Diagnostic Errors ; Humans ; Pneumoconiosis ; diagnosis ; Scleroderma, Systemic ; diagnosis

OBJECTIVE:To compare the effects of morphine and nalbuphine on related indexes of maternal after cesarean sec-tion. METHODS:A total of 120 maternal underwent cesarean section were randomly divided into observation group(60 cases)and control group (60 cases). After surgery,observation group was given Nalbuphine hydrochloride injection 20 mg+0.75% Ropiva-caine hydrochloride injection 20 mL for patient-controlled epidural analgesia. Control group was given Morphine hydrochloride injec-tion 8 mg+0.75% Ropivacaine hydrochloride injection 20 mL for patient-controlled epidural analgesia. VAS score,systolic pres-sure,diastolic pressure,respiration rate(RR),SpO2 at the onset of analgesia(T0),6 h(T1),12 h(T2),24 h(T3)and 48 h(T4) after analgesia as well as the levels of IL-6,IL-8,CRP and PRL at T0,T3,T4 were observed in 2 groups. The satisfaction rate of analgesia and the occurrence of ADR were also observed. RESULTS:There was no statistical significance in satisfaction rate of an-algesia between 2 groups(96.67% vs. 98.33%,P>0.05). At T0,T1,T4,there was no statistical significance in VAS score between 2 groups(P>0.05). VAS scores of 2 groups at T2-3 were significantly higher than at T0,T1,T4,with statistical significance(P<0.05);but there was no statistical significance between 2 groups(P>0.05). There was no statistical significance in diastolic pres-sure,RR and SpO2 between 2 groups at T0-2(P>0.05). The systolic pressure of 2 groups at T3-4 were significantly higher than at T0, with statistical significance(P<0.05);but there was no statistical significance between 2 groups(P>0.05). There was no statisti-cal significance in the levels of IL-6,IL-8,CRP or PRL between 2 groups at T0(P>0.05). The levels of IL-6,IL-8 and CRP in 2 groups at T3 were significantly higher than at T0,but the observation group was significantly lower than the control group;at T4,the levels of IL-6,IL-8 and CRP in control group were significantly higher than at T0,with statistical significance(P<0.05),but there was no statistical significance in observation group,compared to at T0(P>0.05). The levels of PRL in 2 groups at T3-4 were significantly higher than at T0,and increased gradually as time;the observation group and significantly higher than the control group,with statistical significance (P<0.05). The incidence of ADR in observation group was significantly lower than control group,with statistical significance(P<0.05). CONCLUSIONS:For maternal after cesarean section,nalbuphine is similar to mor-phine in analgesic effect and cardiovascular effect,but it is better than morphine in reducing inflammatory level,promoting lacta-tion and safety.

Objective:To evaluate the relationship between serum neopterin levels and nasopharyngeal carcinoma and its clinical significance. Method:The serum neopterin levels were determined in 54 patients with nasopharyngeal carcinoma (NPC group) and 32 healthy adults (normal group) by ELISA. Result:The serum neopterin levels in NPC group were significantly higher than that of in normal group (P<0.001). The serum neopterin levels in UICC-TNM stages were undifferentiated (P>0.05). The serum neopterin levels in patients with no lymph node metastasis were lower than that of in lymph node metastasis (P<0.05). The serum neopterin levels decreased significantly after disappearance of tumor and its lymph node treated by radiotherapy (P<0.01). Conclusion:Cellular immunity mediated by macrophages might be involved in the pathologenesis of nasopharyngeal carcinoma and the measurement of the serum neopterin may be a useful objective index to evaluate cellular immunological functions and curative effects.

Objective To study the application effect of antiskid steel plate internal fixation via exposing lateral and posterior ankle fracture through fibula posterolateral approach in the treatment of Lauge-Hansen supination-eversion ankle fracture.Methods From January 2009 to December 2012,exposed the lateral and posterior ankle fracture through fibula posterolateral approach of 36 patients suffering from the Lauge-Hansen supination-eversion ankle fracture,and fixed the lateral and posterior ankle by the antiskid steel plate.Adopt Olerud-Molander ankle function scoring system to evaluate the postoperative effect of the ankle.Results All the patients were followed up for 7-27 months,with an average follow-up of 19 months.There was no complications such as incision infection and cutaneous necrosis.Only 1 patient occurred with peroneus myotenositis,and the symptom was relieved after taking out the steel plate.The fracture was healed within 16 weeks.Among the 36 cases,22 cases were excellent,9 cases were good,4 cases were medium and 1 case was poor.The fine rate was 86.1％(31/36).Conclusion Using the antiskid steel plate to treat the lateral and posterior ankle fracture through fibula posterolateral approach,can fully expose a single incision,fix the lateral and posterior ankle and reduce the tension in suture,improve the incision healing rate and fracture stability,provide a new method for treating ankle fracture.

Based on the requirements of military professional education reform and in view of the problems existing in the operation and maintenance of first-aid medical equipment in grass-roots forces. We put forward a construction scheme of online course which named operation and maintenance of first-aid medical equipment in grass-roots forces, and then expound the scheme from teaching content construction and teaching mode construction. The teaching content construction consists of two parts: the management theory of conventional medical equipments and the operation and maintenance teaching of specific first-aid medical equipments. In the construction of teaching mode, we elaborate on the organization forms of teaching, answering questions, training and examination units in detail. The design scheme of the online course is in line with the learning characteristics and meets the demand of learning the knowledge of the operation and maintenance of first-aid medical equipment systematically, so as to improve the post competency of the grass-roots forces.

OBJECTIVE: To evaluate the efficacy and safety of Danning Tablet (DNT) in patients with non-alcoholic fatty liver disease (NAFLD) of damp-heat syndrome type. METHODS: A multicenter, randomized, double-blinded and positive drug parallel controlled trial was performed. One hundred and thirty-five patients were enrolled into the study and divided into two groups: DNT-treated group (n=102) and ursodeoxycholic acid (UDCA)-treated group (n=33). Body mass index (BMI), principal symptoms, liver function, blood lipids, iconographic, and compositional parameters were measured before and after treatment, respectively. RESULTS: In the two groups, BMI, distress in hepatic region, fatigue, anorexia, liver function, blood lipids and iconographic parameters were significantly improved, and the improvements of BMI, distress in hepatic region were better in DNT-treated group than in UDCA-treated group. The histological study also showed that DNT had positive effect in treatment of NAFLD. CONCLUSION: DNT is an effective drug to treat patients with NAFLD of damp-heat syndrome type and is more effective than UDCA.

Objective: To evaluate the clinical effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-level lumbar spondylolisthesis treatment with bilateral Spotlight tubular channels. Methods: A total of 21 patients with lumbar spondylolisthesis whom underwent MIS-TLIF via bilateral Spotlight tubular channels were retrospectively analyzed from October 2014 to November 2015. The 21 patients included 11 males and 10 females ranged from 35 to 82 years (average aged 60.7 years). In term of spondylolisthesis category, there were 18 cases of degenerative spondylolisthesis and 3 cases of isthmic spondylolisthesis. With respect to spondylolisthesis degree, 17 cases were grade Ⅰ° and 4 cases were grade Ⅱ°. Besides, 17 cases at L_4-5 and 4 cases at L₅-S₁were categorized by spondylolisthesis levels. Operation duration, blood loss, postoperative drainage and intraoperative exposure time were recorded, functional improvement was defined as an improvement in the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) was also employed at pre and post-operation (3 months and the last follow-up), to evaluate low back and leg pain. Furthermore, to evaluate the recovery of the intervertebral foramen and of lumbar sagittal curvature, average height of intervertebral space, Cobb angles of lumbar vertebrae and operative segments, spondylolisthesis index were measured. At the last follow-up, intervertebral fusion was assessed using Siepe evaluation criteria and the clinical outcome was assessed using the MacNab scale. Radiographic and functional outcomes were compared pre- and post-operation using the paired T test to determine the effectiveness of MIS-TLIF. Statistical significance was defined as P<0.05. Results: All patients underwent a successful MIS-TLIF surgery. The operation time (235.2±30.2) mins, intraoperative blood loss (238.1±130.3) ml, postoperative drainage (95.7±57.1) ml and intraoperative radiation exposure (47.1±8.8) were recorded. Different significance between 3 months post-operative follow-up and pre-operation was exhibited (P<0.01) in respects of lumbar VAS (t=11.1, P<0.01) and leg VAS (t=17.8, P<0.01). Moreover, final follow-up compared with pre-operation, and final follow-up compared with 3 months post-operative follow-up, VAS scores were also statistical difference (P<0.01). At the final follow-up, there were significant differences compared with pre-operation in ODI scores (t=30.1, P<0.01). Comparison between 3 months post-operative follow-up and pre-operation, statistical distinctions were demonstrated (P<0.05) in terms of mean height of intervertebral space (t=-10.9, P<0.01), the Cobb angles of lumbar vertebrae (t=-2.4, P<0.05), operative segments Cobb angles (t=-5.2, P<0.01) and Lumbar spondylolisthesis incidence (t=17.1, P<0.01). In addition, there was statistical difference between final follow-up and pre-operation (P<0.05) as well. For instance, mean height of intervertebral space (t=-10.5, P<0.01), the Cobb angles of lumbar vertebrae (t=-2.7, P<0.05), operative segments Cobb angles (t=-4.2, P<0.01) and Lumbar spondylolisthesis incidence (t=18.6, P<0.01) were involved. All spondylolisthesis vertebrae were restored completely. Lastly, at the last follow-up, 12 cases of grade 1 and 7 cases of grade 2 fusion were present as determined by the Siepe evaluation criteria. McNab scale assessment classified 17 patients having excellent clinical outcome, 3 patients in good and 1 patient having a better clinical outcome. Conclusion MIS-TLIF with bilateral Spotlight tubular channels is a safe and effective approach for single segment lumbar spondylolisthesis.

OBJECTIVE:To analyze the rationality of proton pump inhibitors (PPIs) in the prevention of stress ulcer in perioperative orthopedic patients of our hospitals,and to provide reference for ratioual use of PPIs in clinic.METHODS:The medical records of discharged orthopedic patients were selected during Jan.1st-30th in 2016.Those records were analyzed statistically in respects of the use of PPIs,general information of patients,operation situation,the stressors and risk factors of stress ulcer.The rationality of the use of PPIs was analyzed comprehensively.RESULTS:Among 664 surgical patients,PPIs were used in 210 cases,and H2 receptor antagonist (H2RA) were used in 74 cases,with prophylactic rate of 42.77％.The main types of operation were fracture fixation (74 cases,35.24％),discectomy and discectomy (38 cases,18.11％).Among 210 patients receiving PPIs,all of them used PPIs,among which 68 cases (32.38％) had no medication indications,128 cases (60.95％) were medication timing error,74 cases (35.24％) were administration frequency error and 44 cases (20.95％) were more than 3 d prophylactic drug use.CONCLUSION:When orthopedic patients use PPIs for the prevention of stress ulcer,there are serious irrational phenomena in indications,species selection,usage and dosage,treatment course and so on.Clinicians and regulators should pay great attention to it so as to avoid the excessive application of PPIs.

Objective:To investigate the use of proton pump inhibitors (PPIs)in gynecological patients in a hospital and analyze the use rationality of PPIs for the prevention of stress ulcer so as to provide reference for the clinical application of PPIs. Methods:To-tally 1000 patients' medical records admitted to the gynecological department for the first time from January 1st to December 31st in 2016 were randomly selected to conduct a retrospective analysis,and the rationality of PPIs was evaluated. Results:The preventive use rate of PPIs was 90.72%(880/970). Among the 880 patients, 28.18%(248/880) of the patients were without indications for the preventive medication,95.68%(842/880) of the patients were with wrong administration time, and 91.46%(578/632) of the pa-tients were with wrong usage and dosage. Conclusion:When PPIs are used for the prevention of SU in gynecological surgery,irrational use such as without indications, unsuitable variety selection and wrong usage and dosage still exists. It is suggested that regulators should strengthen technical and administrative interventions and establish standard for the rational use of PPIs in hospitals so as to avoid the excessive use of PPIs and improve the situation of inappropriate application.

Objective: To investigate the mechanism of emodin ( EM) in the expression of related protein for the fibrosis of the transforming growth factor-β1(TGF-β1)-stimulated human renal tubular epithelial (HK-2) cells. Methods: HK-2 cells were randomly divided into the normal control group, TGF-β1-stimulated model control group and emodin ( TGF-β1 +EM) group. The contents of Collage Ⅰ and fibronectin in the culture supernatant were determined by ELISA. After HK-2 cells were stimulated with TGF-β1 for 24 h, the cells were collected for immunofluorescence, Western blot and RT-PCR analysis. RT-PCR was used to detect PI3K, p-Akt and mTOR. The protein expressions of PI3K, p-Akt and mTOR were detected by Western blot. Immunofluorescence was used to detect PI3K. Results: Compared with those in the model control group, the contents of CollageⅠand fibronectin in the supernatant of emod-in group significantly decreased (P<0. 05), the expression of PI3K protein was inhibited, the expression of downstream p-Akt protein decreased, and the downstream mTOR decreased (P<0. 05), the expression levels of PI3K, p-Akt and mTOR mRNA decreased, the differences were statistically significant (P<0. 05), and the expression of PI3K decreased. Conclusion: Emodin can alleviate fibrosis of HK-2 cells stimulated by TGF-β1 through the classical Akt/mTOR pathway of autophagy.