This paper introduces the airway care of a patient with motor neuron disease treated with mechanical ventilation for eight years. The airway care for the patient focused on individualized suctioning,measures to prevent atelectasis such as lung hyperinflation,adjustments of ventilator parameters,regular weaning exercise,as well as measures to prevent ventilator-associated pneumonia such as prevention of aspiration,strict disinfection and isolation,wound care of tracheotomy. The ventilator-associated pneumonia was effectively prevented. Effective nursing care for patients with long-term mechanical ventilation can prevent atelectasis and ventilator-associated pneumonia.

As the actual clinical reflecting of transform Chinese medicine special curative effect, Chinese medicine preparation not only satisfies the need of hospital clinic, scientific research and teaching, but also plays an important role in deepening medical and health system reform, improving people's health level and contributing to the economic growth. However, some problems about administration and approval (tending to western medicine), contraction of the scale, lack of synchronization for clinic and scientific research, and the imbalance of regional development make Chinese medicine preparation move forwards slowly in contradiction. It has not only reduced the effectiveness of the Chinese medicine preparation in hospital clinic, but also brought bad effect on modernized development of Chinese medicine preparation. Research shows that main influencing factors of status quo of Chinese medicine preparation in medical institution include imperfect laws and regulations, high cost than income, and shortage of talents in preparation research. The analysis indicated that the necessary measures to break the contradiction, improve clinical effect of Chinese medicine, and promote the modernization development of Chinese drugs preparation were as follows: government and related departments should strengthen the supporting force in policy by adjusting the examination and approval policy, speeding up dispensing use, reforming pricing system, including into medicare reimbursement, integrating advantage resources and so on; medical institution should actively carry out research and development of traditional Chinese Medicine through drawing the traditional and modern essence, reserving professional talents, and developing characteristic preparation; companies cooperate with hospitals for complementary advantages, which can rapidly transform Chinese medicine preparation into clinical practice.
Chemistry, Pharmaceutical ; economics ; methods ; trends ; China ; Drug Discovery ; economics ; trends ; Drugs, Chinese Herbal ; chemistry ; economics ; pharmacology ; Humans ; Medicine, Chinese Traditional ; economics ; trends

Objective To investigate the clinical manifestations of coexistent rheumatoid arthritis(RA)and systemic lupus erythematosus(SLE)(Rhupus syndrome).Methods Clinical data from a patient with Rhupus syndrome were analyzed combined with literature review.Results The patient was a middle-aged female,who presented with features of RA and developed features of SLE 7 years later.Renal involvement in common cases is rare but presented in our patient with severe renal dysfunction.The patient showed part remission with glucocorticosteroids and cyclophosphamide therapy.Conclusion Rhupus syndrome is a rare condition sharing features of RA and SLE.These patients present with features of one disease but later on develop features of another.Glucocorticosteroids and immune suppressors are effective.Appreciation of these patients with rhupus is important since their therapy and outcome differ from those having RA or SLE alone.

AIM:To discuss the related factors that affected the stability of posterior corneal surface after laser in situ keratomileusis ( LASIK) .
METHODS:About 64 patients (64 eyes) were enrolled. The correlation among the changes in posterior corneal surface 6 month after LASIK, surgery method, corneal flap thickness ( FT ) , ablation thickness ( AT ) , postoperative residual corneal stroma thickness ( RCST ) , preoperative thinnest corneal thickness ( CT ) , flap thickness/preoperative thinnest corneal thickness ( FT/CT ) , ablation thickness/preoperative thinnest corneal thickness ( AT/CT) , postoperative residual corneal stroma thickness/preoperative thinnest corneal thickness ( RCST/CT) , anterior and posterior preoperative corneal height, the difference of the forward shift in posterior corneal surface ( diff value ) of preoperative and preoperative intraocular pressure were analyzed.
RESULTS: The changes of diff value between preoperative and postoperative were related with diopter (r=0.419, P=0.014), AT (r=0.394, P=0.023), AT/CT (r=0.501, P=0.004), Diff value of preoperative (r=0.501, P=0. 004), RCST (r=-0. 385, P=0. 033) and RCST/CT (r=-0. 401, P=0. 025). The changes of height value from posterior corneal surface between preoperative and postoperative were related with diopter (r=0. 520, P=0. 002), AT (r=0.504, P=0. 003), AT/CT (r=0. 442, P=0. 013), Diff value of preoperative (r=0. 624, P=0. 000) and RCST/CT (r=-0. 394, P=0. 028).
CONCLUSION: AT, RCST, AT/CT, RCST/CT and diff value of preoperative should be the key index that predicted the stability of posterior corneal surface after LASIK,the further research will give the range of safety value.

AlM: To research the characteristics of positive relative accommodation ( PRA) , negative relative accommodation (NRA) and PRA/NRA ratio in myopes. To analyze the relationship among PRA, NRA, PRA/NRA ratio, spherical equivalent degree, years and habbits of wearing glasses, myopia development, and pupil diameter.METHODS: Aretrospective study of ninety eyes in the 180 th Hospital of Quanzhou from August 2014 to December 2014. PRA, NRA and PRA/NRA ratio were compared among low, moderate, high myopes and emmetropes. The correlation were analyzed among PRA, NRA, PRA/NRA ratio, spherical equivalent degree, years and habbits of wearing glasses, myopia development and pupil diameter. PRA, NRA, PRA/NRA ratio, years and habbits of wearing glasses and pupil diameter were compared between progress group and non-progress group.RESULTS: ( 1 ) Without statistical differences in age, sex and intraocular pressure, PRA and PRA/NRA ratio of myopes were lower than emmetropes, while NRA was higher. (2) Without statistical differences in age, sex and intraocular pressure, PRA, PRA/NRA ratio and NRA had no statistical differences while years and habbits of wearing glasses had statistical differences among low, moderate, high myopes. ( 3 ) With longer years of wearing glasses, PRA, PRA/NRA ratio were larger and NRA, pupils were smaller. ( 4 ) Without statistical differences in age, diopter and intraocular pressure, one group which were not easy to deepen degree had more often-wear-glasses myopia patiens and longer years of wearing glasses, the other group which were easy to deepen degree had more seldom-wear-glasses myopia patiens and shorter years of wearing glasses.CONCLUSlON: PRA and PRA/NRA ratio of myopes were lower than emmetropes, while NRA was higher. No correlated relation was detected among PRA, NRA, PRA/NRA ratio, spherical equivalent degree and myopia development. lt suggests the onset and progress of myopia are related to many factors. Wearing-glass timely and accurately can release the decline of PRA and PRA/NRA ratio and slow down degree development in myopes.

Objective:To evaluate effects of different medication forms of dexmedetomidine on perioperative cognitive function in elderly patients undergoing radical operation of gastric carcinoma, and Ramsay sedation score.Methods:A total of 150 patients aged 65 years and 75 years scheduled for elective radical operation of gastric carcinoma from December 2018 to December 2019 in Shanxi Provincial Cancer Hospital were enrolled, and they were divided into 3 groups according to random number table method: different medication forms of dexmedetomidine groups (group A, group B) and the control group (group C), 50 cases in each group. The patients in group A and group B continued to pump dexmedetomidine at a rate of 0.5 μg·kg -1·h -1 and 0.3 μg·kg -1·h -1 respectively for 15 min before induction of anesthesia. And the patients in group C were given intravenous pumping of an equal volume of 0.9% NaCl for 15 min. Subsequently, patients in group A and group B received continuous intravenous infusion of 0.3 μg·kg -1·h -1 for 30 min before the end of operation, the patients in group C received 0.9% NaCl infusion of equal volume until the end of operation. The cognitive function of the patients was measured by using the Monterey cognitive assessment scale (MoCA) the day before surgery and on day 1,3 and 7 after surgery, and the incidence of perioperative neurocognitive disorder (PND) was counted. Ramsay sedation score at 30 min, 24 h and 48 h after surgery was compared among the three groups. Results:There were 3 patients in group A and 3 patients in group C were excluded because they were transferred to ICU due to serious postoperative complications. There were significant differences in MoCA score among the three groups on day 1, 3, 7 after operation (all P < 0.01); MOCA score of group A, B and C on day 7 after operation was (26.9±0.7) scores, (26.6±1.0) scores, (26.3±1.2) scores, respectively, and the difference between group A and group C was statistically significant ( P < 0.01). The incidence of PND among the three groups on day 1, 3, 7 after surgery had statistically significant differences (all P < 0.05), and the incidence of PND in group A was lower than that in group B and C (all P < 0.05). Ramsay sedation score among the three groups at 30 min and 24 h, 48 h after operation showed statistically significant differences (all P < 0.01), and that in group C was lower than that in group A and group B, and the differences were statistically significant (all P < 0.01). Ramsay sedation score at 24 h after operation in group A was high than that in group B and group C (all P < 0.01). Conclusions:Dexmedetomidine assisted with anesthesia can reduce the incidence of PND in elderly patients undergoing radical operation of gastric carcinoma and enhance the sedative effect. What's more, the most obvious effect is the infusion of 0.5 μg·kg -1·h -1 before anesthesia induction.

Chinese herbal pieces are a key factor to protecting the quality of the clinical efficacy of traditional Chinese medicine (TCM), and it is one of the basic elements of ensuring the quality of TCM and people's usage safety. However, Chinese herbal pieces has massive problem such as adulteration and counterfeit, dyeing and weighting, pesticide residues, heavy metals in excess of the standards, and all the issues are repeated excessive in the clinic treatment. These issues impacted sound development of production, management and use of TCM, but also brings common people hidden trouble for the clinical safety of medication. Protect and improve the quality of the Chinese herbal pieces demand that continue improve quality system, in-depth scientific research, and strengthen self-discipline and other factors. So it is fundamentally to ensure good quality of Chinese herbal pieces with the color, taste and shape by systematic supervision to it from the source, production, management and research, with strengthened implementation and en- forcement of the "3G".
Drug Contamination ; prevention & control ; Drugs, Chinese Herbal ; adverse effects ; Medicine, Chinese Traditional ; adverse effects ; Total Quality Management ; methods

Objective To investigate the effect of intermedin (IMD) on tubular cells apoptosis induced by renal ischemia/reperfusion (I/R) injury and its associated mechanism.Methods A total of twenty-four male Wistar rats were randomly divided into four groups (control group, I/R group, empty plasmid group and IMD group). One week after the removal of right kidney, ultrasound plasmid was used to transfect empty or IMD plasmid into the left kidney. Renal I/R model was made by clasping the left renal artery for 45 minutes. Tubular cell apoptosis was determined by TUNEL. Expression of Bax, Bcl-2, Fas was detected by semi-quantitative RT-PCR.Activity of caspase-8 and caspase-9 was evaluated with commercially available kits respectively.Protein level of caspase-3 was measured by Western blotting analysis. Results Compared with control group, apoptosis of tubular epithelial cells, expression of Bax and Fas, activities of caspase-8 and caspase-9, as well as protein level of caspase-3 were all significantly increased in I/R group (all P＜0.05). IMD pre-treatment significantly inhibited all these effects (all P＜0.05). There were no differences of above parameters between empty plasmid group and I/R group. Conclusion IMD pre-treatment protects against renal I/R injury by inhibion of tubular epithelial cell apoptosis.

Objective To characterize the internal structures of fluconazole-loaded cubic phase gels and establish a method for determination of fluconazole.Methods Glycerol monooleate( GMO) was used as the liquid crystal material to prepare the fluconazole loaded cubic phase gels.Polarizing light microscopy ( PLM ) and small-angle X-ray scattering ( SAXS) were used to confirm their internal structures and establish an HPLC method for determination of their content. Results Cubic phase gels were the dark field under PLM,SAXS showed that the blank cubic phase gels had two single peaks:q1(0.832 09 nm-1 ) and q2 (1.017 nm-1 ) while the fluconazole-loaded cubic phase gels had two single peaks:q1(0.818 88 nm-1)and q2(0.950 95 nm-1).Under the selected HPLC, the linearity within the range of 20-500 μg/ml was good.Conclusion PLM and SAXS are reliable for characterization of cubic phase gels.The HPLC method can be used in quality control and evaluation of this enema.

Objective To explore the lymphcyte subsets distribution in cerebrospinal fluid in patients with HIV infection ,and to investigate the clinical significance of the lymphocyte subsets in cerebrospinal fluid in HIV central nervous system complication . Methods 34 patients with HIV infection ,including 20 patients without nervous system symptoms (simple HIV group) and 14 pa‐tients with nervous system symptoms (neurological HIV group) ,and 15 cases of healthy people (control group) were selected . Flow cytometry was used to detect lymphocyte subsets ,and immunoturbidimetry was used to detect the level of IgG in cerebrospinal fluid .Results The percentage of CD8+ T cells was higher and percentage of CD4+ T cells was lower in the simple HIV group and neurological HIV group than those in the healthy control ,with statistically significant differences (P<0 .01) .The level of IgG in pa‐tients with HIV infection was higher than that in the healthy control group (P<0 .01) .While no significant difference were found in the percentage of B cells and NK cells among the there group (P>0 .05) .There were also no significant differece between the sim‐ple HIV group and neurological HIV group in the ratio of each lymphcyte subset in cerebrospinal fluid (P>0 .05) .Conclusion The immune disorder in cerebrospinal fluid in patients with HIV infection may appear in the early time before the nervous system com‐plication .The changing trends of lymphocyte subsets are consistent with the peripheral blood ,which demonstrate that the T lym‐phocyte subsets may be correlated with the nervous system symptoms of HIV .