Objective To investigate the mechanism of glucocorticoid resistance in patients with systemic lupus erythematosus(SLE) and the effects of Panax Notoginseng Saponins(PNS) on reversing glucocorticoid resistance in lymphocytes. Methods The relevance between P-glycoprotein (P-gp, %) and SLEDAI integrals or clinical effects was analyzed by linear correlation analysis. The lymphocytes from SLE patients were intervened with PNS or verapamil. P-gp of the lymphocytes and Rhodamine 123 (Rh123, %) accumulated in the lymphocytes were assayed by flow cytometry. The percentage of the apoptosis of the lymphocytes stimulated with PNS or verapamil combined with methylprednisolone was identified by double-tagging with Annexin V and propidium iodide (PI) and detected by flow cytometry. Variance analysis or Student's t test was used for statistics. Results The P-gp in the peripheral blood lymphocytes of SLE patients was significantly related to SLEDAI integrals. The difference of P-gp between lymphocytes in the completely remission cases (12.2±2.5)% and lymphocytes in the partial remission or non-effective cases (16.5±4.0)% was statistically significantce. The difference of P-gp and Rh123 between lymphocytes treated with PNS [(11.2±3.1)%,(70.1 ±5.8)% respectively ] and lymphocytes of the control group [ (15.3±2.9)%, (53.9±5.2)% respectively ]was statistically significant. The lymphocytes apoptosis rate in the lymphocytes stimulated with methylprednisone combined with PNS increased significantly compared to the lymphocytes stimulated with methylprednisolone only. Conclusion The action of PNS in suppressing both the expression and the transfer activity of P-gp is possibly the important mechanism to increase the effects of methylprednisolone in inducing lymphocytes apoptosis.

Objective To observe the effect of one-lung ventilation (OLV) on cerebral oxygen balance and energy metabolism during total intravenous anesthesia for thoracoscopic surgery.Methods Thirty patients scheduled for thoracoscopic surgery were selected.After inducing and intubating,patients were assigned to maintenance of anesthesia with propofol by target controlled infusion in order to maintain a bispectral index(BIS) between 40 and 60,and end-tidal partial pressure of carbon dioxide (PETCO2) between 30mmHg and 35mmHg.Mean arterial pressure (MAP),heart rate (HR),SpO2,PetCO2,cerebral blood flow velocity (CBFv),BIS value and nasopharyngeal temperature(NPT) were measured,always with the patients in the lateral position,in four phases:10min after beginning twolung ventilation (TLV),15 min after beginning OLV (OLV + 15),30min after beginning OLV (OLV + 30) and 60 min after beginning OLV(OLV + 60).Blood samples were drawn simultaneously and analyzed within 5min.The Da-jvO2,CERO2,CMRO2,Da-jvLac and Da-jvGlu at each phase were calculated.Results In all patients,a decrease in PaO2 [(172±85) vs (428±42);(162±54) vs (428±42);(185±61) vs (428±42)] and MAP [(70±10) vs (81 ±11) ; (71 ± 12) vs (81 ± 11)] occurred during OLV (t =15.02,13.14,23.25,20.16,18.02,all P ＜ 0.05).SjvO2 at the phase:OLV + 15 and OLV + 30 were significantly lower than those at TLV [(54.0 ± 1.2) ％ vs (65.0 ± 0.8) ％ ;(55.0±1.5)％ vs (65.0 ±0.8)％] (t =3.12,2.14,all P＜0.05).Ca-jvO2[(50 ± 12)％ vs(40 ± 12)％ ;(54±11)％ vs (40 ± 12)％],CMRO2 [(186 ±40) vs (162 ± 35);(191 ±24) vs (162 ±35)]and CERO2 [(36 ± 12) vs (30 ± 1 1) ; (35 ± 10) vs (30 ± 11)] atthephase:OLV + 15 andOLV + 30weresignificantlyhigher than those at TLV (t =5.23,4.28,1.86,2.01,8.21,10.11,all P ＜ 0.05).After OLV,Da-jvGlu [(0.45 ± 0.10) vs (0.22 ± 0.30) ; (0.52 ± 0.20) vs (0.22 ± 0.30) ; (0.40 ± 0.20) vs (0.22 ± 0.30)] significantly increased (t =6.45,12.03,15.10,all P ＜ 0.05).The differences of Da-jvLac and CBFv at every phase were not significant (P ＞0.05).Conclusion During total intravenous anesthesia,OLV resulted in an increase of consumption of cerebral oxygen and energy.It may be not good for cerebral oxygen balance and energy metabolism.The efficient prevention is necessary clinically.

Objective To investigate the correlation between the positive rate of PCR-reverse dot blot genotyping test and the loads of the viral nucleic acid. Methods The fluorescent PCR assay was used to detect the high-risk HPV(HR-HPV)DNA loads in the cervical mucus samples from 1162 female pa-tients. Patients with positive HR-HPV DNA were further analyzed by PCR-reverse dot blot hybridization as-say for HPV genotyping. Results The overall positive rate of genotyping test was 68. 8% . The positive rate of genotyping test had a significant positive correlation with the Log Koc of HR-HPV DNA loads(r=0. 944, P﹤0. 01). The quadratic curve fitting formula was Y= -1. 806+0. 558X-0. 031X2(Y for genotyping positive rate,X for Log Koc of HR-HPV DNA loads). There were significant differences with the positive rate of gen-otyping test among patients with different viral loads(P﹤0. 01). When HR-HPV DNA loads were 104-105 copies/ ml,105-106 copies/ ml,106-107 copies/ ml and more than 107 copies/ ml,the positive rate of HPV genotyping test were 27. 8% ,48. 5% ,74. 0% ,97. 5% and 33. 3% ,51. 5% ,78. 0% ,97. 5% respective-ly by using different genotyping detection reagents. Conclusion The positive rate of PCR-reverse dot blot genotyping test was correlated with the loads of HPV nucleic acid.

Objective To observe and cpmpare the efficacy and complications of hyperfractional integrated intraeavitary brachtherapy in middle-advanced squamous-cell carcinoma with the traditionsl brachytherapy.Methods In the observed group,328 patients with cervical cancer received hypeffractional integrated intracavitary after loading therapy between Jan 2004 and Jan 2005 were selected.The dose of point A was 2.5 Gy-3.0 Gy/fraction,2 fractions per week,and the total dose of reference point A was 49.8 Gy in stage Ⅱ b,52.6 Gy in stage in Ⅲb.In the control group,331 cases treated with traditional aflerloading brachytherapy between Jan 2002 and Dec 2003 were selected.The dose of point A was 5.0～7.0 Gy/fraction,1 fraction per week,and the total dose of point A was 50.1 Gy in stage Ⅱb,53.5 Gy in stage Ⅲb.In vitro irradiation began at the same time with the intracavitary brachytherapy.The whole pelvic was irradiated with 15 MV X-rays.Results In the observed group,the recent control rate of stage Ⅱb was 97.2%(104/107),94.1%(208/221)for stage Ⅲb.The 3-year survival rate was 80.5%(264/328).and the 5-year survival rate was 68.6%(225/328).The complication rate was 5.2%(17/328)for cystitis, 14.6%(48/328) for proctitis.Out of 331 cases in control group,the recent control rate of stage Ⅱb was 95.4%(103/108),92.8%(207/223)for stage Ⅲb.The 3-year survival rate was 75.2%(249/331),the 5-vear survival rate was 62.5%(207/331).The complication rate was 13.3%(44/331)for cystitis,and 32.3%(107/331)for proctitis.Conclusions Compared with combination of traditional brachytherapy and external radiotherapy,combination of hyperfraetional integrated brachtherapy therapy and external radiotherapy has no significant improvement for recent control rate and long-term survival rate,but could reduce the complication rates of cystitis and proctitis.

Objective:To explore the effects of the comprehensive nursing intervention based on evidence-based nursing and the protection motivation theory in elderly diabetic patients, and provide theoretical support for clinical practice.Methods:Totally 148 elderly diabetic patients hospitalized in Beijing No.6 Hospital from January 2017 to August 2019 were selected by convenient sampling, and divided into the research group ( n=74) and the control group ( n=74) . Patients in the control group received routine care, while patients in the research group received evidence-based nursing intervention based on the protection motivation theory. The self-management behavior score, self-care ability score and blood glucose level of the two groups were compared before and after intervention. Results:After the intervention, 145 valid questionnaires were recovered, including 73 in the control group and 72 in the research group. Before the intervention, there was no statistically significant difference in the scores of self-management behavior, self-care ability and blood glucose between the two groups ( P>0.05) . After the intervention, the self-management behavior score and self-care ability score of the research group were higher than those of the control group, while the blood glucose level was lower than that of the control group, and the differences between the two groups were statistically significant ( P<0.01) . Conclusions:Evidence-based nursing interventions based on the protection motivation theory can give full play to patients' subjective initiative, effectively improve the self-management behavior and self-care ability of elderly diabetic patients, and help control blood glucose levels, thus preventing the occurrence of complications.

Objective To study the application of autoregressive integrated moving average(ARIMA)model to predict the monthly reported malaria cases in China,so as to provide a reference for prevention and control of malaria. Methods SPSS 24.0 software was used to construct the ARIMA models based on the monthly reported malaria cases of the time series of 2006-2015 and 2011-2015,respectively. The data of malaria cases from January to December,2016 were used as validation data to compare the accuracy of the two ARIMA models. Results The models of the monthly reported cases of malaria in China were ARIMA(2,1,1)(1,1,0)12 and ARIMA(1,0,0)(1,1,0)12 respectively. The comparison between the predictions of the two models and actual situation of malaria cases showed that the ARIMA model based on the data of 2011-2015 had a higher ac-curacy of forecasting than the model based on the data of 2006-2015 had. Conclusion The establishment and prediction of ARIMA model is a dynamic process,which needs to be adjusted unceasingly according to the accumulated data,and in addi-tion,the major changes of epidemic characteristics of infectious diseases must be considered.

One case of Listeria monocytogenes bacteremia in third trimester of pregnancy admitted in Zhongnan Hospital was reported .And 25 cases of maternal listeriosis were retrieved from domestic literature search up to March 2017.The clinical features of 26 cases were analyzed .The newly reported case was a 27-year-old primigravida at 37 weeks 5 days of gestation presenting with fever for 23 days. Listeria monocytogenes was identified in blood culture .She was treated with intravenous piperacillin sodium and tazobactam sodium for 3 weeks and recovered .At 39 weeks 4 days of gestation, she gave birth of a male baby by vaginal delivery .The newborn baby was healthy with negative Listeria monocytogene in blood culture.The age of onset of all 26 cases was (30.2 ±4.7)years.There were 1, 13 and 12 patients with listeriosis diagnosed in the first, second and third trimester of pregnancy , respectively.The median time from onset to symptom presentation was 2 days.Clinical manifestations included fever (92%,24/26), leukocytosis (75%,18/24), abdominal pain (27%,7/26), fetal movement decrease or lose (23%,6/26) and vaginal bleeding (15%,4/26).Listeria monocytogenes were isolated from blood (11 cases), uterus swab (7 cases), amniotic fluid (2 cases) and so on.High proportion of adverse pregnancy outcomes occurred (88%,22/25).All gravidae recovered well after the termination of pregnancy .The empirical antibiotics did not cover those sensitive to listeria in all patients .Patients with maternal listeriosis often presented with acute fever and a high incidence of adverse pregnancy outcomes , however, empirical antibiotics can hardly cover Listeria monocytogene.Thus, clinicians should improve awareness of listeriosis to avoid missed diagnosis and misdiagnosis .

Objective To select and evaluate the diluents for quantitative detection of HBV DNA of high loads sample,hope to find the most applicable diluents which could be used in clinical test.Methods The standard substance(2.00 × 109IU/ml)was 10 and 100 times diluted by different diluents,compare the result of test,and the bias was analysis taking negative quality control as standard diluents,negative serum,physiological saline,and distilled water as candidate diluents.Results When 10 times diluted,there was no statistically difference between the standard diluents and distilled water as diluents(t =2.04,P ＞ 0.05),the bias were less than the TEa regulated by professional standard.When used negative serum and physiological saline as diluents,the results were higher than that of standard diluents (P ＜ 0.05),and the ratio of the bias higher than the TEa was 16.67％ and 20.00％.When 100 times diluted,the results of candidate diluents were higher than that of standard diluents.In this time,the result of distilled water diluted detection presented a good linear relationship with the result of standard diluted detection,the formula was Y =0.963X + 0.267 (Y =result of standard diluted detection,X =result of distilled water diluted detection).All the bias were less than the TEa,the sequence of bias sort by ascending counts were negative quality control,distilled water,physiological saline and negative serum.Conclusions The most applicable diluents were negative quality control and distilled water with 10 times dilution.When 100 times diluted was used,the most applicable diluents was negative quality control,then was distilled water,physiological saline and negative serum.If using the distilled water to dilute,we could corrected the result by the formula Y =0.963X + 0.267 to ensure the result to be more exactly.

Objective:To evaluate the efficacy of remimazolam for induction of anesthesia in patients with colorectal cancer.Methods:This was a prospective study. Eighty-two patients scheduled for elective colon and rectal tumor surgery under general anesthesia from June to November 2023 at our hospital, aged 18-80 yr, with body mass index of 18.5-28.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, were divided into 2 groups ( n=41 each) using a random number table method: propofol group (group P) and remimazolam group (group R). Propofol 1.5 mg/kg was intravenously injected in group R and remimazolam 0.3 mg/kg was intravenously injected in group P. When the bispectral index (BIS) value≤60, sufentanil 0.5 μg/kg and cisatracurium 0.2 mg/kg were intravenously injected in both groups. Heart rate and mean arterial pressure were recorded before induction of anesthesia (T 0), 3 min after induction (T 1), immediately after intubation (T 2), and 5 min after tracheal intubation (T 3). The occurrence of hypotension, hypertension, tachycardia and bradycardia during induction, use of vasoactive drugs, and injection pain were recorded. The time to loss of consciousness, time from the beginning of administration to BIS value ≤60, time from the beginning of administration to tracheal intubation, occurrence of BIS value > 60 immediately after intubation and rescue sedation were recorded. Results:Eighty patients were finally included, with 40 in group P and 40 in group R. Compared with group P, the heart rate and mean arterial pressure were significantly increased at T 1 and T 2, the incidence of hypotension and bradycardia was decreased, and the time from the beginning of administration to BIS value ≤60 was prolonged ( P<0.05), and no statistically significant changes were found in the other parameters in group R ( P>0.05). Conclusions:Remimazolam 0.3 mg/kg can be safely and effectively used for anesthesia induction and provides better efficacy in maintaining hemodynamic stability when compared with propofol 1.5 mg/kg in patients with colorectal cancer.

Objective:To evaluate the effects of different doses of dexmedetomidine infused at nighttime on early postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of malignant gastrointestinal tumors.Methods:Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of either sex, aged 65-75 yr, with body mass index of 18-24 kg/m 2, scheduled for elective radical resection of malignant gastrointestinal tumors, were divided into 4 groups ( n=20 each) using a random number table method: control group (group C) and different doses of dexmedetomidine groups (D 1-3 groups). Dexmedetomidine 0.1, 0.2 and 0.3 μg·kg -1·h -1 (infusion rate 4 ml/h) were intravenously infused from 21: 00 on the day of surgery and the first day after surgery until 6: 00 in the next morning.Normal saline was given instead of dexmedetomidine in group C. The period of sleep and the number of awakening at night were recorded before surgery and at 2 and 7 days after surgery.Cognitive function was assessed at 1 day before surgery and 7 days after surgery.The concentrations of plasma cortisol were measured at 16: 00 before surgery and 2 and 7 days after surgery and at 8: 00 in the corresponding morning of the next day.The difference in the plasma cortisol concentration measured at 8: 00 every day and at 16: 00 of the previous day were calculated. Results:The incidence of POCD was significantly lower in D 2, 3 groups than in group C ( P<0.05). The number of awakening at night was significantly decreased at 2 days after surgery in group D 3 as compared with the other three groups ( P<0.05). The difference in the plasma cortisol concentration was significantly decreased at 2 and 7 days after surgery in D 2, 3 groups when compared with group C and group D 1 ( P<0.05). Compared with group D 2, no significant change was found in the difference in the plasma cortisol concentration at each time point in group D 3 ( P>0.05). There were no significant differences in the incidence of hypotension, hypertension, bradycardia, and tachycardia among the four groups ( P>0.05). Conclusion:Infusing dexmedetomidine 0.2 or 0.3 μg·kg -1·h -1 at the nighttime can reduce the development of POCD in the elderly patients undergoing radical resection of malignant gastrointestinal tumors.