Objective To compare cardiovascular responses of intubations by Discopo and Macintosh laryngoscope in elderly patients with hypertension. Methods Sixty elderly hypertensive patients with ASAⅡ~Ⅲundergoing elective surgery were equally randomized into two groups. After induction of general anesthesia , orotracheal intubation was performed with Discopo or Macintosh. The Mean arterial pressure (MBP) and heart rate (HR), as while as Electrocardiogram (ECG) and Blood oxygen saturation (SpO2), were recorded before (baseline values) and at 1,3,5 minutes after intubation(post-induction values). The rate of one-time successive intubation,intubation time and complication were also recorded. Results Compared with the macintosh group, the rate of one-time successive intubation was higher and the intubation time was shorter in the Discopo group (P< 0.05, respectively),with no complications. Compared with T0,MBP and HR at T2 in the two groups and T3 in the Macintosh group increased significantly (P < 0.05). Compared with the Macintosh group,MBP and HR at T2,T3 of the Discopo group decreased significantly (P < 0.05). Conclusion Little effect of tracheal intubation with Discopo on cardiovascular response was observed in elderly hypertensive patients.

[Summary] Considerable efforts have been made to understand the cellular and molecular mechanisms of metformin ,a potent antihyperglycemic agent now recommended as the first‐line treatment of patients with T2DM. The main effect of this drug is to reducethe hepatic glucose output ,primarily through inhibition of the mitochondrial respiratory chain complex Ⅰ and then activating AM P‐activated protein kinase (AMPK) ,which provide a generally acceptable mechanism for the action of metformin on hepatic gluconeogenesis. Beyond its effect on glucose metabolism ,metformin has been reported to improve ovarian function of patients with polycystic ovary syndrome (PCOS) and to reduce the risk of microvascular and macrovascular complications in patients with T2DM. In addition ,metfomin has also recently been suggested as an adjuvant treatment of cancer. Here we reviewed the progress of mechanism research and clinical application of metformin.

The gene chips have been extensively studies and widely applied.Gene chip technology provides a powerful tool for molecular nutrition.This article reviews the rationales,classification,characteristics of gene chips,and their application in molecular nutrition.

Objective:To improve the the completion rate of bed shifting of duty via application of quality con-trol circle( QCC) , and to build a harmonious relationship between doctors and nurses and improve nursing moral standards. Methods:After organizing QCC group, taking improving the completion rate of bed shifting of duty as the theme and analyzing the effect, according to the ten steps of QCC to control the quality. Results:The comple-tion rate of bed shifting of duty was improved from 69% to 69%, the patients' satisfaction was improved from an av-erage of 96 to 100 after the implementation of QCC. Conclusion: QCC can improve the completion rate of bed shifting of duty and patients' satisfaction, and thus worth of promoting in routine nursing.

Objective To estimate and optimize the dosage regimen of vancomycin and linezolid for treatment in different Gram-positive cocci infections. Methods The pharmacokinetic data of vancomycin and linezolid were collected, and the pharmacodynamics in vitro of these drugs for staphylococcus epidermidis, staphylococcus aureus, enterococcus faecalis and enterococcus faecium were analysed. The cumulative response fraction (CFR) was evaluated in different dosage regimens of two drugs against four types of bacteria. Results The regimen of 3 500 mg/d vancomycin was recommended for patients with staphylococcus epidermidis infection. The regimen of 2 500 mg/d vancomycin was recommended for patients with staphylococcus aureus infection. The regimens of 3 000 mg/d vancomycin and 400 mg linezolid given 2 times/day were recommended for patients with enterococcus faecalis infection. The regimens of 2 500 mg/d vancomycin and 400 mg linezolid given 2 times/day were recommended for patients with enterococcus faecium infection. Conclusion In application of vancomycin and linezolid for treatment of Gram-positive cocci infections, different dosage regimens should be used in different types of infections.

Objective To discuss the effect of the quality control circle(QCC)activities in reducing the incidence of cold in reflux-enema of children.Methods The QCC team was built,reducing the incidence of cold in reflux-enema of children was named as the theme,to grasp the present situation,set the goal,fix the methods and carry out countermeasures.Results Through the development of QCC,making the standards of reflux-enema,the incidence rate of cold reduced from 25.0％(7/28) down to 3.6％(1/28),the nurses' abilities of technical operation and communication improved significantly.Conclusions Application of QCC in reflux-enema of children is practical.It can effectively improve the nurses' awareness of participating in the implementation management and nursing management system.By making the standardization of reflux-enema,nurses can improve the quality and effect of the reflux-enema and ensure the quality and safety of nursing.

Objective To investigate the correlation of oxygen extraction rate (ERO2) with blood lactate clearance rate and cardiac output (CO) in the early stage of post-restoration of spontaneous circulation (ROSC) in patients resuscitated from cardiogenic cardiac arrest,and to analyze the relationship between the ERO2 and prognosis.Methods Fourteen patients successfully resuscitated from in-hospital cardiogenic cardiac arrest in the emergency ICU from October 2012 to January 2014 were retrospectively analyzed.These patients were assigned to survival group (n =5) or death group (n =9) as per the outcome at 72 h after ROSC.At admission (0 h),3,6 and 12 h after ROSC,arterial blood and venous blood were drawn to detect ERO2 and lactate clearance rate.Cardiac output (CO) was measured by thoracic impedance method,APACHE Ⅱ scores were assessed,and survival time was recorded.Results The patients in the death group died during the period of 12-72 hours after ROSC.The significantly decreased ERO2 at 6 h and 12 h after ROSC,and decreased blood lactate clearance rate and decreased CO at 3 h,6 h and 12 h after ROSC were found in the death group compared with the survival group (all P ＜ 0.05).The ERO2 at 6 h and 12 h after ROSC was significantly positively related to blood lactate clearance rate (r =0.857,r =0.947,both P ＜ 0.05) and CO (r =0.968,r =0.936,both P ＜ 0.05) at 3 h,6 h and 12 h after ROSC.The ERO2 at 6 h and 12 h after ROSC was significantly negatively related to APPACHE Ⅱ score (r =-0.970,r =-0.973,both P ＜ 0.05);APPACHE Ⅱ scores were significantly negatively correlated with blood lactate clearancerates (r=-0.880,r=-0.899,r=-0.850,all P＜0.05) and CO (r=-0.876,r=-0.922,r=-0.916,all P＜0.05) at 3 h,6 h and 12 h after ROSC.Conclusions The ERO2 at 6h after ROSC may be used to assess the severity and prognosis of patients resuscitated from cardiogenic cardiac arrest.

The present study examined the functional profile of dendritic cells (DCs) in patients with rheumatoid arthritis (RA) and the effects of simvastatin on the function of DCs. A total of 40 patients who was recently diagnosed as having RA were equally assigned to two groups: the routine treatment group (group R) and the routine treatment plus simvastatin group (group R+S). Twenty healthy individuals served as control. The peripheral blood mononuclear cells (PBMCs) were isolated before and 4 weeks after the treatment and then cultured with interleukin-4 (IL-4) and granulocyte-macrophage colony stimulatory factor (GM-CSF) to prepare mature DCs. The expression of co-stimulating factor CD86 on the surface of DCs was assessed by flow cytometry. And the stimulating capacity of DCs was measured by mixed lymphocyte reaction (MLR). The contents of cytokines in culture supernatants of DCs in MLR were detected by ELISA. Blood lipids and high-sensitivity C-reactive protein (hs-CRP) were detected. The relationship between the expression of CD86 and the blood CRP level was also investigated. The results showed that, as compared with the control group, the CD86 expression and the level of cytokines secreted by DCs were significantly increased in RA patients and greater stimulating capacity of DCs in MLR was demonstrated in RA patients. T lymphocytes in MLR secreted higher levels of proinflammatory cytokines (IL-2, IL-17, TNF-α and INF-γ) and lower level of anti-inflammation cytokine (IL-10). The function of DCs was markedly weakened and the level of hs-CRP and low-density lipoprotein was substantially lowered in group R+S in comparison to group R. The CD86 expression was positively correlated with hs-CRP. It was concluded that DCs in RA are highly activated and DC-initiated immune reaction may play an important role in the pathogenesis of RA. Simvastatin administration can significantly inhibit the DCs function and reduce the level of hs-CRP, indicating the suppression on inflammatory reaction may be one of the mechanisms by which simvastatin exerts its effect in treating RA.

Objective To discuss the efficacy and safety of triamcinolone acetonide (TA)retrobulbar injection combined with panretinal photocoagulation (PRP)in the treatment of diabetic macular edema (DME), and to explain the advantages of this combination treatment method in treating DME.Methods Sixty-four cases (64 eyes) with macular edema due to diabetic retinopathy(DR)were randomly divided into combination treatment group(n=34,treated with TA retrobulbar injection combined with PRP)and PRP group(n=30,received PRP treatment only).The changes in the best corrected visual acuity (BCVA), the fovea centralis thickness (CMT), and the intraocular pressure(IOP)before treatment and in 1 month, 3 months, 6 months after treatment were compared. Results The BCVA was improved in both groups after treatment. However, the BCVA improvement in combination treatment group was statistically more significant (P<0.05)compared with PRP group in 1 month, 3 months and 6 months after treatment. The resolution of DME after treatment as compared with that before treatment,the CMT reduced in two groups in 1 month,3 months,6 months after treatment.At each stage,the CMT in combination treatment group was lower than PRP group (P<0.05 ). No complications of glaucoma, cataract,vitreous hemorrhage,retinal detachment,choroidal detachment,and endophthalmitis were found in all patients.Conclusion For the patients with DME,the combination treatment with TA retrobulbar injection and PRP has a better therapeutic effect than the sole PRP treatment in reducing the macular edema and improving the BCVA.The operation is simple and has less complication.

Objective To investigate the value of dual-energy virtual unenhanced and dual-energy iodine value distribution diagram type of kidney cancer.Methods A retrospective analysis of 35 cases of renal cell carcinoma dual-energy CT scan data,compared to kidney pathology data,analyze the image quality and radiation dose dual-energy virtual unenhanced and dual energy distribution of iodine in clear cell carcinoma and non-clear cell carcinoma the differences that exist.Results Unenhanced and virtual unenhanced image quality was quite,CT value (routine unenhanced renal parenchyma 31.90±4.10 HU,abdominal aortic 45.60±6.30 HU,psoas 50.00±6.6 HU3,kidney 1.410±17.06 HU; virtual unenhanced renal parenchyma abdominal aortic 33.20±5.50 HU,48.30±8.00 HU,52.40±10.63 HU psoas kidney 0.87±17.48 HU),signal to noise ratio (routine unenhanced renal abdominal aorta 3.22±1.49,5.13±2.57,4.56±2.12 psoas kidney 3.24±2.27 virtual unenhanced renal abdominal aorta 2.73±1.08,3.79±1.64,3.23±1.35 psoas kidney 2.18± 1.57) had not significantly different (P ＞ 0.05).Clear cell carcinoma of the skin medullart junction of iodinedistribution of images Iodine (2.75±1.05) mg/ml was higher than non-clear cell carcinoma (1.25±0.72) mg/ml,the difference was statistically significant (t =7.048,P ＜ 0.05).Conclusions CT examination in patients with renal cell carcinoma virtual unenhanced image quality is similar with routine unenhanced image quality,it reduces radiation dose.The distribution of iodine can provide more diagnostic information that can help us be more intuitive and accurate judgments of the blood supply and kidney cancer subtypes.