Objective:To prepare flupirtine maleate dry suspension and establish its quality control method. Methods: The dry suspension was prepared by a powder direct mixing method. With the sedimentation and redispersibility as the indices,the suspending effect of the hydrophilic polymers HPMC and CMC-Na was investigated. The optimal formula was obtained. The viscosity was deter-mined by a rotary viscometer. An HPLC fluorescence method was used to determine the content of main component. Results:The sedi-mentation ratio of flupirtine maleate dry suspension was 1 in 3h with good redispersibility and liquidity. The cumulative dissolution in 30min was above 80%. Conclusion:The quality of the prepared flupirtine maleate dry suspension is stable and controllable, and the production process is feasible, which provides basis for the research and development of new preparation of flupirtine maleate.

Objective To investigate the effect of dexmedetomidine on renal function in the patients undergoing cardiac valve replacement under cardiopulmonary bypass.Methods Fifty patients with rheumatic heart disease were randomly divided into the dexmedetomidine group (group D,n=25) and control group (group C,n=25).Arterial blood samples were collected before operation (T0),at postoperative 24 h (T1),48 h (T2),72 h (T3) and 96 h (T4) respectively.Serum Crea,blood urea nitrogen,cystatin C(Cys-C) and glomerular filtration rate(GFR) were detected by the Hitachi7600 automatic biochemical analyzer.Results Compared with T0,the levels of BUN and Cys-C at postoperative various time points were significant increased,while GFR was decreased,the differences were statistically significant (P<0.05).The levels of BUN and Cys-C started to gradually decrease and GFR started to increase from T2,the difference compared with that at T0 was statistically significant(P<0.05).But the levels of various indicators at T4 did not recovered to those before operation;compared with T0,serum Crea level had no statistical difference among postoperative various time points(P>0.05).Serum Crea level at T2-T4 in the group D was significantly lower than that at T0,the difference was statistically significant (P<0.05).There was no statistically significant difference in Crea,BUN,Cys-C and GFR between the two groups(P>0.05).Conclusion Dexmedetomidine can promote the recovery of postoperative renal function in the patients with cardiac valve replacement under cardiopulmonary bypass and has a certain protective effect on kidney.

Objective To evaluate the effects of dexmedetomidine on the expression of Toll-like receptor 2 (TLR2) and TLR4 in monocytes of blood during the perioperative period in the patients undergoing pulmonary lobectomy.Methods Fifty patients of both sexes, aged 40-64 yr, with body mass index of 20-24 kg/m2 , of ASA physical status Ⅰ or Ⅱ , scheduled for elective pulmonary lobectomy under general anesthesia, were randomized into 2 groups (n =25 each) using a random number table: control group (group C) and dexmedetomidine group (group D).In group D, dexmedetomidine was infused intravenously at dose of 1.0 μg/kg over 10 min before induction of anesthesia, followed by continuous infusion at a rate of 0.3 μg · kg-1 · h-1 until 30 min before the end of operation, while the equal volume of normal saline was given in group C.After admission to the operating room, at 1.5 h after beginning of operation, at the end of operation, and at 12 and 24 h after operation, blood samples were taken for blood gas analysis, and for determination of the expression of TLR2 and TLR4 in monocytes.Oxygenation index was calculated.The consumption of propofol and remifentanil and pulmonary complications within 48 h after operation were recorded.Results Compared with group C, the expression of TLR2 and TLR4 in monocytes of venous blood was significantly down-regulated, oxygenation index was increased, and the incidence of pulmonary complications after operation was decreased in group D (P＜0.05).Conclusion The mechanism by which dexmedetomidine attenuates acute lung injury is associated with down-regulation of TLR2 and TLR4 expression in monocytes of blood in the patients undergoing pulmonary lobectomy.

BACKGROUND:Acel ular tracheal matrix is similar to the native trachea with structure and biological performance preserved after decel ularization, and it is an important aim in tissue engineering to find an effective method of decel ularization.
OBJECTIVE:To select the optimal decel ularization method through comparing chemical extraction method with detergent-enzymatic method for preparing rabbit tissue engineering trachea matrix.
METHODS:Thirty tracheas from New Zealand white rabbits were randomly divide into three groups. Twenty of rabbit tracheas were subjected to decel ularization using 2%TritonX-100 combined with deoxyribonuclease I and ribonuclease (chemical extraction method group), and sodium deoxycholate combined with deoxyribonuclease I (detergent-enzymatic group), respectively. The other ten were given no intervention as controls. Samples were col ected and observed by hematoxylin-eosin staining, Masson-trichrome staining, safranin O staining, DAPI staining and scanning electronic microscope.
RESULTS AND CONCLUSION:Hematoxylin-eosin staining demonstrated that compared with the control group, almost al cel ular components of the mucosal epithelium were removed in the detergent-enzymatic and chemical extraction groups, and there were few remnant chondrocytes. Masson-trichrome staining indicated that compared with the control group, components of the mucosal layer chondrocytes in the chemical extraction and detergent-enzymatic groups were completely removed, with only part of remained chondrocytes in the cartilage zone. Glycosaminoglycan was slightly decreased both in the chemical extraction and detergent-enzymatic groups shown by Safranin O staining, but more reduction was found in the chemical extraction group. DAPI staining reveled that only a smal amount of cartilage cel s remained in the dense layer of cartilage and lacuna both in this two methods. Scanning electronic microscope showed that using the detergent-enzymatic method there were the hierarchical structures of native trachea, but slight disruption using the chemical extraction method. In conclusion, decel ularized rabbit trachea matrix obtained by detergent-enzymatic method is better, with little disruption to the matrix.

Objective To study the correlation of human cytomegalovirus infection with carotid atherosclerosis.Methods A total of 120 patients with carotid atherosclerosis and 140 healthy control patients were recruited for HCMV-PP65 antigen detection and Ultrasound examination.Results In carotid atherosclerosis and healthy patients,58.20％(71 cases)and 6.43％(9 cases)of the subjects were positive for HCMV-PP65 antigen(x2 =32.98,P ＜ 0.05).In carotid atherosclerosis group,69.01％(49 cases)of the patients with positive HCMV-PP65 antigen had instable plaques,while it was 47.06％(24 cases)in the patients with negative HCMV-PP65 antigen.The difference in the positivity of HCMV-PP65 between the two groups were significant(x2 =8.22,P ＜ 0.05).Conclusion Active infection of HCMV may be associated with Carotid Atherosclerosis and the plaques will be more instable.

Objective To investigate the mechanism and epidemiological characteristics of carbap-enem-resistant Proteus mirabilis ( PM) strains deficient in swarming motility. Methods PM strains were isolated from Hangzhou General Hospital of CAPF ( Chinese People′s Armed Police Forces) during January 2013 to December 2014. Bacterial motility and flagella of the PM strains were observed through semi-solid agar culture and flagella staining. Pulsed-field gel electrophoresis ( PFGE) was performed for homology anal-ysis. Antimicrobial susceptibility test and phenotypic confirmatory test were also carried out. PCR analysis and DNA sequencing were performed to confirm the genotype of resistant genes. Plasmid electroporation and S1-PFGE in combination with Southern blot hybridization were used to determine the location of the carbap-enem-resistant genes. Genetic structure of the blaKPC-2 gene was obtained by PCR mapping. Results A total of 42 PM isolates deficient in swarming motility were screened out and the resistance rates to imipenem and meropenem were 57. 1% and 52. 4%, respectively. PCR analysis and DNA sequencing confirmed that 24 carbapenem-resistant PM isolates deficient in swarming motility carried blaKPC-2 gene and belonged to three clones as indicated by the results of PFGE. Southern blot hybridization indicated that the blaKPC-2 gene was located on plasmids varying in size (26 kb, 55 kb and 139 kb). In addition, some of the strains harbored several resistant genes, such as blaTEM-1 , blaCTX-M-65 and rmtB. The genetic structures of strains carrying blaKPC-2 gene were ISKpn8, blaKPC-2 and ISKpn6-like from upstream to downstream. Conclusion Compared with the PM strains with swarming motility, the carbapenem-resistance rate was significantly higher in these PM strains deficient in swarming motility. Carbapenemases KPC-2 played an important role in the carbapen-em-resistant PM strains deficient in swarming motility. There was a cloning spread trend for carbapenem-re-sistant PM strains in our hospital. Clinicians should pay more attention to the risk of spreading.

Medical ethics is an important constitutes of medicine project. The medical ethics of military has its particularity and realism meaning. Combined with the spirit of anti-SARS and the actuality of military medicine ethnics,we must adopt some availability measure to promote the education of military medicine ethnics.

Objective To analyze the colistin heteroresistance in Pseudomonas aeruginosa strains and their in vitro susceptibility to antibiotics used in combination.Methods Two hundred and ninety-seven carbapenem-resistant Pseudomonas aeruginosa strains were selected for this study.Broth microdilution method was used to determine the minimum inhibitory concentrations of colistin and other antimicrobials against the Pseudomonas aeruginosa strains.The colistin heterogeneity of 20 colistin sensitive strains was analyzed by using population analysis profiles.The time-kill curves of 3 randomly selected colistin heteroresistant strains were used to determine the bacteriostatic activity of colistin.Chequer-board method was used to measure the combination efficacy of colistin with other antimicrobials including imipenem,meropenem,biapenem,ceftazidime,levofloxcin,piperacillin/tazobactam and cefoperazone/sulbactam.Results The colistin sensitive Pseudomonas aeruginosa strains accounted for 99.66％ of the 297 isolates.Population analysis profiles displayed that 35％ of the 20 isolates were colistin heteroresistant and 20％ of the 20 isolates were heterogeneous.It showed that when colistin was used in combination with other drugs,they mainly had synergistic and additive effects on heteroresistant isolates,but additive and indifferent effects on non-heterogeneous isolates.Conclusion Multidrug resistant Pseudomonas aeruginosa strains were highly susceptible to colistin,but heteroresistant and heterogeneous strains were common.The efficacy of colistin against heteroresistant isolates could be enhanced by using in combination with other drugs.

Objective To study the pain controlling effects of non-pharmaceutical interventions in neonatal intensive care unit (NICU) setting. Methods Infants who received radial artery puncture were assigned into control group, non-nutritive sucking (NNS) group and NNS plus glucose (NNS + GS) group according to their admission sequences. Each group contained 20 patients. Heart rate ( HR), respiratory rate (RR) and oxygen saturation (SpO2 ) before and after the procedure were monitored using Multi-Parameter Monitor ECG. Neonatal pain was evaluated using the preterm infant pain profile (PIPP). Results Among all three groups, after radial artery puncture, HR and RR were significantly increased, and SpO2 was significantly decreased (P < 0. 01). HR, RR and SpO2 variations in NNS group and NNS + GS group were less significant than the control group (P < 0. 05), and recovered to baseline more quickly. During the radial artery puncture, PIPP scores of infants in NNS and NNS + GS group were significantly lower than the control group (P < 0. 01), with NNS + GS group lower than NNS group (P <0. 05). Conclusions HR, RR and SpO2 can be used as physiological indicators of neonatal pain. PIPP score is simple and practical to be used in NICU setting. Both NNS and NNS + GS can partially relieve neonatal pain, and NNS + GS works better.

Objective:　To compare the dynamic changes of int erleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF) in intermingled skin graft with those in other types of skin grafts in rats. 　　Methods:　A 10%-15% third-degree burn was created in 180 Spreg ue-Dawley (SD) rats. After removing the scar, skin grafts were performed on the open wounds immediately with autoskin (aus, n=54), allosk in (als, n=54) and intermingled skin (n=36). That is to say, in the intermingled skin graft, a big piece of alloskin (mals) was grafted first, and 3 days later, small pieces of autoskin (maus) wer e embedded in the alloskin. The rest 36 rats were taken as the controls. And the biological activities of IL-1, IL-6 and TNF in graft sheets in each group wer e detected after skin graft. 　　Results:　The levels of IL-1, IL-6 and TNF in the aus group de creased steadily after their initial elevations, whereas in the als group they i ncreased significantly and kept on the peak level in the later phases. In the in termingled group, there appeared a lowest IL-1 level in the mals and a highest one in the maus simultaneously at 7 (4) days (The number out of parenthesis is t he days after transplanting with alloskin sheets, and the number in parenthesis is the days after embedding autoskin sheets in the intermingled skin graft. Simi larly hereinafter.) after skin graft (P<0.01), and the high level in the maus abruptly decreased at 14 (11) days after skin graft. At exactly the same phase on day 7 (4), a prominent peaked IL-6 in the mals occurr ed. In the later phases, the levels of TNF remained relatively low both in the m als and in the maus. From day 7 (4) on, each cytokine fluctuation in the mals sy nchronized with that in the maus. The longer the post transplantation period las ted, the more the positive cytokine correlated between the mals and the maus. 　　Conclusions:　The low levels of IL-1 and TNF may be important f actors to lighten the intensity of local rejection in the intermingled skin graf t. The temporarily peaked IL-6 is both an inducer which induces the production of local IL-1 receptor antagonists and soluble TNF receptors and a signal which indicates a local enhancement of Th2 cells. The mild rejection process and th e synchronized cytokine level during the later phases suggest a possible chimeri sm between the mals and the maus.