Objective To observe the effects of different levels of stroke volume variation(SVV) directed fluid therapy on prognosis in elderly surgery patients. Methods One hundred and fifty-six patients (ASA gradeⅠorⅡ) having underwent abdominal surgery were selected, and the patients were divided into 3 groups according to the level of SVV with 52 cases each:low SVV group (SVV 3%-6%), middle SVV group (SVV 7% - 10%) and high SVV group (SVV 11% - 14%). Each group accepted different fluid therapy strategy. The intraoperative index, postoperative recovery index and complications were compared. Results The volume of crystalloid and volume of colloform in low SVV group and middle SVV group were significantly higher than those in high SVV group: (2 365 ± 517) and (2 080 ± 378) ml vs. (1 820 ± 579) ml, (1 105 ± 220) and (898 ± 239) ml vs. (559 ± 166) ml, and those in low SVV group were significantly higher than those in middle SVV group, and there were statistical differences (P<0.05). The urine volume in low SVV group was significantly higher than that in high SVV group:(717.4 ± 289.0) ml vs. (511.8 ± 326.3) ml, and there was statistical difference (P<0.05). The first exhaust time in high SVV group was significantly shorter than that in low SVV group:(81.2 ± 27.5) h vs. (98.9 ± 32.5) h, and there was statistical difference (P<0.05). The first level and above nursing time, postoperative hospital stay and total length of hospital stay in middle SVV group were significantly shorter than those in high SVV group and low SVV group: (4.4 ± 2.8) d vs. (5.3 ± 3.2) and (6.4 ± 3.7) d, (13.8 ± 5.2) d vs. (17.7 ± 8.4) and (19.5 ± 8.9 ) d, (22.7 ± 10.4) d vs. (26.8 ± 13.1) and (30.6 ± 10.3) d, and there were statistical differences (P<0.05). The incidence of stomal leak in high SVV group was significantly higher than that in low SVV group: 17.3% (9/52) vs. 3.8% (2/52), the incidences of postoperative infection in high SVV group and middle SVV group were significantly lower than that in low SVV group: 5.8% (3/52) and 5.8% (3/52) vs. 26.9% (14/52), and there was statistical difference (P<0.05). Conclusions The SVV 3% - 6% in elderly surgery patients may increase the risk of postoperative infection and prolong the time of hospitalization. But the SVV 7% - 10% may have a better postoperative recovery, and this level could be a better goal of perioperative fluid therapy in elderly surgery patients.

Objective:To analyze the anti-infection therapy for one lung cancer patient with agranulocytosis and fever after chemo-therapy to provide pharmaceutical care and support for the rational anti-infection drug use in the patient. Methods: Clinical pharma-cists analyzed the drugs used in the patient and provided pharmaceutical care for doctors according to the examination results and diag-nosis of the patient. Results:By participating in the treatment plan, clinical pharmacists ensured the treatment for the patient was safe and effective. Conclusion:Clinical pharmacists should assist doctors in making out the treatment plan according to patients’ situation in order to promote rational drug use in clinics and reflect the value of pharmaceutical care.

A fluorescence nanosensor based on an easily prepared fluorescent molecule, 1-oxo-1H-phenalene-2,3-dicarbonitrile (OPD), was developed for highly sensitive detection of glucose.Under the catalysis of horseradish peroxidase (HRP), 3,3′,5,5′-tetramethylbenzidine (TMB) was oxidized into oxidized TMB (oxTMB) by H2O2.And the fluorescence of OPD was quenched by the intense absorption of the formed oxTMB, thus realizing effective quantitative detection of H2O2.The linear range was 0.05-0.8 μmol/L and 1-10 μmol/L respectively, with limit of detection of 0.02 μmol/L.Besides, on the basis of transformation of glucose into H2O2 through the catalysis of glucose oxidase, this nanosensor could be further exploited for highly sensitive detection of glucose.The TMB-HRP-OPD sensor exhibited linear range of 0.1-3.0 μmol/L and 4.0-30 μmol/L respectively for detection of glucose, with limit of detection of 0.02 μmol/L.Furthermore, it was successfully applied to the determination of glucose in real human serum and the results were in good agreement with the clinical data.

Objective To analyze the clinical and histopathologic features of eruptive microvenular hemangioma (EMVH). MethodsThe clinical and histological findings in six patients with EMVH were retrospectively reviewed.Results The patients were young or middle-aged,with a median age of onset of 34 years.The ratio of males to females was 1 ∶ 1.Clinically,all the patients experienced a sudden development of widespread,asymptomatic,brunneus,flat-topped papules and plaques measuring from 0.1 to 2.0 cm in diameter.Histopathologic examination revealed a poorly circumscribed proliferation of small,irregularly branched,thin-walled blood vessels haphazardly arranged between collagen fiber bundles in the dermis.The lumina of the blood vessels were often collapsed.There was no cellular atypia or mitosis.A variable degree of sclerosis was noted in the surrounding stroma.Immunobistochemical study revealed that the endothelial cells stained positive for CD34,CD31,and factor Ⅷ-related antigen.Conclusions The diagnosis of EMVH is proposed,and awareness of this disease may benefit its early diagnosis and avoidance of unnecessary treatment.

Objective To identify risk factors and preventive measures of nosoconial infections in patients with non-Hodgkin lymphoma (NHL). Methods Clinical data of 65 NHL patients admitted from January to December 2007 were retrospectively analyzed. Results According to WHO classification (2001), 58 patients were with B-cell lymphoma, 7 were with T-cell lymphorna. All patients received CHOP regimen as initial chemotherapy and 23 of them were with nosecomial infections. Logistic regression analysis demonstrated that age, length of stay, pathological type, bone marrow involvement, levels of serum lactate dehydrogenase (LDH), beta2-microglobulin and invasive treatment were identified as risk factors of nosocomial infections. Respiratory tract infections and infections with gram-negative microorganisms were the most popular. Conclusion High nosocomial infection rate is found in NHL patients, and control of risk factors may effectively prevent nosocomial infections in NHL patients.

BACKGROUND: At present, there are some reports regarding the treatment of high-energy shockwave to chronic pain of muscle and born joint, however,the therapeutic effects and mechanism are still uncertain and need further discussion.OBJECTIVE: To explore the curative effects, mechanism and clinical application of high energy shockwave to bone joint myofascitis.DESIGN: Non-randomized case controlled study based on diagnosis SETTING: Rehabilitation Medicine Department of First Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: Totally 90 patients with chronic pain of muscle and bone joint treated in Rehabilitation Medicine Department of First Affiliated Hospital of Sun Yat-sen University from July 2001 to April 2002 were divided into treatment group and control group each with 45 cases by the order of visiting time. There were 17 males and 28 females in the treatment group with mean age of 54 years and 15 males and 30 females in the control group with mean age of 63 years.METHODS: Shockwave therapy was applied to the treatment group while routine physical treatment was conducted to the control group. Simple McGill pain questionnaire(MPQ) was used to evaluate the general reactions of patients to pain and assess the shoulder joint territory and clinical effects.therapeutic effects.RESULTS: There was significant difference on sensory, affective and pain score, visual analogous scale(VAS) and pain presentation inventory(PPI) before and after treatment in the treatment group( t =5.69, 5.67, 7.06, 8.37,6. 21, P ＜ 0.01 ). When compared with control group, there was significant difference on sensory, pain score, VAS between the treatment group and control group(t =4. 66, P ＜ 0.01; t =2.52,3.40, P ＜0.05).CONCLUSION: Extracorporeal high-energy shockwave has reliable effects on treating chronic pain caused by bone joint myofascitis, which is characterized by its effective, quick and safe features.

Objective To evaluate the reversal effect of a cholinergic receptor agonist on acantholysis in pemphigus,and to investigate its mechanism.Methods Human HaCaT keratinocytes were co-cultured with pemphigus vulgaris immunoglobulin G (PV-IgG) to establish a cell model of pemphigus,then classified into two groups to be incubated with the cholinergic receptor agonist carbachol for 12 hours (test group) or remain untreated (control group).Cell dissociation assay was performed to quantitatively estimate the reversal effect of carbachol on acantholysis,and immunofluorescence assay to qualitatively assess the changes of desmosomal proteins.Radio-immunoprecipitation assay (RIPA) lysis buffer and Triton X-100 were used to lyse HaCaT cells to obtain total proteins and cytoplasmic proteins,and Western blot was conducted to determine the expression levels of adhesion-related proteins desmoglein 3 (Dsg3) and plakoglobin (PG) on the surface of HaCaT cells,as well as the phosphorylation levels of p38 mitogen activated protein kinase (p38 MAPK) and epidermal growth factor receptor (EGFR) at different time points.Quantitative polymerase chain reaction (qPCR) was performed to detect the mRNA expressions of the above surface proteins,and coimmunoprecipitation assay to qualitatively evaluate the interaction between Dsg3 and PG.Results The number of cell debris was significantly lower in the test group than in the control group (18.67 ± 2.52 vs.46.67 ± 2.03,t =11.22,P＜0.01).Immunofluorescence assay showed that carbachol could reverse the internalization of desmosomal molecules induced by PV-IgG.In the pemphigus cell model,the levels of total Dsg3 and PG as well as non-desmosomal Dsg3 were decreased,while the level of non-desmosomal PG increased,and the interaction between Dsg3 and PG was attenuated.When the pemphigus cell model was co-cultured with carbachol,these above changes were reversed.Carbachol also increased the mRNA levels (expressed as 2-△△Ct) of Dsg3 and PG from 1.428 ± 0.215 and 1.563 ± 0.247 in the control group to 4.974 ± 0.948 (t =3.65,P =0.01) and 13.420 ± 1.715 (t =6.85,P ＜ 0.01) in the test group respectively.In phosphorylation assay,carbachol inhibited the phosphorylation of EGFR,but had no significant effect on that of p38 MAPK.Conclusions The cholinergic receptor agonist carbachol can reverse acantholysis in pemphigus,likely by inhibiting the internalization of Dsg3 and PG,enhancing their expressions and interaction,and suppressing the phosphorylation of the key signaling molecule for acantholysis,EGFR.

Objective To investigate the hyperuricemia(HUA)and the correlation of blood lipids of the 60 -70years peple in Renqiu area,and to provide the basis for guiding prevention and treatment of the elderly disease the region.Methods According to the cluster random sampling method,Renqiu permanent residents with the age of 60 to 70 years were selected as a screening object.In the total 5 010 cases screened object,2 163 were male(43.2%),2 847 were female(56.8%),with an average age of(64.29 ±3.05)years.The data of blood uric acid and total cholesterol(TC), triglyceride(TG),high -density lipoprotein(HDL -C),low -density lipoprotein(LDL -C)were collected.The rela-tionship between blood uric acid and blood lipids were analyzed.Logistic regression method was used to analysis the relationship between the hyperuricemia and lipids components.Results The overall prevalence of hyperuricemia in Renqiu was 6.1%(9.8% in male,3.2% in female).In men HUA group,the levels of blood uric acid,TG and LDL-L were 464.10(438.00 -508.65)μmol/L,1.54(1.00 -2.19)mmol/Land 2.66(2.25 -3.22)mmol/L,which were higher than those of normal uric acid group of 294.00(249.90 -338.08)μmol/L,1.13(0.84 -1.65)mmol/L and 2.57(2.12 -3.01)mmol/L(P <0.05).In women HUA group,the levels of blood uric acid,TG and LDL -L were 454.15(434.15 -480.78)μmol/L,2.14(1.47 -3.18)mmol/L and 2.96(2.52 -3.76)mmol/L,which were higher than those of normal uric acid group of 250.80(209.00 -299.80)μmol/L,1.53(1.10 -2.20)mmol/L and 2.87(2.40 -3.33)mmol/L(P <0.05).Logistic multi -factor regression analysis showed that TG was an independ-ent risk factor for hyperuricemia,and that HDL -L and gender were protective factors.Conclusion Hyperuricemia is closely associated with blood lipid,especially with TG and HDL -L,so we could screening HUA by blood lipid,which can reduce the occurrence of cardiovascular disease effectively.

Objective To study the induction of nitrous oxide(N2 O)and to compare safety and effec-tiveness of conscious sedation by nitrous oxide inhalation and intravenous sedation with propofol for upper gas-trointestinal(UGI)endoscopy.Methods A total of 400 patients undergoing UGI endoscopy in our hospital from April 2013 to October 2013 were randomly assigned to two groups,N2 O inhalation group(n=200)and in-travenous propofol group(n=200).The systolic pressures,diastolic pressures,heart rates and oxygen satura-tion,onset time,procedure duration,degree of sedation,recovery time,length of hospital stay,complica-tions,satisfaction ratings of doctors and patients,and the number of patients willing to accept the examination again were analyzed.Results The mean time of ideal anesthesia state for N2 O was (3. 16 ±0. 65 )min and there was no difference between the male and female(3. 16 ±0. 71)min vs.(3. 16 ±0. 58)min,t=0. 006,P>0. 05).The mean concentration was (43. 68 ±5. 05 )%,which was higher in male than that in female [(45. 3 ±4. 99)% vs.(41. 46 ±4. 30)%,t=3. 042,P<0. 05].Compared with before,the systolic pres-
sures,diastolic pressures,heart rates and oxygen saturation of patients in the propofol group significantly re-duced during the procedure(P<0. 05),while the same measurements excluding oxygen saturation for those in the N2 O group significantly increased(P<0. 05 ).Compared with the propofol group,patients inhaling N2 O had significantly shorter recovery and hospital stay time,but a longer onset time and procedure duration(P<0. 05 ).Complications that occurred in some patients of propofol group included hyoxemia,hypotension,brady-cardia,while the major complication in the N2 O group was nausea.The satisfaction ratings of doctors or pa-tients and the number of patients willing to accept the examination again in N2 O group were smaller than those in propofol group(86 ±3. 7 vs.96 ±2. 6,87 ±2. 8 vs.98 ±1. 2,87%vs.99%,P<0. 05).Conclusion Both conscious sedation by N2 O inhalation and intravenous sedation with propofol are effective for diagnostic UGI en-doscopy,but the safety of the former is superior to the latter.The key to complete the conscious sedation by ni-trous oxide inhalation is to accurately identify the ideal anesthesia state of N2 O.It is significant to pay attention to the nine factors concerning safe and effective sedation during operation.