d significantly (P

Objective To study the value of laparoscopic cholecystectomy (LC) for treating gallbladder benign diseases in aged patients. Methods Laparoscopy cholecystectomy (3-port or 4-port) was performed in 2335 senile patients with gallbladder benign diseases from December 1992 to May 2005. Results Five patients were found as having the Mirizzi syndrome and were given a subtotal cholecystectomy. In 18 patients with a frozen Callot’s triangle, the anterior wall of the gallbladder was resected and the mucous membrane on the posterior wall was electrocauterized. LC was completed smoothly in the remaining 2312 patients. No conversions to open surgery were needed. The operation time was 8~55 min (mean, 19 min), and the intraoperative blood loss was 1~ 50 ml (mean, 8 ml). An abdominal drainage tube was placed in 213 patients, including double-cannula lavage in 56 patients. The length of hospital stay was 4~16 d (mean, 6 d). Follow-up examinations for 10 days ~13 years in 1859 patients showed no biliary stenosis, gallbladder pouch, or residual stones. Conclusions Laparoscopic cholecystectomy is safe and feasible in aged patients, being the first choice of operative method. Proper perioperative management, careful prevention co-morbidities, and control of operation time as short as possible are important for senile patients.

Objective To observe the curative effect of pricking bloodletting combined with acupuncture on patients with piriformis injury syndrome.Methods A prospective randomized controlled clinical trial was conducted, 84 patients with piriformis injury syndrome admitted to the Department of Acupuncture and Massage in the First Affiliated Hospital of Xinjiang Medical University from May 2011 to May 2014 were enrolled, and they were divided into observation group and control group by random number table, each group being 42 cases. The patients in the observation group were treated with bloodletting once a week (after bloodletting no other treatment was given), and then once a day of acupuncture was performed for 4 days in a week, completing one therapeutic course; while in the control group, the patient was treated with routine acupuncture once a day for 5 days in a week, finishing one therapeutic course. The interval between two therapeutic courses was 2 days, two courses were carried out, and afterwards the clinical therapeutic effects were evaluated in the two groups. The changes of visual analogue scale (VAS) of two groups before and after treatment and the therapeutic effects were observed.Results The VAS score of the two groups after treatment was lower than that before treatment, and the degree of decrease of VAS score in the observation group was significantly lower than that of thecontrol group (1.50±1.35 vs. 2.69±1.68,P < 0.01); the total effective rate in the observation group was obviously higher than that in the control group [100.00% (42/42) vs. 69.05% (29/42),P < 0.01].Conclusion Pricking bloodletting combined with acupuncture therapy for treatment of piriformis injury syndrome can shorten the course of treatment.

Objective To compare the conventional non-enhanced and virtual non-enhanced images of dual-energy computed tomography (CT) in evaluating solitary pulmonary nodules (SPNs).Methods Forty-seven patients with SPNs proved by pathology underwent conventional and enhanced thoracic DECT.The virtual non-enhanced CT images and iodine images were reconstructed based on the enhanced imaging data.The mean CT number,noise,signal to noise (SNR),nodual diameter of SPNs were compared between the true non-contrast CT(TNCT) and the virtual non-contrast CT (VNCT),with paired t test.The image quality and detectability of calcification were also compared.The diagnostic accuracy for malignant nodulesbased on the increased CT values and iodine-enhanced image were compared.The independent t test was used to compare the increased CT number of SPNs and iodine images.The single-phase radioation dose of the single energy,was compared with dual energy scan.Results No significant difference in the mean CT Number(t =1.556,P ＞ 0.05),noise (t =-0.357,P ＞ 0.05),SNR (t =0.767,P ＞ 0.05) on TNCT and VNCT.The mean CT Number,the noise,and SNR were (29.90 ± 12.43)vs (27.52 ± 16.67) HU,(9.60 ±3.74) vs (9.88 ± 2.90),and (3.07 ± 1.93) vs (2.76 ± 2.36),respectively.The increased CT number ofSPNs with TNCT and VNCT from baseline were(18.63 ± 8.03) and(20.45 ± 9.13) HU.The CT number of iodine image was(23.82 ± 9.20)HU.A significant difference was observed between the TNCT and iodineed image (t =-2.371,P ＜ 0.05).The quality scores of VNCT image wasslightly worse than TNCT image.The detectability rate of calcification on VNCT was 92.3％ (72/78).The iodine image carried the highest diagnostic sensitivity rate and accuracy rate,82.3％ (28/34)and 74.5％ (35/47),respectively.The highest specificity rate was 76.9％ (10/13) from the increased CT number with VNCT.No significant difference in single-phase radiation dose was observed between TNCT and VNCT,(5.68 ± 1.31) vs.(4.89 ± 1.27)mSv.Conclusions VNCT could be obtained with similar image quality as TNCT.This methods might favor a reduction in radiation exposure.

Objective To observe the clinical efficacy of acupuncture combined with acupoint injection for treatment of patients with intractable hiccups and to seek its standard therapeutic regimen. Methods A prospective study was conducted. Eighty-six patients with intractable hiccups in various clinical departments in the First Affiliated Hospital of Xinjiang Medical University met the inclusion criteria of this study were selected,and according to the different treatment options they were divided into observation group and control group with 43 cases in each group. In the observation group,on the basis of treatment for their primary diseases,the rules of soothing the chest oppression and regulating the flow of qi(Kuanxiong Liqi)and regulating the stomach and sending down abnormally ascending qi(Hewei Jiangni)were followed in treatment,and acupuncture was carried out at Danzhong,Neiguan(double=bilateral acupoints),Zusanli(double),Sanyinjiao(double),Taichong(double)with the needle staying for 20 minutes each time,1 mL metoclopramide injection was injected at each of the bilateral Zusanli acupoints,once a day. In the control group,the patients received intramuscular injection of 10 mg metoclopramide once a day. Both groups were treated for consecutive 7 days. After treatment for 3 days and 5 days,the clinical efficacy was observed,and before treatment and after treatment for 3,5,7 days,the changes of hiccups frequency and persistent duration were investigated. Results Compared with the control group,the total effective rates in observation group on the 3rd and 5th day after treatment were significantly increased〔3 days:88.4%(38/43)vs. 51.2%(22/43),5 days:95.3%(41/43)vs. 62.8%(27/43),both P<0.01〕. With the prolongation of therapy,the hiccups frequency was gradually decreased and the persistent duration of hiccup was gradually shortened,reaching the lowest degree on the 7th day after treatment,and the changes were more significant in the observation group〔hiccups frequency(times/day):0.57±0.08 vs. 2.04±1.78,hiccup duration time(minutes/time):1.07±0.68 vs. 9.23±5.69,both P<0.05〕. Conclusion The therapeutic effects of acupuncture combined with acupoint injection for treatment of patients with intractable hiccups are superior to signal western medicine therapy.

Objective To explore the status of social support and its relationship with depression in elderly university students.Methods 159 students aged 55 to 79 years of Nanning elderly university were selected using cluster sampling methods.They were surveyed by Social Support Rating Scale and Geriatric Depression Scale.Results ①The total score of social support(40.92±7.63) was higher than that of the national norm(34.56±3.73 ) (t=10.515,P＜0.01),and score of social support,subjective support,utilization of support were higher than those of the elderly in Beijing Xicheng district community that was mental health guidance demonstration area in national community (t=2.064,2.017,9.222; P＜0.05).②Social support score and each dimension score of having a spouse group were higher than those of no spouse group (t=5.78,4.956,4.918,3.175 ; P＜0.0 1).③The positive rate of depression in the sample group was 26.8％.Social support score,objective support score,subjective support score of depression in positive group(37.43±7.41,21.43±4.93,7.67±2.37) were lower than those of negative group(42.17 ±7.35,24.43±4.22,8.78±2.83,t=3.585,2.277,3.776 ; P＜0.05).④Social support,objective support,subjective support and depression were negatively correlated (r=-0.296,-0.194,-0.307; P＜0.01).Conclusion Elderly university student's overall level of social support are higher,and social support is negatively correlated with depressive symptoms.

Objective To evaluate the effects of unilastatin on brain injury in children undergoing aortic arch surgery under cardiopulmonary bypass (CPB).Methods Twenty ASA physical status Ⅲ or Ⅳ children of both sexes,aged 1-24 months,weighing 3-12 kg,undergoing repair of coarctation of aorta or interrupted aortic arch complicated with intracardiac malformations under CPB,were randomly divided into 2 groups (n =10 each):control group (group C) and ulinastatin group (group U).Ulinastatin 20 000 U/kg was diluted into 10 000 U/ml with normal saline and it was then injected intravenously in 3 parts (1/3 was injected via the internal jugular vein after induction of anesthesia; 1/3 at the beginning of CPB and 1/3 at 5 min before aortic unclamping).In group C the equal volume of normal saline was given instead of ulinastatin.Blood samples were taken from the radial artery after induction of anesthesia (T1),at 10 min after aortic clamping (T2),at 10 min after aortic unclamping (T3),at the end of CPB (T4),and at 6 and 24 h after termination of CPB (T5,T6) for determination of plasma S100B protein and neuron-specific enolase (NSE) concentrations.Results There was no significant difference in plasma levels of S100B protein and NSE at T1 between the two groups (P ＞ 0.05).Plasma S100B protein and NSE levels were significantly increased at T2-5 as compared to the baseline values at T1 in both groups (P ＜ 0.05).Plasma S100B protein and NSE levels were significantly lower at T2-5 in group U than in group C (P ＜ 0.05).Conclusion Ulinastatin can attenuate brain injury in children undergoing aortic arch surgery under CPB.

Objective To evaluate the effect of Shenfu Decoction pretreatment on the function of intestinal mucosal barrier of endotoxemic rats.Methods Twenty-four adult male Sprague-Dawley rats,aged 4-6 months,weighing 180-220 g,were randomly divided into 3 groups (n =8 each):blank control group (group C),endotoxemia group (group E) and Shenfu Decoction pretreatment group (group S).Endotoxemia was induced by lipopolysaccharide 10 mg/kg injected intravenously in anesthetized rats in groups E and S.Normal saline and Shenfu Decoction 5 ml/kg were injected intraperitoneally at 30 min before the model of endotoxemia was established in groups E and S,respectively.At 2 h after the model of endotoxemia was estabhshed,blood samples were obtained from the abdominal aorta for measurement of the plasma concentrations of tumor necrosis factor-α (TNF-α),interleukin6 (IL-6),intestinal fatty acid binding protein (i-FABP) and diamine oxidase (DAO) by ELISA.The distal ileum was harvested for detection of the expression of tight junctional protein Zonula Occludens-1 (ZO-1) in the intestinal mucosa of epithelial cells by immunohistochemistry.The changes in pathological morphology of the intestinal mucosa were examined after one segment of the distal ileum was stained with haematoxylin and eosin.The pathological changes were assessed and graded according to Chiu's score.Results Compared withgroup C,the plasma TNF-α,IL-6,i-FABP and D-lac concentrations were significantly increased,Chiu's scores were increased,and the expression of ZO-1 was down-regulated in groups E and S (P ＜ 0.05).Compared with group E,the plasma TNF-α and IL-6 concentrations were significantly decreased,the plasma i-FABP and D-lac concentrations were decreased,Chiu's scores were decreased,and the expression of ZO-1 was up-regulated in group S (P ＜ 0.05).Conclusion Shenfu Decoction pretreatment can attenuate the damage to the intestinal mucosa and protect the function of intestinal mucosal barrier in endotoxemic rats and inhibition of systemic inflammatory responses is involved in the mechanism.

Objective:To investigate the efficacy of systemic glucocorticoid treatment and its related factors in progressive vitiligo patients with vitiligo disease activity (VIDA) scores ≥ 2 points.Methods:A total of 272 progressive vitiligo patients with VIDA scores ≥ 2 points and skin lesion area < 1% of body surface area, who received no systemic glucocorticoid treatment, were collected from Department of Dermatology, the Third People′s Hospital of Hangzhou from June 2018 to June 2019. The area and type of skin lesions, VIDA scores, predisposing factors and special clinical markers (trichrome vitiligo, confetti-like depigmentation, Koebner phenomenon and inflammatory vitiligo) were analyzed. These patients were randomly divided into 3 groups by a random number table: topical glucocorticoid group (62 cases) , oral prednisone + topical glucocorticoid group (76 cases) and compound betamethasone injection + topical glucocorticoid group (134 cases) , and the latter two groups were also called as the systemic and topical glucocorticoid group. The patients in the topical glucocorticoid group were treated with halometasone cream or 0.05% clobetasol propionate cream once a day; during the oral prednisone treatment, the dose was adjusted once every 7 days, and gradually reduced from 30 mg/d to 20, 15, 10 and 5 mg/d, and the treatment lasted 35 days; during the treatment with compound betamethasone injection, intramuscular injection was performed once every 20 days at a dose of 1 ml for 2 sessions. The stable disease rate (defined as the proportion of patients experiencing no progression during the study among the analyzed patients) was calculated in these groups after 3 months of treatment, and changes in vitiligo types were evaluated after 1 year of follow-up. Statistical analysis was carried out by using Kruskal-Wallis H test, χ2 test and Fisher′s exact test. Results:After 3-month treatment, there was a significant difference in the expansion rate of skin lesion area among the 3 groups ( H = 12.468, P < 0.001) , and the expansion rate of skin lesion area was significantly lower in the oral prednisone + topical glucocorticoid group and compound betamethasone injection + topical glucocorticoid group than in the topical glucocorticoid group ( P < 0.001, = 0.005, respectively, α = 0.016 7) ; among the patients with slowly progressive vitiligo (VIDA scores = 2 or 3 points) , the stable disease rate was significantly higher in the systemic and topical glucocorticoid group than in the topical glucocorticoid group ( χ2 = 23.973, 11.877, respectively, both P < 0.001) ; the stable disease rate also significantly differed among the patients with different VIDA scores (VIDA scores = 2, 3 or 4 points) in the systemic and topical glucocorticoid group ( χ2 = 17.122, P < 0.001) . After 3-month treatment, the patients with predisposing factors or special clinical markers showed significantly decreased stable disease rate (47.3% [35/74], 41.2% [47/114], respectively) compared with those without predisposing factors or special clinical markers (70.6% [96/136], 87.5% [84/96]; χ2 = 11.098, 47.548, respectively, both P < 0.001) . After 1 year of follow-up, the proportion of patients with localized vitiligo converted into non-localized vitiligo was significantly higher in the topical glucocorticoid group (41.9%, 26/62) than in the systemic and topical glucocorticoid group (21.9%, 46/210; χ2 = 10.328, P = 0.006) , and higher in the group with predisposing factors or special clinical markers than in that without predisposing factors or special clinical markers respectively (both P < 0.01) . Conclusions:Early systemic glucocorticoid treatment should be performed in the progressive vitiligo patients with high VIDA scores, predisposing factors and special clinical markers.

Innovation education was introduced in medical microbiology teaching practice,including updating the innovative education concept,reforming teaching methods and means,constructing the teaching content system and practice platform adapting to innovation education.