Objective To investigate the effect of preoperative visit on reducing anxiety of patients undergoing carotid endarterectomy. Methods 120 cases of patients with carotid endarterectomy were randomly divided into the observation group and the control group with 60 patients in each group, in the control group, before surgery, the nurse of ward gave routine preoperative nursing care and health education.In the observation group, in addition to routine preoperative care and health education, there were preoperative visits by intensive care unit nurses, the anxiety level was compared 1 day before surgery and 2 to 3 days after surgery. Besides, the cooperation degree of patients was also compared. Results There was no significant difference in anxiety levels in the observation group, but there was significant difference in anxiety levels in the control group, there was significant difference in patients coordination degree between two groups. Conclusions Preoperative visits by intensive care unit nurses can reduce the anxiety level of patients, shorten hospital stay and promote early recovery of patients.

Objective:To use the perineum four-dimensional pelvic ultrasound stereo imaging for detecting injury situation of pelvic diaphragm hiatus and anal levator ani muscle. Understand abnormal classification of pelvic floor muscle. investigate the application of four-dimensional pelvic ultrasound stereo imaging in pelvic floor dysfunction (PFD) for primipara in order to provide more accurate data for clinical practice.Methods: 270 primiparas with pelvic floor dysfunction were divided into the vaginal delivery group (135 cases) and selective cesarean group (135 cases) as random number table; pelvic floor muscle strength, longitudinal diameter, transverse diameter, area of pelvic diaphragm hiatus and thickness of the anus levator were detected by the perineum four-dimensional pelvic ultrasound stereo imaging, respectively, and then to compare differences between the two groups. Results: In 270 cases, 162 cases (60%) were abnormalities in pelvic floor muscle strength, and 189 cases (70%) were abnormalities in vaginal pressure; the results of pelvic floor muscles fatigue grade situation revealed: 127 cases were abnormal muscle fiber strength ofⅠtype (47%), 30 patients were abnormal muscle fiber strength ofⅡ type (11%). There were no significant differences between the two groups in the abnormal rate of pelvic floor muscle strength, vaginal pressure and muscle fiber strength. Longitudinal diameter, transverse diameter and area of pelvic diaphragm hiatus in the vaginal delivery group were higher than that in the selective cesarean group, while thickness of anal levator were thinner than that in the selective cesarean group with significant differences (t=3.730,t=3.467, t=3.826,t=1.809;P<0.05).Conclusions: The perineum four-dimensional ultrasound diagnosis can intuitively and clearly show morphological characteristics of female pelvic diaphragm hiatus, therefore, it can quickly finish diagnosis, and provide the basis for clinical diagnosis and treatment evaluation of postpartum PFD.

Objective To evaluate the effectiveness of uterine arterial embolization (UAE) in the management of uterine fibroids (UF) and adenomyoma. Methods The UAE was carried out in 22 cases of UF and 2 cases of adenomyoma, including bilateral UAE in 23 cases and unilateral UAE in 1 case, by using polyvinyl alcohol (PVA) particles as embolic materials. Results The success rate of UAE in the study was 95 8% (23/24). No serious complications occurred. The uterine and UF volume decreased remarkably in size 6 months after the treatment ( t =2 391 and 3 990, respectively; P =0 022 and 0.000, respectively). In the patient who underwent unilateral UAE, the UF gradually increased in size and a hysterectomy was required. The 2 patients with adenomyoma experienced relief with this treatment but had a recurrence 4 months after the surgery. Conclusions UAE is a safe and effective method in the management of UF but its long-term effects remains a question to be answered through further observations . The efficacy of treatment of this method for adenomyoma is not apparent.

Objective:To provide better clinical treatment plan by grading and classifying four-dimensional ultrasound pelvic floor dynamic imaging primiparas pelvic floor dysfunction.Methods: 270 cases with pelvic floor functional disorders (bladder prolapse) of high-risk mothers were selected, from the beginning of the median sagittal plane and three-dimensional reconstruction of the surface at rest, to observe the bladder and urethra and pelvic diaphragm hiatus and anal status under Valaslva changes in the measurement parameters (bladder neck mobility, posterior horn of bladder and urethra, rotation angle of the urethra) and its Green typing.Results: There was no statistical difference between the mode of delivery cystocele resting corresponding BSD and posterior horn of bladder and urethra (t=1.133,t=1.165;P>0.05). Under Valsalva state, there were significant differences the two groups corresponding to BSD, the bladder neck mobility, posterior horn of bladder and urethra and rotation angle of the urethra (t=2.147,t=5.628,t=3.502,t=4.396;P<0.05). The incidence rate of type II and type III in vaginal delivery group is higher than that in cesarean section group. The incidence rate of type I in vaginal delivery group is less than that in cesarean section group. The differences were statistically significant (x2=6.080,P<0.05). Conclusion: The pelvic floor dynamic four-dimensional ultrasound imaging can clearly show the situation of pelvic floor before primiparas to understand the situation of maternal mode of delivery cystocele production. It can provide a more reliable basis for early clinical diagnosis of maternal pelvic floor dysfunction.

In this study, we constructed a yeast consortium surface-display expression system by using Flo1 as an anchor protein. Endoglucanase II (EGII) and cellobiohydrolase II (CBHII) from Trichoderma reesei, and β3-glucosidase 1 (BGLI) from Aspergillus aculeatus were immobilized on Saccharomyces cerevisiae Y5. We constructed the cellulose-displaying expression yeast consortium (Y5/fEGII:Y5/fCBHII:Y5/fBGLI = 1:1:1) and investigated the enzymatic ability and ethanol fermentation. The displayed cellulolytic enzymes was stabile during the 96-h fermentation. The yeast consortium produced 0.77 g/L ethanol from 10 g/L phosphoric acid swollen cellulose (PASC) within 96 h. The yield (in grams of ethanol produced per gram of carbohydrate consumed) was 0.35 g/g, which correspond to 68.6% of the theoretical yield.
Aspergillus ; enzymology ; Cellulase ; genetics ; Cellulose ; metabolism ; Cellulose 1,4-beta-Cellobiosidase ; genetics ; Enzymes, Immobilized ; genetics ; Ethanol ; metabolism ; Fermentation ; Glucosidases ; genetics ; Mannose-Binding Lectins ; metabolism ; Protein Binding ; Saccharomyces cerevisiae ; genetics ; metabolism ; Saccharomyces cerevisiae Proteins ; metabolism ; Trichoderma ; enzymology

Objective To evaluate the accuracy of vasopressin (VP) secretion in the late phase of septic shock for predicting patient outcomes and further investigate its relationship with the prognosis of septic shock.Methods Fifty-five patients presented at late phase of septic shock,who were admitted to the intensive care unit of our hospital,were enrolled.Their VP secretion was measured.The method for measurement was as follows:3％ sodium chloride solution 600 ml was infused over 2 h,serum concentrations of VP and sodium were measured before and after infusion,the difference in VP before and after infusion (△VP) and in Na before and after infusion (△Na) was calculated,and △VP/△Na was used to reflect VP secretion.The patients were divided into either abnormal secretion of VP group (△ VP/△ Na ≤ 0.5 ng/mmol) or normal secretion of VP group (△VP/△Na＞0.5 ng/mmol) according to △VP/△Na ratio.Immediately before testing VP secretion,venous blood samples were collected for determination of serum lactic acid and C-reactive protein concentrations.The consumption of vasoactive drugs at the moment of enrollment and 28-day fatality rate were recorded.Results There were 30 cases in abnormal group (54％) and 25 cases in normal group (46％).Compared with normal group,the serum lactic acid,C-reactive protein concentrations and consumption of dopamine or norepinephrine were significantly increased,and the 28-day fatality rate was increased (67％ vs 40％) in abnormal group.ROC curve analysis showed that when △VP/△Na 0.5 ng/mmol was used as the criteria for determining prognosis,the sensitivity was 66.7％,specificity was 64.0％,and the area under the ROC curve was 0.828.Conclusion VP secretion in the late phase of septic shock may affect patient prognosis.

Objective To evaluate the efficacy of Ambu AuraOnce laryngeal mask airway (LMA) in Chinese patients undergoing general anesthesia.Methods Fifty-six female patients, aged 20-64 yr, weighing 45-75 kg, of American Society of Anesthesiology physical status Ⅰ or Ⅱ (Mallampati Ⅰ-Ⅲ), scheduled for elective breast surgery under general anesthesia, were equally and randomly divided into either Ambu AuraOnce LMA group (group A) or LMA Supreme group (group S) using a random number table.After induction of anesthesia, Ambu AuraOnce LMA was inserted in group A, and LMA Supreme was placed in group S.After successful placement of LMA, correct position was confirmed by fiberoptic laryngoscopy.Intermittent positive pressure ventilation was performed during surgery to maintain pulse oxygen saturation ＞ 95％ and partial pressure of end-tidal CO2 at 30-45 mmHg.The success rate, insertion time, extubation time, airway sealing pressure, peak airway pressure and occurrence of air leakage of LMA were recorded.After removal of the LMA, the blood stains on the LMA were checked, and the occurrence of hypoxemia, regurgitation, nausea, vomiting and bucking was recorded.The occurrence of sore throat, hoarseness and dysphagia was also recorded within 24 h after surgery.Results There were no significant differences in terms of insertion time, overall success rate, success rate at first attempt, removal of LMA time, airway sealing pressure, and incidence of air leakage of LMA, hypoxemia, blood stains on the LMA, sore throat, hoarseness and dysphagia between the two groups.The rate for correct position of LMA confirmed by fiberoptic laryngoscopy was significantly higher in group A than in group S.Conclusion Ambu AuraOnce LMA can safely and effectively be applied for airway management in Chinese patients undergoing general anesthesia.

Purpose To explore the relation between the expression of Bmi-1 and cancer stem cells and its relation to chemotherapy re-sistance in breast cancer. Methods MTT method was applied to detect the inhibition effect on proliferation of different concentrations (0. 01, 0. 1, 1, 10 μg/ml) of 5-Fluorouracil (5-FU) to MDA-MB-468 cells with 48 and 72 hours culture, a curve of proliferation in-hibition rate was drawn, and a suitable experiment concentration of 5-FU was chosen. MDA-MB-468 cells was serially passaged under continuous interference with the suitable concentration of 5-FU, 6 generations of cells were collected, cells with 5-FU interference were designed as experiment group and a corresponding control group with no 5-FU was set. RT-PCR and Western blot were employed to ex-amine mRNA and protein expression of Bmi-1 and Sca-1, Oct-4 in the 6 generations of cells of both control group and experiment group. Results Results of the MTT test showed that 5-FU could inhibit the proliferation of human breast cancer cell line MDA-MB-468, the 5-FU concentration of 0. 1 μg/ml was chosen as the suitable experiment concentration. RT-PCR tests showed that the differ-ences between the relative mRNA expression values of Bmi-1 and Sca-1, Oct-4 in the 6 generations of MDA-MB-468 cells were not sta-tistically significant in control group (all P>0. 05) and that the differences between the relative mRNA expression values of Bmi-1 and Sca-1, Oct-4 in the 6 generations of MDA-MB-468 cells were of statistical significance in experiment group cells (all P<0. 05). The mRNA expression of Bmi-1, Sca-1 and Oct-4 showed the following tendency in the 6 generations of passaged cells:decrease (1st gen-eration)—increase (2nd generation)—continuous increase (3rd generation)—decrease (4th generation)—increase (5th genera-tion)—decrease (6th generation). Western blot tests indicated that the differences between the relative protein expression values of Bmi-1 and Sca-1, Oct-4 in the 6 generations of MDA-MB-468 cells were not statistically significant in control group and that the differ-ences between the relative protein expression values of Bmi-1 and Sca-1, Oct-4 in the 6 generations of MDA-MB-468 cells were of sta-tistical significance in experiment group cells (all P<0. 05). The expression of Bmi-1 was positively correlated with stem cell associat-ed factors Sca-1, Oct-4 (r=1, all P<0. 01). Conclusions The expression of Bmi-1 gene is positively correlated with expression of stem cell associated factors Sca-1 and Oct-4 in breast cancer cell line MDA-MB-468 cell, and Bmi-1 may be a novel marker for cancer stem cells in breast cancer. Administration of 5-FU can affect the expression level of Bmi-1 and the ration of cancer stem cells in breast cancer cell line MDA-MB-468. Bmi-1 gene may be associated with drug resistance to chemotherapy and recurrence in breast cancer.

Objective To investigate the prognostic value of decreased vasopressin (VP)modulation in the late-phase of septic shock. Methods A prospective study was conducted. Fifty-five septic shock patients hospitalized in intensive care unit (ICU)of the First Hospital of Hebei Medical University from January 2012 to February 2014 were enrolled. All patients received 3% hypertonic saline solution infusion. Serum concentrations of sodium and VP were measured before and after hypertonic saline solution infusion. Patients with ratio of difference in sodium and VP before and after infusion of 3%hypertonic saline (△VP/△Na)≤0.5 pg/mmol were defined as non-responders,and who>0.5 pg/mmol were defined as responders. The levels of lactic acid,C-reactive protein (CRP),and vasoactive drug〔dopamine(DA)and norepinephrine(NE)〕usage between the two groups were compared. The 28-day mortality,live time in the dead,and ICU day in survivors were analyzed between the two groups. The receiver operating characteristic curve (ROC curve)was drawn to assess prognostic value of VP. Results There were 30 cases (54.5%) in non-responsive group,and 25 (45.5%)in responsive group. There were no significant differences in the age,acute physiology and chronic health evaluationⅡ (APACHEⅡ)score,central venous pressure (CVP),blood pressure, plasma albumin level,sodium level before and after hypertonic saline solution infusion between the two groups. The baseline level of VP in the non-responsive group was markedly lower than that of the responsive group (ng/L:10.66± 1.57 vs. 17.13 ±5.12,t=6.091,P<0.001). After hypertonic saline solution infusion,the VP level was also significantly decreased compared with that in the responsive group(ng/L:11.65±1.74 vs. 22.50±5.31,t=9.758,P<0.001). The non-responders showed higher lactic acid (mmol/L:3.04±0.55 vs. 2.28±0.38,t=-5.881,P<0.001) and CRP (mg/L:117.9±23.0 vs. 94.9±17.0,t=-4.143,P<0.001),and received larger dosage of vasoactive drugs〔DA(μg·kg-1·min-1):14.8±3.9 vs. 8.9±1.6,t=-5.725,P<0.001;NE(μg·kg-1·min-1):0.96±0.42 vs. 0.40± 0.09,t=-5.625,P<0.001〕for maintaining blood pressure compared with those in responders. The non-responsive group showed higher 28-day mortality(66.7%vs. 40.0%,χ2=3.911,P=0.048)and longer ICU day(days:9.9±2.3 vs. 6.7±1.7,t=-4.044,P<0.001),but the live time in the dead showed no difference between non-responsive group and responsive group(days:5.8±1.9 vs. 6.1±2.3,t=0.384,P=0.704). ROC curve showed that the area under ROC curve(AUC)forΔVP/ΔNa predicting the outcome was 0.828,and theΔVP/ΔNa threshold value of 0.5 pg/mmol had the sensitivity of 66.7%and specificity of 64.0%for prediction of the outcome(95%confidence interval:0.722-0.934). Conclusion Osmotic pressure-regulated VP secretion was impaired and decreased in the late-phase of septic shock, and made the sense in prognosis.

BACKGROUND:YOUMET cervical dilating rod is made of absorbent polymer materials and has non-toxic side effects, which can avoid cross-infection in one-time use. OBJECTIVE:To observe the clinical effects of YOUMET cervical dilating rod used for cervical orifice dilation before intrauterine device insertion and removal as wel as before artificial abortion operations. METHODS:Totaly 275 female subjects schedule for cervical dilation during intrauterine device insertion and removal operations, and suction abortion for pregnancy within 10 weeks were randomly divided into two groups: 137 were included in observation group in which YOUMET cervical dilating rods were applied and 138 were included in control group in which Gongshuning glue sticks were used. Their cervical softening and dilatation situation, analgesic effect, and combined reactions during operation were observed. RESULTS AND CONCLUSION:Between the two groups, no statistical significance in general biological characteristics was found; Dilating effects in intrauterine device removing operations during child-bearing period and menopause were better in the observation group than the control group (P < 0.05). Rates of pain during insertion were higher in the observation group than the control group (P < 0.05). Rates of pain during indweling period for both groups were comparatively low, which showed no statistical significance. There was no record related to the application of cervical orifice dilating products in postoperative folow-up visit. Both products were safe with no cervical injury, slow heart rate and drop in blood pressure. YOUMET cervical dilating rod has trustworthy and safe dilating effects, which can remarkably aleviate pain.