Objective To explore the application of monitored anesthesia care (MAC) under the guidance of bispectral index in surgical treatment of chronic subdural hematoma in elderly patients.Methods Sixty patients (33 males, 27 females, aged 65-85 years, ASA physical status Ⅱ-Ⅳ) undergoing sphenotresia drainage of chronic subdural hematoma from March, 2014 to May, 2015 were randomly divided into BIS-guided monitored care anesthesia group (group M) and local anesthesia group (group C).Propofol and remifentanil were intravenously infused into patients from group M to maintain BIS index 65-75, vital signs stability and no movement.Local anesthesia was performed before skin incision for each patient.The frequency of medication, the incidence of adverse events were record.The satisfied degree of sedation and analgesia were also evaluated.Results The frequency of movement, local anesthesia drug and additional use of esmolol, were significantly less in group M than those in group C.The satisfaction degree of sedation and analgesia were significantly higher in group M than those in group C (P<0.05).There was no significant difference of respiratory depression and airway obstruction between the two groups.No nausea vomiting reflex and respiration occurred in all groups.Conclusion Bispectral index guidance can be safely applied in surgical treatment of chronic subdural hematoma in elderly patients, which can supply more sedative and analgesic satisfaction than local anesthesia.

Objective To investigate therapeutic efficiency of high frequency electric therapy combined with movement training on osteoarthritis of knee joint.Methods Eighty-five patients were randomly divided into the high frequency electric therapy group (22 cases including 31 knees), movement training group (33 cases including 45 knees) and high frequency electric therapy combined with movement training group (30 cases including 40 knees). All of the patients were assessed with Visual Analogous Scale (VAS) and Lysholm Knee Score Scale (LKSS) before and after treatment.Results Every group had significant improvements compared with selves after treatment. There were significant differences among the three groups (P<0.01).Conclusion Three ways have different therapeutic effect on osteoarthritis of knee, the high frequency electric therapy can slacken the soft tissue, the movement training has reliable effect in the near future; the therapy by high frequency electric therapy combined with movement training is reliable.

Based on the theory of value and value ethics,there were 3 aspects problems as following at the present stage of the health care system reform:paying more attention on the quantity of inpatient services rather than the quality of medical services,taking hospital as the center instead of the close cooperation of various sanitary institutions and inappropriate incentive mechanism.It considered that the next step of the health care system reform of China should make efforts to achieve 3 value goals:to improve people's health level,provide high-quality medical services and service experience and affordable health care costs.To achieve these value goals,it proposed suggestions from five aspects:providing integration services,transforming the functional localization of hospitals,changing the incentive mechanism,improving the medical service quality continually and enhancing the participation of the public.

BACKGROUND: The pathway of cholinergic nerve also with rich opium receptor in the septum-hippocampus areas is an important part for spatial learning memory. There is study that naloxone, an antagonist of opium receptor, can relieve the inhibition of activity of cholinergic neuron caused by opioid peptides in the medial septum and hippocampus, promote the release of acetylcholine (Ach)into synaptic cleft, and improve the impairment of spatial memory.OBJECTIVE: To investigate the intervention effect of naloxone on impairment of spatial working memory of rats induced by scopolamine, a blocker of cholinergic muscarinic receptor.DESIGN: A randomized and controlled trial taking experimental animals as subjects.SETTING: Geriatric Department of Wuzhongpei Memorial Hospital at Shunde District of Foshan City.MATERIALS: The experiment was completed from 2003 to 2004 at the Experimental Animal Center of Medical School of Shantou University. A total of 21 SD rats of clean grade were at random divided into three groups:normal group, scopolamine group and naloxone group (scopolamine and naloxone), with 7 in each group. Build up of Morris water maze: A circular rubber pool, 2 m diameter and 55 cm height, with 30 cm depth of water at20℃-22℃, was built up. At the center of its southeast quadrant, a cylinder platform installed, which was 12 cm in diameter and 1.5 cm below the water surface, the only place for rats to escape death. The water of the pool was covered with bits of white polythene. In the house, there were light tubes, windows and tables in fixed place served as the outside cues of the pool. On the four walls of the pool, there were several randomly-hung and eye-catching markers as inside cues.METHODS: Medicines were intraperitoneally given 30 minutes before the experiment for rats in each group, scopolamine 0.4 mg/kg and naloxone 3mg/kg in two treatment groups, the equal volume saline in normal group.Then escape latencies of rats were recorded for two successive trials through a delayed-matching\task in self-made Morris water maze. After the Morris water maze examination, all rats were put to death, the tissue of left brain was selected, conventionally treated and sliced. The expression level of cholinacetyltranslase (ChAT) in areas of hippocampus and prefrontal lobe were quantitatively assayed by immunohistochemistry and the computerized image technique. At the same time, the tissue of right brain in two rats of each group was selected, the hippocampus was immediately freed, and the change of CAI region of the hippocampus observed with electron microscope.trastructure of CA1 region of hippocampus in rats.cies of two successive trials were very significantly different in normal group[(46.4±17.7)vs (13.4±8.2)s, t =7.32, P＜ 0.01], and significantly different in naloxone treatment group[ (27.9±14.3)vs (9.0±3.8)s, t=3.19, P＜ 0.05], but not pression of ChAT in pyramidal cells in CA1 and CA3 regions of hippocampus and in neurons of prefrontal cortex of three groups was not different statisticalhippocampus in all groups was normal; However, the ultrastructure of the neuron synapsis was abnormal obviously in scopolamine group: The synaptic vesicles were markedly different in size; the vesicles obviously gathered in the part of presynaptic membrane with an enhanced density, and large and sparse in the distal part. Both presynaptic and postsynaptic membranes were indistinct and fused, synaptic cleft not clear, and postsynaptic dense materials not homogeneous, indistinct and without clear borderline.CONCLUSION: Scopolamine could impair the power of spatial working memory in rats. Naloxone could promote great release of Achin neuron synaptic vesicles into synaptic clefts, and increase the density of postsynaptic dense materials, relieve the inhibition of opioid peptide to cholinergic neuron activity in the medial septum and hippocampus, and could improve space memory injury.

Objective To study the effects of P53, PCNA, Bcl-2 protein and their relationship in salivary adenoid cystic carcinoma(SACC). Methods These proteins were examined by immunohistochemistry. Results Overexpressions of P53 and PCNA were revealed in ACC samples, they were higher than those in (polymorphous adenomas) PA, but expression of Bcl-2 protein was not different between ACC and PA. In 3 subtypes of ACC, expressions of 3 proteins were different. Conclusion Mutations of P53, Bcl-2 may be involed in the occurrence of SACC, expression of PCNA and mutation of P53 may coexist in the development of the SACC.

The author analyzed how toelaborate narrative contents using structured standard with electronical -ly structured medical record information model and the relation of the two .Astructured medical record data entry way was worked outcompatible with standard terminology based on ways of expressing narrative contents using structured standard.It provided a theoretical basis for clinical use .

Aim To study the sensitivity of human gastric cancer BGC-823 cells to paclitaxel after trans-fection of SHIP2 ( The SH2 domain containing inositol 5-phosphatase 2 ) cDNA. Methods Apoptotic cells were determined by the propidium iodide method using flow cytometry. The levels of protein and mRNA ex-pression were measured by Western blot analysis and qRT-PCR, respectively. pCMV6-SHIP2 plasmid and empty vector were transiently transfected into BGC-823 cells, respectively. Stable cell lines were established after infecting BGC-823 cell with GV112-Puromycin and GV112-Puromycin-Bim( Bcl-2 interacting mediator of cell death) lentivirus particles. pCMV6-SHIP2 plas-mid was transiently transfected into the stable cell lines. Results BGC-823 cells were relatively insensi-tive to paclitaxel compared with SGC-7901 cells. The apoptotic rate was only (25. 6 ± 1. 6)% after the treat-ment with 0 . 3 μmol · L-1 paclitaxel for 48 h in BGC-823 cells. The expression levels of Bim protein and mRNA in BGC-823 cells treated with paclitaxel at dif-ferent time points were not significantly changed. The expression of Bim protein was increased after transfec-tion of pCMV6-SHIP2 plasmid, and the apoptotic rate was up to ( 50. 8 ± 0 . 9 )% in BGC-823 cells treated with paclitaxel for 48h. The expression of Bim protein was significantly inhibited after infecting with GV112-Puromycin-Bim lentivirus particles. The apoptotic rate of infected BGC-823 cells was only ( 27. 6 ± 1. 6 )%after treatment upon paclitaxel for 48h. Conclusion Overexpression of exogenous SHIP2 can increase the expression of Bim, induce apoptosis and enhance sen-sitivity of BGC-823 cells to paclitaxel.

Objective To investigate the association between social support and family cohesion, adaptability of rural patients undergoing maintenance hemodialysis (MHD). Methods Between August 2012 and November 2012, 94 patients with incident hemodialysis from rural areas in Hebei province were consecutively recruited in the study. The social support inventory (SSI) and the Chinese version of the family adaptability and cohesion evaluation scales (FACESII-CV) were employed in the investigation 3 months after the start of hemodialysis. Pearson correlation analysis was used to estimate the relationship between social support and familiarity, adaptability in rural MHD patients. Results The score on the family cohesion the adaptability were lower than norm(all P<0.001). The social support was associated with family cohesion and adaptability. The total scores on social support, emotional support and material support were positively associated with the scores on the family cohesion and adaptability (P<0.05). Conclusions The family cohesion and adaptability in rural patients undergoing hemodialysis are both at a lower level and are closely related to emotional and material supports. The higher they get social support, the higher the levels in family cohesion and adaptability.

Objective To summarize the nursing methods and effect of artificial femoral head replacement in treatment of osteoporotic interttochanteric fracture in elderly patients. Methods 55 patients with esteoporotic intertrochanteric fracture were selected in our hospital from February 2007 to February 2011.All patients were cared by targeted preoperative and postoperative nursing,helping them conducting functional training in time,giving discharge counseling and follow-up.The hip functional recovery of patients was evaluated by using the Harris evaluation standard,and the excellent rate of surgery was also evaluated. Results After the targeted care,55 patients went through the perioperative period safely,the average length of stay was ( 14.0 ± 3.1 )days,a total of 5 cases (9.09％)patiants suffered varying degrees of complications which were improved after symptomatic treatment.Patients were followed up for 3 to 36 months,only 2 patients died of cerebral vascular accident,all patients gained good recovery of hip function.Harris score was (84.45 ± 9.38),the excellent rate of surgery reached 78.18％. Conclusions Atificial femoral head replacement proves significant effect in treatment of osteoporotic intertrochanteric fractures in elderly patients,but with the accompanying surgical compliuations,special care and timely functional exercise methods should be paid attention to.

Objective To establishthe sensitivity indexes system for estimating nursing quality which conforms to China's national conditions and have the certain representative among the whole country. Methods After usingStructure-process-outcome as the theoretical framework and surveying the literatures domestic and abroad,a total of 42 nursing management experts from 30 provinces were consulted by the Delphi method,including symposium and two rounds of questionnaire consultation. Results The authority coefficient of the two rounds consultation were 0.89 and 0.91,familiarity coefficient were 0.86 and 0.88 respectively,and the coordination coefficient of expert opinion were 0.20 and 0.25. The sensitivity indexes system for estimating nursing qualityconsists of two level index systems,which were divided into three first level indexes and seven second level indexes. The first level index in-cluded nursing manpower allocation,nursing safety and nursing events,while the second level index includes nurse-inpatient ratio,accuracy rate of identification,the number of medication error events,the number of blood transfusion error events,the number of specimen error events,the number of drug extravasation events and high-risk patient falls (falling bed) incidence. Conclusion The results of this study are reliable. There is a clear definition and interpreta-tion of sensitivity indexes for estimating nursing quality and index monitoring is operable.