Currently we are still unclear in the aspect of etiology and mechanisms,and lack of medical advice based on evidence-based medicine on postural tachycardia syndrome,inappropriate sinus tachycardia and vasovagal syncope.It also prompts clinical research direction of the three special arrhythmia in future.Based on this,it is very necessary to interpret the management consensus of these three types of arrhythmia.

Objective To study the influence of general anesthesia and epidural anesthesia on postoperative short-term cognitive function in the elderly patients undergoing orthopedics surgery.Methods 120 patients with hip joint displacement or internal fixation after femur fracture and American Society of Anesthesiology Ⅰ and Ⅱ were randomly divided into general anesthesia and epidural anesthesia groups(n=60 for each group).Artery blood pressure(ABP)and heart rate were recorded before operation,pre-operation after anesthesia,during 30 min operation,during main operation and at operation end.Cognitive function was detected by mini-mental state(MMS)before induction of anesthesia and 6 h,12 h,24 h and 72 h after anesthesia.Results There were no differences in ABP and heart rate during operation between the two groups(P＞0.05).The scores of MMS in general anesthesia group at 6 h(26.5±0.5),12 h(25.4±0.7)and 24 h(27.4±0.3)were decreased as compared with pre-induction of anesthesia(29.5 ± 0.3)(P＜ 0.05),while no difference was found at 72 h(29.3±0.3).The scores of MMS in epidural anesthesia group at 6 h(26.6±0.4)and 12 h(25.6±0.8)were lower(P＜0.05),while had no difference at 24 h(29.1±0.4)and 72 h (29.5±0.4)(P＞0.05)as compared with pre-induction of anesthesia(29.4±0.4).At 24 h after anesthesia,the MMS scores were higher in epidural anesthesia group(29.1±0.4)than in general anesthesia group(27.4±0.3)(P＜0.01).Conclusions General anesthesia may contribute to more obvious influences on cognitive function than epidural anaesthesias within 12h after operation in the elderly patients undergoing orthopedics surgery.

Objective To investigate the clinical significance of serum cystatin C(CysC)level in the diagnosis of renal damage in critically ill children.Methods One handred and forty-two critically ill children admitted to the Boai Hospital pediatric intensive care unit from January 2007 to December 2008 were included in the study.CysC,serum creafinine(SCr)and creatinine clearance rate(Ccr)were collected and analyzed.Pediatric critical illness scoring was done to assess the degree of disease.Renal damage was established according to Ccr＜80 ml/(min·1.73 m~2)(traditional gold standard)and CysC＞1.50 mg/L.The receiver operating characteristic(ROC)was analyzed to get the best point value of the diagnosis,and evaluated its sensitivity and specificity.Results According to the Ccr and CysC standards,the incidence of renal injury were 40.8%(58/142)and 50.7%(72/142),respectively(χ~2 =64.93,P＜0.001);ROC curve analysis showed that the best diagnosis point of renal injury was 1.55 mg/L;sensitivity of 94.8%,specificity 81.0%.Area under the ROC curve was 0.98(95%CI 0.97～0.98),for the diagnosis of renal damage in critically ill children was statistically significant(P=0.000).Conclusion Serum cystatin C level is a better marker of renal damage than the Ccr,can increase the diagnostic sensitivity and specificity.of renal damage in critically ill children.

Objective To investigate the current status about nursing undergraduate students' knowledge,attitude and practice (KAP)regarding nosocomial infection.Methods The self-administered questionnaires were employed to survey 108 undergraduate nursing students on the basis of a simple random sampling method.Results In the knowledge dimension,the nursing students earned 78.3％ of accuracy rate when responding to the questionnaires.The students also demonstrated positive attitudes towards nosocomial infection and occupational safety,particularly the female students.In terms of practice,the students performed relatively poor as 36.1％ of the students were unclear about the classification of medical garbage and 22.2％ of the students used their non-clean hands to touch their eye-glasses.Conclusions The undergraduate nursing students have demonstrated adequate knowledge and proper attitude towards nosocomial infection and occupational safety,however,some behaviors need to be changed.Nursing schools and hospitals should be aware of these findings and provide more training programs regarding nosocomial infection and occupational safety so that they can help students formulate good habits to prevent and control nosocomial infection.

Objective To observe the expression of Klotho and Na+/Pi cotransporter in high phosphorous-induced rats with 5/6 nephrectomy and its relationship with vascular calcification,as well as to investigate the effect of early intervention by sodium thiosulfate (STS) on the progression of vascular calcification.Methods Either 5/6 nephrectomy (n=21) or sham operation (n=14) was conducted on 35 Sprague Dawley rats,who were then fed with high phosphorus (HP) diet or normal phosphorus (NP) diet for 16 weeks respectively.The rats were divided into 5 groups as follows:(1) remnant kidney rats receiving HP diet (NHP,n=7),(2) remnant kidney rats receiving NP diet (NNP,n=7),(3) sham operation rats receiving NP diet (SNP,n=7),(4) sham operation rats receiving HP diet (SHP,n=7),(5) remnant kidney rats receiving HP diet with STS (THP,n=7).The treatment group was given STS intraperitoneally three times a week for 16 weeks.At the end of the 16th week,rats tail artery blood pressures were tested,serum creatinine (Scr),calcium (Ca2+),phosphorus (P3+),FGF23,iPTH and urine protein were examined.Throacic aorta and kidney were then removed.Vascular calcification was confirmed by Von kossa staining.Klotho and Pit-1 expression in aortas were determined by immunohistochemistry.Renal lesion was determined by PASM-Masson staining.Renal Klotho and NaPi-2a mRNA were determined by real time RT-PCR.Results After 16 weeks,Scr,p3+,FGF23,iPTH,uric protein and blood pressure were significantly higher in NHP than those in SNP rats (all P ＜ 0.05).PASM-Masson staining revealed typical renal pathology of chronic renal failure in NHP group.With the treatment of STS,THP rats showed significant decrease in Scr,t3+,FGF23,iPTH,uric protein and blood pressure by comparison with NHP group (all P ＜ 0.05).Significant vascular calcification was found in NHP group while NNP and SHP group occasionally had vascular calcification;THP group had marked alleviation of vascular calcification.The aorta and renal expression of Klotho decreased remarkably while expression of Pit-1 and NaPi-2a increased significantly in NHP compared with SNP group (all P ＜ 0.05).Accordingly,the aorta and renal expression of Klotho increased and Pit-1 and NaPi-2a decreased significantly in THP compared with NHP group (P ＜ 0.05).Conclusions The early intervention of sodium thiosulfate might regulate Klotho and Na +/Pi cotransporter expression in both aorth and kidney,decreasing serum phosphate,delaying progression of vascular calcification and improving renal function.

Objective To study protective effects of Wuzi Yanzong Fang on DNA damage induced by cyclophosphamide (CTX) in mice, and explore its mechanism. Methods BalB/c mice were randomly divided into normal group, model group, Wuzi Yanzong Fang low dose group and Wuzi Yanzong Fang high dose group. Mice in Wuzi Yanzong Fang groups were pretreated with Wuzi Yanzong Fang for 7 days, then the mice in Wuzi Yanzong Fang groups and model group were intraperitoneally injected with CTX (100 mg/kg) every other day for three times, and mice in Wuzi Yanzong Fang groups were continued administered with Wuzi Yanzong Fang. Animals were sacrificed in twelve hours after the final treatment of CTX. ELISA was used to detect 8-OHdG content in serum, and single cell gel electrophoresis to detect DNA damage in bone marrow cells. Results Wuzi Yanzong Fang low dose group and high dose group reduced the level of 8-OHdG in serum. Wuzi Yanzong Fang significantly decreased Olive tail moment, tail moment, tail length and tail DNA%in mouse bone marrow cells. Conclusion Wuzi Yanzong Fang has good protective effects on DNA damage caused by CTX.

Objective To evaluate the efficacy of adductor canal block combined with infiltration anesthesia for postoperative analgesia in the patients undergoing total knee arthroplasty. Methods Sixty pa?tients of both sexes, aged 65-80 yr, weighing 40-80 kg, of American Society of Anesthesiologists physi?cal statusⅠ or Ⅱ, scheduled for elective unilateral total knee arthroplasty, were divided into 3 groups ( n=20 each) using a random number table: single?injection adductor canal block + infiltration anesthesia group ( group A) , single?injection femoral nerve block+infiltration anesthesia group ( group F) , and infil?tration anesthesia group ( group I) . Ultrasound?guided adductor canal block and femoral nerve block were performed with 0.5% ropivacaine 20 ml before induction of anesthesia in A and F groups, respectively. Af?ter completion of the block, all the patients were ventilated through the laryngeal mask airway under general anesthesia. After installation of the knee prosthesis, local infiltration anesthesia was conducted with 0.2%ropivacaine 50 ml around the knee joint. Acetaminophen oxycodone capsule was taken orally one pill every 6 h starting from the morning on 1st day after surgery. When visual analogue scale ( VAS) score > 5, tram?adol 100 mg was injected intramuscularly as rescue analgesic. At 4, 8, 24, 48 and 72 h after surgery, VAS scores at rest and during activity were recorded, the quadriceps strength was measured, and the re?quirement for analgesic drugs and development of adverse reactions were recorded. Results Compared with
group I, VAS scores at rest and during activity were significantly decreased at 4, 8, and 24 h after surger?y, and the consumption of tramadol was significantly decreased after surgery in A and F groups ( P<0.05) . The quadriceps strength at 4 and 8 h after surgery was significantly higher in A and I groups than in group F ( P<0.05) . No patients developed serious adverse reactions in the three groups. Conclusion Adductor ca?nal block combined with infiltration anesthesia provides reliable efficacy for postoperative analgesia with little influence on the quadriceps strength in the patients undergoing total knee arthroplasty.

AIM: To study the effect of Qingqi Liangying Injection on febrile rats induced by zymonsa and on content of PGE_2 as well as cAMP in rat hypothalamus. METHODS: The rat febrific model induced by 10% zymonsa solution was used to observe QingqiLiangying Injection's effect on the rat temperature, and the radioimmunoassay(RIA) was used to determin the content of PGE_2 and cAMP in hypothalamus of rats. RESULTS: Qingqi Liangying Injection had an obvious antipyretic effect on febrile rats; Qingqi Liangying Injection could significantly reduce the content of PGE_2 and cAMP. CONCLUSION: Qingqi Liangying Injection can obviously reduce the rat body temperature and the content of PGE_2 and cAMP in hypothalamus of rats.

Purpose To investigate the expression of EZH2 and p53 protein in breast cancer and to analyze their relationship with the clinical pathologic characteristics and prognosis. Methods The expression of EZH2 and p53 protein were detected by immunohisto-chemical method in 50 cases of breast adenosis tissues, 92 cases of breast invasive lobular carcinoma ( ILC) and 200 cases of breast in-vasive ductal carcinoma ( IDC) , and their correlation was also analyzed. Results There was no statistical significance of EZH2 be-tween ILC and IDC (P>0. 016 7), while its expression in breast adenosis tissues was lower than that in ILC and IDC (P<0. 016 7). In breast cancer the expression of EZH2 protein were not correlated with patient age, menopausal status, histological types, and pTNM stage. In contrast, its expression correlated with the tumor size, lymph node metastasis, molecular subtype, survival status and p53 (P<0. 05). There was no statistical significance of p53 between ILC and breast adenosis tissues (P>0. 016 7), while its expression in IDC was higher than that in ILC and breast adenosis tissues (P<0. 016 7). Its expression had no related to patient age, menopausal status, tumor size, lymph node metastasis in breast cancer, but related to histological types, pTNM stage, molecular subtype and sur-vival status (P<0. 05). The Kaplan-Meier survival analysis showed the expression of EZH2 and p53 had correlated with disease-free and overall survival rates of breast cancer (P<0. 05). Multivariate COX regression analysis showed that the expression of EZH2 and p53 were independent affecting factors to breast cancer patients. Conclusion The expression of EZH2 and p53 protein increase in the breast adenosis, ILC and IDC gradually, and they have positive correlation. The expression levels of EZH2 and p53 protein have im-portant value to evaluate the prognosis of breast cancer patients.

Objective To investigate the feasibility of magnetic resonance diffusion tensor imaging (DTI) as a noninvasive way for assessment of kidney transplant function in the early posttransplantation period.Method Fifty-one kidney transplant recipients less than 1 month after kidney transplantation and 26 age-matched healthy volunteers were included and examined using a fatsaturated echo-planar DTI sequence in oblique-coronal orientation at 3.0 Tesla magnetic resonance (MR) imager (diffusion directions=6,b =0,300 s/mm2).According to the estimated glomerular filtration rate (eGFR) recorded and calculated on the examined day,all subjects were divided into four groups:group 1,healthy volunteers (n =26) ; group 2,eGFR≥60 mL/min/1.73 m2 (n =24) ; group 3,30≤eGFR＜60 mL/min/1.73 m2 (n =19) ; group 4,eGFR＜30 mL/min/1.73 m2 (n =8).Mean apparent diffusion coefficient (ADC) and mean fractional anisotropy (FA) were determined separately for the cortex and the medulla.The paired Students t test was used to compare ADC and FA between cortex and medulla within each group.ADC and FA between groups were compared by using the one-way analysis of variance test.Relationship between ADC and FA with eGFR of the transplants was assessed by using Pearson correlation analysis.Result Mean cortical FA was significantly higher in group 1 than in other three groups (P＜0.01 for all),while differences among groups of allograft recipients were not significant (P＞0.05 for all).There was a gradually decreasing trend of medullary FA and ADC,and cortical ADC from group 2 to group 4,and the differences among groups were all pronounced (P＜0.05 for all).In renal allografts,there was a significant positive correlation between eGFR and medullary FA,medullary ADC as well as cortical ADC (r =0.812,0.756,0.757,respectively,P＜0.01).The cortical-medullary discrimination of FA-map and ADC-map in group 3 and group 4 apparently decreased.Meanwhile,DTI revealed that the radial diffusion tracts in the medulla of group 3 and group 4 obviously broke off and reduced,especially in group 4.Conclusion DTI is a promising way to evaluate kidney transplant function early after transplantion,and can quantitatively and visually distinguish transplants with different functions.