Objective To investigate the clinical efficacy of losartan combined with atorvastatin in the treatment of essential hypertension and its influence on the plasma high sensitive C reactive protein(hs-CRP),endothelin (ET) and the level of nitric oxide(NO).Methods According to the digital table,84 patients with primary hypertension were randomly divided into the two groups of 42 cases,the control group was given losartan for treatment,the observation group was treated with losartan combined with atorvastatin.The clinical curative effect and the changes of plasma hs-CRP,ET and the level of NO before and after treatment were compared between the two groups.Results The effective rate of the observation group was 92.86％,which was significantly higher than 80.95％ of the control group(x2 =7.85,P ＜ 0.05);The levels of plasma hs-CRP and ET of the observation group after treatment were (3.02 ± 0.29) mg/L and (34.44 ± 4.59) μg/L,which were significantly lower than (5.30 ± 0.38) mg/L and (58.30 ± 5.27) μg/L of pretreatment and (4.95 ± 0.36) mg/L and (55.93 ± 5.71) μg/L of the control group (t =7.43,8.10,7.89,8.56,all P ＜ 0.05);The NO level of the observation group after treatment was (70.47 ± 4.58)μmol/L,which were significantly higher than (44.43 ± 3.41)μ mol/L of pretreatment and (46.33 ± 3.81) μmol/L of the control group(t =8.69,9.04,all P＜0.05).Conclusion Atorvastatin combined with losartan has a definite effect in treatment of primary hypertension,which can significantly improve the inflammation and endothelial function of patients that has a good clinical application value.

Objective:To explore the effect of continuous quality improvement theory on patients' satisfaction and nurses'perception of working environment.Methods:Quality nursing service satisfaction survey was conducted in 450 patients,at the same time,100 nurses were investigated for the situation of working environment.Patients' satisfaction and the status of nurses' perception of their own work environment were compared before and after the implementation of continuous quality improvement theory.Results:After the implementation of continuous quality improvement theory,both patients' satisfaction and nurses' perception of working environment were significantly improved (P ＜ 0.05).Gonclusions:Continuous quality improvement theory can improve the satisfaction of patients with high quality nursing service,and enhance the nurses' perception of their working environment.

[ABSTRACT]OBJECTIVETo investigate the effect of accurate airway humidification on hemorrhage, pharyngalgia, mucosal edema and sputum viscosity in patients with low-temperature plasma coblation-assisted tonsillectomy.METHODS58 cases were divided into three groups by using random numbers.In accurate airway humidification group, atomizing inhalation was carried out by AIRVOTM series apparatus; in oxygen atomizing group, budesonide suspension was used; in control group, saline was used. We evaluated the hemorrhage, pharyngalgia, mucosal edema and sputum viscosity in 3 consecutive postoperative days.RESULTSPharyngalgia in accurate airway humidification group and in oxygen atomizing group were both significantly reduced than that of the control group (P<0.001). Besides, in accurate airway humidification group, mucosal edema and sputum viscosity were significantly improved than that of the oxygen atomizing group (P<0.05) and control group (P<0.05).CONCLUSIONAccurate airway humidification could reduce the complications such as pharyngalgia, mucosal edema and purulent sputum after low-temperature plasma coblation-assisted tonsillectomy, and could accelerate recovery from surgery.

Objective To explore the influence of treatment duration on the prognosis of Cryptococcus neoformans meningitis (CNM). Methods The clinical data of 30 patients with CNM were retrospectively analyzed. The time of Cryptococcus neoformans culture in cerebrospinal fluid turned to be negative were compared between patients with and without amphotericin B (AmB)endoneurilemma injection to determine whether endoneurilemma injection would make any difference on prognosis of CNM. Statistic analysis was performed by t test. Results The time of Cryptococcus neoformans culture in cerebrospinal fluid turned to be negative was (22. 73 ± 10. 00) days in 11patients with AmB endoneurilemma injection compared to (18. 92±7. 26) days in 13 patients without endoneurilemma injection. The difference was not statistically significant (t = 0. 172,P>0. 05). The effective rate was 45. 8% after 2-week anti Cryptococcus neoformans treatment, which increased to 100.0% after 6-week treatment. However, the curative rate at week 6 of treatment was 0. All ten patients who finished the treatment (three to four months' treatment) were acquired effective.Conclusion Treatment with standard dosage and adequate duration is crucial in improving the prognosis of Cryptococcus neoformans meningitis.

Objective To compared the reliability and validity of the application of two consciousness assessment scales in neurosurgical patients by Full Outline of Unresponsiveness Score Coma Scale (FOUR) and the Glasgow Coma Scale (GCS), and provide the effective evaluation for the consciousness of the nerve severe patients. Methods A total of 100 neurological intensive patients from Nanfang Hospital, Southern Medical University were enrolled and the consciousness was evaluated by FOUR and GCS. The reliability and validity of these scales were evaluated and compared by the following method such as Cronbach αcoefficient, the inter-rater agreement,content validity index (CVI) and the receiver operating characteristic curve (ROC) which used to predict the discrimination of prognosis.The important experimental indexes of blood of the degree of brain injury were collected in the same period:S-100 B protein and neuron specific enolization enzymes (NSE). Results The Cronbach α coefficient was 0.811 (FOUR) and 0.923(GCS). The overall rater agreement was excellent with an intraclass correlation coefficients of 0.972 (FOUR) and 0.979(GCS). CVI was 0.965 (FOUR) and 0.973 (GCS). Both scales had better distinguish and predictive abilities for the poor prognosis.The area under the curve for mortality was 0.938 for the FOUR and 0.932 for the GCS. The best cut-off values for predicting poor prognosis were FOUR of 12 and GCS of 11. For the FOUR, the correlation coefficient was-0.324(P<0.05) with the level of NSE,-0.427(P<0.01) with the level of S-100B protein. For the GCS,the correlation coefficient was-0.316 (P<0.05) with the level of NSE,-0.395 (P<0.01) with the level of S-100B protein. Conclusions Both FOUR and GCS are a reliable scale for evaluating the level of consciousness in neurosurgical patients. The GCS is familiar with the medical staff while the FOUR is more adapted to assess the patients with tracheotomy or intubated and which more easy to remember and learn by medical staff of neurosurgery department.

Objective To investigate the effects of sevoflurane and propofol on postoperative cognitive function after abdominal surgery for elderly patients with diabetes. Methods Seventy diabetic patients (aged 60~75 yr, ASAⅠorⅡ) underwent abdominal surgery and are included in the research. Diabetic patients were randomly divided into two groups (n=35): sevoflurane group(group DS) and propofol group (group DP). MMSE score, the attachment test, words memory test and Stroop color word test were carried and the results were recorded before operation (T1), postoperative 24 h (T2), 48 h (T3) and 1 w (T4). Results Compared with T1, patients′ MMSE score reduced at T2 and T3. Time spent in attachment test is longer at T2 and T3. Mistaken incidences in Stroop color words test 1, 2 and 3 are higher and time longer at T2. Time spent on Stroop color words test 2 and 3 is longer in T3. Words memory test reveals decline at T2 and T3, whose difference is statistically significant (P < 0.05). Cognitive dysfunction incidence in the two groups shows no statistical significance (P > 0.05). Conclusion Sevoflurane and propofol can result in postoperative cognitive dysfunction for elderly patients with diabetes within 48 h after abdominal surgery, there were no difference between the effects of them.

Objective To compare the effects of different general anesthesia protocols on perioperative cellular immune function in patients undergoing laparoscopic surgery for colorectal cancer.Methods Ninety ASA Ⅰ or Ⅱ colorectal cancer patients,aged 40-64 yr,weighing 50-85 kg,undergoing laparoscopic surgery were randomly divided into 3 groups (n =30 each):group total intravenous anesthesia (group Ⅰ) ; group inhalational anesthesia(group Ⅱ) and group combined intravenous-inhalational anesthesia (group Ⅲ).Anesthesia was induced with iv midazolam,sufentanil,TCI of propofol and remifentanil and vecuronium in groups Ⅰ and Ⅲ.In group Ⅰ anesthesia was maintained with TCI of propofol and remifentanil and intermittent iv boluses of vecuronium,while in group Ⅲ with inhalation of sevoflurane and intermittent iv boluses of vecuronium.In group Ⅱ anesthesia was induced and maintained with inhalation of sevoflurane and intermittent iv boluses of vecuronium.Narcotrend index was used to monitor depth of anesthesia and maintained at 37-64 during operation.Venous blood samples were taken for determination of the levels of T lymphocyte subsets (CD3+,CD4+,CD8+,CD4+/CD8 +) and natural killer cells at 30 min before induction of anesthesia (T0),2 h after skin incision (T1),at the end of operation (T2) and 24 h after operation (T3).Results The levels of CD3 +,CD4 +,CD4+/CD8+ and natural killer cells were significantly decreased at T2 in group Ⅱ,while the levels of natural killer cells were decreased at T2 in group Ⅲ as compared with the baseline at T0,and were significantly lower than those in group Ⅰ.The levels of CD3+ and CD4+ were significantly lower at T2 in group Ⅱ than in group Ⅲ.Conclusion Intravenous anesthesia with midazolam,propofol,sufentanil,remifentanil and vecuronium has less inhibitory effect on perioperative cellular immune function than inhalational anesthesia and combined intravenous-inhalational anesthesia in patients undergoing laparoscopic surgery for colorectal cancer.

Objective To investigate the effects of dexmedetomidine on perioperative cellular immune function and micro-metastasis in blood circulation in patients undergoing radical operation for colon cancer.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 38-69 yr,weighing 45-67 kg,undergoing radical operation for colon cancer,were randomly divided into 2 groups (n =30 each) ∶ dexmedetomidine group (D group) and control group (C group).Anesthesia was induced with midazolam,cisatracurium and sufentanil,and maintained with propofol,remifentanil and sevoflurane.After tracheal intubation,a loading dose of dexmedetomidine 1 μg/kg was injected intravenously,followed by infusion at 0.5μg· kg-1 · h-1 until the end of operation in D group.The equal volume of normal saline was administered in C group.Venous blood samples were obtained at 5 min before induction of anesthesia (T0),1 h after beginning of operation (T1),the end of operation (T2) and 24 h after the end of operation (T3) for determination of the levels of T lymphocyte subsets (CD3+,CD4+,CD8+) and NK cells by flow cytometry.CD4+/CD8+ ratio was calculated.Cytokeratin 20 (CK20) expression in circulation was detected by RT-PCR at T0 and T3 and the positive rate was calculated.Results Compared with the baseline value at T0,the levels of CD3+ and CD4+,CD4+/CD8+ ratio and level of NK cells were significantly decreased at T2 and T3 in group C,and the levels of CD3+ and CD4+ were significantly decreased at T2 and T3 in group D (P ＜ 0.05).The levels of CD3+,CD4+ and NK cells at T2 and T3 were significantly higher and positive rate at T3 was significantly lower in group D than in group C (P ＜ 0.05).Conclusion Dexmedetomidine can improve the cellular immune function and decrease the probability of micro-metastasis in blood circulation in patients undergoing radical operation for colon cancer.

Objective To investigate the effects of different concentrations of parecoxib on proliferation and apoptosis of colon cancer LoVo cells.Methods The colon cancer LoVo cells were inoculated in cuhure plate and cultured for 24 h.The cells were randomly divided into 4 groups (n =6 each):control group (C group) and different concentrations of parecoxib groups (P1-3 groups).The cells were incubated with parecoxib 10,40 and 160μmol/L for 24 h in P1-3 groups respectively.The rates of proliferation inhibition were measured by MTT assay.The colony formation rates were measured by colony formation assay.The apoptotic rate was determined by flow cytometry.The Survivin and caspase-3 mRNA expression in the cells was detected by RT-PCR.Results Compared with C group,the rates of proliferation inhibition and apoptotic rate were significantly increased,the colony formation rates were significantly decreased,the expression of Survivin mRNA was down-regulated,and the expression of caspase-3 mRNA was up-regulated in a concentration-dependent manner in P1-3 groups (P ＜ 0.05).Conclusion Parecoxib can inhibit the proliferation of LoVo cells and induce the apoptosis in LoVo cells in a concentration-dependent manner through down-regulating the expression of Survivin mRNA and up-regulating the expression of caspase-3 mRNA.