Objective To evaluate the effect of postoperative patient controlled epidural analgesia (PCEA) on respiratory function in patients aged over 65 years Methods 41 ASA Ⅰ Ⅱ patients (male 22,female 19)aged between 65 80 years, weighing 58 78kg, scheduled for upper abdominal surgery were divided randomly into two groups: control group(n=20)and PCEA group(n=21) Epidural block was performed at T 8 9 with an epidural catheter inserted cranially for 4 cm A test dose of 1 5% lidocaine 4 5ml was given via epidural catheter When epidural blockade was confirmed, general anesthesia was induced with diazepam 0 2mg?kg -1 ,etomidate 0 3 mg?kg -1 ,fentanyl 4?g?kg -1 and vecuronium 0 1mg?kg -1 ,and maintained with epidural 0 5% bupivacaine infusion (6 7ml/2h) combined with inhalation of low concentration of isoflurane and intermittent iv boluses of fentanyl and vecuronium For postoperative analgesia in control group intramuscular pethidine was given on demand; In PCEA group PCEA was used A loading dose of 3ml of 0 15% bupivacaine mixture (morphine 10mg and haloperidol 5mg/0 15% bupivacaine 100ml) followed by continuous infusion of 0 5 1ml/h Superimposed by boluses of 2ml with a lock out time of 25min The maximal amount of bupivacaine mixture was 8ml/h VAS, Bruggman′s comfort scale and Rawsay′s sedation score were evaluated BP, HR, respiratory rate (RR) and SpO 2 were measured and recorded every 30min 4 h after operation Vital volume, Forced vital capacity, forced expiratory volume (first second:FEV 1 0 ),PEEP, MMEF were measured before operation and on 1st,3rd,5th and 7th postoperative days Blood gas analysis was checked before operation, during operation (30min and 90min after induction of anesthesia) and the 1st,3rd, 5th and 7th postoperative days Results The total amount of narcotic in 72h was 11 36mg (morphine equivalent dose) in control group and 5 4mg in PCEA group VAS was higher in control group than PCEA group The postoperative respiratory function was significantly better in PECA group Conclusions In elderly patient after upper abdominal operation PECA can greatly improve the respiratory function with better analgesia

Objective To investigate the relationship between the expressions of P16 and proliferating cell nuclear antigen(PCNA) in osteosarcoma and clinicopathological features,and explore the effects of them in occurrence and development of osteosarcoma.Methods The expressions of P16 and PCNA were detected by immunohistochemistry(SP) in 71 osteosarcima tissues and 10 normal bone tissues.Results ①The positive rate of P16 expression in osteosarcoma tissues was lower than that in normal bone tissues(P0.05).The expression of PCNA had positive relationship with osteosarcoma's prognosis(P0.05).③There was negative correlation between P16 and PCNA expressions(rs=-0.58,P

Objective To study the relieving cough effect ofPuji-Xuanfei-Xiaodu decoction on acute bronchitis.Methods 87 patients with acute bronchitis of exterior cold and interior heat were randomly divided into two groups(44 cases in a therapy group and 43 cases in a control group).Puji-Xuanfei-Xiaodu decoction was given to the patients in the therapy group and acute bronchitis syrup was given to the control group, to observe the influence on symptoms of cough, sputum, fever and headache. The course of treatment was 7 days. Results On the reliving cough aspect, 28 cases (63.6%) showed cure effect and 13 cases (29.5%) effctive, the total effective rate was 93.2% in therapy group with 44 cases; while in control group (43 cases), 15 cases (43.9%) showed cure effect and 23 cases (53.5%) effctive, the total effective rate was 88.4%. The symptoms of cough, phlegm, fever, headache and aversion to wind were significantly decreased in two groups. In therapy group, the numbers of cure effect, remarkable effect and efficacy were 22 (50%) ,11(25%) and 8 (18.2%) cases respectively, the total effective rate was 93.19% while the numbers of cure effect, remarkable effect and efficacy were 14 (32.6%) ,8(18.6%) and 12 (27.9%) cases respectively, the total effective rate was 79.07% in control group. The total effective ratio of two groups had significant difference (P>0.05).ConclusionsPuji-Xuanfei-Xiaodu decoction is effective in relieving cough.

Objective:To explore the effects of eight-week group positive psychotherapy intervention on de-pression associated self-efficacy and subjective well-being in female nursing students.Methods:Totally 74 female nursing students with mild to moderate depression [the score of Beck Depression Inventory (BDI-Ⅱ)was 14 to 28]were selected from three nursing colleges of Changsha.They were randomly divided into two groups,40 in the control group and 34 in the intervention group.Samples in the intervention group were given the eight-week group positive psychotherapy,while the control group was given nothing (the control group could receive the intervention when the intervention was proved to be effective or the control group needed treatments).The General Self-efficacy Scale(GSES)and Index of Well-being(IWB)were used to get the outcome of female nursing students'self-effica-cy,subjective well-being at baseline,the time after the intervention,3 month follow-up,6 month follow-up.Results:The interactive effect between group and time of self-efficacy,subjective well-being were statistically significant (Ps<0.05).Separate analyses showed that at baseline,there was no significant difference between two groups in all variables (Ps >0.05).At the end of the intervention,3 month follow-up and 6 month follow-up,the GSES score and IWB score in the intervention group were higher than those in the control group (Ps <0.05).Conclusion:Eight-week group positive psychotherapy could improve self-efficacy and subjective well-being of female nursing students who have mild to moderate depressive symptom.This intervention also has a long-term effect.

Objective:To assess the relationship between the characteristic of drug resistance in Acinetobacter baumannii and the syndrome of traditional Chinese medicine(TCM) in intensive care unit(ICU).Methods:Sixty-six strains of Acinetobacter baumannii were isolated from sputum specimens of patients in our ICU from March 2005 to February 2006.The data of the drug sensitivity test in vitro was analyzed.The relation between the syndrome of TCM and drug resistance in Acinetobacter baumannii was probed.Results:The 66 strains of Acinetobacter baumannii were drug resistant to multiple kinds of anti-bacterial drugs(sensitivity rate

Objective: To assess the impact of viable myocardium in left ventricular aneurysm (LVA) and ventricular arrhythmia on prognosis of LVA patients.
Methods: A total of one hundred and sixty LVA patients who received99Tcm-MIBI SPECT and18F-FDG PET were enrolled, including 139 male and 21 female with the mean age of (58 ± 10) years.There were 42 (26.3%) patients combining ventricular arrhythmia. LVEDV, LVESV and LVEF were detected. Semi-quantitative analysis of myocardium perfusion imaging was conducted, viable myocardium in aneurysm was deifned as the perfusion-metabolism mismatch score (MMS) ≥ 2.0. According to myocardium viability, the patients were divided into 2 groups: No viability group,n=97 and With viability group,n=63;based on ventricular arrhythmia, the patients were divided into another 4 groups: Group①, viability-, ventricular arrhythmia-, n=68, Group②, viability-, ventricular arrhythmias+,n=29, Group③, viability+, ventricular arrhythmias-,n=50 and Group④, viability+,ventricular arrhythmias+,n=13. The average follow-up time was (50 ± 7) months, the end point was cardiac death. The survival curve was obtained by Kaplan-Meier method and survival rates were compared by Log-rank analysis.
Results: The mean LVEF in 160 patients was (34 ± 11) %, cardiac death occurred in 19 (11.9%) patients. Long-term survival rates in Groups①,② and③ were 94.1%, 89.7% and 86.0%, respectively,P>0.05; while in Group④, the survival rate was 61.5%, which was lower than the other 3 groups,P=0.004. Multivariate Cox regression analysis showed that female (HR=5.101, 95% CI 1.853-14.044, P=0.002), GPET-ESV (HR=1.009, 95% CI 1.002-1.015,P=0.013), interaction between MMS and ventricular arrhythmia (HR=1.368, 95%CI 1.113-1.681,P=0.003) were independent risk factors for cardiac death;while surgical treatment (HR=0.199, 95% CI 0.054-0.742,P=0.016) could decrease the risk of cardiac death.
Conclusion: Patients with viable aneurysm and ventricular arrhythmia had poor long-term prognosis; while early and active treatment is needed for them (surgery with anti-arrhythmic therapy).

Objective:To explore the application effect of failure mode and effect analysis (FMEA) on reducing the unplanned extubation rates in patients with neurosurgical catheterization.Methods:FMEA theory was used to analyze the causes of unplanned extubation in neurosurgical patients with catheterization. The Risk Priority Number (RPN) was calculated and the failure modes with higher RPN were selected. The causes were analyzed, and the improvement measures were formulated to optimize the nursing plan. A total of 585 patients admitted to the Department of Neurosurgery of the Sixth Medical Center of PLA General Hospital from January 2018 to December 2019 were recruited as the FMEA group, the 631 patients admitted before FMEA application, from January 2016 to December 2017, were recruited as the control group. The control group was given routine nursing of Neurosurgery pipeline, and the FMEA group was given FMEA intervention on this basis. The difference of unplanned extubation rate between the two groups was compared.Results:The total incidence of unplanned extubation in FMEA group was 1.48% (21/1 417) , which was lower than 5.11% (72/1 408) in control group, with statistical significance ( P<0.001) . The unplanned extubation rates of gastric tube, urinary tube and operation related drainage tube in FMEA group were lower than in control group, and the differences were statistically significant ( P<0.05) . There was no significant difference in the incidence of unplanned extubation of endotracheal intubation and deep vein catheterization between the two groups ( P>0.05) . Conclusions:The FMEA model can be effective in reducing the rate of unplanned extubation for patients in neurosurgery, which is worthy of clinical application.

ObjectiveTo explore the dose-effect relationship and safety of high， medium， and low doses of raw Astragali Radix in the modified Huangqi Chifengtang （MHCD） for treating proteinuria in immunoglobulin A （IgA） nephropathy， and to provide scientific evidence for the clinical use of high-dose Astragali Radix in the treatment of proteinuria in IgA nephropathy. MethodsA total of 120 patients with IgA nephropathy， diagnosed with Qi deficiency and blood stasis combined with wind pathogen and heat toxicity， were randomly divided into a control group and three treatment groups. The control group received telmisartan combined with a Chinese medicine placebo， while the treatment groups were given telmisartan combined with MHCD containing different doses of raw Astragali Radix （60， 30， 15 g）. Each group contained 30 patients， and the treatment period was 12 weeks. Changes in 24-hour urinary protein （24 hUTP）， traditional Chinese medicine （TCM） syndrome scores， effective rate， and renal function were observed before and after treatment. Safety was assessed by monitoring liver function and blood routine. ResultsAfter 12 weeks of treatment， 24 hUTP significantly decreased in the high， medium， and low-dose groups， as well as the control group （P<0.05， P<0.01）. The TCM syndrome scores in the high， medium， and low-dose groups also significantly decreased （P<0.01）. Comparisons between groups showed that the 24 hUTP in the high-dose group was significantly lower than in the medium， low-dose， and control groups （P<0.05， P<0.01）， and the 24 hUTP in the medium-dose group was significantly lower than in the control group （P<0.05）. The TCM syndrome scores in the high and medium-dose groups were significantly lower than in the low-dose and control groups （P<0.05， P<0.01）. The total effective rates for proteinuria in the high， medium， low-dose， and control groups were 92.59% （25/27）， 85.19% （23/27）， 60.71% （17/28）， and 57.14% （16/28）， respectively. The effective rates in the high and medium-dose groups were significantly higher than in the low-dose and control groups （χ²=13.185， P<0.05， P<0.01）. The effective rates for TCM syndrome scores in the high， medium， low-dose， and control groups were 88.89% （24/27）， 81.48% （22/27）， 71.43% （20/28）， and 46.43% （13/28）， respectively. The efficacy of TCM syndrome scores in the high and medium-dose groups was significantly higher than in the control group （χ²=14.053， P<0.01）. Compared with pre-treatment values， there was no statistically significant difference in eGFR and serum creatinine in the high and medium-dose groups. However， eGFR significantly decreased in the low-dose and control groups after treatment （P<0.05）， and serum creatinine levels increased significantly in the control group （P<0.05）. No statistically significant differences were observed in urea nitrogen， uric acid， albumin， total cholesterol， triglycerides， liver function， and blood routine before and after treatment in any group. ConclusionThere is a dose-effect relationship in the treatment of IgA nephropathy with high， medium， and low doses of raw Astragali Radix in MHCD. The high-dose group exhibited the best therapeutic effect and good safety profile.