Objective To describe clinical features,polysomnographic (PSG) alterations and characteristics of motor and distribution during rapid eye movement (REM) sleep in narcoleptic patients with REM sleep behavior disorder (RBD).Methods We retrospectively summarized general features of 22 narcoleptic patients with RBD,96 narcoleptic patients without RBD and 21 healthy subjects as controls.We compared their PSG and the related indexes in 3 groups.Then we analyzed a full-night video-PSG recording in a continuous series in 22 narcoleptic patients with RBD to identify their motor behavior and distribution features.Results There was no significant difference in PSG parameter and correlation index between the narcoleptic patients with RBD group and without RBD group.However,compared with normal control group (20.15 ± 4.52),narcoleptic patients with or without RBD (24.07 ± 5.44,23.40 ± 4.50) showed increased the body mass index(F =4.869,P =0.009),shortened NREM sleep and REM sleep (min) latency at night (4.41 ±7.01,3.55 ±3.98 and 14.69 ±9.62,x2 =31.697,P =0.000;69.39 ±81.39,71.04 ±74.45and 115.31 ± 45.13,x2 =11.485,P =0.003),increased percentage of sleep stage 1,decreased percentage of slow wave sleep,delayed the arousal time and increased number of arousal episode longer than 5 minutes.In narcoleptic patients with RBD,RBD episodes occurred frequentlyatany stage of REM sleep through whole night and the frequency of vocalizations did not significantly differ between the two halves of the night.Pantomimes were significantly more frequent in RBD episodes of the second half of the night.Conclusions The prevalence of RBD is high in narcoleptic patients.Sleep architecture doesn' t differ between narcoleptic patients with and without RBD.There is no correlation between the occurrence of RBD and narcoleptic duration.In narcoleptic patients with RBD,vocalizations and pantomimes accounted formajor proportion of RBD episodes while aggressive-violent movements are rare.

Objective To investigate the genotype distribution of CTX-M-type extended-spectrum β-1actamase(ESBLs) by denaturing high-performance liquid chromatography(DHPLC) in Hunan Province and the accuracy of DHPLC assay. Methods The blaCTX-M genes of standard strains and clinical ESBLs-producing Enterobacteriaceae were amplified by multiplex PCR followed by DHPLC and genotype determination. 25 isolates randomly selected were sequenced to assess the accuracy of DHPLC method. Results Among 142 ESBLs-producing isolates, 109 isolates carried blaCTX-M gene (76. 8% ). Four different CTX-M genotypes were detected by DHPLC, including CTX-M-3 (33 isolates), CTX-M-15 (19 isolates), CTX-M-14 (52 isolates) and CTX-M-9 (5 isolates). The DHPLC typing of 25 isolates suggested that 24 isolates were verified uniformly by the sequencing, but one CTX-M-15 isolate typed by DHPLC was shown to be CTX-M-82 by sequencing. Conclusion DHPLC is a powerful tool for genotyping of the resistance gene and is worth being applied in the clinical and scientific research with accurate, rapid and economic advantages.

Objective To explore the expression and function of galanin and its receptor in the female mice of anxiety-and depression-like behavior.Methods In situ hybridization was used to detect the expression of galanin,GalR1,GalR2 and GalR3 in the hippocampus of C57BL/6J female mice.A total of thirty female mice was divided into two groups:experiment group (n=15) and control group (n=15).The experiment group was subjected to the chronic unpredictable mild stress (CUMS) for four weeks,and the control group was not subjected to any treatment.Four weeks later,a series of tests were performed on those two groups,including the sucrose preference test,the novel object recognition test,the open field test and suspension tail test.After behavior tests,the hippocampus RNA was extracted from eight mice in each group to test the expression of galanin and its receptor through qPCR.The rest part of mice were used to mark C-Fos immunostaining in the dentate gyms (DG) of hippocampus.Results The result of in situ hybridization showed that galanin,GalR1 and GalR2 distributed in the Hillus of ventral hippocamous,GalR3 had no positive signal.In the sucrose preference test,the experiment group drunk less sucrose when compared with the control group (P＜0.05).In the novel object recognition test,the experiment group contacted shorter time to the novel object when compared with the control group (P＜0.05).In the open field test,the experiment group had shorter in session time when compared with the control group (P＜0.05).In the suspension tail test,the experiment group had longer immobility time when compared with the control group (P＜0.05).The qPCR result showed that the higher expression of galanin and GalR1 in the hippocampus of experiment group (P＜0.05).More C-Fos positive cells in the DG of hippocampus of experiment mice were immunostained (P＜0.05).Conclusions Galanin,GalR1 and GalR2 mainly distribute in the Hillus of the ventral hippocampus.Galanin may be involved in the anxiety-and depression-like behavior of C57BL/6J through GalR1.

Multiple myeloma is a plasma cell disease with the second highest incidence among hematological malignancies. Its risk of concurrent thrombosis is high, which greatly affects the quality of life and even endangers life of multiple myeloma patients. The pathogenesis of thrombosis in patients with multiple myeloma is complex, which is still unclear. However many mechanisms are considered to be related to hypercoagulable state in patients with multiple myeloma. Currently, there is a lack of thrombosis risk assessment model for multiple myeloma. Therefore, this paper reviews the research and the latest progress of venous thrombosis in patients with multiple myeloma, and provides a theoretical basis for the prevention and treatment of thrombosis.

Objective To measure the nursing workload in ICU,and provide the basis for the scientific distribution of human resources and reasonable scheduling in ICU.Methods ICU patients of the First and Third People's Hospital of Zigong from July to September,2011 were selected.The TISS-28 and NAS were applied to measure the nursing workload in the ICU.The number of staff nurses on each day and on each shift was recorded.Results The total nursing workload and the per capita nursing workload for each day in a week showed no significant difference,and the per capita nursing workload of different shifts and the needs of nurse-patient ratio of different patients in ICU were significantly different.Conclusions The allocation of nursing staff should be balance for each day in a week and different shifts for each day.The configuration of the nursing human resources should be based on actual nursing workload,no only considering the species of the diseases,the disease condition,self-care ability and cooperation of the patients,but also the proficiency of nurse skills.

Objective To summarize the surgical results of patients with quadricuspid aortic valve and aortic regurgitation.Methods From June 2013 to June 2017,4 patients with incompetent quandricuspid aortic valve underwent surgical repair at Guangzhou Women and Children's Medical Center.The age at surgery was 2 months to 5 years,and body weight was 2.7-22.7 kg.3 patients were diagnosed with persistent tmncal arteriosus and underwent complete repair.Another one was diagnosed with tetralogy of Fallot and accepted complete repair 4 years age.All patients were diagnosed with more than moderate quandricuspid aortic valve regurgitation.Repair was performed by tricuspidalization of the native quadricuspid valve,using leaflet and related sinus of Valsalva excision.Results There was no mortality.The ICU stay and hospital stay after operation were 7-12 days and 10-16 days.The follow-up duration was 3 to 51 months.All patients were alive and free from significant aortic valve regurgitation.Conclusion Aortic valve remodeling by leaflet excision and reduction annuloplasty is an effective method for incompetent quadricuspid aortic valve repair.

Objective: To evaluate the safety of clinically-indicated replacement of peripheral intravenous catheters (PIVCs) in old adults. Methods: Total of 1 627 patients with peripheral intravenous catheters in emergency wards at a tertiary hospital in shanghai were recruited. Patients were randomly divided into an experimental group (817 cases) and control group (810 cases) by random digits tale method. PIVCs in the experiment were replaced only when clinical indications appeared, while PIVCs in the control group were routinely changed every 72-96 hours. Indwelling time, complications associated with PIVCs and nurse compliance were compared after indwelling peripheral intravenous catheters. Results: PIVC indwelling time was (3.43±1.36) days in the experimental group, and (3.18±1.16) days in the control group ,there was significant difference between two groups (t value was 4.07, P<0.05). The incidence of phlebitis, occlusion, infiltration, and accidental removal in experimental group was 11.26% (92/817), 17.97% (146/817), 10.77% (88/817), 3.91% (32/817), while in the control group 9.88% (80/810), 15.06% (122/810), 11.23% (91/810), 3.70% (30/810). The two groups showed no statistically difference in catheter phlebitis, occlusion, infiltration, and accidental removal (χ² values were 0.82, 2.33, 0.09, 0.05, P>0.05). The severity of phlebitis in the experiment group was higher than that in the control group, and there was significant difference between two groups (χ² value was 20.99, P<0.05). Nurse compliance achieved in the experimental group 100.00% (817/817) was higher than that in the control group 87.65% (710/810), which showed statistically difference (χ² value was 107.47, P<0.05). Conclusion Indwelling time in the clinically- indicated replacement group was longer than that of the routine replacement group. Peripheral intravenous catheters in old adults can be remove as clinically-indicated with a close monitoring of complications.