Objective To explore the correlative factors of hypotension among hemodialysis patients and to come up with nursing interventions.Methods The histories of 49 maintenance hemodialysis patients were retrospectively reviewed to find out the correlative factors of hypotension and summarize the nursing strategies.Results The major factors for hypotension included large volume of dehydration and fast speed of dehydration in 22 cases,malnutrition and hypoproteinemia in 8 cases,severe anemia in 6 cases,dysfunction of the autonomic nervous system in 5 cases,low concentration of sodium or high temperature of dialysate in 4 case and medication errors and eating too much before or during dialysis in 4 cases.Conclusion The nursing strategies including control of weight,correct assessment of dry weight,right performance of low temperature hemodialysis and sodiun profile hemodialysis as well as mental care to those with depression are critical for prevention of hypotension development in patients undergoing maintenance hemodialysis.

Objective:To study the functional status of the monocytes-derived dendritic cells (DCs) plused with HBsAg from patients with chronic hepatitis B and their capacity of inducing the HBV- special cytotoxic T lymphocytes (CTLs),and explore a new method of inducing the special anti-HBV cell-mediated immunity.Methods:Monocytes of patients were isolated from peripheral blood and incubated with GM-CSF+IL-4+TNF-? to induce DCs generation. Those DCs were pulsed with HBsAg to induce HBV- special DCs. The phenotype of DCs including CD1a,CD80,CD83,CD86,CD40 and HLA-DR was characterized by FCM and the stimulating reaction of allogenic T lymphocytes was detected by MTT assay. The concentration of cytokines such as IL-12 and IL-6 in supernate was tested by ELISA and the cytotoxicity of CTLs inducing by the DCs against HepG2 2.2.15 cells,HepG2 cells and K562 cells were detected by LDH assay.Results:The expression of CD1a, CD80, CD83,CD86, CD40, HLA-DR molecules on the DCs pulsed with HBsAg was higher than those of the control group (P

Objective:To study the radiotherapy sensitization of recombinant human endostatin in patients with cervical cancer.Methods:Sixty patients with advanced cervical cancer (stage ⅡB to ⅣA) from July 2017 to November 2018 in the Second Affiliated Hospital of Dalian Medical University were selected. The patients were divided into experimental group and control group according to random number table with 30 cases each. The patients in experimental group were treated with recombinant human endostatin combined with concurrent chemoradiotherapy, while the patients in control group only received chemoradiotherapy. The serum levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) were measured 1 week before treatment and 1 week after treatment, and short-term efficacy was evaluated 3 months after treatment.Results:The objective remission rate (ORR) and disease control rate (DCR) in experimental group were higher than those in control group: 93% (28/30) vs. 87% (26/30) and 97% (29/30) vs. 93% (28/30), but there were no statistical differences between 2 groups ( P>0.05). There was no statistically significant difference in the occurrence of adverse reactions between 2 groups ( P>0.05). Compared with that before treatment, the serum VEGF and bFGF after treatment were significantly lower, experimental group: (88.07 ± 37.53) ng/L vs. (227.27 ± 142.61) ng/L and (21.03 ± 5.75) ng/L vs. (38.34 ± 18.17) ng/L, control: (120.04 ± 81.22) ng/L vs. (197.34 ± 142.41) ng/L and (24.04 ± 7.29) ng/L vs. (39.78 ± 13.35) ng/L, and there were statistical differences ( P<0.01); after treatment, the serum VEGF and bFGF in experimental group were lower than those in control group, but there were no statistical difference between 2 groups ( P>0.05). Conclusions:For patients with advanced cervical cancer, recombinant human endostatin combined with concurrent chemoradiotherapy can further decrease the serum levels of VEGF and bFGF, improve the sensitivity of chemoradiotherapy, and enhance the short-term efficacy.

Objective To determine the test-retest reliability of functional squat system (FSS) isometric muscle strength tests for patients with knee osteoarthritis. Methods The isometric muscle strength of thirty patientswith knee osteoarthritis (21 males and 9 females; age 45 to 89 years, mean age 68.73 ± 12.19 years) was tested twice within 1 week by the same tester. Three test results were obtained: maximum isometric extension strength, the time to initiate isometric extension and the average isometric extension strength. Intra-class correlation coefficients (ICCs) for the three tests were computed to evaluate their retest reliability. Results The ICCs of the maximum isometric extension strength and average isometric extension strength of the uninvolved and involved extremities were respectively 0.87, 0.88, 0.92 and 0.89. The ICCs of the initiation time for the uninvolved and involved legs were respectively 0.25 and 0.41. Conclusion In these tests of patients with knee osteoarthritis using the functional squat system, both the maximum isometric extension strength and the average isometric extension strength had very good test-retest reliability. These two test results could be used as reliable guidance for treatment and rehabilitation of osteoarthritic knees.

Objective To study the value and feasibility of temporary emergency bedside cardiac pacing. Method Two hundred patients with severe witnessed bradycardia were treated with temporary emergency cardiac pacing. We treated 130 patients with emergency bedside pacing and 70 patients with x-ray-guided pacing. Results Emergency bedside pacing was successful in 127 patients except three patients and no postoperative complications occurred. X-ray-guided pacing was successful in all 70 patients but three patients experienced complications: one deep venous thrombosis and two cardiac tamponades due to myocardial perforation. The pacing electrodes were more likely to be displaced in X-ray-guided pacing than in emergency bedside pacing (six cases versus three cases) . The door-to-operation time was 30-90 min for x-ray-guided cardiac pacing and 5-15 min for emergency bedside pacing. Needle-to-pacing times were similar for both procedures (3.5 ± 1.5 min for x-ray guided pacing versus 4± 2.5 min for bedside pacing). Conclusions Temporary emergency bedside cardiac pacing is a rapid, efficient and safe procedure for treating severe witnessed bradycardia. The technique is easily mastered and may prove lifesaving in an emergency.

Objective To study the effect of multiple IPL treatment on cell senescence markers of skin fibroblasts using UVA as a control and to make clear whether the multiple IPL treatment may result in cell senescence.Methods Cells were divided into three groups: one group without irradiation as a control,one group receiving IPL treatment with 15 J per cm2,and the last group receiving UVA irradiation with 9 J per cm2.IPL and UVA irradiation were performed once a day during five days.On the sixth day,the cells were collected.Senescence-associated β-galactosidase (SA-β-Gal) staining,cell cycle,reactive oxygen species (ROS) and telomere length were determined.Results Our results showed that five consecutive days of IPL irradiation had no effect on the activity of SA-β-Gal and telomere length and decreased the G1 ％ of cell cycle and the level of ROS in comparison with the control group (P＜0.05).On the contrary,five consecutive days of UVA irradiation increased the activity of SA β Gal and the level of ROS,shortened the length of telomere and no obvious change in the G1 ％ of cell cycle in comparison with the control group.Conclusions Multiple UVA irradiations induce cell senescence.On the contrary,multiple IPL treatments could not induce cell senescence.

Objective To investigate the role of activated cylic AMP(cAMP) signaling in chemical-induced podocyte injury.Methods Eight-weeks-old male BalB/C mice were randomly divided into three groups:control group,Adriamycin (ADR) group and Forskolin+ADR group.ADR nephropathy models were established by tail intravenous injection,and part of them were injected Forskolin,an agonist of adenylate cyclase,intraperitoneally.Phosphorylation of cAMP response element binding protein (CREB) was detected by laser confocal microscopy,morphology of foot processes were determined with transmission electron microscope,and WT-1 expression in glomeruli were detected by immunohistochemistry.Conditionally immortalized podocytes were treated with puromycin aminonucleoside (PAN),Exchange protein directly activated by cAMP (Epac) agonist 8-pCPT-2-O-Me-cAMP (2Me),protein kinase A (PKA) antagonist H89 and its agonist pCPT-cAMP(pCPT).Western blot was used to detect the expression levels of Epac,caspase3 and cleaved caspase3.PKA activity was assayed using cAMP-dependent protein kinase detection system.Cell viability was determined by a cell count kit and podocyte apoptosis was estimated by TUNEL staining.Mitochondrial membrane potential was evaluated by JC-1 staining.Results (1)Compared with ADR group,the urine albumin decreased significantly (P ＜ 0.05) among Forskolin + ADR group and the WT-1 positive cells per glomerulus increased obviously (P ＜ 0.05).(2)PAN decreased podocyte number in a time-dependent manner (P ＜ 0.05),pre-treatment with pCPT obviously inhibited PAN induced podocyte decrease (P ＜0.05),but H89 prevented the effect of pCPT in a dose-dependent manner (P ＜ 0.05).(3)JC-1 staining showed that the percentage of podocyte with green fluorescence for control,PAN and pCPT+PAN group were (12.67±2.15)％,(31.35±4.60)％ and (16.96 ± 2.51)％ respectively (P ＜ 0.05),and pretreatment with H89 inhibited the effect of pCPT (P ＜ 0.05).(4) PAN promoted podocyte apoptosis and cleaved caspase3 expression (P ＜ 0.05),and pretreatment with pCPT significantly prevented PAN-induced podocyte apoptosis and cleaved caspase3 expression (P ＜ 0.05).Conclusions cAMP signaling activation ameliorated podocyte injury in ADR nice and PAN-induced podocyte apoptosis,and cAMP/ PKA pathway may mediate these processes.

Objective By analyzing the epidemiological characteristics and trends of brucellosis in Ji'nan City,to provide a scientific basis for further prevention and control of the disease.Methods Serum samples of suspected brucellosis patients were collected from every county (city,district) of Ji'nan City from 2008 to 2014,and these samples were screened by Rose-bengal plate agglutination test (RBPT).Then positive samples were confirmed by Standard tube agglutination test (SAT),and experimental data and results were analyzed by statistics.Results Totally 2713 serum samples of suspected brucellosis patients were tested,and 200 were positive by SAT.Temporal distribution:the serum antibody positive specimens were detected each month throughout the year,and the results showed clear seasonal prevalence by concentrating from March to September (82.07％,151/184).Population distribution:the serum antibody positive rate of males was higher than that of females,the ratio was 2.08:1.00,and the cases were found among 15 to 75 years old,while concentrated from 30 to 65 (67.00％,134/200).Spatial distribution:except Huaiyin District,positive samples were detected in all other 10 counties (cities,districts) of Ji'nan City,most of them (92.5％,185/200) in Shanghe,Zhangqiu,Changqing,Shizhong and Licheng counties (cities,districts).Conclusions Brucellosis epidemic in Ji'nan is serious,and cases have occurred mostly in spring,summer and autumn.It is recommended that health propaganda and education should be strengthened in order to enhance selfprotection awareness of the exposed population,and then improve the physical examination for early discovery,early reporting and early treatment.At the same time,it is important to cooperate with the Department of Livestock to prevent and control brucellosis.

Objective To investigate association between postural changes of blood pressure and carotid atherosclerosis in the elderly.Methods Standardized questionnaires,physical examination and biochemical blood tests were performed to acquire clinical characteristics of the participants.Presences of carotid plaques were identified by carotid ultrasound examination.Orthostatic hypotension (OH) and orthostatic hypertension (OHT) were defined according to the international consensus.Multivariable logistic regression analysis was performed to analyze the associations of carotid plaques with OH and OHT.Results 377 old people were finally included,of which 101 had OH and 33 had OHT.After full adjustment for possible confounders,old people with carotid plaques had significantly increased risk for OH as compared with those without carotid plaques (OR=2.27,95％ CI:1.32-3.90,P=0.003).Participants with bilateral carotid plaques were associated with significantly increased risk for OH (OR=3.45,95％CI:1.74 6.84,P=0.001),while the association between unilateral carotid plaques and OH was not significant (OR=1.71,95％ CI:0.88-3.32,P=0.112).No significant association was identified between carotid plaques (bilateral or unilateral) and OHT.Conclusions Presence of carotid plaques,particularly bilateral plaques,may be an independent risk factor for OH.

Objective To investigate the effectiveness and safety of applying compound lidocaine cream on tracheal mucosa as topical anesthesia to reduce the stress reaction during extubation of tracheal tube. Methods Sixty patients (aged 18-65yr,body weight 40-80kg,ASA Ⅰ-Ⅱ) scheduled for elective surgery under general anesthesia were selected,and they were randomly divided into compound lidocaine cream group (group L,n=30) and control group (group C,n=30). Orotracheal intubation was performed in all the patients. Compound lidocaine cream was uniformly smeared on the foremost third of endotracheal tubes before intubation in group L,and no drug was coated on endotracheal tubes in group C. The changes in blood pressure and heart rates during extubation,the use of hypotensive drugs,cough reflex,breath holding,sore throat and pharyngeal discomfort after extubation were compared between the two groups. Results The operation and intubation time of the two groups showed no significant difference. The blood pressure and heart rate during extubation,the rate of using hypotensive drugs,and the incidence of cough reflex and breath holding were lower in group L than in group C,while the foreign body sensation in pharynx were after extubation was more frequent in group L than in group C. The incidence of pharyngodynia was similar in the two groups,and the pharyngodynia and foreign body sensation in pharynx markedly improved one day after operation in both groups. Conclusion Topical anesthesia of tracheal mucosa using compound lidocaine cream may reduce the cough reflex and breath holding during extubation,and inhibit the stress reaction.