Objective To compare the effects of dexmedetomidine (DEX) and remifentainil (REM) combined with sevoflurane (SEV) for general anesthesia on recovery quality in patients undergoing laparoscopic cholecystectomy (LC).Methods Sixty patients (ASA grade Ⅰ-Ⅱ) who underwent LC were divided into DEX combined with SEV for general anesthesia group (DEX group) and REM combined with SEV for general anesthesia group (REM group) by table of random digit,with 30 cases each.Time of first inspiration,eye opening,extubation,orientation recovery and passage of gas by anus were recorded.Vital sign,numeric rating score (NRS),Ramsay score and untoward reaction were recorded.Degree of satisfaction of patients,post-anesthesia care unit (PACU) nurse and surgeon were evaluated.Results The time of extubation and passage of gas by anus in DEX group were significantly shorter than those in REM group [(12.0 ±3.9) min vs.(15.9 ±5.6) min,t =-3.130,P =0.003; (18.5 ±3.4) h vs.(23.6 ±5.8) h,t =-5.455,P =0.000].However,the time of eye opening and orientation recovery in DEX group were significantly longer than those in REM group [(15.5 ± 4.2) min vs.(11.7 ± 2.9) min,t =4.078,P =0.000;(19.5 ± 4.5) min vs.(14.8 ± 3.6) min,t =4.315,P =0.000].During the first 2 h after operation,Ramsay score in DEX group was significantly higher than that in REM group (P ＜ 0.05),but NRS in DEX group was significanty lower than that in REM group (P ＜ 0.05),the patients with additional analgesics was minor than REM group (2 cases vs.9 cases,P ＜ 0.05).The percentages of patients suffering shivering and postoperative nausea and vomiting in DEX group were significantly lower than those in REM group [3.3％(1/30) vs.33.3％(10/30),6.7％(2/30) vs.30.0％ (9/30),P ＜0.05].Degree of satisfaction of patients and PACU nurse in DEX group were higher than those in REM group [89.0(72.0-100.0) scores vs.80.0(70.0-95.0) scores,Z =-4.066,P =0.000; 92.0 (80.0-99.0) scores vs.90.0 (80.0-95.0) scores,Z =-2.906,P =0.004],but degree of satisfaction of surgeon in REM group was higher than that in DEX group [(91.8 ± 5.8) scores vs.(81.7 ±6.1) scores,t =-6.568,P =0.004].Conclusion Compared with REM combined with SEV for general anesthesia,DEX combined with SEV for general anesthesia has a faster recovery for respiration and passing of gas by anus,lower NRS and incidence rates of shivering,nausea and vomiting,improves the quality of recovery for patients undergoing LC.

Objective To analyse of 150 cases of type A aortic dissection anatomic parameter and the relationship between anatomic parameter and clinic date and prognosis.Methods We identified 150 cases of type A aortic dissection who were diagnosed clearly.All patients were divided into groups by gender and surgical approaches.General clinic data and radiological data were recorded.Survival rate was evaluated by follow up 3 months after surgery.Results The aortic root diameter of group aortic root replacement was(53.25±13.17)mm,group aortic root sparing was (49.08±6.94)mm,there was significant difference between the two group(P<0.05);survival rate was 86.84% and 79.79%,respectively.There was no relevance between diameter of aortic arch and branch with the aortic arch surgery way.The starting diameter of two group were (54.47±9.69)mm and(54.48±8.30)mm,the diameter of aortic arch were (31.39±7.14)mm and(32.73±6.59)mm,respectively.The anonymous artery diameter were (14.65±3.00)mm and(14.28±2.99)mm,respectively.The left common carotid artery diameter were(9.81±2.33)mm and(9.56±2.10)mm,respectively.The start diameter of the left subclavian artery were(11.15±2.84)mm and(11.13±2.56)mm(all P>0.05).There were gender differences between type A dissection parameters of descending aorta,the start diameter of male and female's descending aorta were (41.09±8.86)mm and(37.44±5.60)mm,respectively.The descending aorta in parallel to the pulmonary artery diameter were(34.31±0.59)mm and(31.11±0.88)mm,respectively.Descending aorta diameter of the diaphragm were(31.45±6.50)mm and(28.46±5.20)mm,respectively(all P>0.05).Conclusion In patients who suffer from type A aortic dissection,Parameter of aortic root is one of factors which determine surgical approach to aortic root.When treating descending aorta,surgeon should consider the influence of gender.Our study provided data references for selection and design of endovascular stent-graft.

Objective To study the application of 16-slice spiral CT imaging in diagnosis of aortic dissection.Methods Sixty-one patients with aortic dissection were examined through 16-slice spiral CT imaging.Post-processing techniques were MPR,MIP and VR.Results According to AD,type Ⅰ were 10 cases,type Ⅱ 8 cases and type Ⅲ 43 cases.After contrast-enhanced scanning,true and false lumen and intimal flap of aortic dissection could be shown in all of 61 cases.32 patients have re-entrance,in which 1 patients had five re-entrances,2 patients three re-entrances and three patients haven't any re-entrance.61 patients had explicited true and false lumen.16 patients had intimal calcification and 28 patients had mural thrombus.Conclusion Angiography with 16-slice spiral CT in the diagnosis and evaluation of aortic dissection is a more effective non-invasive screening method with some essential value for the clinical therapies.

Objective To understand the training status and learning requirement of nursing personnel for the aged from the perspective of nursing targets and their relatives in the city of Nanjing.Methods The questionnaire involved six categories,80 questionnaires were sent out,57 of them were recollected.The effective recovery rate was 71.3％(57/80).All the data were input into Excel to do statistical analysis.Results The nursing personnel did not fully grasp the skills of transfusion nursing and muscle injection [45.6％(26/57) and 33.3％(19/57)] in the basic theory of basic care,knowledge and skills from the perspective of nursing targets and their relatives.The Chinese medicine nursing skills such as scrapping [needing very much 40.4％ (23/57)] and burying seeds [needing very much 40.4％ (23/57)] in the ear acupuncture point were also needed to be enhanced.A total of 75.4％ (43/57) of respondents chose online examination as the way of nursing personnel's evaluation.Conclusions Nursing personnel are in great need of on-job professional training.

Objective To explore body mass index(BMI),glucose and lipid metabolism status of high -nor-mal blood pressure that selected Uygur,Kazak and Han nationalities in parts of Xinjiang.Methods Some representa-tive regions were selected,including Fuhai County of Altay,Xinyuan County of Yili,Yanqi County of Korla and Pasto-ral of Urumqi South Mountain in August 2012 -2014 August,each region was randomly selected two survey points respectively,400 -450 people were expected to conduct on -site investigations in every survey point,and 1 046 cases were collected containing Uygur,Kazak and Han nationalities who were conformed to diagnostic standard,206 cases in which the Kazak (115 men and 91 women),Han 518 cases (277 men and 241 women),322 cases of Uygur (174 men and 148 women).in order to realize the BMI,waistline,lipid metabolism and fasting glucose status.Results (1)BMI was descending:Kazak >Uygur >Han,between the three groups respectively were statistically significant differences[(26.07 ±3.23)kg/m2 ,(25.85 ±4.09)kg/m2 ,(24.63 ±3.00)kg/m2 ,F =19.829,P <0.05],sub-group analyzes:BMI for men descending:Kazak >Uygur >Han,comparison between groups of Han,Uygur and Kazak provided results which were statistically significant(F =6.752,P <0.05);but statistical significance merely existed in Han and Kazak female comparison(F =2.248,P <0.05).Waist comparison showed a decreasing sequence:Uygur>Kazak >Han,there were no statistically significant difference between every three groups[(86.32 ±8.63)cm, (85.50 ±10.11)cm,(84.06 ±7.57)cm,F =1.675,P >0.05],gender comparison was found the same characteristics. (2)Blood fat comparison between different ethnic:Descending order of serum TG:Kazak >Han >Uygur,comparison among groups of Han,Uygur and Kazak differences were statistically significant(F =5.829,P <0.05),comparison among groups of Han,Uygur and Kazak differences were statistically significant(F =5.829,P <0.05).Comparison of Serum TC:Han >Uygur >Kazak.Statistical significance indwelled in Han,Uygur and Kazak comparison (F =5.298, P <0.05);The result of comparing serum HDL -C,LDL -C in different ethnic groups:there was no statistically significant difference between different group (F =1.026,0.744,all P >0.05).Descending order was presenting in fasting glucose:Han >Uygur >Kazak.Statistical significance appears in Han,Uygur and Kazak comparison (F =8.989,P <0.05).Conclusion High -normal blood pressure of Uygur,Kazak and Han nationalities who appeared glucose metabolic disorders,BMI and waistline increase(overweight and obesity),combined with the characteristics of different national regional life,it is of great significance to prevent and delay the occurrence of hypertension through strengthening the management and intervention of high -normal blood pressure crowd,giving medical care to the people suffering from overweight,obesity,and glucose metabolic disorders,and making full preparation for the primary of hypertension.

OBJECTIVE:To provide reference for rational use of human serum albumin for surgical inpatients. METHODS:The utilization of human serum albumin for surgical inpatients in a hospital during Jan.-Mar. 2014 was analyzed and evaluated by UHC Guidelines for the Use of Album,Nonprotein Colloid,and Crystalloid Solutions(2010 edition)and European Immune Globu-lin and Albumin Use Recommendation. RESULTS:Among the 556 patients,totally 895 human serum albumin application were con-ducted,mainly involving development of gastrointestinal surgery(29.7%),hepatobiliary surgery(25.9%)and cardiothoracic sur-gery(13.1%). The main reasons were correcting hypoalbuminemia(62.9%),followed by albumin supplemented during major sur-gery(7.9%)and alleviating ascites in patients with cirrhosis(4.4%);only 95 applications(10.6%)were considered appropriate. The most prevalent inappropriate reason was for correcting hypoalbuminemia. CONCLUSIONS:Human serum albumin in the surgi-cal inpatients in the hospital shows a large amount,and low consistent rate between indications and guidelines. The rational stan-dardized utilization of human serum albumin should be strengthened.

Objective To investigate the antitumor effect and its mechanism of microbubble contrast combined with Mitoxantrone exposed to low-frequency ultrasound on human breast cancer cell MCF-7. Methods MTT method was applied to examine the growth inhibition of MCF-7 treated with Mitoxantrone. MCF-7 cells were randomly divided into 4 groups:Mitoxantrone group (group D), ultrasound+Mitoxantrone group (group U+D), ultrasound+microbuble +Mitoxantrone group (group U+M+D) and control group (group C). The cytoactive of each group was examined with MTT. The intracellular drug content in each group was measured with high performance liquid chromatography. The morphology of MCF-7 cells apoptosis was observed with transmission electron microscopy (TEM). Results The IC_(50) of Mitoxantrone was 2.87 μg/ml. The differences of cytoactive among all groups were significant (P<0.05). The intracellular drug content of group U+M+D was higher than that of group U+D, and the latter was higher than that of group D. The morphological changes of apoptosis were observed with TEM. Conclusion Low-frequency ultrasound can promote intracellular drug content as to enhance the sensitivity of chemotherapy drugs on tumor cells, and this effect can be enhanced by microbubble contrast exposure to low-frequency ultrasound.

Objective To study the effect of the combined medial and lateral operative approach for the serious intra -articular fractures of calcaneus.Methods The lateral and medial approach for the treatment of the serious intra -articular fractures of calcaneus 22 cases (26 feet),fully exposed in the medial and lateral subtalar joint surface,reduct subtalar joint surface,drill into Kirschner nails for reduction of the calcaneus angle,then graft bones fully in the defect left after reduction,used calcaneus anatomic plate and screws to fix the fracture on the lateral. Results The patients were followed up for 10 -22 months.According to the American Orthopaedic Foot and Ankle association ankle scoring system,the averange score was 87 points.Normal union of 22 feet,4 feet delayed union,skin necrosis no incision,no infections,no cases of neurovascular injury.Conclusion The combined medial and lateral operative approach for the serious intra -articular fractures of calcaneus is an effective method,and can fully expose the lateral and medial fracture,and is conducive to reduction of the lateral and medial articular surface,and restoration of calcaneus shape,reduce malunion and the foot -pain with walking.

Objective By combining the traditional Chinese medicine(TCM) health care service and the current community puerperal women's health management, to explore the feasibility of TCM health management in the grass-roots community on puerperal women’s breast-feeding. Methods 440 patients meeting the inclusion criteria of puerperal women according to the neighborhood of residence were recruited into a non TCM intervention group of 225 people, and a TCM intervention group of 215 people. The non TCM intervention group was given health guidance on puerperal women. On such basis, the TCM intervention group was further cooperated with appropriate technical guidance of TCM. Puerperal women breastfeeding before and after the intervention was studied. Results After the intervention, the milk shortage of puerperal women breastfeeding rate of TCM intervention group was higher than the non TCM intervention group, 76.9% (60/78) vs. 56.9% (41/72), and mixed feeding rate was lower 21.8% (17/78) vs. 40.3%(29/72), the difference was statistically significant (χ2=5.916, 5.178; P < 0.05). The rate of breast feeding and mixed feeding rate were also statistically different between the TCM intervention group and the non TCM intervention group 78.1%(168/215) and 17.2% (37/215) vs. 62.7% (141/225) and 33.3% (75/225), (χ2=11.860, 14.226; P<0.01). Conclusion TCM health management guidance on puerperal women in the community can effectively improve the hypogalactia puerperal women's breastfeeding rate.

Objective To investigate the role of protein phosphorylation in Pseudomonas aeruginosa (P.aeruginosa) strains in response to stress triggered by mouse macrophages.Methods The strong cation exchange-immobilized metal affinity chromatography (SCX-IMAC) was performed to enrich phosphopeptides.The nanoscale liquid chromatography coupled to tandem mass spectrometry (nano LC-MS/MS) was carried out to identify and analyze phosphoproteome.Results Fourteen phosphopeptides from twelve proteins were identified within thirty-one phosphorylation sites on serine,threonine and tyrosine residues.Fifty percent of these phosphorylated proteins were membrane proteins,indicating that their phosphorylation modification was more critical for bacteria in response to the stress.In terms of biological process of Gene Ontology,these identified proteins were involved in stress response,iron transport,anaerobic respiration,response to hydrogen peroxide and signal transduction by phosphorylation,etc.Conclusion These phosphorylated proteins in P.aeruginosa strains are necessary for signal transduction and their response to harsh environment within the macrophages,such as iron limitation,hypoxia and oxidative stress.This study provides evidence for further investigation on virulence and pathogenesis of P.aeruginosa.