Objective To compare the effects of pressure controlled ventilation and volume controlled ventilation on perioperative blood loss of patients with posterior lumbar interbody fusion (PLIF).Methods According to the random number table method,a total of 88 patients scheduled to PLIF were allocated into two groups,44 cases per groups.Patients received respectively pressure controlled ventilation and volume controlled ventilation in pressure controlled ventilation group (PCV group) and volume controlled ventilation group (VCV group).Mean arterial blood pressure (MAP),heart rate (HR) and central venous pressure (CVP) were continuously monitored at anesthesia induction immediately (T0),10min after supine position to prone position (T1),skin suture immediately (T2),10min after prone position to supine position (T3) and when tracheal extubation (T4).Hemoglobin (Hb) and hematokrit (HCT) were tested from T0 to T4 in the two groups.Respiratory parameters were recorded from T0 to T3 in the two groups.Intraoperative blood loss and blood loss at 96h after operation patients were recorded.Allogeneic blood transfusion,volume of fluid input and the rate of secondary surgery to stop th bleeding were recorded in the two groups.Results Compared to VCV group,peak inspimtory pressure (PIP) from T1 to T3 were all significantly lower (P ＜0.05) in PCV group.There was no statistical significance (P ＞ 0.05) in MAP,HR,tidal volume,respiratory rate (RR),PaO2/FiO2 and PaCO2 between the two groups.There was no statistical significance (P ＞ 0.05) in Hb and Hct at different time points between the two groups.Compared to VCV group,intraoperative blood loss,plasma infusions and red blood cell infusions were al significantly lower (P ＜ 0.05) in PCV group.Conclusion PCV can decrease intraoperative blood loss of patients with PLIF,which may be related to lower PIP during operation.

Acute Disease ; Bacterial Translocation ; C-Reactive Protein ; analysis ; Calcitonin ; blood ; Child ; Humans ; Pancreatitis ; diagnosis ; etiology ; therapy ; Protein Precursors ; blood

Since from 1995, holistic nursing has over 20 years of development in China. And now as the nursing models spread to national wide, holistic nursing aim to the National Twelfth Five-year Plan. At the guidance of the National Twelfth Five-year Plan, the nursing model in China has been began to turn to holistic nursing model. But because of the influence from many factors from the implementation, the way of thinking about to carry out the nursing care using by most of the nurses in clinic is also from the illness and the medical orders. The holistic nursing philosophy and methods, for example the care program, have been not implemented well. Nurse staffing has been in the national plan. And after years of effort the situation has been improved. But it also can not fit the needs in clinic. So as the method to solve the contradiction between the staffing and the needs, the nursing schedule has began to change. The APN model and some mathematic model have been used to the innovation for the nursing schedule. The ability level of the nurses is known as the important fact on the implementation of holistic nursing. So the nurse training is in the attention. But the standardization for the training is the problem we face now. As the chief method and factor to the continual improvement for holistic nursing, quality evaluation system in our country has been improved gradually. But the scientific management methods have not well combine to the fact, and became a factor to restrict the improvement. So the necessary steps for the improvement of holistic nursing in China involve the investigation about the fact and the theory, the innovation and the standardization for the current situation, and the chinization of the theory.

Alzheimer Disease ; therapy ; Amyloid beta-Peptides ; metabolism ; Animals ; Humans ; Medicine, Chinese Traditional

Objective:To investigate the turnover and influencing factors for amniotic membrane transplantation under conjunctiva. Methods:Amniotic membrane stained with DTAF was implanted under conjunctiva of 20 New Zealand white rabbits. After transplantation,we observed the clinical change. The tissue samples from grafted area were observed by HE staining and under laser confocal micro-scope to trace amniotic membrane on 3,5,8,12,16 W after surgery. Results:The amniotic membrane was intact until 3W after trans-plantation. The amniotic membrane was at the bottom of the conjunctiva and fascia,near the top of the sclera. At the 5th week after surgery,the amniotic membrane was bandshaped and began dissolved. Remnants of the amniotic membrane could be identified at the 8th week after surgery. After 12 W,the amniotic membrane basically dissolved,but remnants of curmbly erythroic tissue were locally left. The amniotic membrane totally dissolved after 16W. The types of inflammatory cells were mainly plasma cells,mononucleimacrophages and lymphocytes. At the 3th week after surgery,the inflammatory reaction reached the peak,then the inflammatory cells decreased. The main pathologic reaction was chronic inflammation.Laser confocal microscope discovered that the amniotic membrane persisted for 12 weeks under conjunctiva. Conclusion:The amniotic membrane implanted under conjunctiva persisted for 12 weeks and finally dissolved.

The electrocardiograph is used to record the bioelectric signals generated by the activation of myocardium when the heart is active. It is a commonly used medical electronic instrument for clinical diagnosis and first-aid. However, electrocardiograph adopts a lead wire connection method in existing technology, which is prone to interweaving of wires during movement. It will not only break and wear the lead wire, but also delay the treatment time due to the cleaning of the lead wire. In addition, because the battery capacity is small, it needs to be charged frequently after use, which affects the speed of the instrument use and first-aid. Moreover, the original adsorbed chest lead electrode has a small contact surface with the skin, leading to less comfort and easy to fall off. In order to solve the above problems, an electrocardiograph without lead wire for first-aid was designed by medical staff of Tianjin First Central Hospital, and the National Utility Model Patent of China was obtained (Patent No.: ZL 2019 2 2267837.3). The electrocardiograph adopts the method of wirelessly connecting electrodes, avoids entanglement of lead wire, and increases the portable power source, which prolongs the battery endurance time, improves the contact electrode performance of chest lead and increases the contact surface, the above improvements optimize the medical process operated by medical staff, which is more conducive to clinical first-aid and routine examination, and has the advantages of easy to use, easy to carry and strong safety.

Objective To screen and optimize the formulation and technology of human recombinant neutrophil inhibitory factor and hirulog hybrid(TNHH)for injection,and investigate its stability.Methods Based on the results of the single factor experiment,with the pH range,mannitol dosage and povidone K30 dosage as independent variables,and the content of high molecular protein as response value,the response surface design(CCF)test was used to analyze the effects of the respective variables and their interaction on the content of high molecular protein in TNHH for injection to screen out the optimal formulation. In order to facilitate the operation,the optimal formulation was adjusted to prepare three batches of samples in pilot scale,which were placed at 40 ℃,75% relative humidity(RH)for 2,4 weeks and 2 ～ 8 ℃ for 3,6 months,respectively. The samples were taken and the appearance,pH,purity of reversed phase-high performance liquid chromatography(RP-HPLC)and purity of size exclusion chromatography-high performance liquid chromatography(SECHPLC)were detected to verify the stability of this formulation and process.Results The optimal formulation was pH 4. 982 6,mannitol 7. 986 4% and povidone K30 1. 902 7%,which was finally adjusted to pH 5. 0,mannitol 8. 0% and povidone K302. 0%. The TNHH preparation for injection prepared by the optimized prescription and process were stable in quality and met the clinical medication requirements.Conclusion The optimum formulation of TNHH preparation for injection is reasonable in the process and suitable for industrial production.

High level of eetopie serum ACTH can not be suppressed by endogenous or exogenous glucocorticoid, this is the cardinal characteristic of ectopic ACTH syndrome (EAS), that is to say there exists glucocorticoid resistance in EAS. However, the mechanism of glucocorticoid resistance remains unclear. Identifying the mechanism can help us to diagnose and treat the disease. This review focuses on the mechanism of glucocorticoid resistance from several aspects, including the pre-glucocorticoid receptor (GR), GR and post-GR.

Objective To investigate the relationship between microemboli and lipoprotein-associated phospholipase A2 (LP-PLA2) in patients with acute cerebral infarction.Methods One hundred and ninetytwo patients were selected,among whom 112 patients were acute cerebral infarction in internal carotid or middle cerebral arterial area within 48 hours.The microemboli signal (MES) was measured by transcranial Doppler sonography.The patients were divided into MES positive group (42 cases) and MES negative group (70 cases) according the measured method;80 patients without cerebrovascular disease were as control group (they had no the histories of cerebral vascular diseases and internal and external carotid artery stenosis).Theserum LP-PLA2 levels were measured by enzyme linked immunosorbent assay.Results The LP-PLA2 in control group was (20.09 ± 7.27) μ g/L,in MES negative group was (47.70 ± 23.86) μ g/L,and there was statistical difference (P＜0.01).The LP-PLA2 in MES positive group was (59.45 ± 19.51) μg/L,and there was statistical difference compared with control group (P ＜ 0.01),and there was statistical difference compared with MES negative group (P ＜ 0.05).There was positive correlation between hypertension,hyperlipemia,LP-PLA2 and cerebral infarction (P ＜ 0.05).Conclusions LP-PLA2 relates to instability of atherosclerotic plaque.Microemboli and LP-PLA2 levels are risk factors for cerebral infarction.

Objective To investigate the application value of 6 kinds of tumor markers serum neuron-specific enolase(NSE),cy-tokeratin 19 fragment(Cyfra21-1),carbohydrate antigen 19-9(CA19-9),carbohydrate antigen 12-5(CA12-5),squamous cell carcino-ma antigen(SCC-Ag),carcino embryonic antigen(CEA)in the diagnosis and differential diagnosis of lung cancer.Methods Serum NSE,Cyfra21-1,CA19-9,CA12-5,SCC-Ag and CEA levels were detected in 140 cases of lung cancer,57 cases of benign lung disea-ses and 45 individuals with healthy physical examination as control group by electrochemiluminescence immunoassay.The values of these 6 kinds of tumor marker in the diagnosis and the differential diagnosis of lung cancer were observed.Results The levels of CA12-5,CA19-9 and CEA in the lung cancer group were significantly higher than those in the benign lung diseases group and the healthy physical examination group(P <0.05 ),the sensitivity and accuracy in the combined detection of the six kinds of tumor marker in diagnosing lung cancer were 95.2% and 89.7% respectively,which was superior to those in single index detection.Con-clusion The tumor makers need to be jointly detected,which can increase the sensitivity and accuracy for diagnosing lung cancer and conduces to the differential diagnosis of early lung cancer.