Objective: To compare the efficiencies of cisatracurium and rocuronium during tracheal intubation for general anesthesia. Methods: Sixty ASA I-II patients undergoing elective surgery were randomly divided into 3 groups in which patients received a single bolus of rocuronium 0.6 mg/kg (A group, n = 20), cisatracurium 0.1 mg/kg (B group, n = 20), or 0.15 mg/kg (C group, n = 20). Anesthesia was induced with midazolam, etomidate, and fentanyl. Neuromuscular function was assessed using accelerography with TOF. First twitch (T 1) was used as the study parameter. Patients received a rapid bolus administration of study drugs within 10 seconds after T1 became stable at 100%; meanwhile, mask oxygen inhalation was offered for 2 min and then intubation was carried out. The systolic pressure, diastolic pressure, and heart rate were recorded at baseline level, before and 1,2,3,4,5,10, and 15 min after intubation. The intubation conditions were assessed. Whether intubation could be carried out successfully or not and T1 25% recovery time after the initial bolus were also recorded. The adverse effects and respiratory complication during operation and after operation were observed. Results: The hemodynamic changes within 15 min after intubation were not significantly different compared with those before induction in 3 groups (P>0.05). Maximal neuromuscular block rates in group A,B, and C were (99.4±2.7)%, (99.1±1.9)%, and (99.9±0.3)%, respectively, with no significant differences found between the three groups (P>0.05); the onset time periods of the 3 groups were (1.9±1.1) min, (3.6±2.1) min, and (3.3±1.5) min, respectively, with that of group A significantly shorter than those of B and C groups (P<0.05); the time periods of clinical effects were (35.7±11.6) min, (35.2±13.0) min, and (50.9±15.1) min, respectively, with that of group A significantly shorter than that of group C (P<0.05) and with no significant difference found between group A and group B (P>0.05). The glottis exposure degree in group A was significantly better than that of B and C groups (P<0.05). The successful rates of initial intubation were similar between the three groups (P>0.05). Conclusion: Rocuronium is superior to cisatracurium in induction intubating for general anesthesia in terms of clinical effect time and glottis exposure degree, and it can provide better intubating conditions.

Objective To investigate drug adverse reactions caused by Qingkailing injection,in order to provide a reference for clinical drug rational use.Method 2003-2008 Qingkailing Injection Case reports of adverse reactions collected from the Guizhou Province Monitoring Center Database was analysed descriptively.Result The occurrence of Qingkailing injection adverse reactions was not correlated to gender.The clinical manifestation was mainly for allergic reactions(305 cases,accounting for 35.59%)and systemic damage(417 cases,accounting for 48.66%).There were 652 cases adverse reactions occurred in 30min accounting for 76.08%.Conclusion Clinical physicians,pharmacists should attach importance to Qingkailing injection adverse reactions,persist in rational drug use and focus on the observation,after druguse.

Objective To evaluate the appropriateness of hospitalization days at a tertiary hospital in 2014 by means of the Appropriateness Evaluation Protocol ( AEP ) , and to analyze the causes of inappropriate stays. Methods Medical records of inpatients admitted at a tertiary hospital in 2014 were randomly selected. AEP( US version) was used to evaluate the appropriateness of every hospitalization day, while the causes of inappropriate hospitalization day were also analyzed. Results A total of 1 641 days of stay from 148 medical records were reviewed, and 129 days of stay (7. 9%) were seen as inappropriate. Two major factors for inappropriate stays were waiting for surgery and waiting for test, roughly 89. 1% of the inappropriate hospitalization days. The proportion of inappropriate hospital stays reduced to 4. 8% after adjustment of two-day weekend. Inappropriate hospital stays mostly appeared during the second day to the eighth day after admission(93. 8%). Logistic analysis results showed that with concomitant symptoms, preoperative waiting days > 5 days, high level surgery, non-emergency admission were significantly associated with appropriateness of hospital stays (P<0. 05). Conclusions The rate of inappropriate stays will be reduced and the quality of medical services will be improved if comprehensive measures could be carried out according to the causes of inappropriate stays.

Objective To investigate the influence of CO_2 pneumoperitoneum on intestinal mucosa permeability in rats with liver cirrhosis.Methods Fifty rats were randomly divided into following groups: control group(n=5),cirrhosis group(n=5) and pneumoperitoneum group(n=40);the pneumoperitoneum group was further divided into 8 mm Hg group(n=20) and 13 mm Hg group(n=20).Four time points were chosen,including 0.5,2,6,and 12 hours after the end of pneumoperitoneum.After rat models with cirrhosis were established successfully,the abdominal cavity was insufflated with CO_2 and maintained under the pressures of 8 mm Hg and 13 mm Hg respectively for two hours.The portal venous blood was collected and the levels of D-lactic acid and endotoxin were measured.Results The levels of endotoxin and D-lactic acid in cirrhosis group were much higher than those of control group(P0.05).Conclusion The intestinal mucosa permeability is increased in rats with liver cirrhosis.It can be further increased under CO_2 pneumoperitoneum with certain pressure and time and in a pressure-dependent manner.The permeability can decrease after removal of pneumoperitoneum.

Objective To develop a recognition method of liver steatosis degree on type-B ultrasonic images based on multi-fractal spectrum texture analysis method and pattern recognition. Methods Features of singularity strength width and multi-spectrum area were extracted from the curve of multi-fractal spectrum of each liver ultrasonic images. These two features and the feature of mean intensity ratio comprised a three-dimensional feature vector, which would be classified by BP neural network. Results The classification accuracy was 96.00% for normal liver, 80.00% for mild fatty liver, 88.00% for moderate fatty liver and 92.00% for severe fatty liver. Conclusion Feature vector combined with BP neural network can identify the steatosis degree of liver on the ultrasonic images and can be used as an assistant diagnostic method.

Objective To explore initial application of network in remote consultation system in the manage-ment of obstetrics in primary hospital.Methods Data were collected in questionnaire survey,a total of 54 hospitals in Jiangsu province were involved.The situation of remote consultation and perceive of pregnant and puerpera in primary hospital were investigated to establish an independent cyber in remote consultation system.Results The demand for remote consultation at all levels of hospital was huge(79.63%),there was no significant difference (P >0.05).Third class hospital has been widely carried out the remote medical consultation service,about 85.37% of the level II hospi-tals had not yet been carried out,which did not have the conditions accounted for 68.29%,the difference was statisti-cally significant(P <0.01).There was a significant difference between the demand and the approval degree of the pri-mary hospital in the remote consultation(P <0.01),high school or above,technical staff and urban pregnant women needed the most pressing,high degree of recognition.Conclusion The primary hospital medical personnel profession-al quality was the important factor that affected the use of remote consultation.The corresponding point,independent network creation and combined with face to face diagnosis were needed in the performance of remote consultation.Suc-cessful opening of the remote consultation system,improved the quality of the diagnosis and treatment,promoted the academic exchange between regions.It was conducive to the management of the high -risk pregnancy and should be actively promoted and applied.

Objective To investigate the influence of thymosin beta 4 (Tβ4) with two different dosages on the expression of transforming growth factor beta (TGF-β) and connective tissue growth factor (CTGF) in rats with renal tubular interstitial fibrosis,and to further estimate the changes of renal tubular interstitial lesions.Methods Rat models of renal tubular interstitial fibrosis were established by unilateral ureteral occlusion (UUO).The male SD rats were randomly divided into 4 groups and 15 rats in each group:sham group,model group,treatment group with 1 mg/L Tβ4 and treatment group with 5 mg/L T34.Rats in sham group and model group were poured into the same amount of saline.The renal function and renal pathological changes were observed after the second week.The mRNA and protein expression of TGF-β and CTGF in renal tissues was tested by in-situ hybridization and Western blotting.Results Compared with that in sham group,the expression of TGF-β mRNA and its protein,CTGF mRNA and its protein was significantly higher in model group (all P ＜ 0.01).Compared with rats of model group,Tβ4 treatment rats had lower mRNA and protein expression of TGF-β and CTGF (all P ＜ 0.01),and the expression in treatment group with 5 mg/L Tβ4 was lower than that in treatment group with 1 mg/L Tβ4 (P ＜ 0.05).And the expression of TGF-β mRNA was positively correlated with CTGF mRNA expression (r=0.697,P ＜ 0.01).The 24 h total urinary protein and the area of renal tubular interstitial lesion in model group were significantly more than those in sham group,and also more than those in Tβ4 treatment group (all P ＜ 0.05).Tβ4 treatment attenuated kidney damage,and the effects in treatment group with 5 mg/L Tβ4 were better than those in treatment group with 1 mg/L Tβ4.No difference in serum creatinine and blood urea nitrogen was observed among 4 groups (all P ＞ 0.05).Conclusions Tβ4 treatment can inhibit the renal TGF-β and CTGF expression of rats with tubular interstitial fibrosis in a dose-dependent manner,and play a protective role in kidney.

Objective To investigate the number and activities changes of peripheral blood endothelial progenitor cells (EPCs) in continuous ambulatory peritoneal dialysis (CAPD) patients,and explore the connection between EPCs' number and the levels of advanced glycosylation end products (AGEs),homocysteine (Hcy) and C-reactive protein (CRP).Methods Twenty-five CAPD patients and thirty healthy volunteers were involved.Total mononuclear cells (MNCs) were isolated from peripheral blood of patients.EPCs were characterized as adherent cells by double staining of FITCUEA-1 and DiL-AcLDL binding,and were further demonstrated by positive cells of CD34,CD133 and KDR using flow cytometry.The abilities of cell proliferation,adhesion and migration were further observed by fluorescent microscope.The correlations between the CEPCs' number and the levels of AGEs,Hcy and CRP were analyzed.Results The number and activities including migration and adhesion of EPCs in CAPD group were significantly lower than control group (P ＜ 0.05).The levels of serum AGEs,Hey and CRP in CAPD patients were increased (all P＜0.05) and had negative correlation with EPCs' number.Conclusions The number and activities of EPCs decrease in patients with CAPD,and EPCs' number is negatively correlated to the levels of AGEs,Hcy and CRP.

ObjectiveThe purpose of this study was to assess the efficacy,safety and optimal dose of tacrolimus monotherapy in patients with refractory lupus nephritis(LN) who were resistant to cyclophosphamide(CYC).MethodsA total of 14 LN patients (2 men and 12 women) with persistent proteinuria who were resistant to CYC treatment more than 8 g for half a year were enrolled.Tacrolimus was initiated at 2 mg/d (patient weight＜60 kg) or 3 mg/d(patient weight≥60 kg) which was administered in two divided doses.Prospective data on daily proteinuria,serum album level and serologic lupus activity were collected and followed for 6 months.ANOVA and Pearson correlation analysis were used for statistical analysis.Results Mean age at baseline was(30±9) years.Mean urinary protein decreased significantly from(6.2±5.1) g at baseline to (1.1±0.9) g at 6 months (F=16.21,P＜0.01).Mean serum album level increased significantly from (27.9±9.7) g/L at baseline to(37.8±2.2) g/L at 6 months(F=16.71,P＜0.01 ).Complete or partial response was observed in 86％ of patients receiving tacrolimus therapy.The effective dosage in this study was 0.03-0.06mg·kg-1·d-1 of the patients who had complete response or partial response to tacrolimus.The tacrolimus level in partially and completely responding patients was less than 3 ng/ml.There was no significant difference among blood tacrolimus levels of complete,partial,and no response patients [(1.6-±0.4),(2.0±0.6) and (22±1.1) ng/nl],respectively).No definite correlation was found between efficacy and tacrolimus level.Tacrolimus was well tolerated at current dose,besides one with new onset hypertension and one with alopecia.ConclusionOur results suggest that tacrolimus at low dosage and serum level is potentially effective and safe for the treatment　of patients with LN and persistent proteinuria resistant to CYC.The optimal dosage of tacrolimus for LN may　be 0.03-0.06 mg·kg-1·d-1.